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GOSH > Gynaecology > Flashcards

Gynaecology Flashcards

1
Q

What are red flags for menorrhagia?

A

Weight loss
Recent onset
Dysuria
Painful sex

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2
Q

Under which circumstances would you fast-track for endometrial biopsy?

A
  • > 10mm endometrial thickness (<5mm post-menopause)
  • > 45
  • Resent onset
  • IMB
  • Unresponsive to treatment
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3
Q

What is a 2nd line medical management for menorrhagia?

A
  • Tranexamic acid taken during menstruation only

- NSAIDs - Mefanemic acid - inhibit prostaglandin synthesis

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4
Q

What is a 3rd line medical management option for menorrhagia

A

Progestogens - unsuitable for conception

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5
Q

What is the surgical management for menorrhagia?

A
  • Endometrial ablation

- Hysterectomy

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6
Q

What is a uterine artery embolisation for?

A

Menorrhagia due to fibroids

Can retain uterus and avoid surgery

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7
Q

What is the medical management for irregular/IMB?

A

IUS
COCP
Progestogens

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8
Q

What is the management of ectropions?

A

Freeze via cryotherapy

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9
Q

How can you manage painful periods?

A

NSAIDs - Mefanamic acid/Ibuprofen
COCP
Mirena coil

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10
Q

What can cause primary amenorrhoea?

A
  • Turner’s

- Congenital adrenal hyperplasia, congenital malformations of the Genital tract

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11
Q

What can cause secondary amenorrhea?

A
  • PCOS
  • Hyperprolactinaemia
  • Thyrotoxicosis
  • Asherman’s syndrome
  • Hypothalamic Hypogonadism
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12
Q

What investigations would be necessary for amenorrhoea?

A
  • Pregnancy
  • TFTs
  • Gonadotrophins - high = ovarian, low = hypothalamic
  • Prolactin
  • Androgen levels
  • Oestrodiol
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13
Q

What is required for a diagnosis of PCOS?

A

Two or more of:

  • Amenorrhoea
  • Clinical/biochemical hirsuitism
  • Polycystic ovaries on USS - >8 cysts <10mm in size
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14
Q

What blood tests would you perform to test for PCOS?

A
  • FSH - normal
  • Prolactin - rule out hyperprolactinaemia
  • Testosterone - raised
  • LH - often raised
  • TSH
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15
Q

What are 3 causes of premature menopause?

A
  • Turner’s/Fragile X
  • Hypothyroid, Addison’s, myaesthena gravis
  • Galacgosaemia
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16
Q

What infections can cause premature menopause

A
  • TB
  • Mumps
  • Malaria
  • Varicella
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17
Q

What is tibolone?

A

Synthetic steroid with weak oestrogenic, progestogenic and androgenic effects used to treat menopause:

  • Vasomator, psychological + libido Sx
  • Conserves bone mass and reduces risk of vertebral fracture
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18
Q

What are the risks from taking HRT

A
  • Endometrial cancer
  • Breast cancer
  • VTE in 1st year (4x risk 1-6mnths, 3x risk 7-12mnths)
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19
Q

What type of HRT is indicated for hysterectomy?

A

Oestrogen only for hysterectomy

Oestrogen + progestogen for those wihtout

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20
Q

At what side endometrial thickness would post-menopausal bleeding indicate an endometrial biopsy?

A

> 3mm or >5mm if on HRT

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21
Q

What is adenomyosis?

A

Ectopic implantation of endometrial tissue deep inside myometrium

22
Q

What 3 investigations would be necessary for endometriosis suspection?

A
  • TVUSS - gross endometriosis/chocolate cysts
  • Laparoscopy - peritoneal/biopsy
  • MRI - Presence of adenomyosis in bladder/bowel etc
23
Q

What is the medical management for endometriosis?

A
  • COCP or GnRH - mimic pregnancy/menopause

- Progestogen

24
Q

What is the surgical management for endometriosis?

A
  • Endometrial ablation

- Hysterectomy –> HRT for post-menopausal SE

25
Q

If someone is wanting to conceive and has endometriosis, what might be the best option?

A

Endometrial ablation

26
Q

Which ovarian cyst is most likely to induce endometrial carcinoma?

A

Thecoma - benign oestrogen secreting tumours

27
Q

If someone has CN I what is the management?

A

Follow-up in 6months for cytology

28
Q

What is Radical Trachelectomy?

A

Removal of 80% cervix and vagina - preserves fertility

29
Q

What is the management for Stage I endometrial cancer?

A

Laparoscopic hysterectomy + salpngectomy

30
Q

Which gene is most likely to cause ovarian cancer?

A

BRCA1 then BRCA2 then HNPCC

31
Q

What risk factors increase the risk of vulval cancers?

A

HPV in younger women

Lichen planus in older women

32
Q

What are the legal requirements for a termination of pregnancy?

A
  • Risk to woman’s life
  • Risk to her physical/mental health
  • Risk to existing children - physical/mental
  • Foetus will be handicapped
33
Q

When is a medical abortion indicated?

A

Up to 21 weeks

34
Q

What is the medical management for abortion?

A

Mifepriston then misprostol 48hours later

35
Q

What are the options for surgical management of abortion?

A
  • Vacuum aspiration up to 14 weeks

- Dilatation and evacuation 14-24 weeks

36
Q

What are the risks of an abortion?

A
  • Infection
  • Cervical trauma
  • Failure - 1%
  • Haemorrhage/perforated uterus = very rare
37
Q

What causes infertility with regards to ovulation problems?

A

Disruption of LH surge/system with high/low BMI + thyroid abnormalities

38
Q

What causes infertility with regards to Tubual blockage?

A

PID complication

Endometriosis - scarring/adhesions

39
Q

What causes infertility with regards to Endometrial factors?

A

Prevent implantation of embryo
Fibroids, polyps, adhesions
Surgical resection may improve

40
Q

What drug is used to induce ovulation?

A

Clomiphene citrate

Increases FSH and ovary stimulation to produce more follicles

41
Q

What is ovarian drilling?

A

Passing an electrical current through the ovary to induce ovulation

42
Q

How is ovulation induced for IVF?

A

Injection of hCG

43
Q

What is the success rate for IVF?

A

30% if less than 35

44
Q

What is the success rate of intrauterine insemination?

A

15-20%

45
Q

What would you expect to see on examination of a woman with urinary incontinence?

A

Cystocele/urethrethrocele

Palpation of abdomen to exclude distended bladder

46
Q

What conservative management is there for urinary incontinence?

A
  • Lose weight
  • Smoking - chronic cough
  • Increase pelvic muscle strength - physio
  • Cones - inserted into vagina and held - strengthen
47
Q

What medical management is there for urinary incontinence

A

Dulexitine - Serotonin and noradreanline reuptake inhibitor

48
Q

What are the side effects of Dulexitine?

A

Dry mouth
Dyspepsia
Drowsiness

49
Q

What surgical management of incontinence are there?

A

Mid-urethral sling - tension free vaginal tape placed under urethra to prevent leakage when coughing

50
Q

What can you use to measure contractions on filling and provocation in suspected detrusor overactivity?

A
  • Cystometry
51
Q

What conservative measures are there for urge incontinence?

A
  • Avoid caffeine
  • Reduce fluid intake
  • Time voiding and systemic delay in voiding - resist sensation of urgency and form a timetable
52
Q

What medical management is there for urge incontinence

A
  • Oxybutynin - suppress detrusor by blocking muscarinic receptors
  • Oestrogens - post-menopausal women to improve atrophy, dryness and irritation
  • Botulinum toxin - blocks neurotransmission and injected cystoscopically

GOSH (4 decks)

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