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Obs & Gynae > Gynaecology > Flashcards

Gynaecology Flashcards

1
Q

What is the treatment for PID

A

IM 500mg Ceftrixone (STAT)
100mg BD Doxyclcyine
400mg BD Metronidozole
For two weeks

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2
Q

Potential side effect of the COCP

A

Cervical polyp due to the action of the oestrogen on the squamous epithelium.
Weight gain
Mood changes
Breakthrough bleeding

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3
Q

Define prolapse and the clinical features associated with it

A

Protrusion of an organ or a structure outside its normal anatomical state

Clinical features

  • Falling down sensation
  • Lump/discomfort
  • Sexual symptoms
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4
Q

State the muscles and ligaments of the pelvis

A

Muscles

  • Levator ani muscles
  • Internal obturator muscles
  • perineal muscles

Ligaments

  • Transverse cervical ligament
  • Uterosacral ligament
  • Round ligament
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5
Q

Management of prolapse

A

Conservative
- Persaries (shelf and ring pesaries)

Surgical

  • Mesh repair
  • Colposuspension
  • Sacrospinous fixation
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6
Q

Discuss Ashermann’s syndrome in relation to causes, clinical features and treatment

A

Causes:
Intrauterine adhesions, scarring at the front and the back of the uterus wall stuck together

Clinical features:
Scanty absent periods
Pain
Infertility

Treatment:
Dilleete & cutrage

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7
Q

Ovarian stromal hyperthecosis

A

Hyperplasia of the ovarian storm
Clusters of lutenising cells within the storma

Increase in androstertenedione and testosterone

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8
Q

Clinical features of ovarian stromal hyperthecosis

A 
Hirutisim 
Virulism
Hyperoestrogenic state            
Endometrial hyperplasia
Abnormal uterine bleeding
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9
Q

Discuss the clinical features of PCOS

A 
Oligomenorrhaea 
Infertility 
Acne 
Hirutism
Alopecia 
Obesity
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10
Q

Pathophysiology of POCS

A

Disordered LH production
Peripheral insulin resistance leading to increased insulin
Increase in both LH and insulin = Increase in ovarian androgens production
- Disrupts follicilogenesis: irregular periods

Increase in insulin= Increase in adrenal androgens and decreases production of SHBG

Increase in free androgens levels

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11
Q

Criteria used when diagnosing PCOD

A

Rotterdam Criteria

  • irregular/absent cycle ( >42 days period free)
  • Clinical or biochemical signs of hyperandrogpns
    1) acne
    2) Hirsutism
    3) Alopecia
  • PCOS ovaries on USS (>12 antral follicles on one vary
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12
Q

List potential differential diagnosing PCOS and the subsequent treatment options that are available

A 
Dx: Hypotharyoidism
Hyperprolactinaemia 
Cushing's sysndrome 
Acromegaly 
CAH
Treatment: (If not planing pregnancy)
Co-coypril (Acne or hirsutism)
COCP (menstrual regulation)
Metformin started in secondary care)
Elformithne (hirsutism)
Olistat (wt mamagement)

Treatment (if planning pregnancy)
Clomifene to induce ovulation
Metaformin ( as above)
Laparoscopic ovarian drilling

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13
Q

Define amenorrhea and classify the different types

A

Absences of menstruation

Primary: menstruation has not commenced by ~16years
Secondary: Previously normal menstruation ceases for 6 months or more

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14
Q

List the causes of the primary amenorrhea

A

+ve 2 sexual characteristics

  • Constitutional delay
  • GU malformation
  • Testicular femenisation (androgen resistance and XY karotype)
  • Hyper prolactinoma
  • Pregnancy
  • ve 2 sexual characteristics
  • Ovarian failure
  • Tumours
  • Kallamanns
  • Congenital adrenal hyperplasia
  • Turners
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15
Q

List the causes of secondary amenorrhea

A
  • ve androgen excess
  • Pregnancy
  • Lactation
  • Premature ovarian failure
  • Radiotherapy
  • Contraception
  • BMI <19
  • Hyperprolactinaemia
  • Sheehans syndrome
  • Thyroid disease
  • Post pill
  • Iatrogenic

+ve androgen excess

  • PCOS
  • Cushings syndrome
  • Late onset CAH
  • Adrenal carcinoma
  • Ovarian carcinoma
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16
Q

List the clinical features associated with androgen excess

A 
Hiritusism 
Acne 
Temporal balding 
Thyroid disease 
Cushing's disease
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17
Q

Define menorrhagia

A

Heavy menstrual bleeding that interferes with a women physical, emotional, social quality of life

Possible causes 
Endometriosis 
Fibroids 
Malignancy 
Thyroid disease 
Haemostatic disorder
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18
Q

Define puberty

A

Onset of sexual maturity, marked by the development of secondary sexual charachteristics
~ @13years

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19
Q

State the endocrine axis and the hormones involved in the control of puberty

A

Controlled centrally by the hypothalamic-pituitary axis

GnRH pulses increase in amplitude and frequency

Oestrogen = development of 2 charachteristics (adrenarche and thelarche

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20
Q

Define menopause

A

Cessation of the menstrual period. Retrospective diagnosis made following one year of amenorrhoea

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21
Q

Define perimenopause

A

period leading up to the menopause , irregular periods and menopausal symptoms

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22
Q

Discuss the investigation which would help confirm the diagnosis of menopause

A

FSH: increases (few oocytes remaining)
TFT’s: exclude other causes of irregular periods
Glucose: exclude DM
Antimullerian: decrease AMH, decrease oocytes
Blood cholesterol: exclude any CV risk factors

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23
Q

Menopausal symptoms

A

Short term

  • Hot flushes
  • Night sweats
  • Mood change
  • Irritability
  • Loss of memory
  • Headaches
  • Dry skin

Medium term

  • Recurrent UTI’s
  • Dysparenuria
  • Bleeding
  • Reduced libido
  • Vaginal atrophy

Long term

  • Osteoporosis (>2.5)
  • Fractures of wrist, hip and spine
  • CV disease
  • Dementia
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24
Q

Discuss the clinical features of fibroids

A
  • 30-50 yrs women
  • Menorrhagia
  • Intermittent bleeding
  • Pelvic pain
  • Subfertility
  • Dysmenorrhae
  • Palpable mass
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25
Q

List possible differential dx for intermittent bleeding

A 
Dysfunctional uterine bleeding 
Endometrial Ca
Endometrial lesion
PID
Ovarian tumor
26
Q

List the types of urinary incontinence

A

Overactive bladder: sphincter muscles work as normal, increased bladder pressure above maximal urethral closure pressure

Stress incontinence: sphincter weakness

27
Q

List the clinical features of overactive bladder

A 
Urgency 
Urinary incontinence 
Frequency 
Nocturia 
Key in door 
Handwashing 
Intercourse
28
Q

List the clinical features of stress incontinence

A

Involuntary leakage
Coughing
Lifting
Exercise

29
Q

What is the innervation of the bladder

A

Parasympathetic: sacral nerve

30
Q

List the investigations you would carry out to investigate urinary incontinence

A

Frequency volume chart
Urinanalysis (rule out STI,UTI)
Residual urine measurement
EPAQ questionnaire

31
Q

Management of incontinence

A 
Stress incontinence: 
Physio- Pelvic floor strengthen 
Weight loss
Quit smoking 
Decrease caffeine

Medical
Anticholinergics (Oxybutin)
Mirabegron
BOTOX

Surgery
Calposuspension
Tension free vaginal T

32
Q

Discuss the different grades of the Pelvic Organ Prolapse Quantification (POPQ)

A 
Grade 0:No prolapse 
Grade 1: Prolapse halfway to the hymen 
Grade 2: To the hymen 
Grade 3: Halfway passed the hymen 
Grade 4: Maximum descent
33
Q

List the risk and protective factors for ovarian cancer

A

RISK

  • BRCA 1/2
  • HPNCC
  • Nulliparity
  • Early menarche
  • Late menopause

PROTECTIVE

  • Pregnancy
  • COCP
  • Lactation
34
Q

Pathology of ovarian cancer

A

Epithelial

  • Clear cell adenomas
  • Cystadenomas

Germ cell
- Teratomas

35
Q

Clinical features of ovarian cancer

A 
Vauge ( IBS/ DIVERTICULITS) 
Abdominal distentsion 
Bloating 
Early satiety 
Loss of appetite 
Urgency/ Frequency 
Weight loss
36
Q

List the factors involved in the risk of malignancy index score

A

Uss findings
CA125 Level
Menopausal stauts

37
Q

List the stages in CIN

A

I: Lower 1/3 of the epithelium
II: Lower 2/3 of eptihelium
III: Full thickness of the epithelium
If it invades the basement membrane = cancer

38
Q

Risk factors for CIN

A

Cx: HPV

OCP
Smoking
Immunocompromised

39
Q

Explain the protocol of the national cervical screening programme

A

> 25yrs
Smear every three years

50-64
Smear every 5 yrs

Normal: return to screening programme

Borderline: HPV triage

  • -ve HPV: return to screening
  • +ve HPV: colposcopy

Moderate : urgent colposcopy

40
Q

Pathology of cervical carcinoma

A

Squamous cell carcinoma
Mixed pattern
Adenocarcinoma

HPV cause all

41
Q

Management of CIN

A

Large loop excision of transformational zone (LLETZ)
Cone biopsy
Cryotherapy

42
Q

Clinical features of cervical carcinoma

A

Post coital bleeding
Offensive vaginal discharge
IMB/PMB
Bladder symptoms

43
Q

Management of cervical carcinoma

A

I: Local excision
II: Werthlien hysterectomy, chemotherapy
III: Chemo and radiotherapy (PALLIATIVE)

44
Q

List the risk factors for endometrial cancer

A 
Unopposed oestrogen therapy 
Tamoxifen 
PCOS 
Obesity 
Nulliparity 
Late menopause 
Ovarian granuloma 
TIIDM
45
Q

Clinical features of endometrial cancer

A

Postmenopausal bleeding
Irregular/IMB
Atrophic vaginitis
Cervical smear ( will show abnormal columnar cells)

46
Q

Investigations for endometrial cancer

A 
Transvaginal USS
Biopsy if 
- Endometrim is >4cm in PM 
- Endometrium is >10cm in Premen
MRI for staging
47
Q

Management of endometrial cancer

A

I: Hysterectomy and BS
II: Radical hysterectomy
III: Debulking surgery

48
Q

Pathology of vulval cancer

A

Squamous cell carcinoma

Presentation

  • Unepxlained lump
  • Pruritus
  • Bleeding
  • Discharge

Treatment

  • Local excision
  • May required lymph node removal
49
Q

Pathology of lichen sclerosis

A

Autoimmune disorder

Elastic tissue becomes collagen

50
Q

Clinical features and treatment of lichen sclerosis

A

Clinical features

  • Bruised red purpuric signs
  • Vulvae becomes white , flat and shiny

Treatment
- Clobetasol propionate

51
Q

Clinical features of ovarian torsion

A

Pain

May be intermittent as the ovary torts and releases

52
Q

Features of ovarian haemorrhage

A

Shock

53
Q

Treatment of a ovarian torsion

A

Surgery

If operated on within 6hrs tissue will remain viable

54
Q

List the type of benign breast lumps

A
  1. Breast cyst
    - >35 yrs
    - Fluid filled
    - Rounded lump
    - Not fixed
    - Rx: needle aspiration
  2. Fibroadenoma
    - <40yrs
    - Overgrowths of collagenous mesenchyme of the breast lobule
    - Firm, smooth, mobile lump
    - Painless
    - Rule of thirds (regress, stay the same, get bigger)
    - Rx mammogram to examine lump
  3. Intraductal papilloma
    - Warty lesion behind the areola
    - Small lump
    - Sticky blood stained discharge
    - Rx: Fine needle aspiration
  4. Fat necrosis
    - Large fatty breast lump
    - Calcification of the lump
    - Rx: refer for triple assessment
55
Q

Breast cancer screening programme

A

Screen women every three years aged 50-70

56
Q

Risk factors for breast cancer

A 
Family hx
Age 
Uninterrupted oestrogen exposure 
HRT 
BRCA 
Obesity
57
Q

Clinical features of breast cancer

A

Lump
Nipple discharge
Nipple change
Skin contour changes

58
Q

Explain the triple assessment of breast cancer

A

Clinical examination
Radiology (mammogram, ultrasound)
Histology or cytology

59
Q

Management of breast cancer

A

STAGE 1/2 ( breast only)

  • Surgery
  • Radiotherapy
  • Endocrine agents ( ER Tamoxifen, Aromatase inhibitors)

STAGE 3/4

  • Radiotherapy
  • DEXA scan
  • Bisphosphanates
  • Hormone treatments

Must carry out immunohistochemistry
Oestrogen +ve, HER +ve cancers

Treatment of HER2+ve cancers with perception watch the cardiac function

60
Q

Pagets disease of the nipple

A

Rare malignancy of the nipple

Eczematous lesion of the nipple and is often associated with an underlying in-situ or invasive carcinoma of the breast

Obs & Gynae (2 decks)

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