Gynaecology Flashcards
1
Q
what are the other names for a dermoid cyst?
A
teratoma
benign germ cell tumour
2
Q
what types of benign cyst are there
A
functional (CL or follicular) teratoma benign epithelial (cystoadeonoma)
3
Q
what is Meig syndrome
A
triad of benign ovarian tumour, pleural effusion and ascites
4
Q
give some protective factors for ovarian cancer
A
COCP
multiparity
breastfeeding
anything that decreases ovulation
5
Q
what are the side effects of metformin?
A
GI upset
lactic acidosis
6
Q
how does clomifene work?
A
increases oestrogen so induces an LH surge
7
Q
what are the clinical signs of increased androgens?
A
acne
balding
hirsuitism
8
Q
what are the 4 goals of PCOS treatment?
A
restore fertility
treat hirsuitism
restore menstrual cycles and reduce risk of osteoporosis
control insulin levels
9
Q
name a complication of chronic PID
A
Fitz Hugh Curtis syndrome, inflammation of the liver capsule leading to RUQ pain
10
Q
what are the symptoms of ectopic pregnancy without rupture?
A
pregnancy symptoms
lower abdominal pain
irregular prune juice bleeding
11
Q
what are the risks of female hormones?
A
oestrogen-endometrial cancer, cervical cancer
progesterone-osteoporosis
12
Q
what are the symptoms of red degeneration?
A
pelvic pain
PV bleeding
uterine haemorrhage
have to do MRI to distinguish from uterine mass
13
Q
how is red degeneration treated
A
emergency hysterectomy.
14
Q
what are urinary differentials for pelvic pain?
A
urolithiasis
UTI
interstitial cystitis
bladder polyp
15
Q
what are bowel differentials for pelvic pain?
A
IBS constipation IBD obstruction appendicitis adhesions
16
Q
how does vulval cancer present?
A
vulval itching
lump
bleeding
dysuria
17
Q
how do you monitor response to clomifene?
A
USS and progesterone levels
18
Q
SEs of tamoxifen?
A
fluid retention
leg cramps
hot flushes
19
Q
name 2 agents used in the chemotherapy regimen of breast cancer
A
cyclophosphamide
methotrexate
20
Q
what 2 kinds of staging are used for breast cancer in the UK?
A
Nottingham prognostic index
TMN
21
Q
where is breast cancer likely to metastasise to?
A
bone
lung
liver
brain
22
Q
what can cause gynaecomastia?
A
spironolactone digoxin weed liver failure testicular failure
23
Q
why do aromatase inhibitors increase ovarian cancer risk in premenopausal/perimenopausal women?
A
because they stop oestrogen production leading to negative feedback so they increase it altogether
24
Q
which cancer is unopposed oestrogen associated with?
A
endometrial
25
what are side effects of radiotherapy on the breast?
pneumonitis
pericarditis
rib fractures
26
what are contraindications to radiotherapy on the breast?
previous radiotherapy on the breast
pt cant lie flat
ataxia telangectasia
27
what is the difference between stage and grade?
stage-TNM where it is
| grade-histological appearance
28
side effects of chemotherapy?
early: anaemia, thrombocytopenia, neutropenia, mouth ulcers, thrush
late: neurotoxicity, cardiotoxicity, osteopenia, subfertility
29
what are the dangers of hormone therapy?
premenopausal-tamoxifen-excitatory in endometrium
| if pre given aromatase inhibitors-more oestrogen so ovarian, endometrial
30
define oligomenorrhoea
cycle>35 days
31
common sites of endometriosis
uterosacral ligament
| ovaries
32
what is the triad of symptoms in PCOS?
anovulation
elevated androgens-shown clinically or on bloods
polycystic ovaries on USS
33
what do you look for in sperm sample?
count
morphology
motility
34
what is the os doing in threatened miscarriage?
closed
35
risk factors for ectopic pregnancy?
PID, age, IUD, pelvic surgery, smoking, previous ectopic
36
what does cervical excitation suggest?
PID
| ectopic pregnancy
37
what are the sex cord tumours?
granulosa cell tumours
| thecomas
38
what is the cervical screening programme?
25-49 every 3 years
| 50-64 every 5 years
39
what would the management be if a woman had borderline dyskaryosis on cervical smear?
HPV test
if +ve then colposcopy
if -ve then routine call back
40
RFs for vulval ca?
smoking, lichen scleruosus, immunosuppression
41
when in the cycle should cervical smear be taken?
midcycle
42
benefits and drawbacks of progesterone?
benefits: can be used by smokers and 35+, no increased risk of ca
drawbacks: osteoporosis, acne, mood changes, only 3 hours
43
what are the side effects of the copper coil?
heavy menstrual bleeding
| pain
44
what are the 3 options for emergency contraception?
levonorgestrel 1.5mg under 72hrs
Ulipristal (EllaOne) 30mg under 120 hrs
Intrauterine device under 5 days
45
define secondary amenorrhoea
cessation of menses over 3m
46
what must you do for someone newly diagnosed with PCOS?
diabetes and CVS screen
47
what are the benefits and drawbacks of HRT?
benefits: sx, reduce osteoporosis and colorectal cancer
drawbacks: VTE, breast, endometrial ca
48
what therapy would you use for PID?
triple: IM ceftrioxone, PO metronidazole, PO doxycycline
49
what are the medications used in abortions/
anti-progesterone mifepristone
prostaglandin misoprostol
F BEFORE S
50
what do you need to investigate in someone with recurrent miscarriage
antiphospholipid antibody
karyotype
PCOS
51
define recurrent miscarriage
3 miscarriages in sucession
52
causes of abnormal vaginal bleeding in premenopausal women
```
spotting-implantation bleeding
IUCD
endomtriosis/adneomyosis
STI
ectropion
molar pregnancy
```
53
how is ectropion treated
silver nitrate
cold coagulation or
dithermy
54
what is the indication for 2/52 colposcopy/
severe dyskaryosis
55
causes of abnormal vaginal bleeding in post menopausal women
```
endometrial cancer until proven otherwise
vulval ca or vaginal ca
ectropion from atrophy
atrophic vaginitis
STIs
```
56
what are the RFs for cervical ca
sex stereotype
57
what are the RFs for endometrial ca?
unopposed oestrogen
58
how do you detect ovulation?
mid luteal progesterone
| urine LH
59
what investigations should you order if you suspect anovulation?
FSH, LH, testosterone, prolactin, TFTs
60
when will FSH be elevated
ovarian failure
61
when should FSH level be done?
if low on day 5, this suggests ovarian failure
62
give causes of male infertility
```
varicocele
antipsychotics
antidepressants
chemotherapy
STI
AEDs
sulfasalazine
```
63
what is the normal cycle length?
21-35 days
64
what findings of hormones will you get with someone with a prolactinoma?
prolactin raised but low FSH, LH and oestrogens
65
what investigations should you do in an amenorrhoeic patient
pregnancy test
FBC, U&Es, LFTs, TFTs, testosterone, prolactin
TVS
66
common sites for endometriosis?
pouch of Douglas
uterosacral ligament
peritoneum
ovaries
67
how is endometriosis treated?
only if symptomatic
| NSAIDs/paracetamol then tricycling of COCP then surgery
68
what is adenomyosis
unshed tissue in the myometrium, seen in older multiparous women
69
what are the causes of menorrhagia?
fibroids
polyps
endometrial ca
70
how should you investigate a woman who presents with menorrhagia
abdo and BV exam
bHCG
FBC (anaemia), U&E, clotting screen
TVS
71
what are the symptoms of fibroids?
```
menorrhagia
IMB
dysmenorrhoea
IBS like sx
urinary freq
```
72
how are fibroids treated?
```
mirena and iron supplements
antifibrinolytics
mefanamic acid
surgery
if over 35-pelvic USS/hysteroscopy+endometrial biopsy
```
73
give the causes of menorrhagia
fibroids
polyps
endometrial cancer
dysfunctional uterine bleeding
74
what could trigger PID?
coil insertion
miscarriage
childbirth
75
what should you do with a woman presenting with severe pelvic pain and discharge?
suspect PID as well as STIs:
examine (?cervical tenderness), endocervical swabs, FBC, U&E, blood cultures, urine dip
inflammatory markers will not be raised
76
what blood markers will be raised in red degeneration?
lactate dehydrogenase (cell destruction) and creatinine kinase
77
how do you confirm diagnosis of red degeneration?
MRI
78
how is acute PID treated?
2w of gentamicin or clindamycin then refer to GUM for contact tracing
even if likely to have been triggered by coil-do not remove it
79
what would you do if a patient was shocked?
ABCDE
BUFALO
HCG (if female)
urinalysis for stones then CTKUB
80
how do you treat prolapse?
postural exercises and treat cough then ring pessary then surgery
81
what is the most common kind of ovarian cancer?
serous cystoadenocarcinoma but in younger women more likely to be germ cell
82
how might ovarian cancer present?
bloating, early satiety, DVT, urinary frequency
83
what is included in the risk of malignancy index?
ca125
menopausal status
USS findings
84
what should you do in someone presenting with bloating, difficulty opening bowels, frequency, early satiety, suspecting an ovarian cyst?
in all pts bHCG, ca125 and USS
under 35-lactate dehydrogenase (degeneration of cells) and alpha fetoprotectin
over 35-calculate RMI
85
when do you use alpha fetoprotectin?
when you suspect an ovarian cyst in a woman of under 35
86
when is lactate dehydrogenase used?
ovarian cyst in under 35 and red degeneration-the latter you'd also look at creatinine kinase
87
where is the distal urethral sphincter in men
distal to the prostate
88
what drugs can cause incontinence
diuretics, BB, CCB, doxazosin, opioids, lorazepam
89
what is cystometry used for?
to look at compliance, filling pressures, it's where they fill your bladder and you have 2 catheter-it's used to see how overactive your bladder
90
what is the first test used in incontinence investigations?
post void bladder scan
91
what does uroflowtometry do?
rate of flow
92
define urge incontinence
involuntary leakage of urine accompanied or preceded by a feeling of urgency
93
medical treatment for urge incontinence?
tolteridone, oxybutanin and intravaginal oestrogens, there's not really medical treatment for stress
94
can you get stress incontinence when you're asleep?
no, you're not doing anything to increase intraabdo pressure but you can get urge because it's under autonomic control
95
what fibres does the detrusor carry?
sympathetic-it controls the ext sphincter
96
what are the triple swabs
```
endocervical (gonorrhoea)
chlamydia
high vaginal (BV, candida, trichomonas, GBS)
```
97
when can you refer for infertility?
only after 1 year unless they're over 35, obvious disorder, previous abdo surgery
98
what should you do if someone on the pill has D and V?
double dose
99
what are the benefits to the mini pill?
no interactions with p450 inducers or inhibitors
100
causes of polycystic ovaries other than PCOS?
cushings
| adrenal hyperplasia
101
what are the criteria for medical management-MTX of ectopic pregnancy?
small ectopic
no heartbeat of fetus
mother not clinically compromised
no fluid in the pouch of Douglas
102
what antibiotics should be used in PID?
cefotaxime
doxycline
metronidazole
all IM
103
what antibiotics can be used in pregnancy?
penicillins
cephlasporins
macrolides
104
what level should the HCG be for intrauterine pregnancy to be viable?
1000mIU/mL
| definately should be there if above 1500-where you need to investigate site
105
how do you differentiate between torsion and rupture of ovarian cyst?
cysts improve with analgesia and pain starts to regresss
106
what cysts may occur with high levels of bHCG?
theca lutein cyst
107
what does HRT increase the risk of?
endometrial cancer
breast cancer
VTE
stroke
108
how far apart should bHCG be measured?
48hours
109
what is the most common type of endometrial cancer?
adenocarcinoma of the columnar gland cells
110
what does OCP increase and reduce risk of?
increases risk of CIN
| decreases risk of endometrial cancer and ovarian
111
what are the names of the cervical cancer jabs?
cevarix
| gardasil
112
what is the most common kind of cervical cancer
squamous cell
113
what is the significance of RMI?
over 250 needs MDT and CT for staging
114
what are the 2 types of staging for pelvic prolapse
ICS POP
| Baden Walker and Beecham
