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3a > Gynaecology > Flashcards

Gynaecology Flashcards

1
Q

what are the other names for a dermoid cyst?

A

teratoma

benign germ cell tumour

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2
Q

what types of benign cyst are there

A 
functional (CL or follicular)
teratoma
benign epithelial (cystoadeonoma)
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3
Q

what is Meig syndrome

A

triad of benign ovarian tumour, pleural effusion and ascites

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4
Q

give some protective factors for ovarian cancer

A

COCP
multiparity
breastfeeding
anything that decreases ovulation

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5
Q

what are the side effects of metformin?

A

GI upset

lactic acidosis

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6
Q

how does clomifene work?

A

increases oestrogen so induces an LH surge

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7
Q

what are the clinical signs of increased androgens?

A

acne
balding
hirsuitism

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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

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9
Q

name a complication of chronic PID

A

Fitz Hugh Curtis syndrome, inflammation of the liver capsule leading to RUQ pain

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10
Q

what are the symptoms of ectopic pregnancy without rupture?

A

pregnancy symptoms
lower abdominal pain
irregular prune juice bleeding

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11
Q

what are the risks of female hormones?

A

oestrogen-endometrial cancer, cervical cancer

progesterone-osteoporosis

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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

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13
Q

how is red degeneration treated

A

emergency hysterectomy.

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14
Q

what are urinary differentials for pelvic pain?

A

urolithiasis
UTI
interstitial cystitis
bladder polyp

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15
Q

what are bowel differentials for pelvic pain?

A 
IBS
constipation
IBD
obstruction
appendicitis
adhesions
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16
Q

how does vulval cancer present?

A

vulval itching
lump
bleeding
dysuria

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17
Q

how do you monitor response to clomifene?

A

USS and progesterone levels

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18
Q

SEs of tamoxifen?

A

fluid retention
leg cramps
hot flushes

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19
Q

name 2 agents used in the chemotherapy regimen of breast cancer

A

cyclophosphamide

methotrexate

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20
Q

what 2 kinds of staging are used for breast cancer in the UK?

A

Nottingham prognostic index

TMN

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21
Q

where is breast cancer likely to metastasise to?

A

bone
lung
liver
brain

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22
Q

what can cause gynaecomastia?

A 
spironolactone
digoxin
weed
liver failure
testicular failure
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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

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24
Q

which cancer is unopposed oestrogen associated with?

A

endometrial

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25
Q

what are side effects of radiotherapy on the breast?

A

pneumonitis
pericarditis
rib fractures

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26
Q

what are contraindications to radiotherapy on the breast?

A

previous radiotherapy on the breast
pt cant lie flat
ataxia telangectasia

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27
Q

what is the difference between stage and grade?

A

stage-TNM where it is

grade-histological appearance

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28
Q

side effects of chemotherapy?

A

early: anaemia, thrombocytopenia, neutropenia, mouth ulcers, thrush
late: neurotoxicity, cardiotoxicity, osteopenia, subfertility

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29
Q

what are the dangers of hormone therapy?

A

premenopausal-tamoxifen-excitatory in endometrium

if pre given aromatase inhibitors-more oestrogen so ovarian, endometrial

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30
Q

define oligomenorrhoea

A

cycle>35 days

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31
Q

common sites of endometriosis

A

uterosacral ligament

ovaries

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32
Q

what is the triad of symptoms in PCOS?

A

anovulation
elevated androgens-shown clinically or on bloods
polycystic ovaries on USS

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33
Q

what do you look for in sperm sample?

A

count
morphology
motility

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34
Q

what is the os doing in threatened miscarriage?

A

closed

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35
Q

risk factors for ectopic pregnancy?

A

PID, age, IUD, pelvic surgery, smoking, previous ectopic

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36
Q

what does cervical excitation suggest?

A

PID

ectopic pregnancy

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37
Q

what are the sex cord tumours?

A

granulosa cell tumours

thecomas

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38
Q

what is the cervical screening programme?

A

25-49 every 3 years

50-64 every 5 years

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39
Q

what would the management be if a woman had borderline dyskaryosis on cervical smear?

A

HPV test
if +ve then colposcopy
if -ve then routine call back

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40
Q

RFs for vulval ca?

A

smoking, lichen scleruosus, immunosuppression

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41
Q

when in the cycle should cervical smear be taken?

A

midcycle

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42
Q

benefits and drawbacks of progesterone?

A

benefits: can be used by smokers and 35+, no increased risk of ca
drawbacks: osteoporosis, acne, mood changes, only 3 hours

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43
Q

what are the side effects of the copper coil?

A

heavy menstrual bleeding

pain

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44
Q

what are the 3 options for emergency contraception?

A

levonorgestrel 1.5mg under 72hrs
Ulipristal (EllaOne) 30mg under 120 hrs
Intrauterine device under 5 days

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45
Q

define secondary amenorrhoea

A

cessation of menses over 3m

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46
Q

what must you do for someone newly diagnosed with PCOS?

A

diabetes and CVS screen

47
Q

what are the benefits and drawbacks of HRT?

A

benefits: sx, reduce osteoporosis and colorectal cancer
drawbacks: VTE, breast, endometrial ca

48
Q

what therapy would you use for PID?

A

triple: IM ceftrioxone, PO metronidazole, PO doxycycline

49
Q

what are the medications used in abortions/

A

anti-progesterone mifepristone
prostaglandin misoprostol
F BEFORE S

50
Q

what do you need to investigate in someone with recurrent miscarriage

A

antiphospholipid antibody
karyotype
PCOS

51
Q

define recurrent miscarriage

A

3 miscarriages in sucession

52
Q

causes of abnormal vaginal bleeding in premenopausal women

A 
spotting-implantation bleeding
IUCD
endomtriosis/adneomyosis
STI
ectropion
molar pregnancy
53
Q

how is ectropion treated

A

silver nitrate
cold coagulation or
dithermy

54
Q

what is the indication for 2/52 colposcopy/

A

severe dyskaryosis

55
Q

causes of abnormal vaginal bleeding in post menopausal women

A 
endometrial cancer until proven otherwise
vulval ca or vaginal ca
ectropion from atrophy
atrophic vaginitis
STIs
56
Q

what are the RFs for cervical ca

A

sex stereotype

57
Q

what are the RFs for endometrial ca?

A

unopposed oestrogen

58
Q

how do you detect ovulation?

A

mid luteal progesterone

urine LH

59
Q

what investigations should you order if you suspect anovulation?

A

FSH, LH, testosterone, prolactin, TFTs

60
Q

when will FSH be elevated

A

ovarian failure

61
Q

when should FSH level be done?

A

if low on day 5, this suggests ovarian failure

62
Q

give causes of male infertility

A 
varicocele
antipsychotics
antidepressants
chemotherapy
STI
AEDs
sulfasalazine
63
Q

what is the normal cycle length?

A

21-35 days

64
Q

what findings of hormones will you get with someone with a prolactinoma?

A

prolactin raised but low FSH, LH and oestrogens

65
Q

what investigations should you do in an amenorrhoeic patient

A

pregnancy test
FBC, U&Es, LFTs, TFTs, testosterone, prolactin
TVS

66
Q

common sites for endometriosis?

A

pouch of Douglas
uterosacral ligament
peritoneum
ovaries

67
Q

how is endometriosis treated?

A

only if symptomatic

NSAIDs/paracetamol then tricycling of COCP then surgery

68
Q

what is adenomyosis

A

unshed tissue in the myometrium, seen in older multiparous women

69
Q

what are the causes of menorrhagia?

A

fibroids
polyps
endometrial ca

70
Q

how should you investigate a woman who presents with menorrhagia

A

abdo and BV exam
bHCG
FBC (anaemia), U&E, clotting screen
TVS

71
Q

what are the symptoms of fibroids?

A 
menorrhagia
IMB
dysmenorrhoea
IBS like sx
urinary freq
72
Q

how are fibroids treated?

A 
mirena and iron supplements
antifibrinolytics
mefanamic acid
surgery
if over 35-pelvic USS/hysteroscopy+endometrial biopsy
73
Q

give the causes of menorrhagia

A

fibroids
polyps
endometrial cancer
dysfunctional uterine bleeding

74
Q

what could trigger PID?

A

coil insertion
miscarriage
childbirth

75
Q

what should you do with a woman presenting with severe pelvic pain and discharge?

A

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
Q

what blood markers will be raised in red degeneration?

A

lactate dehydrogenase (cell destruction) and creatinine kinase

77
Q

how do you confirm diagnosis of red degeneration?

A

MRI

78
Q

how is acute PID treated?

A

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
Q

what would you do if a patient was shocked?

A

ABCDE
BUFALO
HCG (if female)
urinalysis for stones then CTKUB

80
Q

how do you treat prolapse?

A

postural exercises and treat cough then ring pessary then surgery

81
Q

what is the most common kind of ovarian cancer?

A

serous cystoadenocarcinoma but in younger women more likely to be germ cell

82
Q

how might ovarian cancer present?

A

bloating, early satiety, DVT, urinary frequency

83
Q

what is included in the risk of malignancy index?

A

ca125
menopausal status
USS findings

84
Q

what should you do in someone presenting with bloating, difficulty opening bowels, frequency, early satiety, suspecting an ovarian cyst?

A

in all pts bHCG, ca125 and USS
under 35-lactate dehydrogenase (degeneration of cells) and alpha fetoprotectin
over 35-calculate RMI

85
Q

when do you use alpha fetoprotectin?

A

when you suspect an ovarian cyst in a woman of under 35

86
Q

when is lactate dehydrogenase used?

A

ovarian cyst in under 35 and red degeneration-the latter you’d also look at creatinine kinase

87
Q

where is the distal urethral sphincter in men

A

distal to the prostate

88
Q

what drugs can cause incontinence

A

diuretics, BB, CCB, doxazosin, opioids, lorazepam

89
Q

what is cystometry used for?

A

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
Q

what is the first test used in incontinence investigations?

A

post void bladder scan

91
Q

what does uroflowtometry do?

A

rate of flow

92
Q

define urge incontinence

A

involuntary leakage of urine accompanied or preceded by a feeling of urgency

93
Q

medical treatment for urge incontinence?

A

tolteridone, oxybutanin and intravaginal oestrogens, there’s not really medical treatment for stress

94
Q

can you get stress incontinence when you’re asleep?

A

no, you’re not doing anything to increase intraabdo pressure but you can get urge because it’s under autonomic control

95
Q

what fibres does the detrusor carry?

A

sympathetic-it controls the ext sphincter

96
Q

what are the triple swabs

A 
endocervical (gonorrhoea)
chlamydia
high vaginal (BV, candida, trichomonas, GBS)
97
Q

when can you refer for infertility?

A

only after 1 year unless they’re over 35, obvious disorder, previous abdo surgery

98
Q

what should you do if someone on the pill has D and V?

A

double dose

99
Q

what are the benefits to the mini pill?

A

no interactions with p450 inducers or inhibitors

100
Q

causes of polycystic ovaries other than PCOS?

A

cushings

adrenal hyperplasia

101
Q

what are the criteria for medical management-MTX of ectopic pregnancy?

A

small ectopic
no heartbeat of fetus
mother not clinically compromised
no fluid in the pouch of Douglas

102
Q

what antibiotics should be used in PID?

A

cefotaxime
doxycline
metronidazole
all IM

103
Q

what antibiotics can be used in pregnancy?

A

penicillins
cephlasporins
macrolides

104
Q

what level should the HCG be for intrauterine pregnancy to be viable?

A

1000mIU/mL

definately should be there if above 1500-where you need to investigate site

105
Q

how do you differentiate between torsion and rupture of ovarian cyst?

A

cysts improve with analgesia and pain starts to regresss

106
Q

what cysts may occur with high levels of bHCG?

A

theca lutein cyst

107
Q

what does HRT increase the risk of?

A

endometrial cancer
breast cancer
VTE
stroke

108
Q

how far apart should bHCG be measured?

A

48hours

109
Q

what is the most common type of endometrial cancer?

A

adenocarcinoma of the columnar gland cells

110
Q

what does OCP increase and reduce risk of?

A

increases risk of CIN

decreases risk of endometrial cancer and ovarian

111
Q

what are the names of the cervical cancer jabs?

A

cevarix

gardasil

112
Q

what is the most common kind of cervical cancer

A

squamous cell

113
Q

what is the significance of RMI?

A

over 250 needs MDT and CT for staging

114
Q

what are the 2 types of staging for pelvic prolapse

A

ICS POP

Baden Walker and Beecham

3a (11 decks)

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