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Final > Gynaecology > Flashcards

Gynaecology Flashcards

1
Q

Adenomyosis

  • def
  • pres
  • tx
A

Endometrial tissue in myometrium

Painful periods
menorrhagia

GnRH agonists
Hysterectomy

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2
Q

Primary amenorrhoea causes

A

Turners

Congenital adrenal hyperplasia

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3
Q

Secondary amenorrhoea (prev menstruation has now stopped for 6 months)

A 
EXCLUDE PREG
Stress
PCOS
Premature ovarian failure
Ashermans (intrauterine adhesions)
Sheehans
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4
Q

What is Sheehans

A

Postpartum hypopituitary)

Caused by ischaemic necrosis in pituitary

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5
Q

Atrophic vaginitis

  • Who
  • Pres
  • Tx
A

Post-Menopausal

Vaginal dryness, painful intercourse

Lubricants, topical oestrogen

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6
Q

Cervical cancer

  • Features
  • Cause
  • RF
A 
Vignal bleeding (postcoital, intermenstrual, postmenopausal)
Abnormal Dicharge

HPV 16, 18, 33

Smoking, HIV, High parity, early 1st intercourse, many partners

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7
Q

Cervical cancer pathophys

A

HPV 16, 18 make oncogenes E6 and E7

These inhibit p53 / RB tsgs

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8
Q

Screening regimen cervical cancer

A

25-64

25-49 3 yearly
50-64 5 yearly

Smear sent for cytology testing for HPV

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9
Q

What isn’t detected by cervical cancer screening

A

Adenocarcinoma (15% of cervical cancer)

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10
Q

Using result from cervical screening

A

If positive for HPV 16/18/33 refer to colposcopy to visualise transformation zone and swab it

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11
Q

What is ectropion

A

Larger area of columnar epithelium (from cervical canal) present on ectocervix

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12
Q

Ectropion causes

A

COCP
Elevated oestrogen (ovulatory phase)
Pregnancy

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13
Q

Dysmenorrhoea

  • Def
  • Primary vs secondary
  • Causes
A

Pain during menstrual period

Primary: no pelvic pathology, pain few hours pre-period (due to rise in PGs)

Secondary due to:
Endometriosis, adenomyositis, PID, Intruterine device (copper), fibroids

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14
Q

Treating dysmenorrhea

A

NSAIDs (Mefanic acid & Ibuprofen) - inhibit prostaglandins (thought to be reason)

COCP second line

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15
Q

Typical site ectopic

A

Fallopian tube: ampulla

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16
Q

Tx ectopic

A

Surgery: salpingectomy or salpingotomy

Medical: Methorexate

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17
Q

RF ectopic preg

A 
Damage to tubes (surgery, salpingitis - PID)
Prev
Endometriosis
IUCD
IVF
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18
Q

Most dangerous ectopic site

A

Pouch of Douglas

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19
Q

Endometrial cancer

  • RF
  • Features
  • Ix
  • Tx
  • Prognosis
A

Obesity, Nulliparity, Early menarche, Late menopause, Unopposed oestrogen (eliminated if given with Progesterone), Tamoxifen, PCOS

Post-menopausal bleeding, intermenstrual bleeding

Transvaginal USS (endometrium under 4mm negative predictor)
Hysteroscopy with endometrial biopsy

Hysterectomy (Progesterone in older women)

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20
Q

Protective for endometrial cancer

A

Oral contraception pill

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21
Q

Endometriosis

  • def
  • features
  • Ix
  • tx
A

Endometrial tissue outside of uterine cavity

chronic pelvic pain, dysmenorrhoea, sub fertility, dysuria, painful defecation
Vaginal lesions may be seen

Laparoscopy is gold standard

NSAIDs ± Para
COCP
secondary care: GnRH analogues (induce negative feedback), Surgery (excision of cysts may improve fertility)

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22
Q

PID

  • Features
  • Investigation
A

Lower abdo pain, vaginal discharge, Perihepatic inflammation (Fitz-hugh curtis) RUQ pain
Fever over 38

FBC (Leukocytosis)
Not preg
High vaginal and urethral swabs

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23
Q

HRT

  • def
  • SE
  • complications
A

Alleviate menopausal symptom with Oestrogen+Progesterone therapy

Nausea, Breat tenderness, weight gain

Breast cancer (inc with progesterone), endometrial cancer (progesterone lowers risk), Ovarian cancer
 VTE, Stroke, Coronary heart disease
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24
Q

Menopause

  • Def
  • Age
  • Criteria
A

Cessation of menstruation due to loss of follicular activity

Average around 51 (perimenopause before this)

12 months from last period in over 50, 24 months if under 51

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25
Q

Menopause symptoms

A

Inc length of menstrual cycles

Vasomotor: Hot flush, night sweats

Urogenital: dryness, atrophy, urinary freq

Psych: anxiety and depression in 10%, short term memory

Osteoporosis, Inc risk IHD

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26
Q

Menopause management

A

Lifestyle modification

  • exercise (mood, cognitive, flushes)
  • good sleep hygiene (cog, sleep dist)

HRT (2-5yrs)
- Oral or transdermal combined therapy

Non-hormone replacement therapy

  • Fluoxetine, citalopram (vasomotor, psych)
  • dryness: lubricant
  • Psych: self help, CBT
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27
Q

CI HRT

A

Current or past breast cancer

Any oestrogen-sensitive cancer

Undiagnosed vaginal bleeding

Untreated endometrial hyperplasia

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28
Q

Ovarian cancer

  • Cell type + site
  • RF
  • Pres
A

90% epithelial
Distal end of fallopian tube

FH, BRCA1/2, many ovulations (early menarche, late menopause, nuliparity)

Abdo distension & bloating
Abdo pain
Urinary symptoms (e.g. urgency)
Early satiety
Diarrhoea
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29
Q

Ovarian cancer

  • Investigations
  • Management
  • Prognosis
A

CA125 initially (endometriosis, cysts, menstruation also raise it)

USS abdo/pelvis if raised CA125

80% advanced with peritoneal mets at pres, 45% 5 yr survival

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30
Q

Ovarian cysts:

  • common type
  • Ix (benign vs malignant)
  • Management (pre/postmenopause)
A

Follicular

USS

  • benign: simple unilocular
  • Malig: complex, multilocular

Premen: conservation, rescan in 8 weeks

Postmen: physiological cysts unlikely, refer to gynae

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31
Q

Ovarian torsion

  • Def
  • Pres
  • Ix
  • Tx
A

Twisting of ovary on ligaments compromising blood supply

Deep colicky pain, vomiting, adnexal tenderness on vaginal exam

USS
Laparoscopy is diagnostic and therapeutic

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32
Q

PID

  • Def
  • Causative organisms
  • Pres
A

Infection/inflammation of female pelvic organs (uterus, fallopian tubes, ovaries)
Ascending infection from endocervix

Chlamydia trachomatis (commonest)
Neisseria gonorrhoea

Lower abdo pain, fever, dyspaerneuria, discharge
Perihepatitis (RUQ pain - Fitz-Hugh Curtis syndrome) in 10%

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33
Q

PID

  • Ix
  • Tx
A

Screen for chlamydia and Gonorrhoea (first catch urine)

Oral Ofloxacin + Metronidazole (OR IM ceftriaxone + MEtronidazole + Doxy)

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34
Q

PID complications

A

Infertility
Chronic pelvic pain
Ectopic pregnancy

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35
Q

Fertility in endometriosis

A

Reduced

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36
Q

Commonest cause of pelvic pain

A

Dysmenorrhoea

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37
Q

Hormone abnormalities seen in PCOS

A

Hyperinsulinaemia

High LH

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38
Q

PCOS Pathology

A

Vicious cycle with high LH made worse by high Oestrogen giving higher LH.
Low FSH gives amenorrhoea

High androgens due to inc production from ovary, inc secretion release from adrenal and aromatisation to oestrogen by peripheral fat

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39
Q

Features of PCOS

A

Subfertility and infertility

Menstrual disturbance (oligomenorrhoea, amenorrhoea

Hirtuism, acne (hyperandrogegism)

Obesity (insulin resistance, high insulin)

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40
Q

Diagnosis of PCOS

A

2 out of

Oligo/Anovulation
Excess androgen activity
Polycystic ovaries on sonograph

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41
Q

PCOS Tx

  • General
  • Hirtuism
  • Infertility
A

General

  • weight loss
  • metformin (insulin resistance)
  • COCP helps regulate cycle

Hirtuism
- COCP

Infertility

  • weight reduction
  • metformin, clomifene (alone or combo) to stimulate ovulation
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42
Q

Differentials of postcoital bleeding

A

Chlamydial cervicitis
Cervical cancer
Polyps
Trauma

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43
Q

Differentials for postmenopausal bleeding

A

Vaginal atrophy (most common)
HRT
Endometrial hyperplasia (abnormal thickening - precursor for Ca)
Cancers: endometrial, cervical, ovarian, Vaginal
Trauma

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44
Q

Investigating Post-menopausal bleeding

A

History and examination of vagina + abdo
CA125

If 2 week wait, transvaginal USS

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45
Q

Preg minor symptoms

A

Amenorrhoea
N&V
Tired
MSK pains

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46
Q

Causes of premature ovarian failure (menopause + elevated Gonodatropins - FSH/LH pre 40)

A

Idiopathic
Chemo
Autoimmune
Radiation

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47
Q

Features of premature ovarian failure

A

Hot flush, night sweats
Infertility
Secondary amenorrhoea
Raised FSH and LH

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48
Q

Premenstrual syndrome

  • def
  • sympt
A

Emotional/physical symptoms women may feel prior to menstruation. (PMS)

Anxiety
Stress
Fatigue
Mood Swings

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49
Q

Causes of recurrent miscarriage

A 
Antiphospholipid syndrome
Endocrine disorders (DM, Thyroid disorders, PCOS)
Uterine abnormality (adhesion, septum)
Chromosomal abnormalities
Smoking
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50
Q

Termination of preg date

A

Upper limit is 24 weeks

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51
Q

Termination of preg Method

  • less than 9 weeks
  • less than 13 weeks
  • more than 15 weeks
A

Mifepristone (anti-progesterone) and PGs - Misoprostol 48 hrs later to stimulations Uterine contractions

Surgical dilation and suction of uterine contents

Surgical dilation and evacuation of uterine contents (late abortion)

52
Q

Urinary incontinence

  • RF
  • Classification
A

Age, preg, high BMI, hysterectomy

Overacitve bladder/Urge: detrusor overactivity

Stress: leaking when laugh/cough (weak pelvis floor)

Overflow: outlet obstruction (e.g. BPH

Mixed )Urge & Stress)

53
Q

Investigating incontinence

A

Bladder diaries
Vaginal exam
Urine dipstick & Culture

54
Q

Management incontinence

A

Bladder training, bladder drugs (antimuscarinic - Oxybutinin)

Pelvic floor muscle training (8, 3x a day)
Surgery: retropubic mid-urethral tape

55
Q

Urogenital prolapse

  • Types
  • RF
  • Pres
  • Tx
A

Cystocele
Rectocele
Uterine prolapse
(enterocoele - pouch of douglas = less common)

Inc age, multiparty, vaginal delivery, Obesity, Spina bifida

Pressure, heaviness.
Urinary: incontinence, frequency, urgency.

asympt/mild - conservative tx (weight loss, Kegels)

Ring pessary

Surgery - hysterectomy, colposuspesion

56
Q

What are fibroids?
What causes them?
RF?

A

Smooth muscle tumours of the uterus

Occur in reproductive years, develop in response to oestrogen.

RF: Afrocaribbean
FH
Early puberty
Advancing age

57
Q

Fibroids types

A

Submucosal
Intramural
Subserosal

58
Q

Fibroids

  • Pres
  • Diagnosis
A 
Menorrhagia (inc SA)
Lower abdo pain (cramping, worse at menstruation)
Bloating
Urinary sympt (frequency)
Subfertility

Transvaginal USS

59
Q

Management fibroids

A

Levonorgestrel-releasing intrauterine device 1st line (Mirena)

Tranexamic acid, COCP

GnRH short term (overstimulation = desensitisation and suppression of reproductive axis)

Surgery: Myomectomy, endometrial ablation, hysterectomy, uterine artery embolisation

60
Q

Vaginal candidiasis

  • RF
  • Features
  • diagnosis
  • Tx
A

Diabetes
Antibiotics, steroids
Preg
Immunosuppression: HIV, iatrogenic

White, non-offensive discharge
Vulvitis (pain on urination and sex)
ITCH
Vulval erythema

Clinical, High vaginal swab (not routine)

Local clotrimazole
Oral itraconazile

61
Q

Discharge for

  • Candida
  • Trichomonas
  • BV
A

Cottage cheese

Offensive, yellow/green, frothy

Offensive, thin, white/grey, fishy (whiff test)

62
Q

Causes of discharge

A

Common
- BV, Candida, Trichomonas, Physiological

Less common
- Gonorrhoea, Chlamydia, ectropion, cancer

63
Q

What is Turners syndrome?

Pres?

A

45XO

Amenorrhoea, neck webbing, short

64
Q

Secondary amenorrhoea causes

A 
Premature failure/menopause
Stress
Exercise
Hyperprolactinaemia Iatrogenic (some contraceptives)
PCOS
65
Q

What is Kallmann syndrome

A

Hypogonadotrpic hypogonadism

delayed or absent puberty

66
Q

Investigating amenorrhoea

A 
FSH/LH, hCG (preg), TFT
Serum androgens (PCOS)
67
Q

Amenorrhoea, raised FSH and LH. Cause?

A

Ovarian failure/menopause commonest

weight loss, anorexia, pituitary tumour

68
Q

Causes of high prolactin?

Drug to Tx?

A

PRolactinoma, Hypothyroid, Anti-psychotics, some antiemetics

Bromocriptine (D-agonist)

69
Q

What causes inc in testosterone in women?

A

Cogenital adrenal hyperplasia
Cushings
Androgen secreting tumour

70
Q

Presentation of Menopause

A 
Hot flushes, 
night sweats, 
vaginal dryness, 
vaginal atrophy, 
sleep disturbance, 
irritability
71
Q

What is seen on ovaries during laparoscopy in endometriosis

A

Chocolate cysts

72
Q

Menorrhagia causes

A

Uterine:
Fibroids, endometriosis/adenomyosis, polyps, malignancy

Systemic:
Coag disorders, hypothyroid, DM
Anticoag Tx

73
Q

What is menorrhagia

A

Over 80ml menstrual loss
AND/OR
Over 7 days of bleeding

74
Q

Common benign functional ovarian cysts

A

Corpus luteal

Follicular cysts

75
Q

Ovarian cyst rupture (mid cycle commonly)
Pres?
Ix? (rule out what)
Tx?

A

Acute abdo pain
PV bleeding
N&V

Urinary hCG to rule out ectopic
FBC, USS

Analgesia

surgery if circulatory collapse

76
Q

Most common ovarian Ca

A

Epithelial serous adenocarcinoma

77
Q

Tamoxifen receptor relationship

A

Antagonist in great but agonist in uterus

78
Q

Cervical Cancer Prevention

A

Screening

Gardasil Vaccine in 12/13 y.o. girls

79
Q

Treatment of moderate dysplasia in cervix at colposcopy

A

Cone biopsy
Laser therapy
Cryotherapy

80
Q

% of couples who conceive in 1 yr? 2 yr?

A

80%, 90%

81
Q

Causes of sub fertility (unable to conceive in 1 year)

A

Male factors 25%

Ovulatory, tubal, uterine disorders

Factors in both

82
Q

PCOS DDx

A

Cushings
Hyperprolactinaemia
Hypothyroid
Acromegaly

83
Q

Female infertility causes

  • Ovarian
  • Tubes & uterus
  • Other
A

PCOS, Pituitary tumours, Sheehans, Hyperprolactinaemia
Premature failure of ovaries, Turners

PID, Ashermans, Fibroids Endometriosis

CAH, Cushings

84
Q

When sexual characteristics present what can cause primary ammenhorea?

A

Usually GU malformation

  • imperforate hymen
  • vaginal septum
85
Q

Cause of CAH?

A

21-hydroxylase deficiency

Reduces efficiency of cortisol synthesis.
Hyperplasia of adrenal cortex, inc ACTH release and inc inc adrenal androgen/testosterone prod (from progesterone and DHEA inc)

86
Q

Pres of CAH

A

severe may give salt wasting (adrenal cortex)

Genital ambiguity

87
Q

Physiological amenorrhoea

A

Preg
LActation
Menopause

88
Q

Gonadotropin in menopause

A

Gonadotrpin levels (FSH, LH elevate

89
Q

What is beta-HCG

A

this is a subunit of HCG.

90
Q

Drugs causing female infertility

A

Spironolactone
Chemo/cytotoxics
Recreational drugs

91
Q

Causes of spermatic failure

A

Chemo of testis
Maldescent
Klinefeltners (47XXY)
Varicocele

92
Q

What is used to induce ovulation

A

Clomifene
Methotrexate

(Risk of ovarian overstimulation syndrome)

93
Q

First line to stimulate ovulation

A

Clomifene

94
Q

What is significance of mid-luteal Progesterone and on what day

A

Day 28

Shows ovulation as progesterone produced by Corpus Luteum

95
Q

Cardiac abnormality assoc with TUrners

A

Aortic stenosis ± coarctation of aorta

96
Q

CAH investigation

A

17-a-hydroxyprogesterone

97
Q

Ovarian cancer staging

A

1) confined to ovaries
2) both ovaries / pelvic extension
3) Peritoneal ± retroperitoneal LNs
4) Distant mets

98
Q

What is female sexual dysfunction

A

Disorder of:

  • Sexual desire
  • Arousal
  • Orgasm

Sexual pain (dysparenuria, vaginismus)

99
Q

Effect of sexual dysfucntion

A

significant personal distress and reduced QoL

100
Q

Causes of female sexual dysfunction

A

Psych

  • trauma/abuse
  • body image
  • depression/anxiety

Social

  • relationship concerns
  • stress
  • pressure to perform

Organic

  • DM
  • vascular (atherosclerosis)
  • hormone imbalance
  • neurological (e.g. cauda equina, MS, paralysis)

Drugs:

  • SSRIs
  • Beta-blockers
101
Q

Superficial dysperenuria causes

A

Thrush
Herpes
Vaginismus (pelvic floor spasm)

102
Q

Deep dysparenuria causes

A

PID
Endometriosis
Lubrication

103
Q

Psychological therapy for sexual dysfunction

A

Sensate focus (increasing touching)

Personal sexual growth programme

CBT

Psychodynamic therapy (talk through unconscious thought processes, unresolved conflicts, past dysfunctional relationships)

104
Q

Physical additions to Psychological therapy

A

Sex toys

Lubricant

Kegel exercises

Treat any medical causes

Oestrogen replacement (if menopausal)

105
Q

Causes of erectile dysfunction?

A

Organic

  • neuro disease
  • CVD
  • androgen deficiency
  • prolactinaemia
  • veno-oclusive

Psychological
- depression

  • performance anxiety
  • relationship problems

drugs:

  • Intoxication/substance abuse
  • SSRIs
  • Alcohol
106
Q

Define rapid ejaculation

A

inability to control ejaculation to allow both partners to enjoy sex

107
Q

Rapid ejaculation causes

A

Penile hypersensitivity
Anxiety
Early learned experience
Lack of sexual experience

108
Q

Rapid ejaculation tx

A

Local anaesthetic spray
Couples therapy
Kegels

109
Q

Low libido causes

A 
Chronic disease
CVD
Anaemia
DM
Obesity
Androgen deficient
Hyperprolatinaemia

Psychological (previous abuse, relationship problems, body image)

110
Q

4 Types of couples therapy

A

CBT (focus on dysfunctional beliefs and behaviours)

Psychodynamic (link between current and past issues explored)

Systemic therapy

Integrative therapy (understanding and intervention from more than 1 approach)

111
Q

What is syndrome related to Chlamydia?

A

Reiters syndrome:

  • Urethritis
  • Uveitis
  • Reactive arthritis
112
Q

Trichomonas:

  • Type of organism
  • Features on Ix
A

Protazoa

Green/Grey discharge

Wet film shows polymorphonuclear leukocytes (Neutrophils)

113
Q

Investigating STI

A 
1st void
Urine CT/GC (Chlam/Gonorr)
NAAT - nucleic acid amp (Chlam)
HIV serolog
Urethral swab
Endocervical/high vaginal swabs
114
Q

Additional Investigation for MSM

A

Pharyngeal/Rectal swab for NAAT

Hep B serology

115
Q

What is NAAT?

A

Nucleic acid amplification test for viral/bacterial DNA e.g. Chlamydia

116
Q

Thrush/Candida Tx

A

Oral Fluconazole

Topical Clotrimazole

117
Q

Herpes simplex symptoms

A

Painful blisters on external genitalia

Viral illness

Recurrence after latent period

(Oral acyclovir and abstain from sex until cleared)

118
Q

Syphilis Primary, Secondary and Tertiary disease

A

Primary:
- Painless chancre lesion

Secondary:

  • Palmar/sole rash (maculopapular)
  • Flu-like symptoms

Tertiary:
- Neuro, CV, Gummatous symptoms

119
Q

Can cold sore give genital herpes

A

Yes

Both HSV 1 and HSV 2 can cause genital lesions

120
Q

Causes of delayed ejaculation

A

Psych (performance pressure, trust/relationship issues, lack of stimulation)

Medications (SSRI, antipsychotics),
Radiotherapy

Pelvic surgery/trauma, diabetic neuropathy, MS

Low testosterone, High prolactin

121
Q

Delayed ejaculation Ix

A

Physical exma
Bloods + PSA/Prolactin/Testosterone
Urine sample
Swabs

122
Q

Delayed ejaculation Tx

A

Couples therapy

Sensate focus

CBT

Kegels

123
Q

Blood investigations of low libido in women

A 
OEstrogen
LH, FSH
GnRH
Testosterone
TSH
Prolactin
HbA1c
FBC
124
Q

Sexual dysfunction impact on partner

A

Low self esteem

Rejection

Pressure on relationship

Break up of relationship

Own sexual problems

125
Q

Female reduced desire Tx:

A

Sensate focus

Sexual growth programme

Oestrogen (vaginal dryness)

Masturbation

Individual and couple psychodynamic therapy

Kegals

Final (26 decks)

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