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OBGYN > Gynaecology > Flashcards

Gynaecology Flashcards

1
Q

PCOD causes + criteria for diagnosis

A

Rotterdam criteria: 1) irregular or absent periods 2) hyperandrogenism = acne, body hair, alopecia, raised testosterone 3) polycystic ovaries on USS Caused by genetics, insulin resistance, obesity

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2
Q

PCOS + insulin relationship

A

Disordered LH production, peripheral insulin resistance, raised insulin levels

Raised LH + insulin = increased androgen production

Raised insulin = reduced hepatic production of steroid hormone binding globulin (SHBG) = increased free androgens

Increased androgens = disrupt folliculogenesis = small ovarian follciles/ cysts + absent periods

Increased peripheral androgens = hirsutism

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3
Q

S+S PCOS

A

Asymptomatic Acne, hirsutism, alopecia

Obesity Irregular/ absent periods

Infertility

Recurrent miscarriage

Acanthosis nigricans

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4
Q

Long term health consequences of PCOS

A

IHD DM2 GDM Endometrial hyperplasia + carcinoma (due to unopposed oestrogen from 2’ amenorrhoea)

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5
Q

Investigations for PCOS

A

TVUSS

FSH raised in ovarian failure, low in hypothalamic disease + normal in PCOS

LH - raised in PCOS

Testosterone

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6
Q

Management of PCOS

A

Diet, exercise COCP + metformin Anti-androgens Clomifene or gonadotrophins for fertility

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7
Q

Menopause + perimenopause

A

Menopause = permanent cessation of menstruation after 12 months of amenorrhoea (this period is perimenopausal)

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8
Q

Climaceric phase

A

Phase from transition from reproductive state to non-reproductive

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9
Q

S+S menopause

A

Hot flushes, night sweats Sexual dysfunction Depression, anxiety, irritability, mood swings

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10
Q

Long term effects of menopause

A

Osteoporosis CV disease Urogenital atrophy

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11
Q

HRT - which to use + SE

A

Hysterectomy = oestrogen alone Uterus still intact = oestrogen + progesterone SE of oestrogen: fluid retention, bloating, breast tenderness, nausea, headaches, leg cramps, dyspepsia SE of progesterone: fluid retention, breast tenderness, headache, mood swings, depression, acne, backache Combined: irregular bleeding, weight gain

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12
Q

Benefits of HRT

A

Reduced vasomotor + urogenital symptoms Reduced risk of osteoporosis + colorectal cancer

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13
Q

Risks of HRT

A

Risk of breast cancer (greatest with combined) Risk of endometrial cancer with unopposed oestrogen Risk of VTE + gallbladder disease

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14
Q

PMS - what is it, treatment

A

Symptoms during luteal phase of cycle Regression with onset of period Psychological, physical + behavioural Use COCP, oestrogen, GnRH analogues, SSRIs + CBT

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15
Q

Endometriosis pathology + investigations

A

Presence of endometrial tissue outside uterine cavity

Oestrogen dependant

Adenomyosis = ectopic endometrial tissue within myometrium

Investigations: laporoscopy

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16
Q

Endometriosis S+S

A

Secondary dysmenorrhoea, deep dysparaeunia, pelvic pain, infertility

Cyclical pain, can get bleeding from other organs (haematuria)

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17
Q

Endometriosis complications

A

Fibrosis, scarring, infertility, endometroma (chocolate cysts)

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18
Q

Endometriosis O/E findings

A

Adnexal masses Nodules in posterior vaginal fornix Thickening behind uterus Fixed retroverted uterus Rectovaginal nodules Investigate with laparoscopy

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19
Q

Management of endometriosis

A

Expectant 1st line

COCP, GnRH analogues, POP 2nd line

Surgery: ablation, resection, TAHBSO

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20
Q

Treatment of subfertility in endometriosis

A

Remove endometriomas surgically

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21
Q

PID causes

A

Infection which has spread from cervix to pelvis Usually STD, TOP or dilatation + curettage

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22
Q

RF for PID

A

Young, previous STD, new sexual partner, postpartum endometritis

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23
Q

S+S PID

A

Asymptomatic Lower abdo pain Discharge Deep dyspareunia Adnexal tenderness

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24
Q

PID complications

A

Fitz-Hugh-Curtis syndrome - perihepatitis (RUQ pain) Tubero-ovarian abscess Ectopic pregnancy Infertiltiy

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25
Q

PID treatment

A

Ceftriaxone IM + oral doxycycline + metronidazole Partner to have doxycycline for 1 week

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26
Q

Fibroids - what are they?

A

Benign tumours from the myometrium of the uterus Usually made of smooth muscle

27
Q

Types of fibroids

A

Submucus: >50% projection into endometrial cavity

Intramural = within myometrium

Subserous: >50% of fibroid mass extends outside the uterus

28
Q

Endometrial polyps - what are they, treatment

A

Adenoma Focal overgrowth of the endometrium - treatment is resection

29
Q

S+S fibroids

A

Asymptomatic Dysmenorrhoea Menorrhagia Pressure symptoms (frequency) Pelvic pain Infertility Pain in pregnancy - from growth

30
Q

Management of fibroids

A

GnRH (ulipristal acetate) shrink fibroids pre surgery Myomectomy Hysterectomy Uterine artery embolisation

31
Q

Types of ovarian cyst

A

Enlarged follicular or corpus luteum cysts (functional cysts) Benign cystic teratomas = arise from germ cells Endometriomas = chocolate cysts

32
Q

RF for ovarian cysts

A

Obesity Infertility Hypothyroidism Early menarche Tamoxifen therapy

33
Q

S+S ovarian cysts

A

Chronic dull ache Pressure on organs - bowel disturbance or frequency Dyspareunia Bleeding, torsion, rupture Mass in abdo

34
Q

Investigations for ovarian cysts

A

USS + CA125 = RMI

35
Q

Management of cysts

A

Analgesia Laparotomy if acute abdo, ?torsion, rupture, haemorrhage

36
Q

Overflow incontinence - what is it, investigations

A

Bladder is large + flaccid, little detrusor tone Usually due to injury Diagnosed when urinary residual is more than 50% of bladder capacity Bladder leaks when full

37
Q

Continuous urinary incontinence - causes

A

Continuous leakage due to fistula or congenital abnormality

38
Q

Management of stress incontinence

A

Weight reduction, stop smoking, reduce caffeine Pelvic floor for 3 months Duloxetine - enhances urethral sphincter activity. SE: nausea Periurethral injections Transvaginal tape

39
Q

Management of urge incontinence

A

Anticholinergic drugs (oxybutynin) SE: dry mouth, constipation, dry eyes, urinary retention Imipramine (TCAs) Surgery Botulinum toxin A - injected into detrusor

40
Q

Types of prolapse

A

Urethrocele (anterior, involves urethra) Cystocele (anterior, involves bladder) Apical (uterus, cervix + vagina) Enterocele (posterior, pouch of douglas) Rectocele (posterior, anterior wall of rectum)

41
Q

Grading of prolapse

A

0 = no descent of pelvic organs 1 = surface of prolapse does not descend below 1cm above the hymenal ring 2 = extends from 1cm above to 1cm below the hymenal ring 3 = extends more than 1cm below the hymenal ring 4 = vaginal completely everted

42
Q

Management of prolapse

A

Physio = pelvic floor Pessary Surgical repair

43
Q

What are teratomas?

A

Dermoid cysts

Benign neoplasms derived from germ cell layers

Include skin, hair, blood, fat, teeth etc

Have Rokitansky’s protuberance

44
Q

Most common causes of recurrent miscarriage

A

Antiphospholipid syndrome (15% of women with recurrent miscarriages)

Endocrine disorders eg diabetes, thyroid disorders, PCOS

Uterine abnormality

Chromosomal abnormalities

Smoking

45
Q

What is tolterodine?

A

Muscarinic antagonist

Used for urge incontinence

46
Q

First line pain relief for periods

A

NSAIDs d

47
Q

Causes of primary amenorrhoea

A

Turners

Testicular feminisation

Congenital adrenal hyperplasia

Congenital malformations of repro system

48
Q

Causes of secondary amenorrhoea

A

PCOS

Hypothalamic amenorrhoea (stress, excess exercise)

Hyperprolactinaemia

Premature ovarian failure

Thyroid issues

Sheehans (excessive blood loss causing ischaemic nerosis)

Asherman’s (intrauterine adhesions)

49
Q

Symptoms of Sheehan’s

A

Agalactorrhoea

Amenorrhoea

S+S of hypothyroidism + hypoadrenalism

50
Q

Lichen planus vs sclerosus

A

Sclerosus - intense itching, white plaques, postmenopausal commonly

Increased risk of squamous cell carcinoma

Lichen planus = itchy red-brown rash

Both treated with topical steroids

51
Q

Managment of cervical ectropion

A

Cryotherapy with AgNO3

52
Q

What are condyloma lata?

A

Wart like lesions on genitals, sign of secondary syphilis

53
Q

How to do a smear?

A

Rotate clockwise 5 times

54
Q

What is the average age of menopause, and what blood test is used if needed?

A

52 - FSH >30 indicates menopause

55
Q

What is the rASRM score?

A

Grading for endometriosis - takes into account location, size, depth, adhesions

56
Q

When is clomifene given to improve fertility + how does it work?

A

Days 2-6 - increases FSH levels via negative feedback

57
Q

What is normal semen volume, concentration + motility?

A

>2ml

>50%

>15 million sperm

58
Q

What is urodynamics?

A

measuring pressure/ volume relationship during filling + voiding + straining. Combined with ambulatory urodynamic monitoring

59
Q

Management for HMB

A

Mefenamic acid, TXA or IUS 1st line

Endometrial ablation 2nd line

60
Q

What investigations to do in HMB?

A

FBC

USS

Hysteroscopy if irregular or thickened

Endometrial biopsy using Pipelle

61
Q

When should a intrauterine pregnancy show on USS?

A

bhCG >1500

TVUSS before 7 weeks

62
Q

Adenomyosis S+S

A

Picked up on scan as incidental finding

63
Q

S+S ovarian cysts

A

Unilateral pain, intermittent
When ruptured: sudden, lower abdo pain, afebrile, bleeding, increased urinary frequency

OBGYN (18 decks)

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