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Gynaecology, Obstetrics and Sexual Health > Gynaecology > Flashcards

Gynaecology Flashcards

1
Q

In general, what medical options are there to reduce volume of abnormal bleeding if someone is complaining of menorrhagia?

A

IUS (Mirena coil), Tranexamic acid, mefanamic acid, combined contraceptive.

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2
Q

In general, what medical options are there to regulate timing of periods if someone is complaining of irregular periods?

A

IUS (Mirena coil), combined contraceptive or cyclical/continuous progesterones.

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3
Q

What is primary amenorrhoea?

A

No menstruation by age 16

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4
Q

What is secondary amenorrhoea?

A

When previously normal menstruation ceases for 6 months or more

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5
Q

What is oligomenorrhoea?

A

Menstruation occurs less frequently than every 35 days

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6
Q

What is the most important thing to exclude in post-coital bleeding?

A

Cervical cancer.

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7
Q

What is cervical ectropion?

A

A condition in which the endocervical columnar epithelium protrudes out through the cervical os and onto the vaginal portion of the cervix, undergoes squamous metaplasia and transforms to stratified squamous epithelium. Although it is physiological (especially in ovulatory phase in younger women and during pregnancy), it is indistiguishable from early cervical cancer so further diagnostic studies must be performed.

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8
Q

What drugs are useful for the management of primary dysmenorrhoea?

A

Usually responds to NSAIDs and ovulation suppression (e.g. the COCP)

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9
Q

What is secondary dysmenorrhoea?

A

Pain is due to pelvic pathology. Pain often precedes and is relieved by the start of menstruation. Most significant causes are due to fibroids, adenomyosis, endometriosis, PID, ovarian tumours. Pelvic US and laparoscopy are useful in helping establish cause

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10
Q

How is pre-menstrual syndrome managed?

A

Active management only necessary if having a signifcant impact on life. SSRIs are effective - either continuous or 2nd half of cycle only. Ablating the cycle may be effective. COCP and oestrogen HRT patches should help. If still no response, trial GnRH agonists and add-back oestrogen therapy to induce pseudo-menopause. Last resort = oophrectomy.

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11
Q

How is Polycystic Ovary Syndrome diagnosed?

A

Fulfilment of >= 2 of the 3 Rotterdam criteria: Polycystic ovaries (12+) on US, Irregular periods (>35 days apart), hirsutism (clinical or biochemical - raised testosterone).

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12
Q

What percentage of cases of anovulatory infertility are caused by PCOS?

A

80%

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13
Q

What can cause excess testosterone to be produced by the ovaries?

A

Excess LH production or raised levels of insulin.

The excessive testosterone production leads to polycystic ovaries

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14
Q

What is the management of PCOS for those not planning pregnancy?

A

Advise weight control with dieting and exercise. Co-cyprindol for hirsutism and acne. COCP to control irregular menstruation.
Orlistat may be used to help weight loss. Eflorinthine may be used to help resolve hirsutism. Metformin is unlicensed but may be used.

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15
Q

What is the management of PCOS for those wishing to conceive?

A

Advise weight control with dieting and exercise. Clomifene induces ovulation. Metformin may be used. If resistant to clomifene, laparoscopic ovarian drilling or gonadotrophins may improve ovulation.

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16
Q

When is the menopause recognised to have occured?

A

After 12 consecutive months of amenorrhoea

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17
Q

What is the average age of the menopause?

A

51 years

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18
Q

What is premature menopause?

A

Menopause that occurs before the age of 40. Ovarian failure with raised FSH for > 1 year clinically clarifies the diagnosis. Recommended to start HRT until 51 for bone preservation.

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19
Q

Why should HRT treatment post-menopause be reviewed after 5 years (especially if consisting of just oestrogen)?

A

Increases the risk of endometrial and breast cancers. Also raises risk of VTE and gallbladder disease

20
Q

What is the most common cause of post-menopausal bleeding?

A

Atrophic vaginitis

21
Q

What percentage of cases of post-menopausal bleeding are due to endometrial cancer?

A

~10%

This is why any PMB is malignancy until proven otherwise

22
Q

What are the symptoms of endometriosis?

A

Dysmenorrhoea (severe, starts few days before period and lasts throughout), low abdo pain, IMB, infertility, deep dyspareunia, pain on defecation/weeing.

23
Q

What is the gold standard investigation for suspected endometriosis and what is seen?

A

Laparoscopy + biopsy. See characteristic ‘chocolate cysts’

24
Q

What hormonal management options are there for endometriosis?

A

COCP (lighter, less painful periods), Mirena IUS (thins uterus lining, lighter bleeds), GnRH analogues (block anterior pituitary releasing gonadotrophins which reduces oestrogen released by the ovaries), progesterone hormone tablets (prevent ovulation), Danazol (reduces gonadotrophin production).

25
Q

Which drugs are most effective for pain relief in endometriosis?

A

NSAIDs (ibuprofen, naproxen) - most effective if taken a few days before period starts and taken regularly to control pain. Also may help to use paracetamol and codeine

26
Q

What surgical management options are there for endometriosis?

A

Laparascopic removal of ectopic endometrial tissue - performed at same time as Dx. This should improve symptoms and fertility.
Open surgery if severe adhesions/large cysts.
TAHBSO - if family complete, provides definitive symptoms relief.

27
Q

How are fibroids managed?

A

If asymptomatic, no Rx necessary. TXA, NSAIDs (ibuprofen, mefanamic acid), mirena IUS (lighter bleeds), OCP.
To shrink fibroids, GnRH agonists (reduce oestogen levels), or uterine artery embolisation
Surgerical: Hysteroscopic removal (if =< 3cm). Open or laparoscopic myomectomy, high recurrence rate). Radical hysterectomy (if family completed, guaranteed cure). Endometrial ablation.

28
Q

How are ovarian cysts managed?

A

Most small cysts resolve within months. Conservative approach if under 35, unlikely to be physiological cysts if post-menopausal.
If =< 5cm, do yearly F/U USS
If > 5cm, MRI, laparoscopy/laparatomy if symptomatic

29
Q

What investigations are needed to make a diagnosis of urodynamic stress incontinence with certainty?

A

After excluding an overactive bladder with cystometry and confirming the stress incontinence with urodynamic studies

30
Q

What is the management of urodynamic stress incontinence?

A

Conservative: advice (lose weight if applicable, reduce excess fluid intake). Pelvic floor muscle training for 3 months led by physio is 1st line. Vaginal cones and sponges can be used.
Medical: Duloxetine (an SNRI) - enhances urethral striated sphincter activity.
Surgical: if previous methods fail. Vaginal tape used.

31
Q

What test is used to diagnose detrusor overactivity and what is seen using this method?

A

Urodynamic studies - characterised by involuntary detrusor contraction during the filling phase which may be spontaneous or provoked (e.g. by coughing in stress incontinence)

32
Q

How is urge incontinence/overactive bladder managed?

A

Conservative: reduce caffeine/alcohol and excess fluid intake, smoking cessation, bladder training.
Medical: Anticholinergics e.g. oxybutynin suppress detrusor overactivity.
Surgical: intravesical botox injection (to paralyse detrusor muscle), sacral nerve stimulation, detrusor myomectomy, neuromodulator implant.

33
Q

What symptoms might someone with urogenital prolapse present with?

A

General: ‘dragging sensation’, vaginal lump
Cystourethrocoele: urinary frequency, incontinence
Rectocoele: difficulty defecating

34
Q

How often are women invited for cervical screening at the various age categories?

A

Age 25-49 = every 3 years
Age 50-64 = every 5 years
Over 65 = only those not screened since 50 or recent abnormal tests.

35
Q

If a woman’s smear test sample shows low grade or borderline dyskaryotic features (suggesting CIN 1), what should then be done?

A

The sample should be tested for HPV and if this is positive, refer the woman for colposcopy. If negative, back to routine screening in 3-5 years.

36
Q

If a woman’s smear test sample shows high grade (moderate or severe) dyskaryotic features (suggesting CIN 2 or 3), what should then be done?

A

Refer to colposcopy without need for HPV testing.

37
Q

If the cytology report from a smear test comes back saying the sample is inadequate, what should then be done?

A

Another sample must be taken in ~3 months. If 3 consecutive samples are deemed ‘inadequate’, send for colposcopy.

38
Q

If after colposcopy, a woman is deemed to have CIN2 or 3, how should they be managed?

A

Large loop excision of the transformation zone (LLETZ) procedure to a depth of 8mm. F/U cytology at 6 months.

39
Q

If after colposcopy, a woman is deemed to have CIN1, how should they be managed?

A

Decide on Rx Vs no Rx.
If no treatment: cytology at 12 months +/- colposcopy
If treatment: cytology at 6 months +/- HPV test +/- colposcopy

40
Q

Which HPV strains carry a high risk of genital warts?

A

HPV 6 and 11

41
Q

Which HPV strains carry a high risk of cervical cancer?

A

HPV 16 and 18

42
Q

Who is eligible for the Gardasil vaccine?

A

Girls aged 12 or 13 and MSM up to age of 45

43
Q

What are some risk factors for endometrial cancer (the most common gynaecological cancer)?

A

Endogenous oestrogen excess: PCOS (unopposed oestrogen and obesity), oestrogen secreting tumour, nulliparity (no oestrogen free period), early menarche, late menopause
Exogenous oestrogen excess: HRT unopposed by progesterone, tamoxifen
Others: Obesity, DM, Lynch type II syndrome, Family history

44
Q

A thickened endometrium of how many millimetres or more on TV USS should make you suspicious of endometrial cancer and provoke you to carry out a hysteroscopy +/- biopsy?

A

4+ mm

45
Q

What level of serum CA-125 should provoke you to request abdominal and pelvic USS for possible ovarian cancer?

A

Serum CA-125 > 35 IU/ml

46
Q

What tumour marker is useful to help detect and monitor ovarian cancer?

A

CA-125

Gynaecology, Obstetrics and Sexual Health (6 decks)

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