Gynaecology

Question 1

Disorders of sex development (DSD):

Answer 1

Was established to describe congenital conditions with atypical development of chromosomal, gonadal or anatomic sex.

Question 2

Delayed puberty (in girls)

Answer 2

Is usually diagnosed if there is no breast tissue by the age of 13 and subsequently no onset of menstruation by 15-16 years of age.

Question 3

The timing of puberty is highly genetic but can be delayed due to:

Answer 3

Very low levels of body fat (athletes, malnourished, eating disorders)

May also occur with hypogonadism

• Ovaries are damaged/not developing correctly
• Problem with parts of the brain involved with puberty

Question 4

Medical conditions/treatments that can lead to hypogonadism

Answer 4

Conditions:
- Hypothyroidism
- Diabetes Mellitus
- Cystic fibrosis
Treatments:
- Chemotherapy
- Radiotherapy

Question 5

Beside the psychosocial impact of delayed puberty, another risk is:

Answer 5

Inadequate skeletal growth and mineralisation

Question 6

Treatment for delayed puberty depends on the cause, but the goal is:

Answer 6

Development of secondary sex characteristics and fertility

Bone growth and mineralisation

Question 7

Precocious puberty:

Answer 7

Starting puberty before what is considered as normal.

Question 8

Early onset puberty can cause initial growth spurt to cause tall stature, however:

Answer 8

Rapid bone maturation can cause linear growth spurt to cease too early, resulting in short adult stature.

Question 9

Central or complete/true precocious puberty:

Answer 9

If the cause can be traced to the hypothalamus or pituitary gland.

Question 10

Causes can include:

Answer 10

Damage to inhibitory mechanisms of the brain

Brain tumours

Question 11

Secondary sex characteristics can be induced by exogenous sex steroids, this is referred to as:

Answer 11

Peripheral/pseudo precocious puberty.

Question 12

Polycystic Ovarian Disease (PCOS)

Answer 12

Is a hormonal disorder common among women of reproductive age.

Women with PCOS may have infrequent or prolonged menstrual periods or excess male hormone (androgen) levels.

The exact cause is unknown.

Early diagnosis and treatment along with weight loss may reduce the risk of long-term complications such as T2DM and heart disease.

Question 13

Signs and symptoms of PCOS

Answer 13

Vary, and a diagnosis is made if two of the following signs are present:

1. Irregular periods. Infrequent, irregular or prolonged menstrual cycles.
2. Excess androgen. Elevated levels of male hormone may result in physical signs like male-pattern baldness, excess body/facial hair, severe acne.
3. Polycystic ovaries. Enlarged, containing follicles that surround the ovaries and turn into multiple cysts and fail to release eggs.

Question 14

Although the exact cause is unknown, some causes may be:

Answer 14

• Excess insulin might increase androgen production, causing difficulty with ovulation.
• Low grade inflammation
  (Research has shown women with PCOS have low-grade inflammation that stimulates polycystic ovaries to produce androgens. Can lead to heart and blood vessel problems.
• Hereditary
• Excess androgens

Question 15

Complications:

Answer 15

Infertility
Gestational diabetes
Miscarriage or premature birth
Metabolic syndrome
T2DM
Sleep apnoea
Depression/anxiety
Endometrial cancer
Abnormal uterine bleeding

Question 16

Endometrial/uterine polyps

Answer 16

Growths attached to the inner wall of the uterus that extend into the uterine cavity or overgrowth of cells in the lining of the endometrium.

Not usually cancerous although can be

Most common in post-menopausal women.

S&S = irregular menstrual bleeding.

Question 17

Endometriosis:

Answer 17

A disease of reproductive aged women characterised by the presence of endometrial tissue outside the uterine cavity and commonly associated with pelvic pain and infertility.

Question 18

Aetiology:

Answer 18

No definitive aetiology but several hypothesis regarding how endometriotic lesions occur.

1 being retrograde menstruation, however, this is more common can endometriosis so other factors may determine is. (hormonal, inflammatory and immunologic)

Question 19

Presentation:

Answer 19

Varies between women and can result in inter-menstrual bleeding, painful periods, painful intercourse, painful defecation and painful urination.

Question 20

Diagnosis:

Answer 20

Only possible with laparoscopy

Question 21

Management:

Answer 21

Primary:
Surgically remove lesions
NSAIDS
Low-dose oral contraceptive

Secondary: (if primary doesn’t work within 3 months)
GnRH or androgens to reduce pain from severe to moderate

Question 22

Endometritis:

Answer 22

An acute inflammation of the uterine lining that is normally due to an infection as a result of a PID, STI’s, retained products.

If untreated, can lead to infertility.

Question 23

Signs and symptoms:

Answer 23

Fever
Purulent vaginal discharge
Lower abdominal pain

treated with antibiotics

Question 24

Cervical cancer:

Answer 24

Growth of abnormal cells in the lining of the cervix, most commonly squamous cell carcinoma (80%)

73% 5 year survival rate

Question 25

Most common signs:

Answer 25

Heavier menstrual bleeding
Bleeding between periods
Excessive tiredness
Unusual vaginal discharge
Leg pain, swelling, low back pain

Question 26

Causes:

Answer 26

Almost all cases are caused by persistent infection with some high risk types of Human Papilloma Virus (HPV) (biggest risk factor whereby 8/10 women will become infected with at some time in their lives.)

Question 27

Vaginal cancer:

Answer 27

Cancer that starts in the vagina and should not be confused with cancer that spreads to the vagina.

One of the rarest forms of cancer affecting female reproductive system.

Question 28

Signs:

Answer 28

Align with cervical cancer signs but may include a lump in the vagina.

Question 29

Risk factors:

Answer 29

A precancerous condition known as ‘vaginal intraepithelial neoplasia (VIN) that often has no symptoms.

HPV

STI’s can lead to development of VIN

Tobacco smoking doubles risk of vaginal cancer.

Question 30

Vulvar cancer:

Answer 30

External female genitals, most commonly the labia minora, majora and perineum.

Question 31

Symptoms:

Answer 31

Itching, burning, soreness of vulva.

Lump, swelling or wart-like growth

Thickened, raised skin patches

Question 32

Risk factors:

Answer 32

VIN and HPV
HIV
Organ transplant

Treated with surgery then radiation

Question 33

Uterine/endometrial cancer:

Answer 33

Endometrial cancers begin in the lining of the uterus and account for 75% of all cases.

Uterine sarcoma’s development in the myometrium and is rarer.

Most common gynaecological cancer in Australia

Question 34

Risk factors:

Answer 34

Postmenopausal 
Endometrial hyperplasia
Never having children
Family Hx
Taking tamoxifen to treat breast cancer

Question 35

Most common treatment:

Answer 35

Hysterectomy, chemotherapy and radiation

Question 36

Urinary tract infection (UTI)

Answer 36

Usually caused by bacteria and affects part of the urinary system (kidneys, bladder, ureters and the urethra)

Treatment includes antibiotics.

Question 37

Utero vaginal prolapse

Answer 37

Lump the size of a small egg protruding from vagina.

Question 38

Management of prolapse:

Answer 38

Depends on the degree, however, topical oestrogen cream can decrease discomfort

Some patients can use a ring pessary