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Obstetrics and Gynaecology > Gynaecology > Flashcards

Gynaecology Flashcards

1
Q

What is the definition of a fibroid

A

benign tumour of the myometrium - also called leiomyoma

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2
Q

State three symptoms and signs of a fibroid

A

symptoms:
• pain inbetween periods
• pain during sex
• heavy periods

Signs:
anaemia, infertility, Menorrhagia, miscarriage

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3
Q

Name the gold standard investigation for fibroids

A

transvaginal USS

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4
Q

Name three investigations for fibroids

A

transvaginal USS
FBC for anaemia
hysteroscopy

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5
Q

name one hormonal, non hormonal and one surgical intervention for fibroids

A

Non hormonal
•Discuss analgesia e.g. paracetamol and ibuprofen
•Tranexamic acid – antifibrinolytics, inhibits tissue plasminogen activator
•reassurance

Hormonal
•Combined hormonal contraceptive
•Cyclical oral progestogens
•Ulipristal acetate – progesterone receptor modulator with a partial progesterone antagonist effect – risk of rare but serious liver injury 
•Intrauterine system (IUS)

Surgical
•hysterectomy
•Laparoscopic/open/hysteroscopic Myomectomy - first line
•Uterine artery embolization

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6
Q

What are the signs and symptoms of an ovarian cyst?

A

swollen abdomen with or without pelvic mass

pelvic pain, nausea, bloating, compression symptoms from other organs e.g. bladder, UTIs

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7
Q

Investigations for ovarian cyst

A 
bimanual examination 
transvaginal USS
pregnancy test
CA 125
FBC
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8
Q

management of ovarian cyst

A

Small (<5cm) - leave alone

Medium to large (5-10cm) - cystectomy to preserve fertility

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9
Q

Definition of ovarian torsion

A

twisting of the ovary and or fallopian tube cutting off the blood supply

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10
Q

signs and symptoms of ovarian torsion

A
  • Sharp unilateral waxing and waning pelvic pain following sex/strenuous exercise
  • Tender abdomen
  • Severe may cause syncope
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11
Q

investigations of ovarian torsion

A

transvaginal/transabdominal ultrasound

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12
Q

treatment of ovarian torsion

A

ABCDE!

salpingo-oophrectomy/ or detorsion

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13
Q

Define lichen sclerosis

A

inflammatory skin condition of the anogenital area

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14
Q

signs and symptoms of lichen sclerosis

A
  • Chronic pruritus
  • Pain
  • Dyspareunia
  • Red inflamed skin with atrophic white shiny patches
  • Bruises, ulcers or blood blisters can develop after scratching or from minimal friction
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15
Q

diagnosis of lichen sclerosis

A

clinical diagnosis + swabs

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16
Q

treatment of lichen sclerosis

A

Topical corticosteroids e.g. clobetasone or diprosone and referral to secondary care
• Avoiding perfumed sprays, creams or lotions
• Clean with only water or emollient soap

17
Q

complications of lichen sclerosis

A

vulval cancer

18
Q

Definition of endometriosis

A

Endometrium type tissue growing outside of the uterus, inducing a chronic inflammatory reaction. on ovaries called a chocolate cyst

19
Q

signs and symptoms of endometriosis

A
  • Pain: cyclic, dysmenorrhoea, dyspareunia
  • Infertility – possibly from adhesions and inflammation which alter the anatomy of the pelvis
  • Chronic condition
  • High risk of recurrence
20
Q

investigations for endometriosis

A 
•	Laparoscopy and biopsy (gold standard) 
•	FBC
•	TVS            
•	Endometrial biopsy if >45yrs and:
o	IMB
o	Unresponsive to treatment
•	Place of hysteroscopy
o	Unresponsive to treatment
o	Abnormal scan
o	Assess suitability for OP ablation
21
Q

treatment and management of endometriosis

A

Non hormonal
• Reassurance
• Tranexamic acid – antifibrinolytics, inhibits tissue plasminogen activator
• Mefenamic acid – NSAIDs, Inhibits cyclooxygenase & block PGE2 receptors
• Also consider ibuprofen or naproxen or paracetamol if unable to take NSAIDS
Hormonal – if does not want to conceive
• Progestogens - Least effective if used in the luteal phase, Must be used from day 5 – 25, Best for anovulatory and chaotic bleeding
• Danazol – inhibits sex steroid production, blocks receptors, s/e: acne, deep voice, excess hair growth – consider HRT for women taking this long term
• Combined oral contraceptive pill – inhibits ovarian function, high patient satisfaction rate
• LNG IUS (Mirena) – local release of levonorgestrel
Surgical
• Endometrial ablations
• Excision
• Oophorectomy
• Pelvic clearance

22
Q

definition of adenomyosis

A

Ectopic endometrial tissue within the myometrium

23
Q

signs and symptoms of adenomyosis

A
  • Cyclic pain: Dysmenorrhoea + Dyspareunia
  • Heavy painful periods
  • Pre-menstrual pelvic pain and feelings of heaviness/discomfort in the pelvis
  • Pain relating to bowel movements
  • ‘boggy’ uterus
24
Q

definition of menopause

A

cessation of menstruation

25
Q

definition of perimenopause

A

irregular periods and symptoms leading up to the menopause

26
Q

definition of premature ovarian insufficiency

A

menopause less than 40

27
Q

clinical features of the menopause

A 
SHORT TERM
Vasomotor symptoms
•	experienced by 60-80% women
•	last on average 2-7 years
•	Impact on sleep, mood and QoL
Generalise symptoms
•	mood change/irritability
•	loss of memory/concentration
•	headaches, dry and itchy skin, joint pains
•	loss of confidence, lack of energy
MEDIUM TERM
Urogenital atrophy
•	Dyspareunia
•	Recurrent UTIs
•	PMB
•	Peak incidence of urinary incontinence and prolapse in 55-65 year olds

LONG TERM
Osteoporosis
• Menopause well established as a significant risk factor
• Effects reliably reversible with oestrogens
Cardiovascular disease
• Adverse changes in lipid
• Increased prevalence with early menopause
Dementia
Increased prevalence with early menopause
Risk reduction strategies should start at the time of the
menopause

28
Q

diagnosis of the menopause

A

• Diagnose the following without laboratory tests in otherwise healthy women aged over 45 years with menopausal symptoms:
o Perimenopause — if the woman has vasomotor symptoms and irregular periods.
o Menopause — if the women has not had a period for at least 12 months.
o Menopause — based on symptoms in women without a uterus.
• Consider using the follicle stimulating hormone (FSH) blood test to diagnose menopause

29
Q

diagnosis of premature ovarian insufficiency

A

Diagnosis FSH >25IU/l – 2 samples >4 weeks apart + 4 months of amenorrhoea. Consider anti-mullerian hormone testing If there is doubt

30
Q

management of menopause

A 
•	Holistic approach
•	Lifestyle advice
•	Reduce modifiable risk factors
•	Inform about options
-Hormonal eg HRT, vaginal estrogens
-Non Hormonal  eg clonidine
-Non pharmaceutical eg CBT

hormonal
progesterone, mirena, estradiol cream

non-hormonal
• Alpha adrenergic receptor agonist - Clonidine
• SSRI: Fluoxetine, Paroxetine, Citalopram, Sertraline
• SSRI-SNRI - Venlafaxine
• Anti-epileptics - Gabapentin

31
Q

risks of HRT

A

VTE, breast cancer, stroke

32
Q

Definition of polycystic ovaries

A

Transvaginal USS appearance of multiple (12 or more) small (2-8mm) follicles in an enlarged (>10mL volume) ovary

33
Q

Which criteria is used in the diagnosis of polycystic ovaries, and state the components

A

Rotterdam criteria

1) PCO on USS (12 or more follicles or ovarian volume >10mL on USS)
2) oligo-ovulation and/or anovulation
3) -clinical and/or biochemical signs of hyperandrogenism
- acne or hirsutism
- raised serum testosterone

34
Q

Investigations for polycystic ovaries

A

transvaginal USS

  • FSH = normal
  • raised LH
  • raised LH:FSH ratio (about 3:1)
  • serum testosterone raised
35
Q

Treatment and management of polycystic ovaries

A

Conservative Mx VERY IMPORTANT
• Maintain normal weight/ LOSE WEIGHT
• Exercise & Diet advice
• Smoking cessation

Improving Menstrual Regularity
• COCP (also treats hirsutism)
• Metformin (improves ovulation rates too)
-Insulin-sensitising agent, also reduces androgen levels
-No impact on hirsutism

Controlling Symptoms
(Anti-androgens – do not give during conception or pregnancy)
• Cyproterone acetate - Can be combined with COCP
• Spironolactone
• Vaniqa (Eflornithine) facial cream

Subfertility
Weight loss alone may be enough to achieve spontaneous ovulation

Ovulation Induction
• Antioestrogens (Clomid – clomifene citrate)
-Taken orally, safe, inexpensive
-Can develop CC resistance
• Gonadotrophins (FSH/LH/pulsatile GnRH analogues)
-Incr. risk of multiple pregnancy & OHSS
• Laparoscopic ovarian diathermy
-Recommended by NICE for those not responding to Clomid
• IVF & ART

36
Q

Definition of pelvic inflammatory disease

A

inflammation of the upper genital tract

37
Q

Clinical features of pelvic inflammatory disease

A
  • Can begin with a acute infection that resolves completely or develop into a chronic course with recurrent episodes
  • May be asymptomatic
  • Pelvic pain (usually bilateral)
  • Deep dyspareunia
  • Vaginal discharge
  • Dysmenorrhoea/Oligomenorrhoea
  • IMB/PCB
  • Fever
  • Tachycardia, Fever
  • Abdominal tenderness, Bilateral adnexal tenderness, Cervical excitation
38
Q

Diagnosis of pelvic inflammatory disease

A
  • History (including sexual Hx) + Examination
  • FBC (WCC/CRP), consider Blood Cultures
  • Triple swabs screen for STIs
  • Urine Pregnancy Test – exclude EP
  • Pelvic/TVUSS – exclude ovarian tube abscess/ ovarian cyst accident
  • Laparoscopy – gold standard, only when Dx uncertain
39
Q

Treatment/management of pelvic inflammatory disease

A
  • IM Ceftriaxone 500mg stat +
  • PO Doxycycline 100mg bd 14d +
  • PO Metronidazole

Obstetrics and Gynaecology (4 decks)

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