Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Specialties > Gynaecology > Flashcards

Gynaecology Flashcards

1
Q

what is used to treat dysmenorrhoea

A

NSAID - Mefenamic Acid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What medical management treat Menorrhagia

A 
Mirena Coil (IUS) 
Antifibrinolytics - Tranexamic Acid 
NSAIDS - Mefenamic Acid 
COCP
Progestogens - Norethisterone 
Gonadothrophins
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What surgical management can treat Menorrhagia

A

Endometrial Ablation
Uterine Artery Embolisation
Hysterectomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What can cause Primary Amenorrhoea

A

Turners Syndrome
Androgen Insensitivity Syndrome (make sure to examine external genitalia
Absent Uterus and Vaginal Agenesis
Malnutrition

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

When should you investigate Primary Amenorrhoea

A

at 14 with no breast development, or at 16

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What causes Secondary Amenorrhoea

A

Ovarian Failure-Surgery, Radiotherapy, Chemotherapy and X chromsome disorders
Hypothalamic-Pituitary-Ovarian Axis Malfunction - Exercise, Stress and Weight Loss
Hyperprolactaemia- Hypothyroidism, renal/liver failure, drugs, pituitary tumours
Ovarian Caurses- PCOS and Ovarian Tumours
Uterine Causes - Pregnancy and Ashermans Syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Treatment for Amenorrhoea

A

Manage cause - eg hypothyroidism, tumours, PCOS etc.
Ovarian failure - no treatment give HRT
Manage Lifestyle for axis dysfunction - gain weight, reduce exercise and reduce stress
Clomifene can encourage ovulation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

COCP components

A

Ethinylestradiol + Norethisterone or Levonorgestrel

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What gene mutation can increase risk of fibroids

A

Fumarate Hydratase (can also cause benign smooth muscle tumours of the skin and increase risk of renal cancer)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is a fibroid

A

It is a benign smooth muscle tumour

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are the 4 types of Fibroids

A

Subserosal
Submucosal
Pedunculated
Intramural

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is a subserosal fibroid

A

A fibroid in the uterine wall bulging out under the visceral peritonium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is a submucosal fibroid

A

A fibroid under the endometrium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is an intramural fibroid

A

A fibroid in the muscular wall of the uterus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is a pedunculated fibroid

A

A fibroid attached to the uterine wall by a peduncle

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are fibroids associated with

A

FH
increasing age
Afro-Caribbean
Gene mutation - Fumarate Hydratase

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What are fibroids dependent on

A

Oestrogen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What causes fibroids to increase in size

A

Pregnancy or COCP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What causes fibroids to atrophy

A

Menopause

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What are the symptoms of fibroids

A 
asymptomatic
menorrhagia and anaemia
pain
Abdominal mass if large 
Fertility problems
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What investigations are used for fibroids

A

US or Hysterscopy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Treatment of fibroids

A

No treatment if asymptomatic
If causing menorrhagia but no other symptoms - IUS
GnRH or Ullipristal Acetate can be used to shrink fibroids prior to surgery but not long term use
Myomectomy - to remove fibroids
uterine artery embolisation
Hysterectomy - only if women has finished family

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What can be used to medically shrink fibroids before surgery

A

GnRH or Ullipristal Acetate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What is red degeneration

A

(most common in pregnancy) When a fibroid outgrows its blood supply, or torsion of fibroid and its blood supply - leads to thrombosis of vessels and venous engorgement and inflammation:
Symptoms: Abdominal pain, vomiting, low grade fever
US aids diagnosis
treatment: expectant (bed rest and analgesia) relsolves 4-7 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What is an ovarian cyst

A

A fluid filled sac on or in the ovary

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What are the two broad groups of ovarian cysts

A

Functional Cysts or Neoplastic Cysts

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What are the types of Functional cysts

A

Caused by disruption to normal cyclic activity

there are follicular cysts or luteal cysts (Associated with PCOS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What are the types of Neoplastic cysts

A

Mature cystic Teratomas
Endometriomas
Malignant ovarian tumours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What are the symptoms of Ovarian cysts

A

Most are asymptomatic
But if they are they cause: dull, aching pain, dyspareunia and feeling of pressure, (pain may be cyclical if . endometrioma)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What are the 3 complications of ovarian cysts

A

Haemorrhage/Bleeding
Torsion
Rupture

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

What symptoms do you get with ovarian cyst complications

A

3s’s: Severe, Sudden, Sharp pain
In Torsion: pain, vomiting and low grade fever
In Rupture: Signs of shock: high HR, low BP and haemoperitonium (causes shoulder pain)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

What investigations would you do for someone with ovarian cysts

A

TVS or AUS if indefinite do a MRI
Screen for CA125
Gold standard for type of cyst is US guided biopsy/aspiration or histological analysis on removal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

What is the treatment of cysts in pre-menopausal women

A

Try and preserve womens fertility wherever possible
If cyst under <5cm, non malignant or asymptomatic- Observe and don’t surgically treat
If cyst over 5cm, malignant or symptomatic perform laparoscopic ovarian cystectomy or oopherectomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

What is the treatment of cysts in post-menopausal women

A

Calcualate risk of malignancy index - CA125, menopause status and US findings
Low risk, under <5cm can be managed with observation and CA125
High risk of malignancy, >5cm or causing complications - bilateral laproscopic oopherectomy and staging

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

What is the treatment of ruptured cysts

A 
Uncomplicated Rupture (clinically stable): expectant management and NSAIDS
Complicated Rupture: cyst that is haemorraging severely - give IV fluids or blood transfusion (treat symptoms of shock) surgery may be needed to remove cyst or ovary and stop bleeding
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

What is the treatment of torsion

A

Laproscopic surgery may be needed since lack of blood flow can damage ovaries

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

What is an ectopic pregnancy and where is most common?

A

A fertilised ovum outside the uterine cavity and is most common in the ampulla of the fallopian tube

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

What are the predisposing factors of Ectopic Pregancy?

A 
Damage to fallopian tubes (PID and prev. surgery)
Previous ectopic
endometriosis
Smoking
POP or IUCD
IVF or subfertility 
Tube Ligation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

What are the symptoms of ectopic

A 
Bleeding
Nausea/Vomiting +/- Diarrhoea 
Abdominal Pain - can be non specific L abdo pain but classically unilateral 
Fainting/ Dizziness
Amemorrhoea for 6- 8 weeks 
Shoulder pain - from haemoperitoneum
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

What are the signs on bilateral vaginal examination for Ectopic Pregnancy

A 
Adnexal Tenderness (DONT palpate for adnexal mass could cause rupture)
Cervical motion tenderness/ Excitation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

What signs my you find on examination on ovarian cysts

A

May be normal if cyst small or woman obese

Acute presentation e.g rupture: pelvic mass, tenderness, peritonsim, bleeding cervival excitation and adnexal tenderness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

What are the investigations for ectopic pregnancy

A 
TVS for location of ectopic pregnancy 
Progesterone levels (lower in ectopic)
hCG leveles (lower in ectopic as rise more slowly)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

What are the three types of management for an ectopic pregnancy

A

Expectant/Observant
Medical Management
Surgical Management

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

What is the criteria for expectant/observant management of ectopic pregnancy

A

asymptomatic/ very mild symptoms

clinically stable

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

What is done in expectant/observant management ectopic pregnancy

A

Watch hCG levels fall. If they fall at an unacceptable rate precede to active intervention

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

What is the criteria for first line medical management ectopic pregnancy

A

hCG < 1500 (if hCG <5000 can choose surgical or medical intervention as long as all other criteria is met)
no significant pain
adnexal mass <3.5cm and no fetal heart beat
No intrauterine pregnancy on scan

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

What is medical management of ectopic pregnancy

A

One dose Methotrexate (observe on day 4 and 7 if hCG has fallen by <15% give second dose)
REMEMBER: ensure they are on reliable contraception for 3 months after as its teratogenic
Analgesia can help with the pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

What is the criteria for surgical intervention

A

hCG >5000 (if hCG under <5000 but all criteria met below precede to surgical management not medical)
significant pain
adnexal mass >3.5cm and a fetal heart beat
No intrauterine pregnancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

What is surgical management of ectopic pregnancy

A

Salpingectomy if other fallopian tube is healthy

Salpingostomy if other fallopian tube is unhealthy to preserve fertility

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

What is the definition of endometriosis

A

Endometrial tissue present outside the uterus hormonally driven by oestrogen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

What is the commonest location of endometriosis

A

Endometrioma (chocolate cyst)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

What is the cause of endometriosis

A

Unknown: But 3 theories:

  1. Retrograde menstruation causes adhesions, growth and invasion
  2. Metaplasia of Mesothelial tissue e.g nose and lungs
  3. Immunity impairment: retrograde endometrial cells fail to be destroyed by immune response
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

What are the symptoms of endometriosis

A 
Some people may be asymptomatic 
Cyclical 
Constant chronic pain from adhesions causing chronic inflammation
Dysmennorhoea 
Deep Dyspareunia ( due to involvement of uterosacral ligaments)
Dysuria 
Dyschezia 
Sub-fertility
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

What would you find on examination of endometriosis

A

May be no findings
Speculum: may reveal cervical and vaginal lesions
Bimanual examination: Fixed Retroverted uterus, Adrenal masses or tenderness and tender nodules over Uterosacral ligaments

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

What investigations would you carry out for endometriosis

A

TVS may show endometrioma but little else
MRI is useful for bowel involvement
CA125 may be raised
Gold Standard is Laparoscopy for biopsy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

What is the treatment for endometriosis

A 
Medical Management
Pain relief: NSAIDs e.g. Mefenamic Acid
1st line: COCP or Mirena (IUS)
2nd Line: Progestogen e.g Norethisterone
3rd line: GnRH analogues with HRT therapy 
Surgical Intervention:
Laproscopy using ablation and excision to destroy endometriosis
Hysterectomy last resort
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

What cancers predominantly lead to vaginal cancer

A 
Primary Vaginal cancer is rare
Most commonly due to metatastic spread from:
Vulva
Uterus 
Cervix
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

What cells does primary vaginal cancer most commonly originate from and what location?

A

Vaginal cancer is most commonly squamous and most commonly found in the upper 1/3 of the vagina

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

What is the most common symptom of vaginal cancer

A

Bleeding

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

What are the associations with vaginal cancer

A

older women
Previous CIN (cervical intraepithelial neoplasia)
Previous Radiotherapy
Long term vaginal inflammation from pessaries and uterine prolapse
HPV related

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

What is the treatment and prognosis of vaginal cancer

A

Radiotherapy and prognosis is generally poor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

What should be done for patients presenting with unexplained vulva lumps

A

They should be referred immediately

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

What cell type does vulva cancer originate from

A

90% squamous

Other types: Melanoma, Basal Cell and Bartholins Cyst Carcinoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

What is the most common symptom of vulva cancer

A

Persistent Lump or non healing lesion
Vulval itching and soreness
Bleeding
Pain on passing urine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

What is VIN

A

Vulva Intraepithelial Neoplasia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

How does VIN present

A

White patches surrounded areas of inflammation which may be itchy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

What should be done for VIN

A

Surveillance and Biopsy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

What is the most common cause of VIN

A

HPV

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

What is the treatment for vulva cancer

A

Surgery - radial/conservative (partial/total vulvectomy)
Chemotherapy
Radiotherapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
70
Q

What is CIN

A

Cervical Intraepithelial Neoplasia - The pre invasive phase of cervical cancer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
71
Q

Where does CIN occur and what cell type does it most commonly occur to

A

the basal layer of the transformation zone

the immature squamous epithelium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
72
Q

What are the stage of CIN

A

CIN1- neoplasia of lower 1/3 of basal layer thickness
CIN2- neoplasia of < lower 2/3 of basal layer thickness
CIN3- neoplasia of > lower 2/3 of basal layer thickness
Carcinoma in Situ - full thickness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
73
Q

What is the expectations of CIN1

A

Most will regress (60%) to normal within 2yrs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
74
Q

What are the expectations of CIN2, 3 and Carcinoma in situ

A

Less likely to regress - a significant amount will develop into invasive squamous carcinoma of the cervix

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
75
Q

What HPV types are associated with CIN

A

16, 18, 31 and 33 main ones (15 all together known)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
76
Q

What is the screening criteria for cervical cancer

A

Sexually active women aged 25-64
3 yrs for women aged 25-50
5yrs for women over 50-64

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
77
Q

What is the process for screening for cervical cancer

A

Cervical Smear - cells looked under microscope for dyskaryosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
78
Q

What is the process for women with borderline/mild cervical dyskaryosis

A

Perform HPV test is +ve send for colposcopy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
79
Q

What is the process for women with moderate/severe cervical dyskaryosis

A

Send straight for colposcopy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
80
Q

Risk factors for CIN

A 
Type of HPV
Early age of intercourse 
Increased number of sexual partners
Not using condoms 
Increased exposure time to HPV
Immunocompromised- HIV, transplant, immunosuppressed
Smoking
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
81
Q

What is an example of primary prevention of CIN

A

HPV Vaccination is primary prevention

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
82
Q

How is CIN investigated using Colposcopy

A
  1. Cervix is examined

2. Transformation zone is painted with acetic acid (5%) neoplastic cells take more up so abnormal areas are highlighted

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
83
Q

How is CIN managed

A

Large Loop Excision of Transformation Zone (LLETZ)

  • CIN1 (low grade) - should regress without treatment offer 6 month colposcopy and LLETZ if persistant
  • > CIN1 (high grade) - spontaneous regression much less likely - excision with LLETZ recommended if high risk HPV after LLETZ - offer 6 monthly smears
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
84
Q

What age groups is Cervical Cancer common in

A

Two peaks of incidence
30-39
>70

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
85
Q

What is the biggest risk factor for cervical cancer

A

HPV - Early age of intercourse, Multiple sexual partners, STDs, smoking, Previous CIN, multiparity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
86
Q

What are the signs and symptoms of cervical cancer

A 
Vaginal bleeding - especially post coital (post menopausal in older women)
Smelly watery discharge 
Dysuria 
Vaginal discomfort
Advanced Disease:
- Constipation
- Ureteric obstruction and haematuria 
- Heavy vaginal bleeding
- Weight Loss
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
87
Q

What would be found on examination of cervical cancer

A

Bimanual Examination: hard and rough cervix
Speculum Examination: irregular mass and bleeding on contact
Colposcopy: high/dense uptake of acetic acid, irregular cervix surface

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
88
Q

Investigations of cervical cancer

A

LLETZ for biopsy is contraindicated as it causes heavy bleeding
FBC, U&Es and LFTs
CT abdomen and pelvis, MRI of pelvis - can help staging
Cystopscopy and Hysteroscopy - EUA can help staging

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
89
Q

What are the stages of cervical cancer

A 
Stage 1a: Confined to cervix (microscopic)
Stage 1b: Confined to cervix (macroscopic)
Stage 2a: Spread to upper 2/3 of vagina
Stage 2b: Spread to parametria 
Stage 3a: Spread to lower 1/3 of vagina 
Stage 3b: Spread to pelvic wall
Stage 4a: Spread to bladder and bowel
Stage 4b: Spread to distant organs
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
90
Q

How is cervical cancer treated

A

Stage 1:
Radial Trachylectomy (can lead to incompetent cervix)
Hysterectomy (wider excision margins)

Stage 2+

  • Radiotherapy
  • Chemotherapy
  • Palliative Care
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
91
Q

What are the complications of treatment for radical hysterectomy and lymphadenectomy

A

Radical Hysterectomy: bleeding, infection, VTE, bladder injury
Radiotherapy: acute bladder and bowel dysfunction, vaginal stenosis, shortening and dryness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
92
Q

What is the most common histological type of endometrial cancer

A

Adenocarcinoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
93
Q

What is the cause of endometrial cancer

A

Related to the exposure to oestrogen unopposed by progesterone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
94
Q

What age group does endometrial cancer most commonly occur in

A

postmenopausal women

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
95
Q

What are the most common signs/symptoms of endometrial cancer

A

POSTMENOPAUSAL BLEEDING
Vaginal watery discharge or pyometra
Before menopause: intermenstrual bleeding or heavier menstrual bleeding
Less common: Abdo pain, dyspareunia
Late disease: Back pain, tiredness, loss of appetite, weight loss

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
96
Q

What are the risk factors for endometrial cancer

A 
HTN, obesity and T2DM
Early menarche
Late Menopause
Nulliparity 
Oestrogen only HRT
PCOS
Breast Cancer
Genetic Predisposition (Lynch 2 syndrome)
Tamoxifen
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
97
Q

What are protective factors of endometrial cancer

A

COCP

Parity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
98
Q

What investigations are used in endometrial cancer

A

Examination may be normal in early disease
TVS - endometrial thickness >4mm
Hysteroscopy - biopsy - staging/histology and diagnosis
CT/MRI - help per-op staging

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
99
Q

What are the stages for endometrial cancer

A
  1. in body of uterus
  2. in body of cervix
  3. extending out of uterus but not beyond pelvis
  4. extending beyond pelvis e.g bladder and bowel
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
100
Q

What is the treatment for endometrial cancer?

A

Depends on stage and function of patient

  1. early stage - total hysterectomy with salpingo-oopherectomy (open or laproscopic) +/- Removal of lymph nodes +/- adjuvant radiotherapy
  2. advanced stage - radiotherapy to control bleeding and high dose progesterone can help with palliation of symptoms
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
101
Q

What is the commonest origin of ovarian cancer

A

epithelial

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
102
Q

Why does ovarian cancer present late

A

vague symptoms and insidious outset

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
103
Q

What is the cause of ovarian cancer

A

evidence shows fallopian tubes play a role in development

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
104
Q

What are the most common risk factors of ovarian cancer

A

nulliparity
early menarche
late menopause
genetic predisposition e.g lynch 2 syndrome and BRACA 1 & 2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
105
Q

What is protective for ovarian cancer

A

COCP
parity and breastfeeding
tube ligation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
106
Q

What can ovarian cancer be mistaken as due to similar symptoms

A

IBS or diverticular disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
107
Q

What are the symptoms of ovarian cancer

A 
Bloating
unexplained weight loss, loss of appetite and early satiety 
Change in bowel habit 
Change in urinary symptoms e.g frequency/urgency
Abdominal pain 
Palpable pelvic mass 
Vaginal pain
fatigue
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
108
Q

What may be found on examination in ovarian cancer

A

Fixed abdo/pelvic mass
Ascites
Pleural effusion
Supra-clavicular lymph node enlargement

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
109
Q

What in investigations may be performed for supsected ovarian cancer

A 
FBC, U&amp;Es and LFTs
Tumour Markers - CA125
CXR - pleural effusion, lung metastises 
TVS
MRI/CT - for staging and metastises eg liver 
Ascites or pleural fluid sampling
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
110
Q

What are the treatments for ovarian cancer

A

Full stage laparotomy - hysterectomy, bilateral salpingo-oopherectomy, omentectomy, para-aortic and pelvic lymphectomy, peritoneal washing
Adjuvant Chemotherapy recommended after surgery in all other than low grade stage 1 disease
Advanced disease: chemotherapy can be used for palliative treatment of symptoms
*young women try and spare fertility in early disease e.g saving the other ovary

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
111
Q

What are the two most common types of thrush and which is more difficult to treat

A

Candida Albicans 95%

Candida Glabrata 5% - more difficult to treat

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
112
Q

What is the typical presentation of thrush

A

Vulva and Vagina - redness, itchiness, soreness and fissures
Disharge - non offensive and resembles white curds like cottage cheese

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
113
Q

What are the risk factors for candida

A 
Diabetes
Pregnancy`
Abx
Steroids
Immunodefficiency 
Contraception
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
114
Q

What is the diagnosis of candida

A

MC&S - mycelia and spores

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
115
Q

What is the treatment for candida

A 
Topical treatment - clotrimazole 
Oral treatment - fluconazole 
Resistant C. Glabrata - imidazole 
Pregnant tropical treatment only 
Recurrent infection maintenance dose of treatment
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
116
Q

What sort of disease is lichen sclerosis

A

Autoimmune

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
117
Q

What occurs in lichen sclerosis

A

Elastic tissue turns to collagen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
118
Q

What are the symptoms of lichen sclerosis

A

Pruritis
Soreness
Fissures
Bruised red purpuric signs e.g blood filled blisters, ulcers bruises
Eventually the vulva will turn white, flat and shiny as well as atrophy
May see typical hourglass shape around vagina and anius

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
119
Q

What is a major risk for lichen sclerosis patients

A

may be premalignant leading to Vulva cancer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
120
Q

What is the treatment for lichen scelerosis

A

Topical steroids Clobetasol Propionate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
121
Q

What does trichomonas vaginalis present with

A

Yellow/green frothy and thin fishy smelling discharge
Vaginitis - swelling, soreness, redness of vagina and surrounding area
Strawberry Cervix
Dysuria ans Dyspareunia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
122
Q

How is trichomaniasis diagnosed

A

Wet films - motile pearl shaped, flagellated protozoa

Exclude Gonorrhoea as they often co-exist

123
Q

What is trichomonas vaginalis

A

a parasite

124
Q

What is the treatment for trichomaniasis

A

Metronidazole

Treat partner as well!!!

125
Q

What is bacterial vaginosis caused by

A

an imbalance of bacterial flora and anaerobe overgrowth

126
Q

What are the common symptoms of bacterial vaginosis

A

Thin grey/off white discharge with fishy odour

Vaginitis and pruritus is uncommon (more likely trichomonas)

127
Q

What can bacterial vaginosis increase your risk of

A

preterm labour
intra-amniotic infection
increased HIV susceptibility
Post termination sepsis

128
Q

How do you diagnose bacterial vaginosis

A

mix with 10% potassium hydroxide - whiff of ammonia

Cultures/wet film - clue cells

129
Q

What are clue cells

A

Epithelial cells coated with bacteria - giving stippled appearance

130
Q

What is the treatment for bacterial vaginosis

A

Metronidazole (PV gel or oral) only treat partner if necessary not STI

131
Q

What are common causes of vaginal discharge in children

A

Infection from faecal floral (associated with alkalinity from lack of oestrogen) due to poor hygiene
Staph and Strep infections may cause pus
Exclude foreign bodies by PR and vaginal exam
Exclude sexual abuse
Threadworms may cause pruritus

132
Q

What would you do to examine a child with vaginal discharge

A

PR and vagina exam + vaginal swabs and smears
MSU sample
XR/US for prolonged discharge

133
Q

How would you manage a child with vaginal discharge

A

Offer hygiene advice
Offer Abx if needed e.g erythromycin
Maybe try oestrogen cream

134
Q

What are the symptoms of chlamydia

A

Often asymptomatic
Dysuria and Dyspareunia
Intermenstrual Bleeding or post coital bleeding
Abnormal Vaginal Discharge

135
Q

What has been introduced to reduce the prevalence of chlamydia

A

The National Chlamydia Screening Programme

16-24 yrs yearly screening self administered kit or to those with +ve partners any age

136
Q

What are the complications of chlamydia

A

PID - Ectopic pregnancy and Infertility

Pregnancy - cam cause PROMS and premature labour as well as neonatal conjunctivitis and pneumonia

137
Q

How is Chlamydia diagnosed

A

Vaginal Swab/urine sample - Nucleotide Acid Amplification Test (NAAT)

138
Q

How would you treat Chlamydia

A

Doxycycline or Azithromycin

azythromycin if pregnant

139
Q

What is essential for successful treatment of Chlamydia and Gonorrhoea

A

Treating the partner

And abstaining from intercourse until both partners are treated

140
Q

What is gonorrhoea

A

A gram negative diplococci

141
Q

What is a current problem with gonorrhoea

A

It is becoming increasingly antibiotic resistant

142
Q

What is the presentation of gonorrhoea

A

Dysuria and Dyspareunia
Abdominal Pain
Post coital bleeding or Intermenstrual Bleeding
Abnormal Discharge - may be green/yellow

143
Q

What are the complications of gonorrhoea

A

PID - ectopic pregnancy and infertility
Bartholins Abscess
Disseminated Gonorrhoea

144
Q

What is the presentation of disseminated Gonorrhoea

A

Fever
Migratory Polyathalgia
Pustular Rash
Septic Arthritis

145
Q

How is gonorrhoea diagnosed

A

Vaginal Swab, can also rectal, pharyngeal or urethral swab
Swabs sent for Nucleotide Acid Amplification Testing
If it comes back +ve send for MC&S due to increased Abx resistance - on film will see gram negative stain diplococci

146
Q

What is the treatment of Gonorrhoea

A

Ceftriaxone IM plus Azithromycin PO

147
Q

What are the complications associated with gonorrhoea and pregnancy

A

PROMs
Preterm Delivery
Chorioamniotitis - intra amniotic infection
Baby - ophthalmia neonatorum

148
Q

What is pruritus vulvae and what can cause it

A

Vaginal itch
Causes - Infections, Allergy, Skin Disease, infestations (e.g pubic lice, scabies), obesity
Treat cause

149
Q

What is pelvic inflammatory disease

A

Infection of the upper genital tract

150
Q

What is the most common cause of PID

A

Ascending infections from the endocervix e.g STIs, Uterine instrumentation (hysteroscopy, insertion of IUCD and TOP), Post partum
Descending infections from infected organs (appendicitis)

151
Q

Which STIs contribute the most to PID

A

Main cause Chlamydia

Gonorrhoea

152
Q

What are the risk factors for PID

A

<25, multiple sexual partners, previous STI

153
Q

What is protective for PID

A

COCP and barrier contraception

154
Q

What is the presentation of PID

A 
Abdominal pain - constant or intermittent 
Deep Dyspareunia 
Abnormal Vaginal Discharge 
Post coital or intermenstrual bleeding
Dysmenorrhoea and/or fever
155
Q

What would you find on examination of PID

A

Abnormal vaginal discharge
Cervival excitation/ cervical motion tenderness
Adnexal Tenderness
Fever (afebrile in mild/chronic PID)

156
Q

What investigations do you want to do for someone with PID

A

Vulvovaginal/ Endocervical Swabs
If acutely unwell - FBC, U&Es, CRP and Blood cultures for SEPSIS
TVS - if tubo-ovarian abscess is suspected

157
Q

What are the complications of PID

A

Ectopic Pregnancy and Infertility
Tubo- Ovarian Abscess and Hydrosalpinges - needs draining laparoscopically
Fitz-Hugh-Curtis Syndrome (liver capsule inflammation)

158
Q

What is the treatment for PID

A

Outpatients - if well
IM Ceftriaxone + PO Doxycycline and PO Metronidazole
Inpatients
Same but IV

159
Q

What does chronic PID lead to

A

Fibrosis and Adhesions between Pelvic Organs and tubes may fill with liquid or pus
Similar symptoms to PID but may also have menorrhagia

160
Q

What could be a differential for symptoms similar to PID and how would you differential between the two

A

Endometriosis

Laparoscopy

161
Q

Are Abx helpful in chronic PID

A

No

162
Q

What three things does PCOS comprise of

A

Hyperandrogenism
Oligomenorrhoea
Polycystic ovaries - >12 cysts or ovarian . mass greater than 10cm3

163
Q

What other differentials cause symptoms similar to PCOS

A

Congenital Adrenal Hyperplasia

Cushings

164
Q

Whats causes PCOS

A

unknown but it leads to increased production of androgens by the ovaries including increased oestrogen and testosterone production

165
Q

What is PCOS associated with

A 
Obesity 
HTN
Hyperlipidaemia 
T2DM
Sleep Apnoea 
Insulin resistance leading to hyperinsulinaemia - darkened skin in skin flexures and neck
166
Q

Long term complications of PCOS

A

T2DM and Gestational Diabetes
Endometrial Cancer
Cardiovascular Disease

167
Q

What is the presentation of PCOS

A

Hursuitism
Acne
Oligomenorrhoea
Subfertility

168
Q

How is PCOS diagnosed

A

Rotterdam Criteria: 2 of the 3 following -
1. Oligomenorrhoea/ anovulation
2. Clinical features and blood tests (increased testosterone) showing hyperandrogenism
3. Polycystic ovaries on US - >12 cysts or ovarian mass >10cm3
Rule out other causes of irregular cycles: e.g hypothyroisism, hyperprolactaemia, androgen secreting tumours, congenital adrenal hyperplasia

169
Q

How is PCOS managed

A

Lifestyle changes:
1st line: Weight loss and Exercise

Find and treat associations - HTN, T2DM, Hyperlipidaemia

Don’t want to get pregnant?
: COCP - to help regulate periods and protect against endometrial cancer
Metformin - for T2DM and help fertility

Want to get pregnant?
Clomefene can help with fertility
Metformin
Ovarian Drilling can help fertility if medical interventions do not help
Anti androgens e.g cyproterone to help with facial hair and acne

170
Q

What is a prolapse

A

When the supporting pelvic structures weaken causing the pelvic organs to bulge into the vagina
The weakness may be congenital

171
Q

What are the risks associated with prolapse

A 
Prolonged labour 
trauma from instrumental delivery 
lack of pelvic floor exercises postnatally 
obesity 
constipation 
chronic cough
172
Q

What are the main 4 types of prolapse

A

Cystocele
Enterocele
Rectocele
Uterine Prolapse

173
Q

What is a cystocele prolapse and what symptoms may it present with

A 
The bladder bulging into the anterior wall of the vagina 
May cause:
Increased frequency and urgency 
Urinary retention
Incomplete Bladder emptying
174
Q

What is a rectocele prolapse and what symptoms may it present with

A

The rectum bulging into the posterior wall of the vagina
May cause:
Constipation
Difficulty Defficating

175
Q

What is a enterocele

A

Small bowel bulging into top of the vagina

176
Q

What is a uterine prolapse

A

Uterus bulging down into vagina

177
Q

Why is a 3rd degree uterine prolapse with cystocele a danger to health

A

It can lead to obstruction of the urethra

178
Q

What are the 4 grades of prolapse

A

1st degree - lowest part of prolapse extends to level half way down vagina
2nd degree - lowest part of prolapse extends to level of vaginal introitus
3rd degree - lowest part of prolapse extends through introitus and out of vagina
4th degree - procidentia - uterus lies outside vagina

179
Q

What are the general symptoms of prolapse

A

Discomfort and dragging sensation
Dyspareunia
Back Ache

180
Q

What examination would you perform to confirm prolapse

A

May do a bimanual
Speculum Exam! - Woman lies laterally and Sims speculum is used to look at anterior and posterior walls
If no prolapse present ask woman to cough or stand

181
Q

How can you prevent prolpase

A

Pelvic floor exercises, lower parity

182
Q

How can you manage prolapse

A

Conservative - mild - weight loss, pelvic floor exercises/physiotherapy, quitting smoking and stopping straining
Pessaries - women unsuitable/ decline surgery, affects sexual function, needs changing every 6months, post menopausal women give oestrogen cream to prevent vaginal erosion
Surgery - Sacrospinous Fixation treatment for prolapse of uterus and vault of vagina

183
Q

What is Female Genital Mutilation/Genital Cutting

A

The partial or total removal of female external genitalia for no medical reason, it is a form of child abuse in the UK

184
Q

What countries are highly associated with FGM

A

Africa, India and Indonesia

185
Q

What are the reasons for FGM

A 
Social and community acceptance 
Family Honour 
Status 
Seen as a woman's right of passage
to preserve virginity 
Respect
186
Q

What are the 4 stages of FGM

A

Stage 1 - cliteroidectomy - partial or total
Stage 2 - Excision of the clitoris and labia minor +/- removal of labia majora
Stage 3 - Infibulation - narrowing of the vaginal orifice by sealing +/- removal of clitoris
Stage 4 - other - any other form of harm, scraping, incising, piercing and pricking

187
Q

What are the acute complications of FGM

A 
Blood loss
Sepsis
Death
Infection - HIV, Hepatitis, Tetanus
Urinary Retention 
Pain
188
Q

What are the long term complications of FGM

A 
emotional trauma
chronic pain
amenorrhoea
anorgasmia
apareunia 
increased risk of C-section
fear of child birth 
Sexual dysfunction 
Subfertility 
UTIs and urinary retention
189
Q

What is the management of FGM

A

Defibulation - favourably preconception but can be done during pregnancy up to 20 weeks or 1st stage labour
If not possible before birth make sure she is in a specialist obstetric unit with a planned labour

190
Q

When should investigations begin for subfertility

A

1 year after trying or eariler if known pathology affecting fertility

191
Q

What are the causes of subfertility

A 
Fibroids
Endometriosis 
Age (greater/or equal to 35)
PID and STIs
previous surgery 
Anovulation - PCOS, Turners, Hyperprolactaemia, Ovarian failure, Hypopituitrism, Hypothalmic-pituitary-ovarian axis
Ovarian Reserve - premature ovarian failure 
Tubal factors
Male factors 
Obesity 
Smoking and Alcohol
Medication 
Rubella 
Low frequency of intercourse
192
Q

What investigations would you do for subfertility

A

Key investigation: Measure Progesterone: 7 days before period (mid luteal phase)
Calculate: (last day of cycle - 7 days) usually around 21

STI screening 
Ovarian Reserve testing: LH and FSH 
TVS and hysteroscopy
Hyster-salpingogram  
Laproscopy and Dye test - gold standard for assessing tubal patency
193
Q

What lifestyle management can be performed for subfertility

A 
Weight loss or gain 
Regular exercise or reducing exercise 
reducing stress
Quitting smoking
Reducing alcohol
Increasing frequency of intercourse
194
Q

What management can help stimulate ovulation in subfertility

A

Clomifene
Ovarian Drilling - only in PCOS
Gonadotrophins
Metfromin - in PCOS however not licensed

195
Q

What surgical management can help subfertility

A

Tubal Catheterisation

Laproscopic ablation of adhesions in endometriosis and Ashermans Syndrome

196
Q

What is Ashermans Syndrome and what can cause it

A 
Intrauterine adhesions 
Causes:
Dilation &amp; Curettage (D&amp;C) (scraping Rx for abortion)
PID
Endometriosis
Infection e.g genital TB
197
Q

What is IVF used for

A 
Tubal disease
Male factor subfertility 
Endometriosis 
Age affected fertility 
Clomifene resistance 
unexplained subfertility for greater than 2 years
198
Q

What increases success of IVF

A 
Not smoking
Lower BMI
Lower age 
Length of subfertility 
Lower Anti mullarian Hormone (AMH)
Salpingectomy for Hydrosalpinges
199
Q

What is the process of IVF

A
  1. Ovarian Stimulation and Monitoring
  2. Egg Collection
  3. Insemination
  4. Fertilisation
  5. Embryo Culture
  6. Embryo Transfer
  7. Luteal support - 2 weeks of progesterone
  8. Pregnancy Test
200
Q

Why are only 1-2 eggs transferred in IVF

A

To prevent multiple pregnancy

201
Q

What is the NHS criteria for IVF

A 
Generally no children already
Non smoker
BMI <30 
Age 45 and under
Not requiring donor gametes
202
Q

What Assisted fertility options are there

A 
Donor Insemination
Intrauterine Insemination
In Vitro Fertilisation 
Intracytoplasmic sperm injection 
In vitro maturation
203
Q

What are common causes of male infertility

A

Most common - oligoasthenoteratozoospermia
Testicular cancer
Drugs, smoking and alcohol
Varicoceles
Azoospermia - can be pretesticular, obstructive, non-obstructive
Immunological
Coital problems e.g. erectile dysfunction
Cystic Fibrosis
Androgen Insensitivity Syndrome
Hypoandrogenism

204
Q

What investigations would you do for male infertility

A

Semen Analysis: count, motility and morphology

Testicular examination  
Rectal Exam - Prostate 
General appearance and external male genitalia
Testosterone levels
testicular US and biopsy
205
Q

How can male subfertility be treated

A

Lifestyle changes: quit smoking, diet, exercise, avoid tight underwear and heated seats, cute down alcohol
Itrauterine insemination or Intracytoplasmic Sperm Injection for men with low/mild subfertility
IVF
Azoospermia - donor insemination
Surgery for obstruction, varicocele
Gonadotrophins, Clomifene, Testoterone Replacement therapy

206
Q

Abortion Act 1967 - Allow termination if:

A

A. the mothers life is at risk
B. it is necessary to prevent grave physical/mental harm to the mother
C. continuance of pregnancy risks greater physical/mental harm to mother than termination
D. continuance of pregnancy risks greater physical/mental harm to existing children than termination
E. there is a substantial risk the child will be born with physical/mental abnormalities causing the child to be severely handicapped

207
Q

Who must be present to sign the certificate of abortion

A

2 doctors

208
Q

Which 2 parts of the abortion act can only allow termination of the fetus up to 24 weeks

A

C. continuance of pregnancy risks greater physical/mental harm to mother than termination
D. continuance of pregnancy risks greater physical/mental harm to existing children than termination

209
Q

Before termination of pregnancy what should you offer

A

Screening of STIs
Contraception advice
Antibiotic Prophylaxis: for post op infection e.g metronidazole or azithromycin

210
Q

What two types of treatment should be offered for Termination of Pregnancy (TOP) and up to what date

A

Medical and Surgical

Up to 24 weeks

211
Q

What is the medical management of TOP

A

Antiprogestogen - Mifepristone

Prostoglandin (24hrs later) - Misoprostol

212
Q

What is the surgical management of TOP

A

Prostoglandin - Misoprostol pre op to prime/dilate the cervix
Vacuum/Suction - can be performed up to 15 weeks
Dilation and Evacuation - using surgical forceps

213
Q

What is the menopause

A

The time of waining fertility leading up to last period

214
Q

When is the menopause said to have happened

A

12 months after last period

215
Q

What causes the symptoms of the menopause

A

Falling oestrogen levels

216
Q

What are the symptoms of the menopause

A

Change in periods- periods become irregular (oligmenorrhoea) and make become heavier or lighter

Vasomotor symptoms -sweats, palpitations and hot flushes

Atrophy of oestrogen dependent areas - breasts and genitalia, vagina dryness and bleeding, dyspareunia, increased risk of UTIs, prolapse and stress incontinence

Increased risk of Osteoporosis

Mood Changes/Irritability/Memory loss/Difficulty concentrating

217
Q

What bones are at risk of fracture after menopause

A

Radius
Femur
Neck
Vertebrae

218
Q

What conservative management can help menopause

A

Exercise and Diet

219
Q

What investigations can be done for the menopause

A

Rule out other causes of symptoms - Thyroid TFTs and Psychiatry
FSH - two consecutive readings over 30 2 weeks apart(not recommended by NICE)

220
Q

What can help the menorrhagia in the menopause

A

Mirena Coil

221
Q

What contraception advice should be offered to women in the menopause

A

use contraception for a year after amennorhoea in women over 50 and for 2 years under 50

222
Q

What HRT would you you give women without a uterus

A

Oestrogen only HRT

223
Q

What HRT would you give a woman with a uterus

A

Combined HRT e.g estridol and norethisterone

224
Q

Why should women with a uterus take combined HRT

A

unopposed oestrogen is a major risk factor for endometrial cancer

225
Q

What are the two types of HRT treatment routines and what criteria decides which one you take

A

Cyclical HRT: women with menopausal symptoms still having periods or haven’t had a period within a year (progesterone only take for part of cycle)
Combined Continuous HRT: women who are post menopausal

226
Q

Can HRT be used as contraception

A

NO

227
Q

What are the contrindications of HRT

A 
Oestrogen dependent cancer 
past pulmonary embolism
undiagnosed PV bleed
pregnancy and breastfeeding
raised LFTs
228
Q

What are the SE of HRT

A 
bloating
fluid retention
nausea
breast tenderness
headache 
leg cramps 
progestogens can cause depression/mood swings, acne and back ache
229
Q

What are the benefit of HRT

A

reduced vasomotor symptoms
improves urogenital and sexual function
reduces risk of osteoporotic fractures
reduces risk of colorectal cancer

230
Q

What are the risks of HRT

A 
increased risk of breast cancer
increased risk of VTE
slight increased risk of stroke
increased risk of gallbladder disease
increased risk of endometrial cancer in oestrogen only HRT
231
Q

What would be used 1st line for osteoporosis but no other symptoms of menopause

A

NOT HRT
use calcium and vit D
Bisphosphates

232
Q

What are alternatives of HRT

A

SSRIs e.g. cloridene for vasomotor symptoms

Oestrogen cream or lubricants for vaginal dryness

233
Q

What is the definition of a miscarriage

A

Loss of pregnancy before 24 weeks gestation

234
Q

What are the 5 types of miscarriage

A 
Threatened 
Inevitable 
Incomplete
Complete
Septic
Missed
235
Q

What is a threatened miscarriage

A

Mild symptoms of pain and bleeding but os remains closed (75% will resolve)

236
Q

What is an inevitable miscarriage

A

More severe symptoms of pain and bleeding and os is open, uterine content will pass into the vagina

237
Q

What is an incomplete miscarriage

A

Some products of the uterus still remain in the uterus

238
Q

What is a complete miscarriage

A

All products of the pregnancy have been passed and the os is now closed

239
Q

What is a septic pregnancy and how may a patient present

A

Products of the pregnancy have become infected in the uterus causing endometritis
Woman may present with adnexal tenderness, fever and offensive vaginal discharge

240
Q

What is a missed miscarriage

A

Fetus has died in the uterus but os remains closed, woman may present with no symptoms or symptoms of pain and bleeding

241
Q

How is a missed miscarriage diagnosed

A

TVS will show no fetal HR

242
Q

What are the symptoms of a miscarriage

A

Abdomial Pain
Cramping
Bleeding
PROMS

243
Q

What should you note on examination of a miscarriage

A

The source of bleeding - is it uterus or cervical lesions
Quantify the bleeding - are they haemodynamically stable
Is the os open or closed
Is there evidence of products of conception
Is pain worse than period
Does the uterus size match pregnancy dates

244
Q

What investigations should be performed for miscarriage

A

bhCG - these will begin to fall but pregnancy will stay +ve for few days after miscarriage
TVS - rule out ectopic
Laproscopy if ectopic

245
Q

What initial assessment should be performed before miscarriage management

A

ABCDE

246
Q

What are the three types of miscarriage management

A

Expectant
Medical
Surgical

247
Q

Who is most appropriate for expectant miscarriage management

A

Women with mild bleeding who have undergone an incomplete miscarriage less appropriate for missed

248
Q

What is medical management of missed miscarriage

A

prostoglandin (Misoprostol) appropriate for missed miscarriage

249
Q

Who should undergo surgical management for miscarriage and what does it entail

A

Severe symptoms of bleeding, infection or significant retained products from pregnancy
Prime cervix with prostoglandins e.g Misoprostol
Followed by D&E or Suction (<15 weeks)

250
Q

What is the definition of recurrent miscarriage

A

Loss of 3 consecutive pregnancies before 24 weeks gestation

251
Q

What are the causes of recurrent miscarriage

A
  • increases with age
  • antiphospholipid syndome - treat with heparin and aspirin
  • Endocrine disorders e.g diabetes, thyroid
  • Thrombophillia - treat with heparin
  • Incompetent Cervix
  • Chromosomal abnormalities
  • Infection
  • Uterine abnormalities e.g bicornuate or unicornuate uterus
252
Q

What investigations should be performed for recurrent miscarriage

A 
antiphospholipid antibodies
thrombophillia screening
karyotyping and genetic counselling
Pelvic US
Diabetic testing and TFTs
253
Q

What maintains urinary continence

A

External Sphincter and Pelvic floor muscles

254
Q

What occurs in micturition

A

External Sphincter and pelvic floor muscles relax and detrusor muscle contracts

255
Q

What is the definition of stress incontinence

A

Involuntary leakage of urine due to increased stress/pressure usually due to exercise, coughing, sneezing and heavy lifting

256
Q

What causes stress incontinence

A 
External sphincter weakness
Pregnancy
Oestrogen deficency after menopause 
Congenital 
Surgery
Radiotherapy
257
Q

What investigations should be performed in stress incontinence

A

Urinalysis - to Exclude UTI and diabetes
Frequency/Volume charts will be normal
Urodynamics

258
Q

What is the management of stress incontinence

A

Conservative- weight loss, manage comorbidities, pelvic floor exercises
Medical management - Dulotexine rarely used
Surgical management - tension free vaginal tape

259
Q

What is urge incontinence

A

Involuntary leakage of urine with the strong desire to pass urine, presents with increased frequency and nocturia (overactive bladder syndrome)

260
Q

What are the symptoms of urge incontinence

A

Increased frequency
nocturia
may worsen in the cold

261
Q

What are the causes of urge incontinence

A

MS
Spina bifida
Idiopathic
Surgery

262
Q

What investigations should be performed for urge incontinence

A

Urinalysis - Exclude UTI and diabetes
Frequency/Volume charts will show increased frequency and nocturia
Urodynamics - are diagnostic! will show involuntary detrusor contraction

263
Q

What is the management of of urge incontinence

A

Conservative - cut down alcohol, caffeine and carbonated drinks, bladder retraining to suppress urge, avoid excessive fluid intake
Medical management:
Anticholinergic- Oxybutinin (dont use in old patients can increase risk of falls)
Botulinum Toxin injections into detrusor muscle
Surgical management last resort

264
Q

What is overflow incontinence and how is it managed

A

Caused by bladder insult or injury

Management: Catheterise

265
Q

What is mixed urinary incontinence and how should it be treat

A

Mixture of stress and urge incontinence

Treat the predominant one first

266
Q

What are the forms of barrier contraception

A 
Condoms 
Caps
Cervical Sponges 
Female condoms 
Spermcide 
Also protect against most UTIs
267
Q

What are the forms of fertility awareness/natural methods of contraception

A

Menstrual cycle monitoring
Cervical mucus monitoring
Basal body temperature monitoring
Lactational amenorrhoea - natures contraception

268
Q

What is the IUCD?

  • How long does it last
  • What are the symptoms and risks
  • Can it be used as a emergency contraception?
A

Intrauterine Copper Device
- it lasts 5-10 years
- it can cause dysmenorrhoea and menorrhagia
- it can increase risk of ectopic and PID
Yes it can be used as emergency contraception

269
Q

What is the IUS?

  • How long does it last
  • What symptoms can it relieve
  • What risks are lower using the IUS instead of IUCD
  • What can the IUS be used to treat
  • Can it be used as emergency contraception?
A

Intrauterine System

  • it lasts around 5 years
  • it can relieve symptoms of menorrhagia and dysmenorrhoea by making periods lighter or cause amenorrhoea
  • Can cause irregular bleeding
  • the IUS has lower risks of ectopic and PID
  • the IUS can be used to treat endometriosis and menorrhagia
  • the IUS cannot be used as emergency contraception
270
Q

What are the types of emergency contraception

A

The IUCD - 120hrs or up to 5 days after earliest ovulation
Ullipristal Acetate - 120 hrs
Levonorgestrel - 72 hrs

271
Q

What are the reasons to avoid the COCP

A 
CVD
Increased BMI 
Past/Current VTE and family Hx 
Migraines 
Oestrogen reliant cancers (breast cancer)
Liver disease
272
Q

What are the risks of the COCP

A

increased risk of: stroke, VTE, breast and cervical cancer

273
Q

What are the SE of the COCP

A

Mood swings, bloating, breast tenderness, headaches

274
Q

What are the benefits of COCP

A

Improves acne, protects against endometrial, ovarian and bowel cancer, helps reduce symptoms of menorrhagia and dysmenorrhoea

275
Q

What are the different types of progesterone only contraception

A

Progestogen only pill
The depot injection
The implant

276
Q

What are the SE of POP

A

Most common: Irregular menstrual bleeding

Depression, acne, back ache. increased risk of ectopic

277
Q

What are the SE of depot

A

Weight gain, osteoporosis

278
Q

What are the SE of the implant

A

irregular or frequent or prolonged periods

279
Q

What are reasons to avoid POP

A

Current breast cancer
liver disease
SLE with antiphospholipid syndrome
new sympttoms of migraine, stroke etc while taking POP

280
Q

What are the two types of sterilisation

A

Tubal ligation - women (difficult to reverse)

Vasectomy - men (safer can be reversed takes up to 3 months to work to use up sperm stores

281
Q

Where is the most appropraite place to insert implant contraception

A

Non dominant arm, subdermal layer

282
Q

What is defined as premature ovarian failure

A

40 years

283
Q

What is the best tool to diagnose Adenomyosis

A

MRI pelvis

284
Q

If there have been 3 inadequate cervical smears what should be the next step

A

Refer for colposcopy

285
Q

What is oxybutinin

A

An Anticholinergic - antimuscarinic

286
Q

Should HIV positive women breastfeed

A

No

287
Q

What is Mittelschmerz

A

Cause of mid cycle pain caused by a small amount of fluid released mid ovulation, often sharp onset and settles after 24-48 hrs

288
Q

What is the most common cause of post coital bleeding

A

Cervical Ectropian

289
Q

What are the rules for missed pill POP

A

Traditional POP - take within 3 hrs of normal time
Desogesterel - taken within 12 hrs of normal time
If missed outside time frame take missed pill and use safety measures for 48hrs e.g condoms

290
Q

What is a bartholins cyst

A

Blockage of the bartholins gland leading to a fluid filled sac
Causes unilateral swelling and perineal tenderness

291
Q

What is the treatment of bartholins cyst

A

Marsupialisation

292
Q

What is Adenomyosis

A

Presence of endometrial tissue in the myometrium - it causes uterine enlargement

293
Q

What is adenomyosis associated with

A

Endometriosis

Fibroids

294
Q

As growth of endometrial tissue is oestrogen dependent when would it subside

A

After menopause - no oestrogen

295
Q

What symptoms would you get in adenomyosis

A

Menorrhagia

Dysmenorrhoea

296
Q

What would you find on examination of someone with adenomyosis

A

Tender Uterus

297
Q

How would you manage adenomyosis

A

Non- hormonal: pain relief: mefanamic acid, Antifibrinolytics e.g tranexamic acid
Hormonal: COCP, POP, IUS

298
Q

What causes continuous dribbling go urine

A

Vesicovaginal Fistula

299
Q

What are causes of Menorrhagia

A 
Fibroids 
Endometriosis 
Polyps 
Endometrial Hyperplasia 
PID
PCOS
Coagulation Problems 
Infection (irregular, heavy bleeding)
300
Q

What is in the risk of malignancy index (RMI)

A

CA125 x USS score x Menopause status

301
Q

When is a woman most likely to conceive

A

Last day - 14

302
Q

What should pregnent women avoid in pregnancy

A 
Vitamin A - strong link with congenital abnormality 
Soft Cheeses -Listeria 
Cold Meats 
Raw Eggs which aren't fully boiled - Salmonella 
Liver 
Shell Fish - Listeria &amp; Salmonella 
Tuna - Mercury 
Cat Litter - Toxoplasmosis
303
Q

What amount of folic acid should normal pregnant women take

A

400 micrograms

Specialties (4 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions