3A > Gynaecology > Flashcards

Gynaecology Flashcards

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1
Q

Fibroids aetiology

A

Benign proliferation of smooth muscle
Oestrogen responsive

Enlarge during pregnancy
Calcify during menopause

RFs

  • Afro-Caribbean
  • Early menarche
  • Younger women
  • Family Hx
  • Genetic - Fumarate hydratase

Protective…

  • COCP
  • Late menarche
  • Parity
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2
Q

Fibroids presentation

A

Dysfunctional BLEEDING!

  • Menorrhagia
  • Dysmenorrhoea
  • Intermenstrual

Bloating
Urinary urgency
Suprapubic pain

SUBFERTILITY!

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3
Q

Fibroids investigations

A

O/E - BULKY UTERUS

TVUS

MRI - Adenomyosis?
FBC - Anaemia

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4
Q

Fibroids management

A
  1. MIRENA COIL

< 3cm + HMB

  • Tranexamic acid
  • NSAIDS
  • Progesterones
  • COCP

> 3cm + HMB

  • Ullipristal acetate
  • Surgery

Myomectomy - If looking to conceive

Ablation
Hysterectomy
Uterine artery embolisation

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5
Q

Fibroids complications

A

Subfertility

Degeneration

  • Hyaline
  • Cystic
  • Calcification

Red degeneration - Blood in fibroid

  • Occurs in pregnancy
  • N/V + Abdo pain + fever
  • NSAIDS + Rest

Torsion of pedunculated

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6
Q

Fibroids pregnancy complications

A

Premature labour
Obstructed labour

Malpresentation
PPH

Red degeneration

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7
Q

Adenomyosis aetiology / presentation / investigations / management

A

Endometrial tissue in the myometrium

RFs

  • Multiparous
  • Age ^^^

Boggy uterus
Dysmenorrhoea
Menorrhagia

Investigations - MRI

Management

  • GnRH analogue
  • Hysterectomy
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8
Q

Endometrial hyperplasia

A

Abnormal proliferation of endometrium outside normal menstrual cycle

Cancer risk!

Presentation - Dysfunctional bleeding

Management

  • Typical - High dose progesterones - MIRENA COIL
  • Atypical - Hysterectomy
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9
Q

Endometriosis aetiology + location

A

Endometrial tissue outside the uterine cavity

  • Uterosacral ligament
  • Ovaries

Cause - UNKNOWN

  • Retrograde menstruation
  • Impaired immunity
  • Genetic
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10
Q

Endometriosis presentation

A

Pain!

  • Deep dyspareunia
  • Cyclical dysmenorrhoea - Before period

Subfertility

Urinary symptoms

  • Dysuria
  • Urgency

Dyschezia

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11
Q

Endometriosis investigations + examination

A

O/E

  • Reduced organ motility
  • Tender modularity in posterior fornix
  • Fixed retroverted uterus

Laparoscopy and biopsy
- Endometrium outside the uterine cavity

TVUS - Look for ovarian cysts
Ca125
MRI - Adenomyosis

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12
Q

Endometriosis management

A

Analgesia

Stop cycle

  • COCP
  • Mirena coil
  • Progesterones

Secondary care

  • GnRH analogue
  • Surgery - Ablation
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13
Q

Endometriosis complications

A

Fibroids
Adhesions

Subfertility
Ectopic pregnancy

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14
Q

Endometrial cancer risk factors

A

75% post-menopausal

Unopposed oestrogen

Obesity
Diabetes

Early menarche
Late menopause
Nulliparity

Hereditary non-polyposis colorectal cancer - HNPCC
PCOS

Tamoxifen

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15
Q

Endometrial cancer types / presentation

A

Adenocarcinoma
Adenosquamous - Poor prognosis

PMB
PMB
PMB

Intermenstrual bleeding
Pain

Pyometra - Uterine infection

B-symptoms - Fatigue and weight loss

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16
Q

Endometrial cancer investigations

A

2WW REFERRAL!!!!

TVUS

Hysteroscopy and biopsy > 4mm thickness

CT/MRI staging

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17
Q

Endometrial cancer staging and management

A
  1. Confined to uterus - Hysterectomy and BSO
  2. Uterus and cervix - Radical hysterectomy*
  3. Uterus, cervix, serosa - Chemo and radiotherapy
  4. Distant mets - Chemo and radiotherapy
  • Radical hysterectomy
  • Uterus
  • Ligaments
  • 1” of vagina

Prognosis - Early detection - GOOD!

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18
Q

PMB DDx

A
  1. Endometrial cancer
  2. Vaginal atrophy

Endometrial hyperplasia

HRT spotting

Ovarian cancer
Ovarian cyst

Cervicitis
Cervical cancer

Vaginal cancer

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19
Q

Intrauterine cysts / polyps

A

Risk factors - OESTROGEN

  • Late menopause
  • Early menarche
  • Obesity
  • Nulliparity
  • Diabetes
  • PCOS

PC - Dysfunctional bleeding
Ix - TVUS
Rx - Curettage / Diathermy
Complications - Cancer and subfertility

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20
Q

Cervical histology

A

Uterus - Simple columnar

Endocervix - Glandular ciliated columnar - Adenocarcinoma

Transformational zone - Squamocolumnar junction - Malignancy risk

Ectocervix - Stratified squamous epithelium

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21
Q

Cervical screening age groups / method

A

< 25 - Not offered - Screening not shown to reduce number of cancers

25-49 - Every 3 years
50-64 - Every 5 years

Immunocompromised - Annually

Liquid based cytology - Examination of cervical cells

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22
Q

Cervical screening results and management

A

Normal - Repeat in 3/5 years

Inadequate

  • Repeat smear
  • If 2 inadequate - Refer for colposcopy

Borderline - Mild dyskaryosis

  • HPV test
  • Positive - Refer for colposcopy
  • Negative - Return to routine

Moderate or severe dyskaryosis
- 2ww colposcopy referral

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23
Q

CIN aetiology

A

Pre-malignant state
Atypical cells present in squamous epithelium

70% SCC
15% Adenocardinoma
15% mixed

HPV - 16, 18, 33

Sexual partners ^^^
Smoking
Immunosuppression

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24
Q

CIN presentation

A

Post-coital bleeding
Intermenstrual bleeding
Post-menopausal bleeding

Vaginal discharge

Asymptomatic?

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25
CIN investigations / grading / management
Colposcopy Punch biopsy CT-PET 1. Dyskaryosis in 1/3 epithelium 2. Dyskaryosis in 2/3 epithelium 3. Dyskaryosis in > 2/3 - Carcinoma in situ Malignant - Invasion of basement membrane LLETZ - Large loop excision of transformational zone REPEAT SMEAR IN 6 MONTHS!
26
Cervical ectropion RFs Presentation Management
Endocervix spreads to ectocervix - EVERSION RFs - OCP and pregnancy Presentation - PCB - Discharge Management - Stop OCP - Cryotherapy
27
Cervicitis Presentation Management
Infection of the cervix Presentation - Discharge Management - Antibiotics - Antivirals - Antifungals - Cryotherapy
28
Cervical polyps Presentation Management
Aetiology Benign tumour of the cervix Presentation - IMB - PCB Management - Avulsion
29
Cervical cancer staging
1. Confined to cervix 2a. Cervix and upper vagina 2b. Cervix, upper vagina and parametrium 3. Cervix, upper vagina, parametrium, lower vagina and pelvic wall 4. Cervix, upper vagina, parametrium, lower vagina, pelvic wall, bowel, bladder and other structures
30
Cervical cancer management
1. Cone biopsy Pelvic nodes -ve - Hysterectomy Pelvic nodes +ve - Radical hysterectomy 2a. Hysterectomy, radiotherapy, chemotherapy
31
Ovarian cyst types
Physiological - Follicular - Corpus luteum Benign cell tumour - Dermoid cyst Benign epithelial tumour - Serous cystadenoma - Mucinous Benign sex cord tumour Fibroma
32
Ovarian cyst - Physiological
Follicular - Non-rupture of dominant follicle - Regress after a few menstrual cycles Corpus luteum - Corpus luteum does not break down - Fills with blood or fluid
33
Benign germ cell tumour
Dermoid cyst Skin Hair Teeth Seen in < 30
34
Benign epithelial tumour
Serous cystadenoma - Seen in 40-50s - Can be malignant Mucinous - Very large - May rupture to become pseudomyxoma peritonei
35
Ovarian cyst presentation / investigations
Bloating Lower back pain Deep dyspareunia Early satiety Dyschezia Urinary symptoms TVUS Ca125 - Rule out cancer Laparoscopy - Aspiration MSU hCG
36
Ovarian cyst management
Pre-menopausal < 5cm - Watch and wait Pre-menopausal > 5cm - Laparoscopic ovarian cystectomy Post-menopausal < 5cm - Watch and wait Post-menopausal > 5cm - Bilateral oophorectomy
37
Ovarian cyst complications
Torsion - Fever - Abdo pain - Vomiting Rupture - Abdo pain - Shock Haemorrhage Peritonitis
38
Ovarian torsion aetiology
Ovary twists on supporting ligaments Blood supply is compromised Fallopian tube involvement = Adnexal torsion Ovarian cyst Ovarian cancer Pregnancy Fertility treatments
39
Ovarian torsion presentation / investigations / management
Fever Colicky abdo pain Vomiting Adnexial mass Examination - Adnexal tenderness USS - Free fluid - Whirlpool sign Management - Laparoscopy
40
Ovarian cancer - Aetiology Risk factors vs Protective factors
Oestrogen responsive 80% serous carcinoma RFs - BRCA!!! - HNPCC - Nulliparity - Early menarche - Late menopause Protective... - COCP - Pregnancy
41
Ovarian cancer presentation / investigations
IBS symptoms - Early satiety - Abdo pain - Change in bowel habit Urinary symptoms 1. Ca125 2. If > 35 - Urgent USS - Abdo and pelvis 3. Laparotomy and biopsy to confirm
42
Ovarian cancer risk of malignancy index
U x M x Ca125 U - USS findings - BAMMS M - Menopausal status Score > 125 - Requires MDT and staging
43
Ovarian cancer - USS findings
BAMMS ``` Bilateral lesions Ascites Mets Multilocular cysts Solid areas ```
44
Ovarian cancer staging and management
1. Ovary 2. Pelvic 3. Abdo invasion 4. Mets outside the abdomen Surgery Radiotherapy Platinum based chemo
45
Hyatidiform mole aetiology
Gestational trophoblastic disease Implantation of non-viable foetus Asian Extremes of age Previous HM
46
HM presentation
hCG ^^^ Hyperemesis gravidarum Painless menstrual bleeding - Obvs weird when they're preggo Hyperthyroid picture - hCG mimics T4 Proteinuria HTN Abdo pain
47
HM investigations
hCG ^^^ Urine dip - Proteinuria BP - HTN USS - Snowstorm appearance - Bunch of grapes - Honeycomb
48
Menorrhagia aetiology
Bleeding that patient deems to be excessive or abnormal Idiopathic - 50% Fibroids - 30% Uterine - Fibroids - Polyps - Adenomyosis Systemic - Thyroid - Bleeding disorders - Diabetes - Obesity Iatrogenic - Anticoags - IUD - Copper coil
49
Menorrhagia investigations
FBC Other bloods if indicated... - TFT - Clotting - LFTs TVUS - Fibroids?
50
Menorrhagia management
Treat anaemia Contraceptives... - Mirena coil - COCP Non-contraceptives - Tranexamic acid - Mefenamic acid - Pain relief
51
Dysmenorrhoea aetiology and management
Idiopathic - Normal? Endometriosis Adenomyosis Fibroids PID Ovarian tumour Management - Treat cause - Mefenamic acid - COCP - TENS
52
PCB causes
Cervical ectropion Cervical cancer Cervicitis Cervical polyps Trauma
53
IMB causes
Non-malignant - Fibroids - Uterine polyps - Adenomyosis - Ovarian cyst - PID Malignant - Endometrial cancer - Ovarian cancer - Cervical cancer
54
IMB investigations and management
FBC TFT Clotting Cervical smear if due? TVUS Management - IUD - COCP
55
Acute pelvic pain DDx
Woman of childbearing age - Ectopic until proven otherwise! Mittleschmerz - Pain midway through menstrual cycle - Normal Miscarriage Ovarian cyst rupture Ovarian torsion PID UTI Appendicitis
56
Chronic pelvic pain DDx
Go to answer - Endometriosis! IBS/IBD PID Ovarian cyst Adenomyosis Uterine prolapse Adhesions Psychological - Previous abuse
57
PID aetiology and presentation
STI - Chlamydia - Gonorrhoea Pelvic pain Deep dyspareunia Cervical excitation Fever STI symptoms RUQ pain Dysfunctional menstrual bleeding
58
PID investigations / management / complications
Triple swab - Endocervical chlamydia swab - Endocervical sample - High vaginal swab TVUS - Rule out differentials Management - Treat infection - PO ofloxacin + Met - IM Cef + PO doxy + PO met Complications - Subfertility - Ectopic - Chronic pelvic pain
59
Vaginal intraepithelial neoplasia
Usual - Common in 35-50 - May develop into squamous cell carcinoma Differentiated - More common in older women - Associated with lichen sclerosis - Higher risk of squamous cell carcinoma
60
Vaginal intraepithelial neoplasia Presentation Investigations Management
Presentation - Pruritus - Pain Management - Local surgical excision - Imiquimod
61
Vulval cancer aetiology and histology
Most common in > 65 Squamous cell carcinoma Causes - HPV - VIN - Lichen sclerosis - Immunosuppression
62
Vulval cancer presentation / investigations / management
Ulcer/mass in labia majora! Bleeding Pruritus Discharge Superficial dyspareunia Investigations - Biopsy lesions Management - Wide local excision - Groin lymphadenectomy
63
Lichen simplex
Presentation - Itching - Thick labia majora Risk factors - Sensitive skin - Dermatitis and eczema Management - Avoid irritant - Antihistamines - Steroid cream
64
Lichen planus
Associated with AI disease Presentation - Flat purple lesions - PO and PV - Painful - Erosive Management - Steroid cream
65
Lichen sclerous
Associated with AI disease Presentation - Thin vulval epithelium - Pink and white papule - Parchment like skin - Itching - Dyspareunia Associated with SCC Management - Steroid cream and emollients
66
Atrophic vaginitis
Post-menopausal women Presentation - PMB - Vaginal dryness - Itching - Dyspareunia TVUS - Rule out endometrial cancer Management - Topical oestrogen - Lubricants - Creams
67
Vaginal cancer
Squamous cell carcinoma Clear cell carcinoma Presentation - Dysfunctional menstrual bleeding - PMB - Discharge - Mass Management - Radiotherapy
68
Female genital mutilation
Partial or complete removal of external genitalia Any injury to female organs For non-medical reasons 1. Removal of clitoris 2. Excision - Removal of clitoris and labia 3. Infibulation - Narrowing of the vagina 4. Any other harmful procedure - Piercing - Incising - Scraping
69
Prolactinoma
Pituitary adenoma - Benign tumour of the pituitary gland Micro < 1cm Macro > 1cm Secretory/functioning - Excess of a particular hormone OR Non-secretory/functioning
70
Excess prolactin symptoms
Women - Amenorrhoea - Infertility - Galactorrhea - Osteoporosis Men - Impotence - Loss of libido - Galactorrhea
71
Prolactinoma diagnosis and management
Diagnosis - MRI Management... Dopamine agonists - Inhibit release of prolactin - Cabergoline - Bromocriptine Surgery?
72
Prolapse aetiology
Age ^^^ Childbirth Radiotherapy Chronic pressure - Tumour - Constipation - Cough - Obestity
73
Prolapse types
Anterior - Cystocele - Urethrocele - Cystourethrocele Posterior - Enterocoele - Rectocele Vault - Upper vagina drops down Uterine - Uterus drops into vagina
74
Prolapse presentation and grading
Dragging sensation Heaviness "Bearing down" Urinary symptoms Sexual difficulties ``` 0 - No descent with strain 1 - 1cm above hymen 2 - Within 1cm of hymen 3 - 1cm below hymen 4 - Vaginal eversion ```
75
Prolapse management
Conservative - Pelvic floor exercises - Weight loss Ring pessary Oestrogen cream - If menopausal Surgery - Anterior colporrhaphy - Posterior colporrhaphy - Hysterectomy
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