Brainscape's Knowledge GenomeTM

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


See full index

EOY4 > Gynaecology > Flashcards

Gynaecology Flashcards

1
Q

What is the definition of primary amenorrhoea?

A

Periods have never started, potentially due to:

Delayed puberty e.g. chromosomal abnormality e.g. Turner’s

Absence of a uterus or functional endometrium

Polycystic Ovarian Syndrome

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

What is the definition of secondary amenorrhoea?

A

Periods have started but have stopped for over 6 months

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

Give 3 physiological causes of amenorrhoea

A

Pregnancy

Lactational Amenorrhoea

Menopause

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

Give 2 ovarian causes of amenorrhoea

A

Polycystic Ovarian Syndrome

Premature Menopause

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

Give 2 iatrogenic causes of amenorrhoea

A

Hormonal contraceptives e.g. IUS/POP/Depot/COCP

Antipsychotics

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

Give 3 other non-gynae causes of amenorrhoea

A

Stress

Low body weight/ eating disorder/ over-exercising

Untreated coeliac disease

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

What is the definition of menorrhagia?

A

> 80 mls of menses in ~ 7 days

HOWEVER

Go off what the patient reports as everyone is different and it’s their problem!

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

Give 6 endometrial causes of menorrhagia

A

Dysfunctional Uterine Bleeding (most common)

Fibroids

Endometriosis

Adenomyosis

Endometrial Polyp

Endometrial Carcinoma (esp if >45 years old or PMB)

(PID can also cause but doesn’t fit into a category)

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

Give an iatrogenic causes of menorrhagia

A

Contraception e.g. IUD or POP

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

Give 3 systemic causes of menorrhagia

A

Hypothyroidism

Coagulopathy

Diabetes Mellitus

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

Give 5 cervical causes of post-coital bleeding

A

Trauma

Polyps

Ectropion

Carcinoma

Cervicitis

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

Give 3 other gynae causes of post-coital bleeding

A

Sexually Transmitted Infections

Pelvic Inflammatory Disease

Pelvic Organ Prolapse

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

Give 2 physiological causes of inter-menstrual bleeding

A

Reduction in oestrogen just before ovulation

Pregnancy related e.g. implantation

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

Give a tubal cause of inter-menstrual bleeding

A

Ectopic Pregnancy

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

Give 2 endometrial causes of inter-menstrual bleeding

A

Polyps

Carcinoma/ Hyperplasia

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

Give 3 gynae causes of inter-menstrual bleeding

A

Miscarriage

STIs

PID

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

Give 4 cervical causes of inter-menstrual bleeding

A

Trauma

Polyps

Ectropion

Cervicitis

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

Give an iatrogenic cause of inter-menstrual bleeding

A

Hormonal contraception e.g. IUCD

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

Give an ovarian cause of inter-menstrual bleeding

A

Polycystic Ovarian Syndrome

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

What are the main causes of post menopausal bleeding? (5)

A

Endometrial carcinoma/ hyperplasia

Pelvic Organ Prolapse

Polyps (endometrial or cervical)

Atrophic Vaginitis

Ovarian Cysts

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is a fibroid? What are the 4 types?

A

A leiomyoma

A benign smooth muscle tumour of the uterus

Subserosal (most common), intramural, submucosal, pedunculated

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

Which group of people are fibroids more common in?

A

Afro-carribean women, older women or those with a family history

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

What is the pathophysiology of fibroids?

A

Oestrogen dependent so can increase in size in response to pregnancy/ COCP/ high oestrogen states

Can also atrophy during the menopause (low oestrogen) or suddenly (red degeneration)

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

What are 5 symptoms of fibroids?

A

Menorrhagia (due to ↑ surface area of the uterus) but no PCB or IMB

Sub-fertility e.g. submucosal fibroids may prevent implantation

Abdominal mass +/- irregularly shaped uterus

Urinary frequency (presses on bladder)

Pain (red degeneration)

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

How do fibroids present on examination?

A

Enlarged, firm and irregularly shaped uterus

Uterus is NON TENDER

Mass is mobile

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

Which imaging is diagnostic for fibroids?

A

Transvaginal and transabdominal ultrasound scan

Refer if any sinister signs

(may do FBC if anaemia)

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

What is the conservative management of fibroids?

A

If asymptomatic/incidental finding just watch and wait

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

What is the medical management of fibroids?

A

Non-hormonal = Tranexamic acid/NSAIDS

Hormonal =
Mirena IUS if <3cm
POP
Can also use a GnRH analogue to shrink before surgery but not a permanent solution
Can also give HRT just have to council about symptoms

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

What is the the surgical management of fibroids and the indication to do so?

A

Fibroid is >3cm in diameter

1) Uterine artery embolisation (painful, long recovery and not if of childbearing age)
UA ablation - also need contraception

2) Myomectomy
3) Hysterectomy (older and/or don’t want to preserve fertility)

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

What are the complications of fibroids? (4)

A

Adjacent organ or venous compression

Infertility/problems within pregnancy

Red degeneration

Can calcify

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

What is red degeneration?

A

Torsion of a pedunculated fibroid

Cuts off blood supply

Leads to haemorrhagic necrosis

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

What is the definition of polycystic ovarian syndrome?

A

Hyperandrogenism + oligomenorrhoea + polycystic ovaries

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

What is the definition of oligomenorrhoea?

A

~4-9 menstrual periods per year following regular establishment of menstruation prior to irregularity

leads to anovulatory cycles

In the absence of other PCO causes e.g. Cushing’s

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

What is the pathophysiology of PCOS?

A

Ovaries are stimulated to produce excess androgens…

Excess LH production by the anterior pituitary due to ↑ frequency of GnRH pulses

Hyperinsulinaemia

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

What is the role of obesity in PCOS?

A

Aromatase enzyme is present in adipose tissue

Aromatase converts testosterone to oestrogen

PCOS = excess androgens and oestrogen = male pattern symptoms and inhibition of FSH so follicle doesn’t mature

Hyperinsulinaemia (see other card)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

How does hyperinsulinaemia lead to PCOS?

A

↑ frequency of GnRH pulses…

↑LH compared to FSH (↑ratio) = ↓ follicle maturation
↑ ovarian androgen production
↓ binding of sex hormone binding globulin (SHBG)

ALSO
upregulaiton of 17 alpha-hydroxylase = ↑ androgen synthesis

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

What are 3 menstrual symptoms associated with PCOS?

A

oligomenorrhoea

Amenorrhoea (unless given exogenous hormones)

Hypermenorrhoea (heavy and prolonged)

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

What are the male pattern symptoms seen with PCOS?

A

Acne

Hirutism (hairy women)

Andogenic Alopecia (head hair thinning/loss)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

What are the metabolic symptoms associated with PCOS?

A

Central Obesity

Insulin resistance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Which criteria is used to assess PCOS?

A

Rotterdam criteria: need 2 or 3

Excess androgen activity
Oligoovulation/anovulation/polycystic ovaries
Exclusion of other causes of excess androgens

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

What are the blood investigations for PCOS?

A

LH and FSH levels

Free testosterone

Glucose tolerance test and fasting insulin levels (not diagnostic just indicated risk factors and need once a year)

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

What imaging can be done for PCOS?

A

Transvaginal ultrasound - 12+ follicles seen ? in periphery/string of pearls appearance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

What is the conservative management for PCOS?

A
  • manage weight and obesity related behaviours/conditions
    e. g. smoking cessation and diabetes control (↑ insulin sensitivity)

Hair removal

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

What is the medical management for PCOS?

A

Hormonal = contraception, either IUS or COCP or a progestogen

Non-hormonal = metformin (↑insulin sensitivity but short term and not licensed)

Anti-androgens/spironolactone for acne (though teratogenic)

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

How does the COCP help in PCOS?

A

Regulation of cycle and ↓ risk of endometrial cancer due to ↑ unopposed oestrogen on endometrium

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

How does a progestogen help in PCOS?

A

Need to shed the endometrium 4-5 times a year to maintain health and ↓ endometrial cancer risk

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

What is the definition of pelvic organ prolapse?

A

Descent of 1+ pelvic organs leading to a protrusion of the vaginal wall +/- uterus. There are usually also urinary/bowel/sexual/local pelvic symptoms

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

What is the function of the pelvic ligaments? name them

A

Support the uterus

Pubocervical (pubic symphysis to cervix)

Cardinal (cervix to lateral uterine wall)

Uterosacral (uterus to anterior sacrum)

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

What are the types of incontinence?

A

Frequency/Urge

Stress

Mixed

Overflow

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

What is stress incontinence?

A

Involuntary leakage when there is an increase in intra-abdominal pressure e.g. due to laughing or coughing o r exercise

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

What is urge/frequency incontinence?

A

Urgency symptoms/feeling of needing to go +/- frequency and nocturia but NO URINARY SYMPTOMS

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

What are the causes of stress incontinence?

A

↑ pressure = ovarian masses/pressure from superior structures/obesity/chronic cough

Oestrogen deficiency e.g. menopause

Vaginal trauma e.g. childbirth/ surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

What are the causes of urge incontinence?

A

Triggers = running water, turning key in door

Pelvic surgery/nerve damage

neurological e.g. MS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

What are the bedside investigations for incontinence?

A

Urinalysis to rule out a UTI

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

What imaging should be done to investigate incontinence?

A

1) Cystoscopy if recurrent UTI or haematuria just to check anatomy
2) USS of post void residual volume
3) Urodynamics - looks at storage and voiding of urine

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

What are the two types of urodynamics?

A

Uroflowmetry - for voiding difficulties and done in private

Cystometry - fill bladder with saline and measure the pressure when patient gets feeling to void, coughing, straining etc

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

What are two conservative assessments for urinary incontinence?

A

Bladder diary - monitor patterns of incontinence and behaviours

QOL questionnaire

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

What is the conservative management for stress urinary incontinence?

A

Reduce fluid +/- caffeine +/- alcohol intake

Weight loss

Continence pads

Pelvic floor exercises (v effective if done - refer for 3 months of physio)

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

What is the conservative management for urge urinary incontinence?

A

Behaviour therapy e.g. alarm

Electrical stimulation to pudendal nerve

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

What is the medical management of stress urinary incontinence?

A

Duloxetine (SNRI so side effects)

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

What is the medical management of urge urinary incontinence?

A

Anticholinergics/muscarinics (↑ storage)

Botox (retention is SE)

Oxybutynin (severe SE e.g. dry mouth)

Tolterodine/Solifenacin

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

What are the types of prolapse?

A

Cystocele

Rectocele

Enterocele

Vault

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

Define a cystocele. Which type of incontinence does this lead to?

A

Weakness in the anterior vaginal wall allowing the bladder to prolapse in

Stress incontinence/ frequent UTIs/ residual urine

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

Define a rectocele. Which type of incontinence does this lead to?

A

Weakness in the posterior vaginal wall allowing the rectum to prolapse in

Faecal incontinence/ back ache/ pressure

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

Define an enterocoele. Which type of incontinence does this lead to?

A

Weakness in the upper vaginal wall allowing prolapse of the vagina and peritoneal sac +/- bowel or omentum

Backache, faecal incontinence, bleeding

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

What is a vault prolapse?

A

Descent of the vagina post hysterectomy +/- cyst/rect/enterocele

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

How is prolapse graded? (4)

A

1st degree - uterus is halfway down vag to Introits

2nd degree - uterus is at the level of the Introitus and comes through when straining

3rd degree - uterus is through the introitus and outside

Procidentia - Uterus is outside the vagina

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

What are the general symptoms of prolapse? (5)

A

‘something coming down’

Dragging sensation

Dyspareunia

Urinary/Bowel symptoms

Low mood/affecting QOL

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

What are the risk factors for prolapse? (8)

A

Non-Modifiable

  • Older age
  • Asian/hispanic
  • Spina Bifida (?)
  • Connective Tissue Disorder
  • FHx

Modifiable

  • Obesity
  • Vaginal delivery +/- forceps/trauma/macrosomia/prolonged 2nd stage
  • Multiparity
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
70
Q

What are the investigations for prolapse?

A

Very much a clinical diagnosis/examination

Do a bimanual/speculum

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

What is the conservative management of prolapse?

A

Symptom and severity dependent

manage risk factors (cough, constipation, weight, stop smoking)

Pelvic floor training

Pessary - Ring is first line and can still shag. Also good for short term relief before surgery

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

What are the complications of using a pessary?

A

PV discharge +/- odour

Can cause trauma to walls and fistula formation

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

What is the surgical management of prolapse?

A

Only if pessary/previous surgery fails or definitive management is wanted

TVT/colposuspension/hysterectomy

General surgical complications apply

74
Q

Define endometriosis

A

The presence of the endometrium outside of the uterus leading to chronic inflammation

Oestrogen driven so get cyclical symptoms and affects women of reproductive age

75
Q

What is the pathophysiology of endometriosis?

A

Unknown

1) retrogade menstruation
2) metaplasia of mesothelial cells
3) reduced immunity

76
Q

What are the risk factors for endometriosis?

A

1st degree relative also has endometriosis

Early menarche
long flow
short cycles

vaginal obstruction- FGM, hydrocolpos, uterine defects

77
Q

How does adenomyosis differ to endometriosis?

A

Adenomyosis is the presence of endometrium within the myometrium

78
Q

How does endometriosis normally present?

A

PAIN

S
Q - constant due to adhesion formation
I - SEVERE
T - cyclical, maybe also during ovulation
A - cyclical, worse during periods. Dyspareunia due to uterosacral ligament involvement
R -
S - Bloating, fatigue, constipation, lower back pain

79
Q

What are some other symptoms of endometriosis?

A

Subfertility - ?adhesions ?higher prostaglandins

Extrapelvic - LUTS, dyschezia (pain when pooing), cyclical bleeding and epistaxis

80
Q

How does does endometriosis present on examination?

A

May be normal

Might have:
Retroverted uterus (v common)
Blue nodules @ pos fornix
Tender @ adnexae

81
Q

What are the bedside investigations for endometriosis?

A

Acute exclusion of UTIs etc

82
Q

What are the blood tests for endometriosis?

A

Have raised CA-125 although this is of no diagnostic value

83
Q

What imaging is appropriate for endometriosis?

A

Transvaginal USS is good if tissue is present at the ovary

Otherwise, MRI allows location to be seen

84
Q

How is endometriosis diagnosed?

A

Laparoscopy + biopsy is gold standard

Have to avoid if within 3 months of hormonal treatment

85
Q

What is the conservative management of endometriosis?

A

Pain management - hot water bottle, analgesia e.g. NSAIDS (ibuprofen, naproxen, mefenamic acid)

Reassurance and advice - sign post to support groups e.g. endometriosis UK and SHE trust Uk

86
Q

What is the hormonal medical management of endometriosis?

A

Contraceptive management wanted =

COCP if under 35 and have no contraindications. do a 3 month trial of a conventional regime then continuous if pain isn’t managed

Progesterone - POP/mirena/IM otherwise

GnRH analogue - creates a pseudo menopause = reduces oestrogen and stops ovulation

87
Q

What is the non-hormonal management of endometriosis?

A

Oral progestogen (medroxyprogesterone)

Thins the endometrium and reduces oestrogen levels

88
Q

What are the problems with using a GnRH analogue for endometriosis?

A

menopause symptoms

only for 6 months due to cancer risk

pre-IVF?

89
Q

What is the surgical management of endometriosis?

A

Laparoscopic ablation/excision of endometriosis (reduces pain, preserves fertility)

Total hysterectomy + bilateral oophrectomy (removes oestrogen driving force but last resort)

90
Q

What are the complications of endometriosis?

A

Chocolate cysts (endometrial tissue in ovary. bleeds but blood is trapped so turns brown)

Infertility

Increased risk of ectopic

Non-Hodgkins lymphoma risk

IBD risk

Risk of obstruction

91
Q

Define pelvic inflammatory disease

A

Infection of the upper genital tract including the uterus, Fallopian tubes and ovaries

initiated by an infection that ascends from the vagina +/- cervix

92
Q

What are the most likely causative organisms of PID?

A

Chlamydia Trachomatis

Neisseria Gonorrhoea

The rest are anaerobes or ascension of bac vag

93
Q

How can an organism ascend to cause PID?

A

untreated infection

uterine instrumentation e.g. IUD insertion

Post partum

94
Q

What are the risk factors for PID?

A

Under 25 years old

New/multiple sexual partners

No condom use

Low socioeconomic satus

95
Q

How does PID normally present?

A

BIG VARIATION

Pain - lower abdominal, usually bilateral/constant, deep dyspareunia, dysmenorrhoea. Cervical excitation and adnexal tenderness o/e

Bleeding - ICB/PMB

Abnormal discharge - increased, ?mucopurulent, change in smell and colour etc

Active chronic infection will be afebrile

96
Q

What are the bedside investigations for PID?

A

STI screen (supports but doesn’t diagnose)
Pregnancy Test
Urinalysis

97
Q

What are the blood tests for PID?

A

Generic infection markers - FBC, CRP, U&E

LFTs - Fitz-Hugh-Curtis

98
Q

What imaging can be done for PID?

A

TVS for ?tubo-ovarian abscess

99
Q

How can PID be diagnosed?

A

Gold standard is laparoscopy but not always possible

100
Q

What is the medical management for PID?

A

Antibiotics ASAP
Outpatient = Ceftriaxone IM OR Azithromycin PO + Doxycycline for 14 days + metronidazole

Inpatient = Ceftriaxone IV + Doxycycline IV AND PO + metronidazole PO for 14 days

101
Q

What is the surgical management of PID?

A

Laparoscopic drainage + adhesiolysis

102
Q

What is the general management of PID?

A

Analgesia

Contact tracing

Avoid sex until both have finished treatment and been followed up

103
Q

What are the complications of PID?

A

Tubo-ovarian abscess > adhesions > infertility/ectopic

Fitz-Hugh-Curtis - inflammation of Glisson’s capsule + perihepatic adhesions = RUQ pain

Recurrence > chronic inflammation > chronic pelvic pain

104
Q

Define dysfunctional uterine bleeding

A

Heavy menstrual bleeding in the absence of pathology

Diagnosis of exclusion and accounts for the majority of cases

105
Q

What is the pathophysiology of DUB?

A

Loss of cyclical oestrogen so levels are constantly stable

Endometrium proliferates but doesn’t slough until it outgrows its own blood supply

106
Q

What are the bedside investigations for DUB?

A

History

Examination - abdo, pelvis, speculum

107
Q

What are the blood tests for DUB?

A

FBC - anaemia

Clotting - ?coagulopathy/Fhx

Coagulation screen

TFT - hypothyroidism

HcG - exclude pregnancy

108
Q

What is the hormonal medical management of DUB?

A

1) mirena - suppresses oestrogen and thins endometrium

2) COCP/depot/POP

109
Q

What is the non-hormonal medical management of DUB?

A

1) Tranexamic acid

2) Mefanamic acid

110
Q

What is the MOA of tranexamic acid?

A

Binds reversibly to lysine receptor on plasminogen

Reduces breakdown of plasminogen to plasmin

Means fibrin isn’t broken down

CI = thromboembolic disease

111
Q

What is the MOA of mefanamic acid? Contraindications?

A

NSAID so inhibits COX1 and COX2

Inhibits prostaglandin formation

CI = PUD, IBD, Asthma

112
Q

Define endometrial cancer

A

Usually an adenocarcinoma that arises from the endometrium and is oestrogen dependent

113
Q

Define endometrial hyperplasia

A

A pre-malignant condition where the endometrium overgrows, potentially due to prolonged and persistent oestrogenic stimulation

114
Q

What is the overall pathophysiology of endometrial cancer?

A

Unopposed oestrogen from:
endogenous sources

exogenous sources

genetics

115
Q

How does unopposed endogenous oestrogen from lower progesterone lead to endometrial cancer? Give examples of sources

A

Less progesterone

Anovulation e.g. PCOS. Immature follicles mean no corpus luteum to produce progesterone = unopposed oestrogen

Nulliparous - less endogenous progesterone

116
Q

How does unopposed endogenous oestrogen from ↑oestrogen lead to endometrial cancer? Give examples of sources

A

Obesity/Associated conditions e.g. T2DM/HTN. Aromatase is present in adipose tissue meaning more testosterone converted to oestrogen

Early menarche/late menopause

117
Q

How does unopposed exogenous oestrogen from lower progesterone lead to endometrial cancer? Give examples of sources

A

Tamoxifen (selective oestrigen receptor modulator/partial oestrogen receptor agonist)

HRT - Can only give ERT if no uterus

118
Q

Give an example of a genetic condition that is also associated with endometrial cancer

A

Hereditary Non-polyposis Colon Cancer (HNPCC)

119
Q

What are the symptoms of endometrial cancer?

A

Post-menopausal Bleeding (red flag if unexplained and after 1 year of amenorrhoea)

Pre-menopausal bleeding - v v heavy and irregular

120
Q

When should a women with PMB be 2ww?

A

> 55 and PMB

Consider if <55

121
Q

What imaging should be done to diagnose endometrial cancer?

A

Transvaginal ultrasound scan

Hysteroscopy +/- biopsy (outpatient or GA)

122
Q

What are the TVS findings for endometrial cancer that indicate a hysteroscopy is needed?

A

Thickness:
> or = to 4mm (not on HRT)
> or = to 5mm (on HRT)

~12mm could be a polyp?

Offer if bleeding and taking tamoxifen

123
Q

What is the medical management for endometrial hyperplasia?

A

Progesterone therapy e.g. mirena/POP

longer term benefits e.g. 5 years

124
Q

What is the medical management for endometrial canceR?

A

Adjuvant therapy

Chemo - post op stage III and IV
Radio - Reoccurence?
External beam to control bleeding

125
Q

What is the surgical management for endometrial cancer?

A

Total abdominal hysterectomy and bilateral salpingoophrectomy

Refer to oncologists too

126
Q

When are women invited for cervical screening?

A

25-49 = invited every 3 years via their GP

50-64 = invited every 5 years

127
Q

Why are women invited for cervical screening?

A

Screening for dyskaryosis as a way of cancer prevention by checking health of cervix

look for cervix specific low grade abnormal cell changes (dyskaryosis)

Look specifically for HPV 16&18 as are high risk for cervical cancer

128
Q

How is a cervical smear performed?

A

Cervix looked at using a speculum

Small brush is used to scrape cells from transformation zone then suspended in a liquid (liquid based cytology)

129
Q

When are women discharged back to the cervical screening programme?

A

Low grade dyskaryosis and HPV NEGATIVE

130
Q

When are women referred to colposcopy from the cervical screening programme?

A

Low grade dyskaryosis and HPV POSITIVE

High grade (moderate) dyskaryosis

High grade (severe) dyskaryosis

3 inadequate smears in a row

131
Q

To which groups of people is the HPV vaccine offered to? Which strains does this protect against?

A

Both girls and boys aged 12-14

MSM up to 45 or HIV +ve

Protects against HPV 16&18 (high risk for cancer) and HPV 6&11 (majority of anogenital warts)

132
Q

What is the pathophysiology of cervical cancer?

A

Usually HPV 16&18

Infects epithelium and gains access to basal layer without disrupting the squamous layer

Alters p53 (t. suppressor) and pRB = unregulated growth

Epithelial cells become koilocytes (pre-cancerous)

133
Q

What are the risk factors for cervical malignancy relating to HPV?

A

Multiple partners

Not using barrier methods

Early 1st sexual experience

134
Q

What are the hormonal risk factors for cervical malignancy?

A

High parity

Long term COCP use

135
Q

What are 2 other risk factors for cervical malignancy? HPV and hormones already said

A

Smoking (reduces viral clearance)

Immunosuppression e.g. HIV or transplant

136
Q

How does cervical cancer normally present?

A

Bleeding - PCB/PMB/IMB (HMB if advanced)

Abnormal (watery discharge)

Dyspareunia

Cancer symptoms - weight loss/fatigue

Advanced - ureteric obstruction/vesivovaginal fistula/ change in bowels

137
Q

How does cervical cancer present on colposcopy?

A

Abnormal cervix on colposcopy and dense uptake of acetic acid

138
Q

How does cervical cancer present on examination?

A

Feels rough and hard on bimanual

Irregular mass on speculum

139
Q

What are the pre and post menopausal investigations of cervical cancer?

A

Pre = check for STI. Colposcopy and biopsy if negative.

Post = 2ww? colposcopy and biopsy

140
Q

What is the FIGO staging?

A

0 = CIN

1 = Just in cervix

2 = Beyond cervix and some in vag

3 = pelvic side wall and lower 1/3 vag

4 = metastases to other organs e.g. bladder

141
Q

What is the treatment of cervical cancer according to the FIGO staging?

A

0 = large loop excision of the transformation zone

1 = local excision or hysterectomy + lymphadenectomy

2 = chemoradiotherapy

3 = chemoradiotherapy

4 = palliative care and chemoradio

**important to consider fertility sparing options

142
Q

Define infertility

A

No clinical pregnancy within 1 year of regular, unprotected sex

primary = never conceived
secondary = conceived before i.e. have had a pregnancy but not necessarily a baby
143
Q

What is the rule of 1/4 in relation to infertility

A

Cause is:

25% is idiopathic

25% is tubal factors
25% is ovarian function

25% male factors

144
Q

What are the tubal factors that may cause infertility?

A

Adhesion formation

PID/endometriosis/previous surgery

Illegal abortions

145
Q

What are the ovarian factors that may cause infertility?

A

THINK HPO

H - rare e.g. ischaemic damage

P - Hypogonadotrophic hypogonadism e.g. neoplasia, trauma OR hyperprolactinaemia (GnRH inhibition)

O - ovarian insufficiency/PCOS/Excess body fat loss/Turners

146
Q

What are the male factors that may cause infertility?

A

Sperm problems - production/function/delivery i.e. blockage of vas deferens

147
Q

What are the specific questions to consider when taking a history about infertilitY?

A

O&G history
Social Hx
High BMI/pelvic pathology

Undescended testes/ adult mumps/PMH

148
Q

Which blood tests should be done when investigating infertility?

A

Female
Hormone profile - Day 2-5 FSH and LH
Mid luteal progesterone - 7 days before period due to start and do again if low as ovulation doesn’t occur each month

Rubella status
?prolactin and TFTs

149
Q

What imaging should be done when investigating infertility?

A

Tubal patency test +/- TVS +/- laparoscopy

TVS for uterine abnormalities

150
Q

What male investigations should be done when investigating infertility?

A

Semen analysis - maybe do 2 as large variability

STI screen (for both)

151
Q

What is the conservative management for infertility? (6)

A

General life advice

Weight loss if high BMI but keep above 19

No smoking/cessation support

No alcohol for women but in safe limits for men

Folic acid 0.4mg per day

Have sex 2-3 times a week but don’t pressure

152
Q

What is the medical management for infertility?

A

Ovulation induction using clomifene citrate (anti-oestrogen so increases FSH)

Take 2-6 days of the cycle for 8-12 cycles

Can cause menopausal symptoms

need to monitor ovaries due to hyper stimulation risk

153
Q

What is the surgical management for infertility?

A

Can catheterise proximal tubal blocks

IVF but NHS has really specific criteria

154
Q

What are the main causes of pre-menopausal adnexal masses? (6)

A

Functional cysts

Cystic Neoplasms

Sex Cord Stromal

Ectopic Pregnancy

Endometrioma/sis

Fallopian tube lesion

155
Q

What is a functional cyst?

A

Follicular i.e. hasn’t ruptured or corpus luteum i.e. hasn’t matured

usually dissolves on its own but may cause pain if ruptures

156
Q

What are the main cystic neoplasms in a pre-menopausal woman?

A

Germ Cell

Either a benign cystic teratoma or a Dermoid cyst (the one with the teeth)

157
Q

What is a fallopian tube lesion in relation to adnexal masses?

A

Hydrosalpinges

The Fallopian tube becomes abnormally dilated, usually due to PID

158
Q

What are the main causes of adnexal masses in post-menopausal women?

A

Ovarian fibroma - benign tumour of connective tissue (slow growing and variable size)

Cystic neoplasm

159
Q

What are the main cystic neoplasms in a post-menopausal woman?

A

Serous cystadenoma (25% malignant)

Mucinous (the massive ones, 5% malignant)

Endometroid malignant

160
Q

How do adnexal masses normally present? (4)

A

Incidental/asymptomatic

Pain - acute if torted/ruptured or chronic if cyclical or dyspareunia

irregular pv bleeding

abdominal swelling/bloating that doesn’t go away when bladder is empty and is dull to percuss

161
Q

Which blood tests should be done to investigate adnexal masses?

A

CA-125

<40 = AFP(germ cell tumours), LDH, hCG

162
Q

What imagine should be done to investigate adnexal masses?

A

1) TVS on 2WW

2) CT/MRI if big or complex

163
Q

What special tests can be done to investigate adnexal masses?

A

Fine needle aspiration and cytology

164
Q

What is the treatment for adnexal masses in pre-menopausal women?

A

Try to preserve fertility

<7cm = no surgery

> 7cm and symptoms = lap cystectomy

165
Q

What is the treatment for adnexal masses in post-menopausal women?

A

Risk of malignancy index

low risk = CA-125 and repeat TVS every 4 months then stop after 1 year

High risk = bilateral oophrectomy

166
Q

What is the deal with the irreversible part of sterilisation?

A

Reversing the procedure is never funded on the NHS

Should be viewed as irreversible even though 3-10% women express regret

Have to document explicitly what you told them and if don’t agree have to hand over to HCP for 2nd opinion

167
Q

What is the failure rate of females compared to males for sterilisation?

A

1:200 in women but 1:2000 in men!!!!! WTF!

This failure rate is worse than the mirena!!! Also mirena is a lot less invasive make sure you discuss this!

168
Q

What are the complications of female sterilisation?

A

Specific - Increased risk of ectopic pregnancy, damage to surrounding structures, failure

General surgical complications

169
Q

What are the two types of HRT?

A

Combined HRT using both oestrogen and progesterone

Oestrogen only HRT (ERT)

170
Q

What are the two types of combined HRT and when can they be used?

A

Cyclical - if perimenopausal i.e. still having a period or withdrawal bleed and can see a natural end to periods

Continuous - used if post-menopausal/have had amenorrhoea for over a year OR have been on cyclical for >1year OR <45 OR 2 years since LMP

171
Q

When can ERT be used?

A

Only if uterus is NOT PRESENT (due to unopposed oestrogen and endometrial cancer risk)

Or having progesterone from another source e.g. mirena

172
Q

What are the modes of administration for HRT?

A

Oral

Transdermal Patch

Topical e.g. oestrogen cream or pessary

173
Q

What are the benefits and risks of oral HRT?

A

Benefits - lowest atherogenic risk

Risks - highest VTE risk and undergoes first pass metabolism so not for liver disease

SO

Good for women with high CVD risk but not for high clot risk

174
Q

What are the benefits and risks of HRT via a transdermal patch?

A

Benefits - Lowest VTE risk (reduces clotting factor production @ liver)

Risks - skin allergies

SO

Good for women with migraines/diabetes/high VTE risk

175
Q

When would topical HRT be used?

A

If urogenital symptoms are most concerning

Has small systemic absorption

176
Q

When can IUS+oestrogen be used as HRT?

A

Contraception wanted + bleeding on cyclical

177
Q

What are the overall risks of HRT?

A

Breast cancer - highest risk is on combined HRT. Risk increases by 2.3% every year up to 5 years but returns to initial risk after this

Endometrial cancer - ERT is highest risk but mirena can be used to oppose this

Oral preparations = VTE risk

Increased risk CVD

178
Q

What are the benefits of HRT?

A

Symptom Relief!

Reduced risk of osteoporosis

Reduced risk of colorectal cancer

179
Q

What are the contraindications to HRT? (5)

A

Pregnancy/breastfeeding

Hx breast cancer - offer neither

Hx VTE

Liver disease

Undiagnosed pv bleed

180
Q

What should be monitored in a woman using HRT? (5)

A

Blood pressure - stop if >160/100

Breasts - screening attendance

Weight

Pv bleeds

check effect aat 3 months

EOY4 (22 decks)

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