Brainscape's Knowledge GenomeTM

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


See full index

Med Student Finals > Gynaecology > Flashcards

Gynaecology Flashcards

1
Q

Menstruation

Hormones (5)

A

Cycle controlled by hypothalamic-pituitary-ovarian axis
Gonadotrophin-releasing hormones are produced by the hypothalamus
Stimulates pituitary to produce gonadotrophins: FSH + LH
They stimulate the ovary to produce oestrogen and progesterone
They modulate production of gonadotrophins by negative feedback on the hypothalamus and pituitary

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

Menstruation

Cycle (8)

A

At start, FSH levels high, stimulating development of a primary follicle
The follicle produces oestrogen, which stimulates the development of a glandular ‘proliferative’ endometrium and of cervical mucus receptive to sperm
14 days before menstruation the oestrogen level becomes high enough to stimulate surge of LH, stimulating ovulation
Primary follicle forms corpus + produces progesterone
Endometrial lining prepared for implantation, ‘secretory phase’
Cervical mucus becomes hostile to sperm
If ovum not fertilised, corpus luteum breaks down and hormone levels fall
Reduced hormones causes arteries in uterine endothelium to constrict and slough

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

Hypothalamo-Pituitary Ovarian Axis Feedback

A

+ve feedback: oestrogen on hypothalamus and anterior pituitary days 12-14
-ve feedback: oestrogen and progesterone on hypothalamus and anterior pituitary for most of cycle, this prevent more than one egg being released

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

Hormones in the Ovarian Cycle

A

Oestrogen is present in the follicular phase
Progesterone is released in the luteal phase to prepare the uterus for pregnancy, if no implantation the corpus luteum degenerates
Corpus luteum secretes progesterone

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

Roles of Main Female Reproductive Hormones

A

GnRH (from hypothalamus): stimulates LH and FSH secretion from anterior pituitary
LH (from anterior pituitary): maintains dominant follicle and stimulates corpus luteum function
FSH (from anterior pituitary): stimulates follicular recruitment and development
Oestradiol (from granulosa cells): supports secondary sex characteristics, -ve feedback of LH + GnRH
Progesterone (from corpus luteum): maintains secondary endometrium

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

Primary Amenorrhoea

Definition (1)

A

Failure to start menstruating before age 16, or 14 if no secondary sexual characteristics

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

Primary Amenorrhoea

Aetiology (6)

A 
Familial late puberty 
Heavy exercise/stress/weight loss
Pituitary and hypothalamus disease 
Gonadal dysgenesis (ovaries prematurely depleted of follicles and oocytes) 
Turner syndrome 
PCOS
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Primary Amenorrhoea

Treatment (4)

A

Weight gain/less exercise/less stress
If amenorrhoea persists for >12 months, consider osteoporosis prophylaxis
Treat hypothalamic/hypoprolactinaemic causes
HRT or COCP if amenorrhoea >12 months

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

Secondary Amenorrhoea

Definition (1)

A

Periods stop for >6 months in the absence of pregnancy

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

Secondary Amenorrhoea

Aetiology (7)

A

Hypothalamic-pituitary-ovarian causes are common: stress, weight loss, exercise
Hyperprolactinaemia: may have galactorrhoea
Hypo- and hyper-thyroidism
PCOS
Ovarian insufficiency/failure (premature menopause, secondary to chemo/radio, genetic- Turner’s)
Post-pill amenorrhoea
Asherman’s syndrome (adhesions after D+C)

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

Secondary Amenorrhoea

Investigations (6)

A

BhCG to exclude pregnancy
Serum free androgen index (increased in PCOS)
FSH/LH (low if hypothalamic-pituitary cause but may be normal if weight loss/exercise)
Prolactin (increased by stress, hypothyroidism, prolactinomas)
TFTs
Testosterone level (may indicate androgen secreting tumour)

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

Secondary Amenorrhoea

Treatment (2)

A

Premature ovarian failure can’t be reversed but hormone replacement is necessary to control symptoms of oestrogen deficiency and protect against osteoporosis
For hypothalamic-pituitary-ovarian malfunction: weight loss + lifestyle measures, clomifene/gonadotrophin releasing hormone for fertility

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

Polycystic Ovarian Syndrome

Signs + symptoms (5)

A 
Oligomenorrhoea/amenorrhoea 
Hirsutism (excess hair) 
Acne 
Subfertility 
Acanthosis nigrans (reflects hyperinsulinaemia)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q 
Polycystic Ovarian Syndrome
Rotterdam Criteria (4)
A

2 out of 3 must be present
Polycystic ovaries (12 or more follicles or ovarian volume >10cm3 on ultrasound)
Oligo-ovulation or anovulation
Hyperandrogenism (clinical or biochemical signs)

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

Polycystic Ovarian Syndrome

Investigations (6)

A 
TFTs (rule out dysfunction) 
Prolactin (rule out hyperprolactinaemia) 
Rule out androgen secreting tumours 
Rule out Cushing's 
Testosterone high 
LH high
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Polycystic Ovarian Syndrome

Treatment (6)

A

Weight loss (high insulin sensitivity)
Metformin (improve insulin sensitivity and improve menstrual disturbance)
Clomifene (induces ovulation)
Ovarian drilling when don’t respond to clomifene (intent is to reduce steroid production)
COCP (control bleeding and reduce risk of unopposed oestrogen)
Anti-androgen (reduce hirsutism)

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

Polycystic Ovarian Syndrome

Complications (4)

A

Gestational diabetes
Type 2 diabetes
CV disease
Endometrial cancer

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

Menorrhagia

Definition (1)

A

Heavy periods, blood loss >80ml/cycle

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

Menorrhagia

Aetiology (8)

A 
Dysfunctional uterine bleeding (most common)- heavy and/or irregular bleeding in absence of pelvic pathology
Fibroids 
Endometriosis 
Adenomyosis 
Early pregnancy loss 
Hypothyroidism 
Coagulation disorders (vWB, platelet abnormalities, warfarin) 
Endometrial cancer
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Menorrhagia

Signs + symptoms (7)

A

Heavy, prolonged vaginal bleeding, often worse at extremities of reproductive life
Dysmenorrhoea
Symptoms of anaemia
Pallor
If intermenstrual or post coital bleeding check smear history
Enlarged uterus suggests fibroids or adenomyosis
Speculum examination may reveal a cervical polyp

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

Menorrhagia

Investigations (6)

A 
Exclude pregnancy 
FBC 
TSH 
Cervical smear if due 
STI screen 
If <45 no further investigation and start treatment, if >45 with risk factors/failed medical therapy then do transvaginal US and biopsy to look for fibroids, polyps, endometrial thickness
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Menorrhagia

Treatment (7)

A

Mirena IUS 1st line
Antifibrinolytics eg.tranexamic acid during bleeding
NSAIDs eg. mefanamic acid during bleeding, especially if also dysmenorrhoea
COCP
3rd line progestogens IM eg. norethisterone stops heavy bleeding short term
Endometrial ablation
If have fibroids but wish to retain fertility: uterine artery embolisation or myomectomy, otherwise hysterectomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q 
Menopause 
Average age (1)
A

52

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

Menopause

Pathology (2)

A

Perimenopause: high number of anovulatory cycles leads to less progesterone and less endometrial secretory changes and irregular menses
Menopause: oestradiol falls due to lack of developing follicles and their granulosa cells, lack of -ve feedback to pituitary causes and increased FSH and LH

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

Menopause

Signs + symptoms (4)

A

Menstrual irregularity as cycles become anovulatory, before stopping
Vasomotor disturbance- sweats, palpitations and flushes
Atrophy of oestrogen-dependent tissues (vagina, breasts)- vaginal dryness which my lead to vaginal and urinary infections, stress incontinence and prolapse
Osteoporosis: menopause accelerates bone loss

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

Menopause

Treatment (3)

A

Contraception until >1 year amenorrhoea
Oestrogen cream for vaginal dryness
HRT: systemic- tablets/patches (bypasses 1st pass metabolism so reduces VTE risk) or local-creams, no uterus = oestrogen only, uterus = oestrogen + progesterone (oestrogen and cyclical progesterone whilst still having periods, continuous combined HRT in post-menopausal)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q 
Menopause 
HRT contraindications (6)
A 
Oestrogen-dependent cancer 
Past PE 
Undiagnosed PV bleeding 
High LFTs 
Pregnancy 
Breastfeeding
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Menopause

Effects of HRT (6)

A 
Fluid retention 
Bloating 
Breast tenderness 
Nausea 
Headaches 
Mood swings, depression , acne due to progesterone
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Menopause

Alternatives to HRT (3)

A

SSRIs for vasomotor symptoms
Calcium, vitamin D, bisphosphonates for osteoporosis
Lubricants/vaginal oestrogens if vaginal dryness main symptom

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

Menopause

Benefits of HRT (4)

A

Reduction of vasomotor symptoms (usually evident by 4 weeks and maximum effect by 3 months)
Improved genital symptoms and sexual function
Reduced osteoporotic fractures
Reduced risk of colorectal cancer

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

Menopause

Risks of HRT (3)

A 
Breast cancer (increases risk by 2.3% per year, back to never user after 5 years) 
Endometrial cancer (unopposed oestrogen only) 
VTE (doubled risk)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Post Menopausal Bleeding

Differentials (6)

A 
Endometrial cancer 
Vaginal atrophy 
Cervical cancer 
Bleeding related to HRT use 
Endometrial hyperplasia or polyp 
Vaginal cancer
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Post Menopausal Bleeding

Investigations (3)

A

TVUSS: endometrial thickness >4mm requires further investigation
Endometrial biopsy
Hysteroscopy

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

Post-Coital and Intermenstrual Bleeding

Differentials (3)

A

Upper: pelvic inflammatory disease
Cervical: cervicitis (chlamydia/gonorrhoea), cervical ectropion/erosion, cervical/endometrial polyps, cervical cancer
Vaginal: vaginal atrophy, trauma/sexual abuse, vaginal cancer

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

Intermenstrual Bleeding Only

Differentials (6)

A

Pregnancy related
Physiological: ovulation spotting, perimenopausal
Vaginal: vaginitis
Uterine: endometrial cancer, fibroids, adenomyosis, endometritis
Ovary: oestrogen secreting tumours
Iatrogenic: post smear/colposcopy, missed OCPs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q 
Endometriosis
Definition (1)
A

Endometrial tissue outside uterus (oestrogen dependent)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q 
Endometriosis
Risk factors (3)
A

Reproductive age (oestrogen driven)
Family history
Nulliparity

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

Endometriosis

Signs + symptoms (7)

A

Pin- may be cyclical due to endometrial tissue responding to menstruation or it amy be constant due to formation of adhesions from chronic inflammation
Severe dysmenorrhoea
Deep dyspareunia
Subfertility
Tender nodules in rectovaginal septum or uterosacral ligaments
Fixed retroverted uterus
Adnexal masses

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q 
Endometriosis
Investigations (3)
A

Laparoscopy + biopsy gold standard: chocolate cysts filled with old blood
TVUSS: identifies ovarian endometriotic cysts but poor for other disease parameters
MRI: maps extent of endometriosis, especially good for bowel involvement

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q 
Endometriosis
Treatment (2)
A

Medical: COCP, progesterone (POP, Depo, Mirena), GnRH analogues with addback HRT
Surgical: if medical fails, laparoscopy using ablation/excision/coagulation, hysterectomy last resort

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

Adenomyosis

Definition (1)

A

Endometrial tissue in or deep to the myometrium

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

Adenomyosis

Signs + symptoms (2)

A

Dysmenorrhoea

Menorrhagia

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

Adenomyosis

Investigations (2)

A

MRI indicates diagnosis

Laparoscopy/hysteroscopy may be normal but do uterine muscle biopsy

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

Adenomyosis

Treatment (2)

A

Mirena

Hysterectomy

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

Leiomymoma (Fibroids)

Defintion (2)

A

Benign smooth muscle tumours of the uterus

Submucosal (under endometrium), intramural, subserosal (under the visceral peritoneum)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q 
Leiomymoma (Fibroids)
Risk factors (5)
A 
Age
Family history 
Increased weight 
Afro-Caribbean 
Enlarge in pregnancy and on combined pill because they are oestrogen dependent (atrophy after menopause)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

Leiomymoma (Fibroids)

Signs + symptoms (6)

A 
May be asymptomatic 
Menorrhagia 
Fertility problems if submucosal 
Pain 
Mass abdominally 
If large, may cause urinary frequency or obstructed labour
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

Leiomymoma (Fibroids)

Investigations (3)

A

TVUSS
Hysteroscopy
Endometrial biopsy

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

Leiomymoma (Fibroids)

Treatment (5)

A

GnRH analogues: shrunk fibroids
Selective progesterone receptor modulator (ullipristal acetate) to shrink fibroids and induce amenorrhoea
Myomectomy to retain fertility
Uterine artery embolisation (doesn’t retain fertility)
Hysterectomy only cure

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

Leiomymoma (Fibroids)

Complications (1)

A

Red degeneration in pregnancy: capsular vessel thrombosis then venous engorgement causes abdo pain, vomiting and fever

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q 
Endometrial Cancer
Risk factors (8)
A 
Post-menopausal 
Unopposed oestrogen 
Nulliparity (pregnancy = progesterone) 
Obesity, type 2 diabetes (increased peripheral oestrogen) 
Anovulatory cycles as PCOS (absence of corpus luteum = absence of progesterone) 
Early/late menopause 
Genetic: HNPCC
Oestrogen-only HRT
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

Endometrial Cancer

Pathology (2)

A

Adenocarcinoma most common

Serous and clear cell carcinoma more aggressive, older women affected

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

Endometrial Cancer

Sings + symptoms (3)

A

Post-menopausal bleeding
PV discharge
If pre-menopausal, irregular + heavy periods

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

Endometrial Cancer

Investigations (4)

A

TVUSS (endometrial thickness >4mm)
Endometrial biopsy
Hysteroscopy
CT/MRI for staging

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

Endometrial Cancer

Staging (FIGO) (4)

A

I- body of uterus only
II- body + cervix
III- advancing beyond uterus but not beyond pelvis
IV- outside pelvis eg. bladder/bowel

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

Endometrial Cancer

Treatment (3)

A

Total hysterectomy + bilateral salpingooophorectomy
Also do radiotherapy if advanced
High dose progesterone for palliation

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

Endometrial Cancer

Survival (2)

A

Stage I: 85% 5 year survival

Stage IV: 25% 5 year survival

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

HPV Infection

Epidemiology (2)

A

Peak prevalence 15-25

Lifetime exposure risk 75%

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

HPV Infection

Aetiology (2)

A

6+11 cause genital warts

16+18 cause cervical cancer

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

HPV Infection

Pathology (2)

A

Virus enters cell nuclei disrupting the normal cell cycle to cause abnormal cell growth
Most low grade: intraepithelial lesions (LSILs) cleared within 6-12 months but some persist + progress to HSIL

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

HPV Infection

Vaccination (1)

A

Girls + boys aged 12

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q 
HPV Infection 
Cervical screening (3)
A

Women aged 25-64 (3 yearly 25-50, 5 yearly until 64 if normal)
Cells removed from transformation zone (columnar endocervical canal meeting squamous ectocervix- vaginal cervix)
Looking for dyskaryosis, if present then do colposcopy

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

Cervical Intra-Epithelial Neoplasia

Aetiology (2)

A

HPV 16+18 cause high grade changes

HPV 6+11 can cause transient low grade changes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q 
Cervical Intra-Epithelial Neoplasia 
Risk factors (4)
A

Persistent high-risk HPV infection
Exposure risk increased by having multiple partners
Smoking
Immunocompromised

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

Cervical Intra-Epithelial Neoplasia

Pathology (4)

A

Non-invasive squamous cell changes that don’t invade beyond basement membrane
CIN1 (mild): lowest 1/3 epithelium
CIN2 (moderate): 2/3 epithelial thickness, 3-5% progress to cancer
CIN3 (severe): full epithelial thickness, 20-30% progress to cancer

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

Cervical Intra-Epithelial Neoplasia

Treatment (2)

A

CIN1: 6-monthly colposcopy if HPV +ve and LLETZ (large loop excision of transformation zone) if persistent
CIN 2/3: LLETZ

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q 
Cervical Cancer
Risk factors (5)
A 
HPV 16/18 
Multiple partners 
Early first intercourse age 
Smoking 
45-55 years old
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

Cervical Cancer

Pathology (1)

A

Squamous carcinoma

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

Cervical Cancer

Signs + symptoms (5)

A

Post coital bleeding
Watery, offensive discharge
On speculum: visible tumour that bleeds on contact
On bimanual: roughened + hard cervix, becomes fixed when advances
Advanced disease: heavy vaginal bleeding, ureteric obstruction, weight loss

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

Cervical Cancer

Investigations (4)

A

FBC, U&E, LFT
Punch biopsy for histology
Colposcopy
CT/MRI abdo pelvis for staging

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

Cervical Cancer

Staging (FIGO) (4)

A

I: confined to cervix (1a microscopic, 1b macroscopic)
II: spread to upper 2/3 vagina
III: spread to lower 1/3 vagina
IV: spread to bladder/rectum

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

Cervical Cancer

Treatment (4)

A

Stage 1a <3mm in depth: local excision (fertility sparing) or hysterectomy
Stage 1a-IIa: radical hysterectomy
Stage IIB/IVA/unfit: radical chemoradiation, 24h caesium insertion
Stage IVB: palliative radiotherapy to control bleeding

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

Pelvic Mass

Differentials (5)

A 
Ovarian: benign cyst, ovarian cancer 
Fallopian: ectopic, PID 
Uterine: fibroid, endometrial cancer 
Colorectal cancer 
Pelvic lymphadenopathy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
74
Q 
Ovarian Cancer
Risk factors (5)
A 
Nulliparity 
Early menarche and/or late menopause 
BRCA 1+2
HNPCC
Age (rare <30)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
75
Q 
Ovarian Cancer
Protective factors (4)
A

Pregnancy
Breastfeeding
COCP
Tubal ligation

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

Ovarian Cancer

Signs + symptoms (10)

A 
Often vague symptoms misinterpreted as IBS/diverticular disease, 75% only present to gynae at stage III 
Indigestion
Bloating 
Weight loss/gain 
Early satiety 
Fatigue 
Altered bowel habit 
Pelvic mass 
Ascites 
Supraclavicular node enlargement
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
77
Q

Ovarian Cancer

Investigations (6)

A 
FBC, U&amp;E, LFT
CA125 (although also raised in endometriosis, menstruation, benign ovarian cysts) 
TVUSS + TAUSS
CXR (pleural effusion/lung mets) 
CT abdo/pelvis 
Ascitic fluid pathology
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
78
Q

Ovarian Cancer

Risk of malignancy index (5)

A 
RMI = U x M x CA125
U= ultrasound features, 1 point each for; multilocular/solid areas/bilateral/ascites/intra-abdominal mets
M= menopausal status (1= pre, 3= post) 
C= CA125
RMI >200 suggestive of malignancy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
79
Q

Ovarian Cancer

Staging (4)

A

Stage 1- limited to ovary within capsule
Stage 2- one/two ovaries with pelvic extension
Stage 3- one/two ovaries with peritoneal implants outside pelvis/nodes
Stage 4- distant mets

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

Ovarian Cancer

Treatment (2)

A

Full staging laparotomy + removal of as much tumour as possible
Chemotherapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
81
Q

Ovarian Cancer

Screening (3)

A

Population screening not proven
Screen high risk women (gene mutations/2+ relatives) with pelvic exam, ultrasound CA125 yearly
For high risk women may recommend bilateral salpingoophorectomy

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

Ovarian Cancer

5 year survival (4)

A

Stage 1: 75-90%
Stage 2: 45-60%
Stage 3: 30-40%
Stage 4: <20%

83
Q

Benign Ovarian Tumours

Classification (6)

A

Functional cysts: enlarged/persistent follicular or corpus luteum cysts, extremely common and physiological if of reproductive age
Endometriomas: ovarian cysts filled with old blood
Fibromas
Teratomas: from primitive germ cells, may contain hair/teeth
Serous cystadenomas: cyst appears solid
Mucinous cystadenomas: commonest large ovarian tumours, filled with mucinous material

84
Q

Benign Ovarian Tumours

Investigations (4)

A

FBC
Tumour markers
TVUSS
MRI for large cysts, distinguishing benign from malignant disease

85
Q

Benign Ovarian Tumours

Treatment (2)

A

Pre-menopausal: if no features of malignancy and cyst <5cm discharge, if >5cm or symptomatic then laparoscopic ovarian cystectomy
Post-menopausal: do RMI, cysts <5cm managed conservatively, moderate cysts bilateral oophorectomy

86
Q

Acute Pelvic Pain

Differentials (8)

A 
Pregnancy: miscarriage, ectopic 
Ovarian: cyst rupture or torsion 
PID 
Pelvic tumour 
Dysmenorrhoea 
Appendicitis 
IBS 
Strangulated hernia
87
Q

Pelvic Inflammatory Disease

Definition (1)

A

Infection of the upper genital tract

88
Q

Pelvic Inflammatory Disease

Aetiology (2)

A

Usually from ascending infection from endocervix (STIs, uterine instrumentation, post-partum)
Descending infections from other organs eg. appendicitis

89
Q 
Pelvic Inflammatory Disease
Risk factors (3)
A

Age <25
Previous STI history
New/multiple sexual partners

90
Q

Pelvic Inflammatory Disease

Signs + symptoms (7)

A 
Lower abdo pain 
Deep dyspareunia 
Vaginal discharge 
Intermenstrual/post-coital bleeding 
Dysmenorrhoea 
Fever
Cervical excitation on examination
91
Q

Pelvic Inflammatory Disease

Investigations (3)

A

Vulvovaginal/endocervical swabs for chlamydia and gonorrhoea
If acutely unwell: FBC (high WCC), CRP (high), blood cultures if septic
TVUSS if suspect tubo-ovarian abscess

92
Q

Pelvic Inflammatory Disease

Treatment (3)

A

Contact tracing
Ceftriaxone IM as outpatient
Ceftriaxone IV and doxycycline IV then oral as inpatient

93
Q

Pelvic Inflammatory Disease

Complications (4)

A

Tubo-ovarian abscess
Ectopic pregnancy
Subfertility
Tubal blockage

94
Q

Ovarian Torsion

Pathology (4)

A

Ovarian cyst disrupts the weight of the ovary causing the ovary to tort
Venous return to ovary occluded
Becomes oedematous, occluding arterial supply
Pain improves after 24h after ovary starts to die

95
Q

Ovarian Torsion

Signs + symptoms (4)

A

Sudden severe lower unilateral abdo pain
Nausea + vomiting
Lower abdo tenderness
Adnexal tenderness/mass

96
Q

Ovarian Torsion

Investigations (1)

A

Pelvic USS: oedematous ovary with reduced blood flow

97
Q

Ovarian Torsion

Treatment (1)

A

Urgent laparoscopy to untwist ovary and remove cyst

98
Q

Ruptured Ovarian Cysts

Aetiology (1)

A

Ovarian cyst ruptures due to physical activity

99
Q

Ruptured Ovarian Cysts

Signs + symptoms (2)

A

Sudden onset unilateral lower abdo pain

Shock if fluid and blood loss in very large cysts

100
Q

Ruptured Ovarian Cysts

Investigations (1)

A

Pelvic USS: free fluid (commonly in pouch of Douglas)

101
Q

Ruptured Ovarian Cysts

Treatment (2)

A

Haemodynamically stable: observation and analgesics

Haemodynamically unstable: urgent laparoscopy to control haemorrhage

102
Q

Vulval Lumps and Ulcers

Differentials (7)

A 
Vulval cancer 
Local varicose veins 
Viral warts 
Herpes simplex 
Molluscum contagiosum 
Inguinal hernia 
Varicocele
103
Q

Vulval Itching and Plaques

Differentials (6)

A 
VIN 
Vulval cancer 
Lichen sclerosis 
Lichen planus 
Lichen simplex 
Vulvovaginitis
104
Q

Vulval Pain

Differentials (2)

A

Vulvovaginitis

Vulvodynia (chronic vulval pain with no identifiable cause)

105
Q 
Vulva Intraepithelial Neoplasia
Risk factors (5)
A 
Smoking 
HPV 16+18 
Other genital tract intraepithelial neoplasia
Immunosuppression 
Lichen sclerosis
106
Q

Vulva Intraepithelial Neoplasia

Signs + symptoms (4)

A

Ulcer/plaque with red, white or brown discolouration
Raised papules/plaques
Roughened appearance
Sharp border

107
Q

Vulva Intraepithelial Neoplasia

Investigations (1)

A

Punch biopsy

108
Q

Vulva Intraepithelial Neoplasia

Treatment (3)

A

Painful irritation lesions excised
Topical treatments- imiquimod
Recurrence is common so follow up regularly

109
Q

Vulva Cancer

Pathology (2)

A

Squamous cell carcinoma preceded by VIN or lichen sclerosis

Basal cell carcinoma/melanoma less common

110
Q 
Vulva Cancer
Risk factors (6)
A 
Age 70-80 
HPV 16+18 
Smoking 
Other genital tract intraepithelial neoplasia/malignancy 
Immunosuppression 
Lichen sclerosis
111
Q

Vulva Cancer

Signs + symptoms (6)

A 
Pain 
Itch 
Bleeding 
Lump 
Ulcer 
Enlarged groin nodes
112
Q

Vulva Cancer

Investigations (1)

A

Punch biopsy

113
Q

Vulva Cancer

Staging (4)

A

I: microinvasion <2cm
II: >2cm
III: local spread + local node involvement
IV: distant/local advanced spread and pelvic node involvement

114
Q

Vulva Cancer

Treatment (5)

A

If <2cm: local excision
If >1mm deep: radical local excision with unilateral/bilateral node dissection
Advanced disease: radical vulvectomy
Radiotherapy pre-op to shrink tumours if sphincters may be affected
Chemoradiation if unfit for surgery

115
Q

Vulva Cancer

Survival (1)

A

5-year survival >80% if <2cm and no nodes, otherwise <50%

116
Q

Incontinence

Control of bladder function (2)

A

In women, continence is maintained in the urethra by the external sphincter and pelvic floor muscles maintaning a urethral pressure
Micturition occurs when these muscles relax and the bladder detrusor muscle contracts

117
Q

Incontinence

Signs + symptoms (8)

A

Involuntary leakage of urine
Continuous leakage is most commonly due to vesicovaginal fistula or an ectopic ureter
Increased daytime voids (normal is 4-7)
Nocturia (up to 70 >1 night time void = abnormal)
Nocturnal enuresis
Urgency (most frequently due to detrusor overactivity)
Voiding difficulties (hesitancy, straining and slow/intermittent stream)
May have feeling of incomplete emptying, bladder pain (interstitial cystitis) or signs of a UTI

118
Q

Incontinence

Classification (4)

A

Stress incontinence: leakage on effort/exertion, or on sneezing/coughing commonly due to urethral sphincter weakness
Urge incontinence: leakage with a strong desire to pass urine, commonly coexists with frequency and nocturia and forms overactive bladder syndrome
Mixed incontinence: combo of urge and stress
Overflow incontinence: usually due to injury/insult eg. post-partum- treat with catheter

119
Q

Incontinence

Investigations (5)

A

Urinalysis + MSU for MC+S to exclude UTI
Frequency/volume chart (normal in stress incontinence, high diurnal frequency and nocturia in overactive bladder)
Imaging for incomplete bladder emptying and check for pelvic mass
Cystoscopy for anatomical visualisation
Urodynamics (looks at ability of bladder to store and void urine)- shows involuntary detrusor contractions in overactive bladder

120
Q

Stress Urinary Incontinence

Epidemiology (1)

A

1 in 10

121
Q

Stress Urinary Incontinence

Pathology (1)

A

Detrusor pressure exceeds closing pressure of the urethra

122
Q 
Stress Urinary Incontinence
Risk factors (5)
A 
Pregnancy 
Oestrogen deficiency after menopause leads to weakening of pelvic support and thinning of the urothelium 
Radiotherapy 
Congenital weakness 
Trauma or radical pelvic surgery
123
Q

Stress Urinary Incontinence

Treatment (7)

A

Weight loss
Smoking cessation
Pelvic floor exercises for at least 3 months
Duloxetine
Peri-urethral injections of bulking agents often successful and have lower morbidity than other procedures
Tension free vaginal tape most common
Colposuspension (now rare)

124
Q

Overactive Bladder Syndrome

Epidemiology (1)

A

1 in 6 women

125
Q

Overactive Bladder Syndrome

Pathology (3)

A

Implies underlying detrusor overactivity
Unpredictable and may be confused with stress incontinence
Diagnosis made on urodynamics- involuntary detrusor contractions during filling

126
Q

Overactive Bladder Syndrome

Treatment (4)

A

Conservative: avoid excessive fluid intake, caffeinated and carbonated drinks + alcohol, bladder retraining- to suppress urinary urge and extend intervals between voiding
Anticholinergics main pharmacological treatment, blocks parasympathetic nerves and relaxing detrusor
Intravaginal oestrogen cream in vaginal atrophy
Botulinum toxin injections into detrusor very effective

127
Q

Pelvic Organ Prolapse

Classification (5)

A

Urethrocele: prolapse of lower anterior vaginal wall involving urethra only
Cystocele: prolapse of upper anterior vaginal wall involving bladder
Uterovaginal prolapse: uterus + cervix + upper vagina
Enterocele: prolapse of upper post. wall of vagina usually containing small bowel loops
Rectocele: prolapse of lower post. wall of vagina involving rectum bulging

128
Q 
Pelvic Organ Prolapse
Risk factors (7)
A

Pregnancy (parity, macrosomia)
Vaginal birth (prolonged second stage, forceps)
Previous pelvic surgeries
Age
Obesity
Sport (long distance running, weight lifting)
Chronic cough

129
Q

Pelvic Organ Prolapse

Grading (3)

A

1st degree: lowest part of the prolapse descends halfway down the vaginal axis to the introitus
2nd degree: lowest part of prolapse extends to the level of the introitus and through the introitus on straining
3rd degree: lowest part of prolapse extends through the introitus and outside the vagina

130
Q

Pelvic Organ Prolapse

Signs + symptoms (5)

A

Dragging sensation
Feeling of something ‘coming down’
Dyspareunia
With cystocele, urinary urgency + frequency, incomplete bladder emptying
With rectocele, constipation and difficulty defecating

131
Q

Pelvic Organ Prolapse

Treatment (4)

A

Pelvic floor muscle training
Silicone ring pessaries
Colposuspension surgery
Hysterectomy

132
Q

Female Infertility

Aetiology (3)

A

Anovulation: PCOS
Tubal: endometriosis, tubal surgery
Unknown

133
Q

Female Infertility

History (6)

A 
Duration of infertility 
Contraception
Fertility in previous relationships 
Sexual history 
Smoking + alcohol 
Menstrual history
134
Q

Female Infertility

Examination (3)

A

BMI
Hair and body fat distribution
Abdo + pelvic exam: pelvic mass, fixed retroversion, tenderness

135
Q 
Female Infertility
Referral criteria (3)
A

Immediate: regular periods, abnormal tests, HIV or Hep B
After 1 year of trying <35
After 6 months of trying 35-45

136
Q

Female Infertility

Investigations (9)

A 
TSH 
Rubella status 
Chlamydia screen 
If periods are regular, mid-luteal progesterone 7 days before expected period 
If periods are irregular, day 1-5 FSH, LH, testosterone
TVUSS 
Histo-salpingo contrast sonography 
Laparoscopy 
Dye test of tubal patency
137
Q

Female Infertility

Management (5)

A

Lifestyle modification
Anovulation: weight loss/gain, clomifene, gonadotrophins, laparoscopic ovarian drilling
Tubal disease: tubal catheterisation
Intrauterine adhesions: hysteroscopic adenolysis
IVF: tubal disease, endometriosis, anovulation not responding to clomifene, maternal age, unexplained subfertility >2 years

138
Q

Male Infertility

Aetiology (5)

A

Semen abnormality: testicular cancer, alcohol, smoking
Azoospermia: anabolic steroids, hypogonadotrophic hypogonadism, cryptochordism, orchitis, Klinefelter’s syndrome, congenital absence of vas deferens, chlamydia + gonorrhoea
Immunological: anti-sperm antibodies, infective (rubella)
Coital: erectile dysfunction, phimosis, retrograde ejaculation, failure of ejaculation (MS, spinal cord injury)

139
Q

Male Infertility

History (6)

A 
Duration of infertility 
Fertility in previous relationships 
Sexual history 
Smoking and alcohol 
History of undescended testes 
History of mumps
140
Q

Male Infertility

Examination (4)

A

Testicular size
Testicular maldescent
Epididymitis (STI)
Vas deferens (CF/vasectomy)

141
Q 
Male Infertility
Referral criteria (3)
A

Immediate: testicular problems, abnormal tests, HIV or Hep B
After 1 year <35
After 6 months 35-45

142
Q

Male Infertility

Investigations (3)

A 
Semen sample (low vol, low conc, low motility) 
Hormone profile (FSH, LH, testosterone, oestradiol, sex hormone binding globulin) 
Urine analysis for retrograde ejaculation
143
Q

Male Infertility

Management (4)

A

Lifestyle modification
Abnormal serum analysis: prescribe multivitamin (selenium, zinc, vit C) and re-test in 3 months
Intracytoplasmic sperm injection
IVF: male subfertility unexplained subfertility >2 years

144
Q

Regular Contraception: COCP
Mode of action (3)
Effectiveness (1)

A

Mode of action:
- prevent ovulation by altering FSH + LH due to -ve feedback of progesterone and oestrogen on hypothalamus and pituitary to stop surge
- prevents implantation (inadequate endometrium)
- alters cervical mucus to prevent sperm penetration
Effectiveness:
- 99% if taken perfectly

145
Q

Regular Contraception: COCP
Contraindications (5)
Risks (3)
Side effects (4)

A 
Contraindications: 
- smoker 
- migraine with aura 
- breastfeeding up to 6 months 
- FH of breast cancer 
- CV/VTE risk 
Risks: 
- VTE
- breast cancer 
- cervical cancer
Side Effects: 
- headaches 
- nausea
- mood swings 
- breast tenderness
146
Q

Regular Contraception: COCP
Advantages (4)
Disadvantages (3)

A 
Advantages: 
- controlled timing of periods 
- reduced PMS 
- reduced risk of ovarian, endometrial and colon cancer 
- improves acne 
Disadvantages: 
- requires remembering to take at same time each day 
- breakthrough bleeding 
- user dependent
147
Q

Regular Contraception: Combined Contraceptive Patch
Mode of action (1)
Use (1)

A

Mode of action:
- inhibits ovulation
Use:
- wear patch 3 weeks then 1 week patch free

148
Q

Regular Contraception: Combined Vaginal Ring

Mode of action (1)

A

Inhibits ovulation

149
Q

Regular Contraception: Progesterone Only Pill
Mode of action (2)
Effectiveness (1)

A 
Mode of Action: 
- thickens cervical mucus
- hormones either norethisterone, levonorgestrel, desogestrel 
Effectiveness: 
- 99% if taken perfectly
150
Q

Regular Contraception: Progesterone Only Pill
Contraindications (3)
Risks (2)
Side effects (3)

A 
Contraindications: 
- breast cancer 
- severe cirrhosis 
- liver tumours 
Risks: 
- ovarian cysts
- breast cancer 
Side Effects: 
- acne
- breast tenderness 
- mood changes
151
Q

Regular Contraception: Progesterone Only Pill
Advantages (4)
Disadvantages (1)

A 
Advantages: 
- suitable for breastfeeding 
- ok for migraine with aura 
- ok for high BMI 
- improved period timing 
Disadvantages: 
- remembering to take (but no breaks)
152
Q

Regular Contraception: Depo-Provera Injection
Mode of action (3)
Side effects (3)

A 
Mode of Action: 
- inhibits ovulation 
- thickens cervical mucus 
- given every 12 weeks 
Side Effects: 
- irregular bleeding 
- weight gain 
- fertility can take up to 1 year to return
153
Q

Regular Contraception: Implant
Mode of action (3)
Side effects (4)

A 
Mode of Action: 
- inhibits ovulation 
- thickens cervical mucus 
- lasts 3 years
Side Effects: 
- heavy/irregular bleeding 
- headache 
- nausea
- breast pain
154
Q

Regular Contraception: Intrauterine System
Mode of action (3)
Advantages (2)
Risks (3)

A 
Mode of Action: 
- levonorgestrel 
- prevents endometrial proliferation 
- thickens cervical mucus 
Advantages: 
- initially frequent bleeding but later light menses with less dysmenorrhoea and some get amenorrhoea 
- lasts 3 years (Jaydess) or 5 years (Mirena) 
Risks: 
- perforation 
- PID 
- expulsion
155
Q 
Regular Contraception: Intrauterine Contraceptive Device 
Mode of action (2) 
Advantages (1) 
Disadvantages (1) 
Risks (3)
A 
Mode of Action: 
- decreases sperm motility and survival 
- lasts 10 years 
Advantages: 
- effective immediately 
Disadvantages: 
- makes periods heavier, longer and more painful 
Risks: 
- perforation 
- PID
- expulsion
156
Q

Emergency Contraception

Levonorgestrel (4)

A

Dose 1.5mg
Mode of action: stops ovulation and inhibits implantation
72h after unprotected sex
Side effects: disturbance of current menstrual cycle, vomiting, diarrhoea

157
Q

Emergency Contraception

Ulipristal (4)

A

Dose 30mg
Mode: progesterone receptor modulator which inhibits ovulation
120h after unprotected sex
Side effects: disturbance of current menstrual cycle, vomiting, diarrhoea

158
Q 
Emergency Contraception 
Intrauterine device (3)
A

Mode: inhibits fertilisation or implantation
5 days after unprotected sex or if after 5d then up to 5d after likely ovulation date
Advantages: very effective, can be left in for long term contraception

159
Q

Termination of Pregnancy

Incidence (3)

A

Worldwide >20% of pregnancies are terminated
In the UK 1/3 of women have had a termination by age 45
>200,000 per year in UK

160
Q

Termination of Pregnancy

Abortion Act Criteria (5)

A

2 doctors sign + fetus <24 weeks
Risk to mother’s life if pregnancy continues
Termination necessary to prevent grace injury to physical/mental health of mother
Continuance risks physical/mental health of existing children of mother
Substantial risk that if child were born he/she would suffer such physical or mental abnormalities as to be seriously handicapped

161
Q 
Termination of Pregnancy 
Before termination (5)
A

Offer counselling and information
Ultrasound to confirm gestation and identify non-viable/ectopic pregnancies
Screen for STIs
Antibiotics prophylaxis to reduce post-op infections
Plan contraception

162
Q

Termination of Pregnancy
Medical (1)
Surgical (2)

A 
Medical: 
- mifepristone to prime cervix followed by misoprostol (prostaglandin) 
Surgical: 
- vacuum aspiration: from 7-14wks 
- dilation and evacuation: 13-24wks
163
Q

Termination of Pregnancy

Complications (4)

A

Failure 1:100
Infection
Haemorrhage
Uterine perforation/rupture

164
Q

Vaginal Discharge Differentials (4)

A

Physiological: pregnancy, puberty, COCP
Non-STI infection: thrush, bacterial vaginosis
STI: chlamydia, gonorrhoea
Paediatric: fecal flora, pre-pubertal atrophic vaginitis (lack of vaginal oestrogen), staph/strep infection, foreign body, sexual abuse

165
Q

STI Symptoms in Females (9)

A

Vaginal discharge: gonorrhoea, chlamydia, trichomoniasis, BV
Postcoital bleeding: gonorrhoea, chlamydia
Intermenstrual bleeding: gonorrhoea, chlamydia
Dyspareuria: genital herpes, gonorrhoea, chlamydia
Dysuria: gonorrhoea, chlamydia, trichomoniasis, herpes
Vulvitis: thrush, BV, herpes, gonorrhoea, chlamydia
Skin changes: herpes, warts
Abdo/pelvic pain: PID
Systemic: PID (fever), HIV (weight loss)

166
Q

STI Symptoms in Males (6)

A

Testicular pain/swelling: epidydmo-orchitis (secondary to gonorrhoea/chlamydia)
Itching/sore skin: candida, herpes, HSV, genital warts
Skin lesions: herpes, genital warts
Urethral discharge: gonorrhoea, chlamydia
Dysuria: gonorrhoea, chlamydia, herpes
Systemic: PID (fever), HIV (weight loss), chlamydia (Reiter’s syndrome)

167
Q 
Chlamydia 
Incubation period (1)
A

7-14 days (chlamydia trichomatis)

168
Q

Chlamydia

Signs + symptoms (4)

A

M: asymptomatic in 20%, slight penile dischage, dysuria
F: asymptomatic in 80%, vaginal discharge, dysuria, intermenstrual bleeding, postcoital bleeding
Conjunctivitis
Cervical bleeding on contact

169
Q

Chlamydia

Investigations (1)

A

Nucleic acid amplification test (NAAT) via 1st void urine M and self-taken vaginal swab in F

170
Q

Chlamydia

Treatment (1)

A

Azithromycin 1g, follow up test for reinfection at 3-12 months

171
Q

Chlamydia

Complications (3)

A

F: PID, Fitz Hugh Curtis Syndrome (complication of PID involving liver capsule inflammation leading to adhesions), infertility
M: epididymitis (can cause infertility), prostatitis
B: reactive arthritis (Reiter’s syndrome)

172
Q 
Gonorrhoea 
Incubation period (1)
A

5-6 days on average 2 day- 2 week range (Neisseria gonorrhoea)

173
Q

Gonorrhoea

Signs + symptoms (2)

A

M: asymptomatic, dysuria
F: asymptomatic (50%), dysuria, vaginal discharge (thick and yellow), IMB, PCB

174
Q

Gonorrhoea

Investigations (2)

A

NAAT 1st void urine in M

Culture for antibiotic sensitivities (smear from urethra, vagina, rectum)

175
Q

Gonorrhoea

Treatment (2)

A

IM 500g ceftriaxone + 1g azithromycin

Test cure at 2 weeks and test for reinfection at 3 months

176
Q

Gonorrhoea

Complications (2)

A

M: epididymitis, prostatitis
F: PID, Bartholin’s abscess

177
Q 
Trichomoniasis
Incubation period (1)
A

5-28 days (trichomoniasis vaginalis- flagellated parasite)

178
Q

Trichomoniasis

Signs + symptoms (2)

A

M: asymptomatic
F: asymptomatic (10-30%), vaginal discharge (thin, green, frothy and foul), vulvitis

179
Q

Trichomoniasis

Investigations (1)

A

Microscopy of wet preparation of high vaginal swab

180
Q

Trichomoniasis

Treatment (1)

A

Metronidazole 400mg oral twice daily for 5 days OR 2g single dose

181
Q 
Syphilis
Incubation period (1)
A

9-90 days until chancre appears (treponema pallidum- spirochete)

182
Q

Syphilis

Signs + symptoms (5)

A

Primary: chancre (painless ulcer)
Secondary: 6w-6m following primary infection, non-pruritic rash on palms and soles, generalised lymphadenopathy, systemic symptoms (pyrexia, fatigue, malaise)
Early latent: asymptomatic infection and positive diagnosis within 2y of infection
Late latent: asymptomatic infection and positive diagnosis after 2y of infection
Tertiary: untreated over many years (neurosyphilis- general paresis, stroke, cardiovascular syphilis- aortitis, aortic aneurysm)

183
Q

Syphilis

Investigations (3)

A

Serology of treponema pallidum: IgG/IgM, enzyme immunoassay, particle agglutination test (serology always remains +ve)
PCR: ulcer swab
Disease activity: cardiolipin serology tests

184
Q

Syphilis

Treatment (2)

A

Early (<2w): benzylpenicillin once IM or doxycycline 100mg oral 2x/day for 2 weeks
Late (>2y): benzylpenicillin IM weekly for 3w or doxycycline 100mg 2x/day for 28 days

185
Q

Herpes

Aetiology (2)

A

HSV type 1 (spread through oral sex)

HSV type 2 (main cause)

186
Q 
Herpes
Incubation period (1)
A

5 days- months

187
Q

Herpes

Signs + symptoms (2)

A

Asymptomatic (80%)
Recurring symptoms monthly or annually (burning/itching followed by tender ulceration, tender inguinal lymphadenopathy, flu-like symptoms)

188
Q

Herpes

Investigations (1)

A

PCR swab from lesion

189
Q

Herpes

Treatment (3)

A

Primary outbreak: aciclovir 200mg 5x/day or 400mg 3/day for 5 days
Infrequent recurrences: lidocaine ointment, aciclovir 1x/day until symptoms gone
Frequent recurrences: aciclovir 400mg 2x/day as suppression

190
Q

Anogenital Warts

Aetiology (1)

A

HPV 6+11

191
Q 
Anogenital Warts 
Incubation period (1)
A

2w-8m

192
Q

Anogenital Warts

Signs + symptoms (2)

A

Lumps

Occasional itching/bleeding

193
Q

Anogenital Warts

Treatment (1)

A

Popphyllotoxin as home treatment, cryotherapy, imiquimod, diathermy removal if bulky

194
Q

Thrush

Aetiology (1)

A

Candida albicans

195
Q 
Thrush 
Risk factors (6)
A 
Pregnancy 
Contraceptives 
Steroids 
Immunodeficiencies 
DM 
Antibiotics
196
Q

Thrush

Signs + symptoms (3)

A

Curd-like non-offensive discharge
Sore + itchy vulva and vagina
Redness

197
Q

Thrush

Investigations (1)

A

Microscopy and culture shows mycelia and spores

198
Q

Thrush

Treatment (1)

A

Clotrimazole 500mg pessary and cream for vulva or oral fluconazole 150mg single dose

199
Q

Bacterial Vaginosis

Aetiology (1)

A

Altered bacterial flora eg. Gardnerella vaginalis

200
Q

Bacterial Vaginosis

Signs + symptoms (1)

A

Fishy discharge

201
Q

Bacterial Vaginosis

Investigations (1)

A

Microscopy and culture

202
Q

Bacterial Vaginosis

Treatment (1)

A

Metronidazole 2g oral once

203
Q

Bacterial Vaginosis

Complications (3)

A

Pre-term labour
Intra-amniotic infection in pregnancy
HIV susceptibility

Med Student Finals (23 decks)

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