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Gynaecology Flashcards

1
Q

In young patients, what does Gilick competence refer to?

A

-Children under 16 can consent if they have sufficient understanding and intelligence to understand what is involve in proposed treatment, and potential consequences etc

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2
Q

If a child does not pass Gilick test, who’s consent is needed prior to treatment?

A

Parental consent

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3
Q

What is the competency guideline used for provision of contraception to someone under the age of 16?

A

Fraser Guidelines

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4
Q

When may Fraser Guideline enable the provision of contraceptive to someone under the age of 16?

A
  • The child will understand the advice
  • The doctor cannot persuade her to inform her parents that they are seeking contraceptive advice
  • They are very likely to continue to have sexual intercourse with or without contraceptive treatment
  • Their physical or mental health will likely suffer unless contraceptive advice/treatment is given.
  • Their best interests require it without parental consent.
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5
Q

What happens in female changes in puberty?

A
  • Growth accelerates and secondary sexual characteristics appear
  • Increase in pulsatile GnRH from hypothalamus at night
  • Increase in pulsatile secretion of LH
  • Rise in estradiol
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6
Q

What takes place in gynaecological history taking in someone under the age of 16?

A
  • Establish rapport
  • Age of menarche
  • Cycle
  • Number of pads/tampons?
  • Pain
  • Sexual Activity, Contraception (in absence of parents)
  • Weight gain/loss
  • Exercise
  • Remember sexual abuse
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7
Q

What takes place in gynaecological examination in someone under the age of 16?

A

Not done in first visit!

  • General
  • Breast
  • Gynaecological
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8
Q

What defines precocious puberty?

A

Secondary sexual characteristics before 8 yrs in girls, 9 in boys

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9
Q

What defines delayed puberty?

A
  • No testicular development in boys by 14

- No breast development in girls by 13 (Or no periods by 15)

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10
Q

What is pain attributed to in periods?

A

Prostaglandins

So anti-prostaglandins like mefenamic acid can be v helpful

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11
Q

What can be used to help treat dysmenorrhoea?

A

-Mefenamic acid

Combined Oral Contraceptive Pill (COCP)

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12
Q

What types of bleeding disorders should be considered in a gynaecological history?

A
  • Von Willebrands, Platelet defects
  • Leuakemia

Also consider pregnancy complications and sexual abuse

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13
Q

What infections can result in pathological vaginal discharge?

A
  • Infections with organisms (E.coli, Proteus, Pseudomonas)
  • Hameolytic streptococcal vaginitis
  • Monial vaginitis
  • Forein body
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14
Q

What things should be considered for adolescent transgender patients?

A

Sandyford clinics
Support for individual/family/school
Fertility preservation - gamete freezing

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15
Q

What is the definition of prolapse?

A

Protusion of an organ or structure beyond its normal anatomical confines

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16
Q

What is the sympathetic supply to the bladder? (Storage)

A

T10-L2

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17
Q

What is the parasympathetic supply to the bladder? (Voiding)

A

S2-4

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18
Q

What provides the voluntary supply to the bladder?

A

S2-4 (Pudendal nerve)

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19
Q

What is the normal maximum volume of the bladder?

A

400-600ml

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20
Q

What situations contraindicate HRT?

A
  • Current Hormone dependant cancer (breast/endometrium)
  • Current active liver disease
  • Uninvestigated abnormal bleeding
  • Seek advice for prev VTE, thrombophilia, FH VTE, previous CA breast
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21
Q

What are some benefits to combined E+P HRT?

A

Lower endometrial cancer risk

Bleed free after 3 months or so

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22
Q

What are the benefits of HRT treatment?

A
  • Vasomotor symptom relief
  • Local genital symptom relief
  • Osteoporosis treatment
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23
Q

What are the risks of HRT treatment?

A

Breat cancer in combined HRT
Ovarian cancer risk
Venous thrombosis/stroke if oral route

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24
Q

What is the first line treatment for osteoporosis prevention/treatment?

A

Bisphosphonates

Not HRT

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25
Q

What happens to testosterone levels in middle aged women?

A

Testosterone falls (Starting around age 30)

26
Q

What is normal blood loss in a period?

A

Less than 80ml

27
Q

What is the average age of menarche?

A

12 years

28
Q

In what phase of the menstrual cycle does progesterone increase?

A

Luteal phase

29
Q

In what ways can menstruation be disturbed?

A

Frequency disturbance
Regularity disturbance
Duration abnormalities
Abnormal volumes

30
Q

What would be considered infrequent periods?

A

> 38 days between cycles

31
Q

What are some risks involved in hysterectomy?

A 
Infection
DVT
Bladder
Bowel
Vessel Injury
Altered bladder function
Adhesions
32
Q

What are some disadvatanges of salpino-oophorectomy?

A

Immediate menopause

33
Q

What are some advatanges of salpino-oophorectomy?

A

Reduces risk of subsequent ovarian cancer

34
Q

List some structural causes of heavy menstrual bleeding?

A

PALM

Polyp
Adenomyosis
Leiomyoma/Fibroid
Malignancy

35
Q

List some non-structural causes of heavy menstrual bleeding?

A

COEIN

Coagulopathy
Ovulation Dysfunction
Endometrium/Hyperplasia
Iatrogenic
Not Yet Classified
36
Q

What types of cancers may be caused by HPV?

A 
Cervix
Penis
Vulva/Vagina
Anus
Mouth
Oropharynx
37
Q

What name is given to abnormal growth of cervical squamous cells detectable on a smear?

A

Squamous intraepithelial lesion (SIL)

38
Q

What name is given to abnormal cells in the cervix detected by biopsy and histological examination?

A

Cervical Intraepithelial neoplasia (CIN)

39
Q

What cells are within the endocervix?

A

Columnar epithelium

40
Q

What cells are within the ectocervix?

A

Squamous epithelium

41
Q

Why is the transitional zone of the cervix important?

A

Site of immature cells
Unstable hormonal environment
Vulnerable to infection (HPV) etc

42
Q

What us used to stain the smear of cervical cells?

A

Papanicolaou method (PAP)

43
Q

What are the features of abnormal cells in a cervical smear?

A 
Nuclear features:
Increased size and nuclear:cytoplasmic ratio
Variation in size, shape and outline
Coarse irregular chromatin
Nucleoli
44
Q

What type of cells reflect HPV infection in a cervical smear?

A

Koilocytes

Cells with wrinkled nucleus + perinuclear halo

45
Q

Which test - cytology or HPV test - identifies cellular changes?

A

Cytology

46
Q

Which test - cytology or HPV test - is specific?

A

Cytology

47
Q

What are the next steps if a positive hrHPV test is picked up on a smear?

A
  • Check cytology -> If normal, repeat test 1 year

- If dyskaryosis - refer to colposcopy for biopsy

48
Q

What takes place in a colposcopy?

A 
Education and advice
Colposcopy
-Magnification and light to see cervix
-Exclude obvious malignancy
-Use of acetic acid =/- Iodene:	
Identify limits of lesion
Select biopsy site
Define area to treat
49
Q

What are the low risk types of HPV?

A

HPV 6, 11, 42, 44 etc

Causes genital warts + Low grade CIN

50
Q

What are the high risk types of HPV?

A

HPV 16, 18, 31, 45 etc

Persistent infection
Causes high grade CIN and rarely cancer

51
Q

Which proteins are overexpressed in persistent HPV infection?

A

Viral E6 and E7 proteins

52
Q

What is the definition of FGM?

A

Comprises all procedures that involve partial or total removal of the external female genitalia for cultural or non-medical reasons

53
Q

What is excision in type 2 FGM?

A

Partial/total removal of the clitoris and the labia minora, with or without excision of labia majora

54
Q

What is infibulation in type 3 FGM?

A

Narrowing of the vaginal opening through the creation of a covering seal.

55
Q

What is de-infibulation?

A

Surgical procedure to open up the closed vagina of FGM type 3

56
Q

What are justifications used for FGM?

A 
Preservation of virginity and chastity 
Religion, in the mistaken belief that it is a religious requirement 
Social acceptance
Fear of social exclusion 
To ensure the girl is marriageable or to improve marriage prospect
Hygiene and cleanliness 
Increasing sexual pleasure for the male 
Family honour 
Enhancing fertility
57
Q

What short-term health impacts can FGM have?

A 
Severe pain + shick
Infection
Injury to adjacent tissues
Sprains, dislocations, broken bones etc from being restrained
Immediate fatal haemorrhaging
Infection by BBV
58
Q

What long-term health impacts can FGM have?

A
  • Urine retention and difficulties in menstruation
  • Uterine, vaginal and plevic infections
  • Cysts and neuromas
  • Complications in pregnancy and childbirth
  • Increased risk of fistula
  • On-going impact of trauma/PTSD
  • Sexual dysfunction
  • Psychological Effects
59
Q

What law prohibits FGM in Scotland?

A

Prohibition of Female Genital Mutilation (Scotland) Act 2005

60
Q

What are risk factors for FGM?

A
  • Mother/other female relatives have undergone FGM
  • Mother etc has requested re-infibulation following childbirth
  • Parents express views that they value the practice
  • Girl withdrawn from teaching classes on PSE in higher education
  • Withdrawal from school for extended holiday
61
Q

What services are available in relation to FGM?

A

Amina - Muslim women resource centre

Saheliya

Roshni

Reproduction (15 decks)

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