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4th year OBS AND GYNAE > Gynaecology > Flashcards

Gynaecology Flashcards

1
Q

Most common cause of post-coital bleeding in pre-menopausal women?

A

Cervical ectropion

Even more common in women on the COCP.

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2
Q

Abnormal bleeding causes
PALM = structural

COEIN = non-structural

A

Polyps
Adenomyosis- outside of uterus
Leiomyoma/fibroid
Malignancy

Coagulopathy disorders
Ovulatory function 
Endometrial disorders /polyps
Iatrogenic causes
Not yet classified
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3
Q

Medical treatmentf for period pain

A

Mefanamic acid

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4
Q

Medical treatment for HEAVY periods

If completed family..

A
  • Tranexamic acid
    + MIRENA coil (Levonogestral IUD) 1st line
    2nd line COCP

If completed family..

  1. Endometrial ablation
  2. Hysterectomy
  3. Reoval of ovaries = makees u post-menopausal
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5
Q

Cervical polyp

A

irregular bleeding, post-coital bleeding, intermenstrual bleeding

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6
Q

Coagulation disorder

A

Heavier menstrual bleeding, Excessive bruising, FH, bleeding from other sites

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7
Q

PID

A

Bleeding Post-coital and unusual discharge

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8
Q

Thyroid disease

A

Hypo/Hyper = heaveir or lighter periods

Weight gain, skin changes, fatigue

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9
Q

Fibroids
OESTROGEN DEPENDENT

Syx:

RF

Tx

A

Heavier and more painful periods
Can get urinary symptoms

Subserosal = outside
Intramural = in the wall
Submucosal = inside the womb

RF: = Oestrogen high eg no pregnancy, obesity

TX: GNRH Goesrelin shrinks fibroids
Surgical removal
Uterine Artery embolisation

Complicaiton= subsubfertility and PPH

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10
Q

Pre-menstrual syndrome treatment

A

1st line COCP

2nd line oestradiol patches and SSRI

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11
Q

PCOS criteria - Rotterdam

Treatment

A

Need 2/3

  1. Amennorhoea / oligo
  2. Clinical or biochemical androgenism
  3. PCOS on ultrasound

TX

  1. COCP for menstruation
  2. Metformin for hyperinsulinaemia
  3. Clomifene = induce ovulation (increase LH and FSH)
  4. weight loss
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12
Q

Menopause
Biological ?

Risk increased

Treatment

A

12 months continuous amenorrhea
LH and FSH rise and oestrogen falls = FSH > 30 is diagnostic
Low anti-mullerian hormone is good marker = shows low follicular reserve

After= risk of osteoporosis, coronary heart diease and breast cancer increase

Treatment

  1. Oesotrogen + progesterone combined if have uterus
  2. Just oestrogen if no uterus
  3. SSRI if too many Rx for oestrogen e.g obese, VTE rx
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13
Q

Post menopausal bleeding
Causes

Endometrial thickness size for concern

A 
ABNORMAL if not on HRT so FAST TRACK
causes
1. Atrophic vaginitis = most common cause 
2.Endometrial polyps
3. Endometrial hyperplasia / carcinoma
4. Cervical carcinoma
5. HRT breakthrough bleed

Endometrial thickness
<3mm or <5mm and on HRT = reassuring
If greater = endometrial biopsy needed

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14
Q

Endometriosis

A

Severe colicky cyclical pelvic pain, heavy menstrual loss
Deep dyspareunia, cyclical haemoptosis etc

IVX- Ultrasound and MRI to detect lesions

TX: NSAIDS, COCP
GNRH eg Goserelin = side effects of menopause as increase LH and FSH and decrease oestrogen
Surgcial diathermy or Hysterectomy if completed the family

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15
Q

Adenomyosis

A

Endometrial tissue within myometrium
Get boggy large uterus
syx: heavy painful menstruation

IVX - USS

TX: induce amenorrhea

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16
Q

Pelvic inflammatory disease

RF

CF

Tx

A

RF: young females sexually active multiple partners, most commonly chlamydia

CF: Lower abdo pain, deep dysparaneuria, abnormal vaginal bleeding, abnormal vaginal discharge, worst after sex

Treatment: NO SEX UNTIL TREATMENT FINISHED
1. Ceftrioxone, Doxycyline and Metronidazole depending on cause

17
Q

Ectopic pregnancy
IVX

Management

A

Syx: abdo pain, vaginal bleeding, shoulder tip pain
Ruptured = acute + shock

Ivx: Serum B-HCG, TVUS

Management:
Methotrexate but most commonly Salpingectomy (remove whole tube) or Salpingotomy.

18
Q

Molar pregnancy syx

A

Dark brown to bright red vaginal bleeding during the first trimester.
Severe nausea and vomiting.
Sometimes vaginal passage of grapelike cysts.
Pelvic pressure or pain.

Marked elevated levels of BHCG >1000 + snow storm appearance on US

19
Q

Cervical ectropion

RF

A

RF = PPP, Puberty, Pill and Pregnancy

Can cause bleeding

20
Q

Subfertility

A

Inability to concieve after 2 years of regular unprotected sex

21
Q

Stress incontience

syx

Tx

A
  1. syx = leakage when laugh or sneeze, rx increase by child birth
  2. treatment = Duloxiteine SSRI and physio to streghthen pelvic floor muscles
22
Q

Overactive bladder/ detruser overactivity

A
  1. syx = contracts out of nowhere so suddently need a wee
  2. treatment = OXYBUTYNIN anticholinergic
    se- dry mouth, constipation
23
Q

Incontience investigations

A

urine MSU/. distick to rule out infection
Frequency / volume charts
Urodynamics can differentiate between detrusor overactivity and stress incontience

24
Q

Pelvic organ prolapse

A 
Urethrocele- urethral descent
Cystocele - bladder descent 
Cystourethrocele - bladder and urethral descent 
rectocele - rectal 
entero - small bowel
25
Q

Cervical cancer

A

HPV 16 + 18
Transformaiton zone
RF: Smoking, early sexual activity

26
Q

Endometrial cancer
Cell type

RF
CF

Staging?

A

Adenocarcinoma
Caused by unapposed oestrogen
- HRT (increases E2, PCOS, obesity, late menopause early menarche

CF: post-menopausal bleeding, lower abdo pain
FIGO staging

Tx = total hysterectomy

27
Q

Ovarian carcinoma

A

Ovarian epithelium + poor prognosis
RF: bloating, abdo pelvic pain, decrease appetite, change in bowel habit

Tumour marker Ca125

TX: hysteroscopy and remove lymph nodes

28
Q

Vulval carcinoma

A

Squamous cell
CF: lump, vulval pain, post-menopausal bleeding
Pre-malignant is lichen sclerosis form

TX: wide deep excision

29
Q

How to treat polyps

A

All post-menopausal women with polyps and premenopausal women who are symptomatic or have endometrial polyps more than 1 cm should have a resection.

30
Q

Ovarian cysts

Normal size?

A

If simple and <5 cm then non concerning
BUT any postmenopausal woman with an ovarian cyst regardless of nature or size should be referred to gynaecology for assessment

4th year OBS AND GYNAE (4 decks)

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