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CP2 OBGYN > Gynaecology > Flashcards

Gynaecology Flashcards

1
Q

What is considered a regular menstrual cycle?

A

28 days +/- 6 days

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2
Q

What is the average age of menarche?

A

13

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3
Q

What happens during days 1-4 of the menstrual cycle?

A

Menstruation
Endometrium shed
Myometrial contractions occur (painful)

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4
Q

What happens during days 5-13 of the menstrual cycle?

A

Proliferative phase
Hypothalamus releases GnRH - acts on receptors
FSH is released
Follicular recruitment due to FSH
Thecal layer follicle stim’d by FSH –> testosterone –> oestradiol
Oestradial thickens endometrium by incr mitotic activity

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5
Q

What happens during days 14-28 of the menstrual cycle?

A 
Secretory phase 
LH released day 14 - ovulation 
FOllicle --> CL - prod O + P
CL relies on LH to survive - if egg not fertilised dies - < O + P 
Endometrium starts to break down
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6
Q

Causes of Abnormal Uterine bleeding - PALM-COEIN

A 
Polyps 
Adenomyosis 
Leiomyomas 
Malignancy 
Coagulopathy 
Ovulatory dysfunction 
Endometrial 
Iatrogenic 
Not specified
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7
Q

Causes of IMB (7)

A 
Anovulatory cycles 
Fibroids 
Polyps 
Adenomyosis 
Ovarian cysts 
Chronic pelvic infection 
Malignancy
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8
Q

Ix IMB (4)

A

Hb
Cerivcal smear
USS (if >35)
Endometrial biopsy

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9
Q

Drug Mx IMB - 1st line

A

IUS/COCP

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10
Q

Drug Mx IMB - 2nd line

A

Progestogens

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11
Q

Drug Mx IMB - 3rd line

A

HRT (if perimenopause)

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12
Q

Surgical Mx IMB

A

Hystoscope - polyp removal/fibroid/ablation

Radical - hysterectomy/myomectomy

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13
Q

Def post-coital bleeding

A

Bleeding following intercourse that is NOT menstrual loss

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14
Q

Causes of post-coital bleeding (5)

A 
Cervical carcinoma 
Cervical ectropion 
Cervical polyps 
Cervicitis/vaginitis 
Atrophy
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15
Q

Mx post-coital bleed (4)

A

Inspect cervix + smear
If polyp - avulse + send histology
If ectropion - cryo
If neither - colposcopy - excl maligancy

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16
Q

Def post-menopausal bleeding

A

Vaginal bleeding > 12 months post menopause

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17
Q

FSH levels menopause

A

> 30

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18
Q

Most common cause PMB

A

Atrophic changes to vaginal tract

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19
Q

Causes of PMB - ovarian (2)

A

Carcinoma of ovary

Oestrogen secreting tumour

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20
Q

Causes of PMB - uterine body (4)

A

Myometrial submucosal fibroid
Endometrium - atrophy
Polyp
Hyperplasia

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21
Q

Causes of PMB - cervical (4)

A

Atrophic changes
Malignancy
Squamous carcinoma
Adenocarcinoma

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22
Q

Causes of PMB - vaginal

A

Atrophic changes

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23
Q

Causes of PMB - urethral (2)

A

Urethral caruncle

Haematuria

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24
Q

Causes of PMB - vulval (3)

A

Vulvitis
Dystrophies
Malignancy

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25
Q

Local Sx of oestrogen deficiency - PMB (3)

A

Vaginal dryness
Vaginal soreness
Superficial dyspareunia

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26
Q

Ix PMB

A

Full gynae + abdo exam
USS pelvis
Hysteroscopic exam uterine cavity
Endometrial biopsy

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27
Q

Def dysmenorrhoea

A

Pain associated with menstruation

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28
Q

What is 1’ dysmenorrhoea

A

Occurs from menarche

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29
Q

What is 2’ dysmenorrhoea

A

Either occurs in women who has had previously painless periods, or 2’ to pathology

30
Q

RF dysmenorrhoea (5)

A 
Early menarche
Long menstrual phase
Heavy periods
Smoking 
Nulliparity
31
Q

CF dysmenorrhoea (5)

A 
Lower abdo pain radiating to lower back 
Crampy, 48-72h 
Worst @ onset menses 
Assoc w/ malaise, N+V+D, dizziness 
Uterine tenderness
32
Q

DDx dysmenorrhoea (6)

A 
2' dysmenorrhoea
Endometriosis 
Adenomyosis 
PID
Adhesions 
Non gynae - IBS/IBD
33
Q

Ix dysmenorrhoea (2)

A

High vag/endocervical swab

If mass palp’d –> TVUS

34
Q

Mx dysmenorrhoea

A 
Lifestyle - stop smoking 
NSAIDS + paracetamol = 1st line 
Local apply heat
TENS 
2nd line = 3-6m COCP/mirena
35
Q

Causes of 2’ dysmenorrhoea (5)

A 
Fibroids 
Endometriosis 
Adenomyosis 
PID
Ovarian tumours
36
Q

Ix 2’ dysmenorrhoea (2)

A

USS

Diagnostic laparoscopy

37
Q

Def precocious puberty (2)

A

Either menstruation before 9

Or 2’ sex characteristics before 8

38
Q

What is the majority of cause of precocious puberty?

A

No cause (80%)

39
Q

Mx of precocious puberty b/c no pathological cause

A

GNRH agonist

40
Q

Central causes of precocious puberty (5)

A 
Meningitis
encephalitis 
CNS tumour 
Hydrocephaly 
Hypothyroidism
41
Q

Mx of central causes of precocious puberty

A

GNRH agonist

42
Q

Ovarian/adrenal causes of precocious puberty

A

Hormone prod tumour in ovary/adrenals

Mc-Cune-Albright syndrome (bone + ov cysts)

43
Q

Mx of ovarian/adrenal causes of precocious puberty

A

Tumour excision

Cyproterone acetate

44
Q

What is cortical adrenal hyperplasia

A

Defective cortisol production –> decr ACTH hence decr androgen secretion

45
Q

PS cortical adrenal hyperplasia

A

Ambiguous genitalia

46
Q

Mx CAH

A

Cortisol + mineralcorticoid replacement

47
Q

What is androgen insensitivity syndrome

A

Cells receptors are insensitive to androgens, hence peripheral conversion of androgens to oestrogens

48
Q

PS androgen insensivity syndrome

A

Appears F

But amenorrhoea + absent uterus

49
Q

Mx androgen insensitivity syndrome

A 
Remove testes (b/c can --> malignant) 
Oestrogen replacement
50
Q

Def chronic pelvic pain

A

Pain that persists >6M

51
Q

Causes of chronic pelvic pain - GYNAE (MOT CheckP)

A 
Menstrual - adenomyosis 
Ovaries
Tubes - PID 
Cervix - herpes/malig 
Pelvic wall - endometriosis 
Perineum - Barthrolins cysts
52
Q

Sx of Pelvic congestion syndrome

A

Pain, much better in AM

Watery non-odourous discharge

53
Q

When does pelvic congestion syndrome tend to occur?

A

Post pregnancy –> valvular insufficiency –> incr varicosity pelvis

54
Q

Non-gynae causes of chronic pelvic pain (5)

A 
Urinary stones 
GIT esp IBS 
MSK - OA
Neurological 
Psychological
55
Q

Assoc Sx chronic pelvic pain (7)

A 
Dysmenorrhoea 
Dyspareunia 
Dyschezia
Haematuria
Abdo bloating 
Diarrhoea/constipation 
Urinary Sx
56
Q

What do 30% of women w/ chronic pelvic pain have aHx of

A

sexual abuse

57
Q

O/E chronic pelvic pain

A 
Pain mapping on physical exam 
Abdo palpation 
General exam 
Vulval/vaginal inspection 
Bimanual exam - tenderness, mass
58
Q

DDx - tenderness on bimanual palp - chronic pelvic pain (3)

A

Generalised - PID
Unilateral - ov cyst/ectopic pregnancy
Tender noduls - endometriosis?

59
Q

DDx - mass on bimanual palp - chronic pelvic pain (4)

A

Tubo-ovarian abscess
Ovarian cyst
Endometriotic cyst
Fibroid

60
Q

Ix chronic pelvic pain

A 
DIP urine
FBC
Swabs/speculum/biopsy
USS/CT abdo
Prengnacy test 
Laparoscopy = gold standard
61
Q

Common causes of acute pelvic pain (7)

A 
Ectopic pregnancy 
Ovarian cysts 
PID
Sepsis 
Acute bleed
Vulva
Haemorrhagic cyst
62
Q

Superficial dyspareunia - congenital causes (2)

A

Vaginal atresia

Vaginal septum

63
Q

Superficial dyspareunia - infective cause

A

Vulvovaginitis

64
Q

Superficial dyspareunia - post surgical cause (2)

A

Childbirth

Pelvic floor repair

65
Q

Superficial dyspareunia - vulval cause (30

A

Bartholin’s cyst
Vulval dystrophies
Carcinoma of vulva

66
Q

Superficial dyspareunia - psychosexual cause

A

Vaginismus

67
Q

Deep dyspareunia - congenital causes (2)

A

Incomplete vaginal atresia

Vaginal septum

68
Q

Deep dyspareunia - infective cause

69
Q

Deep dyspareunia - post-surgical causes (2)

A

Relating to childbirth

Pelvic floor repair

70
Q

Deep dyspareunia - pelvic disease causes (3)

A

Endometriosis
Fibroids
Ovarian cyst/tumours

71
Q

Deep dyspareunia - pelvic prolapse cause (3)

A

Endometriosis
Fibroids
Ov cysts/tumours

CP2 OBGYN (21 decks)

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