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Module 3 > Gynaecology > Flashcards

Gynaecology Flashcards

1
Q

What phase of the menstrual cycle does PMS affect?

A

Luteal phase

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2
Q

Premenstrual dysphoric disorder affects what 2 areas?

A

Physical (breast tenderness) and emotional (irritability)

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3
Q

3 recommendations to manage PMS

A
  1. Adopt a healthy balance lifestyle
  2. Continuous use of COCP
  3. Antidepressants
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4
Q

Menorrhagia refers to

A

> 80 ml of blood loss per month - this may be due to excessive volume or excessive duration > 1 week

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5
Q

3 different questions to ask to categorise ‘very heavy periods’

A
  1. How long does it take you to fill a sanitary towel? - 1-2 hours
  2. Bleeding lasting > 7 days
  3. Passing large clots
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6
Q

5 causes of menorrhagia

A
  1. Lack of ovulation: PCOS, hypothyroidism
  2. Structural: Endometriosis, leiomyomas, polyps.
  3. Pregnancy complication: Miscarriage
  4. Coagulopathies
  5. Iatrogenic: Anticoagulant, copper IUD
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7
Q

3 disorders to rule out on bloods when a patient has menorrhagia

A
  1. Anaemia (iron studies)
  2. Hypothyroidism (TFT)
  3. Coagulation screening (thrombophilia)
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8
Q

Management of heavy periods (4 points)

A
  1. No pain: Tranexamic acid to reduce blood loss
  2. Pain: Mefenamic acid (NSAID)
  3. Contraceptives: Particularly levonorgestrel IUD (Mirena) or POP
  4. Surgery: Endometrial ablation if finished having children, hysterectomy
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9
Q

What type of drug is tranexamic acid and what is its MOA?

A

Antifibrinolytic that blocks conversion of plasminogen to plasmin, thus prevents fibrin degradation

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10
Q

Investigations for menorrhagia

A
  1. Bloods: Rule out anaemia, thyroid disorders, coagulopathies
  2. Swabs: Rule out infection
  3. Pelvic/transvaginal ultrasound: Rule out polyps, cancer
  4. Hysteroscopy
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11
Q

Dysmenorrhoea refers to

A

Painful menstruation with or without pelvic pathology

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12
Q

Primary dysmenorrhoea refers to

A

Painful periods in absence of pelvic pathology

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13
Q

Primary dysmenorrhoea is most common in

A

First year after menarche as ovulation becomes established

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14
Q

Secondary dysmenorrhoea refers to

A

Pain many years after the menarche, during menstruation or in the luteal phase, due to pelvic pathology

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15
Q

5 causes of secondary dysmenorrhoea

A
  1. PID
  2. Endometriosis
  3. Leiomyoma
  4. Polyps
  5. Adenomyosis
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16
Q

Difference between primary and secondary dysmenorrhoea

A

Primary dysmenorrhoea is in the absence of pelvic pathology, often in 1st year post menarche.

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17
Q

Investigations for dysmenorrhoea

A
  1. Bloods
  2. STI test
  3. Urinalysis
  4. Pelvic/transvaginal ultrasound
  5. Laparoscopy/hysteroscopy
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18
Q

Amenorrhoea refers to

A

Transient/permanent absence of menstrual flow

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19
Q

Primary menorrhoea refers to

A

Absence of menarche by 13 years with no pubertal maturation or by 15 years with appropriate secondary sexual characteristics

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20
Q

Secondary amenorrhoea refers to

A

Lack of menses in a non-pregnant female for < 3 cycles of previous interval or < 6 months if previously having irregular periods

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21
Q

4 causes of primary dysmenorrhoea

A
  1. Family history of delayed periods
  2. Structural pathology: FGM, imperforate hymen
  3. Turner’s Syndrome (XO)
  4. Hypogonadotropic hypogonadism (Kallman Syndrome - reduced/absent smell), damage to gonads (mumps, cancer)
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22
Q

5 causes of secondary dysmenorrhoea

A
  1. Pregnancy
  2. Menopause/premature ovarian failure
  3. Hormonal contraception
  4. Hypogonadotropic hypogondadism (reduced GnRH) secondary to weight loss/excess exercise/chronic disease/stress
  5. PCOS
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23
Q

Investigations for secondary dysmenorrhoea

A
  1. HCG urine test
  2. Measure LH/FSH or FSH:LH ratio - high LH or high LH:FSH = PCOS
  3. Measure TFT
  4. Measure androgens
  5. MRI for pituitary tumours (hyperprolactinaemia)
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24
Q

Menopause is defined as

A

Cessation of menses for < 12 months without a reason such as pregnancy/hormone therapy/premature menopause

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25
Q

5 signs/symptoms of menopause

A
  1. Amenorrhoea > 60 years (menopause likely in 2 years)
  2. Irregular menstrual cycle
  3. Vasomotor symptoms - Hot flushes, night sweat
  4. Vaginal symptoms - Dryness, itching, dyspareunia due to reduced oestrogen causing urogenital atrophy
  5. Mood swings
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26
Q

Management for menopause (4 points)

A
  1. Contraception: If < 50 y/o for 2 years; if > 50 y/o for 1 years - does not affect menopause
  2. Hormone therapy (oestrogen/transdermal oestradiol and progestin patches) to prevent against endometrial hyperplasia and cancer
  3. Topical oestrogen and vaginal moisturisers
  4. Testosterone for reduced libido
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27
Q

PCOS triad (2 out of 3 are diagnostic)

A

Rotterdam Criteria

  1. Irregular/absent ovulation
  2. Hyperandrogensim
  3. Polycystic ovaries on ultrasound (volume > 10 cm3)
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28
Q

5 signs/symptoms of PCOS

A
  1. Irregular menstruation
  2. Infertility
  3. Hirsutism: Male facial hair pattern, darkened hair
  4. Acne
  5. Obesity/hypertension/diabetes
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29
Q

What is a risk factor of having PCOS

A

Endometrial cancer

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30
Q

Why are women with PCOS most at risk of endometrial cancer?

A

Obesity/diabetes/amenorrhoea reduces progesterone. Endometrial lining continues to proliferate under influence of oestrogen but is not shed - increasing risk of cancer.

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31
Q

Blood tests for PCOS

A
  1. Testosterone
  2. Serum 17-hydroxyprogesterone: Excludes adult adrenal hyperplasia
  3. ** High LH or high LH:FSH **
  4. TFT
  5. Prolactin
  6. Oestrogen
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32
Q

Gold-standard for diagnosing PCOS

A

Transvaginal ultrasound - best view of ovaries

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33
Q

What is not reliable in teenagers with possible PCOS?

A

Pelvic ultrasound

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34
Q

Transvaginal US PCOS findings

A

String of pearls - > 12 follicles/ovary and/or ovarian volume > 10cm3

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35
Q

Initial management of absent periods/infertility in someone with PCOS

A

Weight loss

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36
Q

Management of risk of endometrial cancer in PCOS

A

Contraception - Mirena coil provides continuous protection, regular withdrawal bleeds if using COCP/POP

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37
Q

Cervicitis is most commonly caused by

A

STI

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38
Q

What should be performed before any internal vaginal examination?

A

Pregnancy test

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39
Q

What procedure will diagnose dyskaryosis?

A

Smear test/cervical screening cytology results

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40
Q

A woman receives a diagnosis of cervical dyskaryosis. What does this mean?

A

Dyskaryosis describes abnormal changes in the squamous cells lining the cervix with varying degrees of severity.

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41
Q

What procedure diagnoses CIN?

A

Colposcopy

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42
Q

Biggest risk factor for non-HPV cervical cancer

A

Non-compliance with cervical screening

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43
Q

2 HPV strains that cause cervical cancer

A

HPV 16 and 18

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44
Q

2 HPV strains that cause genital warts

A

HPV 6 and 11

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45
Q

3 signs/symptoms of CIN/cervical cancer

A
  1. Abnormal bleeding
  2. Mucoid/purulent/blood vaginal discharge
  3. Pelvic pain and dyspareunia
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46
Q

Ways to prevent cervical cancer

A
  1. HPV vaccine (Gardasil)
  2. Regular smear testing
  3. Smoking cessation
  4. Safe sex
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47
Q

How often must women aged 25-49 have cervical screening?

A

Every 3 years

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48
Q

How often must women aged 50-64 have cervical screening?

A

Every 5 years

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49
Q

How often must women with HIV/previous CIN etc have cervical screening?

A

Every year

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50
Q

How long must a post-partum woman wait for a smear test?

A

12 weeks

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51
Q

Management of CIN I

A

Repeat smear every 3-6 months, may resolve by itself

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52
Q

Management of CIN II or III

A

Biopsy - Punch or large loop excision of transformation zone under local
Treat - Cone biopsy under GA

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53
Q

Most common type of cervical cancer

A

Squamous cell

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54
Q

Gold-standard management for cervical cancer

A

Chemoradiation

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55
Q

Prognosis for a woman with stage 1A cervical cancer

A

98%

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56
Q

Cervical polyps may be a sign of

A

Cervical cancer

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57
Q

3 causes of cervical polyps

A
  1. Cancer
  2. Increased oestrogen (tamoxifen treatment, HRT)
  3. Infection - HPV, herpes
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58
Q

When are women commonly diagnosed with cervical insufficiency?

A

During pregnancy or cervical screening

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59
Q

RF of having cervical insufficiency in a pregnant woman

A

Spontaneous loss in 2nd trimester - management includes progesterone supplements in 2nd/3rd trimester or cervical cerclage (stitch cervix close and re-open in 3rd trimester)

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60
Q

3 causes of an incompetent cervix

A
  1. Trauma
  2. Congenital conditions
  3. Pregnancy
61
Q

Cervical ectropion is defined as

A

Benign eversion of the endocervix (columnar epithelium) into the ectocervix (stratified squamous cells).

62
Q

What cells are found at the ectocervix in cervical ectropion?

A

Columnar epithelial cells

63
Q

2 main symptoms of cervical ectropion (typically asymptomatic)?

A
  1. Excessive discharge - Columnar epithelial cells at endocervix and now the ectocervix secrete discharge
  2. Post-coital bleeding - Columnar epithelial cells are fragile and therefore easily damaged during sexual intercourse
64
Q

Main finding on a speculum examination in a woman with cervical ectropion

A

Well-demarcated red ring around cervical os, surrounded by pale pink squamous epithelium

65
Q

Main cause of cervical ectropion

A

Increased oestrogen - Pregnancy, COCP, younger women

66
Q

If you’re unsure on a diagnosis of cervical ectropion what management is recommended?

A
  1. Cervical screening to screen for pre-malignant changes

2. Colposcopy to screen for malignancy

67
Q

Most common type of vaginal/vulval cancer

A

Squamous cell, rarely malignant melanomas.

68
Q

What skin condition can cause vaginal cancer?

A

Lichen sclerosis

69
Q

RF for lichen sclerosis

A

Women, pre-existing autoimmune conditions, skin conditions, thyroid conditions

70
Q

What is a rectocele?

A

Posterior vaginal prolapse caused by the rectum prolapsing forwards into the vagina

71
Q

3 symptoms of rectocele

A
  1. Palpable lump in vagina that can be moved
  2. Constipation
  3. Urinary symptoms
72
Q

3 stages of management for rectocele

A
  1. Conservative: Kegel exercise, weight loss, reduce caffeine, pads, increase fluid/fibre to resolve constipation
  2. Pessary to support vagina with oestrogen cream
  3. Surgery
73
Q

General RF for rectocele

A

Increased intra-abdominal pressure (i.e. chronic constipation, obesity, coughing)

74
Q

What is a cystocele?

A

Anterior vaginal wall defect whereby the bladder prolapses into the vagina

75
Q

What is a Bartholin’s cyst?

A

Fluid-filled, non-infected sac in one of the Bartholin’s glands located on the labia majora caused by duct blockage.

76
Q

What can a Bartholin’s cyst develop into?

A

Bartholin’s abscess which is infected and requires treatment

77
Q

A pea-sized, non-tender lump in the labia majora could be

A

Bartholin’s cyst

78
Q

When should a biopsy be performed in someone with a suspected Bartholin’s cyst?

A

Woman > 40 y/o as ?vulval malignancy

79
Q

2 types of surgery for a Bartholin’s abscess

A
  1. Word catheter/gland balloon under LA

2. Marsupialisation under GA

80
Q

Most common bacteria that causes a Bartholin’s abscess

A

E. coli then STIs

81
Q

What is a small benign cyst near the cervical os called?

A

Nabothian’s cyst

82
Q

Candidiasis is also known as

A

Thrush

83
Q

Creamy white plaques adherent to the mucosa alongside vulva discomfort could be a sign of

A

Candidiasis

84
Q

What pH is candidiasis on a swab?

A

Acidotic < 4.5

85
Q

What can anti fungals damage?

A

Latex condoms

86
Q

Canesten Duo contains what 2 medications

A

Antifungal Fluconazole tablet with anti fungal clotrimazole cream

87
Q

Vulva itchiness in a young girl is termed

A

Vulvovaginitis

88
Q

Vulva itchiness in a post-menopausal woman is termed

A

Atrophic vaginitis

89
Q

Atrophic vaginitis is caused by

A

Reduced oestrogen levels that lead to vaginal dryness and vaginal atrophy

90
Q

Vulvovaginitis is caused by

A

Faecal bacteria spreading and irritating the vulva and vagina

91
Q

What typically protects the vagina and vulva from infection in a fertile woman?

A

Oestrogen

92
Q

2 types of infection causing infective vaginitis

A

STIs and candidiasis

93
Q

2 types of management for atrophic vaginitis/dryness

A
  1. Vaginal lubricants
  2. Topical oestrogen - contraindicated with systemic HRT and may increase risk of endometrial hyperplasia so yearly reviews.
94
Q

A longitudinal vaginal septum gives

A

A double vagina

95
Q

A young girl presents to the GP with uncontrolled period flow even when using a tampon. What may be the cause?

A

Longitudinal vaginal septum - gives the appearance of 2 vaginas

96
Q

A young girl has yet to start her period. She presents to A&E with severe abdominal pain that has been gradually getting worse. What could this be?

A

Transverse vaginal septum - blood will collect behind vagina

97
Q

Purple patches with white lines (Wickham’s Striae) on the vulva is a sign of

A

Lichen planus

98
Q

Shiny white patches affecting the vulva could be a sign of

A

Lichen sclerosus

99
Q

A woman complains of vulva itchiness and skin changes that worsen when wearing tight underwear. What is this phenomenon termed?

A

Koebner’s

100
Q

Management for vulval lichen conditions

A

Clobetasol propionate topical steroid and emollients

101
Q

Loss of lactobacillus in the vagina causes an acidotic or alkaline pH?

A

Alkaline as less lactic acid produced

102
Q

What type of cells might be shown on a BV swab?

A

Clue cells - Gardnerella vaginalsis

103
Q

Offensive fishy-smelling, grey-white, thin discharge is a sign of

A

BV

104
Q

What should be avoided when taking metronidazole and why?

A

Alcohol as can cause flushing, nausea, vomiting, shock, angioedema.

105
Q

BV increases the risk of what 2 things

A
  1. Catching STIs

2. Pregnancy complications

106
Q

Endometriosis is defined as

A

Presence of ectopic endometrial tissue outside of the uterus

107
Q

Endometriomas in the ovaries are termed

A

Chocolate cysts

108
Q

Endometriomas found in the myometrium are termed

A

Adenomyosis

109
Q

Retrograde menstruation is defined as

A

Endometrial lining flowing backwards in menstruation into the fallopian tubes, pelvis and peritoneum

110
Q

3 RF for endometrios

A
  1. Early menarche
  2. FH
  3. White ethnicity
111
Q

Gold-standard for endometriosis diagnosis

A

Laparoscopy - biopsy confirms lesions and these can be removed to improve symptoms

112
Q

3 primary care steps of management for endometriosis

A
  1. Pain and symptom diary
  2. Analgesia: NSAID and paracetamol
  3. Hormonal treatment either with COCP/POP/Mirena etc to stop ovulation/reduce endometrial lining or HRT
113
Q

When to refer a woman with endometriosis (3 points)

A
  1. Symptoms are severe/persistent/recurrent
  2. Pelvic symptoms
  3. GI/GU symptoms
114
Q

What is a leiomyoma?

A

Oestrogen-sensitive benign fibroid tumour of the uterine myometrium

115
Q

What 2 fibroids can be pedunculate?

A

Subserosal and submucosal

116
Q

What type of fibroid may press on the bladder?

A

Subserosal

117
Q

What type of fibroid may extend into the uterine cavity and cause reduced fertility?

A

Submucosal

118
Q

5 referral criteria for referring a lady with leiomyoma

A
  1. Compressive symptoms
  2. Dyspareunia
  3. Pelvic pain
  4. Fertility issues
  5. Fibroid > 3 cm
119
Q

What must be avoided in women with uterine distortion?

A

IUD/IUS

120
Q

What are pregnant women with a history of large > 5 cm fibroids at risk of?

A

Red degeneration of fibroids - fibroid outgrows blood supply leading to ischaemia, infarction and necrosis

121
Q

What shape is a bicornuate uterus?

A

Heart-shaped

122
Q

What is a uterus didelphys?

A

A double uterus

123
Q

What type of cancer is endometrial cancer?

A

Oestrogen-dependent adenocarcinoma

124
Q

What is the biggest cause of endometrial cancer?

A

Exposure to unopposed oestrogen

125
Q

6 RF for exposure to unopposed oestrogen

A
  1. Age
  2. Early menarche
  3. Late menopause
  4. PCOS/obesity/T2DM
  5. No/few pregnancies
  6. Oestrogen-only HRT or tamoxifen
126
Q

3 symptoms of endometrial cancer

A
  1. Post-menopausal bleeding (> 12 months since last period)
  2. Abnormally heavy menstruation
  3. Haematuria/anaemia/raised platelets
127
Q

Normal endometrial thickness in a post-menopausal woman

A

< 4 mm

128
Q

Type of biopsy that diagnoses endometrial cancer

A

Pipelle biopsy

129
Q

Referral criteria for a transvaginal ultrasound in suspected endometrial cancer

A

Women > 55 years with

  1. Unexplained discharge
  2. Visible haematuria and raised platelets, anaemia, glucose
130
Q

Cloudy discharge with abnormal vaginal bleeding could be a sign of

A

Chlamydia

131
Q

STI investigation test for chlamydia/gonorrhoea in women

A

NAAT

132
Q

STI test for chlamydia/gonorrhoea in men

A

Gram stain urine

133
Q

Skin lesions, poly arthritis and conjunctivitis can be a sign of

A

Disseminated gonorrhoea

134
Q

Primary syphilis is marked by the formation of a

A

Chancre

135
Q

Secondary syphilis affects what 3 areas

A

Skin - Maculopapular rash
Lymph nodes - Lymphadenopathy
Mucous membranes - Fever/malaise

136
Q

Genital herpes is caused by what 2 HSV strains?

A

1 and 2

137
Q

3 treatments for candidiasis

A

Clotrimazole cream
Clotrimazole pressary
Flucanazole tablet

138
Q

What can antifungals for thrush damage?

A

Condoms

139
Q

Thick, frothy, green fish-smelling discharge can be a sign of

A

Trichomoniasis parasitic inception

140
Q

Abx for trichomoniasis

A

Metronidazole

141
Q

Complication of 2 year + use of contraceptive injection?

A

Osteoporosis

142
Q

What layer of the skin is the contraceptive implant placed into?

A

Subdermal

143
Q

What affects the efficacy of the contraceptive pills?

A

Nausea and vomiting

144
Q

Female tubal occlusion has a failure rate of

A

1/200

145
Q

What emergency contraception is used if unprotected sex has been within 72 hours?

A

Levonelle

146
Q

What emergency contraceptive dose has to be doubled when a woman is > 70 kg?

A

Levonelle

147
Q

If someone takes Levonelle and within 2 hours vomits, what is recommended?

A

IUD or another dose

148
Q

What’s the time frame to take Ella-One or ulipristal acetate?

A

120 hours

Module 3 (6 decks)

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