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ΩΩ 3a Bateman - Obs and Gynae > Gynaecology > Flashcards

Gynaecology Flashcards

1
Q

WHAT IS OVARIAN CANCER?

A

Type of cancer that begins in the ovaries

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2
Q

What are the different types of ovarian cancer?

A

Epithelial tumors
Begin in the thin layer of tissue that covers the outside of the ovaries.
About 90 percent of ovarian cancers are epithelial tumors.

Stromal tumors
Begin in the ovarian tissue that contains hormone-producing cells. These tumors are usually diagnosed at an earlier stage than other ovarian tumors.

Germ cell tumors
Begin in the egg-producing cells. These rare ovarian cancers tend to occur in younger women.

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3
Q

What is the ovarian cancer risk malignancy index based on?

A
  1. CA125
  2. Menopausal status
  3. Ultrasound findings
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4
Q

What are the risk factors for ovarian cancer?

A
  1. Old age
  2. Inherited gene mutations - BRCA1 and BRCA2
  3. Early menarche
  4. Late menopause
  5. Nulliparity
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5
Q

What are the symptoms of ovarian cancer?

A
  1. Abdominal distension and bloating
  2. Abdominal and pelvic pain
  3. Urinary symptoms e.g. Urgency
  4. Early satiety
  5. Diarrhoea
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6
Q

How do you diagnose ovarian cancer?

A
  1. Imaging tests
    • Ultrasound
  2. Blood tests
    • CA125
  3. Diagnostic laparotomy

If suspicion of ovarian cancer but there is an abdominal or pelvic mass, CA125 and US test can be bypassed and the patient directly referred to gynaecology

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7
Q

How do you treat ovarian cancer?

A

Stage 2-4 = Surgery

Platinum-based Chemotherapy

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8
Q

What are the different stages of ovarian cancer?

A

Stage 1
Tumour confined to ovary

Stage 2
Tumour outside ovary but within pelvis

Stage 3
Tumour outside pelvic but within abdomen

Stage 4
Distant metastasis

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9
Q

WHAT IS ENDOMETRIOSIS?

A

Tissue similar to the tissue that normally lines the inside of your uterus — the endometrium — grows outside your uterus.

Endometriosis most commonly involves your ovaries, fallopian tubes and the tissue lining your pelvis.

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10
Q

What are the causes of endometriosis?

A
  1. Retrograde menstruation
  2. Surgical scar implantation
  3. Immune system disorder
  4. Endometrial cell transport
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11
Q

What are the symptoms of endometriosis?

A
  1. Painful periods (dysmenorrhea)
  2. Pain with intercourse
  3. Pain with bowel movements or urination
  4. Excessive bleeding
  5. Infertility
  6. Pain can be continuous and not just with periods
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12
Q

How do you diagnose endometriosis?

A

Laparoscopy is the gold-standard investigation

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13
Q

What is the treatment of endometriosis?

A

1) Analgesics
Ibuprofen, Naproxen

  • *Hormone therapy**
    2) Hormone contraceptives (medroxyprogesterone acetate)
    3) Gonadotropin-releasing hormone agonists and antagonists
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14
Q

WHAT IS ADENOMYOSIS?

A

Occurs when the normal tissue which lines the uterus (endometrial tissue) grows in the muscular wall of the uterus

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15
Q

What are the causes of adenomyosis?

A
  1. Invasive tissue growth
    • Some experts believe that endometrial cells from the lining of the uterus invade the muscle that forms the uterine walls - C-section
  2. Developmental origins
  3. Uterine inflammation related to childbirth
  4. Stem cell origins
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16
Q

What are the symptoms of adenomyosis?

A

Can be no symptoms but can cause:

  1. Heavy, prolonged menstrual bleeding
  2. Severe menstrual cramps
  3. Abdominal pressure and bloating
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17
Q

How is adenomyosis diagnosed?

A
  1. MRI - Modality of choice
  2. Transvaginal ultrasound
  3. Histology - after hyterectomy
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18
Q

What is the treatment for adenomyosis?

A
  1. Anti-inflammatory medicaitons
    • NSAIDs
  2. Hormone therapy - control bleeding
    • Levonorgestrel-releasing IUD
  3. Uterine artery embolisation
    • Block blood supply to the adenomyosis
  4. Endometrial ablation
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19
Q

WHAT IS DYSFUNCTIONAL/ABNORMAL UTERINE BLEEDING?

A

Vaginal bleeding to occur outside of the regular menstrual cycle

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20
Q

What is the cause of abnormal/dysfunctional endometrial bleeding not in pregnancy?

A
  1. Medical conditions
    PCOS - produce more oestrogen and progesterone
    Endometrosis
    Uterine polyps
    Uterine fibroids
    STDs
  2. Medications
    Birth control pills
    Hormonal agents
    Warfarin
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21
Q

What are the symptoms of abnormal/dysfucntional uterine bleeding?

A
  1. Heavy menstrual bleeding
  2. Bleeding that contains many clots or large clots
  3. Bleeding that lasts more than seven days
  4. Bleeding that occurs less than 21 days from the last cycle
  5. Spotting
  6. Bleeding between periods
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22
Q

How is abnormal/dysfucntional uterine bleeding diagnosed?

A
  1. Pregnancy
    • Urine or blood tests
  2. Thyroid hormone and prolactin hormone abnormalities
    • ​​Blood tests
  3. Menopause
    • ​​Blood tests to determine if estrogen levels are falling, which suggests the beginning stages of menopause
  4. Abnormalities of the uterus or ovaries
    • ​​A transvaginal ultrasound in which a small, rodlike probe is inserted into the vagina to take measurements of the endometrial lining
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23
Q

How is abnormal/dysfucntional uterine bleeding treated?

A
  1. Puberty - no action is taken
  2. Combination oral contraceptive pills
  3. Heavy bleeding can be stopped with higher doses of hormone pills
  4. Dilation and curettage
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24
Q

WHAT IS ANDROGEN INSENSITIVITY SYNDROME?

A

A child born with AIS is genetically male, but the external appearance of their genitals may be female or somewhere between male and female.

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25
Q

What is the cause of androgen insensitivity syndrome?

A

AIS is caused by genetic defects on the X chromosome.

These defects make the body unable to respond to testosterone that produce a male appearance

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26
Q

What are the different types of androgen insensitivity syndrome?

A

Complete AIS
Penis and other male body parts fail to develop

  • *Partial AIS**
  • Failure of one or both testes to descend into the scrotum
  • Hypospadias, a condition in which the opening of the urethra is on the underside of the penis, instead of at the tip
  • Reifenstein syndrome (also known as Gilbert-Dreyfus syndrome or Lubs syndrome)
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27
Q

What are the symptoms of androgen insensitivity syndrome?

A
  1. Genotype is MALE but appearance is FEMALE
  2. A person with complete AIS appears to be female but has no uterus
  3. They have very little armpit and pubic hair.
  4. At puberty, female sex characteristics (such as breasts) develop.
  5. However, the person does not menstruate and become fertile.
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28
Q

How is androgen insensitivity syndrome diagnosed?

A
  1. Often not diagnosed in the child
    • Gowth is found in the abdomen which is found to be a testicle
  2. Buccal smear or chromosomal analysis to reveal 46XY genotype
  3. FSH and LH levels
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29
Q

What is the management of androgen insensitivity syndrome?

A
  1. Removal of the undescended testicle
  2. Eostrogen therapy is prescribed after puberty
  3. Psycological therapy - can result in gender dysphoria
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30
Q

What is the menopause?

What age does it normally begin?

A

Menopause occurs when a woman hasn’t menstruated in 12 consecutive months and can no longer become pregnant naturally.

It usually begins between the ages of 45 and 55, but can develop before or after this age range.

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31
Q

What is the cause of the menopause?

A

It happens when your ovaries stop producing as much of the hormone oestrogen and no longer release an egg each month.

Examples are:

Naturally declining reproductive hormones

Surgery that removes the ovaries (oophorectomy)

Chemotherapy and radiation therapy

Primary ovarian insufficiency

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32
Q

What are the symptoms of the menopause?

A
  1. Hot flushes
  2. Night sweats
  3. Vaginal dryness and discomfort during sex
  4. Difficulty sleeping
  5. Low mood or anxiety
  6. Reduced sex drive (libido)
  7. Problems with memory and concentration
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33
Q

What are the complications as a result of the menopause?

A
  1. Cardiovascular disease
  2. Osteoporosis
  3. Urinary incontinence
  4. Sexual function
  5. Weight gain
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34
Q

How is the menopause diagnosed?

A
  1. Mostly diagnosed through the signs and symptoms of the individual
  2. First line investigation - FSH levels increase
  3. Oestrogen levels decrease
  4. TSH and underactive thyroid can mimic symptoms
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35
Q

What is the treatment for the menopause?

A

HRT

Vaginal oestrogen creams

CBT

Healthy, balanced diet and exercising regularly

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36
Q

What is atrophic vaginitis?

When does it mostly occur?

A

Thinning, drying and inflammation of the vaginal walls

Occurs with less estrogen.

Vaginal atrophy occurs most often after menopause.

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37
Q

What is the cause of atrophic vaginitis?

A

Natural menopause or oophorectomy.

Anti-oestrogenic treatments - eg, tamoxifen, aromatase inhibitors.

Radiotherapy or chemotherapy.

It can also occur postpartum or with breast-feeding, due to reduced oestrogen levels.

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38
Q

What are the symptoms of atrophic vaginitis?

A

Vaginal dryness

Dyspareunia

Occasional spotting

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39
Q

What is the diagnosis of atrophic vaginitis?

A

Vaginal examination

  1. Thin mucosa with diffuse erythema
  2. Occasional petechiae or ecchymoses
  3. Dryness
  4. Lack of vaginal folds

Urine test

Acid balance test

  1. More alkaline
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40
Q

What is the management of atrophic vaginitis?

A

Vaginal lubricants and moisturisers

Topical oestrogen cream

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41
Q

What is the menarche?

A

Is the first menstural cycle, or first menstrual bleeding

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42
Q

What is the average age of menarche?

A

13

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43
Q

What are the physiological processes that puberty fullfills to start the menarche?

A
  1. Attainment of a sufficient body mass (typically 17% body fat)
  2. Disinhibition of the GnRH pulse generator in the arcuate nucleus of the hypothalamus
  3. Secretion of oestrogen by the ovaries in response to pituitary hormones.
  4. Over an interval of about 2 to 3 years, oestrogen stimulates growth of the uterus
  5. Oestrogen stimulates growth and vascularity of the endometrium, the lining of the uterus.
  6. Fluctuations of hormone levels can result in changes of adequacy of blood supply to parts of the endometrium
  7. Death of some of the endometrial tissue from these hormone or blood supply fluctuations leads to deciduation, a sloughing of part of the lining with some blood flow from the vagina
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44
Q

Is there always an egg released at the menarche?

A

No, the majority of menarches are anovulatory for the first year

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45
Q

What conditions impact the timing of the menarche?

A

Chornic illness
Asthma
Coeliac disease
Diabetes

Conditions and disease states

Effects of stress and social environment

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46
Q

What are endometrial polyps?

A

Uterine polyps, also called endometrial polyps, are small, soft growths on the inside of a woman’s uterus, or womb.

They come from the tissue that lines the uterus, called the endometrium.

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47
Q

What is the cause of endometrial polyps?

A

Exact cause is unknown

Rising and falling oestrogen levels thought to play a role in the normal cycle

You are more at risk if:
Obesity
High blood pressure
The breast cancer drug tamoxifen

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48
Q

What are the symptoms of endometrial polyps?

A
  1. Irregular menstrual bleeding
  2. Bleeding between menstrual periods
  3. Excessively heavy menstrual periods
  4. Vaginal bleeding after menopause
  5. Infertility
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49
Q

How do you diagnose endometrial polyps?

A
  1. Transvaginal ultrasound
  2. Hysteroscopy
  3. Endometrial biopsy
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50
Q

What is the treatment for endometrial polyps?

A
  1. Watchful waiting
  2. Medications
    Progestins and gonadotropin-releasing hormone agonists (gonadorelin)
  3. Surgical removal
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51
Q

WHAT IS POLYCYSTIC OVARY SYNDROME (PCOS)?

A

A condition which affects how the ovaries work

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52
Q

What is the cause of polycystic ovary syndrome?

A

Exact cause is unknown, factors thought to play a role are:

Excess insulin - causing excess androgens

Low-grade inflammation

Heredity

Excess androgen

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53
Q

What are the symptoms of polycystic ovary syndrome (PCOS)?

A

Irregular periods – which means your ovaries do not regularly release eggs (ovulation)

Excess androgen – facial or body hair

Polycystic ovaries – your ovaries become enlarged and contain many fluid-filled sacs

2/3 necessary to be diagnosed

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54
Q

How do you diagnose polysytic ovary syndrome (PCOS)?

A
  1. Pelvic ultrasound: multiple cysts on the ovaries
  2. FSH, LH
  3. Prolactin
    • ​​Normal or mildly elevated
  4. TSH
  5. Testosterone
    • Normal or midly elevated
  6. Check for impaired glucose tolerance
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55
Q

What is the treatment of polycystic ovary syndrome?

A

No specific treatment for PCOS but can control the symptoms

  1. Lifestyle changes to lose weight
  2. Combination birth control pills
    • Control bleeding
  3. Progestin therapy
  4. Help you ovulate
    • Letrozole
    • Clomiphene
    • Metformin
  5. Prevent exessive hair growth
    • Birth control pills
    • Spironolactone
    • Eflornithine
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56
Q

What is Turner’s syndrome?

A

X chromosomes (sex chromosomes) is missing or partially missing

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57
Q

What are the causes of Turners syndrome?

A

Monosomy
The complete absence of an X chromosome

Mosaicism
This results in some cells in the body having two complete copies of the X chromosome

X chromosome abnormalities
Abnormal or missing parts of one of the X chromosomes can occur

Y chromosome material

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58
Q

What are the symptoms of Turners syndrome?

What age is it diagnosed?

A
  1. short stature
  2. shield chest, widely spaced nipples
  3. webbed neck
  4. bicuspid aortic valve (15%), coarctation of the aorta (5-10%)
  5. primary amenorrhoea
  6. cystic hygroma (often diagnosed prenatally)
  7. high-arched palate
  8. Underdeveloped ovaries
  9. Normally diagnosed at 8 - 14 years old
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59
Q

How do you diagnose Turners syndrome?

A
  1. In mother
    • Chorionic villus sampling
    • Amniocentesis
  2. In child
    • Raised FSH and LH
    • Low Oestrogen
    • Abscence of Barr body
    • 45, XO karyotype
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60
Q

What is the treatment of Turners Syndrome?

A
  1. Growth hormone - increase height
  2. Oestrogen therapy - promote breast development and increase uterus size
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61
Q

What is Asherman’s sydrome?

A

Asherman’s syndrome is an acquired condition that refers to having scar tissue in the uterus or in the cervix

This scar tissue makes the walls of these organs stick together and reduces the size of the uterus

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62
Q

What are the causes of Asherman’s syndrome?

A
  1. Scar tissue from uterine surgery like dilation and curettage (D&C). (This is the cause of more than 90% of IUA.)
  2. Scar tissue after a Cesarean section or from sutures used to stop hemorrhages
  3. Endometriosis
  4. Infections of the reproductive organs
  5. Radiation treatment
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63
Q

What are the symptoms of Asherman’s syndrome?

A
  1. Having very light periods (hypomenorrhea)
  2. Having no periods (amenorrhea)
  3. Having severe cramping or pain
  4. Being unable to get or stay pregnant
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64
Q

How do you diagnose Asherman’s syndrome?

A
  1. Hysteroscopy
  2. Hysterosalpingography
  3. Saline infusion sonography
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65
Q

What is the treatment of Asherman’s syndrome?

A

Hysteroscopy
Cutting the adhesions with very small scissors, lasers

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66
Q

What is Sheehan’s syndrome?

A

Sheehan’s syndrome is a complication of severe postpartum haemorrhage (PPH)

In which the pituitary gland undergoes ischaemic necrosis which can manifest as hypopituitarism.

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67
Q

What are the symptoms of sheehan’s syndrome?

A

Lack of postpartum milk production and amenorrhoea following delivery.

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68
Q

How do you diagnose sheehan’s syndrome?

A

Inadequate prolactin and Gonadotropin stimulation tests in patients with a history of severe PPH.

69
Q

What is the management of sheehan’s sydrome?

A

Replacement of hormones

  1. Corticosteroids
  2. Levothyroxine
  3. Oestrogen
70
Q

What is a prolactinoma?

A

Noncancerous tumor of the pituitary gland, causes the pituitary to produce to much prolactin

71
Q

What is the cause of prolactinomas?

A

Exact cause is unknown

72
Q

What are the symptoms of prolactinomas?

A

Men
Impotence
Loss of libido
Galactorrhoea

Women
Amenorrhoea
Infertility
Galactorrhoea
Osteoporosis

73
Q

How do you diagnose a prolactinoma?

A

Blood tests
Raised prolactin and whether levels of other hormones controlled by the pituitary are within the normal range.
Women of childbearing age also will have a pregnancy test.

Brain imaging (MRI)
Pituitary tumor on an image generated

74
Q

What is the treatment for prolactinoma?

A

Return the production of prolactin to normal levels
Restore normal pituitary gland function
Dopamine analogue - bromocriptine, cabergoline

Surgery
Nasal surgery
Transcranial surgery

75
Q

What is pelvic inflammatory disease (PID)?

A

Pelvic inflammatory disease (PID) is an infection of the female reproductive organs

It most often occurs when sexually transmitted bacteria spread from your vagina to your uterus, fallopian tubes or ovaries.

76
Q

What is the cause of pelvic inflammatory disease?

A

Gonorrhea

Chlamydia

77
Q

What are the causative organisms of pelvic inflammatory disease?

A

Chlamydia trachomatis

+ the most common cause

Neisseria gonorrhoeae

Mycoplasma genitalium

Mycoplasma hominis

78
Q

What are the symptoms of pelvic inflammatory disease?

A
  1. Pain
  2. Abnormal or heavy vaginal discharge/unpleasant odor
  3. Abnormal uterine bleeding, especially during or after intercourse, or between menstrual cycles
  4. Pain during intercourse
  5. Fever, sometimes with chills
  6. Painful, frequent or difficult urination
79
Q

How is pelvic inflammatory disease diagnosed?

A
  1. A pregnancy test should be done to exclude an ectopic pregnancy
  2. High vaginal swab
    • These are often negative
  3. Screen for Chlamydia and Gonorrhoea
80
Q

What is the treatment for pelvic inflammatory disease?

A
  1. Antibiotics
    - Oral ofloxacin + oral metronidazole
    - Or intramuscular ceftriaxone + oral doxycycline + oral metronidazole
  2. Treatment for your partner
  3. Temporary abstinence
81
Q

What are the complications of pelvic inflammatory disease?

A

Perihepatitis (Fitz-Hugh Curtis Syndrome)
It is characterised by right upper quadrant pain and may be confused with cholecystitis

  1. Infertility
  2. Chronic pelvic pain
  3. Ectopic pregnancy
82
Q

What is pre-menopausal syndrome?

A

Premenopause is when you have no symptoms of perimenopause or menopause

83
Q

What are the symptoms of pre-menopausal/perimenopause syndrome?

A

Changes in your period cycle

Hot flashes

Sleep disturbances

Mood swings

84
Q

How long does the perimenopause last for?

A

4 years

85
Q

How is the pre-menopause/perimenopause diagnosed?

A

Normally blood tests and history

86
Q

What is the treatment for pre-menopause/perimenopause?

A

Changes to your hormone therapies

Things which improve your mental well-being

87
Q

What are fibroids?

A
  1. Uterine fibroids are noncancerous growths of the uterus that often appear during childbearing years.
  2. Also called leiomyomas (lie-o-my-O-muhs) or myomas, uterine fibroids aren’t associated with an increased risk of uterine cancer and almost never develop into cancer.
88
Q

What are the symptoms of fibroids?

A
  1. Heavy menstrual bleeding
  2. Menstrual periods lasting more than a week
  3. Pelvic pressure or pain
  4. Frequent urination
  5. Difficulty emptying the bladder
  6. Constipation
  7. Backache or leg pains
89
Q

What are the different types of fibroids?

A

Fibroids are generally classified by their location.

Intramural fibroids grow within the muscular uterine wall.

Submucosal fibroids bulge into the uterine cavity.

Subserosal fibroids project to the outside of the uterus.

90
Q

What are the causes of fibroids?

A
  1. Genetic changes
  2. Hormones
  3. Growth factors e.g. insulin-like growth factors
  4. Extracellular matrix (ECM)
91
Q

What is the diagnosis of a fibroid?

A
  1. Uterine fibroids are frequently found incidentally during a routine pelvic exam.
  2. Uterine fibroid - Transvaginal ultrasound
92
Q

What is the treatment of a fibroid?

A

If <3cm then managed medically

  1. Progestin-releasing intrauterine device (IUD/IUS)
  2. Transexamic acid
    • ​​Best for when trying to convieve
  3. Medications which can shrink the fibroids
    e. g. Gonadotropin-releasing hormone (GnRG) e.g. Triptorelin - blocks production of oestrogen and progesterone SHORT TERM

>3cm or causing significant problems

  1. Surgery
    • ​​Myomectomy - adhesions common
      Endometrial ablation
      Hysterectomy
93
Q

WHAT ARE THE DIFFERENT TYPES OF OVARIAN CYSTS?

A
  1. Physiological cysts
  2. Benign germ cell tumours
  3. Benign epithelial tumours
  4. Benign sex cord stromal tumours
94
Q

What cyst looks like a chocolate cyst due to the external appearance?

A

Endometriotic cyst

95
Q

What are the physiological cysts?

A

Follicular cysts

  1. Commonest type of ovarian cyst
  2. Due to non-rupture of the dominant follicle or failure of atresia in a non-dominant follicle
  3. Commonly regress after several menstrual cycles

Corpus luteum cyst

  1. During the menstrual cycle if pregnancy doesn’t occur the corpus luteum usually breaks down and disappears. If this doesn’t occur the corpus luteum may fill with blood or fluid and form a corpus luteal cyst
  2. More likely to present with intraperitoneal bleeding than follicular cysts
96
Q

What are the benign germ cell tumours?

A

Dermoid cyst

  1. Also called mature cystic teratomas. Usually lined with epithelial tissue and hence may contain skin appendages, hair and teeth
  2. Most common benign ovarian tumour in woman under the age of 30 years
  3. Median age of diagnosis is 30 years old
  4. Bilateral in 10-20%
  5. Usually asymptomatic. Torsion is more likely than with other ovarian tumours
97
Q

What are the different ovarian benign epithelial tumours?

A

Serous cystadenoma

  1. The most common benign epithelial tumour which bears a resemblance to the most common type of ovarian cancer (serous carcinoma)

Mucinous cystadenoma

  1. Second most common benign epithelial tumour
  2. They are typically large and may become massive
  3. If ruptures may cause pseudomyxoma peritonei
98
Q

What are the complications with an ovarian cyst?

A
  1. Bleed or burst
  2. Torsion of the ovary
  3. Press on nearby structures
  4. Some can develop into cancer
99
Q

How is an ovarian cyst diagnosed?

A

Most have no symptoms so are found on a routine examination

Ultrasound CA125 test - does not rule out cancer if normal

100
Q

What is the treatment for an ovarian cyst?

A

Observation

Operation

101
Q

WHAT IS OVARIAN TORSION?

A

Ovarian torsion (adnexal torsion) occurs when an ovary becomes twisted around the tissues that support it.

Sometimes, the fallopian tube may also become twisted. This painful condition cuts off blood supply to these organs.

102
Q

What are the symptoms of ovarian torsion?

A

Severe, sudden pain in the lower abdomen

Cramping

Nausea

Vomiting

These symptoms usually present suddenly and without warning.

103
Q

Who is more at risk at developing an ovarian torsion?

A
  1. Ovarian mass: present in around 90% of cases of torsion
  2. Being of a reproductive age
  3. Pregnancy
  4. Ovarian hyperstimulation syndrome
104
Q

How is ovarian torsion diagnosed?

A
  1. Transvaginal ultrasound
    • Whirpool
  2. Pelvic exam
  3. Blood and urine tests to rule out infection, ovarian abscess, ectopic pregnancy, appendicitis
105
Q

What is the treatment for ovarian torsion?

A

Laparoscopy

Laparotomy

Oophorectomy

Salphingo-Ooporectomy

106
Q

What is Lichen sclerosus?

Who are more at risk?

A

Inflammatory condition which usually affects the genitalia and is more common in elderly females.

Leads to atrophy of the epidermis with white plaques forming

Postmenopausal women are more at risk

107
Q

What are the symptoms of lichen sclerosus?

A
  1. Redness Itching (pruritus), which can be severe
  2. Discomfort or pain
  3. Smooth white patches on your skin
  4. Blotchy, wrinkled patches
108
Q

What is the cause of lichen sclerosus?

A

Unknown

Overactive immune system and hormone imbalances are thought to play a role

109
Q

How is lichen sclerosus diagnosed?

A
  1. A physical examination
  2. Biopsy
110
Q

What is the treatment for lichen sclerosus?

A
  1. Corticosteroids - Dermovate, clobetasol propionate
  2. Tacrolimus (Protopic)
111
Q

What is cervical cancer?

A

Cervical cancer starts in the cells lining the cervix

112
Q

What are the different parts of the uterus?

What type of cells are found here?

What is the zone called where the two zones meet?

A

Endocervix (Glandular cells)

Exocervix (squamous cells)

Transitional zones

113
Q

What are the risk factors for cervical cancer?

A
  1. HPV 16, 18 & 33
  2. Smoking - two fold increase
  3. Human immunodeficiency virus
  4. Early first intercourse, many sexual partners
  5. High parity
  6. Lower socioeconomic status
  7. Combined oral contraceptive pill*
114
Q

What are the different types of cervical cancer?

A
  1. Squamous cell carcinoma (9 out of 10)
  2. Adenocarcinoma
  3. Mixed carcinomas (uncommon)
115
Q

What is the most common cause of cervical cancer?

A

Human papillomavirus (HPV)

116
Q

What are the symptoms of cervical cancer?

A
  1. Mostly none in the early stages
  2. Pain when you have sex
  3. Abnormal bleeding, such as after sex or between periods
117
Q

What is the screening called for cervical cancer?

What further tests can they do?

A

Smear test

Colposcopy

118
Q

What is the treatment for cervical cancer?

A

1A
Hysterectomy
Cone biopsy is wanting children

1B
Radiotherapy then chemo (cisplatin)

2+3
Radiotherapy

4
Radiotherapy then chemo
Pallative

119
Q

WHAT IS ENDOMETRIAL HYPERPLASIA?

A

Endometrial hyperplasia may be defined as an abnormal proliferation of the endometrium in excess of the normal proliferation that occurs during the menstrual cycle.

A minority of patients with endometrial hyperplasia may develop endometrial cancer

120
Q

What medication increases the risk of endometrial hyperplasia?

A

Tamoxifen

121
Q

What are the features of endometrial hyperplasia?

A

Abnormal vaginal bleeding e.g. intermenstrual

122
Q

What is the management of endometrial hyperplasia?

A
  1. simple endometrial hyperplasia without atypia: high dose progestogens with repeat sampling in 3-4 months. The levonorgestrel intra-uterine system may be used
  2. atypia: hysterectomy is usually advised
123
Q

WHAT IS ENDOMETRIAL CANCER?

A

Type of cancer that begins in the uterus

Endometrial cells which line the uterus

124
Q

What are the symptoms of endometrial cancer?

A
  1. Vaginal bleeding after menopause
  2. Bleeding between periods
  3. Pelvic pain
125
Q

What are the risk factors for endometrial cancer?

A
  1. Obesity
  2. Oestrogen Increasing Reasons
    Nulliparity
    Early menarche
    Late menopause
    Unopposed oestrogen
  3. Diabetes mellitus
  4. Tamoxifen
  5. Polycystic ovarian syndrome
  6. Hereditary non-polyposis colorectal carcinoma
126
Q

What is the cause of endometrial cancer?

A

Unknown

127
Q

How do you diagnose endometrial cancer?

A

Women >= 55 years who present with postmenopausal bleeding should be referred using the suspected cancer pathway

1) Trans-vaginal ultrasound - a normal endometrial thickness (< 4 mm) has a high negative predictive value
2) Hysteroscopy with endometrial biopsy

128
Q

What is the treatment for endometrial cancer?

A
  1. Localised disease is treated with total abdominal hysterectomy with bilateral salpingo-oophorectomy
  2. Patients with high-risk disease may have post-operative radiotherapy
  3. Progestogen therapy is sometimes used in frail elderly women not consider suitable for surgery
129
Q

WHAT IS MENORRHAGIA?

A

Excessive vaginal bleeding

130
Q

What is the definition of menorrhagia?

A

What a woman considers to be excessive

131
Q

What are the causes of menorrhagia?

A
  1. Dysfunctional uterine bleeding: this describes menorrhagia in the absence of underlying pathology. This accounts for approximately half of patients
  2. Anovulatory cycles: these are more common at the extremes of a women’s reproductive life
  3. Uterine fibroids
  4. Hypothyroidism
  5. Intrauterine devices*
  6. Pelvic inflammatory disease
  7. Bleeding disorders, e.g. von Willebrand disease
132
Q

What are the investigations for menorrhagia?

A
  1. A full blood count should be performed in all women
  2. Routine transvaginal ultrasound scan if symptoms (for example, intermenstrual or postcoital bleeding, pelvic pain and/or pressure symptoms) suggest a structural or histological abnormality. Other indications include abnormal pelvic exam findings.
133
Q

What is the treatment for menorrhagia?

A

Does not require contraception

  1. either tranexamic acid - first line or mefenamic acid. Both are started on the first day of the period
  2. if no improvement then try other drug whilst awaiting referral

Requires contraception, options include

  1. intrauterine system (Mirena) should be considered first-line
  2. combined oral contraceptive pill
  3. long-acting progestogens
134
Q

Which contraceptive is best used for women with breast cancer?

A

IUD

135
Q

What are these cancer markers of?

CA 125

CA 19-9

CEA

AFP

HER2

A

CA 125 Ovarian cancer

CA 19-9 Pancreatic cancer

CEA Bowel cancer

AFP Liver cancer and germ cell tumours (e.g. testicular)

HER2 Breast cancer receptor

136
Q

What is the most common type of vulval cancer?

A

Secondary metastatic Cancer

Most common primary is:

Squamous cell carcinomas.

80% of vulval cancers

Most cases occur in women over the age of 65 years

137
Q

What are the features of vulval cancer?

A
  1. Lump or ulcer on the labia majora
  2. May be associated with itching, irritation
138
Q

What are the different cateogries of ovulatory disorders?

A

Class 1 (hypogonadotropic hypogonadal anovulation) - notably hypothalamic amenorrhoea (5-10% of women)

Class 2 (normogonadotropic normoestrogenic anovulation) - polycystic ovary syndrome (80% of cases)

Class 3 (hypergonadotropic hypoestrogenic anovulation) - premature ovarian insufficiency (5-10% of cases). In this class, any attempts at ovulation induction are typically unsuccessful and therefore usually require in-vitro fertilisation (IVF) with donor oocytes to conceive

139
Q

Which hypoglycaemic is safe to use during breastfeeding?

A

Metformin

140
Q

What is the best hypoglycaemic agent in breastfeeding?

A

Metformin

141
Q

WHAT ARE THE CONTRAINDICATIONS FOR HRT?

A
  1. Current or past breast cancer
  2. Any oestrogen-sensitive cancer
  3. Undiagnosed vaginal bleeding
  4. Untreated endometrial hyperplasia
142
Q

What HRT is given to women who have had a hysterectomy?

A

Oestrogen only

If they have ovaries oestrogen alone can increase risk of cancer

143
Q

What device can act as the component of combined HRT?

A

IUS

144
Q

What HRT is given to perimenopausal women?

A

Cyclical combined HRT

145
Q

What HRT is given to postmenopausal women?

A

Continuous combined HRT

146
Q

What type of cancer is vaginal cancer?

A

Squamous cell carcinoma

147
Q

What are the clinical features of vaginal cancer?

A
  1. Post-coital bleeding
  2. Later followed by offensive watery discharge
148
Q

What are the investigations for vaginal cancer?

A
  1. FIRST LINE - Trans-vaginal ultrasound
  2. Speculum examination
149
Q

What is the management for vaginal cancer?

A
  1. Radiation or surgery
150
Q

WHAT IS A HYDATIDIFORM MOLE?

A

Benign tumour arising from the trophoblast

151
Q

How are more at risk of developing a hydatidiform mole?

A
  1. Previous molar pregnancy - increases risk 40 fold
  2. Age - more common among mothers less than 20 and older than 40 years
  3. Racial origin - more common among Asian and Taiwanese mothers than Caucasian
  4. Diet -Low consumption of folic acid
152
Q

What are the genetics for a hydatidiform mole?

A

Usually 46 XX karotype but with both X chromosomes derived from the father

153
Q

What are the clinical features of a hydatidiform mole?

A

Symptoms

  1. Painless heavy or irregular vaginal bleeding, usually after 6-12 weeks of amenorrhoea
  2. Hyperemesis gravidarum - excessive nausea and vomiting
  3. Pre-eclampsia - irritability, dizziness, photophobia

Signs

  1. Enlarged uterus
  2. Ovarian enlargement
  3. Hypertension
154
Q

What are the investigations of hydatidiform mole?

A

Normally clinically diagnosed

  1. Bleeding after a prolonged period of amenorrhoea
  2. Early pre-eclampsia
  3. Hyperemesis gravidarum
  4. Large uterus

Investigations include

  1. Ultrasound - ‘snow-storm’ pattern/echoes with numerous small anechoic spaces
  2. Abnoramlly high serum hCG
  3. Negative results with foetal doppler
155
Q

What is the management for a hydratidiform mole?

A
  1. Cross-match blood
  2. Arrange for an evacuation of the uterus under GA w oxytocin to reduce blood loss
  3. Monitor beta-hCG levels
  4. Rarely needs a hyterectomy
156
Q

WHAT IS PREMATURE OVARIAN INSUFFICIENCY?

A
  1. Premature ovarian insufficiency is defined as the onset of menopausal symptoms and elevated gonadotrophin levels before the age of 40 years.
  2. It occurs in around 1 in 100 women.
157
Q

What are the causes of premature ovarian insufficiency?

A
  1. Idiopathic
    • the most common cause
    • there may be a family history
  2. bilateral oophorectomy
    • having a hysterectomy with preservation of the ovaries has also been shown to advance the age of menopause
  3. radiotherapy
  4. chemotherapy
  5. infection: e.g. mumps
  6. autoimmune disorders
  7. resistant ovary syndrome: due to FSH receptor abnormalities
158
Q

What are the features of premature ovarian insufficiency?

A
  1. climacteric symptoms: hot flushes, night sweats
  2. infertility
  3. secondary amenorrhoea
  4. raised FSH, LH levels
    • e.g. FSH > 40 iu/l
    • elevated FSH levels should be demonstrated on 2 blood samples taken 4–6 weeks apart
  5. low oestradiol
    • e.g. < 100 pmol/l
159
Q

What is the management for premature ovarian insufficiency?

A
  1. hormone replacement therapy (HRT) or a combined oral contraceptive pill should be offered to women until the age of the average menopause (51 years)
    • it should be noted that HRT does not provide contraception, in case spontaneous ovarian activity resumes
160
Q

WHAT ARE THE CAUSE OF DYSMENORRHOEA?

A

Primary

  1. No underlying pathology

Secondary

  1. Endometriosis
  2. Adenomyosis
  3. Pelvic inflammatory disease
  4. Intrauterine devices*
  5. Fibroids
161
Q

What is the timing of pain in dysmenorrhoea?

A

Primary

  1. Pain typically starts just before or within a few hours of the period starting
  2. Suprapubic cramping pains which may radiate to the back or down the thigh

Secondary

  1. Pain usually starts 3-4 days before the onset of the period
162
Q

What can be used to relieve primary dysmenorrhea?

A

1st Line

  1. NSAIDs
    Mefanamic acid
    Ibruprofen
    They work by inhibiting prostaglandin production

2nd Line

  1. Combined oral contraceptive pills
163
Q

What is the management for secondary dysmennorrhoea?

A

Refer to gynaecology for investigation

164
Q

WHAT IS PREMENSTRUAL SYNDROME?

A

Premenstrual syndrome (PMS) describes the emotional and physical symptoms that women may experience in the luteal phase of the normal menstrual cycle.

165
Q

What are the faatures of prementrual syndrome?

A
  1. PMS only occurs in the presence of ovulatory menstrual cycles - it doesn’t occur prior to puberty, during pregnancy or after the menopause.
  2. Emotional symptoms include:
    • anxiety
    • stress
    • fatigue
    • mood swings
  3. Physical symptoms
    • bloating
    • breast pain
166
Q

What is the management of premenstural syndrome?

A

Options depend on the severity of symptoms

  1. Mild symptoms can be managed with lifestyle advice
    • apart from the usual advice on sleep, exercise, smoking and alcohol, specific advice includes regular, frequent (2–3 hourly), small, balanced meals rich in complex carbohydrates
  2. Moderate symptoms may benefit from a new-generation combined oral contraceptive pill (COCP)
    • examples include Yasmin® (drospirenone 3 mg and ethinylestradiol 0.030 mg)
  3. Severe symptoms may benefit from a selective serotonin reuptake inhibitor (SSRI)
    • this may be taken continuously or just during the luteal phase (for example days 15–28 of the menstrual cycle, depending on its length)
167
Q

WHAT IS CERVICAL ECTROPION?

A

On the ectocervix there is a transformation zone where the stratified squamous epithelium meets the columnar epithelium of the cervical canal. Elevated oestrogen levels (ovulatory phase, pregnancy, combined oral contraceptive pill use) result in larger area of columnar epithelium being present on the ectocervix

168
Q

What are the symptoms of cervical ectropion?

A
  1. Vaginal discharge
  2. Post-coital bleeding
169
Q

What is a risk factor for cervical ectropion?

A

Combined oral contraceptive pill

ΩΩ 3a Bateman - Obs and Gynae (6 decks)

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