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MBBS VI - SpC - Obstetrics and Gynaecology > Gynaecology - Menstrual disorders: AUB, Amenorrhea and Menopause, Dysmenorrhoea > Flashcards

Gynaecology - Menstrual disorders: AUB, Amenorrhea and Menopause, Dysmenorrhoea Flashcards

1
Q

FIGO definition of normal menstruation

A
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2
Q

FIGO classification of AUB

A
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3
Q

AUB

Ddx

A
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4
Q

AUB

Approach and history taking questions

A
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5
Q

Heavy menstrual bleeding

Ddx

A
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6
Q

HMB

Approach and history taking questions

A
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7
Q

HMB

Physical exam

A
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8
Q

HMB

First line Ix

A

Blood test:
- CBC: Hb, platelets
- Pregnancy test: to exclude pregnancy → must be done (or document no unprotected sex) before EA
- ± clotting profile: if HMB since menarche, or FHx +ve
- ± Fe profile: for Fe def anemia
- ± TFT: only when clinically symptomatic (uncommon)

Further investigations:
- Endometrial aspirate/sampling (EA) (子宮內膜吸取術)
- Hysteroscopy (宮腔鏡檢查術) ± endometrial biopsy
- Pelvic US when suspect structural pathology
- Saline infusion sonography (sonohysterography, SIS)

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9
Q

Endometrial aspirate

Indications
Process

A
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9
Q

Hysteroscopy and endometrial biopsy

Indications
Process

A
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10
Q

Compare TAUS and TVUS

A
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11
Q

Saline Infusion sonography

Indication and use

A
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12
Q

HMB

Medical management options

A

Hormonal treatment:
- Combined OC pills (COCP): 1st line unless C/I
- Levonorgestrel IUD (Mirena): also 1st line unless C/I
- High-dose oral progestin: if prefer to avoid or C/I to estrogen
- Danazol: a/w significant S/E, NOT used nowadays
- Gonadotrophin-releasing hormone agonist (GnRHa): a/w significant S/E, NOT used nowadays

Non-hormonal treatment:
- NSAIDs: e.g. mefenamic acid (Ponstan)
- Tranexamic acid (TXA, Transamin): antifibrinolytic agent (flow control only)
- Fe supplement: FeSO4 300mg BD ×12w

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13
Q

HMB

Surgical management options

A

Endometrial ablation (子宮內膜去除術)

Hysterectomy (子宮切除術)
- Abdominal hysterectomy (AH)
- Vaginal hysterectomy (VH): approach through vaginal introitus
- Laparoscopic hysterectomy (LH)
- ± concurrent oophorectomy: preferred when near menopause: ovaries no use after menopause

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14
Q

HMB

COCP
- Forms
- MoA
- Effect
- Advantage
- S/E
- C/I

A
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15
Q

HMB

Mirena
- MoA
- Effect
- Advantage
- S/E
- C/I

A
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16
Q

HMB

High-dose oral progestin
- Forms
- MoA
- Advantage
- S/E

A
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17
Q

HMB

Mefenamic acid
- MoA
- Effect
- Use

A
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18
Q

HMB
Transamin

  • MoA
  • Max dose
  • C/I
A
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19
Q

HMB

Endometrial ablation
- Indications
- C/I
- Preoperative preparation
- Procedure
- Complications

A
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20
Q

HMB
Hysterectomy

  • Indication
  • Choice of route of hysterectomy
A
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21
Q

Intermenstrual and Irregular Bleeding

Ddx

A
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22
Q

IMB

History taking questions

A
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23
Q

IMB

PE

A
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24
Q

IMB

First line investigations

A
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25
Q

IMB

Management options

A
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26
Q

Post coital bleed

Ddx

A
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27
Q

Post coital bleed

Management flowchart

A
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28
Q

Post menopausal bleed

Definition
Ddx

A
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29
Q

Post menopausal bleed

History taking questions
PE

A
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30
Q

PMB

First-line investigations
Treatment options

A
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31
Q

Primary and secondary amenorrhea

Definitions

A
32
Q

Primary amenorrhea

Ddx

A
33
Q

Secondary amenorrhea

Ddx

A
34
Q

Physiological causes of amenorrhea

A
35
Q

Functional hypothalamic amenorrhea

Hormonal profile
Common causes

A
36
Q

Primary ovarian insufficiency

  • Definition
  • Hormonal profile
  • Causes
A
37
Q

PCOS

Diagnostic criteria

A
38
Q

Cryptomenorrhea

Classical symptom
Causes

A

Cryptomenorrhea (outflow tract obstruction)
- present with cyclical abdominal pain due to accumulation of blood in vagina (hematocolpos) or uterus (hematometra)

39
Q

Genetic causes of amenorrhea

A
40
Q

Primary amenorrhea

Common clinical presentation and features

A
41
Q

Secondary amenorrhea

Common clinical presentation and features

A
42
Q

Primary amenorrhea

Key history taking questions

A
43
Q

Secondary amenorrhea

Key history taking questions

A
44
Q

Primary amenorrhea

P/E features

A
45
Q

Secondary amenorrhea

P/E features

A
46
Q

Primary amenorrhea

Workup investigations

A
47
Q

Secondary amenorrhea

Workup investigations

A
48
Q

Primary and secondary amenorrhea

Routine hormonal investigations

A
49
Q

Primary and secondary amenorrhea

Second-line investigations

A
50
Q

Hypogonadotropic hypogonadism (Class 1)

Cause
Ix results

A
51
Q

Hypogonadotropic hypogonadism (Class 1)

Management of underlying cause
Hormonal and fertility management

A
52
Q

Normogonadotropic anovulation (Class 2)
- Cause
- Ix results

A
53
Q

Normogonadotropic anovulation (Class 2)

Management of underlying cause
Hormonal and fertility management

A
54
Q

Hypergonadotropic hypogonadism (Class 3)

Cause
Ix findings

A
55
Q

Hypergonadotropic hypogonadism (Class 3)

Management of underlying cause
Hormonal and fertility management

A
56
Q

Hyperprolactinemia (Class 4)

Ix findings
Management

A
57
Q

Outflow tract abnormalities

Ix findings
Management

A
58
Q

Concealed male karyotype

Ix findings
Management

A
59
Q

Outline flowchart for amenorrhea assessment

A
60
Q

Define Climacteric, Menopause and Perimenopause

A
61
Q

Types of menopause

A
62
Q

Menopause

Stages and endocrine stages

A
63
Q

Climacteric symptoms

  • Vasomotor symptoms
A
64
Q

Climacteric symptoms

  • Neuropsychiatric symptoms
A
65
Q

Climacteric symptoms

  • Sexual and urogenital changes
A
66
Q

Postmenopausal osteoporosis

  • Cause
  • Risk factors
  • Risk assessment
A
67
Q

Menopause

Diagnosis

A
68
Q

Menopause
Hormone replacement therapy
- duration
- options/ regimens

A
69
Q

HRT

Benefits and risks

A

The combined regimen has a higher risk of CA breast and CAD compared to Estrogen only regimen despite conventional belief that estrogen only regimen induces CA breast

70
Q

HRT

Contraindications

A

Fibrocystic disease is not a relative C/I

71
Q

HRT

Indications

A

Initiating HRT:

Indication:
- premature menopause: <40y for bone and cardiac protection (no extra lifetime risk)
- symptomatic menopausal pt: only for vasomotor symptoms ± mild mood disorder (not for cardio- and bone protection alone)
- (menopausal women with established osteoporosis)
- (hypopituitarism and other endocrine disease)

Timing: need not await amenorrhea before starting HRT

72
Q

HRT

When to stop therapy

A

Standard duration about 2-3 years
Taper from standard to low dose after 1st year
Stop regimen during winter
Investigations for metabolic and cardiovascular profile every 2 years
Rapid symptom control within a month usually
Taper off and remain low dose regimen if possible after few months of symptom relief

73
Q

HRT

Algorithm of HRT administration

A
74
Q

Menopause

Management of menopausal symptoms

A
75
Q

Postmenopausal osteoporosis

A
76
Q

Primary ovarian insufficiency

  • Definition
  • Causes
A
77
Q

Primary ovarian insufficiency

Workup
Management

A

MBBS VI - SpC - Obstetrics and Gynaecology (42 decks)

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