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Women's Health > Gynaecology Part 2 > Flashcards

Gynaecology Part 2 Flashcards

1
Q

Type 1 female genital mutilation:

A

partial or total removal of clitoris and/or prepuce

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2
Q

Type 2 female genital mutilation:

A

partial or total removal of clitoris and labia minora, with or without excision of labia majora

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3
Q

Type 3 female genital mutilation:

A

narrowing of vaginal orifice with creation of covering seal by cutting and positioning labia minora or majora, with or without excision of clitoris (infibulation)

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4
Q

Type 4 female genital mutilation:

A

all other harmful procedures to female genitalia: pricking, piercing, incising, scraping and cauterisation

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5
Q

How can fibroid degeneration come about and how does it present and treatment?

A
  • sensitive to oestrogen so grows during pregnancy
  • growth outstrips blood supply - red/carneous degeneration
  • low grade fever, pain and vomiting
  • manage conservatively with rest and analgesia (resolves within 4-7 days)
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6
Q

Features of Mittelschmerz:

A
  • mid cycle pain
  • sharp onset
  • little systemic
  • recurrent
  • settles over 24-48 hours
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7
Q

Investigation and treatment of mittelschmerz:

A
  • FBC normal
  • US may show small quantity free fluid
  • conservative management
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8
Q

Features of endometriosis pain:

A
  • 25% asymptomatic
  • menstrual irregularity, infertility, pain and deep dyspareunia
  • intermittent small bowel obstruction
  • intra abdominal bleeding - localised peritoneal inflammation
  • recurrent episodes
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9
Q

Investigations endometriosis:

A
  • US - free fluid

- laparoscopy - lesions

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10
Q

Features of ovarian torsion pain:

A
  • suden onset
  • deep seated colicky abdominal pain
  • vomiting and distress
  • adnexial tenderness
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11
Q

Investigation of ovarian torsion:

A
  • US - free fluid

- laparoscopy diagnostic and therapeutic

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12
Q

Features of ectopic gestation pain:

A
  • symptoms of pregnancy without evidence of intrauterine gestation
  • emergency with evidence of rupture or impending rupture
  • small amount of vaginal discharge
  • adnexial tenderness
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13
Q

Investigation and management of ectopic gestation:

A
  • US - no intrauterine pregnancy
  • beta hCG elevated
  • intra abdominal free fluid
  • laparoscopy or laparotomy if harm-dynamically unstable
  • salpingectomy usually
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14
Q

Features of PID pain:

A
  • bilateral lower abdominal pain
  • associated with vaginal discharge
  • may also have dysuria
  • peri-hepatic inflammation secondary to Chlamydia (Fitz Hugh Curtis)
  • may have RUQ discomfort
  • fever >38 degrees
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15
Q

Investigation and management of PID:

A
  • FBC: leucocytosis
  • pregnancy test negative
  • amylase - normal or slightly raised
  • high vaginal and urethral swabs
  • medical management
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16
Q

Investigations carried out if menorrhagia:

A
  • FBC

- routine transvaginal US if symptoms suggest structural or histological abnormality

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17
Q

If a patient with menorrhagia does not require contraception, use:

A

mefenamic acid 500mg tds (especially if also dysmenorrhoea) or tranexamic acid 1g tds

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18
Q

If a patient with menorrhagia does require contraception, use:

A
  • intrauterine (mirena) first line
  • COCP
  • long acting progestogens
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19
Q

What can be used as a short term option to rapidly stop heavy menstrual bleeding?

A

norethisterone 5mg tds

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20
Q

What is HRT typically used for in women?

A

small dose of oestrogen to help alleviate menopausal symptoms (also progestogen if uterus)

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21
Q

Side effects of HRT:

A
  • nausea
  • breast tenderness
  • fluid retention and weight gain
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22
Q

Complications of HRT:

A
  • increased risk breast cancer
  • increased risk endometrial cancer
  • increased risk of VTE
  • increased risk of stroke
  • increased risk of ischaemic heart disease if more than 10 years after menopause
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23
Q

In what way does HRT increase risk of breast cancer:

A
  • increased by addition of progestogen
  • increased risk with duration of use
  • risk of breast cancer begins to decline when HRT stopped and reaches previous level after 5 years
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24
Q

How does HRT increase risk of endometrial cancer?

A
  • oestrogen on its own should not be given as HRT to women with a womb
  • reduced by the addition of progestogen but not eliminated
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25
Q

How does HRT increase risk of VTE?

A
  • increased by addition of progestogen
  • transdermal HRT does not increase risk
  • refer to haematology before starting treatment if high risk
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26
Q

What is hyperemesis gravidarum thought to be due to?

A

raised beta hCG levels

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27
Q

Associations with hyperemesis gravidarum:

A
  • multiple pregnancies
  • trophoblastic disease
  • hyperthyroidism
  • nulliparity
  • obesity
  • smoking DECREASES incidence
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28
Q

Referral criteria for n&v in pregnancy:

A
  • continued n&v and unable to keep down liquids or oral antiemetics
  • continued n&v with ketonuria and/or weight loss, despite treatment with oral antiemetics
  • confirmed or suspected comorbidity
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29
Q

What triad must be present before diagnosis of hyperemesis gravidarum:

A
  • 5% pre-pregnancy weight loss
  • dehydration
  • electrolyte imbalance
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30
Q

What scoring system can be used to classify severity of NVP:

A

Pregnancy-Unique Quanitification of Emesis PUQE

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31
Q

Management of hyperemesis gravidarum:

A
  • antihistamines first line
  • cyclizine
  • ondansetron and metoclopramide second line
  • ginger and P6 (wrist) acupressure
  • admission for IV hydration
32
Q

Complications of hyperemesis gravidarum:

A
  • Wernicke’s encephalopathy
  • Mallory Weiss tear
  • central pontine myelinolysis
  • acute tubular necrosis
  • foetal: small for gestational age, pre-term birth
33
Q

Long term complications of hysterectomy:

A
  • enterocoele

- vaginal vault prolapse

34
Q

Acute complication of hysterectomy:

A

urinary retention

35
Q

Causes of infertility:

A
  • male factor 30%
  • unexplained
  • ovulation failure
  • tubal damage
  • other causes
36
Q

Basic investigations of infertility:

A
  • semen analysis

- serum progesterone 7 days prior to expected next period. For a typical 28 day cycle, done on day 21

37
Q

Interpretation of serum progestogen in infertility investigations:

A
  • <16nmol/L - repeat if consistently low, refer to specialist
  • 16-30nmol/L - repeat
  • > 30nmol/L - ovulation
38
Q

Average age for menopause:

A

51yo

39
Q

Recommended time to use effective contraception until:

A
  • 12 months after last period in women >50yo

- 24 months after last period in women <50yo

40
Q

When can the clinical diagnosis of menopause be made?

A

no period for 12 months

41
Q

Contraindications of using HRT for menopause symptoms:

A
  • current or past breast cancer
  • oestrogen sensitive cancer
  • undiagnosed vaginal bleeding
  • untreated endometrial hyperplasia
42
Q

Management of vasomotor symptoms in menopause: (hot flushes, night sweats)

A
  • fluoxetine
  • citalopram
  • venlafaxine
43
Q

Management of vaginal dryness in menopause:

A
  • vaginal lubricant

- moisturiser

44
Q

How should HRT be stopped in menopause:

A
  • gradually reducing HRT is effective at limiting recurrence in short term
  • long term - no difference symptom control
45
Q

Long term complications of menopause:

A
  • osteoporosis

- increased risk ischaemic heart disease

46
Q

Causes of menorrhagia:

A
  • dysfunctional uterine bleeding
  • anovulatory cycles
  • uterine fibroids
  • hypothyroidism
  • intrauterine devices
  • PID
  • bleeding disorders e.g. VW disease
47
Q

Threatened miscarriage:

A
  • painless vaginal bleeding before 24 weeks (typically at 6-9)
  • bleeding less than menstruation
  • cervical os closed
  • complicates 25% pregnancies
48
Q

Missed (delayed) miscarriage:

A
  • gestational sac which contains dead foetus before 20 weeks without expulsion symptoms
  • may have light bleeding/discharge
  • not usually pain
  • closed cervical os
  • when sac >25mm and no embryonic part seen - blighted ovum or anembryonic pregnancy
49
Q

Inevitable miscarriage:

A
  • heavy bleeding with clots and pain

- cervical os open

50
Q

Incomplete miscarriage:

A
  • not all products of conception expelled
  • pain and bleeding
  • open cervical os
51
Q

What is abortion:

A

the expulsion of products of conception before 24 weeks

52
Q

How many diagnosed pregnancies will miscarry in early stages?

A

15-20%

53
Q

Miscarriages should be managed surgically or medically if:

A
  • increased risk of haemorrhage (late first trimester, coagulopathies, unable to have blood transfusion)
  • previous adverse experience
  • evidence of infection
54
Q

What kind of medical management can be used for miscarriages:

A
  • vaginal misoprostol - prostaglandin analogue binds to myometrial cells to cause myometrial contractions
  • oral mifepristone not added
  • contact doctor if bleeding doesn’t start in 24 hours
  • antiemetics and pain relief
55
Q

What surgical management can be used for miscarriages:

A
  • vacuum aspiration

- surgical in theatre

56
Q

Risk factors of ovarian cancer:

A
  • family history: mutations of BRCA1 or BRCA2 gene

- many ovulations: early menarche, late menopause, nulliparity

57
Q

Clinical features of ovarian cancer:

A
  • abdominal distension and bloating
  • abdominal and pelvic pain
  • urinary symptoms
  • early satiety
  • diarrhoea
58
Q

Investigations ovarian cancer:

A

-CA125
(do not use in asymptomatic women)
-US
-diagnosis: laparotomy

59
Q

What can also raised CA125 other than ovarian cancer?

A
  • endometriosis
  • mensturation
  • benign ovarian cysts
60
Q

A CA125 above what level requires urgent US scan of the abdomen and pelvis?

A

> =35 IU/mL

61
Q

Management ovarian cancer:

A

surgery and platinum based chemotherapy

62
Q

What kind of ovarian cysts should be biopsied?

A

complex (multi-loculated) to exclude malignancy

63
Q

What are the physiological cysts (functional cysts):

A
  • follicular

- corpus luteum

64
Q

What is a follicular ovarian cyst?

A
  • most common
  • non-rupture of dominant follicle or failure of atresia in non-dominant follicle
  • commonly regress after several cycles
65
Q

What is a corpus luteum cyst?

A
  • during cycle if pregnancy does not occur, corpus luteum may fill with blood or fluid
  • intraperitoneal bleeding more common than cyst
66
Q

What is a benign germ cell ovarian tumour?

A
  • dermoid cyst
  • also mature cystic teratomas
  • lined with epithelial tissue
  • most common under 30yo
  • bilateral in 10-20%
  • usually asymptomatic (torsion more likely than with other tumours)
67
Q

What are the benign epithelial tumours?

A
  • serous cystadenoma

- mucinous cystadenoma

68
Q

What is a serous cystadenoma?

A
  • most benign epithelial tumour
  • looks like most common type of cancer (serous carcinoma)
  • bilateral 20%
69
Q

What is a mutinous cystadenoma?

A
  • large

- if rupture, may cause pseudomyxoma peritonei

70
Q

What can initial imaging modality for suspected ovarian cysts/tumours reveal?

A
  • ultrasound used
  • simple: unilocular, more likely physiological or benign
  • complex: multilocular, more likely to be malignant
71
Q

Management of ovarian enlargement finding in premenopausal women:

A
  • conservative if <35yo
  • if cysts small <5cm and simple, likely to be benign
  • repeat US for 8-12 weeks and referral if persistent
72
Q

Management of ovarian enlargement finding in postmenopausal women:

A
  • physiological cysts unlikely

- all referred to gynaecology

73
Q

What is ovarian hyper stimulation syndrome?

A
  • complication of some infertility treatment e.g. IVF
  • multiple luteinised cysts in ovaries causes high oestrogen and progesterone and vasoactive substances such as VEGF
  • increased membrane permeability and loss of fluid from intravascular compartment
74
Q

Classification of OHSS:

A
  • mild: pain, bloating
  • moderate: n&v, as above, US ascites
  • severe: as above, ascites, oliguria, haematocrit >45%, hypoproteinaemia
  • critical: as above, ARDS, thromboembolism, anuria, tense ascites
75
Q

What is ovarian torsion?

A
  • partial or complete torsion of ovary on supporting ligaments
  • can compromise blood supply
  • if fallopian tube as well - adnexal torsion
76
Q

Risk factors ovarian torsion:

A
  • ovarian mass
  • reproductive age
  • pregnancy
  • OHSS
77
Q

Features of ovarian torsion:

A
  • sudden onset deep colicky pain
  • vomiting and distress
  • fever in minority
  • vaginal examination - adnexial tenderness
  • US: free fluid or whirlpool sign
  • laparoscopy - diagnostic and therapeutic

Women's Health (5 decks)

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