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Year 4 > Gynaecology student presentations > Flashcards

Gynaecology student presentations Flashcards

1
Q

What is the definition of a miscarriage?

A

Loss of the pregnancy before viability (23weeks)
- Usually due to chromosomal abnormalities

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2
Q

What are the 4 types of miscarriage?

A
  • Threatened miscarriage: vaginal bleeding but a confirmed viable pregnancy
  • Incomplete miscarriage: history of vaginal bleeding with previously confirmed viable pregnancy. Now not viable but some products of conception remain inside the uterus
  • Complete miscarriage: history of vaginal bleeding, with previously confirmed pregnancy but now there are no products of conception in uterus
  • Missed miscarriage: no symptoms of miscarriage but confirmation on ultrasound. Entire gestational sac may still be within the uterus
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3
Q

What is the management of a threatened pregnancy?

A
  • If bleeding gets worse, or persists beyond 14 days, return for further assessment and an ultrasound
  • If the bleeding stops, she should start or continue routine antenatal care

If she has had a previous miscarriage offer vaginal progesterone until 16weeks

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4
Q

What is the management of an incomplete miscarriage?

A

Tissue may pass out of the womb naturally
Medication can help
Surgery is available

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5
Q

What is a chemical pregnancy?

A

When the pregnancy test is briefly positive but becomes negative

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6
Q

How is a miscarriage diagnosed?

A

Transvaginal or abdominal ultrasound is done and repeated 7 days later to confirm

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7
Q

What are the features of an intrauterine pregnancy on an ultrasound scan?

A

Gestation sac seen (once HCG >1500)
yolk sac (at 4+ weeks)
Fetal pole ( at 5 weeks)
Fetal heart beat (at 6 weeks)

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8
Q

What is the drug misoprostol used for in gynaecology?

A

A synthetic prostaglandin used for medical management of miscarriage

Also used for medication abortion, induction of labour, and cervical ripening before labour

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9
Q

When is a woman offered further investigations for misscarriage?

A

After 3 or more consecutive first trimester miscarriages or one+ second trimester miscarriages

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10
Q

What investigations for miscarriage are offered?

A
  • Tests for Antiphospholipid Antibodies are offered 6 weeks after a pregnancy
  • Karyotype of the fetal tissue is offered
  • For a second trimester loss a complete thrombophilia screen is offered
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11
Q

What is the management of pregnancy when women has Antiphospholipid Antibodies?

A

Treatment with LMWH and aspirin

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12
Q

What is the presentation of an ectopic pregnancy?

A

Abdominal/pelvic pain (often unilateral)
PV bleeding
Dizziness
Shoulder-tip pain

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13
Q

What are the risk factors for an ectopic pregnancy?

A

Previous pelvic surgery
Pelvic infection (PID)
Smoking
IVF pregnancy
Subfertility
Contraception failure
Previous ectopic pregnancy

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14
Q

How is an ectopic pregnancy managed?

A
  • Monitor HCG, should be decreasing
  • Methotrexate is given to stop grow of pregnancy
  • Surgery to remove pregnancy and affected fallopian tube
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15
Q

What is antepartum haemorrhage?

A

Bleeding from genital tract, from 24+0 weeks of pregnancy

Important causes: placenta previa and placental abruption

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16
Q

How is the severity of antepartum haemorrhage monitored?

A

By the volume of blood bled

Eg.
- Spotting
- Minor haemorrhage- blood loss <50ml that has settled
- Major haemorrhage- blood loss of 50-100ml, with no signs of clinical shock
- Massive haemorrhage- blood loss >1000ml and/or signs of clinical shock
- Recurrent APH- episodes of APH more than one occasion

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17
Q

What is placenta previa?

A

When the placenta partially or completely covers the opening of the uterus

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18
Q

What is placental abruption?

A

When the placenta partially or completely separates from the inner wall of the uterus

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19
Q

What is the difference in presentation of placenta previa vs placental abruption?

A

Previa:
- Painless vaginal bleeding
- Unprovoked bleeding
- Abdomen: soft, non-tender

Abruption:
- constant abdominal pain
- Associated with trauma
- Abdomen: tense and tender

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20
Q

What is the management of antepartum haemorrhage?

A

A-E approach

  • Establish cause
  • May require delivery of baby
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21
Q

What is endometriosis?

A

The presence of endometrial-like tissue outside the uterus, inducing a chronic, inflammatory state

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22
Q

What are the risk factors for endometriosis?

A
  • Nulliparity
  • Early menarche
  • Short menstrual cycle
  • Being white or Asian
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23
Q

What are the reasons for misdiagnosis of endometriosis?

A
  • Intermittent contraception causing hormonal suppression of symptoms
  • Misdiagnosis eg. IBS
  • Attitude towards menstruation
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24
Q

What are the symptoms of endometriosis?

A
  • Subfertility
  • Gi: bloating, diarrhoea, constipation, cycling PR bleeding
  • Fatigue/tiredness
  • Bladder pain
  • Haematuria
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25
Q

What is dyschezia?

A

Difficult pooing
Eg. pain, straining, obstructed defecation

26
Q

How is endometriosis diagnosed?

A

Transvaginal ultrasound and laparotomy

27
Q

What is an endometrioma?

A

Cystic lesions that stem from the disease process of endometriosis

  • Treated with a laparoscopic excision
28
Q

What is adenomyosis?

A

When endometrial tissue grows into the muscular wall of the uterus causing and enlarged uterus and very heavy menstrual bleeding

Not the same as endometriosis

29
Q

What is a fibroid?

A

A non-cancerous growth in the wall of the uterus

30
Q

What are the symptoms of a fibroid?

A

-A symptomatic sometimes
- Menorrhagia
- Subfertility
- Pressure symptoms depending on the size and site

31
Q

How are GnRH analogues used to treat fibroids?

A

They can help shrink the fibroid prior to resection

32
Q

What is the treatment for fibroids?

A

Only treated if causing symptoms

  • Bleeding treated as other heaving menstrual bleeding: tranexamic acid and mefenamic acid or contraception
  • Can be surgically resected
33
Q

What is gestational trophoblastic disease?

A

When abnormal trophoblast cells grow inside the uterus after conception inside the uterus from tissue that forms after conception

Happens when the sperm fertilises and empty egg or 2 sperms fertilise a normal egg

34
Q

What is the most common type of gestational trophoblastic disease?

A

A hydatidiform mole (benign)
- Originates from the placenta and become invasive as it spreads

35
Q

What is the difference between a complete and partial molar pregnancy?

A

Complete: no sign of baby, cord, or amniotic membranes (2 sets of DNA)
Partial: early sign of baby, cord, and amniotic membrane but it cannot survive or develop (3 sets of DNA)

36
Q

What are some types of malignant gestational trophoblastic disease?

A

Invasive mole
Choriocarcinoma
Placental site trophoblastic tumour
Epithelioid trophoblastic tumour

37
Q

What are the risk factors for a molar pregnancy?

A
  • Extremes of age: <15 or >40
  • Previous molar pregnancy
  • Previous spontaneous miscarriage
  • Blood group AB or A
  • High gamma globulin in absence of hepatic disease
38
Q

What is the clinical presentation of a molar pregnancy?

A
  • Abnormal PV bleeding in early pregnancy
  • Lower abdominal pain
  • Early onset pre-eclampsia (25%)
  • Hyperemesis gravidarum (25%)
  • Large for dates uterus in complete mole (50%)
  • Missed miscarriage, small for dates uterus in partial mole(90%)
  • Hyperthyroidism (1-7%)
  • Enlarged ovaries with theca lutein cyst (25-50%
39
Q

How is a molar pregnancy diagnosed?

A

Ultrasound: ‘bunch of grapes’ appearance, no fetus, enlarged ovaries

Bloods: abnormally high HCG (>100,000)

  • Confirmed by histology -
40
Q

How is a molar pregnancy managed?

A
  • Surgical evacuation
  • Registration of the patient at the Gestational Trophoblastic Disease Service ( Charing Cross)
  • Advise patient to avoid pregnancy by using reliable contraception ( barrier) until the HCG levels have dropped
  • Early scan in future pregnancies
41
Q

What is Rotterdam criteria for?

A

Diagnosis of PCOS

  1. Oligo- or anovulation
  2. Clinical and/or biochemical signs of hyperandrogenism
    -Polycystic ovaries

(Diagnosis with 2 of those and exclusion of related disorders)

42
Q

What is the pathophysiology of PCOS?

A
  • Chronically elevated LH (hyperandrogenism) and insulin resistance
  • There is increased conversion of testosterone into more potent dihydrotestosterone
43
Q

What is the clinical presentations of PCOS?

A
  • Hirsutism/ acne/ alopecia
  • Oligo/amenorrhoea
  • Infertility
  • Obesity
  • Acanthosis nigricans
44
Q

What is acanthosis nigracans?

A

Dark, thick, velvety skin in the folds and creases of the body
Eg, armpits, groin, and neck

45
Q

How is PCOS diagnosed?

A

Clinical presentation, biochemical, and ultrasound

46
Q

What are some causes of premature ovarian insufficiency?

A
  • Idiopathic
  • Chromosomal abnormalities – e.g Turners syndrome (gonadal dysgenesis)
  • Previous chemotherapy and radiotherapy
  • Pelvic surgery involving ovaries or interruption of blood supply to ovaries (can occur in hysterectomy)
  • Autoimmune disease
47
Q

Why is FSH used to diagnoses premature ovarian insifficiency?

A

Because when oestrogen is no longer being produced, there is a feedback loop of that to the hypothalamus and pituitary gland that stimulates production of GnRH and FSH

48
Q

What are the different types of ovarian masses?

A
  • Epithelial cell – cells covering the outer surface of the ovaries (most common)
  • Germ Cells – cells that are destined to form eggs
  • Stromal Cells – cells that release hormones (rare)
49
Q

What are the different types of endometrial cancers?

A

Adenosarcoma
- Most common
- Begins from glandular tissue
- Usually postmenopausal

Myometrial cancer
- From uterine muscle
- Associated with Lynch syndrome

Uterine sarcoma
- Very rare

50
Q

How does obesity contribute to onset of endometrial cancer?

A

Fatty tissue produces oestrogen that increases risk of uterine cancer

70% of uterine cancers are linked to obesity

51
Q

What is the clinical presentation of uterine cancer?

A
  • Abnormal menstrual bleeding
  • Postmenopausal bleeding
  • Intermenstrual bleeding
  • Pain during sex
52
Q

What is the aetiology of cervical cancer?

A

HPV and smoking

53
Q

What is the clinical presentation of cervical cancer?

A
  • Usually detected through screening
  • Abnormal vaginal bleeding: post-coital bleeding, intermenstrual bleeding, postmenopausal bleeding
54
Q

What is Lichen sclerosis?

A

A skin condition that causes itchy white patches on the genitals and body, there is no cure

Untreated, it can change the look of the genitals and narrow the opening of the vulva

55
Q

What is the aetiology of vulval cancer?

A

HPV and Lichen sclerosis

56
Q

What are some differentials for pelvic pain?

A
  • Endometriosis
  • Pelvic infection
  • Pelvic adhesions
  • Ectopic pregnancy
  • Ovarian cyst accident
  • Torsion, haemorrhage
  • Non-gynaecological cause of pain: eg, appendicitis and UTI
57
Q

What is hydrosalpinx?

A

Fluid blockage in your fallopian tubes that may make it difficult for you to become pregnant

Can be caused by thing like UTI’s

Treatment: draining, repairing, or removing the fallopian tubes

58
Q

What is a colposcopy?

A

Taking a closer look at the cervix

59
Q

What is the first line medication given for long and heavy periods with no red flags?

A

Tranexamic acid

60
Q

Which medication is used to treat anovulatory infertility like in PCOS?

A

Clomifene citrate

61
Q

What is the preferred contraceptive in PCOS?

A

Ethinyloestradiol and cyproterone acetate

As is helps with the hirsutism and acne

Year 4 (100 decks)

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