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MSRA LS > GYNE > Flashcards

GYNE Flashcards

1
Q

57-year-old female
urine leakage
frequent voiding and not always being able to get to the toilet in time.
denies losing urine when coughing or sneezing.
dx?
tx?

A

urge incontinence

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2
Q

57-year-old female
urine leakage
frequent voiding and not always being able to get to the toilet in time.
denies losing urine when coughing or sneezing.
dx?
tx?

A

urge incontinence

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3
Q

classic description of PID?

common cause?

mx?

A

characterised by bilateral lower abdominal pain associated with vaginal discharge and high fever

Causative organisms
Chlamydia trachomatis

+ the most common cause
Neisseria gonorrhoeae
Mycoplasma genitalium
Mycoplasma hominis

oral ofloxacin + oral metronidazole
intramuscular ceftriaxone + oral doxycycline + oral metronidazole

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4
Q

describe secondary dysmenorrhoea?
causes?
mx?

A

typically develops many years after the menarche and is the result of an underlying pathology. In contrast to primary dysmenorrhoea the pain usually starts 3-4 days before the onset of the period. Causes include:
endometriosis
adenomyosis
pelvic inflammatory disease
intrauterine devices*
fibroids

GYNE REFERRAL

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5
Q

Miscarriage
threatened?
missed?
inevitable?
incomplete?

which one has the Os open/closed?

A

Threatened miscarriage
painless vaginal bleeding occurring before 24 weeks, but typically occurs at 6 - 9 weeks
the bleeding is often less than menstruation
cervical os is closed
complicates up to 25% of all pregnancies

Missed (delayed) miscarriage
a gestational sac which contains a dead fetus before 20 weeks without the symptoms of expulsion
mother may have light vaginal bleeding / discharge and the symptoms of pregnancy which disappear. Pain is not usually a feature
cervical os is closed
when the gestational sac is > 25 mm and no embryonic/fetal part can be seen it is sometimes described as a ‘blighted ovum’ or ‘anembryonic pregnancy’

Inevitable miscarriage
heavy bleeding with clots and pain
cervical os is open

Incomplete miscarriage
not all products of conception have been expelled
pain and vaginal bleeding
cervical os is open

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6
Q

cervical screening
what age and how many times?

A

If the repeat test is now hrHPV negative they can return to normal recall.

If the repeat test is still hrHPV positive and cytology is still normal they should have a further repeat test 12 months later.

If the second repeat test at 24 months is negative for hrHPV, they can return to normal recall.

If the second repeat test at 24 months is positive for hrHPV, they should be referred for colposcopy.

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7
Q

tumour marker for ovarian cancer?

A

ca125

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8
Q

who is suitable for watch and wait management of ectopic?

A

if they have abdo pain then NO NO!!

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9
Q

large uterine fibroid
perform a hysterectomy to remove it

Which medication would be most appropriate in preparation for her surgery?

A

GnRH agonists may reduce the size of the fibroid but are typically useful for short-term treatment

LEUPROLIDE

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10
Q

conceive for baby- try for 12 months but early referral can be done…

basic investigation for female?

A

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

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11
Q

key features of t.vaginialisis vs bacterial vaginosis?

A

Trichomonas vaginalis: Offensive, yellow/green, frothy discharge, Vulvovaginitis, Strawberry cervix

Bacterial vaginosis: Offensive, thin, white/grey, ‘fishy’ discharge

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12
Q

menorrhagia
1.5 cm uterine fibroid uterine fibroid which is not distorting the uterine cavity
initial tx for menorrhagia?

A

uterine fibroid is less than 3cm in size, and not distorting the uterine cavity, medical treatment can be tried (e.g. IUS, tranexamic acid, COCP etc)

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13
Q

pregnant
has thrush
tx?

A

clotrimazole pessary

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14
Q

Secondary amenorrhoea: Premature ovarian insufficiency vs hypothalamic amenorrhoea
FSH, LH, OESTRODIAL levels?

A

high FSH (demonstrated on two blood samples) LH
low oestrodiol

hypothalamic amenorrhoea: low-level gonadotrophins indicate a hypothalamic causes

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15
Q

Older woman with labial lump and inguinal lymphadenopathy?

A

vulval carcinoma

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16
Q

what is looked at in a smear test?

A

test for HPV first
if positive then cytology

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17
Q

Hyperemesis gravidarum, diagnostic criteria triad:

A

5% pre-pregnancy weight loss
dehydration
electrolyte imbalance

18
Q

most common cause of recurrent first trimester spontaneous miscarriage?

A

Antiphospholipid antibodies

19
Q

ectopic medical mx vs surgical, what levels of HCG?

A

MEDICAL HCG <1,500
SURGICAL HCG >5,000

20
Q

Dysfunctional uterine bleeding?

A

menorrhagia in the absence of underlying pathology

21
Q

30 yo woman, menorrhagia, has kids and does not want to have anymore

tx?

A

Menorrhagia - intrauterine system (Mirena) is first-line

22
Q

Tranexamic acid is used in

A

menorrhagia. It is a non-hormonal treatment option that is offered to those who do not wish to have the IUS.

23
Q

primary dysmenorrhoea there is no underlying pelvic pathology.
tx> 1st and 2nd line?

A
  1. NSAIDs such as mefenamic acid and ibuprofen are effective in up to 80% of women. They work by inhibiting prostaglandin production
  2. combined oral contraceptive pills are used second line
24
Q

what class of drugs may worsen symptoms of stress incontinence by relaxing the bladder outlet and urethra?

A

alpha blockers ie doxazosin

25
Q

Endometriosis presentation?

A

significant pain during intercourse!!

26
Q

Endometriosis
IX?
mx?

A
27
Q

woman has fibroids, struggling to get pregnant

mx?

A

myomectomy

28
Q

combined oral contraceptive pill is a protective factor for

A

endometrial cancer

29
Q

22-year-old woman presents with a thin, purulent, and mildly odorous vaginal discharge.

swab shows a Gram-negative diplococcus.

dx tx?

A

gonorrhoea,

IM ceftriaxone 1g

30
Q

Human papillomavirus infection …?number… is by far the most important risk factor

A

16
18
33

31
Q

chocolate cysts ?

A

ENDOMETRIOTIC CYST

32
Q

most common ovarian cancer

A

SEROUS CARCINOMA

33
Q

‘simple cyst’

A

FOLLICULAR CYST

34
Q

ectopic pregnancy
initial Ix?

A

transvaginal ultrasound

35
Q

Premature ovarian insufficiency:

tx?

A

hormone replacement therapy (HRT) or a combined oral contraceptive pill should be offered to women until the age of 51 years

36
Q

follicular cyst on us
mx?

A

repeat us in 12 wks

If the cyst persists after 12 weeks referral should be considered

37
Q

menopause
levels of FSH,LH, OESTRADIOL,PROGESTERONE?

A

cessation of oestradiol and progesterone

FSH and LH levels will often increase.

38
Q

contraception after the menopause

A
39
Q

CYST RUPTURES MAY CAUSE pseudomyxoma peritonei

A

Mucinous cystadenoma

40
Q

urinary urge, bladder training failed…muscarinic antagonist?

A

oxy, tolterodine, darifenacin

41
Q

woman going through menipause, hot flushes, has the marina in stiu

tx?

A

just estradiol since has the progesterone in coil

The Mirena intrauterine system is licensed for use as the progesterone component of HRT for 4 years

42
Q

stress incontenince mx?

A

pelvic floor muscle training
least 8 contractions performed 3 times per day for a minimum of 3 months
surgical procedures: e.g. retropubic mid-urethral tape procedures

duloxetine may be offered to women if they decline surgical procedures
a combined noradrenaline and serotonin reuptake inhibitor
mechanism of action: increased synaptic concentration of noradrenaline and serotonin within the pudendal nerve → increased stimulation of urethral striated muscles within the sphincter → enhanced

MSRA LS (22 decks)

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