GYNE Flashcards
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?
urge incontinence
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?
urge incontinence
classic description of PID?
common cause?
mx?
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
describe secondary dysmenorrhoea?
causes?
mx?
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
Miscarriage
threatened?
missed?
inevitable?
incomplete?
which one has the Os open/closed?
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
cervical screening
what age and how many times?
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.
tumour marker for ovarian cancer?
ca125
who is suitable for watch and wait management of ectopic?
if they have abdo pain then NO NO!!
large uterine fibroid
perform a hysterectomy to remove it
Which medication would be most appropriate in preparation for her surgery?
GnRH agonists may reduce the size of the fibroid but are typically useful for short-term treatment
LEUPROLIDE
conceive for baby- try for 12 months but early referral can be done…
basic investigation for female?
serum progesterone 7 days prior to expected next period. For a typical 28 day cycle, this is done on day 21.
key features of t.vaginialisis vs bacterial vaginosis?
Trichomonas vaginalis: Offensive, yellow/green, frothy discharge, Vulvovaginitis, Strawberry cervix
Bacterial vaginosis: Offensive, thin, white/grey, ‘fishy’ discharge
menorrhagia
1.5 cm uterine fibroid uterine fibroid which is not distorting the uterine cavity
initial tx for menorrhagia?
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)
pregnant
has thrush
tx?
clotrimazole pessary
Secondary amenorrhoea: Premature ovarian insufficiency vs hypothalamic amenorrhoea
FSH, LH, OESTRODIAL levels?
high FSH (demonstrated on two blood samples) LH
low oestrodiol
hypothalamic amenorrhoea: low-level gonadotrophins indicate a hypothalamic causes
Older woman with labial lump and inguinal lymphadenopathy?
vulval carcinoma
what is looked at in a smear test?
test for HPV first
if positive then cytology
Hyperemesis gravidarum, diagnostic criteria triad:
5% pre-pregnancy weight loss
dehydration
electrolyte imbalance
most common cause of recurrent first trimester spontaneous miscarriage?
Antiphospholipid antibodies
ectopic medical mx vs surgical, what levels of HCG?
MEDICAL HCG <1,500
SURGICAL HCG >5,000
Dysfunctional uterine bleeding?
menorrhagia in the absence of underlying pathology
30 yo woman, menorrhagia, has kids and does not want to have anymore
tx?
Menorrhagia - intrauterine system (Mirena) is first-line
Tranexamic acid is used in
menorrhagia. It is a non-hormonal treatment option that is offered to those who do not wish to have the IUS.
primary dysmenorrhoea there is no underlying pelvic pathology.
tx> 1st and 2nd line?
- NSAIDs such as mefenamic acid and ibuprofen are effective in up to 80% of women. They work by inhibiting prostaglandin production
- combined oral contraceptive pills are used second line
what class of drugs may worsen symptoms of stress incontinence by relaxing the bladder outlet and urethra?
alpha blockers ie doxazosin
Endometriosis presentation?
significant pain during intercourse!!
Endometriosis
IX?
mx?
woman has fibroids, struggling to get pregnant
mx?
myomectomy
combined oral contraceptive pill is a protective factor for
endometrial cancer
22-year-old woman presents with a thin, purulent, and mildly odorous vaginal discharge.
swab shows a Gram-negative diplococcus.
dx tx?
gonorrhoea,
IM ceftriaxone 1g
Human papillomavirus infection …?number… is by far the most important risk factor
16
18
33
chocolate cysts ?
ENDOMETRIOTIC CYST
most common ovarian cancer
SEROUS CARCINOMA
‘simple cyst’
FOLLICULAR CYST
ectopic pregnancy
initial Ix?
transvaginal ultrasound
Premature ovarian insufficiency:
tx?
hormone replacement therapy (HRT) or a combined oral contraceptive pill should be offered to women until the age of 51 years
follicular cyst on us
mx?
repeat us in 12 wks
If the cyst persists after 12 weeks referral should be considered
menopause
levels of FSH,LH, OESTRADIOL,PROGESTERONE?
cessation of oestradiol and progesterone
FSH and LH levels will often increase.
contraception after the menopause
CYST RUPTURES MAY CAUSE pseudomyxoma peritonei
Mucinous cystadenoma
urinary urge, bladder training failed…muscarinic antagonist?
oxy, tolterodine, darifenacin
woman going through menipause, hot flushes, has the marina in stiu
tx?
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
stress incontenince mx?
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
