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3rd year - Obstetrics and Gynecology > Gynecology > Flashcards

Gynecology Flashcards

1
Q

Ontario Cervical Screening Guidelines

A

21-70 years
Interval 3 years if normal
Cessation at 70 if adequate negative screening history last 10 years (3 negative tests q 3y)

Exceptions
Previously treated for dysphasia - annual screening or HPV test and screening both negative q2y
Immunocompromised - annual screening
Total hysterectomy (patient does not have cervix) for benign disease - no screening

REMEMBER any visual cervical abnormality or abnormal sx should be investigated regardless of etiology findings

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2
Q

Abnormal cytology results

A

ASCUS - atypical squamous cells of undetermined significance
ASC-H - atypical squamous cells, cannot exclude HSIL
AGC - atypical glandular cells
LSIL - low grade squamous intraepithelial lesion
HSIL - high grade squamous intraepithelial lesion
Neoplasia - squamous carcinoma, adenocarcinoma, others

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3
Q

Follow up of ASCUS under age 30

A
  1. Repeat cytology in 6 months
    - Abnormal result: colposcopy
    - Negative result: repeat colpo
  2. Repeat colpo in 6 months
    - Abnormal: colpo
    - Negative result: routine screening in 3 years
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4
Q

Follow-up ASCUS 30 years +

A

Image

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5
Q

Follow up of LSIL

A

Image

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6
Q

What’s the deal with Trichomoniasis

A

Only STI that you need vaginal culture for
Need to get to lab <12h
Regular swab, mid vagina, rub well on sides

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7
Q

Cervical cultures

A

For chlamydia and gonorrhea
Into cervical os 1-2 cm, wipe away heavy discharge if needed
180o rotating into os (chlamydia intracellular)
Labelling needs to say “cervical culture”

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8
Q

Bloodwork

A

For HIV, Hepatitis C, Hepatitis B, Syphilis
Needs specific consent for HIV and document on chart
Remember latency periods - if concerned about recent contact repeat at 3 and 6 months

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9
Q

Urine Test (PCR)

A

Now available for chlamydia and gonorrhea
Culture still gold standard
Need dirty urine (urethral) first stream 20 mL (as opposed to UTI need midstream) - no voiding for 2h before taking sample

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10
Q

Diagnosing Herpes

A

No accepted screening test

Very common - 75% HSV1, 20% HSV 2 (no longer great distinction between oral and genital)

If lesion present - need to open intact vehicle (carefully! With a needle) and culture the liquid with a special swab with liquid virus transport medium - send to lab ASAP within hours

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11
Q

Pharynx swab tests for

A

Gonorrhea

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12
Q

Hepatitis C screening

A

Because there is treatment now, 45 years+ everyone gets Hep C testing

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13
Q

Rectum swab tests for

A

Gonorrhea and Chlamydia

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14
Q

Syphilis

A
  1. Starts at soft chancre that is painless at the site of entry (usually genitals) — thus less likely to diagnose as primary syphilis
  2. First lesion resolves
  3. Rash and swollen nodes
  4. Tertiary syphilis with brain, liver manifestations
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15
Q

Pelvic inlet

A

Sacrum

Ileopetineal line

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16
Q

What nerve is at risk of denervation during childbirth

A

Pudendal nerve

Internal pudenedal nerve and vessels pass behind the ischial spine through Alcock’s canal.

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17
Q

Components of the lavatory ani muscles

A

Iliococcygeus
Pubococcygeus
Puborectalis

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18
Q

Role of elevator ani muscles

A

Pulls rectum

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19
Q

Uterosacral ligament origins

A

Originate from S2-4

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20
Q

Pelvic diaphragm

A

Legatos ani plus _ coccygeus muscles posteirorly and fasciae coverings of these muscles

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21
Q

Urogenital diaphragm

A

External to pelvic diaphragm

Comprised of deep

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22
Q

Parasympathetic innervation of the bladder

A

ACh
Muscarinic (M2 + M3)
S2-S4

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23
Q

Sympathetic innervation of the bladder

A

NA
Alpha1 and beta 3 adrenoreceptors
T10-12

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24
Q

Somatic innervation of the bladder

A

.

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25
Q

Risk factors for urinary incontinence

A 
Immobility 
Medcition use 
Smoking - nicotine and cough (valsalva) 
Chronic valsalva maneuvers (constipation) 
Pelvic floor relaxation
Pregnancy and childbirth 
Obesity 
Neurological problems 
Hypoestrogenic state - tissues weakened and dry and can fracture with hypoestrogen
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26
Q

Stress incontinnece definition and etiology

A

Involuntary loss of urine during increased intra-abdominal pressure

Etiology
Displacement of UVJ from normal anatomic location (lets urine go before tube hits the back wall, which provides the back pressure to close the tube. This is because the back wall is more floppy and the tube takes more time to get there)
Intrinsic sphincter deficiency (tube is very rigid such as past surgery or radiation and becomes more like a tube. ISD is like a plastic straw vs paper straw)

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27
Q

Urge incontinence definition and etiology

A

Known as overactive bladder now

The involuntary loss of urine preceded by strong urge to void whether or not the bladder is full

Etiology:
Detrusor instability — overactive wet
Bladder irritants — overactive dry (this one is just giving in to sensation to pee at a certain volume, usually no nocturia)

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28
Q

Overflow incontinence

A

Urine loss associated with over distension of the bladder

Etiology
Obstructive
Neurogenic

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29
Q

Functional incontinence

A

Mental or physical issues may prevent individual from reaching the toilet in time
Such as dementia, or mobility, environmental factors

30
Q

If you have women with new overflow incontinence and no previous surgical history, what condition do you have to rule out

A

MS

31
Q

Most common type of fistula in women

A

Bladder and vagina (vesicuvaginal fistula)

32
Q

Most common cause of vesicovaginal fistulas in developed world

A

Hysterectomy

Abdominal hysterectomy more commonly because bladder is empty and cleared and easier to miss, vs vaginal

33
Q

Most common cause of vesicuvaginal fistula in developing country

A

Prolonged labour (constant pressure on bladder from baby’s head causes ischemia)

34
Q

Pelvic organ prolapse

A

Hernia like protrusions

35
Q

Types of prolapse

A

Cystocele (anterior vaginal prolapse)
Rectocele (lower posterior vaginal prolapse)
Enterocele (upper posterior vaginal prolapse)
Apical vaginal/uterine prolapse

36
Q

Etiology uterine prolapse

A

Poor cardinal or uterosacral ligament support

37
Q

Potential complications of cytocele

A

High PVR and risk of recurrent UTIs due to kinking of the urethra and difficulty voiding. This can result in renal implications

38
Q

Rectocele etiology

A

.

39
Q

Enterocele etiology

A

.

40
Q

Rectocele complication

A

Chronic constipation, diarrhea
Flatal, fecal incontinence
…

41
Q

Baden Walker Classification system

A

.

42
Q

Urogynocological exam

A

Stroke labia and then clitoris with q tip
Looking for symmetric rise of the legatos ani muscles
If not symmetric rise need to investigate MS

43
Q

Prolapse examination

A

Empty bladder before examination

44
Q

Q tip test

A

Q tip in urethra

30o+ of hyper mobility is positive test

45
Q

Stress incontinence management

A

Kegels
Topical estrogen, alpha adrenergics (no longer used due to hypertension), duloxetine (no longer available)
Prolapse devices

Surgery

46
Q

Urge incontinence management

A 
Decrease caffeine and nicotine 
Bladder drill
Vaginal estrogen 
Medications - anticholinergics, beta 3 agonist 
Pessary 
Surgery
47
Q

What are the most common HPV types that cause cervical cancer?

A

HPV type 16 and 18 account for 75% of all cervix cancers

48
Q

Risk factors for cervical cancer

A 
Smoking 
Immunosuppression
HIV 
Chlamydia 
High parity 
OCP use 
HPV
49
Q

Acetowhite area on colposcopy meaning

A

Hallmark of dysplasia

50
Q

Investigations for gross lesion on cervix

A

Biopsy needed to rule out cancer and look with colposcope

Pap smear is NOT appropriate

51
Q

Cervix cancer symptoms

A
  • Abnormal vaginal bleeding
  • Pelvic pain
  • Involuntary loss of urine or feces through the vagina
  • Hydronephrosis due to ureter obstruction
  • Weakness, weight loss and anemia
52
Q

Most common type of cervix cancer

A

Squamous cell (>60%)
Adenocarcinoma 30%
Unspecified

Consistent decline in SCC, unclear why adeno is on the rise

All due to HPV

53
Q

Cervical cancer treatment

A

Early- surgery (stage I)

Locally advanced disease - chemoradiation with external beam radiation and intracavitary brachytherapy with chemo as radiosensitizer

54
Q

Most common gynaecological malignancy in North America

A

Endometrial cancer

55
Q

Endometrial cancer risk factors

A

Increased estrogen

  • Endogenous (obesity, polycystic ovarian syndrome, anovulation/infertility, early menarche, late menopause, nullip)
  • Exogenous (Tamoxifen)

HNPCC Syndrome (Lynch Syndrome) - these patients should be screened with endometrial biopsy/TVUS for endometrial thickness

56
Q

Endometrial cancer signs and symptoms

A

Signs - obesity, acanthosis nigricans, stigmata of diabetes

Symptoms - Unscheduled vaginal bleeding (postmenopausal, non bloody vaginal discharge)
- pelvic pain, pressure, mass, weight loss in more advanced disease

57
Q

Most common type of pathology of endometrial cancer

A

Adenocarcinoma

Histology - endometrioid

58
Q

Endometrial cancer treatment

A

Gold standard is surgery - total abdominal hysterectomy, bilateral salpingo-oophorectomy (+/- pelvic nodes)
Surgery is only not recommended if comorbidities that would decrease surgical success

Radiation

  • Primary therapy (rare)
  • Adjuvant treatment (based on tumour factors)
59
Q

Precursor to endometrial cancer

A

Endometrial hyperplasia

Architecture - simplex or complex
Cellularity - atypia or no atypia

60
Q

Ovarian tumour types and epidemiology

A

Epithelial tumours - women 50-60s
Germ cell tumours - younger women
Stromal tumours - any age, very uncommon (ex. Granulosa cell tumour, Sertoli-Leydig cell tumour)

61
Q

Ovarian cancer treatment

A

Surgery and chemo

62
Q

Ovarian cancer etiology

A 
Genetic (BRCA 1 and 2) and HNPCC 
Molecular mechanisms (loss of p53 tumour suppressor gene found in 55% of ovarian cancer)
63
Q

Ovarian cancer risk factors

A

Industrialized countries where dietary fat intake is high, have higher incidence

History of nulliparity, infertility, late childbearing and delayed menopause increase risk

OCP reduces risk, prophylactic oophorectomy

64
Q

Ovarian cancer signs and symptoms

A

Vague and usually diagnosed late (highest mortality rate of all gynecologic malignancies)

Appetite, N/V
Abdominal girth
Bladder, bowel

65
Q

Ovarian cancer screening

A

Ca 125
Ultrasound

Usually in symptomatic or post menopausal women

66
Q

Vulvar cancer etiology

A

HPV strongly associated in young, not in older women

67
Q

Vulvar cancer risk factors

A

Smoking

Immunosuppression

68
Q

Vulvar cancer signs and symptoms

A

Pruritus or mass is presentation for more than 50% of women
Pain
Bleeding
20% of women are asymptomatic

69
Q

Vulvar cancer diagnosis

A

Lesion biopsy from edge (compare normal to abnormal tissue)

70
Q

Vulvar cancer treatment

A

Staging is surgical, radical local excision and evaluation of regional nodes

3rd year - Obstetrics and Gynecology (7 decks)

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