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Specialities > Gynecology > Flashcards

Gynecology Flashcards

1
Q

Define Primary and secondary amenorrhoea:

A

Primary:
- Absence of Menses by age 16 years.
- with secondary sexual characteristics
(imperforated hymen, Mullerian agenise, Transvaginal septae)

  • Absence of menses by age 14 years
  • without secondary sexual characteristics
    (Turner’s syndrome, Kalmann’s syndrome, testicular feminisation syndrome)

Secondary:
- >3 months in a female who previously had regular cycles

  • > 6 months in a female who previously had irregular cycles
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2
Q

What would you want to establish in this history of someone with heavy menstrual bleeding?

A
  • regularity of bleeding
  • amount
  • how long they last
  • date of last period
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3
Q

What are some investigations into heavy menstrual bleeding?

A 
Bloods: 
- FBC
\+/- 
- Hormones 
- TFTs 
- Coagulation

Orifices:

  • Urine dipstick
  • Hysteroscopy

X-rays:
- Transvaginal ultrasound scan

Special tests:
- Endometrial biopsy

**biopsy always in persistent bleeding and >45 years old.

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4
Q

What are the treatment options for heavy menstrual bleeding?

A

Non-hormonal:

  • Mefenamic acid
  • Tranexamic acid - used 5 days during menstrating

Hormonal:

  • Combined pill
  • Progesterone
  • levonorgestrel releasing intra-uterine device - 1st line

GnRH analogues

Surgical:

  • endometrial ablation
  • Hysterectomy

+/-
- Uterine artery ablation for fibroids

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5
Q

What examination should be done into heavy menstrual bleeding?

A

Abdominal examination

Bimanual examination

Speculum

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6
Q

What is the criteria for PCOS?

A

Rotterdam Criteria:

  • clinical evidence of high androgens
  • Oligomenorrhoea
  • Ultrasound of Cysts
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7
Q

How should intermenstrual bleeding be investigated?

A

Cervical smear

Bimanual examination and Speculum
+ Abdominal examination

STD Screen + treatment

Urine pregnancy test

TVS incase of endometrial pathology

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8
Q

How should post menopausal bleeding be investigated?

A

Transvaginal ultrasound

  • Biopsy if Endometrium >4mm
  • Biopsy if endometrium >8mm and on HRT
  • Biopsy if on tamoxifen

**remember that this measurement is a double thickness layer. i.e. both sides of the endometrium are measured.

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9
Q

What staging is used for endometrial cancer?

A

International Federation of Obs and Gyn

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10
Q

What is the definition of PID?

A

Infection of the upper female reproductive organs which includes:

  • uterus
  • Fallopian tubes (salpingitis)
  • ovaries (salpingo- oophoritis)
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11
Q

What are some risk factors for PID?

A

History of STIs

Multiple sexual partners

Lack of protection

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12
Q

What are the complications of PID?

A

Tubo-ovarian Abscess

Hydro-salpinx

Fitz- Hugh Curtis Syndrome

Subfertility

Ectopic pregnancy

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13
Q

How is PID treated?

A

Ceftriaxone 500mg IM STAT

followed by:

  • Doxycycline
  • Metronidazole
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14
Q

What is it called when there is fluid build up in the fallopian tube?

A

Hydro-salpinx

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15
Q

What are the classical symptoms of endometriosis?

A

Cyclical pain

  • dysmenorrhoea
  • dyspareunia
  • dysuria
  • dyschezia
  • subfertility

Bleeding at distant sites. i.e.
- haemothorax

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16
Q

What things may be noted on a bimanual examination of the uterus in a patient with endometriosis?

A

Fixed retroverted uterus

Uterosacral ligament nodules

General tenderness

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17
Q

What are the differentials for endometriosis?

A

PID

Ectopic Pregnancy

Fibroids

IBS

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18
Q

What is the definitive diagnosis for endometriosis and what findings may be seen?

A

Laparoscopy

  • Chocolate cysts
  • Adhesions
  • Peritoneal deposits
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19
Q

What is the normal position of the uterus?

A

Anteverted

- where it sits leaning forward

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20
Q

What are the markers for ovarian cysts/ tumours and which one’s specifically for teratomas?

A

Ca125

CEA
Alpha fetal protein
hCG

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21
Q

What are the genes associated with ovarian cancer?

A

BRCA -1
BRCA -2
Lynch syndrome -II / HNPCC

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22
Q

What staging is used for ovarian cancer?

A

FIGO staging
1 - limited to ovaries

2 - limited to pelvis

3 - limited to abdomen, including lymph nodes

4 - distant mets

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23
Q

What investigations should be conducted into suspected ovarian cancer?

A

Bloods:

  • FBC
  • LFTs
  • U&Es

Tumour markers:

  • Ca125
  • CEA
  • AFP
  • LDH
  • hCG

X-rays:

  • TVS / Pelvic ultrasound
  • MRI
  • CT C/A/P
24
Q

What is the treatment for ovarian cancer?

A

Full staging laparotomy

25
Q

What are the types of prolapses that can occur?

A

cystocele
- bladder prolapse

Uterine Prolapse

Urethrocele

Rectocele
- rectum prolapses in

Enterocele
- part of the large bowel prolapses in

Vaginal vault prolapse
- this usually occurs following hysterectomy

26
Q

How are prolapses graded?

A

Pelvic Organ Prolapse Quantification

27
Q

What are some of the complications that can occur with ring pessaries used for prolapses?

A

Interfere with sex

Ulceration

Fistula formation

Infection

Difficult to remove

28
Q

Define Menopause:

A

Diagnosis made >12 months after last period

29
Q

What is the peri-menopausal period of time called?

A

Climacteric

30
Q

What are the symptoms of menopause?

A

Vasomotor symptoms

  • flushing
  • heat intolerance

Vulvo-vaginal dryness

Sleep disturbance

Mood changes

Sexual dysfunction

31
Q

What are some contraindications to HRT?

A

Recent VTE

Chronic liver disease

Undiagnosed PV bleeding

32
Q

What are some of the complications of HRT:

A

Breast cancer

VTE

Endometrial cancer

33
Q

What is the follow up of endometrial cancer?

A

Follow up for 5 years.
- 3 monthly appts
- 6 monthly appts
discharged at 5 years.

appts include:

  • history taking
  • bimanual examination
  • coloscopy
34
Q

What are the different types of cyst formations on the ovaries?

A

Functional cysts

  • Follicular
  • Corpus luteal cysts

Benign Teratoma cysts / Dermoid

Epithelial cysts

  • serous
  • Mucinous
  • Endometroid

Sex-cord stromal
- fibroid

35
Q

What are the options for treating CIN?

A

LLETZ - loop diathermy

Cone Biopsy
- done under GA

Cold Coagulation - heating to 120 Celsius

36
Q

What should be done when there is a high grade (CIN II, III) found on a smear?

A

Referral for Colposcopy and staining with acetic acid.
+/-
Punch Biopsy (based on clinician preference)

37
Q

What is the ligament that contains the vessels to the ovary?

A

Suspensory ligament of the ovary (infundibulopelvic ligament)
- a mass here can torsion in it.

38
Q

What are the different subtypes of ovarian tumours?

A

Epithelial

  • serous
  • Mucinous
  • Endometroid
  • Brenner

Germ Cell

  • Dysgerminoma
  • Teratoma
  • Yolk sac
  • Choriocarcinoma

Sex cord:

  • granulosa
  • Sertoli - Leydig cell

Metastasis
- Krukenberg Tumour

39
Q

Which type of ovarian tumour has Psammoma bodies?

A

Serous cystadenocarcinomas

40
Q

Which type of ovarian tumour produces excessive thyroid hormones?

A

Struma Ovarri

41
Q

Which type of ovarian tumour is described as resembling primitive glomeruli?

A

Yolk Sac tumours

42
Q

Which type of ovarian tumour has Call exner bodies?

A

Granulosa cell

43
Q

Which tumour can cause right sided pleural effusion and ascites?

A

Meig’s tumour

- ovarian fibroma (sex-chord stroma)

44
Q

What are the clinical signs of vulva cancer? and what are the two major types of vulva cancer?

A
  • Itch/ irritation
  • ulceration

Types:

  • VIN related
  • Lichen sclerosis related
45
Q

What is the treatment of vulva cancer?

A

WLE
or
Vulvectomy

> 1mm lesion then groin lymphectomy should be conducted.

46
Q

What types of treatment should be done for a Bartholin cyst?

A

Marsupialisation **not a simple incision
or
Balloon catheter Insertion

47
Q

What are the top causes of pelvic pain?

A 
PID 
Endometriosis 
Pelvic adhesions 
Pelvic congestion 
Bowel pathology
48
Q

What are the top causes for dysmenorrhoea?

A 
Endometriosis 
Adenomyosis
Intrauterine causes (polyps/ fibroids)  
Infections 
Copper IUD
49
Q

What are the top causes of dyspareunia?

A

Superficial:

  • vulvovaginitis
  • Narrow of the introitus to vagina (FGM)
  • Vagina atrophy
  • Lichen sclerosis

Deep:

  • Endometriosis
  • Cervical cancer
  • Retroverted uterus etc
50
Q

What are the key investigations into Menorrhagia?

A

FBC
TFTs

TVS
Hysteroscopy
Biopsy

51
Q

What is the management for adenomyosis?

A

GnRH
or
Hysterectomy

52
Q

Where is the most likely location of an ectopic pregnancy?

A

Ampulla

53
Q

What is a key risk factor for developing ovarian cancer?

A

Early menarche

54
Q

What are the absolute contraindications to HRT?

A 
Recent or reoccurring VTE 
Liver disease 
Undiagnosed vaginal bleeding 
Past or present breast cancer 
Endometrial cancer
55
Q

Which type of HRT does not increase the risk of VTE? and what are the other options for HRT?

A

Transdermal

Oral tablet 
Gel 
Transdermal patch 
Subcut injection
Vaginally - gels, pessary
56
Q

Which other cancer is associated with endometrial cancer?

A

HNPCC

57
Q

What investigations can be done into secondary amenorrhea?

A
  1. Pregnancy test
  2. Assess for underlying illness causing stress on body

Bloods

  • TFTS
  • FSH levels (high in premature ovarian failure)

Special tests:
- Prolactin test

  • *prolactin is progesterone which is given for 10 days. if the ovaries have been responding to FSH normally they will have produced oestrogen which will (if the endometrium is working properly) will proliferate.
  • given progesterone will inhibit the growth and maintain the endometrium.
  • on removal of the progesterone there will be shedding
  • *this demonstrate the ovaries are responding to oestrogen and the endometrium is able to proliferate.
  • highly suggestive of PCOS (anovulation)

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