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Obs & Gyny - Risk Factors > Gyny (causes, investigation & management) > Flashcards

Gyny (causes, investigation & management) Flashcards

1
Q

Menorrhagia - causes

A

Primary - DUB Secondary - Clotting problems (Factor V von lieden) - Structural (fibroids, polyp, ectropion) - Endometriosis - PID - Cancer - Hypothyroidism

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2
Q

Menorrhagia - Investigations

A

1) FBC 2) If indicated - TFTs 3) If indicated - Clotting screen 4) if indicated - TV USS 5) Cervical smear 6) Endometrial biopsy

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3
Q

Menorrhagia - management

A

1) Rule out 2* (otherwise treat) 2) IUS is first line 3) COCP OR Tranexamic/Mefanamic acid

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4
Q

Menstrual history

A

1) First day of last period 2) Duration of period -> length of bleeding/flow 3) Length & regularity 4) Abnormal bleeding - IMB/ICB 5) Menarche

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5
Q

Dysmenorrhooea - causes

A

1) endometriosis 2) adenomyosis 3) Fibroids 4) pelvic inflammatory disease 5) intrauterine devices*

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6
Q

Dysmenorrhoea - investigations

A

1) Pelvic ultrasound 2) Cervical smear 3) High vaginal swab

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7
Q

Dysmenorrhoea - management

A

1) NSAIDs - Ibuprofen/Menefamic acid 2) COCP 3) IUS

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8
Q

Amenorrhoea - Causes

A

1) Hypothalamic a) Kalmann syndrome - Primary b) Exercise, stress, eating - Secondary 2) Pituitary a) Sheehan syndrome b) Hyperprolactinaoma 3) Gonadal a) turner syndrome - primary b) CAH - primary c) PCOS - secondary d) Pregnancy - secondary e) Anovulation - secondary 4) Outflow tract a) Mullerian genesis b) Vaginal atresia

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9
Q

PCOS Path

A

Hyperinsulinaemia -> Raised LH -> Raised Oestrogen & Testosterone

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10
Q

PCOS Presenting

A

1) Outward -> Hirstuitism, alopecia, acne 2) Inward -> Oligoamenorrhoea/amenorrhoea/infertiltiy 3) Physical -> Polycystic ovaroes

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11
Q

PCOS Investigations

A

1) FSH, LH, Testosterone, TSH, Prolactin 2) OGTT

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12
Q

PCOS Management

A

1) Lifestyle -> Lose weight, exercise more 2) Menstrual -> COCP 3) Infertility -> Clomiphene

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13
Q

Ectopic Pregnancy Presenting

A

1) Abdominal/Pelvic pain (first symptom) 2) Amenorrhoea or missed period 3) Vaginal bleeding (brown) 4) Shoulder tip pain, breast tenderness, urinary symptoms

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14
Q

Ectopic Pregnancy Examination

A

1) Pelvic tenderness 2) Pallor/tachycardia 3) Cervical motion tenderness

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15
Q

Ectopic Pregnancy Investigations

A

1) Pregnancy Test 2) TV USS 3) Serial HCG (if surgery)

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16
Q

Ectopic Pregnancy Management

A

1) Methotrexate 2) Surgical (Salpingotomy) 3) Anti-D Prophylaxis

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17
Q

Ectopic Pregnancy criteria for Methotrexate

A

1) No sig pain 2) <35mm and no HB 3) No IUP 4) Serum HCG <1500

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18
Q

Ectopic Pregnancy criteria for surgery

A

1) Significant pain 2) >35mm 3) Fetal HB on scan 4) Serum HCG >5000

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19
Q

Methotrexate use in Ectopic - Actions

A

1) LFTs and serial HCGs 2) Warn pelvic pain 2-3 days afterwards 3) Warn do not get pregnant for 6-months

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20
Q

Chlamydia screening (3)

A

1) Anyone in GUM clinic 2) Sexually active <25 annually 3) Sexual partners

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21
Q

Chlamydia symptoms (In Chlamydia you get the D!)

A

Chlamydia 1) Discharge 2) Dysuria 3) Deep dyspareunia 4) Duff bleeding (IMB or PCB)

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22
Q

Chlamydia management

A

1) Partner notification 2) Screening for other STIs 3) Management 1g Azithromycin OR 75mg Doxcycline (7-days)

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23
Q

Gonorrhoea symptoms (In Gonnorrhoea you get the D!)

A

1) Discharge 2) Dysuria 3) Deep dyspareunia 4) Duff bleeding (IMB or PCB)

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24
Q

Diagnosis Chlamydia & Gonorrhoea

A

Women - VVS Men - First catch urine

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25
Gonorrhoea management
1) Partner notification 2) Screening for other STIs 3) Management - Ceftriaxone 500mg IM - Azithromycin 1g orally
26
How do you differentiate gonorrhoea and chlamydia?
Gonorrhoea is a gram-'ve intracellular diplococci on microscopy
27
Trichomoniaisis Vaginalis symptoms
- Itchy, sore vulva/vagina - dyspareunia - Frothy green fishy discharge
28
Diagnosis of TV
VVS
29
Management TV
Metronidazole
30
Bacterial vaginosis symptoms
White/grey foul smelling discharge
31
Bacterial vaginosis diagnosis & microscopy
Increased pH Clue cells & lactobacilli
32
Bacterial vaginosis management
Metronidazole
33
HSV symptoms
- multiple painful blisters which burst to leave erosions
34
HSV management
Aciclovir
35
HPV 6 & 8 symptoms
Genital warts
36
HPV 6 & 8 management
Freeze warts
37
Candidiasis management
Clotrimazole cream
38
Pelvic inflammatory disease investigations
1) B HCG 2) Endocervical swabs for Chlamydia & N gonorrhoea 3) CRP 4) Urine dip & culture
39
Pelvic inflammatory disease complications
Fitz-hugh curtis Ectopic pregnancy Reiter's syndrome Tuboovarian abscess Asherman sydrome
40
Pelvic inflammatory disease management
Ceftriaxone IM + Doxycycline + Metronidazole
41
Syphillis stages
Primary - painless chanchre Secondary - Flu like illness, widespread rash Tertiary - neurological/cardiac
42
Syphillis diagnosis
1) HIV test 2) Treponemal enzyme immunoassay 3) Pregnancy test
43
Syphillis management
1) Bezathine penicillin
44
Syphillis in pregnancy
Causes miscarriage & still birth
45
Genitourinary Prolapse - types by compartment
Anterior - Cystocoele - Urethrocoele Middle - Uterine prolapse - Vaginal vault prolapse - Enterocoele Posterior - Rectocoele
46
Genitourinary Prolapse Symptoms
Vaginal - Fullness - "Coming down" - Pain Urinary - Frequency, urgency, incotinence Rectal - Splinting (pushing through vagina to enable defecation) Coital - Dyspareunia, loss of senstation
47
Genitourinary Prolapse Management
Conservative 1) Watchful waiting, lifestyle modification, pelvic floor 2) Vaginal Pessary 3) Surgery/Mesh repair
48
Genitourinary examination
1) Examine standing and in left lateral position 2) Bivalve speculum
49
Write definitions for the following miscarriage types: Complete Incomplete Threatened Inevitable Missed
Complete - products of conception expelled, cervical os closed, no IUP on USS Incomplete - Products of concepts only partially expelled, cervical os opened, POC visualised in vaginal canal Threatened - Cramps, bleeding, cervical os closed, IUP confirmed (90% grow to normal getation) Inevitable - Vaginal bleeding, cramping, cervical os opened, no POC passed yet Missed - None viable IUP has remained within womb, cervical os closed, USS confirmed.
50
Define miscarriage
Pregnancy loss \<24 weeks Early \<12 weeks Later 13 - 25 weeks
51
Key questions to ask on presentation of miscarriage
Symptoms: * Amenorrhoea * Vaginal bleeding (details regarding quantity and pattern) +/- syncope (indicating significant blood loss) * Cramping abdominal pain * Passage of any fetal tissue * Fever ?septic miscarriage Menstrual cycle: LMP / cycle length / days bleeding / clots / flooding If known to be currently pregnant: dating based on LMP / USS results
52
Investigations miscarriage (After speculum examination & Bimanual)
1) USS - confirm whether pregnancy IUP 2) Serial HCG (\>63% increase indicates viable pregnancy, \>50% decrease indicates failing)
53
Outline three types of management in miscarriage
Expectant - No action, repeat pregnancy test 14 days later Medical - Misoprostol (missed & incomplete miscarriage). Pregnancy test in 3-weeks. Present if symptoms get worse. Surgical - General anaesthetic. Indications retained tissue, trophoblastic, excessive bleeding. MUST BE GIVEN ANTI D.
54
How does misoprostol work?
Prostaglandin, causes softening of cervix and uterine contraction
55
What is classed as recurrent miscarriages?
x 3 miscarriages in a row
56
Counselling stat for miscarriage
Miscarriage occurs in 12-24% of recognised pregnancies.
57
Causes of recurrent miscarriages (5+ investigations)
Antiphospholipid syndrome - anticardiolipin antibodies Genetic - non-disjunction - Karyotyping Structural (Asherman's syndrome, septate uterus, cervical weakness) - USS Endocrine - PCOS - PCOS investigations Infections - BV, TORCH screening
58
How to manage antiphospholipd syndrome?
Low molecular weight heparin
59
Define infertility
Inability to conceive in \<1 year in a couple having regular sexual intercourse without contraception
60
Female causes of infertility
**_ENDOCRINE_** 1) PCOS 2) GENETIC: TURNER, KALLMAN 3) SHEEHAN SYNDROME * *_OVARIAN_** 1) PREMAURE OVARIAN FAILURE **_TUBES & STUFF_** 1) PID - TUBOVARIAN ABSCESS 2) STRUCTURAL - ASHERMAN'S, SEPTATE UTERUS, FIBROIDS 3) ENDOMETRIOSIS
61
Male causes of infertility
TESTES 1) Cryptorchidism 2) Kallman syndrome 3) Varicoele
62
How often is infertility male? (bonus point for naming the other bits)
30% ## Footnote Unexplained infertility (no identified male or female cause) (25%). Ovulatory disorders (25%). Tubal damage (20%). Factors in the male causing infertility (30%). Uterine or peritoneal disorders (10%).
63
Investigations for couple trying to conceive but not being successful
1) Semen analysis 2) Day 21 progesterone 3) PCOS investigations 4) Genetic testing
64
Semen analysis values
Volume 1.5ml Total sperm 39 Sperm conc 15 Motility 40% Progressive motility 32% Vitality 58% Morphology 4%
65
How to assist in ovulation?
Lifestyle - Abstain from alcohol, smoking, lose weight Medications - Folic acid Ovulation/Sperm - Intrauterine insemination - Clomiphene citrate
66
Define hyperemesis gravidarum
1. \>10% weight loss 2. Clinical dehydration 3. Metabolic abnormalities (hyponatraemia, hypokalaemia)
67
Management hyperemesis gravidarum
1) Fluid & electrolyte replacemetn 2) Anti-emetic -\> Cyclizine 3) Thromboprophylaxis
68
Outline complete and incomplete hydatidiform mole
Complete - 46 chromosomes, 2x sperms and empty egg Incomplete - 69 chromosomes 2x sperm + 1x egg
69
Three ways in which gestational trophoblastic disease can present
1) Bleeding after miscarrige 2) Large for dates uterus 3) Routine USS - snowstorm appearance
70
Investigations for Molar pregnancy
1) Urinary and serum B HCG 2) USS for snowstorm appearance 3) Tissue histology
71
Management of hydatidiform mole
1) B HCG three weeks after evacuation, and at two week intervals for 6 months 2) Anti-D prophylaxis 3) Suction curretage
72
Indications for chemotherapy in GTD
1. Plateaued or rising hCG levels after evacuation. 2. Histological evidence of choriocarcinoma. 1. Evidence of metastases in the brain, liver, or gastrointestinal (GI) tract, or radiological opacities \>2 cm on CXR.
73
Management of fibroid
1) Myomectomy 2) Hysterectomy 3) GnRH analogue
74
Complications of fibroid in pregnancy
1) Early preg bleeding 2) PROM 3) PPH
75

Obs & Gyny - Risk Factors (18 decks)

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