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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
Q

Gonorrhoea management

A

1) Partner notification 2) Screening for other STIs 3) Management - Ceftriaxone 500mg IM - Azithromycin 1g orally

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26
Q

How do you differentiate gonorrhoea and chlamydia?

A

Gonorrhoea is a gram-‘ve intracellular diplococci on microscopy

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27
Q

Trichomoniaisis Vaginalis symptoms

A
  • Itchy, sore vulva/vagina - dyspareunia - Frothy green fishy discharge
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28
Q

Diagnosis of TV

A

VVS

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29
Q

Management TV

A

Metronidazole

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30
Q

Bacterial vaginosis symptoms

A

White/grey foul smelling discharge

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31
Q

Bacterial vaginosis diagnosis & microscopy

A

Increased pH Clue cells & lactobacilli

32
Q

Bacterial vaginosis management

A

Metronidazole

33
Q

HSV symptoms

A
  • multiple painful blisters which burst to leave erosions
34
Q

HSV management

A

Aciclovir

35
Q

HPV 6 & 8 symptoms

A

Genital warts

36
Q

HPV 6 & 8 management

A

Freeze warts

37
Q

Candidiasis management

A

Clotrimazole cream

38
Q

Pelvic inflammatory disease investigations

A

1) B HCG 2) Endocervical swabs for Chlamydia & N gonorrhoea 3) CRP 4) Urine dip & culture

39
Q

Pelvic inflammatory disease complications

A

Fitz-hugh curtis Ectopic pregnancy Reiter’s syndrome Tuboovarian abscess Asherman sydrome

40
Q

Pelvic inflammatory disease management

A

Ceftriaxone IM + Doxycycline + Metronidazole

41
Q

Syphillis stages

A

Primary - painless chanchre Secondary - Flu like illness, widespread rash Tertiary - neurological/cardiac

42
Q

Syphillis diagnosis

A

1) HIV test 2) Treponemal enzyme immunoassay 3) Pregnancy test

43
Q

Syphillis management

A

1) Bezathine penicillin

44
Q

Syphillis in pregnancy

A

Causes miscarriage & still birth

45
Q

Genitourinary Prolapse - types by compartment

A

Anterior

  • Cystocoele
  • Urethrocoele

Middle

  • Uterine prolapse
  • Vaginal vault prolapse
  • Enterocoele

Posterior

  • Rectocoele
46
Q

Genitourinary Prolapse Symptoms

A

Vaginal

  • Fullness
  • “Coming down”
  • Pain

Urinary

  • Frequency, urgency, incotinence

Rectal

  • Splinting (pushing through vagina to enable defecation)

Coital

  • Dyspareunia, loss of senstation
47
Q

Genitourinary Prolapse Management

A

Conservative

1) Watchful waiting, lifestyle modification, pelvic floor
2) Vaginal Pessary
3) Surgery/Mesh repair

48
Q

Genitourinary examination

A

1) Examine standing and in left lateral position
2) Bivalve speculum

49
Q

Write definitions for the following miscarriage types:

Complete

Incomplete

Threatened

Inevitable

Missed

A

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
Q

Define miscarriage

A

Pregnancy loss <24 weeks

Early <12 weeks

Later 13 - 25 weeks

51
Q

Key questions to ask on presentation of miscarriage

A

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
Q

Investigations miscarriage (After speculum examination & Bimanual)

A

1) USS - confirm whether pregnancy IUP
2) Serial HCG (>63% increase indicates viable pregnancy, >50% decrease indicates failing)

53
Q

Outline three types of management in miscarriage

A

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
Q

How does misoprostol work?

A

Prostaglandin, causes softening of cervix and uterine contraction

55
Q

What is classed as recurrent miscarriages?

A

x 3 miscarriages in a row

56
Q

Counselling stat for miscarriage

A

Miscarriage occurs in 12-24% of recognised pregnancies.

57
Q

Causes of recurrent miscarriages (5+ investigations)

A

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
Q

How to manage antiphospholipd syndrome?

A

Low molecular weight heparin

59
Q

Define infertility

A

Inability to conceive in <1 year in a couple having regular sexual intercourse without contraception

60
Q

Female causes of infertility

A

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
Q

Male causes of infertility

A

TESTES

1) Cryptorchidism
2) Kallman syndrome
3) Varicoele

62
Q

How often is infertility male? (bonus point for naming the other bits)

A

30%

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
Q

Investigations for couple trying to conceive but not being successful

A

1) Semen analysis
2) Day 21 progesterone
3) PCOS investigations
4) Genetic testing

64
Q

Semen analysis values

A

Volume 1.5ml

Total sperm 39

Sperm conc 15

Motility 40%

Progressive motility 32%

Vitality 58%

Morphology 4%

65
Q

How to assist in ovulation?

A

Lifestyle

  • Abstain from alcohol, smoking, lose weight

Medications

  • Folic acid

Ovulation/Sperm

  • Intrauterine insemination
  • Clomiphene citrate
66
Q

Define hyperemesis gravidarum

A
  1. >10% weight loss
  2. Clinical dehydration
  3. Metabolic abnormalities (hyponatraemia, hypokalaemia)
67
Q

Management hyperemesis gravidarum

A

1) Fluid & electrolyte replacemetn
2) Anti-emetic -> Cyclizine
3) Thromboprophylaxis

68
Q

Outline complete and incomplete hydatidiform mole

A

Complete - 46 chromosomes, 2x sperms and empty egg

Incomplete - 69 chromosomes 2x sperm + 1x egg

69
Q

Three ways in which gestational trophoblastic disease can present

A

1) Bleeding after miscarrige
2) Large for dates uterus
3) Routine USS - snowstorm appearance

70
Q

Investigations for Molar pregnancy

A

1) Urinary and serum B HCG
2) USS for snowstorm appearance
3) Tissue histology

71
Q

Management of hydatidiform mole

A

1) B HCG three weeks after evacuation, and at two week intervals for 6 months
2) Anti-D prophylaxis
3) Suction curretage

72
Q

Indications for chemotherapy in GTD

A
  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
Q

Management of fibroid

A

1) Myomectomy
2) Hysterectomy
3) GnRH analogue

74
Q

Complications of fibroid in pregnancy

A

1) Early preg bleeding
2) PROM
3) PPH

75
Q
A

Obs & Gyny - Risk Factors (18 decks)

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