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Obs & Gynae (Gynae) > Inflammatory & Infective Disorders > Flashcards

Inflammatory & Infective Disorders Flashcards

1
Q

Pelvic pain is described as being chronic when it has been present for how long?

A

More than 6 months

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2
Q

What are the two most common causes of chronic pelvic pain?

A

Endometriosis and PID

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3
Q

What is endometriosis?

A

The presence of endometrial glands and stroma outside the uterine cavity

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4
Q

What is the most widely accepted theory behind the occurrence of endometriosis?

A

Retrograde menstruation

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5
Q

Describe the relationship between endometriosis and genetics?

A

Women are 5 times more likely to have endometriosis if their mother also had the condition

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6
Q

The prevalence of endometriosis is lower in women using what medication?

A

Hormonal contraceptives

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7
Q

What are the three main clinical features of endometriosis?

A

Cyclical pelvic pain, deep dyspareunia and subfertility

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8
Q

When does the pelvic pain of endometriosis usually begin in relation to the menstrual cycle?

A

A few days before the onset of bleeding

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9
Q

What is the typical examination finding of severe endometriosis?

A

A fixed, retroverted uterus

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10
Q

What is the relationship between the severity of symptoms of endometriosis and the extent of disease?

A

These do not correlate well

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11
Q

What are some non-gynaecological symptoms of endometriosis?

A

Fatigue, depression, bowel and urinary symptoms

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12
Q

What are some bowel symptoms that may occur in endometriosis?

A

Pain on defaecation, diarrhoea

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13
Q

What are some urinary symptoms that may occur in endometriosis?

A

Dysuria, haematuria, urgency

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14
Q

The presence of blood filled ‘chocolate’ ovarian cysts on ultrasound is suggestive of what diagnosis?

A

Endometriosis

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15
Q

Endometriosis increases the risk of developing which malignancy?

A

Epithelial ovarian cancer (particularly endometrioid, clear cell and low grade serous)

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16
Q

What is the gold standard diagnostic investigation for endometriosis?

A

Laparoscopy

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17
Q

What effect does pregnancy have on endometriosis?

A

It usually makes the condition better

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18
Q

What symptomatic management is offered first line to women with endometriosis?

A

NSAIDs and/or paracetamol

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19
Q

What is the aim of medical management for endometriosis?

A

To suppress ovulation and induce amenorrhoea

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20
Q

What are some options of medical management that can be used in endometriosis to suppress ovulation and induce amenorrhoea?

A

COCP, POP, contraceptive implants, injections or IUS

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21
Q

If hormonal contraceptives are not successful in the management of endometriosis, what is the next line medical management and what is the effect of this?

A

GnRH analogues and HRT - stimulate the menopausal state but without the symptoms

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22
Q

What is done if medical management fails in the treatment of endometriosis, or the woman is wishing to become pregnant in the near future?

A

Surgical management (ablate/excise endometrial deposits, remove cysts, divide adhesions)

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23
Q

Intractable symptoms of endometriosis may warrant what surgical procedure?

A

Hysterectomy

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24
Q

When do symptoms of endometriosis usually resolve and why?

A

After the menopause as there are lower levels of circulating oestrogens

25
Q

What organism is the most common cause of PID?

A

Chlamydia trachomatis

26
Q

The risk of PID can be reduced how?

A

Barrier contraceptives

27
Q

What are some risk factors for the development of PID?

A

Aged < 25, multiple sexual partners, unprotected sex, recent insertion of Cu-IUD

28
Q

What types of abnormal menstrual bleeding may be seen in those with PID?

A

Inter-menstral and post-coital bleeding

29
Q

What are some features that may be seen on examination of someone with PID?

A

Cervical excitation, adnexal tenderness and swelling

30
Q

What blood tests are useful in the investigation of suspected PID?

A

WCC and CRP

31
Q

How should chlamydia and gonorrhoea be screened for in women with suspected PID?

A

NAATs from high vaginal and endocervical swabs

32
Q

What imaging investigations can be used in individuals with suspected PID?

A

Trans-vaginal US, MRI

33
Q

In those with PID, there may be free fluid where?

A

The rectouterine pouch

34
Q

What is Fitz-Hugh-Curtis syndrome, and what infection is most likely to cause it?

A

Peri-hepatic adhesions, caused by chlamydia

35
Q

How does Fitz-Hugh-Curtis syndrome present?

A

RUQ pain

36
Q

How long are antibiotics given for in the treatment of PID?

A

14 days

37
Q

What is the standard outpatient antibiotic treatment for PID?

A

Ofloxacin and metronidazole PO (bd)

38
Q

What is the outpatient antibiotic treatment for PID in those aged < 18 years or who are at high risk of gonorrhoea?

A

PO metronidazole and PO doxycycline (bd) and a single dose of IM ceftriaxone

39
Q

What antibiotics are used in the inpatient treatment of PID?

A

IV ceftriaxone and metronidazole and PO doxycycline

40
Q

Do patients with mild PID need to have their Cu-IUD removed (if present)?

A

No

41
Q

When may surgery be necessary in the treatment of PID?

A

To drain pelvic abscesses that do not respond to antibiotics

42
Q

What are some long-term consequences of PID?

A

Chronic pelvic pain, adhesions, ectopic pregnancy, infertility

43
Q

Who are vulval skin disorders typically seen in?

A

Post-menopausal women

44
Q

What type of condition is lichen sclerosus?

A

Autoimmune

45
Q

What is the risk associated with the majority of vulval skin conditions?

A

Risk of progression to vulval cancer

46
Q

What vulval skin disorder is this describing: whitened skin in a figure of eight distribution, and loss of vulval architecture?

A

Lichen sclerosus

47
Q

What are some risk factors for vulval intra-epithelial neoplasia?

A

High risk HPV infection, immunosuppression and smoking

48
Q

What vulval skin disorder is this describing: white, red or pigmented nodules that may co-exist with an invasive vulval carcinoma?

A

Vulval intra-epithelial neoplasia

49
Q

What vulval skin disorder is this describing: red plaques with white ‘cake icing’ effect?

A

Extra-mammary Paget’s disease

50
Q

Extra-mammary Paget’s disease may be associated with which malignancies?

A

Breast, colon or GU tract

51
Q

What vulval skin disorder is this describing: reddened vulval skin in a ‘nappy distribution’?

A

Chronic vulval dermatitis

52
Q

What are the most common symptoms of vulval skin disorders?

A

Itching and irritation

53
Q

An extremely painful, hot, swollen, red labium is suggestive of what diagnosis?

A

Bartholin’s cyst abscess

54
Q

If cases of vulval skin disorders do not respond to treatment or are ambiguous, what investigation is necessary?

A

Vulval biopsy

55
Q

What can be used to relieve symptoms in cases of lichen planus, lichen sclerosus and vulval intra-epithelial neoplasia?

A

Topical corticosteroids

56
Q

When is surgical excision considered in women with vulval skin disorders?

A

If symptoms are unbearable or if there is suspicion of cancer

57
Q

How are patients with lichen sclerosus, lichen planus and vulval intra-epithelial neoplasia followed up?

A

Annual review to exclude malignancy

58
Q

Where does Mittelschmerz cause pain?

A

RIF

59
Q

What is the imaging investigation of choice for adenomyosis?

A

Pelvic MRI

Obs & Gynae (Gynae) (5 decks)

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