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1. Senior Block- O&G > Lower Gynaecological Problems > Flashcards

Lower Gynaecological Problems Flashcards

1
Q

What is a urethral prolapse?

A

Inner lining of urethra protrudes into the vestibule.

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2
Q

Give 3 risk factors for a female urethral prolapse

A 
Pre-puberty
Obesity
Hx of UTIs
Constipation 
Trauma to vulva
African-American
Hispanic
Heavy coughing
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3
Q

Give the main clinical features of urethral prolapse in females

A

Spotting in underwear
Pain on wiping
Urethral orifice looks larger and pinker

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4
Q

How is a urethral prolapse treated?

A

Oestrogen cream
Vasoline
Sitz bath

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5
Q

What is the pathophysiology of a Bartholin’s cyst?

A

Bartholin gland becomes blocked usually due to an STI or UTI and fluid builds up causing a cyst to form

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6
Q

Give 2 risk factors of a Bartholin cyst

A

Sexually active

20-30 yrs old

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7
Q

What symptoms may be experienced from a Bartholin cyst?

A

Soft, painless lump
May feel tugging pain on moving
If infected –> red, swollen, tender, hot

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8
Q

How is a Bartholin cyst treated?

A

Soak in water
OTC analgesia
Abx and drain if infected

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9
Q

Which group of women typically get lichen sclerosus?

A

Post-menopausal

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10
Q

What is lichen sclerosus?

A

Atrophic change or thickening of the vulval epidermis.

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11
Q

What are the symptoms of lichen sclerosus?

A

Itchy, white areas of skin around the vulva and anus. Can scar and become tight over time

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12
Q

How is lichen sclerosus treated?

A

Steroid cream

Wash genitalia regularly

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13
Q

Which cancer is lichen sclerosus a risk factor for?

A

Vulval cancer

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14
Q

What is Vulval Intraepithelial Neoplasia (VIN)?

A

Pre-cancerous skin disease. Squamous cell epithelia show dysplasia but the basement membrane remains intact so non-invasive

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15
Q

What is the epidemiology of Usual type VIN?

A

30-40 yrs
Smoker
High risk HPV infection

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16
Q

What is the epidemiology of Differentiated VIN?

A

50-60yrs
Lichen sclerosus
Higher risk of this type developing into cancer

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17
Q

Gve 3 clinical features of VIN

A

Itching on vulva
Pain
Skin changes
Pain during sex

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18
Q

How is VIN treated?

A

Imiquimod cream
Laser treatment
Wide local excision

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19
Q

What is an epithelial inclusion cyst?

A

Rare, benign, fluid-filled lesion on vaginal wall which is lined by squamous epithelium

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20
Q

Give 2 risk factors of epithelial inclusion cysts

A

Childbirth trauma
Invasive procedure on genital tract
30-40 yrs

21
Q

Give 3 clinical features of an epithelial inclusion cyst

A 
75% asymptomatic!
Soft lump 
Discomfort using tampons, walking and sitting
Itching 
Pelvic pain
22
Q

How is an epithelial inclusion cyst managed?

A

Watch and wait
Sitz bath
Abx if infected

23
Q

What is atrophic vaginitis?

A

Post-menopausal women have a lack of oestrogen so the vaginal mucosa thins

24
Q

Give 4 clinical features of atrophic vaginitis

A 
Dry vagina
Spotting (PMB)
Itching
Pain on urination 
Pain after sex
25
Q

How is atrophic vaginitis managed?

A

HRT

Topical oestrogen creams/pessary

26
Q

Give 4 predisposing factors of Vaginal Intraepithelial Neoplasia (VAIN)

A 
HPV
Smoking 
Immunosuppression 
Hx of cervical cancer or CIN
Radiotherapy to pelvic area
>50 yrs old
27
Q

What is the pathophysiology of VAIN?

A

Pre-malignant histological cell changes in the vagina limited to epithelial layer. Basement membrane not infiltrated.
VAIN 1 –> 1/3rd thickness
VAIN 2 –> 2/3rds thickness
VAIN 3 –> full thickness –> carcinoma in situ (stage 0)

28
Q

How is VAIN detected?

A

Asymptomatic

Found incidentally on cervical smear tests pr post hysterectomy

29
Q

How is VAIN managed?

A

Local ablation
Wide local excision
Chemotherapy creams (5FU, Imiquimod)

30
Q

What is a cervical ectropion?

A

Columnar epithelium of cervix is visible around the external os of the cervix. Normal finding in young women especially if taking the pill.

31
Q

Give 2 risk factors for cervical polyps

A

Multiparous

Perimenopausal

32
Q

What is a cervical polyp?

A

Benign tumour on the cervical canal. Bright red, spongy, finger-like growth

33
Q

Give 4 clinical features of a cervical polyp

A 
*Most are asymptomatic*
Intermenstrual bleeding
Menorrhagia
Post-coital bleeding
White vaginal discharge
34
Q

How is a cervical polyp removed?

A

Use ring forceps
Cauterise bleeding
Send for histology to check for cancer

35
Q

What is cervical stenosis?

A

Cervix becomes narrowed or completely closed secondary to trauma, inflammation and scarring

36
Q

Give 3 risk factors for cervical stenosis?

A 
Menopause
Cervical surgery
Radiation 
Cervical/uterine cancer
Endometrial ablation 
Repeated infections
37
Q

Give 3 clinical features of cervical stenosis

A

Haematometra (build up of blood in uterus)
Pelvic pain
Sporadic bleeding

38
Q

How is cervical stenosis managed?

A

Dilation and stenting of cervix

Laser removal of scar tissue

39
Q

When may cervical stenosis improve on its own?

A

Normal vaginal birth

40
Q

What pathological changes may be seen in a woman who has been exposed to DES (Diethylstilbestrol)?

A

Glandular epithelium on ectocervix and upper vagina

Association with clear cell cancer of the vagina or cervix.

41
Q

Give 4 risk factors for Cervical Intraepithelial Neoplasia (CIN)

A 
<45 yrs old
High number of sexual partners
HPV infection 
COCP 
Smoking 
Immunocompromised 
Long-term steroid use
42
Q

What is the pathophysiology of CIN?

A

At the transformation zone in the cervix, columnar epithelia changes to squamous epithelia. Excessive metaplasia can result in carcinoma formation over time.
HPV incorporates into host DNA so there is an increased risk of mutation
CIN I: mild dysplasia (1/3rd affected)
CIN II: moderate dysplasia (2/3rds affected)
CIN III: severe dysplasia (full thickness affected) (carcinoma in situ)

43
Q

How is CIN diagnosed?

A

asymptomatic

Found on cervical smears

44
Q

How is CIN managed?

A

CIN II and CIN III –> large loop excision around transformation zone (LLETZ)

45
Q

What risk is associated with large loop excision of the cervical transformation zone?

A

Pre-term delivery in the future

46
Q

What is Mullerian agenesis?

A

Genetic mutation causes patients to have an excess of androgens during development. The Mullerian duct is deformed or absent so there will be no uterus, cervix or upper vagina formed. The lower vagina and ovaries will still be present.

47
Q

How does Mullerian agenesis present?

A

Primary amenorrhoea

Painful intercourse due to short vagina

48
Q

What is an imperforate hymen?

A

Failure of the hymen to perforate during fetal development so period blood cannot drain. Presents as primary amenorrhoea and cyclical pelvic pain.

1. Senior Block- O&G (11 decks)

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