Minimal Gynaecology Flashcards
What is the definition of secondary amenorrhoea?
Periods stop for 6 months, not due to pregnancy
- were occurring before
Rx for primary dysmenorrhoea?
Cramping without organ pathology due to uterine cramping causing ischaemia
NSAIDs- mefanamic acid (inhibits prostaglandins)
Combined Pill
Causes of secondary dysmenorrhoea + questions to ask:
More constant throughout period, may be associated with dyspareunia:
Adenomyosis
Endometriosis
Chronic sepsis- chlamydia infection (PID)
Fibroids
Tests to do if a woman has secondary amenorrhoea (no periods for 6 months):
Urinary bHCG- pregnant FSH- high in menopause, low in exercise Prolactin level TFTs Testosterone levels- androgen secreting tumour
3 features of polycystic ovarian syndrome:
- Hyperandrogenism- pattern baldness, hirsuitism, acne
- Oligo-ovulation- subfertility
- Polycystic ovaries- 12 follicles or >10cm ovarian volume
Insulin resistance- ancanthosis nigricans
Who needs investigating for primary amenorrhoea?
Failure to start menstruating by age 15
Or age 14 if no breast development
Rx of menorrhagia?
Heavy menstrual blood loss
- Progesterone containing IUCDs- Mirena
- Antifibrinolytics (tranexamic acid), NSAID (mefanamic acid), combined pill
Surgical: endometrial ablation- if family complete
Uterine artery embolization or myomectomy- for fibroids, family incomplete
At how many weeks is a pregnancy loss a miscarriage?
24 weeks
How may an ectopic pregnancy present:
Abdo pain Vaginal Bleeding Fainting D+V Amenorrhoea for 8 weeks
Peritonism + shock if rupture
Shoulder-tip pain, pain on defication + urination = pelvic blood
EHx: enlarged uterus 30%, cervical excitation 50%, adnexal mass 60%
Tests for ectopic pregnancy:
Urinary bHCG
Blood bHCG
Transvaginal USS- intrauterine gestational sac
Management of ectopic pregnancy:
Shock- emergency laparotomy + fluids
May require salpingotomy or salpingectomy
Small early ectopic- Methotrexate
No acute Sx + bHCG falling- Expectant, monitor bHCG levels + USS
5 conditions for termination of pregnancy:
2 doctors agree:
- Risk to mother’s life of continuing pregnancy
- Prevent permanent grave injury to physical/mental health of woman
- Risks injury to the physical or mental health of woman greater than if terminated
- Risks injury to health of existing children if not terminated
- Risk of seriously handicapped fetus
Aside from abortion procedure what other therapies does a woman require in a termination of pregnancy?
Antibiotics: reduce post-op infection rates
Anti-D antibodies if rhesus -ve
Discussion of contraception and STI screen
Mechanism of medical and surgical abortions:
Mifepristone- disimplants fetus
Prostaglandin- triggers evacuation
Vacuum aspiration + dilatation or surgical forceps used
Difference between the discharge found in trichomoniasis and bacterial vaginosis:
Trichomoniasis- frothy yellow/green fish smelling discharge
Bacterial vaginosis- thin white discharge + fishy smell
Lab findings in vaginal discharge suggest which diagnosis:
A. Mycelia + spores on microscopy
B. Stippled vaginal ‘clue’ cells
C. Motile flagellates on wet films
Rx: clotrimazole or fluconazole
A. Candida (thrush)
Rx: metronidazole
B. Bacterial vaginosis- also overgrowth of bacterial flora
C. Trichomoniasis
Which vaginal infections require a high vaginal swab?
High vaginal swab = posterior fornix
Trichomonas
Candida
Bacterial vaginosis
Endocervical canal is for NAAT- chlamydia + gonorrhoea
Rx for chlamydia + gonorrhoea + syphilis?
Chlamydia: azithromycin once off, doxycycline 7ds
Gonorrhoea: azithromycin PO + ceftriaxone IM
Syphilis: benzylpenicillin
Which GI condition can endometriosis be mistaken for?
IBS- causes pain on defication
May be associated with deep dyspareunia or secondary dysmenorrhoea
Cyclical pelvic pain or constant (adhesions)
How is endometriosis diagnosed?
EHx: endometriosis
Fixed retroverted uterus (adhesions)
Generalised tenderness
Adenomyosis:
Boggy enlarged tender uterus
Laparoscopy: cysts, adhesions, peritoneal deposits
At what point can you offer investigation for subfertility?
After 1 year of trying
Earlier if female is <35 years, not having periods or has had PID or cancer treatments or undescended testes in the past
Rx of stress and urge incontinence:
Stress:
- Pelvic floor exercises 3 months
- Duloxetine SNRI
- Surgery, mid-urethral slings + tapes, urethral bulking
Urge:
- Bladder training 6 weeks
- Oxybutinin, Tolterodine
- Botox, sacral nerve stimulation
Mixed:
Treat urge first before stress
Which drugs cause voiding difficulties in women?
Anticholinergics- atropine, chlorpromazine
Tricyclic antidepressants
Anaesthetics
CI to oral contraceptive pill
CVS RFs: obesity, diabetes, HTN, dyslipidaemia, smoking
VTE: FHx +ve <46 years, major surgery due
Migrane + aura
Breast or liver CA
Post-natal
Which form of oral contraception do you not take breaks with?
Progesterone oral contraceptive
When can the different emergency contraception be given?
Levonorgestrel- 3 days
Ulipristal- 5 days
Intrauterine device- within 5 days of UPSI or earliest ovulation
Earliest ovulation is shortest cycle length based on most recent period -14 days
What do you say to women after prescribing emergency contraception?
- Repeat dose if vomiting within 2/3 hours
- May have irregular bleeding or late period
- Pregnancy test in 3 weeks
- Ongoing contraception
Features of menopause:
Menstrual irregularity
Vasomotor disturbance- sweats, palpitations, flushes
Atrophy of vagina, breasts + skin
Osteoporosis
For how long does a woman need contraception during the menopause:
For 1 year from becoming amenorrhoeic if over 50, 2 years if under 50
CI to HRT:
Oestrogen dependent cancer- breast Past PE or phlebitis Undiagnosed PV bleeding Pregnancy + breastfeeding LFTs abnormal
Which US features are suggestive of a malignant ovarian mass:
Multi-loculated cyst Solid areas Ascites Intra-abdominal mets Bilateral lesion
Which types of cancer does BRCA 1 + 2 genes predispose patients to?
Breast + ovarian cancer
Aside from colorectal cancer, what other cancers are patients with hereditary non-polyposis colorectal cancer predisposed to?
Ovarian + endometrial cancer
Difference between placenta praevia + abruption?
Placenta praevia: not much pain, uterus non-tender
Avoid PV exam as can trigger further bleeding
-due to placenta lying in lower uterine segment
Abruption: shock out of keeping with visible blood loss, pain constant, tense tender uterus, fetal heart absent or distressed
- due to placenta detaching from uterus
Definition of pre-eclampsia:
Pregnancy induced hypertension with proteinuria
± oedema
Due to failed trophoblastic invasion of the spiral arteries leaving them vasoactive
PC: headache, chest/epigastric pain, vomiting, tachycardic
Visual disturbance, shaking, hyperreflexia, irritable
What constitutes severe pre-eclampsia and how is it managed?
> 160/110 + proteinuria
Or >140/90 + proteinuria +
seziures/visual disturbance/ headache/ clonus/ papilloedema / low platelets/ ALT high/ liver tenderness
Rx: MgS04 IV
Labetalol IV (or hydralazine)
Fluid restrict
Expedite labour
