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Gynaecology > Miscellaneous gynae > Flashcards

Miscellaneous gynae Flashcards

1
Q

What is adenomyosis?

A

The presence of endometrial tissue within the myometrium.

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2
Q

What is the most common demographic of adenomysois?

A

Usually seen in multiparous women towards the end of their reproductive years.

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3
Q

What are the clinical features of Adenomyosis?

A

Dysmenorrhoea

Menorrhagia

Enlarged “boggy” uterus

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4
Q

What is androgen insensitivity syndrome?

A

An X-linked recessive condition due to end organ resistance to testosterone. This means that men (XY) have the phenotypic appearance of a woman.

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5
Q

What are the clinical features of androgen insensitivity syndrome?

A
  • primary amenorrhoea
  • Undescended testes
  • Breast development may occur
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6
Q

What is the management for androgen insensitivity syndrome?

A
  • counselling - the child is raised as female
  • bilateral orchidectomy as undescended testes increases risk of testicular cancer
  • oestrogen therapy
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7
Q

What is atrophic vaginitis and how does it present?

A

atrophy of the vagina that occurs in post menopausal women.

Clinical features include: dyspareunia, vaginal dryness, a pale vagina on speculum, and occasional spotting.

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8
Q

What is the management for atrophic vaginitis?

A

Vaginal lubricants and moisturisers. If this doesn’t work then topical HRT (oestrogen) can be prescribed.

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9
Q

What is a molar pregnancy?

A

Also known as trophoblastic disease, it is where trophoblast cells proliferate too quickly occupying the space where the embryo develops.

partial mole: where two sperm fertilise one egg and there is too much.

complete mole: one or two sperm fertilise an egg with no genetic material inside.

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10
Q

What are the clincial features of a molar pregnancy?

A
  • Vaginal bleeding
  • Uterus larger than expected for gestational age
  • Abnormally high hCG.
  • USS: snowstorm appearance on ultrasound.
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11
Q

Describe the WHO classification for female genital mutilation (FGM)?

A

Type 1: Partial or total removal of the clitoris

Type 2: Partial or complete removal of the clitoris and labia minora, with or without the removal of the labia majora

Type 3: Narrowing of the vaginal orifice with the creation of a seal.

Type 4: All other harmful procedures to the female genitalia for non medical purposes.

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12
Q

What is the cause of fibroid degeneration?

A

Uterine fibroids are more sensitive to oestrogen and if they outgrow their blood supply they will degenerate.

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13
Q

How does uterine fibroid degeneration usually present?

A

Low grade fever, pain and vomiting. This is usually treated conservatively and should resolve within 4-7 days.

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14
Q

What is pelvic inflammatory disease and what are the most common causative organisms?

A

It is inflammation of the female pelvic organs and surrounding peritoneum. The most common causative organisms are:

  • Chlamydia trachomatis
  • Neisseria gonorrhoea
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15
Q

What are the clinical features of pelvic inflammatory disease?

A
  • deep dyspareunia
  • pelvic pain
  • dysuria and menstrual abnormaltiies
  • cervical excitation
  • abnormal discharge
  • fever
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16
Q

How should pelvic inflammatory disease be investigated?

A
  • A pregnancy test to rule out ectopic pregnancy
  • High vaginal swab
  • Screen for Chlamydia and Gonorrhoea
17
Q

What is the management for PID?

A

IM Ceftriaxone + oral doxycycline + oral metronidazole

18
Q

What are the complications of PID?

A

Fitz-Hugh Curtis syndrome: presents as RUQ pain

Infertility

Chronic pelvic pain

Higher incidence of ectopic pregnancy

19
Q

What is the differential diagnosis for acute pelvic pain?

A

1) Ectopic pregnancy
2) Miscarriage
3) UTI
4) Appendicitis
5) PID
6) Ovarian torsion

20
Q

What is the differential diagnosis for chronic pelvic pain?

A

1) Endometriosis
2) Genital prolapse
3) Endometriosis
4) IBS

21
Q

What are the causes of post-coital bleeding?

A
  • Idiopathic in 50% of cases
  • Cervical ectropion is the most common cause secondary to this
  • Cervicitis as a result of infection - e.g. Chlamydia.
  • Cervical cancer
  • Trauma
  • Polyps
22
Q

What are uterine fibroids?

A

Benign tumours of the smooth muscle in the uterus that occur in 20% of caucasian women and 50% of afro-carribean women. They usually present in the later reproductive years.

23
Q

What are the clinical features of uterine fibroids? + how are they diagnosed?

A
  • Abdominal cramping
  • Menorrhagia - as a result iron deficiency anaemia can occur.
  • Urinary symptoms - e.g. Frequency can present in larger fibroids
  • Bloating
  • Subfertility

Diagnosis: transvaginal ultrasound

24
Q

What is the management for menorrhagia secondary to fibroids?

A
  • NSAID’s - e.g. Mefanamic acid/Tranexamic acid
  • IUS can help with menorrhagia
  • COCP, POP or depo-provera can also be used.
25
Q

What is the management plan for shrinking fibroids?

A
  • GnRH agonists are usually used short term
  • myomectomy - if the woman wishes to conceive in the future
  • hysteroscopic endometrial ablation: if the woman wishes to conceive in the future
  • hysterectomy
26
Q

What are risk factors for thrush?

A
  • Diabetes mellitus
  • Drugs: Abx or steroids
  • Pregnancy
  • Immunosuppression
27
Q

What is the management for thrush?

A

Local treatment includes a Clotrimazole pessary or creams.

Systemic treatment includes PO Fluconazole 150mg STAT or PO Itraconazole 200mg BD for 1 day.

28
Q

How would you define recurrent thrush?

A

4 or more episodes per year

29
Q

What is the management plan for recurrent thrush?

A

An induction and maintenance regime of oral fluconazole

  • Induction is 150mg Fluconazole every 3 days for 3 doses
  • Once weekly dose of Fluconazole for 6 months.
30
Q

How would vaginal discharge present in the following conditions
- Trichomonas vaginalis

  • Candidiasis
  • Bacterial vaginosis (Gardnerella vaginalis)
A
  • Trichomonas vaginalis: offensive yellow/green frothy discharge
  • Candida: White cottage cheese like discharge
  • Offensive thin/white fishy discharge

Gynaecology (3 decks)

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