notion galvanised - gynae Flashcards
ovarian torsion occurs due to 2 main reasons
hyper mobility of the ovary,
adnexal mass most commonly a dermoid cyst
what is raised in ovarian torsion
white cell count
what is the most common cause of acute pelvic pain in an afebrile, premenopausal woman
ruptured ovarian cyst
when do you need surgery for a ruptured ovarian cyst
if its a haemorrhage cyst or ruptures cyst in a post menopausal woman
what is a general term for infection of the upper female genital tract, including uterus, fallopian tubes and ovaries
pelvic inflammatory disease
symptoms of PID
deep dyspareunia
dysuria
abnormal bleeding and discharge
signs of PID
may be capable masss
may be cervical excitation
management of pid
metronidazole and ofloxacin
management of PID if under 18 or high risk of gonorrhoea
ceftriaxone, doxycycline and metronidazole
when are cervical polyps common
during the reproductive years -20s
cervical polyps are often asymptomatic but if symptomatic what is the most common clinical feature
abnormal vaginal bleeding
should you remove cervical polyps
yes as 0.5 risk of malignant transformation so small chance but still should
cervical intraepithelial neoplasia is the pre invasive stage of what cancer
cervical
cervical glandular intraepithelial neoplasia is the pre invasive phase of what cancer
endocervical adenocarcinoma
what out of CIN and CGIN is more detectable on cervical screening
CIN
the vast majority of cervical squamous cell cancers are caused by what
HPV 16 and 18 - E6 and E7 proteins
the majority of cervical cancers are
squamous cell carcinomas
cervical cancer is often asymptomatic but what is the most common presenting symptom
abnormal vaginal bleeding
investigations for cervical cancer
colposcopy and biopsy. if pre menopausal do chlaymdia infection first
causes of heavy menstrual bleeding
fibroids, polyps, adenomyosis, coagulopathy, malignancy
most common coagulopathy to cause heavy menstrual bleeding
von williebrand disease
2 main rf for heavy menstrual bleeding are
age and obesity
what is a rf for adenomyosis
previous C section
heavy bleeding with a tender uterus or cervical excitation point towards
adenomyosis/ endometriosis
4 lines of management for heavy menstrual bleeding
1- mirena coil (levonorgestrel releasing intrauterine system)
2- transexamic acid, COC
3 -progesterone only
4- surgery
what is prolonged menses and intermenstrual bleeding
menometrorrhagia
endometrial hypeplasia is a precursor of
adenocarcinoma
abnormal uterine bleeding what is usually indicated for a biopsy
> 16mm in pre menopausal and >4mm in postmenopausal woman
what is pre menstrual syndrome
symptoms experienced by some women in the days immediately before menstruation
symptoms must be present in what phase in pre menstrual syndrome
luteal phase
where can tumours arise from in the ovary
surface epithelium
germ cell
sex cord
what are 3 genetic components to ovarian cancer
BRCA1 and 2 and Lynch syndrome
an example fo a functional cyst in ovary
follicular or corpus luteal
what cyst is thin walled and lined with granulose cells
follicular
what are pathological cysts
endometrioma, polycystic ovaries and theca lutein cyst
what is referred to as chocolate cysts and has endometrial glands and storm outside the uterine body
endometrioma
what are a result as a consequence of markedly raised hCG
theca lutein cyst
molar pregnancy has raised hCG and what if got will regress upon reoslution of the raised hCG
theca lutein cyst
what is a Brenner tumour
tumour of transitional type epithelium, usually benign
example of a benign germ cell tumour
dermoid cyst
examples of sex cord stromal tumours
fibroma, sertoli-Leydig cell tumours
borderline ovarian tumours have cytological abnormalities, proliferative but with no
stromal invasion
the 2 types of serous carcinomas
high grade - serous tubal intraepithelial carcinoma (STIC)
low grade- serous borderline tumour
types of malignant tumours of the ovary
serous carcinoma, endometriod and clear cell carcinoma, germ cell tumours, granulosa cell tumour
what ovarian malignant tumours has strong association with endometriosis of the ovary and association with Lynch syndrome
endometriosis and clear cell carcinoma
dermoid cysts can (rarely) become what tumours
germ cell
what is a malignant type of sex cord tumour
granulosa cell tumour
when should you suspect Kruckenberg tumour
when ratio of CA125/CEA <25
kruckenberg tumour is usually metastatic from where
stomach
what is the triad of meig’s syndrome
benign ovarian tumour, pleural effusion and ascites
women over 50 who present with IBS symptoms should be tested for
ovarian cancer
increased urinary urgency and or frequency and persistent abdominal extension are symptoms of
ovarian cancer
alpha foeto protein is raised in what
embryonal carcinoma
hcg is raised in what
choriocarcinoma
LDH is raised in
dysgerminoma
scan for ovarian cancers should be US first then what is pre or post menopausal
pre- MRI
post - CT
other word for leiomyomas
fibroids
what is usually non tender if there is fibroids
uterus
what is the presence of functional endometrial tissue within the myometrium of the uterus
adenomyosis
symmetrically enlarged tender uterus is a sign of
adenomyosis
what is the only curative therapy for adenomyosis
hysterectomy (removal of uterus(womb))
what can be used if got adenomyosis and want to preserve fertility - can work in the short/ medium term
uterine artery embolisation
what is when endometrial tissue is located at sites other than the uterine cavity
endometriosis
early menarche is a rf for
endometriosis
fixed, retroverted uterus and uterosacral ligament nodules are signs of what
endometriosis
what provides definitive diagnosis for endometriosis
Laparoscopy
the malignancy that can result from endometriosis
endometriod carcinoma
what can suppress ovulation in endometriosis
COCP, norethisterone, Mirena
what cancer is uncommon in under 40
endometrial carcinoma
what is the precursor for endometriod and mucinous carcinoma
atypical hyperplasia- related to unopposed oestrogen
what is the precursor for serous and clear cell carcinoma
serous intraepithelial carcinoma - not associated with unopposed oestrogen
what is more aggressive out of serous and clear cell/ ans endometriod and mucinous
serous and clear cell although it is less common
how does endometrial cancer typically present
genereally with abnormal bleeding most commonly post menopausal bleeding
first line scan for a post menopausal woman with bleeding
transvaginal US - can detect abnormally thickened endometrium. If >4mm then do biopsy
is suspect lynch sydnrome what can be done
immunohistochemisty- staining of tumour for mismatch repair proteins
what is a characteristic of defective mismatch repair that may be seen in lynch syndrome
microsatellite instability (MSI)
what is a mixed tumour with malignant epithelial and stromal elements
carcinosarcoma
where in the vagina are bartholins cysts usually seen
posterior aspect of the labia majora
word catheter and marsupialisation are treatments for what
bartholins cyst
what is bacterial vaginosis
overgrowth of anaerobic bacteria in the vagina
bacteria most commonly associated with bacterial vaginosis
gardnerella vaginalis
what are the main component of the healthy vaginal bacterial flora
lactobacilli
in bacterial vaginosis is the vagina more acidic or alkaline
alkaline
what is the standard presenting feature of bacterial vaginosis
fishy smelling watery grey or white vaginal discharge
ph of vaginal in bacterial vaginosis
above 4.5
what is the antibiotic of choice for bacterial vaginosis
metronidazole
what is referred to as thrush
candidiasis
most common organism in candidiasis
candida albicans
these are symptoms of:
thick, white discharge that does not typically smell. Vulval and vaginal itching, irritation or discomfort
candidiasis
management for candidiasis
antifungal eg clotrimazole
what is lichen sclerosis associated with
other autoimmune conditions and smoking
management for lichen sclerosus
good skin care - wash, avoid tight clothing,
can give steriod
why do patietns with lichen sclerosus need to be follwed p
risk of developing into SSSC (2-5%)
what symptom is especially seen in children with lichen sclerosus
constipation
what is a vulval discomfort most often described as a burning pain but absent dindings
vulvodynia
what may need to be offered before birth to those had female genital mutilation
deinfibulation
pagets disease of the vulva presents with
crusting rash
pagets disease of the vulva is what in situ
adenocarcinoma
what is a procidentia
when prolapse means it is entireluy outside vagina
what can pessary be used for
prolapses
cant have period for how long to then be in menopause
12 months
what do you give for premature ovarian insufficiency
HRT until average age of menopause
avergae age of menopause
51
urge incontine is caused by what muscle
detrusor
what is overactive bladder syndrome
frequency and nocturia with/out urge incontinence
what is provomed by cold, running taps, keys in lock
overactive bladder
what is a medical treatment that can be used for any of the incontinces
vaginal oestrogen
tolterodine, soliphenacin and mirabegron can be used for urge incontine and overactive bladder what kind of drugs are they
tolterodine, soliphenacin- anticholinergics
mirabegron- B3 adrenoceptor agonist
chlamydia affects what kind of epithelium
columnar
what is first line investigation for chlamydia or gonorrhoea
women- vulvovaginal swab
men- first catch urine sample
first and second line management for chlamydia
first- doxycycline
second- azithromycin
what is Fitz Hugh curtis
inflammation of the liver capsule
what is a gram negative intracellualr diplococcus
gonorrhoea
treatment for gonorrhoea
first - ceftriaxone
second- cefixime plus azithromycin
trichomoniasis is a type of
parasite
what is vaginal discharge like in trichomoniasis
frothy and yellow-green, may have a fishy smell
sign of trichomoniasis
strawberry cervix
management for trichomoniasis
metronidazole
is HSV 1 or 2 the most common cause of genital hereps
1
blistering and ulceration of the external genitalia and painful blisters are seen in
herpes
investigation for herpes
viral swab
management for herpes
acyclovir
what is caused by treponema pallidum
syphilis
primary chancre seen in
priamry syphillis
rash on palms and soles
syphillis
what is the most infectious lesion in syphillis
condylomata lata
management for syphilis
benzathine penicilin
lymphogranuloma venerum is caused by
chlamydia trachomatis
podophyllotoxin and imiquimod are used to treat
HPV warts
what is a RNA retrovirus
HIV
what are the target site for HIV
CD4+receptors
pneuomocystis penumonia presnts wiwth
insiddious onset SOB and dry cough
investigation for HIV
HIV antibody testing
HAART ( highly active antiretroviral therapy) is used for
HIV
Phthirus pubis are
pubic lice
most common presentation for pubic lice
itchy red papules
management of pubic lice
malathion lotion or permethrin cream
