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Obs and gynae > notion galvanised - gynae > Flashcards

notion galvanised - gynae Flashcards

1
Q

ovarian torsion occurs due to 2 main reasons

A

hyper mobility of the ovary,
adnexal mass most commonly a dermoid cyst

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2
Q

what is raised in ovarian torsion

A

white cell count

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3
Q

what is the most common cause of acute pelvic pain in an afebrile, premenopausal woman

A

ruptured ovarian cyst

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4
Q

when do you need surgery for a ruptured ovarian cyst

A

if its a haemorrhage cyst or ruptures cyst in a post menopausal woman

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5
Q

what is a general term for infection of the upper female genital tract, including uterus, fallopian tubes and ovaries

A

pelvic inflammatory disease

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6
Q

symptoms of PID

A

deep dyspareunia
dysuria
abnormal bleeding and discharge

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7
Q

signs of PID

A

may be capable masss
may be cervical excitation

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8
Q

management of pid

A

metronidazole and ofloxacin

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9
Q

management of PID if under 18 or high risk of gonorrhoea

A

ceftriaxone, doxycycline and metronidazole

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10
Q

when are cervical polyps common

A

during the reproductive years -20s

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11
Q

cervical polyps are often asymptomatic but if symptomatic what is the most common clinical feature

A

abnormal vaginal bleeding

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12
Q

should you remove cervical polyps

A

yes as 0.5 risk of malignant transformation so small chance but still should

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13
Q

cervical intraepithelial neoplasia is the pre invasive stage of what cancer

A

cervical

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14
Q

cervical glandular intraepithelial neoplasia is the pre invasive phase of what cancer

A

endocervical adenocarcinoma

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15
Q

what out of CIN and CGIN is more detectable on cervical screening

A

CIN

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16
Q

the vast majority of cervical squamous cell cancers are caused by what

A

HPV 16 and 18 - E6 and E7 proteins

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17
Q

the majority of cervical cancers are

A

squamous cell carcinomas

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18
Q

cervical cancer is often asymptomatic but what is the most common presenting symptom

A

abnormal vaginal bleeding

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19
Q

investigations for cervical cancer

A

colposcopy and biopsy. if pre menopausal do chlaymdia infection first

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20
Q

causes of heavy menstrual bleeding

A

fibroids, polyps, adenomyosis, coagulopathy, malignancy

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21
Q

most common coagulopathy to cause heavy menstrual bleeding

A

von williebrand disease

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22
Q

2 main rf for heavy menstrual bleeding are

A

age and obesity

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23
Q

what is a rf for adenomyosis

A

previous C section

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24
Q

heavy bleeding with a tender uterus or cervical excitation point towards

A

adenomyosis/ endometriosis

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25
Q

4 lines of management for heavy menstrual bleeding

A

1- mirena coil (levonorgestrel releasing intrauterine system)
2- transexamic acid, COC
3 -progesterone only
4- surgery

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26
Q

what is prolonged menses and intermenstrual bleeding

A

menometrorrhagia

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27
Q

endometrial hypeplasia is a precursor of

A

adenocarcinoma

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28
Q

abnormal uterine bleeding what is usually indicated for a biopsy

A

> 16mm in pre menopausal and >4mm in postmenopausal woman

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29
Q

what is pre menstrual syndrome

A

symptoms experienced by some women in the days immediately before menstruation

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30
Q

symptoms must be present in what phase in pre menstrual syndrome

A

luteal phase

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31
Q

where can tumours arise from in the ovary

A

surface epithelium
germ cell
sex cord

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32
Q

what are 3 genetic components to ovarian cancer

A

BRCA1 and 2 and Lynch syndrome

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33
Q

an example fo a functional cyst in ovary

A

follicular or corpus luteal

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34
Q

what cyst is thin walled and lined with granulose cells

A

follicular

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35
Q

what are pathological cysts

A

endometrioma, polycystic ovaries and theca lutein cyst

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36
Q

what is referred to as chocolate cysts and has endometrial glands and storm outside the uterine body

A

endometrioma

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37
Q

what are a result as a consequence of markedly raised hCG

A

theca lutein cyst

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38
Q

molar pregnancy has raised hCG and what if got will regress upon reoslution of the raised hCG

A

theca lutein cyst

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39
Q

what is a Brenner tumour

A

tumour of transitional type epithelium, usually benign

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40
Q

example of a benign germ cell tumour

A

dermoid cyst

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41
Q

examples of sex cord stromal tumours

A

fibroma, sertoli-Leydig cell tumours

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42
Q

borderline ovarian tumours have cytological abnormalities, proliferative but with no

A

stromal invasion

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43
Q

the 2 types of serous carcinomas

A

high grade - serous tubal intraepithelial carcinoma (STIC)
low grade- serous borderline tumour

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44
Q

types of malignant tumours of the ovary

A

serous carcinoma, endometriod and clear cell carcinoma, germ cell tumours, granulosa cell tumour

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45
Q

what ovarian malignant tumours has strong association with endometriosis of the ovary and association with Lynch syndrome

A

endometriosis and clear cell carcinoma

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46
Q

dermoid cysts can (rarely) become what tumours

A

germ cell

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47
Q

what is a malignant type of sex cord tumour

A

granulosa cell tumour

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48
Q

when should you suspect Kruckenberg tumour

A

when ratio of CA125/CEA <25

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49
Q

kruckenberg tumour is usually metastatic from where

A

stomach

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50
Q

what is the triad of meig’s syndrome

A

benign ovarian tumour, pleural effusion and ascites

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51
Q

women over 50 who present with IBS symptoms should be tested for

A

ovarian cancer

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52
Q

increased urinary urgency and or frequency and persistent abdominal extension are symptoms of

A

ovarian cancer

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53
Q

alpha foeto protein is raised in what

A

embryonal carcinoma

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54
Q

hcg is raised in what

A

choriocarcinoma

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55
Q

LDH is raised in

A

dysgerminoma

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56
Q

scan for ovarian cancers should be US first then what is pre or post menopausal

A

pre- MRI
post - CT

57
Q

other word for leiomyomas

A

fibroids

58
Q

what is usually non tender if there is fibroids

A

uterus

59
Q

what is the presence of functional endometrial tissue within the myometrium of the uterus

A

adenomyosis

60
Q

symmetrically enlarged tender uterus is a sign of

A

adenomyosis

61
Q

what is the only curative therapy for adenomyosis

A

hysterectomy (removal of uterus(womb))

62
Q

what can be used if got adenomyosis and want to preserve fertility - can work in the short/ medium term

A

uterine artery embolisation

63
Q

what is when endometrial tissue is located at sites other than the uterine cavity

A

endometriosis

64
Q

early menarche is a rf for

A

endometriosis

65
Q

fixed, retroverted uterus and uterosacral ligament nodules are signs of what

A

endometriosis

66
Q

what provides definitive diagnosis for endometriosis

A

Laparoscopy

67
Q

the malignancy that can result from endometriosis

A

endometriod carcinoma

68
Q

what can suppress ovulation in endometriosis

A

COCP, norethisterone, Mirena

69
Q

what cancer is uncommon in under 40

A

endometrial carcinoma

70
Q

what is the precursor for endometriod and mucinous carcinoma

A

atypical hyperplasia- related to unopposed oestrogen

71
Q

what is the precursor for serous and clear cell carcinoma

A

serous intraepithelial carcinoma - not associated with unopposed oestrogen

72
Q

what is more aggressive out of serous and clear cell/ ans endometriod and mucinous

A

serous and clear cell although it is less common

73
Q

how does endometrial cancer typically present

A

genereally with abnormal bleeding most commonly post menopausal bleeding

74
Q

first line scan for a post menopausal woman with bleeding

A

transvaginal US - can detect abnormally thickened endometrium. If >4mm then do biopsy

75
Q

is suspect lynch sydnrome what can be done

A

immunohistochemisty- staining of tumour for mismatch repair proteins

76
Q

what is a characteristic of defective mismatch repair that may be seen in lynch syndrome

A

microsatellite instability (MSI)

77
Q

what is a mixed tumour with malignant epithelial and stromal elements

A

carcinosarcoma

78
Q

where in the vagina are bartholins cysts usually seen

A

posterior aspect of the labia majora

79
Q

word catheter and marsupialisation are treatments for what

A

bartholins cyst

80
Q

what is bacterial vaginosis

A

overgrowth of anaerobic bacteria in the vagina

81
Q

bacteria most commonly associated with bacterial vaginosis

A

gardnerella vaginalis

82
Q

what are the main component of the healthy vaginal bacterial flora

A

lactobacilli

83
Q

in bacterial vaginosis is the vagina more acidic or alkaline

A

alkaline

84
Q

what is the standard presenting feature of bacterial vaginosis

A

fishy smelling watery grey or white vaginal discharge

85
Q

ph of vaginal in bacterial vaginosis

A

above 4.5

86
Q

what is the antibiotic of choice for bacterial vaginosis

A

metronidazole

87
Q

what is referred to as thrush

A

candidiasis

88
Q

most common organism in candidiasis

A

candida albicans

89
Q

these are symptoms of:
thick, white discharge that does not typically smell. Vulval and vaginal itching, irritation or discomfort

A

candidiasis

90
Q

management for candidiasis

A

antifungal eg clotrimazole

91
Q

what is lichen sclerosis associated with

A

other autoimmune conditions and smoking

92
Q

management for lichen sclerosus

A

good skin care - wash, avoid tight clothing,
can give steriod

93
Q

why do patietns with lichen sclerosus need to be follwed p

A

risk of developing into SSSC (2-5%)

94
Q

what symptom is especially seen in children with lichen sclerosus

A

constipation

95
Q

what is a vulval discomfort most often described as a burning pain but absent dindings

A

vulvodynia

96
Q

what may need to be offered before birth to those had female genital mutilation

A

deinfibulation

97
Q

pagets disease of the vulva presents with

A

crusting rash

98
Q

pagets disease of the vulva is what in situ

A

adenocarcinoma

99
Q

what is a procidentia

A

when prolapse means it is entireluy outside vagina

100
Q

what can pessary be used for

A

prolapses

101
Q

cant have period for how long to then be in menopause

A

12 months

102
Q

what do you give for premature ovarian insufficiency

A

HRT until average age of menopause

103
Q

avergae age of menopause

A

51

104
Q

urge incontine is caused by what muscle

A

detrusor

105
Q

what is overactive bladder syndrome

A

frequency and nocturia with/out urge incontinence

106
Q

what is provomed by cold, running taps, keys in lock

A

overactive bladder

107
Q

what is a medical treatment that can be used for any of the incontinces

A

vaginal oestrogen

108
Q

tolterodine, soliphenacin and mirabegron can be used for urge incontine and overactive bladder what kind of drugs are they

A

tolterodine, soliphenacin- anticholinergics
mirabegron- B3 adrenoceptor agonist

109
Q

chlamydia affects what kind of epithelium

A

columnar

110
Q

what is first line investigation for chlamydia or gonorrhoea

A

women- vulvovaginal swab
men- first catch urine sample

111
Q

first and second line management for chlamydia

A

first- doxycycline
second- azithromycin

112
Q

what is Fitz Hugh curtis

A

inflammation of the liver capsule

113
Q

what is a gram negative intracellualr diplococcus

A

gonorrhoea

114
Q

treatment for gonorrhoea

A

first - ceftriaxone
second- cefixime plus azithromycin

115
Q

trichomoniasis is a type of

A

parasite

116
Q

what is vaginal discharge like in trichomoniasis

A

frothy and yellow-green, may have a fishy smell

117
Q

sign of trichomoniasis

A

strawberry cervix

118
Q

management for trichomoniasis

A

metronidazole

119
Q

is HSV 1 or 2 the most common cause of genital hereps

A

1

120
Q

blistering and ulceration of the external genitalia and painful blisters are seen in

A

herpes

121
Q

investigation for herpes

A

viral swab

122
Q

management for herpes

A

acyclovir

123
Q

what is caused by treponema pallidum

A

syphilis

124
Q

primary chancre seen in

A

priamry syphillis

125
Q

rash on palms and soles

A

syphillis

126
Q

what is the most infectious lesion in syphillis

A

condylomata lata

127
Q

management for syphilis

A

benzathine penicilin

128
Q

lymphogranuloma venerum is caused by

A

chlamydia trachomatis

129
Q

podophyllotoxin and imiquimod are used to treat

A

HPV warts

130
Q

what is a RNA retrovirus

A

HIV

131
Q

what are the target site for HIV

A

CD4+receptors

132
Q

pneuomocystis penumonia presnts wiwth

A

insiddious onset SOB and dry cough

133
Q

investigation for HIV

A

HIV antibody testing

134
Q

HAART ( highly active antiretroviral therapy) is used for

A

HIV

135
Q

Phthirus pubis are

A

pubic lice

136
Q

most common presentation for pubic lice

A

itchy red papules

137
Q

management of pubic lice

A

malathion lotion or permethrin cream

138
Q
A

Obs and gynae (3 decks)

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