OBGYN Flashcards
what is histology of ectocervix
stratified squamous
what is histology of endocervix
columnar (glandular)
what is histology of transition zone
squamo-columnar junction
what is does the normal menstrual cycle composed of
Normal Menstrual Cycle:
Cycle length usually 28 days
Between 21-35days
Day 1-14 = follicular phase (↑ FSH & oestrogen)
Day 14 – 28 = luteal phase (↑ LH & progesterone)
Ovulation occurs 24-36hours post LH surge
tx for DUB
1st line = mirena IUS
2nd line = cOCP, POP
non-hormonal = tranexamic acid
what is a normal vaginal flora
lactobacillis
buzzword = itchy, white, curd-like
candida
buzzword = Fishy, watery discharge, clue cells on microscopy, increased pH
bacterial vaginosis
Most common, asymptomatic or urethritis (M), discharge (F)
chlamydia
Gram positive diplococci (kidney bean shaped)
gonorrhoea
Painful genital ulcer
herpes
what causes genital warts
HPV 6 and 11
buzzword = Musty smelling, frothy discharge, strawberry cervix
trichomonas
Ix for chlamydia and gonorrhoea
FEMALE 1st line = Endocervical swab
MALE 1st line = first pass urine for PCR/NAAY
Ix for syphilis
Screening = ELISA
Specific = TPPA
Monitoring = VDRL
Ix for herpes
swab ulcer for PCR
Ix for tricomonas
high vaginal swab
Mx of candida
topical clotrimazole/oral fluconazole
MX of chlamydia and gonorrhoea
C = PO Doxy
G = IM ceftriaxone
what is post-menopausal bleeding most suggestive of
endometrial cancer
Menorrhagia/dysmenorrhoea + bulky uterus =
fibroid
Abdo distension, “clothes don’t fit”, SOB =
ovarian tumour
adenoma + ascites + pleural effusion =
meig’s syndrome
cOCP + increased discharge =
ectropion
Contact bleeding/dyspareunia =
cervical cancer
Fat, acne, oligomenorrhoea =
PCOS
what is the tumour markers for = ovarian, bowel, pancreas, breast
CA125 - ovarian
CEA – bowel
CA19-9 – pancreas
CA15-3 - breast
how is CIN 2 and 3 treated
LLETZ
- large loop excision of transition zone
what investigation should be offered to a woman with symptoms suggest of cervical cancer
colposcopy
[not smear as that is screening not diagnostic]
what is the cervical screening program
A smear test is offered to all women between the ages of 25-64 years
25-49 years: 3-yearly screening
50-64 years: 5-yearly screening
what are risk factors for cervical cancer
Smoking
Increased no. of sexual partners & younger age
HPV 16 & 18
risk factors for endometrial cancer
Exposure to oestrogen
- HRT
- Tamoxifen
- PCOS & Lynch syndrome (HNPCC)
- Increased BMI (increased aromatase)
Ix for endometrial cancer
1st line = TVUSS [shows increased endometrial thickness]
Tx for endometrial cancer
Hysterectomy + bilateral salpingo-oophrectomy
chemo/radiotherapy if required
Tx for adenomyosis
hysterectomy
Tx for PCOS
1st line = Weight loss, metformin
2nd line = No pregnancy: cOCP – dianette
3rd line = Pregnancy – clomifene +/- metformin
4th line = Hirsutism – eflornithine cream/ laser treatment
Bartholins cyst v abscess?
Bartholin’s cyst– typically soft, fluctuant and non-tender
Bartholin’s abscess– typically tense and hard, with surrounding cellulitis
cause and Sx of overactive/urge incontinence
Urgency, frequency, nocturia – detrusor over-activity
Tx for urge incontinence
bladder diary
bladder training
Oxybutinin [s.e. increase risk of falls in elderly]
Tx for stress incontinence
pelvic floor training
duloxetine [SNRI]
Ix only done in stress incontinence
urodynamic studies
Tx for vault prolapse
sacrospinous fixation
Tx for Incident cystocele picked up on cervical screening
pelvic floor exercises
Tx for elderly woman with prolapse and multiple co-morbidities
pessary
surgical treatment for bartholin’s abscess
marsupialization
OGTT results for people without diabetes
fasting value before test = < 6
at 2 hours = < 7.8
OGTT results for people with impaired glucose tolerance
fasting value before test = 6 - 7
at 2 hours = 7.9 - 11
OGTT results for people with diabetes
fasting value before test = > 7
at 2 hours = > 11
diagnostic criteria for diabetes
If the patient is symptomatic:
fasting glucose greater than or equal to 7.0 mmol/l
random glucose greater than or equal to 11.1 mmol/l (or after 75g oral glucose tolerance test)
what is the screening for gestational diabetes
women who’ve previously had gestational diabetes a OGTT should be performed after booking (8-12weeks) and at 24-28 weeks if the first test is normal.
women with any of the other risk factors should be offered an OGTT at 24-28 weeks
diagnostic criteria for gestational diabetes
fasting glucose is >= 5.6 mmol/l
2-hour glucose is >= 7.8 mmol/l
