Obs and Gynae Flashcards
Dysfunctional uterine bleeding
Can refer to intermenstural bleeding, post-coital bleeding or breakthrough bleeding.
C: IMB - Infection, ectropion, polyps, vaginal/cervical cancer, trauma, sexual abuse, vaginal atrophic change.
PCB - during ovulation, adenosis, vaginitis, tumours, chlamydia, gonorrhoea, cervical polyps or ectropion, fibroids, adenomyosis, endometritis.
Breakthrough bleeding - COCP, POP, depot injections, coil, implant, emergency contraception.
S: Vaginal bleeding
D: PV exam, abdo exam, pregnancy test, infection screen, blood tests (FBC, TFTs, FSH/LH, clotting), transvaginal ultrasound, hysteroscopy.
T: Infection - antibiotic treatment, cancer - 2WW, hormonal contraception - change after 3 months, ectropion - cauterised with silver nitrate, polyps - avulsed and sent for biopsy, fibroids - medication, vascular embolisation, surgery.
Cervicitis
Inflammation of the cervix.
C: Herpes simplex, chlamydia, trichomoniasis, gonorrhea, HPV, allergy to spermicide or condom latex, or tampons, regular vaginal bacteria, cancer.
S: Abnormal vaginal bleeding, persistent grey or white discharge that might be smelly, vaginal pain, pain during intercourse, feeling of pelvic pressure, backache.
D: Bimanual pelvic exam, swab from vagina and cervix, cervical biopsy, cervical discharge culture.
T: Avoid certain products. Watchful waiting. Antibiotics based on swab. Cervical cancer/precancer - cryosurgery or silver nitrate to kill abnormal cells.
Vaginitis
Infection/inflammation of the vagina.
C: Overgrowth of Gardnarella, Candida albicans, herpes simplex, HPV, pinworms, scabies, lice, poor hygiene, tight clothing, trichomonas vaginitis, chlamydia, gonorrhea, chemical irritants.
S: Irritation, itching, inflammation around labia and perineal areas, strong-smelling vaginal discharge (Gardnarella - white fishy, Candida - white cottage cheese, STI - green, yellow, grey), discomfort whilst urinating.
D: Culture vaginal discharge, pelvic examination, vulva biopsy.
T: Cleasing advice, warm shallow baths.
Vaginosis - oral metronidazole 400 mg twice a day for 5 to 7 days or intravaginal metronidazole gel/clindamycin cream.
Candida - an intravaginal antifungal cream or pessary (clotrimazole, econazole, miconazole, or fenticonazole) or an oral antifungal (fluconazole or itraconazole).
Treat STIs.
Dysmenorrhoea
Low anterior pelvic pain which occurs in association with periods.
C: Primary - comes on with period, lasts 24-72 hours.
Secondary - may be due to endometriosis, pelvic inflammatory disease, fibroids, adhesions, developmental abnormalities, copper coil.
S: Pain - typically suprapubic but may be felt in the back of the legs or lower back.
Also associated with diarrhoea, nausea, headaches and light-headedness.
D: Abdo exam, PV exam, high vaginal swabs, transvaginal ultrasound, laparoscopy.
T: Self-help - TENS machine, hot water bottle, massage.
NSAIDs - ibuprofen or mefenamic acid.
Weak opioids
Contraception - COCP, POP, depot, coil.
Hysterectomy
Premenstrual syndrome
A condition that affects a woman’s emotions, physical health, and behaviour during certain days of the menstrual cycle. Starts 5-11 days before period.
C: Changes in oestrogen, progesterone and serotonin.
S: Abdo pain, bloating, sore breasts, acne, food cravings, constipation, diarrhoea, headaches, fatigue, irritability, anxiety, depression, emotional outbursts.
D: History, pelvic exam, TFTs, pregnancy test.
T: Drinking fluids, increased fruit and veg, reduce salt, coffee, sugar, alcohol.
Supplements - folic acid, vitamin B-6, calcium, and magnesium, vitamin D.
Analgesia, sleep, exercise, reduce stress.
Menopause
The period of change leading up to the last period. It can only be defined with certainty after twelve months’ spontaneous amenorrhoea.
C: Finite number of ovarian follicles becomes depleted.
Decrease in oestrogen and progesterone. Increase in LH and FSH. Can be induced through surgical removal of ovaries or through use of GnRH analogues.
S: Menstural irregularity, hot flushes and sweats, vaginal discofmort and dryness, disturbed sleep, anxiety, nervousness, irritability, memory loss, low libido, thinning of skin, hair loss, aches and pains.
D: Clinical diagnosis, TFTs, FSH, cevical smears, glucose, pelvic scan for atypical symptoms.
T: Lifestyle changes - stop smoking, reduce alcohol, lose weight, exercise.
HRT - particularly effective in treating hot flushes, mood swings, vaginal/bladder symptoms.
Phyto-oestrogens are naturally occurring compounds found in soy beans, nuts, wholegrain cereals and oilseeds.
Endometriosis
A chronic oestrogen-dependent condition characterised by the growth of endometrial tissue in pelvic cavity (including the ovaries), the uterosacral ligaments, the pouch of Douglas, the rectosigmoid colon, and the bladder and distal ureter.
C: Unknown. Some theories - retrograde mensturation, lymphatic or circulatory dissemination, genetic predisposition, metaplasia, immune dysfunction.
S: Dysmenorrhoea, dyspareunia, chronic pelvic pain, subfertility, bloating, lethagy, constipation, menorrhagia, diarrhoea, haematuria, cystic lesions on ovaries.
D: Laparoscopy, transvaginal ultrasound, MRI scan, FBC, urinalysis, cervical swabs, beta-hCG.
T: COCP, medroxyprogesterone acetate and gonadotrophin-releasing hormone analogues.
Analgesia.
Surgical options include removing severe and deeply infiltrating lesions, ovarian cystectomy, adhesiolysis and bilateral oophorectomy.
IVF for fertility.
Genitourinary Prolapse
Descent of one or more of the pelvic organs including the uterus, bladder, rectum, small or large bowel, or vaginal vault. There is resulting protrusion of the vaginal walls and/or the uterus.
C: Weakening of the levator ani muscles and the endopelvic fascia through direct muscle trauma, neuropathic injury, disruption or stretching.
Risk factors - pregnancy, obesity, age, hysterectomy.
S: Sensation of pressure or of something ‘coming down’, feeling a bulge, incontinence, frequency, urgency, the need to reduce the prolapse before voiding, loss of vaginal sensation, vaginal flatus, loss of arousal, constipation/straining, urgency of stool, incontinence of flatulence/stool, digital evacuation in order to pass stool.
D: Urinalysis, U&Es, ultrasound, MRI, PV exam, PR exam.
T: Treatment is not necessary unless symptomatic.
Conservative - weight loss, pelvic floor exercises.
Vaginal pessary insertion.
Surgery
Cervical dysplasia
Healthy cells on the cervix undergo some abnormal changes.
C: HPV
Risk factors - immunocompromised, having multiple sexual partners, smoking, having sex before aged 18.
S: Asymptomatic. May have abnormal bleeding.
D: Smear test - to look for a squamous intraepithelial lesion (SIL). Colposcopy and biopsy may be needed.
If a biopsy shows dysplasia, it’s then classified as cervical intraepithelial neoplasia (CIN).
T: Mild dysplasia may resolve on its own.
For CIN 2 or 3, treatment can include: Cryosurgery, laser therapy, loop electrosurgical excision procedure (LEEP), cone biopsy.
Cervical cysts
Nabothian cysts are tiny cysts that form on the surface of your cervix that are filled with mucus.
C: Skin cells clog the cervical glands causing a build up of mucus.
Can be caused by childbirth, physical trauma or chronic cervitis.
S: Range in size from few mm to 4 cm, smooth, appear white/yellow.
D: PV exam, ultrasound, colposcopy, biopsy.
T: Doesn’t usually require treatment.
In rare cases, the cysts may become large and distort the shape and size of your cervix, in which case they may need to be surgically removed.
Vaginal neoplasm
Uncontrollable multiplication of abnormal cells in the vagina.
Types: Squamous Cell Cancer, Adenocarcinoma, Melanoma, Sarcoma.
C: Unknown. Risk factors - over 70, HPV, HIV, smoking, alcohol.
S: Asymptomatic, vaginal bleeding after intercourse, abnormal vaginal discharge, pelvic or vaginal pain.
D: PV and pelvic exam, smear test and biopsy, CT/MRI
T: Surgery - Laser surgery or a simple excision.
Radiotherapy
Chemotherapy
Bartholin’s cyst and abscess
Cyst that develops on Bartholin’s glands - secretions maintain the moisture of the vestibular surface of the vagina.
C: STIs, Escherichia coli.
Risk factors - women who have never been pregnant or have a low parity.
S: Asymptomatic, labial oedema, pain, sudden relief of pain if it bursts, vaginal discharge, unilateral labial mass, may be soft and fluctuant and non-tender (cyst) or tense and hard with surrounding erythema (abscess), fever.
D: Swabs to culture, biopsy.
T: No action if the cyst is small.
For an abscess, incision and drainage may be required.
Warm baths may encourage spontaneous rupture and symptomatic relief.
Antibiotics based on culture, co-amoxicalv whilst waiting.
Surgical removal or Balloon catheter insertion.
Mastitis
Inflammation of the breast. Can be infectious or non-infectious.
C: Stopping breastfeeding causing a build up of milk, may be due to baby sleeping through the night, baby is ill, bottle-feeding.
Other - tight bra, seatbelt for a long time, crackled nipples, sleeping on your front.
S: Area of hardness, pain, redness and swelling in the breast. Malaise, headaches, aches, fever.
D: Clinical diagnosis.
T: Drink fluids, warm compress, analgesia, regularly express milk with a pump, antibiotics - flucloxacillin 500 mg four times a day for 10–14 days (erythromycin/clarithromycin if allergic).
Breast abscess
An abscess is a collection of pus that causes a firm, red, tender lump.
C: Usually follows mastitis.
S: Symptoms of mastitis, plus feverish and fluey.
D: Ultrasound. Culture the abscess fluid.
T: Drainage of the abscess (by ultrasound-guided needle aspiration or surgical drainage).
Encourage the mother to continue breastfeeding/expressing to prevent it from becoming engorged.
Antibiotics guided by culture.
Fibroadenoma
Noncancerous tumour in the breast that’s commonly found in women under the age of 30. Can be unilateral or bilateral.
C: Link to high oestrogen levels and taking the oral contraceptive pill young. Also increased risk in pregnancy.
S: Clearly defined, mobile, non-tender, ‘rubbery’ mables.
D: Breast exam, mammogram/breast ultrasound. Fine needle aspiration and biopsy.
T: Closely monitored with ultrasound and mammograms. Removing depends on family history, the shape, whether it causes pain, whether the biopsy is borderline.
