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Finals Revision > Obstetrics & Gynaecology/Contraception/Sexual Health > Flashcards

Obstetrics & Gynaecology/Contraception/Sexual Health Flashcards

1
Q

What criteria can be used when choosing appropriate contraception?

A

WHO Eligibility criteria- graded 1-4 from no restriction to unacceptable risk

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2
Q

How does the COCP work?

A

Acts on hypothalamic-pituitary-ovarian axis, suppresses synthesis and secretion of FSH + LH - inhibits development of ovarian follicles + ovulation

  • -> Increased cervical mucus
  • -> Reduces endometrial receptivity to prevent implantation
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3
Q

Pros of COCP

A

Very effective and reversible
Can relieve menstrual problems, endometriosis
Reduces risk of ovarian, endometrial and colorectal cancer
Can take up to 24hrs after missed pill- take 2

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4
Q

Cons of COCP

A

Breakthrough bleeding, mood swings, breast tenderness
Increased risk VTE, MI, Stroke
Increased risk breast cancer

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5
Q

Contraindications to the COCP

A

Migraine with aura, <6wks postpartum, smoker age > 35, Hypertension, Hx VTE, ischaemic heart disease, Hx CVA, active breast ca, diabetes with complications

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6
Q

How does the progesterone-only pill work?

A

Inhibits ovulation, delayed transport of ovum, thickens cervical mucus, endometrium unsuitable for implantation

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7
Q

Pros of progesterone-only pill

A 
Reliable + reversible
Avoids CNS risk of oestrogen
Can be used when CIs for oestrogen
Can be used during breast-feeding
Can be used up to age 55
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8
Q

Cons of progresterone-only pill

A

Menstrual problems eg amenorrhoea + breakthrough bleeding
Only 3hr window
Increased risk functional ovarian cysts
Risk of ectopic

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9
Q

Contraindications to the progesterone-only pill

A

Hx breast ca, stroke, coronary heart disease, SLE

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10
Q

How does the DEPO injection work?

A

Suppresses ovulation, makes endometrium unsuitable for implantation, increases thickness of cervical mucus

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11
Q

Pros of DEPO

A

Effective and convenient
Can be used during breastfeeding
Amenorrhoea common

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12
Q

How often is DEPO given?

A

Every 12 weeks

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13
Q

Cons of DEPO

A

Not quickly reversible- delayed return to fertility up to 1yr
Associated with breast and cervical cancer
Reduced bone density
Proven weight gain

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14
Q

Contraindications to DEPO

A

<18s, breast cancer, liver impairment, risk of VTE

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15
Q

How does the contraceptive implant work?

A

Contains etonogestrel

Inhibits ovulation, thickens cervical mucus, thins endometrium

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16
Q

Pros of contraceptive implant

A

Very effective
Long duration of action
Reversible
Reduction in menstrual problems eg dysmenorrhoea

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17
Q

Cons of contraceptive implant

A

Irregular bleeding, changes in weight, mood and libido

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18
Q

Contraindications to contraceptive implant

A

Active breast cancer

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19
Q

How does the copper IUD work?

A

Fertilisation prevented
Effect of copper on cervical mucus –> reduced penetration by sperm
Endometrial inflammatory reaction –> anti-implantation effect

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20
Q

Pros of copper IUD

A 
Very effective, reversible
Effective directly after fitting- emergency contraception
No hormones
Effective up to 10yrs
Reduced risk of endometrial cancer
Immediate return to fertility on removal
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21
Q

Cons of copper IUD

A 
Insertion unpleasant
Spotting, IMB, increased blood loss
Pelvic pain
Longer periods
1 in 20 expulsion/displacement
Increased risk of PID
Uterine perforation
Ectopic pregnancy
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22
Q

Contraindications to copper IUD

A

History of PID, recent STI exposure, up to 4wks post-partum, uterine abnormality eg fibroids, gynae cancer, copper allergy, immunosuppression

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23
Q

How does IUS work?

A

Reduces endometrial growth and prevents implantation

Effects on cervical mucus prevent penetration by sperm

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24
Q

Pros of IUS

A

Very effective and reversible
Reduces blood loss and dysmenorrhoea
Can be used for menorrhagia & endometrial protection with HRT

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25
Q

Cons of IUS

A 
Insertion unpleasant
Menstrual irregularities in 1st 6 months
Progestogenic SEs: acne, breast tenderness, headache, mood changes
Dysfunctional ovarian cysts
Expulsion/perforation risk
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26
Q

Contraindications to IUS

A

Hx PID, recent STI exposure, up to 4 weeks postpartum, uterine abnormality eg fibroids, gynae cancer, VTE, IHD, immunosuppression

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27
Q

What methods can be used for emergency contraception?

A
  1. Copper IUD
  2. Ulipristal acetate
  3. Levonorgestrel
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28
Q

How long after unprotected sex can Copper IUD be used for emergency contraception?

A

Up to 5 days

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29
Q

How does Ulipristal acetate work?

A

Delays or inhibits ovulation- selective progesterone modulator

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30
Q

How long after unprotected sex can Ulipristal acetate be used for emergency contraception?

A

Up to 120hrs

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31
Q

Contraindications to Ulipristal acetate?

A

Need to exclude pregnancy, severe liver disease, uncontrolled asthma, repeated use in same menstrual cycle

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32
Q

Side effects of Ulipristal acetate

A

N&V- repeat dose if vomit within 2hrs

Dizziness, menstrual irregularities, abdominal/back/pelvic pain, headache, mood disorders

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33
Q

How does Levonorgestrel work?

A

Delays ovulation- needs to be used early in cycle

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34
Q

How long after unprotected sex can Ulipristal acetate be used for emergency contraception?

A

Up to 72hrs

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35
Q

Contraindications to Levonorgestrel

A

Severe liver disease, severe malabsorption

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36
Q

Side effects of Levonorgestrel

A

N&V- repeat dose if vomit within 2hrs

Menstrual irregularities, dizziness, diarrhoea, breast tenderness

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37
Q

How can sexual dysfunction be grouped?

A
  1. Desire- HSDD, Sexual aversion
  2. Arousal- ED, FSAD, paraphilias
  3. Orgasm- ejaculatory disorders
  4. Resolution- pain disorders, dyspareunia, vaginismus
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38
Q

Define dyspareunia

A

Pain during intercourse

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39
Q

Causes of dyspareunia

A

Physiological: infection, injury, circumcision, interstitial cystitis, poor lubrication, menopause, vaginal atrophy, endometriosis, adhesions, IBS
Psychological: previous sexual abuse, insufficient relaxation
Relationship- poor partner technique, fear of intimacy

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40
Q

Management of dyspareunia

A

Steroid creams eg dermovate
Treat the cause
Couples therapy

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41
Q

What is Sexual Aversion Disorder?

A

Persistent or recurrent extreme aversion to and avoidance of all or almost all genital sexual contact with a sexual partner which causes distress or interpersonal difficulty

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42
Q

Management of Sexual Aversion Disorder?

A

Psychosexual therapy

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43
Q

What is Hypoactive Sexual Desire Disorder (HSDD)?

A

Deficient sexual fantasies and desire for sexual activity in the context of age and a person’s life, not better accounted for by another condition

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44
Q

Causes of Hypoactive Sexual Desire Disorder (HSDD)

A

Cardiovascular disease, Diabetes, depression, androgen deficiency, hypothyroidism, Addison’s disease, anti-depressants, COCP, previous trauma/abuse etc

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45
Q

Management of Hypoactive Sexual Desire Disorder (HSDD)

A

Androgen deficient- Androgen therapy
Testosterone replacement
Psychosexual therapy

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46
Q

What is Female Orgasmic Disorder?

A

Orgasm does not occur or is markedly delayed

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47
Q

Management of Female Orgasmic Disorder

A

Psychotherapy/behavioural interventions

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48
Q

What is Vaginismus?

A

Involuntary contraction of muscles around the entry point to the vagina

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49
Q

Causes of vaginismus

A

Thrush, FGM, fear, relationship dissatisfaction, previous sexual abuse/trauma

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50
Q

What is Erectile Dysfunction?

A

Difficulty attaining or maintaining an erection

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51
Q

Causes of Erectile Dysfunction

A

Cardiovascular disease, diabetes, psychological, neurogenic, endocrine, drugs (SSRIs, TCAs)

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52
Q

Management of Erectile Dysfunction

A

Manage risk factors
1st line drug- Oral phosphodiesterase-5-inhibitors- Sildenafil
Vaccuum device, psychological therapy
2nd line drug- Intraurethral/intercavernosal eg Alprostadil

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53
Q

What is rapid/premature ejaculation?

A

Inability to control ejaculations sufficiently for both partners to enjoy sexual interaction

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54
Q

Causes of rapid/premature ejaculation

A

Hyperthyroidism, Prostatitis, Penile hypersensitivity, Anxiety, Lack of sexual experience

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55
Q

Management of rapid/premature ejaculation

A

Therapy
Sertraline/Paroxetine
Local anaesthetic Lidocaine spray

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56
Q

What is Peyronie’s disease?

A

Curvature and bend of penis due to plaques

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57
Q

Presentation of Peyronie’s disease

A

Erectile dysfunction, pain and shortening of shaft of penis

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58
Q

What are Petok’s 4 principles?

A

Relate to religion in sexual health problems

  1. Ask about religious beliefs in initial visit
  2. Ask about religious teachings regarding sexual behaviour
  3. When in doubt, consult with a religious expert
  4. Help couples to set reasonable expectations consistent with their beliefs
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59
Q

What are the 4 couples therapy approaches?

A
  1. Cognitive-behavioural
  2. Psychodynamic
  3. Systemic
  4. Integrative
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60
Q

What are the 5 key principles of couples therapy?

A
  1. Improve communication
  2. Modify dysfunctional behaviour
  3. Decrease emotional avoidance
  4. Change view of relationships
  5. Promote strengths
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61
Q

Define paraphilia

A

Abnormal sexual desire, typically extreme or dangerous activities, desires are specific and unchanging

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62
Q

Define fetishism

A

Sexual fixation on a non-living object or non-genital body part

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63
Q

Define gender dysphoria

A

The distress experienced by an individual about their assigned gender which is in comflict with their internal gender identity

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64
Q

Management Trans-male

A 
Testosterone injections
Psychotherapy
Store eggs?
Androgens/GnRH analogue
SALT
Male chest reconstruction
Hysterectomy + Bilateral oophorectomy
Phalloplasty
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65
Q

Management Trans-female

A 
Oestrogens/anti-androgens
SALT
Facial hair removal
Vaginoplasty
Augmentation mammoplasty
Facial feminisation surgery
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66
Q

At what age can hormonal treatment start to be prescribed for transgender management?

A

Age 7

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67
Q

Define sex addiction

A

Compulsive participation or engagement in sexual activity

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68
Q

What is the causative organism in Syphilis?

A

Treponema pallidum

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69
Q

Presentation of Syphilis

A

Primary: days to weeks, chancre (painless genital sore)
Secondary: mths, gum lesions, rash, lymphadenopathy
Tertiary: years, gummatous, neuro, cardiac

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70
Q

Management of Syphilis

A

IM Penicillin

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71
Q

What type of infection is Trichomonas Vaginalis?

A

Protozoal

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72
Q

Presentation of Trichomonas Vaginalis

A

Green, frothy, smelly discharge

Strawberry cervix

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73
Q

Green, frothy, smelly discharge
Strawberry cervix
What is the diagnosis?

A

Trichomonas Vaginalis

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74
Q

Diagnosis of Trichomonas Vaginalis

A

High vaginal swab

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75
Q

Management of Trichomonas Vaginalis

A

Metronidazole

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76
Q

What is the aetiology of Bacterial Vaginosis?

A

Anaerobes overgrowing normal vaginal flora

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77
Q

Presentation of Bacterial Vaginosis

A

Grey-white discharge with fishy odour

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78
Q

Grey-white discharge with fishy odour, what is the diagnosis?

A

Bacterial Vaginosis

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79
Q

Management of Bacterial Vaginosis

A

Metronidazole

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80
Q

What is the aetiology of thrush?

A

Candida albicans infection

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81
Q

Risk factors for thrush

A

Diabetes, pregnancy, tight clothing, over-washing

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82
Q

Presentation of thrush

A

Itching, local inflammation, superficial dyspareunia

Odourless cottage cheese discharge

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83
Q

Itching, local inflammation, superficial dyspareunia
Odourless cottage cheese discharge
What is the diagnosis?

A

Thrush- candida albicans

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84
Q

Diagnosis of thrush

A

High vaginal/urethral swabs (low pH)

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85
Q

Management of thrush

A

Antifungals- Clotrimazole pessary or Fluclonazole tablets

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86
Q

Asymptomatic sexual health screening- Female

A

Swab for chlamydia/gonorrhoea NAAT

Bloods for Syphilis/HIV

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87
Q

Asymptomatic sexual health screening- Male

A

1st void urine for chlamydia/gonorrhoea NAAT

Bloods for Syphilis/HIV

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88
Q

Asymptomatic sexual health screening- MSM

A

1st void urine for chlamydia/gonorrhoea NAAT
Pharyngeal + rectal swabs for chl/gon NAAT
Bloods for Syphilis, Hep B and HIV

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89
Q

What is primary, secondary and tertiary prevention in sexual health?

A

Primary- reduce risk of acquiring STIs eg condoms, advice, hep B vaccine
Secondary- earlier identification of asymptomatic disease eg targeted screening, contact tracing
Tertiary- reduce morbidity/mortality eg treat the disease

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90
Q

What is the causative organism in Chlamydia?

A

Chlamydia trachomatis

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91
Q

Presentation of Chlamydia

A

Discharge, dysuria/pelvic pain, bleeding

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92
Q

Diagnosis of Chlamydia

A

1st void urine NAAT/endocervical swabs

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93
Q

Management of Chlamydia

A

1 week Azithromycin

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94
Q

What is the causative organism in Gonorrhoea?

A

Neisseria Gonorrhoea

Gram -ve diplococci

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95
Q

Diagnosis of Gonorrhoea

A

1st void urine NAAT/endocervical swabs

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96
Q

Presentation of Gonorrhoea

A

Discharge, dysuria/pelvic pain, bleeding

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97
Q

Management of Gonorrhoea

A

Single-dose Ceftriaxone

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98
Q

What is classed as a prolonged 2nd stage of labour?

A

Nulliparous: >2hrs
Multiparous: >1hr

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99
Q

What is abnormal 1st stage of labour?

A
  • Inefficient uterine contractions –> amniotomy + Syntocinon
  • Cephalopelvic disproportion (malposition/malpresentation/inadequate pelvis) –> C section
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100
Q

Describe active management of the 3rd stage of labour

A
  • IM Syntometrine/Syntocinon
  • Deferred clamping + cutting of cord
  • Controlled cord traction
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101
Q

What score is used to predict likelihood of successful vaginal delivery?

A

Bishops score

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102
Q

What is Bishops score?

A 
Used to predict likelihood of successful vaginal delivery
BISHOP:
- I- (e)ffacement
- Station
- Hard or soft- consistency
- Open or closed- dilatation
- Position/presenting part
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103
Q

At what Bishop score is induction considered?

A

<=5

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104
Q

What is cord prolapse?

A

Cord is the presenting part –> vasospasm

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105
Q

Risk factors for cord prolapse

A

PROM, polyhydramnios, long cord, malpresentation, multiparity, multiple pregnancy

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106
Q

Management of cord prolapse

A

Trendelenburg with knees and hips up

Push presenting part off cord with hand

107
Q

What is shoulder dystocia?

A

Failure of the anterior shoulder to pass under symphysis pubis after delivery of the head

108
Q

Risk factors for shoulder dystocia

A

Macrosomia, maternal diabetes, post-maturity, maternal obesity, prolonged labour

109
Q

Management of shoulder dystocia

A

HELPERR:

  • call for Help
  • Episiotomy
  • Legs in McRoberts
  • supraPubic pressure
  • Enter pelvis
  • Rotational maneouvres
  • Remove posterior arm
110
Q

Complications of shoulder dystocia

A

Mum- tear, PPH, psychological

Baby- hypoxia, fits, cerebral palsy

111
Q

Risk factors for gestational diabetes

A

Maternal obesity, previous macrosomic baby, previous GDM

112
Q

Complications of gestational diabetes

A

SMASH

  • Shoulder dystocia
  • Macrosomia
  • Amniotic fluid excess- polyhydramnios
  • Stillbirth
  • Hypertension/Hypoglycaemia
113
Q

Diagnosis of gestational diabetes

A

OGTT > 7.8, Fasting glucose > 5.6

114
Q

Management of gestational diabetes

A

Drugs- stop ACEi, statins, hypoglycaemics except Metformin, Insulin and Glibenclamide
Give folic acid
Delivery < 40+6- offer induction at 37-38+6
Consider C-section if >4kg
Intrapartum- insulin sliding scale + IV dextrose

115
Q

In gestational diabetes, how should glucose levels be controlled during labour?

A

Insulin sliding scale + IV dextrose

116
Q

What is the aetiology of Rhesus disease in pregnancy?

A

Sensitisation in 1st pregnancy, initial IgM cannot cross placenta
Re-exposure in subsequent pregnancy, memory B cells - IgG immune response- crosses to foetal circulation
–> Haemolytic anaemia

117
Q

What events can cause Rhesus sensitisation?

A

Previous pregnancy

TOP, Ectopic, external cephalic version, blunt abdo trauma, CVS, delivery

118
Q

Investigations for Rhesus disease

A

Rhesus status checked at booking, 28+34 weeks
MCA doppler to assess foetal anaemia
Kleihauer test to determine how much foetal blood been transferred to mother’s bloodstream

119
Q

Management of Rhesus disease

A

Prevention by anti-D immunoglobulin

120
Q

How is hypertension in pregnancy classified?

A
  1. Chronic hypertension- before pregnancy or <20wks
  2. Pregnancy-induced hypertension- >20 weeks without pre-eclampsia
  3. Pre-eclampsia- Hypertension + Proteinuria
121
Q

What is classified at hypertension in pregnancy (cut-off)?

A

> 140/90

122
Q

Risk factors for pre-eclampsia

A

NOPE2FAT:

  • Nulliparity
  • Obesity
  • Previous history
  • Extremes of age
  • 2- twins
  • FH
  • Autoimmune
  • Twins
123
Q

What is the aetiology of pre-eclampsia?

A

Failure of trophoblastic endovascular remodelling –> placental ischaemia

124
Q

Presentation of Pre-eclampsia

A

Headaches, visual disturbance, epigastric/RUQ pain, brisk hyperreflexia, ankle clonus

125
Q

Maternal complications of pre-eclampsia

A

Eclampsia (seizures), HELLP syndrome, cerebral haemorrhage/stroke, renal failure, placental abruption

126
Q

Foetal complications of pre-eclampsia

A

IUGR, Preterm, oligohydramnios, IUFD

127
Q

What is HELLP syndrome?

A

A complication of pregnancy usually seen in eclampsia or pre-eclampsia
Haemolysis
Elevated Liver enzymes
Low Platelets

128
Q

Definition of pre-eclampsia

A

New persistent BP >140/90 after 20wks gestation + Proteinuria > 300mg in 24hrs or +2 on dipstick

129
Q

What is the only cure for pre-eclampsia?

A

Delivery

130
Q

Management of pre-eclampsia

A

Only cure- delivery
Low-dose aspirin 75mg from 12wks to birth
Steroids (Betamethasone) at 34wks
Labetalol

131
Q

What is Eclampsia?

A

Pre-eclampsia (BP + Proteinuria) WITH seizures

132
Q

Management of Eclampsia

A

IV Magnesium Sulphate then delivery

133
Q

Define Antepartum haemorrhage

A

Vaginal bleeding from 24wks to onset of labour

134
Q

How is antepartum haemorrhage classified?

A

Minor < 50ml
Major 50-1000ml
Massive > 1000ml + signs of shock

135
Q

Causes of Antepartum haemorrhage

A

Uterine- placental abruption, placenta/vasa praevia
Cervical- show, cervical cancer, ectropion
Vaginal- trauma, infection

136
Q

Risk factors for placenta accreta

A

Previous accreta, previous c-section, uterine surgery

137
Q

What is placenta accreta?

A

When the placenta is morbidly attached to the uterine wall to an increasing degree

138
Q

Name the different types of placenta accreta

A
  1. Placenta accreta
  2. Placenta increta
  3. Placenta percreta
139
Q

Management of placenta accreta

A

Deliver at 35-36wks

C-section hysterectomy or uterine-preserving surgery

140
Q

What is placenta praevia?

A

Where the placenta is lying in the lower portion of the uterus, at a lower point than the presenting part of the fetus

141
Q

Risk factors for placenta praevia

A

Multiparity, smoking, multiple pregnancy, increased age, previous praevia or c-section

142
Q

How is placenta praevia classified?

A
  • Marginal- close to cervical os- 2cm away

- Major- overlying os

143
Q

Presentation of placenta praevia

A

Intermittent painless bleeds

Foetal malpresentation- head not engaged and high

144
Q

Investigations for placenta praevia

A

TVUSS at 2nd trimester- repeat at 32 weeks, repeat at 36 weeks

145
Q

Management of placenta praevia

A

Avoid sex/intense exercise- vaginal examination contraindicated
Major: admit until delivery, elective CS at 37-39wks
If severe bleed- emergency CS
Single dose steroids 34-36wks
Tocolysis eg Nifedipine prevents contractions

146
Q

What is placental abruption?

A

Premature separation of a normally sited placenta from uterine wall

147
Q

Risk factors for placental abruption

A

Previous abruption, pre-eclampsia, IUGR, rapid uterine decompression

148
Q

Presentation of placental abruption

A

Abdo pain +/- bleeding

Woody hard uterus, maternal shock, foetal distress

149
Q

Woody hard uterus, what is the diagnosis?

A

Placental abruption

150
Q

Management of placental abruption

A

Emergency C-section and resuscitation

151
Q

What is vasa praevia?

A

Foetal vessels run in the membrane below the presenting part

152
Q

Presentation of vasa praevia

A

Triad of…

  1. Rupture of membranes
  2. Antepartum haemorrhage (painless bleed)
  3. Foetal distress (bradycardia)
153
Q

How is postpartum haemorrhage classified?

A

Minor 500-1000ml
Major > 1000ml
Primary- within 24hrs of giving birth
Secondary- 24hrs-6wks postpartum

154
Q

What is secondary PPH?

A

24hrs-6wks postpartum

155
Q

What is the main cause of secondary PPH?

A

Infection (endometritis) or retained products of conception

156
Q

What is primary PPH?

A

Within 24hrs of giving birth

157
Q

Causes of primary PPH

A

4Ts:

  • Tissue- retained placenta
  • Tone- uterine atony
  • Trauma- lacerations
  • Thrombin- coagulopathy- haemophilia A/B, DIC
158
Q

Complications of PPH

A

Shock, DIC

159
Q

Management of PPH

A 
Minor- IV fluids, cross match, monitor
Major: ABCDE
- Lacerations- suture
- Retained placenta- manual evacuation
- Uterine Atony- Bimanual uterine compression --> Ergometrine IV/IM --> Oxytocin infusion --> Surgery eg uterine tamponade
160
Q

What is a TORCH screen?

A

Tests for infections in pregnant women

  • Toxoplasmosis
  • Other- HIV, Syphilis, Measles, EBV, HepB)
  • Rubella
  • Cytomegalovirus
  • Herpes simplex
161
Q

Management of Group B Streptococcal infection in pregnancy

A

Intrapartum IV Benzylpenicillin if…

  • previous baby with GpB strep
  • GpB strep colonisation in current pregnancy
162
Q

What are the routine antenatal US scans?

A

12 weeks- dating pregnancy and confirming viability

18-20+6 weeks- structural abnormalities

163
Q

What is the combined test in pregnancy?

A

For T13, T18 and T21
Done in 1st trimester
1. Nuchal translucency + serum testing (PAPP-A + BhCG)
2. CVS/Amniocentesis if +ve

164
Q

What abnormalities are testing for in the combined test in pregnancy?

A

T13- Patau syndrome
T18- Edwards syndrome
T21- Down’s syndrome

165
Q

What is included in serum testing for trisomies in the combined test?

A

PAPP-A

BhCG

166
Q

When in pregnancy is blood tested for haemoglobinopathy and what is it tested for?

A

8-10wks

Sickle cell and thalassaemia

167
Q

Difference between CVS and Amniocentesis

A

CVS can be done earlier but less accurate and increased risk of miscarriage than amniocentesis

168
Q

What are the ‘baby blues’?

A

Brief period of feeling emotional and tearful about 3-10 days after giving birth

169
Q

What is endometriosis?

A

Presence of endometrial tissue outside of the uterus

170
Q

What is stress incontinence?

A

Involuntary leakage of urine on effort or exertion due to urethral sphincter weakness

171
Q

Causes of stress incontinence

A

Pregnancy, vaginal delivery, instrumental delivery, oestrogen deficiency (menopause), pelvic trauma/irradiation, age

172
Q

Investigation of stress incontinence

A

Exclude UTI
Frequency-volume chart
Urodynamics

173
Q

Management of stress incontinence

A

1st line- pelvic floor training
2nd line- surgery
Drug- Duloxetine

174
Q

What is urge incontinence?

A

Involuntary leakage of urine associated with urgency due to detrusor overactivity

175
Q

Causes of urge incontinence

A

Idiopathic, secondary to pelvic/incontinence surgery, UTI, neurogenic

176
Q

Investigation of urge incontinence

A

Exclude UTI

Urodynamics

177
Q

Management of urge incontinence

A

Conservative- avoid ++ fluid intake, avoid caffeine/fizzy drinks, weight loss, pelvic floor exercises
1st line- Bladder training
Drugs- Anticholinergic- Oxybutinin

178
Q

Types of vaginal prolapse

A

Anterior wall- Cystocele, Urethrocele, Cystourethrocele
Posterior wall- Enterocele (small bowel), Rectocele
Apical- Uterovaginal, Vault prolapse

179
Q

Risk factors for vaginal prolapse

A

Pelvic floor weakness

Vaginal delivery, pregnancy, congenital, menopause, raised intra-abdominal pressure eg obesity, surgery

180
Q

Presentation of vaginal prolapse

A

Dragging sensation, feeling of a lump, dyspareunia

181
Q

Management of vaginal prolapse

A

Pessary

Surgery if symptomatic or severe

182
Q

Prevention of vaginal prolapse

A

Weight loss
Smoking cessation
Pelvic floor exercises

183
Q

How does the menopause and pregnancy affect endometriosis?

A

Endometriosis is oestrogen-dependent, so it regresses after the menopause and pregnancy

184
Q

Aetiology of endometriosis

A

Theory of retrograde menstruation
Free blood –> inflammation, progressive fibrosis + adhesions
–> frozen pelvis
–> chocolate cysts- accumulated dark brown blood on ovaries

185
Q

Presentation of endometriosis

A

Chronic cyclical pelvis pain, deep dyspareunia and backache

Infertility due to adhesions and inflammation

186
Q

Diagnosis of endometriosis

A

Laparoscopy + biopsy gold standard

187
Q

Management of endometriosis

A

NSAIDs
Continuous COCP/GnRH agonists
Laparoscopic surgery- laser ablation + adhesiolysis
Hysteretomy + BL salpingo-oophorectomy

188
Q

What are fibroids?

A

Leiomyoma

Benign neoplasm of smooth muscle in myometrium

189
Q

Types of fibroids

A 
Pedunculated
Subserosal
Submucosal
Intramural
Intracavity
190
Q

How to fibroids change in pregnancy?

A

Oestrogen dependent
Increase in size with oestrogen/progesterone therapy/Clomifene/Pregnancy
Most regress after menopause

191
Q

Presentation of fibroids

A

Menorrhagia, intermenstrual bleeding, dysmenorrhoea, subfertility
Pressure effects: bladder retention, constipation

192
Q

What is a risk of fibroids in pregnancy?

A

Red degeneration- loss of blood supply causes acute pain and fever

193
Q

Management of fibroids

A

Medical: tranexamic acid, NSAIDs, progestogens, IUS, COCP
Uterine artery embolisation
Surgery

194
Q

What is ectopic pregnancy?

A

Implantation of conceptus outside of the uterine cavity

195
Q

What is the most common location for ectopic pregnancy?

A

Ampulla of the fallopian tube

196
Q

Risk factors for ectopic pregnancy

A

PIPA:

  • Previous ectopic
  • IUCD
  • Pelvic surgery
  • Assisted reproduction
197
Q

Presentation of ectopic pregnancy

A

Triad of…
1. Amenorrhoea
2. Lower abdominal pain- unilateral colicky then constant
3. PV Bleed
Intraperitoneal blood loss- collapse + shoulder-tip pain
Cervical excitation

198
Q

Investigations for ectopic pregnancy

A

Pregnancy test- BhCG + serial serum hCG

Laparoscopy gold standard

199
Q

Management of ectopic pregnancy

A
  1. Expectant- serial serum hCG
  2. Medical- IM Methotrexate + monitor hCG
  3. Surgical- Salpingectomy/Salpingotomy
200
Q

How is infertility defined?

A

Failure to conceive after 1 year of trying- refer

201
Q

When should somebody be referred for infertility?

A

After 1 year of trying

202
Q

Investigations of infertility

A

Semen analysis
Mid-luteal (day 21) progesterone
FSH, antral follicle count, anti-Mullerian hormone
Tubal patency

203
Q

Management of female infertility

A

Clomifene ovulation induction
Donor eggs
Refer for IVF after 2 years of trying

204
Q

What is Polycystic Ovarian Syndrome (PCOS)?

A

Transvaginal ultrasound appearance of 12 or more small (2-8mm) follicles in an enlarged (>10cm) ovary

205
Q

What criteria is used for diagnosis of Polycystic Ovarian Syndrome (PCOS)?

A

Rotterdam criteria- need 2/3 of…

  1. PCO on USS
  2. Oligoovulation/Anovulation
  3. Clinical/Biochemical Hyperandrogenism: acne, hirsutism, raised serum testosterone
206
Q

What are the clinical/biochemical criteria in the Rotterdam criteria for Polycystic Ovarian Syndrome (PCOS)?

A

Acne
Hirsutism
Raised serum testosterone

207
Q

What is the Rotterdam criteria?

A

Criteria used for diagnosis of Polycystic Ovarian Syndrome (PCOS):
Need 2/3 of…
1. PCO on USS
2. Oligoovulation/Anovulation
3. Clinical/Biochemical Hyperandrogenism: acne, hirsutism, raised serum testosterone

208
Q

What conditions does Polycystic Ovarian Syndrome (PCOS) increase a patient’s risk of?

A

Type 2 Diabetes

Gestational diabetes

209
Q

Blood tests in Polycystic Ovarian Syndrome (PCOS)

A

LH:FSH ratio 3:1

Raised serum testosterone day 21

210
Q

Management of Polycystic Ovarian Syndrome (PCOS)

A

Conservative- lose weight, smoking cessation
Menstrual regularity- COCP, Metformin
Control Sx- Antiandrogens (Cyproterone acetate)
Ovulation induction- Anti-oestrogens (Clomifene citrate), Laparoscopic ovarian diathermy

211
Q

Most common cause of Pelvic Inflammatory Disease (PID)?

A

Chlamydia

212
Q

Risk factors for Pelvic Inflammatory Disease (PID)

A

Chlamydia infection

Surgical TOP, ERCP, IUD, miscarriage

213
Q

Presentation of Pelvic Inflammatory Disease (PID)

A

Pelvic pain, deep dyspareunia, vaginal discharge, fever, intermenstrual bleeding/post-menstrual bleeding
Cervical excitation

214
Q

Complications of Pelvic Inflammatory Disease (PID)

A

Ectopic pregnancy, infertility, adhesions

215
Q

Diagnosis of Pelvic Inflammatory Disease (PID)

A

Laparoscopy gold standard

Swab for STIs

216
Q

Management of Pelvic Inflammatory Disease (PID)

A

IM Ceftriaxone + PO Doxycycline + PO Metronidazole

217
Q

Presentation of ovarian cyst accident

A

Sharp unilateral abdominal pain after sex or strenuous exercise, tenderness

218
Q

Investigation of ovarian cyst accident

A

Free fluid in pelvic cavity

219
Q

Presentation of adnexal torsion

A

Unilateral sharp waxing/waning pain, N&V, tender palpable mass on bimanual examination

220
Q

Investigation of adnexal torsion

A

USS- enlarged oedematous ovary with Whirlpool sign

221
Q

Define primary amenorrhoea

A

No menses by age 16 in the presence of secondary sexual characteristics

222
Q

Causes of primary amenorrhoea

A

Hypothalamic, Turner’s, PCOS, intense exercise, Mullerian agenesis, Kallman’s syndrome

223
Q

Define secondary amenorrhoea

A

Cessation after onset of menses

224
Q

Causes of secondary amenorrhoea

A

Weight loss, exercise, PCOS, Sheehan’s syndrome

225
Q

What BMI is needed to start periods and to maintain regular?

A

Start- 17

Regular- 19

226
Q

What age is defined as precocious puberty?

A

< 8 in girls

< 9 in boys

227
Q

Causes of menorrhagia

A

Coagulopathy, uterine fibroids, uterine polyps, adenomyosis, endometriosis

228
Q

What are the 2 week wait criteria in menorrhagia?

A

Endometrial biopsy for women aged >45 with IMB which is unresponsive to treatment

229
Q

Management of menorrhagia

A 
Antifibrinolytics: Tranexamic acid
NSAIDs: Mefenamic acid
Progestogens
COCP/IUS
ENdometrial ablations
Hysterectomy
230
Q

What is adenomyosis?

A

Presence of endometrium and underlying stroma in the myometrium

231
Q

How does the menopause affect adenomyosis?

A

It subsides after menopause

232
Q

Presentation of adenomyosis

A

Painful heavy menstruation, cyclical pain, dysmenorrhoea, dyspareunia

233
Q

Investigation of adenomyosis

A

MRI: black halo line around uterus

234
Q

Management of adenomyosis

A

IUS, COCP, NSAIDs

Hysterectomy

235
Q

Risk factors for endometrial cancer

A 
Increased oestrogen (COCP reduces risk)- PCOS, diabetes, obesity, early menarche, late menopause, HRT
Inherited syndromes- Lynch, BRCA1, Cowden
Precancerous conditions- Endometrial hyerplasia/neoplasia
236
Q

What inherited syndromes are associated with endometrial cancer?

A

Lynch, BRCA1, Cowden

237
Q

What precancerous conditions are associated with endometrial cancer?

A

Endometrial hyperplasia/neoplasia

238
Q

What types of endometrial cancer are there?

A

Sarcoma/Carcinoma/Mixed

239
Q

Presentation of endometrial cancer

A

Uterine bleeding

240
Q

Investigation of endometrial cancer

A

TVUSS: endometrial thickness, biopsy

241
Q

Staging of endometrial cancer

A

Stage 1: within endometriun
Stage 2: into cervix
Stage 3A: ovary 3B: vagina 3C: lymph nodes
Stage 4: spread to other organs

242
Q

Management of endometrial cancer risk in Lynch syndrome

A

Prophylactic hysterectomy

243
Q

Risk factors for ovarian cancer

A

Prolonged ovulation, COCP, multiparity

244
Q

Staging of ovarian cancer

A

Stage 1A: in one ovary
1B: Both ovaries
1C: ovary and surface of other obary
Stage 4: spread to other organs

245
Q

Investigations of ovarian cancer

A

Ca125, USS

246
Q

What score can be used to calculate risk of ovarian cancer?

A

RIsk of malignancy index =

Ca125 x USS score x pre/postmenopausal

247
Q

Types of cervical cancer

A

Squamous cell carcinoma or Adenocarcinoma

248
Q

Risk factors for cervical cancer

A

HPV16/18, intraepithelial neoplasia, smoking, COCP

249
Q

Presentation of cervical cancer

A

Post-coital bleeding, irregular bleeding, mucopurulent discharge

250
Q

What staging score is used for cervical cancer?

A

FIGO score 1-4

251
Q

Prevention of cervical cancer

A

Smear, HPV vaccine

252
Q

Risk factors for breast cancer

A

Age, FH (BRCA1+2, TP53), duration of oestrogen exposure, late 1st pregnancy, HRT > 5yrs, obesity, alcohol

253
Q

What factor is protective of breast cancer?

A

Breast feeding

254
Q

What is the name of the risk assessment tool for breast cancer

A

Manchester risk assessment tool

255
Q

What is the screening programme for BRCA1+2 carriers?

A

Annual MRI up to age 50
Annual mammogram over age 40
Triannual mammogram over age 60

256
Q

What is the NHS screening programme for breast cancer?

A

Age 50-71 every 3 years

257
Q

Presentation of breast cancer

A

Painless lump, nipple discharge/inversion, skin tethering, surface ulceration/erythema

258
Q

What is the triple assessment for breast cancer?

A
  1. Clinical score- Hx and Ex
  2. Imaging score- mammogram/USS
  3. Biopsy- fine needle aspiration/core needle biopsy/excision biopsy/incisional
259
Q

Types of breast cancer

A

Mostly ductal or lobular

Also Paget’s disease of nipple

260
Q

Management of breast cancer

A 
Radiotherapy
Hormonal- Tamoxifen if premenopausal; Letrozole if postmenopausal
HER2+ve- Trastuzumab (Herceptin)
ER+ve- Docetaxel
Chemotherapy
Surgery
261
Q

Average age of menopause

A

51

262
Q

Presentation of the menopause

A
  • Vasomotor- hot flushes + sweats
  • MSK- muscle and joint pain
  • Low mood + sexual dysfunction
  • Local effects- vaginal atrophy –> dryness
  • Loss of memory/concentration
  • Osteoporosis
  • Cardiovascular disease
263
Q

When can menopause be diagnosed?

A

12 months after last period

264
Q

What is premature ovarian insufficiency?

A

Menopause < 40yrs

Finals Revision (13 decks)

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