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Other Important Topics Flashcards

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1
Q

What is Asherman syndrome?

A

Formation of fibrous bands and adhesions within the endometrial cavity resulting in subfertility.

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2
Q

RFs for asherman syndrome

A

Pelvic Surgery (e.g. C-section, myomectomy, dilation and curettage)
Pelvic Irradiation
Pelvic Inflammatory Disease

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3
Q

Presentation of asherman syndrome

A

Reduced or absent menstrual bleeding
Subfertility
Pelvic pain

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4
Q

Investigations for asherman syndrome

A

Imaging & Other
Hysteroscopy

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5
Q

Management of asherman syndrome

A

Adhesiolysis (surgical breakdown of adhesions)
Pain management

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6
Q

What is bartholin’s cyst?

A

Cyst formation within Bartholin’s gland.

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7
Q

PACES: what are bartholin’s glands?

A

pea-sized glands that are located around the vaginal introitus and produce vaginal lubricant.

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8
Q

RFs for Bartholin’s cysts?

A

Nulliparous
Child-bearing age
Previous Bartholin’s cyst
Sexually active (though STIs do not, themselves, cause cysts)

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9
Q

Presentation of bartholin’s cyst

A

Discomfort or pain
Dyspareunia
Discharge from cyst

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10
Q

Presentation of bartholin’s abscess

A

Significant pain and tenderness
Erythema
Fever

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11
Q

Investigations for bartholin’s cyst

A

Clinical diagnosis
Bedside
Swab (for MC&S)

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12
Q

Management of bartholin’s cyst

A

Conservative
Soak cyst for 10-15 mins in warm water several times per day for 3-4 days
Apply a warm compress to the area
Advise taking simple analgesia like paracetamol and ibuprofen

Medical
Abscesses are likely to require intervention of some form
If the abscess is discharging and the patient is well, it can be treated with oral antibiotics (e.g. flucloxacillin or co-amoxiclav)
May require incision and drainage
May be accompanied by insertion of a balloon catheter or marsupialisation of the cyst

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13
Q

PACES: Conservative management for bartholin’s cyst

A

Soak cyst for 10-15 mins in warm water several times per day for 3-4 days
Apply a warm compress to the area
Advise taking simple analgesia like paracetamol and ibuprofen

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14
Q

Medical management for bartholin’s abscess

A

Abscesses are likely to require intervention of some form
If the abscess is discharging and the patient is well, it can be treated with oral antibiotics (e.g. flucloxacillin or co-amoxiclav)
May require incision and drainage
May be accompanied by insertion of a balloon catheter or marsupialisation of the cyst

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15
Q

ABx options for bartholin’s asbscess

A

flucloxacillin or co-amoxiclav

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16
Q

Options for incision and drainage of bartholin’s abscess

A

May be accompanied by insertion of a balloon catheter or marsupialisation of the cyst

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17
Q

What is cervical ectropion?

A

Condition in which the columnar epithelium of the endocervix becomes visible on the ectocervix. This may appear macroscopically as a red area around the external cervical os. It is NOT pathological.

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18
Q

What causes cervical ectropion?

A

Cervical ectropion normally develops under the influence of high circulating oestrogen levels

This, in turn, may be related to puberty, the combined oral contraceptive pill or pregnancy

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19
Q

Presentation of cervical ectropion

A

Often asymptomatic and incidentally noted upon speculum examination (e.g. when attending for a cervical smear)
Postcoital bleeding
Intermenstrual bleeding
Abnormal vaginal discharge

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20
Q

post-coital bleeding on COCP

A

cervical ectropion

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21
Q

When is cervical ectropion usually noted?

A

speculum examination

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22
Q

Management of cervical ectropion

A

Does NOT require treatment if it is asymptomatic
If symptoms are problematic, the following should be conisdered:
Changing from oestrogen-based hormonal contraceptives
Cervical ablation (cryocautery)
Take cervical and genital tract swabs to exclude STI
Take smear to exclude cervical malignancy/premalignancy

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23
Q

What should be excluded in cervical ectropion if symptoms are problematic?

A

Take smear to exclude cervical malignancy/premalignancy

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24
Q

Classification of FGM

A

Type 1: Clitoridectomy (partial or total removal of the clitoris)
Type 2: Excision (partial or total removal of the clitoris and the labia minora with or without excision of the labia majora)
Type 3: Infibulation (narrowing of the vaginal orifice with creation of a covering seal)
Type 4: Unclassified (all other harmful procedures to the female genitalia for non-medical purposes)

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25
Type 1 FGM
Type 1: Clitoridectomy (partial or total removal of the clitoris)
26
Type 2 FGM
Type 2: Excision (partial or total removal of the clitoris and the labia minora with or without excision of the labia majora)
27
Type 3 FGM
Type 3: Infibulation (narrowing of the vaginal orifice with creation of a covering seal)
28
Type 4 FGM
Type 4: Unclassified (all other harmful procedures to the female genitalia for non-medical purposes)
29
Complications of FGM
Infection and abscess formation Urethral injury Recurrent UTI Dysmenorrhoea Sexual dysfunction Psychological trauma Obstetric complications
30
Management of FGM
Any case of FGM must be reported in the notes Any case of FGM in children < 18 years must be referred to the police and social services The mandatory duty to tell the appropriate agency will NOT apply to at risk of suspected cases over 18 years Check to see whether other young girls in the family are at risk of FGM De-Infibulation (reversal of infibulation) Should be performed with adequate analgesia and sedation to reduce the risk of psychological distress Provide access to specialist services and support groups
31
What is the surgical procedure that can be performed for FGM?
De-Infibulation (reversal of infibulation) Should be performed with adequate analgesia and sedation to reduce the risk of psychological distress Provide access to specialist services and support groups
32
ETHICAL RULES FOR FGM
Any case of FGM must be reported in the notes Any case of FGM in children < 18 years must be referred to the police and social services The mandatory duty to tell the appropriate agency will NOT apply to at risk of suspected cases over 18 years Check to see whether other young girls in the family are at risk of FGM
33
When is it mandatory to tell the appropriate agency aboutFGM?
Any case of FGM in children < 18 years must be referred to the police and social services The mandatory duty to tell the appropriate agency will NOT apply to at risk of suspected cases over 18 years
34
Should FGM be reported in the notes?
Any case of FGM MUST be reported in the notes
35
What is lichen sclerosis?
Chronic skin condition characterised by the formation of itchy, pale patches on the genitals, perineal and perianal skin. It can, more rarely, affect other parts of the body like the axilla.
36
Where does lichen sclerosis usually affect?
genitals, perineal and perianal skin
37
Presentation of lichen sclerosis
itchy, pale patches that are usually asymptomatic If symptomatic: Itching Skin tightness (e.g. phimosis) Pain Dyspareunia
38
Investigations for lichen sclerosis
Primarily a clinical diagnosis Imaging & Other Biopsy Usually only considered if it fails to respond to a trial of treatment
39
When is biopsy considered in lichen sclerosis?
Usually only considered if it fails to respond to a trial of treatment
40
Management of lichen sclerosis
Encourage good skin care 1st Line: Strong Steroid Ointments (e.g. clobetasol propionate) 2nd Line: Topical Calcineurin Inhibitor
41
1st line management for lichen sclerosis
1st Line: Strong Steroid Ointments (e.g. clobetasol propionate) Followed by 2nd Line: Topical Calcineurin Inhibitor
42
Strong steroid ointment used 1st line in lichen sclerosis
cobetasol propionate
43
What is menopause?
The state that is reached once a woman has not had a period for 12 months and is not on any contraception.
44
Presentation of menopause
Hot flushes Mood swings Night sweats Sleep disturbance Weight gain
45
Conservative management of menopause
Stop smoking Reduce alcohol consumption Aim for a healthy BMI
46
Types of HRT
Oestrogen only Oestrogen with progesterone
47
Who can use oestrogen only HRT?
Only suitable for women who have had a hysterectomy
48
Why is progesterone added in combined HRT?
Progestogen is added to protect the endometrium from the action of oestrogen
49
What types of combined HRT is most appropriate for women who still have periods but are approaching menopause?
Cyclical. Types: Monthly: oestrogen every day of the month + progestogen for the last 14 days 3-Monthly: oestrogen every day for 3 months + progestogen for the last 14 days Withdrawal bleed is likely to occur when receiving the progestogen
50
Perimenopausal
women who still have periods but are approaching menopause
51
What type of combined HRT is most appropriate for women who have reached the menopause?
Continuous, progesterone can be administered as a levonorgestrel IUS
52
Benefits of HRT
Improved vasomotor symptoms Prevention of osteoporosis Improved genital tract symptoms (e.g. dryness)
53
Risks of HRT
Breast cancer Cardiovascular disease Venous thromboembolism
54
Contraindications for HRT
Pregnancy Breast Cancer Endometrial Cancer Uncontrolled Hypertension Current VTE Current Thrombophilia
55
ABSOLUTE CONTRAINDICATIONS FOR HRT
PREGNANCY, BREAST CANCER, ENDOMETRIAL CANCERN
56
Non-hormonal treatments for HRT
Alpha Agonists (e.g. clonidine) Beta-Blocker (e.g. propranolol) SSRIs (e.g. fluoxetine) Symptomatic Treatments (e.g. vaginal lubricants)
57
What is a nabothian cyst?
Cysts that form when the columnar glands within the transformation zone of the cervix become sealed over.
58
Presentation of nabothian cyst
Asymptomatic and usually noted incidentally on speculum examination
59
Management of nabothian cyst
Reassurance
60
What is urinary incontinence defined as?
involuntary loss of urine
61
Types of urinary incontinence
Urge Incontinence (also known as Overactive Bladder) Due to overactivity of the detrusor muscle Stress Incontinence Leaking during times of increased intra-abdominal pressure (e.g. coughing or laughing) due to weakness of the urethral sphincter Mixed Incontinence Combination of both urge and stress incontinence Overflow Incontinence Leakage of urine in the context of chronic bladder outflow obstruction
62
Urge incontinence AKA
overactive bladder
63
Urge incontinence
Overactivity of the detrusor muscle
64
Stress incontinence
Leaking during times of increased intra-abdominal pressure (e.g. coughing or laughing) due to weakness of the urethral sphincter
65
Mixed incontinence
Combination of both urge and stress incontinence
66
Overflow incontinence
Leakage of urine in the context of chronic bladder outflow obstruction
67
RFs for urge incontinence
Diabetes mellitus Medications (e.g. diuretics) Neurological disorders (e.g. Parkinson's disease, multiple sclerosis) Obesity Smoking Parity
68
RFs for stress incontinece
Age Instrumental delivery Obesity Previous pelvic surgery
69
Presentation of urge incontinence
Sudden need to go to the toilet
70
Presentation of stress incontinence
Leakage of urine when sneezing, coughing, laughing or lifting heavy objects
71
Investigations for urinary incontinence
Bedside Ask the patient to maintain bladder diaries Vaginal examination (exclude structural cause such as vaginal prolapse) Urine Dipstick and MSU Imaging & Other Urodynamic Testing
72
Why may vaginal examination be done for urinary incontinence?
exclude structural cause such as vaginal prolapseM
73
Management of urge incontinence
Conservative: Avoid caffeinated drinks, aim for 1.5-2.5 L fluid intake per day, lose weight 1st Line: Bladder Retraining for 6 weeks Aims to gradually increase the intervals between voiding 2nd Line: Bladder Stabilising Drugs Antimuscarinics: Oxybutynin, Tolterodine, Darifenacin WARNING: Caution should be exercised with antimuscarinics in frail elderly patients as it can worsen cognitive impairment 3rd Line: Mirabegron (beta-3 agonist) 4th Line: Surgical Procedures Botox Injection Percutaneous Tibial Nerve Stimulation (PTNS) or Sacral Nerve Stimulation (SNS)
74
PACES: conservative management advice for urge incontinence
Avoid caffeinated drinks, aim for 1.5-2.5 L fluid intake per day, lose weight
75
1st line management for urge incontinence
1st Line: Bladder Retraining for 6 weeks Aims to gradually increase the intervals between voiding Followed by: 2nd Line: Bladder Stabilising Drugs Antimuscarinics: Oxybutynin, Tolterodine, Darifenacin 3rd Line: Mirabegron (beta-3 agonist) 4th Line: Surgical Procedures Botox Injection Percutaneous Tibial Nerve Stimulation (PTNS) or Sacral Nerve Stimulation (SNS)
76
Why should caution be exercised with antimuscarinics in frail elderly patients?
can worsen cognitive impairment and cause falls usually 2nd line treatment after bladder retraining
77
Alternative to antimuscarinics if patient is old and frail with urge incontinence
Mirabegron (beta-3-agonist)
78
Beta 3 agonist
Mirabegron
79
Antimuscarinic
Oxybutynin, Tolterodine
80
Surgical procedures for urge incontinence
Botox Injection Percutaneous Tibial Nerve Stimulation (PTNS) or Sacral Nerve Stimulation (SNS)
81
Management of Stress incontinence
1st Line: Pelvic Floor Muscle Training Recommend at least 8 contractions performed 3 times per day for a minimum of 3 months Adjunct: Duloxetine Alternative: Pseudoephedrine 2nd Line: Surgical Procedures Retropubic Mid-Urethral Tape Procedures Bulking (injection into the urethral sphincter) Autologous Fascial Slings Burch Colposuspension
82
1st like management for stress incontinence
1st Line: Pelvic Floor Muscle Training Recommend at least 8 contractions performed 3 times per day for a minimum of 3 months Adjunct: Duloxetine Alternative: Pseudoephedrine
83
What is recommended for pelvic floor muscle training in stress incontinence?
8 contractions performed 3 times per day for a minimum of 3 months Duloxetine is given adjunct as 1st line treatment

Gynae (8 decks)

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