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Gynae > Other Important Topics > Flashcards

Other Important Topics Flashcards

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
Q

Type 1 FGM

A

Type 1: Clitoridectomy (partial or total removal of the clitoris)

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26
Q

Type 2 FGM

A

Type 2: Excision (partial or total removal of the clitoris and the labia minora with or without excision of the labia majora)

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27
Q

Type 3 FGM

A

Type 3: Infibulation (narrowing of the vaginal orifice with creation of a covering seal)

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28
Q

Type 4 FGM

A

Type 4: Unclassified (all other harmful procedures to the female genitalia for non-medical purposes)

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29
Q

Complications of FGM

A

Infection and abscess formation
Urethral injury
Recurrent UTI
Dysmenorrhoea
Sexual dysfunction
Psychological trauma
Obstetric complications

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30
Q

Management of FGM

A

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

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31
Q

What is the surgical procedure that can be performed for FGM?

A

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

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32
Q

ETHICAL RULES FOR FGM

A

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

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33
Q

When is it mandatory to tell the appropriate agency aboutFGM?

A

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

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34
Q

Should FGM be reported in the notes?

A

Any case of FGM MUST be reported in the notes

35
Q

What is lichen sclerosis?

A

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
Q

Where does lichen sclerosis usually affect?

A

genitals, perineal and perianal skin

37
Q

Presentation of lichen sclerosis

A

itchy, pale patches that are usually asymptomatic

If symptomatic:
Itching
Skin tightness (e.g. phimosis)
Pain
Dyspareunia

38
Q

Investigations for lichen sclerosis

A

Primarily a clinical diagnosis

Imaging & Other
Biopsy
Usually only considered if it fails to respond to a trial of treatment

39
Q

When is biopsy considered in lichen sclerosis?

A

Usually only considered if it fails to respond to a trial of treatment

40
Q

Management of lichen sclerosis

A

Encourage good skin care
1st Line: Strong Steroid Ointments (e.g. clobetasol propionate)
2nd Line: Topical Calcineurin Inhibitor

41
Q

1st line management for lichen sclerosis

A

1st Line: Strong Steroid Ointments (e.g. clobetasol propionate)

Followed by
2nd Line: Topical Calcineurin Inhibitor

42
Q

Strong steroid ointment used 1st line in lichen sclerosis

A

cobetasol propionate

43
Q

What is menopause?

A

The state that is reached once a woman has not had a period for 12 months and is not on any contraception.

44
Q

Presentation of menopause

A

Hot flushes
Mood swings
Night sweats
Sleep disturbance
Weight gain

45
Q

Conservative management of menopause

A

Stop smoking
Reduce alcohol consumption
Aim for a healthy BMI

46
Q

Types of HRT

A

Oestrogen only
Oestrogen with progesterone

47
Q

Who can use oestrogen only HRT?

A

Only suitable for women who have had a hysterectomy

48
Q

Why is progesterone added in combined HRT?

A

Progestogen is added to protect the endometrium from the action of oestrogen

49
Q

What types of combined HRT is most appropriate for women who still have periods but are approaching menopause?

A

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
Q

Perimenopausal

A

women who still have periods but are approaching menopause

51
Q

What type of combined HRT is most appropriate for women who have reached the menopause?

A

Continuous, progesterone can be administered as a levonorgestrel IUS

52
Q

Benefits of HRT

A

Improved vasomotor symptoms
Prevention of osteoporosis
Improved genital tract symptoms (e.g. dryness)

53
Q

Risks of HRT

A

Breast cancer
Cardiovascular disease
Venous thromboembolism

54
Q

Contraindications for HRT

A

Pregnancy
Breast Cancer
Endometrial Cancer
Uncontrolled Hypertension
Current VTE
Current Thrombophilia

55
Q

ABSOLUTE CONTRAINDICATIONS FOR HRT

A

PREGNANCY, BREAST CANCER, ENDOMETRIAL CANCERN

56
Q

Non-hormonal treatments for HRT

A

Alpha Agonists (e.g. clonidine)
Beta-Blocker (e.g. propranolol)
SSRIs (e.g. fluoxetine)
Symptomatic Treatments (e.g. vaginal lubricants)

57
Q

What is a nabothian cyst?

A

Cysts that form when the columnar glands within the transformation zone of the cervix become sealed over.

58
Q

Presentation of nabothian cyst

A

Asymptomatic and usually noted incidentally on speculum examination

59
Q

Management of nabothian cyst

A

Reassurance

60
Q

What is urinary incontinence defined as?

A

involuntary loss of urine

61
Q

Types of urinary incontinence

A

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
Q

Urge incontinence AKA

A

overactive bladder

63
Q

Urge incontinence

A

Overactivity of the detrusor muscle

64
Q

Stress incontinence

A

Leaking during times of increased intra-abdominal pressure (e.g. coughing or laughing) due to weakness of the urethral sphincter

65
Q

Mixed incontinence

A

Combination of both urge and stress incontinence

66
Q

Overflow incontinence

A

Leakage of urine in the context of chronic bladder outflow obstruction

67
Q

RFs for urge incontinence

A

Diabetes mellitus
Medications (e.g. diuretics)
Neurological disorders (e.g. Parkinson’s disease, multiple sclerosis)
Obesity
Smoking
Parity

68
Q

RFs for stress incontinece

A

Age
Instrumental delivery
Obesity
Previous pelvic surgery

69
Q

Presentation of urge incontinence

A

Sudden need to go to the toilet

70
Q

Presentation of stress incontinence

A

Leakage of urine when sneezing, coughing, laughing or lifting heavy objects

71
Q

Investigations for urinary incontinence

A

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
Q

Why may vaginal examination be done for urinary incontinence?

A

exclude structural cause such as vaginal prolapseM

73
Q

Management of urge incontinence

A

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
Q

PACES: conservative management advice for urge incontinence

A

Avoid caffeinated drinks, aim for 1.5-2.5 L fluid intake per day, lose weight

75
Q

1st line management for urge incontinence

A

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
Q

Why should caution be exercised with antimuscarinics in frail elderly patients?

A

can worsen cognitive impairment and cause falls

usually 2nd line treatment after bladder retraining

77
Q

Alternative to antimuscarinics if patient is old and frail with urge incontinence

A

Mirabegron (beta-3-agonist)

78
Q

Beta 3 agonist

A

Mirabegron

79
Q

Antimuscarinic

A

Oxybutynin, Tolterodine

80
Q

Surgical procedures for urge incontinence

A

Botox Injection
Percutaneous Tibial Nerve Stimulation (PTNS) or Sacral Nerve Stimulation (SNS)

81
Q

Management of Stress incontinence

A

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
Q

1st like management for stress incontinence

A

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
Q

What is recommended for pelvic floor muscle training in stress incontinence?

A

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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