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Other O&G Flashcards

1
Q

When do you get pain from ovarian cysts?

A

Mid-cycle

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2
Q

What is Asherman syndrome?

A

Intrauterine adhesions, most commonly forming after intrauterine surgery

Rare

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3
Q

Which strains of HPV cause 95% of genital warts?

A

6 and 11

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4
Q

What is a grade 1 prolapse?

A

Organ is > 1cm above the hymen (halfway descent to the hymen)

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5
Q

What is a grade 2 prolapse?

A

Organ is <1 cm to the hymen

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6
Q

What is a grade 3 prolapse?

A

Organ is > 1cm below the hymen but does not protrude out more than 2cm less the vaginal length

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7
Q

What is a grade 4 prolapse?

A

The vagina is completely everted

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8
Q

What are 3 clinical features of Sheehan syndrome?

A

Low prolactin → failure of lactation

Low LH → amenorrhoea

Low ACTH → low androgens → loss of pubic and axillary hair

Low ACTH → low cortisol → adrenal insufficiency → vomiting, hypotension, hypoglycaemia

Low FSH → hypothyroidism

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9
Q

Urethral hypermobility and an intrinsic sphincter deficiency cause which type of incontinence?

A

Stress

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10
Q

Neurological conditions such as Parkinson disease are most likely to cause which type of incontinence?

A

Urge

Due to sensory and/or motor dysfunction

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11
Q

Pelvic floor exercises, lifestyle changes and pessaries are used to treat which type of incontinence?

A

Stress

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12
Q

Anticholinergics are used to treat which type of incontinence?

A

Urge

→ block parasympathetic → decreased detrusor overactivity → reduced voiding

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13
Q

What is overflow incontinence?

A

Urinary retention and bladder distension caused by outlet obstruction (e.g., prostatic enlargement) or detrusor underactivity

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14
Q

UTIs, bladder cancer and renal stones are likely to cause which type of incontinence?

A

Urge

Local irritation → detrusor instability

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15
Q

What is functional incontinence?

A

Urine loss associated with difficulty reaching a toilet when needed i.e. impaired physical or cognitive functioning

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16
Q

Why might alpha blockers aggravate patients with stress incontience?

A

Decreased sphincter tone

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17
Q

What is the difference between detrusor instability/overactive bladder and urge incontinence?

A

People with overactive bladder are not necessarily incontinence but have urgency

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18
Q

Name 2 anticholinergics which can be used for urinary incontinence

A
  1. Oxybutynin
  2. Tolterodine
  3. Solifenacin
  4. Darifenacin
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19
Q

What are 3 side effects of anticholinergics?

A
  1. Dry eyes
  2. Dry mouth
  3. Constipation
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20
Q

Name 2 drugs other than anticholinergics that can be used for urinary incontinence

A
  1. Duloxetine (SNRI)
  2. Imipramine (TCA)
  3. Mirabegron (beta 3 adrenergic agonist)
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21
Q

What is the first-line surgical procedure for stress incontinence?

A

Midurethral sling

Reduces bladder neck hypermobility

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22
Q

What are two procedures that can be performed for urge incontinence?

A
  1. Botulinium toxin
  2. Sacral nerve stimulation
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23
Q

What are 4 lifestyle interventions for incontinence?

A
  1. Pelvic floor exercises
  2. Reduce caffeine intake
  3. Smoking cessation
  4. Bladder training (urge)
  5. Weight loss (stress)
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24
Q

Rank the prevalence of stress, urge and mixed incontinence

A
  1. Stress
  2. Mixed
  3. Urge
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25
Q

What is detrusor sphincter dyssnergia?

A

Simultaneous contractions of the detrusor muscle and involuntary activation of the internal urethral sphincter → blockage of bladder outlet → small amounts of urine are pressed through the contracted sphincter muscle

Seen in MS or spinal cord injury

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26
Q
  • Irregular, small volume incontinence with urinary retention
  • No associated urge to void
  • Spinal cord injury/MS

is characteristic of which type of incontinence?

A

Detrusor sphincter dyssynergia

Detrusor contraction with internal urethral sphincter activation

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27
Q

What are the two main mechanisms of stress incontinence?

A
  1. Urethral hypermobility
  2. Intrinsic sphincter deficiency
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28
Q

Why does urethral hypermobility cause incontinence?

A

Weak pelvic floor → insufficient support for the urethra and bladder neck → hypermobility

Weak pelvic floor → increases in intra-abdominal pressure cannot be transmitted to the urethra, causing closure

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29
Q

Why is decreased oestrogen a risk factor for incontinence?

A

→ atrophy of the superficial and intermediate layers of the urethral mucosal epithelium → atrophic urethritis, diminished urethral mucosal seal, loss of compliance, irritation

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30
Q
  • Dribbling of urine in the absence of urge
  • Incomplete bladder emptying

is characteristic of which type of incontinence?

A

Overflow

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31
Q

What are the two causes of overflow incontinence?

A
  1. Detrusor underactivity
  2. Bladder outlet obstruction
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32
Q

Which receptor is targeted in anticholinergics for incontinence?

A

M3

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33
Q

What is the first line treatment for lichen sclerosis?

A

Topical corticosteroids

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34
Q

How do corpus luteum cysts form?

A
  1. Failure of involution of the corpus luteum (by day 28)
  2. Surrounding blood vessels bleed into the corpus luteum
  3. The corpus luteum continues to produce progesterone, which may delay menses
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35
Q

Which type of ovarian cyst is haemorrhagic?

A

Corpus luteum

36
Q

How do theca lutein cysts form?

A

Excessive hCG stimulation

37
Q

What are some of the causes of theca lutein cysts?

A

Gestational trophoblastic disease

Multiple gestation

Diabetes mellitus

PCOS

38
Q

How do follicular cysts form?

A

Failure of the follicle to rupture at day 14 of the menstrual cycle

39
Q

What is a cervical ectopion?

A

May cause PV bleeding due to exposure of the fragile columnar epithelium to the acidic environment of the vagina

40
Q

What are fibroids?

A

Benign tumours of the myometrium.

41
Q

What is the histological appearance of fibroids?

A

Spiralled bundles of smooth muscle

42
Q

What are the risk factors for developing fibroids?

A

African-Caribbean

Increasing age

Nulligravidity

Obesity

43
Q

What are the medical therapies used as adjuncts to surgery in the management of fibroids?

A

GnRH analogues

NSAIDs

Tranexamic acid

Androgenic agonists e.g., danazol (suppress fibroid growth)

44
Q

What is the difference between small for gestational age and intrauterine growth restriction?

A

SGA: fetus is small for expected size at certain gestation, but continues to grow at a normal rate

IUGR: fetus is small or normal sized for expected size at a certain gestation, but the growth rate slows down as the pregnancy advances

45
Q

What are the causes of symmetrical IUGR?

A

Chromosomal abnormalities

Fetal alcohol syndrome

Intrauterine infections

46
Q

What are the 5 stages of twin-twin transfusion syndrome?

A

I - Oligohydraminos and polyhydramnios

  1. Donor bladder is not visualised
  2. Abnormal Doppler indices
  3. One or both fetuses show signs of hydrops
  4. One or both fetuses have died
47
Q

How is Chlamydia treated?

A

Doxycycline or azithromycin

48
Q

How is gonorrhoea treated?

A

Ceftriaxone

PLUS

Azithromycin

49
Q

How is bacterial vaginosis diagnosed?

A

Amsel’s criteria: 3/4 of the following on vaginal discharge sample

Whiff test - 1-2 drops of 10% KOH intensifies fishy odour

Vaginal pH > 4.5

No leukocytes on microscopy

Clue cells: vaginal epithelial cells covered with bacterial identified on wet mount preparation

50
Q

How is bacterial vaginitis treated?

A

Oral metronidazole

51
Q

What pathogen causes bacterial vaginitis?

A

Overgrowth of Gardnerella vaginalis

52
Q

What is the primary risk factor for bacterial vaginitis?

A

Sexual intercourse (but not an STD)

53
Q

Curd-like vaginal discharge is characteristic of which disease?

A

Vulvovaginal candidiasis

54
Q

Malodourous, fish-smelling vaginal discharge is characteristic of which infection?

A

Bacterial vaginosis (Gardnerella vaginalis)

55
Q

Purulent, malodorous discharge, which may be accompanied by burning, pruritus, dysuria, frequency, and/or dyspareunia is characteristic of which condition?

A

Trichomoniasis

56
Q

What are the steps in performing a pelvic exam?

A
  1. Light lower abdominal palpation
  2. Speculum and CST
  3. Bi manual
  4. Pelvic floor test

Optional

  • High vaginal swab
  • Endocarvical smear
  • Breast examination
57
Q

Prior to a speculum examination, why is a light abdominal palpation performed?

A

‘ice breaker’ for the patient

Scars, masses, tenderness

Raised lymph nodes (infection or malignancy)

58
Q

When is terbutaline used in O&G?

A

Tocolysis

59
Q

How is lichen sclerosus treated?

A

Topical corticosteroids

60
Q

Which conditions are associated with lichen sclerosis?

A

Autoimmune

e.g., thyroid, pernicious anaemia, alopecia, DM, vitiligo

61
Q

What genitalia (external and internal) is present in people with androgen insensitivity syndrome?

A

External: female

Internal: male

Karotype: 46 XY

62
Q

What type of ovarian cyst is classically bilateral?

A

Theca lutein

Due to excessive hCG stimulation - GTD, multiple gestation, DM, PCOS

63
Q

How is trichominiasis treated?

A

Metronidazole

64
Q

What cause(s) of vulvovaginitis are sexually transmitted?

A

Trichomoniasis

Not candidasis or bacterial vaginosis

65
Q

What does a strawberry cervix suggest?

A

Trichomoniasis

Petechiae on the vagina and cervix

66
Q

What should be avoided with metronidazole therapy?

A

Alcohol consuption

67
Q

What is condylomata lata?

A

Broad-based, wart-like papular erosions in secondary syphilis

68
Q

Where do you swab when testing for chlamydia/gonorrhoea?

A

Cervix

69
Q

What are 3 complications of chlamydia?

A
  1. PID
  2. Ectopic pregnancy
  3. Fitz-High-Curtis syndrome
  4. Reactive arthritis
  5. Chronic pelvic pain
  6. Perinatal infection (conjunctivitis, pneumonia)
70
Q

What are 2 complications of congenital chlamydia?

A
  1. Conjunctivitis
  2. Pneumonia
71
Q

How can HPV warts be treated?

A

Podopyllotoxin cream

Imiquimod cream

Cryotherapy

Excision

72
Q

What are the potential complications of syphilis?

A

Gumma: destructive granulomatous lesions with a necrotic centre (can affect any organ)

Cardio: aortic aneurysm, dilated aortic root

Neurosyphilus: tabes dorsalis, general paresis

73
Q

What organisms cause bartholin gland abscesses?

A

Anaerobes + polymicrobial

E. coli, Staphylococcus, Streptococcus, N. gonorrhoea, C. trachomatis

74
Q

What is toxic shock syndrome?

A

Multi-organ failure to due S. aureus exotoxin

75
Q

What is an endometrioma?

A

Ovarian cyst secondary to endometriosis

76
Q

What are some of the complications of lichen sclerosis?

A

Secondary infection

Increased risk of STI due to open excoriations and fissures

Increased SCC risk

Labial fusion

77
Q

How is a diagnosis of lichen sclerosis confirmed?

A

Punch biopsy

78
Q

Which drugs are associated with hyperprolactinemia?

A

1st generation antipsychotics

Risperidone

Metoclopramide/domperidone

Methyldopa

79
Q

In which populations is ectropion most common?

A

Adolescents

Pregnant women

COCP

80
Q

What microbiological testing is done for PID?

A

Endocervical (+/- high vaginal) swab

  • Chlamydia trachomatitis*
  • Neisseria gonorrhoea*
  • Mycoplasma genitalium*
81
Q

What are the risks of lichen sclerosis?

A

5% risk of SCC over 20 years

Secondary infections

Labial fusion

Increased STI risk due to open excoriations and fissures

82
Q

What are the risks of oestrogen-only HRT?

A

Endometrial cancer

83
Q

What are the risks of combined HRT?

A

Breast cancer

  • But oestrogen only increases risk of endometrial cancer*
  • Use over oestrogen-only HRT in any woman with an intact uterus*
84
Q

What AFP, hCG and PAPP-A results are found in Down syndrome?

A

AFP - low

hCG - high

PAPP-A - low

85
Q

Which antifungal drug is contraindicated in pregnancy?

A

Fluconazole

O&G (13 decks)

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