Other O&G Flashcards
When do you get pain from ovarian cysts?
Mid-cycle
What is Asherman syndrome?
Intrauterine adhesions, most commonly forming after intrauterine surgery
Rare
Which strains of HPV cause 95% of genital warts?
6 and 11
What is a grade 1 prolapse?
Organ is > 1cm above the hymen (halfway descent to the hymen)
What is a grade 2 prolapse?
Organ is <1 cm to the hymen
What is a grade 3 prolapse?
Organ is > 1cm below the hymen but does not protrude out more than 2cm less the vaginal length
What is a grade 4 prolapse?
The vagina is completely everted
What are 3 clinical features of Sheehan syndrome?
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
Urethral hypermobility and an intrinsic sphincter deficiency cause which type of incontinence?
Stress
Neurological conditions such as Parkinson disease are most likely to cause which type of incontinence?
Urge
Due to sensory and/or motor dysfunction
Pelvic floor exercises, lifestyle changes and pessaries are used to treat which type of incontinence?
Stress
Anticholinergics are used to treat which type of incontinence?
Urge
→ block parasympathetic → decreased detrusor overactivity → reduced voiding
What is overflow incontinence?
Urinary retention and bladder distension caused by outlet obstruction (e.g., prostatic enlargement) or detrusor underactivity
UTIs, bladder cancer and renal stones are likely to cause which type of incontinence?
Urge
Local irritation → detrusor instability
What is functional incontinence?
Urine loss associated with difficulty reaching a toilet when needed i.e. impaired physical or cognitive functioning
Why might alpha blockers aggravate patients with stress incontience?
Decreased sphincter tone
What is the difference between detrusor instability/overactive bladder and urge incontinence?
People with overactive bladder are not necessarily incontinence but have urgency
Name 2 anticholinergics which can be used for urinary incontinence
- Oxybutynin
- Tolterodine
- Solifenacin
- Darifenacin
What are 3 side effects of anticholinergics?
- Dry eyes
- Dry mouth
- Constipation
Name 2 drugs other than anticholinergics that can be used for urinary incontinence
- Duloxetine (SNRI)
- Imipramine (TCA)
- Mirabegron (beta 3 adrenergic agonist)
What is the first-line surgical procedure for stress incontinence?
Midurethral sling
Reduces bladder neck hypermobility
What are two procedures that can be performed for urge incontinence?
- Botulinium toxin
- Sacral nerve stimulation
What are 4 lifestyle interventions for incontinence?
- Pelvic floor exercises
- Reduce caffeine intake
- Smoking cessation
- Bladder training (urge)
- Weight loss (stress)
Rank the prevalence of stress, urge and mixed incontinence
- Stress
- Mixed
- Urge
What is detrusor sphincter dyssnergia?
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
- Irregular, small volume incontinence with urinary retention
- No associated urge to void
- Spinal cord injury/MS
is characteristic of which type of incontinence?
Detrusor sphincter dyssynergia
Detrusor contraction with internal urethral sphincter activation
What are the two main mechanisms of stress incontinence?
- Urethral hypermobility
- Intrinsic sphincter deficiency
Why does urethral hypermobility cause incontinence?
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
Why is decreased oestrogen a risk factor for incontinence?
→ atrophy of the superficial and intermediate layers of the urethral mucosal epithelium → atrophic urethritis, diminished urethral mucosal seal, loss of compliance, irritation
- Dribbling of urine in the absence of urge
- Incomplete bladder emptying
is characteristic of which type of incontinence?
Overflow
What are the two causes of overflow incontinence?
- Detrusor underactivity
- Bladder outlet obstruction
Which receptor is targeted in anticholinergics for incontinence?
M3
What is the first line treatment for lichen sclerosis?
Topical corticosteroids
How do corpus luteum cysts form?
- Failure of involution of the corpus luteum (by day 28)
- Surrounding blood vessels bleed into the corpus luteum
- The corpus luteum continues to produce progesterone, which may delay menses
Which type of ovarian cyst is haemorrhagic?
Corpus luteum
How do theca lutein cysts form?
Excessive hCG stimulation
What are some of the causes of theca lutein cysts?
Gestational trophoblastic disease
Multiple gestation
Diabetes mellitus
PCOS
How do follicular cysts form?
Failure of the follicle to rupture at day 14 of the menstrual cycle
What is a cervical ectopion?
May cause PV bleeding due to exposure of the fragile columnar epithelium to the acidic environment of the vagina
What are fibroids?
Benign tumours of the myometrium.
What is the histological appearance of fibroids?
Spiralled bundles of smooth muscle
What are the risk factors for developing fibroids?
African-Caribbean
Increasing age
Nulligravidity
Obesity
What are the medical therapies used as adjuncts to surgery in the management of fibroids?
GnRH analogues
NSAIDs
Tranexamic acid
Androgenic agonists e.g., danazol (suppress fibroid growth)
What is the difference between small for gestational age and intrauterine growth restriction?
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
What are the causes of symmetrical IUGR?
Chromosomal abnormalities
Fetal alcohol syndrome
Intrauterine infections
What are the 5 stages of twin-twin transfusion syndrome?
I - Oligohydraminos and polyhydramnios
- Donor bladder is not visualised
- Abnormal Doppler indices
- One or both fetuses show signs of hydrops
- One or both fetuses have died
How is Chlamydia treated?
Doxycycline or azithromycin
How is gonorrhoea treated?
Ceftriaxone
PLUS
Azithromycin
How is bacterial vaginosis diagnosed?
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
How is bacterial vaginitis treated?
Oral metronidazole
What pathogen causes bacterial vaginitis?
Overgrowth of Gardnerella vaginalis
What is the primary risk factor for bacterial vaginitis?
Sexual intercourse (but not an STD)
Curd-like vaginal discharge is characteristic of which disease?
Vulvovaginal candidiasis
Malodourous, fish-smelling vaginal discharge is characteristic of which infection?
Bacterial vaginosis (Gardnerella vaginalis)
Purulent, malodorous discharge, which may be accompanied by burning, pruritus, dysuria, frequency, and/or dyspareunia is characteristic of which condition?
Trichomoniasis
What are the steps in performing a pelvic exam?
- Light lower abdominal palpation
- Speculum and CST
- Bi manual
- Pelvic floor test
Optional
- High vaginal swab
- Endocarvical smear
- Breast examination
Prior to a speculum examination, why is a light abdominal palpation performed?
‘ice breaker’ for the patient
Scars, masses, tenderness
Raised lymph nodes (infection or malignancy)
When is terbutaline used in O&G?
Tocolysis
How is lichen sclerosus treated?
Topical corticosteroids
Which conditions are associated with lichen sclerosis?
Autoimmune
e.g., thyroid, pernicious anaemia, alopecia, DM, vitiligo
What genitalia (external and internal) is present in people with androgen insensitivity syndrome?
External: female
Internal: male
Karotype: 46 XY
What type of ovarian cyst is classically bilateral?
Theca lutein
Due to excessive hCG stimulation - GTD, multiple gestation, DM, PCOS
How is trichominiasis treated?
Metronidazole
What cause(s) of vulvovaginitis are sexually transmitted?
Trichomoniasis
Not candidasis or bacterial vaginosis
What does a strawberry cervix suggest?
Trichomoniasis
Petechiae on the vagina and cervix
What should be avoided with metronidazole therapy?
Alcohol consuption
What is condylomata lata?
Broad-based, wart-like papular erosions in secondary syphilis
Where do you swab when testing for chlamydia/gonorrhoea?
Cervix
What are 3 complications of chlamydia?
- PID
- Ectopic pregnancy
- Fitz-High-Curtis syndrome
- Reactive arthritis
- Chronic pelvic pain
- Perinatal infection (conjunctivitis, pneumonia)
What are 2 complications of congenital chlamydia?
- Conjunctivitis
- Pneumonia
How can HPV warts be treated?
Podopyllotoxin cream
Imiquimod cream
Cryotherapy
Excision
What are the potential complications of syphilis?
Gumma: destructive granulomatous lesions with a necrotic centre (can affect any organ)
Cardio: aortic aneurysm, dilated aortic root
Neurosyphilus: tabes dorsalis, general paresis
What organisms cause bartholin gland abscesses?
Anaerobes + polymicrobial
E. coli, Staphylococcus, Streptococcus, N. gonorrhoea, C. trachomatis
What is toxic shock syndrome?
Multi-organ failure to due S. aureus exotoxin
What is an endometrioma?
Ovarian cyst secondary to endometriosis
What are some of the complications of lichen sclerosis?
Secondary infection
Increased risk of STI due to open excoriations and fissures
Increased SCC risk
Labial fusion
How is a diagnosis of lichen sclerosis confirmed?
Punch biopsy
Which drugs are associated with hyperprolactinemia?
1st generation antipsychotics
Risperidone
Metoclopramide/domperidone
Methyldopa
In which populations is ectropion most common?
Adolescents
Pregnant women
COCP
What microbiological testing is done for PID?
Endocervical (+/- high vaginal) swab
- Chlamydia trachomatitis*
- Neisseria gonorrhoea*
- Mycoplasma genitalium*
What are the risks of lichen sclerosis?
5% risk of SCC over 20 years
Secondary infections
Labial fusion
Increased STI risk due to open excoriations and fissures
What are the risks of oestrogen-only HRT?
Endometrial cancer
What are the risks of combined HRT?
Breast cancer
- But oestrogen only increases risk of endometrial cancer*
- Use over oestrogen-only HRT in any woman with an intact uterus*
What AFP, hCG and PAPP-A results are found in Down syndrome?
AFP - low
hCG - high
PAPP-A - low
Which antifungal drug is contraindicated in pregnancy?
Fluconazole
