Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Obstetrics and Gynaecology > Reproductive and Benign Gynaecology > Flashcards

Reproductive and Benign Gynaecology Flashcards

1
Q

What are ovarian cysts?

A

Fluid filled sacs

Can be functional based on fluctuating hormones in premenopausal, concerning for malignancy if in postmenopausal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is the presentation of ovarian cysts?

A 
Usually asymptomatic, found incidentally on USS
Pelvic pain
Bloating
Fullness in the abdomen
Palpable pelvic mass if very large cysts
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

When might ovarian cysts present with acute pain?

A

Ovarian torsion, haemorrhage, rupture of cyst

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are functional ovarian cysts?

A

Follicular cysts due to the developing follicle

Most common type of cyst that are harmless and disappear after a few cycles

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are corpus luteum cysts?

A

Occurs when the corpus luteum fails to break down and instead fills with fluid, may cause pelvic discomfort, pain or delayed menstruation. Common in early pregnancy.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is a serous cystadenoma?

A

Tumours of the epithelial cells in the ovary

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are mucinous cystadenomas?

A

Tumours of the epithelial cells, can become very large and take up lots of space in the abdomen.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are endometriomas?

A

Lumps of endometrial tissue within the ovary, occurs in patients with endometriosis, can cause pain, disrupt ovulation.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are dermoid cysts?

A

Teratomas, benign ovarian tumours
Come from germ cells, so may contain different tissue types like skin, teeth hair and bone.
Associated with ovarian torsion.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are sex cord stromal tumours?

A

Rare, either benign or malignant

Come from stroma or sex cords

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is important in the assessment of an ovarian cyst?

A

Examine for bloating, reduced appetite, early satiety
Weight loss
Urinary symptoms, pain, ascites, lymphadenopathy

Assess for risk factors of ovarian malignancy
Age, postmenopause, increased number of ovulations
Obesity, HRT, smoking, breastfeeding (protective) FH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What factors will reduce the number of ovulations?

A

Later onset of menarche
Early menopause
Any pregnancies
Use of the combined oral contraceptive pill

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What investigations are needed for ovarian cysts?

A

If premenoapusal with simple ovarian cyst less than 5cm on USS, do not need further investigations.

CA125 tumour marker for ovarian cancer.

Other tumour markers if complex ovarian mass -
lactate dehydrogenase, alpha fetoprotein, human chorionic gonadotropin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are causes of a raised CA125?

A

Not very specific, tumour marker for epithelial cell ovarian cancer

endometriosis
fibroids
adenomyosis
pelvic infection
liver disease
pregnancy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is the risk of malignancy index?

A

Estimates risk of an ovarian mass being malignant

Menopausal status
Ultrasound findings
CA125 level

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is the management of ovarian cysts?

A

Possible ovarian cancer; complex cysts or raised CA125 requires 2WW referral.

Dermoid cyst - further investigation, consider surgery.

Simple cysts in premenopausal women
Less than 5cm should resolve within 3 cycles, follow up if not
5cm to 7cm routine referral and yearly ultrasounds
More than 7cm consider MRI or surgical evaluation

Simple cysts in postmenopausal women and normal CA125 monitored with USS every 4-6 months.

Persisting or enlarging cysts need surgery; laparoscopy, ovarian cystectomy, possible oophrectomy.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What are the complications of ovarian cysts?

A

Present with acute onset of pain
Torsion
Haemorrhage into the cyst
Rupture with bleeding into the peritoneum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is Meig’s syndrome?

A

A triad of
ovarian fibroma - a benign ovarian tumour
pleural effusion
ascites

Typically occurs in older women
removal of the tumour results in complete resolution of effusion and ascites

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is ovarian torsion?

A

Where the ovary twits in relation to surrounding connective tissue, fallopian tube and blood supply (the adnexa)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What are the causes of ovarian torsion?

A

Usually due to ovarian mass larger than 5cm such as a cyst or tumour, more likely with benign tumours.

Can happen in normal ovaries in younger girls before menarche when they have longer infundibulopelvic ligaments.

Twisting leads to ischaemia, if persists can lead to necrosis and function of ovary lost, is an emergency.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is the presentation of ovarian torsion?

A

Sudden onset severe unilateral pelvic pain
Pain is constant, gets progressively worse,
Nausea and vomiting

Pain not always severe, can be milder and last longer and can twist intermittently causing pain that comes and goes.

Localised tenderness on palpation, palpable mass in pelvis, but absence does not exclude diagnosis.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

How can ovarian torsion be diagnosed?

A

Pelvic ultrasound, TV ideal, can do TA
Whirlpool sign - free fluid in the pelvic, oedema if the ovary

Doppler may shock lack of blood flow

Definitive diagnosis made with laparoscopic surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What is the management of ovarian torsion?

A

Emergency admission

Laparoscopic surgery to untwist and fix in place, or remove affected ovary by oophrectomy.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What are the complications of ovarian torsion?

A

Loss of function of that ovary
If the only ovary can lead to infertility and menopause
Necrotic ovary not removed - infection, abscess, sepsis
May rupture, causing peritonitis and adhesions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What is Asherman’s syndrome?

A

Where adhesions form within the uterus
Usually after pregnancy related dilatation and curettage after RPOC
Can also occur after uterine surgery or pelvic infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What is the presentation of asherman’s syndrome?

A

Secondary amenorrhoea
Significantly lighter periods
Dysmenorrhoea
May also present with infertility

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

How can asherman’s be diagnosed?

A

Hysteroscopy - and allows for dissection and treatment of adhesions
Hysterosalpingography - contrast and x-rays
Sonohysterography - uterus filled with fluid and ultrasound performed
MRI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What is the management for asherman’s?

A

Dissecting the adhesions during hysteroscopy

Recurrence common

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What is cervical ectropion?

A

Occurs when the columnar epithelium of the endocervix extends to the ectocervix, is visible on speculum
More fragile, prone to bleeding - PCB

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What is cervical ectropion associated with?

A

Higher levels of oestrogen

More common in younger women, COCP, pregnancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

What is the transformation zone of the cervix?

A

Border between the columnar epithelium of the endocervix and the stratified squamous of the ectocervix

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

What is the presentation of cervical ectropion?

A

Asymptomatic found on speculum examination.
Increased vaginal discharge
Vaginal bleeding, dyspareunia
Intercourse causes minor trauma and PCB

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

What is the management of cervical ectropion?

A

Typically resolves as patient gets older, stops pill or no longer pregnant.
Problematic bleeding may need treatment - cauterisation using silver nitrate or cold coagulation during colposcopy.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

What are nabothian cysts?

A

Fluid filled cysts often seen on the surface of the cervix
Columnar epithelium of the endocervix produces cervical mucus, if squamous epithelium slightly covers it the mucus is trapped.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

What can cause nabothian cysts?

A

Childbirth, minor trauma, cervicitis.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

What is the presentation of nebothian cysts?

A

Raised, discoloured appearance on cervix
Usually asymptomatic, may cause feeling of fullness
Usually near to the os, whitish or yellow

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

What is uterine prolapse?

A

The uterus itself descends into the vagina

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

What is vault prolapse?

A

After a hysterectomy, the top of the vagina descends

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

What is a rectocele?

A

Defect in posterior vaginal wall, allows rectum to prolapse into the vagina
Causes constipation and faecal loading
Urinary retention due to compression on urethra
Palpable lump in vagina

Pressing on lump corrects anatomical position of rectum and allows bowels to open

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

What is a cystocele?

A

Defect in anterior wall of vagina

Bladder can prolapse backwards into vagina

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

What is a urethrocele?

A

Prolapse of the urethra into the vagina

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

What is a cystourethrocele?

A

Prolapse of both the bladder and the urethra

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

What are risk factors for pelvic organ prolapse?

A

Weak and stretched muscles and ligaments
Multiple vaginal delivers
Instrumental, prolonged or traumatic delivery
Advanced age and postmenopause
Obesity
Chronic respiratory disease causing coughing
Chronic constipation causing straining

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

What is the presentation of pelvic organ prolapse?

A

Feeling of something coming down
Dragging or heavy sensation in the pelvis
Urinary symptoms e.g. incontinence, urgency, frequency, weak stream and retention
Bowel symptoms e.g. constipation, incontinence, urgency
Sexual dysfunction e.g. pain, altered sensation, less enjoyment

May have lump they can push back themselves
Worse on straining or bearing down

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

How is a patient examined for pelvic organ prolapse?

A

Empty bladder and bowels, dorsal and left lateral position for examination
Sim’s speculum, to support anterior and posterior walls
Cough and bear down to assess descent

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

What are the grades of uterine prolapse?

A

Pelvic organ prolapse quantification POP-Q

Grade 0 normal
Grade 1 lowest part more than 1cm above introitus (opening of vagina)
Grade 2 within 1cm of introitus
Grade 3 lowest part more than 1cm below
Grade 4 full descent, eversion of the vagina

Prolapse beyond the introitus is uterine procidentia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

What management is available for prolapse?

A

Conservative
Vaginal pessary
Surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

What conservative management is available for prolapse?

A

Physiotherapy and pelvic floor exercises
Weight loss
Lifestyle changes e.g. for associated stress incontinence - less caffeine, incontinence pads
Treatment of related symptoms e.g. anticholinergics for incontinence
Vaginal oestrogen cream

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

What pessaries are available for prolapse?

A

Inserted into the vagina for extra support, but can be easily removed
Ring pessaries sit around the cervix, hold uterus up
Cube, donut, hodge/rectangular

Can cause vaginal irritation and erosion, oestrogen cream helps protect against this

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

What surgery is available for prolapse?

A

For bladder or urethral prolapse:
Colporrhaphy - plication, folding of fibromuscular layer of anterior vaginal wall
Colposuspension - sutures used

For uterine prolapse:
Hysterectomy
Sacrohysteropexy - uterus attached to anterior longitudinal ligament, requires mesh
Sacrospinous fixation - fixed to sacrospinous ligament

Same surgeries for vault prolapse

Obliterative surgery - moves the pelvic viscera back into the pelvis and closes the vaginal canal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

What are the complications of pelvic organ prolapse surgery?

A

Pain, bleeding, infection, dvt, risk of anaesthetic
damage to bladder or bowel
recurrence of prolapse
altered experience of sex

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

What is the complications with mesh repairs?

A 
NICE recommends should be avoided entirely
Chronic pain
Altered sensation
Dyspareunia
Abnormal bleeding
Urinary or bowel problems
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

What are the functions of the pelvic floor?

A

Support of abdominopelvic viscera
Resistance to increases in intra-pelvic pressure during activities e.g. heavy lifting, coughing
Urinary and faecal continence

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

What muscles make up the pelvic floor?

A

Levator ani muscles - puborectalis, pubococcygeus and ileococcygeus
Coccygeus muscle
Fascia coverings of the muscles

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

What investigations are needed in prolapse?

A

Diagnosis based on history and examination
If urinary symptoms, consider urinalysis, urodynamics, renal ultrasound
If bowel symptoms anal manometry, defecography

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

What are the indications for surgical referral of prolapse?

A 
Failure of conservative treatment
Presence of voiding problems or obstructed defecation
Recurrence of prolapse after surgery
Ulceration
Irreducible prolapse
Preference of treatment
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

What is urge incontinence?

A

Overactivity of the detrusor muscle of the bladder

Sudden urge to pass urine, rush to bathroom

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

What is stress incontinence?

A

Weakness of pelvic floor and sphincter muscles

Urine leaks with increased pressure on the bladder e.g. coughing or laughing.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

What is mixed incontinence?

A

Combination of urge and stress

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

What is overflow incontinence?

A

When there is chronic urinary retention due to obstruction to the outflow
Due to anticholinergics
Fibroids
Pelvic tumours
Neurological conditions e.g. MS, diabetic neuropathy, spinal cord injuries

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

What are the risk factors for urinary incontinence?

A 
Increased age
Postmenopause
Increased BMI
Previous pregnancies and vaginal deliveries
Pelvic organ prolapse
Pelvic floor surgery
Neurological conditions e.g. MS
Cognitive impairment and dementia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

What are the side affects and risks of vaginal pessaries for prolapse?

A

Can cause discharge, odour, vaginal erosions, fistulas and sepsis

63
Q

What is the first line non-surgical management option for urogenital prolapse?

A

16 weeks of pelvic floor muscle exercises
AND/OR

vaginal pressary

64
Q

What should be assessed with incontinence?

A

Medical history for type of incontinence symptoms
Modifiable lifestyle factors e.g. caffeine, alcohol, medication, BMI
Severity - frequency of urination and incontinence, nighttime urination, use of pads and changing clothes
Examination to assess pelvic tone - look for pelvic organ prolapse, atrophic vaginitis, urethral diverticulum, pelvic masses

65
Q

What are voiding symptoms?

A

Voiding symptoms occur usually due to bladder outlet obstruction making it more difficult to pass urine, therefore symptoms being hesitancy, intermittency, straining, terminal dribbling and incomplete emptying.

66
Q

What are storage symptoms?

A

Storage symptoms occur when the bladder should otherwise be storing urine, symptoms being urgency, frequency, nocturia, and urgency incontinence.

67
Q

What is functional incontinence?

A

Can’t get to toilet in time due to mobility issues

68
Q

How is urinary incontinence investigated?

A

Bladder diary for 3 days
Urine dip - infection, glucose, protein?

Speculum - prolapse? visualise if able to contract pelvic flood muscles
Quality of life questionnaire
Post micturition bladder scan - residual volume

Urodynamic tests
Patients stop taking anticholinergic and bladder related medicines 5 days before tests
Thin catheter inserted into bladder, another into rectum
Measures pressure in bladder and rectum to compare

69
Q

What readings are taken in urodynamic studies?

A

Cystometry - detrusor muscle contraction and pressure
Uroflowmetry - flow rate
Leak point pressure - point at which pressure in the bladder results in leaking of urine, pt coughs, jumps.
Post void residual volume - incomplete emptying
Video urodynamic test - fill with contract, x-ray

70
Q

How can urinary incontinence be temporarily managed?

A

Pads - done until diagnosis and full management plan in place

71
Q

What lifestyle changes are suggested in the management of urge incontinence?

A

Reduce caffeine
Lose weight - if BMI >30

Drink 2L per day

72
Q

What is the stepwise management plan for urge incontinence?

A

1 - Bladder training
2 - Medication

3 - Botulinin toxin A injections
4 - percutaneous sacral nerve stimulation

73
Q

What is bladder retraining?

A

6 week plan where patients have scheduled voiding times with increasing time intervals

74
Q

What medication can be used for urge incontinence?

A

Antimuscarinics - effect may take 4 weeks to be seen
- Oxybutynin - immediate release

  • Tolterodine - immediate release
  • Darifenacin

Mirabegron for elderly as oxybutynin contraindicated

75
Q

What is the MOA, ADR’s and CI’s for antimuscarinics in urge incontinence?

A

MoA - Relax urinary smooth muscle
ADR - Constipation, dizzy, dry mouth and eyes, flushing, temperature

CI - severe UC and urinary retention, oxybutynin not for frail elderly

76
Q

How long does botulinin toxin A for incontinence last?

What are the risks?

A

Benefits seen after 4 days. Last 6-9 months

Risks - urinary retention requiring catheter, UTI

77
Q

Describe the use of percutaneous sacral nerve stimulation in urge incontinence

A

Done in 2 stages - test phase and then implantation if test successful

Percutaneous sacral nerve stimulation

78
Q

What medication can be used if nocturnal symptoms of urge incontinence are particularly severe?

A

Desmopressin

79
Q

What is the conservative management for stress incontinence?

A

Pelvic floor exercises

8 Contractions 3x a day for 3 months

80
Q

What is the surgical management for stress incontinence?

A

Colposuspension

Autologus rectal fascial sling

Retropubic mid-urethral mesh sling - NICE recommend offering the other 2 first as some concerns over mesh slings

81
Q

What are the risks of surgical management of stress incontinence?

A

Damage to bladder and bowel
Damage to nerves

Urge incontinence
Pelvic pain
Dyspareunia

82
Q

What are the specific risks of using a mesh sling for stress incontinence?

A

Vaginal mesh exposure can lead to pain

Discharge and bleeding

Mesh may come through bladder or urethra –> urinary symptoms

Women should be warned it is not reversible - the mesh may never be able to be completely removed

83
Q

What management options are available for stress incontinence if the women doesn’t want surgery?

A

Intramural bulking agents

Duloxetine

84
Q

What are the risks of intramural bulking agents?

A

Urinary retention

Urge incontinence

UTI

85
Q

What are the ADR’s associated with duloxetine?

A

GI disturbance
Dry mouth

Headache
Decreased libido
Anorgasmia

86
Q

What is the first line management for mixed incontinence?

A

Either bladder retraining therapy or pelvic floor muscle exercises

87
Q

a bladder diary shows
a) reduced volume that is always the same

b) reduced volume that differs each time

What is the likely diagnosis?

A

a) bladder wall pathology eg carcinoma

b) overactive bladder i.e. detrusor overactivity

88
Q

Describe the appearance of a flow rate graph (x axis is time and y axis is rate) for
a) stress

b) obstruction

A

a) very quick rise and then fall in flow rate as little resistance so get superflow
b) reduced flow rate and urinates over a longer period of time i.e. takes longer to empty bladder as reduced flow rate

89
Q

What is atrophic vaginitis?

A

Dryness and atrophy of the vagina mucosa due to lack of oestrogen
Genitourinary syndrome of menopause
Oestrogen levels fall, mucosa becomes thinner, less elastic and more dry, prone to inflammation.

90
Q

What is the presentation of atrophic vaginitis?

A

Itching
Dryness
Dyspareunia
Bleeding due to localised inflammation

Consider in those with recurrent UTIs, stress incontinence and pelvic organ prolapse.

91
Q

What is seen on examination in atrophic vaginitis?

A 
Examination of labia and vagina
Pale mucosa, thin skin, reduced skin folds
Erythema, inflammation
Dryness
Sparse pubic hair
92
Q

What is the management of atrophic vaginitis?

A

Sylk, replens and yes vaginal lubricants.
Topical oestrogen e.g. cream, pessaries, tablets e.g. Vagifem, ring replaced every three months.

Contraindications include breast cancer, angina, VTE.

93
Q

Where are the bartholin’s glands located?

A

Deep to posterior aspect of labia majora

Also called greater vestibular glands

94
Q

What is the function of the bartholin’s glands?

A

Secrete mucus to lubricate vagina

95
Q

What is the pathophysiology of a bartholin’s cyst?

A

Build up of mucus secretions can cause duct of gland to become blocked - cyst develop

Cyst can become infected and if untreated develop into abscess

96
Q

What organisms can infect a bartholin’s cyst?

A

Usually aerobic

E.Coli, MRSA and STI’s most common

97
Q

Who gets bartholin’s cysts?

A

Nulliparous women of reproductive age

98
Q

How do bartholin’s cysts present?

A

Often asymptomatic
Vulval pain on sitting or walking

Superficial dyspareunia

Soft fluctuant and non tender mass

99
Q

How do bartholin’s abscesses present?

A

Acute onset of pain
Difficulty passing urine

Hard mass and surrounding cellulitis

100
Q

How are bartholin’s cysts diagnosed?

A

Clinical diagnosis

If >40yo a biopsy should be done - exclude vulval malignancy
If signs of STI - swab

101
Q

How are bartholin’s cysts managed?

A

Warm bath - aid spontaneous rupture in small asymptomatic cysts

NO SIMPLE INCISION AND DRAINAGE - reaccumulate

Either word catheter or marsupialisation

102
Q

Describe the use of word catheters for bartholin’s cysts

A

Small rubber tube with balloon at end
Local anaesthetic to numb area
Incision made, pus drained from abscess
Word catheter inserted into space, inflated to 3ml with saline
Fluid can drain round the catheter preventing cyst or abscess from recurring
Risks - recurrence, dyspareunia, scarring

103
Q

Describe how marsupialisation is used for bartholin’s cysts

A

Incision into cyst allow drainage. Cyst wall everted and sutured to vaginal mucosa

General anaesthesia

Risks - hameatoma, dyspareunia

104
Q

What is lichen sclerosus?

A

Chronic inflammatory skin disease which has the potential to progress to squamous cell carcinoma
Presents with patches of shiny white skin

Commonly affects the labia, perineum and perianal skin
Associated with type 1 diabetes, alopecia, hypothyroid and vitiligo.

105
Q

What is the presentation of lichen sclerosus?

A 
Typically 45-60 complaining of vulval itching and skin changes in the vulva, may be asymptomatic 
Itching
Soreness and pain, worse at night
Skin tightness
Painful sex
Erosions and fissures

Koebner phenomenon - worse with friction e.g. underwear.

106
Q

What is the appearance of lichen sclerosus?

A 
Porcelain white in colour
Shiny, tight, thin
Slightly raised
May be papules or plaques
Associated fissures, cracks, erosions, haemorrhages under the skin
107
Q

What is the epidemiology of lichen sclerosis?

A

Bimodal incidence - prepubescent girls and post-menopausal women

108
Q

What is the pathophysiology of lichen sclerosis?

A

Atrophy of the epidermis - thin stratified squamous epithelium

Band-like infiltrate of chronic inflammatory cells beneath epithelial layer

109
Q

How would you investigate lichen sclerosis?

A

Biopsy

Only needed if suspicious of vulval cancer or not responding to treatment

110
Q

What are the main differentials for lichen sclerosis?

A

Vitiligo
Vulval cancer

Candida

111
Q

How would you manage lichen sclerosis?

A

Topical steroids and emollients- clobetasol propionate
Initially used once a day for four weeks, then reduced in frequency every four weeks to alternate days, then twice weekly.

112
Q

Why is follow up important for lichen sclerosis?

A

Risk of developing squamous cell carcinoma (2-5% lifetime risk)

113
Q

What are the complications of lichen sclerosus?

A

Risk of squamous cell carcinoma of the vulva
Pain and discomfort
Sexual dysfunction
Bleeding
Narrowing of the vaginal or urethral openings

114
Q

What acute conditions can lead to pelvic pain?

A

Dysmenorrhoea
Mittelschmerz

Ectopic pregnancy
UTI
Appendicitis
PID
Ovarian torsion
Miscarriage
115
Q

What chronic conditions can lead to pelvic pain?

A

Endometriosis
IBS

Ovarian cyst
Urogenital prolapse
Adhesions
Psychological issues

116
Q

What investigations would you request for pelvic pain?

A

Pregnancy test
MSU

High vaginal swabs
USS
Laparoscopy

117
Q

How is cyclical pain managed?

A

Trial of COCP or GnRH agonist for period of 3-6 months

Diagnostic laparoscopy

Pain management team

118
Q

What are the causes of post-coital bleeding?

A

50% - no cause
33% - cervical ectropion (more common if COCP)

Cervicitis, cervical cancer, polyps, trauma

119
Q

What are some causes of inter-menstrual bleeding?

A

Physiological - spotting can happen around ovulation
Pregnancy related - ectopic

Cervicitis due to infection
Cervical ectropion
Polyps - cervical or endometrial
Uterine fibroids/cancer
Missed OCP
120
Q

How would you investigate abnormal vaginal bleeding?

A

Speculum examination
Cervical smear and HPV

Pregnancy test
High vaginal swabs
TV USS
Cervical biopsy
Colposcopy
121
Q

How is post menopausal bleeding defined?

A

Vaginal bleeding after 12 months of amenorrhoea in women of menopausal age or in younger women with early menopause or primary ovarian failure

122
Q

What must you do in primary care if a patient comes in with postmenopausal bleeding?

A

Confirm bleeding is vaginal
Risk factors - endometrial cancer

Full menstrual history
Gynae and abdo exam
FBC, urine dip (haematuria), CA-125

If worrying - 2 week wait referral

123
Q

What are the common causes of postmenopausal bleeding?

A

Use of HRT
Vaginal atrophy

They don’t exclude cancer so need investigating

124
Q

What happens in secondary care if a woman is referred via 2 week wait for postmenopausal bleeding?

A

Transvaginal USS - endometrial thickness >5mm = higher chance of cancer

Endometrial biopsy - during hysteroscopy or by pipelle biopsy

125
Q

What are some other causes of postmenopausal bleeding?

A

Simple endometrial hyperplasia
Endometrial cancer

Bleeding disorders
Trauma
Polyps
Cervical, ovarian or vaginal cancer

126
Q

What differentials may you consider if a woman presents with a labial or vulval mass?

A

Bartholin’s cyst/abscess
Vulval cancer - 90% = squamous cell carcinoma

Other cysts - sebaceous, scene’s duct, mucous
Bartholin gland carcinoma - rare
Bartholin’s benign tumour - adenoma and nodular hyperplasia (rare)
Other solid masses - fibroma, lipoma, leiomyoma

127
Q

What is the initial imaging modality for ovarian masses?

A

Ultrasound

128
Q

What can an ultrasound of an ovarian mass tell you about it?

A

Whether cyst is

Simple - unilocular, more likely to be physiological or benign
Complex - multilocular - more likely to be malignant

129
Q

How are premenopausal women with an ovarian mass managed?

A

If cyst small (<5cm) and reported as simple, likely to be benign
- Repeat USS 8-12 weeks if problem persist

If cyst complex

  • ca-125, alpha feta protein, b-HCG
  • DO NOT ASPIRATE
130
Q

How are postmenopausal women with an ovarian mass managed?

A

Physiological cysts unlikely

Refer to gynaecology for assessment regardless of nature or size

131
Q

What is FGM?

A

Surgically changing the genitals of a female for non-medical reasons, a cultural practice before puberty
Safeguarding issue and form of child abuse

132
Q

What is the Female Genital Mutilation Act 2003?

A

It is illegal, there is a legal requirement for healthcare professionals to report cases of FGM to the police.

133
Q

What are the types of FGM?

A

1 - removal of all or part of the clitoris
2 - removal of part or all of the clitoris, and labia minora, the labia majora may also be removed
3 - narrowing or closing the vaginal orifice (infibulation)
4 - all other unnecessary procedures to the female genitalia

134
Q

When must the risk of FGM be considered?

A

Coming from a community which practices FGM
Having relatives affected by FGM
Pregnant women with FGM with a possible female child
Siblings or daughters of women or girls affected
Extended trips with infants or children where FGM is done
Women that decline examination or cervical screening
New patients from communities which practise FGM

135
Q

What are the immediate complications of FGM?

A

Pain, bleeding, infection

Swelling, urinary retention, urethral damage, incontinence

136
Q

What are the long term complications of FGM?

A

Vaginal infections e.g. bacterial vaginosis
Pelvic infections
UTIs
Dysmenorrhoea
Sexual dysfunction, dyspareunia
Infertility, pregnancy related complications
Significant psychological issues and depression
Reduced engagement with healthcare and screening

137
Q

What is the management of FGM?

A

Educate patients and relatives it is illegal
Mandatory to report all cases in patients under 18 to police
Over 18 - risk assessment to consider whether there are any other female relatives at risk, unborn child may be at risk then make a referral.

De-infibulation procedure can be performed for type 3, to correct narrowing or closure, improve symptoms, try to restore normal function. Illegal to perform re-infibulation procedure following childbirth.

138
Q

What are common causes of pelvic pain?

A 
PID
UTI
Miscarriage
Ectopic pregnancy
Torsion or rupture of ovarian cysts
139
Q

What are pregnancy related causes of pelvic pain?

A

Miscarriage, ectopic, premature labour, placental abruption, uterine rupture

140
Q

What are gynaecological causes of pelvic pain?

A

Ovulation, dysmenorrhoea, PID, rupture or torsion of ovarian cyst, degenerative changes in a fibroid, pelvic tumour, pelvin vein thrombosis

141
Q

What is the definition of chronic pelvic pain?

A

Intermittent or constant pain in the lower abdomen or pelvis in women
Lasting for at least 6 months
Not occurring exclusively with menstruation or sexual intercourse
Not being associated with pregnancy

142
Q

What are possible causes of chronic pelvic pain?

A 
Endometriosis
Adhesions
IBS
Interstitial cystitis
MSK problems
Pelvic organ prolapse
Nerve entrapment
143
Q

What are red flag symptoms or signs in chronic pelvic pain?

A 
Bleeding PR
New bowel symptoms
New pain after menopause
Pelvic mass
Suicidal ideation
Excessive weight loss
Irregular vaginal bleeding
PCB
144
Q

What are the investigations for chronic pelvic pain?

A 
Screen for STIs
FBC, CRP
CA125 if appropriate
Urinalysis, send MSU
TV USS, MRI ?adenomyosis
Diagnostic laparoscopy gold standard if needed
145
Q

What is the management of chronic pelvic pain?

A

If a non-gynae component - referral to relevant specialist
Cyclical pain - offered COCP or GnRH agonist for 3-6 months before having a diagnostic laparoscopy.

Women with IBS should be offered a trial with antispasmodics, and be encouraged to amend their diet to attempt to control their symptoms.

146
Q

What structure do congenital structural abnormalities in the reproductive organs relate to in the fetus?

A

Mullerian ducts

147
Q

What is a bicornuate uterus?

A

Two horns, diagnosed on pelvic ultrasound scan
Associated with adverse pregnancy outcomes
Complications include miscarriage, premature birth, malpresentation

148
Q

What is an imperforate hymen?

A

Hymen at entrance of vagina is fully formed, without an opening.

Menses sealed in vagina, cyclical pain and cramps.

If not treated can lead to retrograde menstruation and endometriosis

149
Q

What is a transverse vaginal septae?

A

Septum forms transversely across the vagina, either perforate or imperforate and completely sealed.

Diagnosis by examination, ultrasound, MRI. Treatment with surgical correction.
Complications are stenosis and recurrence.

150
Q

What is vaginal hypoplasia and agenesis?

A

Abnormally small vagina.
Agenesis is an absent vagina.

Occur due to failure of the mullerian ducts and may be associated with an absent uterus and cervix.

151
Q

What is androgen insensitivity syndrome?

A

Cells are unable to respond to androgen hormones due to lack of androgen receptors.

Extra androgens converted into oestrogen, resulting in female secondary characteristics.

Genetically male have XY, but absent response to testosterone so converted to oestrogen.

Do not have female reproductive organs, because anti-mullerian hormone has prevented their development.
Testes are in the abdomen.

152
Q

What is the presentation of androgen insensitivity syndrome?

A

Inguinal hernias in infancy
Primary amenorrhoea
Raised LH, normal or raised FSH, normal or raised testosterone and oestrogen

153
Q

What is the management of androgen insensitivity syndrome?

A

Bilateral orchidectomy - removal of testes to avoid testicular tumours
Oestrogen therapy
Vaginal dilators or vaginal surgery as usually raised as female

Obstetrics and Gynaecology (11 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions