Textbook notes

Question 1

Heavy menstrual bleeding

• what it is
• investigations 4

Answer 1

Menorrhagia-
think rage -> interferes with personal life.

• check Hb
• check coagulation and thyroid function
• transvaginal ultrasound
• endometrial biopsy

Question 2

Intermenstrual bleeding

• causes 2
• investigations 3
• treatment 3

Answer 2

1. anovulatory phase (either really young or near menopause)
2. pevlic problems - polyps and adenomyosis, ovarian cysts

investigations:

• assess effect of loss of blood
• check Hb
• exclude malignancy

treatment:
IUS
COCP
surgery to remove polyps

Question 3

what is primary and secondary ammenhorrea

Answer 3

primary: never had it by 16
secondary: when normal periods stop for 3 months or more

Question 4

causes of physiological amenorrhoea -3

Answer 4

• pregnancy
• menopause
• lactation

Question 5

causes of pathological amenorrhea - 5

Answer 5

1. congenital (turners)
2. Hypothalamus (decreased GnRH)
3. Pituitary - hyperplasia making lactation
4. Adrenal/thyroid -
5. PCOS

Question 6

post coital bleeding

• investigations - 2
• treatment - 2

Answer 6

investiatigations:
cervix examaintations
smear test

treatment:
progesterone IUS
Pill and NSAIDs

Question 7

what is adenomyosis

• symptoms 4
• investigations 2
• treatment 2

Answer 7

when endometrium is in the myometrium
symptoms:
-none
-pain
-regular, heavy periods
-large, tender uterus

investigations:

• ultrasound
• MRI

treatment:

• progesterone IUS
• pill and NSAIDS

Question 8

fibroids

• what are they dependent on?
• symptoms 3
• complications 2
• investigations 1
• treatment 5

Answer 8

1. benign tumours in myometrium
2. depend on O and P

• symptoms
  none
  painful, heavy periods
  dysuria

-complications
can grow, calcify, malignant

• investigations
  ultrasound

- treatment
tranexamic acid
NSAID
progesterones
GnRH
surgical

Question 9

endometriosis

what is it dependent on?
- symptoms 4

• investigations 4
• treatment 6

Answer 9

dependent on oestrogen
can be 2nd to STI

- symptoms
inflammation
tender pelvis
systemic infections
none

- investigations
ca125 serum levels
transvaginal ultrasound
MRI
laproscopy
biopsy

- treatment
if no symptoms -> don't treat
AB if infection
NSAID
combined pill
POP
GnRH
surgical

Question 10

intrauterine polyps

• what
• who
• symptoms 3
• investigations 1
• treatment 1

Answer 10

what:
small, benign tumours, when OE is high

who:
40-50
tamoxifen

• symptoms
  nonr
  menorrhagia
  intermenstrual bleeding
• investigations
  ultrasound
• treatment
  re-section polyp

Question 11

Endometrial cancer
2 types and features of both

RF - 5

Answer 11

1 = majority = OE sensitive
2 = not OE sensitive

RF:obestiy
OE exposure
diabetes
late periods
late menopause
tamoxifen

Question 12

endometrial cancer

• symptoms 3
• investigations 4
• treatment 2

Answer 12

- symptoms
hyperplasia of endometrium
post - menopausal bleeding
tumours
- investigations
physical exam
ca 125
ultrasound
mri

• treatment
  removal
  radiotherapy

Question 13

cervical cancer

• what kind of cell carcinoma
• symptoms 5
• investigations 3
• treatment 3

Answer 13

squamous cell carcinoma

- symptoms
post coital bleeding
smelly discharge
IMB
postmenopause bleeding
uclers or mass visible

• investigations
  biopsy
  MRI
  FBC
• treatment
  removal
  hysterectomy
  chemo-radiotherapy

Question 14

PCOS

• symptoms - I know
• complications 1
• investigations 1
• treatment 3

Answer 14

complications - T 2 D
investigations:
diagnosis of exclusions
bloods
transvag

treatment:
diet
exercise
cocp

Question 15

vulva disorders
2 names and characteristics

treatment for both is the same

Answer 15

1. lichen planus
   -papular rash, purple, pain
   give steroid
2. lichen sclerosus
   -loss of collagen, autoimmune, thyroid
   give steroid

Question 16

Prolapse

• causes 4
• symptoms 6
• investigations 3
• treatment 5

Answer 16

causes:
- NVD
- collagen deficit
- obesity
- constipation

symptoms:

• dragging feeling
• lump
• ulcerate and bleed
• discharge
• urinary frequency
• problems pooping

investigation:

• abdo exam
• speculum
• ultrasound

treatment:

• weight decrease
• stop smoking
• physio
• pessaries
• hysterectomy

Question 17

urinary incontinence

• investigations 4
• treatment 7

Answer 17

investigations:

• speculum
• ask to cough and see if there is a leak
• abdo
• urine dip for infection

treatment:

• loose weight
• chronic cough treated
• reduce fluid intake
• pelvic floor muscle training
• vaginal cones
• duloxetine - SSRI
• surgery

Question 18

Non - STI

bacterial vaginosis
- presentation
-treatment
candidas
- symptoms
-treatment

Answer 18

bacterial vaginosis:

• presentation: grey-white discharge, fishy odour
  treatment: metronidazole or clindamycin cream

candidas:
itching
treatment: imidazole or oral fluconazole

Question 19

Chlamydia

symptoms 3
treatment 2

Answer 19

-Discharge
- IMB, post coital bleeding
- Can lead to infertility and chronic pelvic
pain

Treatment:
Azithromycin
Doxycycline

Question 20

Gonorrhoea

symptoms 2
investigation 1
treatment 2

Answer 20

• Asymptomatic in women
• Can have discharge, urethritis, pelvic
  infection

Investigations: swabs

Treatment:
Azithromycin and cefixime

Question 21

Genital herpes
symptoms 4
treatment 2

Answer 21

• Primary infection
• Local lymphadenopathy
• Acute urinary retention
• Flu like illness
• Treat with Aciclovir, valaciclovir

Question 22

Syphilis

• can it be transmitted to fetus?
• how is it diagnosed?
• how is it seen?

Answer 22

• Can be transmitted to fetus
• Diagnosed with positive serology
• Painless genital ulcers

Question 23

Pelvic inflammatory disease
what is it
symptoms
investigations
treatment

Answer 23

what:
Infection in vagina and cervix
Usually chlamydia and gonorrhoea

symptoms:
o Asymptomatic
o Subfertility
o Period problems
o Bilateral lower abdomen pain
o Abnormal vaginal bleeding and
discharge
o If severe: tachycardia, high fever

investigations:
swabs

treatment:
o Analgesia
o Doxy, metronidazole