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MD3 > WH- Gynaecology > Flashcards

WH- Gynaecology Flashcards

1
Q

Causes of secondary amenorrhoea

A
  • Post-pill amenorrhoea
  • Pregnancy
  • PCOS, premature ovarian failure
  • Asherman’s syndrome
  • Hypothalamic causes: weight loss, exercise, chronic illness, psychological distress
  • Hyperprolactinaemia
  • Hypopituitarism
  • HPG axis damage: tumour, head injury, infiltration
  • Thyroid disease
  • Cushing’s syndrome
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2
Q

Initial investigations for work up of secondary amenorrhoea

A

B-HCG, FSH/LH, TSH, prolactin ± pelvic US

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3
Q

What history questions would you ask a woman presenting with infertility (not her partner)?

A
  • Age
  • Past reproductive history and outcomes
  • Past gynaecological history: menstrual history, sexual history and STIs, contraceptive use, Pap tests, past Ix for infertility
  • Development throughout puberty
  • Endometriosis: spotting before menses, after sex
  • PCOS: weight gain, hirsutism, acne
  • Pituitary tumours: visual disturbance
  • PMHx
  • Previous chemotherapy
  • FHx of genetic or autoimmune disease
  • Vaccination status
  • Alcohol, smoking and drug use
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4
Q

What history questions would you ask a man presenting with infertility (not his partner)?

A
  • Age
  • Past reproductive history and outcomes
  • Development throughout puberty
  • PMHx including of testicular disease or trauma
  • Sexual dysfunction, eg/ premature ejaculation, problems with erection or libido
  • Previous chemotherapy
  • FHx of genetic or autoimmune disease
  • Vaccination status
  • Steroid use
  • Alcohol, smoking and drug use
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5
Q

What investigations are performed initially in infertility?

A
  • Mid-luteal progesterone to confirm ovulation
  • Semen analysis
  • Screening bloods: FBE and iron studies, blood group, rubella, HIV and HCV status
  • Pelvic US
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6
Q

What are the principles of management of azoospermia?

A
  • Ix = serum testosterone and FSH
  • If pre-testicular cause = low T and FSH = Mx of pathology
  • If testicular cause = normal/high FSH and normal T = ICSI and IVF if sperm can be identified on biopsy
  • If post-testicular cause = normal T and FSH = surgery or ICSI/IVF
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7
Q

What are the conservative treatment options for managing prolapse?

A
  • No treatment
  • Pelvic floor exercises
  • Oestrogen replacement
  • Lifestyle changes, eg/ drinking less coffee and alcohol
  • Pessary
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8
Q

Reasons for a false negative Pap test

A
  • Sampling error
  • Laboratory failure in reading sample
  • Infected lesions or smear obscured by blood cells
  • Poor fixation of sample
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9
Q

What are the benefits of HRT?

A
  • Most effective Tx of menopausal symptoms
  • Improved vaginal dryness
  • Maintains or improves bone density, reduces fracture risk
  • Improves QoL, sleep and muscle aches and pains
  • Reduced DM risk
  • Reduced CRC risk
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10
Q

As per current cervical cancer screening protocols, who should be referred to colposcopy?

A
  • 2x LSIL
  • HSIL
  • Smear reported as: ?carcinoma
  • Suspicious symptoms
  • Cervix suspicious of invasive disease
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11
Q

What is the management of HSIL of the cervix?

A

Laser ablation, loop excision or cone biopsy with follow up

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12
Q

What conditions must be excluded in post-menopausal bleeding?

A

Endometrial hyperplasia and malignancy

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13
Q

What are the symptoms of endometriosis?

A
  • Cyclical pain (dysmenorrhoea, mid-cycle pain, pre-menstrual pain)
  • Provoked pain: dyspareunia, on inserting tampon
  • Premenstrual spotting
  • Infertility
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14
Q

What are the signs of endometriosis?

A
  • Lower abdominal tenderness
  • PV tenderness
  • Palpable adnexal mass or vaginal nodule or thickening on POD
  • Fixed uterus
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15
Q

What are the management options for endometriosis?

A
  • Do nothing
  • Analgesia
  • OCP is first line for hormonal therapy
  • Surgery if 6mo of failure
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16
Q

What are the causes of stress incontinence?

A
  • Increased intra-abdominal pressure: pregnancy, cough, abdominal mass, obesity, constipation
  • Failure of intrinsic urethral sphincter: trauma, devascularisation, faulty collagen
  • Damage to pelvic floor (ageing, pregnancy, surgery)
17
Q

What are the disadvantages of HRT?

A

Oestrogen alone:

  • Increased risk of stroke, VTE and PE
  • Cholecystitis
  • Endometrial hyperplasia and cancer

Combined:

  • As above
  • Increased breast density and abnormal mammogram
  • Increased risk of breast cancer (>5y)
  • Increased risk of stroke and CHD (controversial)
  • Unscheduled bleeding
18
Q

What are the management options for fibroids?

A
  • If asymptomatic, do nothing
  • Medication: GnRH agonists, mifepristone, mirena IUD, NSAIDs
  • Uterine artery embolisation (infertile)
  • Ablation (MRgFUS)
  • Surgery
19
Q

What are the disadvantages of a mirena IUD?

A
  • Irregular bleeding and menstrual changes
  • Expulsion risk
  • Perforation
  • Pelvic infection
  • Ectopic pregnancy
20
Q

What are the benefits of COCs?

A
  • Effective, convenient and reliable
  • Independent of sex
  • Reduced pelvic pain and menstrual flow
  • Reduced PID, ovarian cysts, ovarian and endometrial cancer, and benign breast disease
21
Q

What are the causes of urge incontinence?

A

Overactive bladder or detrusor instability due to:

  • Idiopathic
  • Psychosomatic
  • Neuropathic, eg/ MS
  • Complication of incontinence surgery
  • Outflow obstruction
  • Bladder pathology causing irritation, eg/ stones, cancerW
22
Q

What is the management of urge incontinence?

A
  • Conservative: decrease fluid intake to 1.5L/day, physiotherapy for bladder re-training
  • Medical: anti-cholinergics or TCAs (especially if nocturia)
  • Surgical
23
Q

How might a uterine fibroid be detected?

A
  • Incidentally on US scan

- Pressure symptoms: urinary frequency, menstrual disturbance (HMB) or pregnancy issues

24
Q

What are the non-hormonal management options in menopause?

A
  • Gabapentin, SSRI/SNRI and clonidine for hot flushes

- Consider local oestrogen for vaginal dryness

25
Q

What are the treatment options for stress incontinence?

A
  • Pelvic floor exercises
  • Pads
  • Pessary
  • Surgery: burch colposuspension
26
Q

What investigations are first line for investigating primary amenorrhoea

A

FSH/LH, pelvic US

27
Q

What is the main contraindication to progestin-only pills?

A

Hormone-dependent cancers

28
Q

What is the Tx of chlamydia?

A

Azithromycin

29
Q

At what age should you Ix primary amenorrhoea?

A

16yo

30
Q

Common sites of endometriosis

A

Uterosacral ligaments, ovaries, POD and anterior vesicle pouch

31
Q

What features constitute severe endometriosis?

A

Chocolate cysts and infertility

32
Q

What hormonal treatment is first line for endometriosis?

A

Continuous OCP

33
Q

When is surgery recommended for endometriosis?

A

After 6months of failed treatment

MD3 (21 decks)

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