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Phase 3a conditions list flashcards > Women's health - gynaecology > Flashcards

Women's health - gynaecology Flashcards

1
Q

What is considered in the field of gynaecology?

A
  • Female organ problems
  • Pregnancy before 13 weeks
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2
Q

How long is a normal menstrual cycle?

A

21-35 days

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3
Q

What are the stages of the ovarian menstrual cycle and how long do they last?

A
  • Follicular (d1-13)
  • Ovulation (d14)
  • Luteal (d14-28)
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4
Q

What are the stages of the uterine menstrual cycle and how long do they last?

A
  • Menses (d1-5)
  • Proliferative (d6-14)
  • Secretory (d15-28)
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5
Q

What is considered the first day of the menstrual cycle?

A

The first day of the menstruation

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6
Q

When is the fertile window in the menstrual cycle?

A

5 days before ovulation until the day after ovulation (so d9-15)

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7
Q

Draw out the menstrual cycle - phases of cycle, thickness of the endometrium and levels of oestrogen and progesterone.

A

Follow link, scroll to bottom of page
https://zerotofinals.com/obgyn/reproductivesystem/menstrualcycle/

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8
Q

What stimulates LH and FSH production?

A

Gonadotrophin releasing hormone

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9
Q

Where are LH and FSH released from?

A

Anterior pituitary

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10
Q

Where is oestrogen released from?

A

Theca and granulose cells in ovaries

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11
Q

What causes the release of oestrogen?

A

LH + FSH

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12
Q

What are the effects of oestrogen (4)?

A
  • Growth + development of breast + female reproductive organs
  • Increase BMD
  • Growth of endometrium
  • Development of blood vessels in uterus
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13
Q

Where is progesterone released from?

A

Corpus luteum

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14
Q

What are the functions of progesterone (3)?

A
  • Maintain endometrial thickness
  • Thicken cervical mucous
  • Increase body temp
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15
Q

What does FSH act on and what does it do?

A

Granulose cells –> stimulates folliculogenesis

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16
Q

What effect does oestrogen alone have on LH and FSH?

A

Increases LH levels and FSH

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17
Q

What effect does high oestrogen and progesterone have on LH and FSH?

A

Negative feedback

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18
Q

What are the main presenting complaints in gynaecology (9)?

A
  • Amenorrhoea (no periods)
  • Irregular menstruation
  • Intermenstrual bleeding
  • Dysmenorrhoea (painful periods)
  • Menorrhagia (heavy periods)
  • Postcoital bleeding
  • Pelvic pain
  • Vaginal discharge
  • Pruitis vulvae (itchy vagina)
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19
Q

When does puberty in girls typically begin?

A

8 to 13 years
menarche 2 years after this

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20
Q

What are the two types of amenorrhoea?

A
  • Primary - never started periods
  • Secondary - > 3 months no period (in normally regularly menstruating woman)
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21
Q

What is primary amenorrhoea defined as (2)?

A
  • No periods + no evidence of puberty at 13 years
  • All 15 year olds without periods
    or 3 years after starting breast development
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22
Q

What is the first sign and stages of puberty in females (3)?

A
  • 1st = breast buds
  • 2nd = pubic hair
  • 3rd = menstruation
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23
Q

What are the two fundamental causes of primary amenorrhoea?

A
  • Hypogonadotrophic hypogonadism
  • Hypergonadotrophic hypogonadism
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24
Q

What are some causes of hypogonadotrophic hypogonadism (5)?

A
  • Hypopituitarism
  • Delayed growth + development (but otherwise normal)
  • Excessive exercise/ dieting/ failure to thrive
  • Endocrine disorders e.g. hypothyroidism/ growth hormone deficiency
  • Kallman syndrome
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25
Q

What are some causes of hypergonadotrophic hypogonadism (relating to primary amenorrhoea) (4)?

A
  • Turners syndrome
  • Damage to ovaries e.g. cancer, torsion, infection
  • Absence of ovaries
  • Androgen insensitivity syndrome (although high levels of sex hormones this is still hypogonadism as the function is decreased)
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26
Q

What other condition may cause primary amenorrhoea?

A

Congenital adrenal hyperplasia (this often causes high levels of androgens, but lack of periods)

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27
Q

How is primary amenorrhoea typically investigated (6)?

A
  • Standard bloods - coeliac screen, U&E for CKD, anaemia
  • FSH, LH levels
  • TFTs
  • ILGF-1
  • Genetic testing
  • USS + other imaging
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28
Q

What are some causes of secondary amenorrhoea (8)?

A
  • Pregnancy
  • Menopause
  • PCOS
  • Hyperprolactinaemia
  • Psychological/ physiological stress (weight loss/ extreme exercise)
  • Ashermans syndrome
  • Sheehans syndrome (damage to pituitary gland - typically after birth due to shock)
  • Hyperthyroidism
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29
Q

Why does hyperprolactinaemia cause amenorrhoea?

A

Prolactin acts on hypothalamus to prevent GnRH release –> low LH + FSH –> no periods

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30
Q

How is secondary amenorrhoea investigated (3)?

A
  • Hormone bloods
  • USS
  • Urine bHCG
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31
Q

What is included in the hormone blood tests for secondary amenorrhoea?

A
  • FSH +LH
  • Prolactin
  • TSH
  • Testosterone
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32
Q

What are some congenital structural abnormalities that occur in females (4)?

A
  • Bicornuate uterus
  • Imperforate hymen
  • Transverse vaginal septum
  • Vaginal hypoplasia and agenesis
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33
Q

What is a bicornuate uterus?

A

Uterus with two horns (heart shaped appearance)

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34
Q

What are some complications of bicornuate uterus (3)?

A
  • Miscarriage
  • Premature birth
  • Malpresentation
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35
Q

How does an imperforate hymen present?

A

When girls start to menstruate they will get ‘period cramps’ but without any bleeding

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36
Q

What is a transverse vaginal septum?

A

Septum forms transversely across the vagina - can be imperforate or perforate (with a hole)
presents similarly to imperforate hymen

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37
Q

What is vaginal hypoplasia and agenesis?

A

Abnormally small or non-existent vagina

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38
Q

What causes vaginal hypoplasia and agenesis?

A

Failure of mullerian ducts to properly develop

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39
Q

What is the typical amount of blood lost during menstruation?

A

40 ml

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40
Q

What is considered menorrhagia in terms of blood loss?

A

> 80ml
rarely measured in practice - rely on history

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41
Q

What causes menorrhagia (2 big ones, 6 others)?

A
  • Dysfunctional uterine bleeding
  • Fibroids
  • IUD
  • Hypothyroidism
  • Bleeding disorders
  • Endometriosis + adenomyosis
  • PCOS
  • Cancers
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42
Q

How is menorrhagia investigated (3)?

A
  • FBC, clotting, ferritin, TFTs
  • USS
  • Hysteroscopy
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43
Q

What is dysfunctional uterine bleeding?

A

No identifiable cause for the menorrhagia

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44
Q

How is dysfunctional uterine bleeding managed symptomatically (2)?

A
  • Transexamic acid (reduces bleeding)
  • Mefanamic acid (when there is associated pain - reduces bleeding and pain, type of NSAID)
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45
Q

How is dysfunctional uterine bleeding typically treated (3)?

A
  1. Mirena coil
  2. COCP
  3. Cyclical oral progesterones
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46
Q

What is a fibroid also known as and what are they?

A

Uterine leiomyomas - benign tumours of the smooth muscle

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47
Q

What age are fibroids most common?

A

Child bearing age 30-50 years old

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48
Q

What percent of females have fibroids of child bearing age?

A

1/3rd

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49
Q

What tends to happen to fibroids after menopause?

A

Shrink as oestrogen sensitive

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50
Q

What are the types of fibroids (4)?

A
  • Subserosal = just below the outer layer of uterus - can grow to fill abdomen
  • Intramural = within the myometrium
  • Submucosal = just below the lining of uterus (endometrium)
  • Pedunculated = on a stalk
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51
Q

What are some risk factors for fibroids (4)?

A
  • Nulliparous
  • Black
  • Early menarche/ late menopause
  • Obesity
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52
Q

What are the signs/ symptoms of fibroids?

A
  • Menorrhagia
  • Prolonged periods (> 7 days)
  • Abdo pain
  • Deep dyspareunia
  • Reduced fertility
  • Bowel/ urinary Sx/ bloating
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53
Q

How are fibroids investigated (3)?

A
  • Bimanual exam = large, irregular, non tender uterus
  • TV USS
  • Hysteroscopy
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54
Q

How are fibroids managed medically (3)?

A

Same as dysfunctional endometrial bleeding:
* Mirena coil
* COCP
* Symptomatic management = transexamic acid

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55
Q

How can fibroids be managed surgically (4)?

A
  • Uterine artery embolisation
  • Hysteroscopic endometrial ablation/ resection
  • Myomectomy
  • Hysterectomy
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56
Q

What size should fibroids be referred?

A

Larger than 3 cm

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57
Q

What is uterine artery embolisation?

A

Radiologically guided catheter insertion –> particles injected to block artery to fibroid

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58
Q

What is myomectomy?

A

Laparoscopic procedure to remove fibroid

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59
Q

What is a big advantage of myomectomy?

A

Can improve fertility in women of child bearing age

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60
Q

What are some complications of fibroids (6)?

A
  • Red degeneration
  • Reduced fertility
  • Pregnancy complications
  • Malignant change (very rare)
  • IDA
  • Torsion (usually affecting pedunculated fibroids)
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61
Q

What is red degeneration?

A

Ischemia, infarction, necrosis of fibroid due to interruption of blood supply

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62
Q

When does red degeneration often present?

A

During pregnancy - often in 2nd + 3rd trimester due to changing shape of uterus interrupting the blood supply

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63
Q

How does red degeneration present (4)?

A
  • Mild fever
  • Tachycardia
  • Vomiting
  • Pain
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64
Q

How is red degeneration managed?

A

Supportive

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65
Q

What is a differential for a fibroid (2)?

A
  • Endometrial polyps
  • Malignant tumours
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66
Q

What is dysmenorrhoea?

A

Painful periods

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67
Q

What are some causes of painful periods (6)?

A
  • Primary dysmenorrhoea (no underlying cause)
  • Endometriosis
  • Adenomyosis
  • Fibroids
  • PID
  • IUD
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68
Q

What are the features of primary dysmenorrhoea (2)?

A
  • Present from menarche (or within 1-2 years)
  • Just before or after start of period (not days before)
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69
Q

How is primary dysmenorrhoea managed (2)?

A
  1. NSAIDs e.g. mefenamic acid
  2. COCP
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70
Q

What is endometriosis?

A

Ectopic endometrial tissue (outside the uterus)

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71
Q

What age does endometriosis most commonly occur?

A

20-40 year old

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72
Q

What percentage of females have endometriosis in uk?

A

10%

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73
Q

Where does endometrial tissue sometimes form (4)?

A
  • Urinary tract
  • Bowel
  • Abdomen (especially ovaries)
  • Thorax (may present with cyclical haemoptysis)
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74
Q

What are some theories for the cause of endometriosis (4)?

A
  • Retrograde menstruation
  • Embryonic cells destined to become endometrial tissue remained outside uterus during development
  • Spread via lymphatic system
  • Cells change via metaplasia
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75
Q

What are some risk factors for endometriosis (5)?

A
  • Nulliparous
  • Early menarche/ late menopause
  • Vaginal outflow obstruction
  • Autoimmune disease
  • Family history
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76
Q

What are the signs/ symptoms of endometriosis (5)?

A
  • Cyclical abdo/ pelvic pain
  • Dysmenorrhoea
  • Deep dyspareunia
  • Infertility
  • Cyclical bleeding (in GI or uriniary or resp tract)
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77
Q

How is endometriosis investigated (3)?

A
  • Bimanual vaginal exam + abdo exam (adnexal motion tenderness + fixed retroverted uterus)
  • TV USS = first line
  • Laparoscopic surgery = gold standard
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78
Q

What is a staging system that can be used for endometriosis?

A

ASRM (stages 1-4)
american society of reproductive medicine

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79
Q

How is endometriosis managed (5)?

A
  • NSAIDs
  • COCP
  • GnRH analogue
  • Laparoscopic ablation/ excision
  • Hysterectomy
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80
Q

What does a GnRH analogue do?

A

Prevents the anterior pituitary producing LH and FSH

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81
Q

What is an example of a GnRH analogue?

A

Goserelin

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82
Q

What is endometrial tissue in the ovaries known as?

A

Chocolate cyst

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83
Q

What is a side effect of GnRH analogues?

A

OSTEOPOROSIS (no oestrogen)

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84
Q

What are the different types of hysterectomy (4)?

A
  • Partial hysterectomy = ONLY uterus
  • Total hysterectomy = uterus + cervix
  • Radical hysterectomy = uterus + cervix + part of vagina/ soft tissues
  • Hysterectomy with bilateral salpingo-oophrectomy = uterus + cervix + fallopian tubes + ovaries
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85
Q

What is a major differential/ sister condition of endometriosis?

A

Adenomyosis

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86
Q

What is adenomyosis?

A

Endometrial tissue in myometrium

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87
Q

What are some risk factors for adenomyosis (2)?

A
  • Multiparous
  • Uterine surgery/ trauma
    *
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88
Q

What age does adenomyosis typically occur?

A

Later in reproductive age (35-45)
resolves with menopause

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89
Q

What percentage of women are affected by adenomyosis?

A

10%

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90
Q

What are the signs/ symptoms of adenomyosis (4)?

A
  • Dysmenorrhoea/ cyclical pain
  • Menorrhagia
  • Deep dyspareunia
  • Subfertile
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91
Q

How is adenomyosis investigated (3)?

A
  • Bimanual exam
  • TV USS
  • Excision + biopsy (post hysterectomy)
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92
Q

What is the classic finding on a bimanual exam for adenomyosis?

A

BOGGY uterus

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93
Q

How is adenomyosis managed (6)?

A
  • Symptomatic = transexamic/ mefenamic acid
  • Mirena coil = first
  • COCP
  • Cyclical oral progesterones
  • GnRH analogues
  • Surgery (hysterectomy, myomectomy, uterine artery embolisation)
    + REFER
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94
Q

What are some complications on pregnancy of adenomyosis (7)?

A
  • Miscarriage
  • Infertility
  • Preterm
  • Small for gestational age
  • Malpresentation
  • PPH
  • C-section (increased likelihood)
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95
Q

What is polycystic ovarian syndrome?

A

A metabolic and reproductive condition causing multiple cysts (immature follicles) on the ovaries

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96
Q

What criteria are used to diagnose PCOS?

A

Rotterdam criteria

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97
Q

What are the Rotterdam criteria to diagnose PCOS (3)?

A
  • Oligo/anovulation (irregular/ absent periods)
  • Hyperandrogenism (hirtuism + acne)
  • Polycystic ovaries/ ovaries over 10cm^3 on USS
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98
Q

How many Rotterdam criteria are needed for a diagnosis of PCOS?

A

2 out of 3

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99
Q

What are the signs/ symptoms of PCOS (8)?

A
  • Oligo/anovulation (or oligo/amenorrhoea)
  • Infertility
  • Obesity (up to 70% of people with PCOS)
  • Hirsutism
  • Acne
  • Male pattern hair loss
  • Mood swings
  • Acanthosis nigricans
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100
Q

What are some complications of PCOS (5)?

A
  • Insulin resistance/ diabetes
  • Infertility
  • Endometrial hyperplasia + cancer
  • OSA
  • Metabolic syndrome
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101
Q

What is metabolic syndrome?

A

At least 3 of the 5 medical conditions:
* Abdo obesity
* High blood pressure
* High blood sugar
* High serum triglycerides
* Low HDL

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102
Q

What are the effects of insulin resistance on PCOS (3)?

A
  • Insulin increases production of androgens (e.g. testosterone)
  • Insulin surpreses sex hormone binding globulin (SHBG) –> more testosterone free in blood –> hirsutism
  • Insulin further halts the development of follicles in ovaries –> anovulation
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103
Q

Other than PCOS what are some other causes of hirsutism (3)?

A
  • Medications (e.g. steroids, phenytoin - anticonvulsant)
  • Cushings
  • Congenital adrenal hyperplasia
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104
Q

How is PCOS investigated (3)?

A
  • Bloods
  • TV USS
  • OGTT (check for diabetes - not HbA1C)
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105
Q

What blood are done on those with PCOS (5)?

A
  • Testosterone
  • LH + FSH
  • SHBG
  • Prolactin
  • TSH
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106
Q

What would the blood test results typically show for those with PCOS?

A
  • Raised LH
  • Raised LH:FSH ratio
  • Raised testosterone
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107
Q

What finding on ultrasound would satisfy one of the Rotterdam criteria (2)?

A

either:
* Ovary more than 10cm^3
* 12 or more developing follicles in one ovary
“beads on string” appearance

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108
Q

How is PCOS managed?

A
  • Lifestyle advice
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109
Q

What are some examples of lifestyle advice for those with PCOS?

A
  • Weight loss
  • Stop smoking
  • Exercise
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110
Q

How can increased risk of endometrial cancer be managed for those with PCOS?

A

Mirena coil

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111
Q

How can reduced fertility be managed in those with PCOS (3)?

A
  • Clomifene (induces OVULATION)
  • Metformin
  • IVF
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112
Q

How can hirsutism be managed in those with PCOS (4)?

A
  • COCP
  • Topical eflornifine
  • Spironolactone (reduces androgens)
  • Laser hair removal
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113
Q

How is acne managed in those with PCOS?

A

COCP

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114
Q

What are the important gynaecological cancers to know about (4)?

A
  • Endometrial cancer
  • Cervical
  • Ovarian cancer
  • Vulval cancer
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115
Q

How are all gynaecological cancers staged?

A

Using FIGO staging criteria
International Federation of Gynaecology and Obstetrics

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116
Q

What is the most common gynaecological cancer worldwide?

A

Cervical
endometrial in UK - due to HPV vaccine

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117
Q

When should endometrial and cervical cancer be suspected?

A
  • Endometrial = post menopausal bleeding (until proven otherwise)
  • Cervical = intermenstrual
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118
Q

What is the most common type of endometrial cancer?

A

Adenocarcinoma (80%)
starts in glandular tissue

119
Q

What is a key feature of endometrial cancer in terms of its pathophysiology?

A

It is oestrogen sensitive

120
Q

What are the two types of endometrial cancer?

A
  • Type 1 = oestrogen sensitive (often remain within uterus)
  • Type 2 = rarer, faster growing, spread outside uterus, may resemble ovarian tumours
121
Q

What is the histology of type 2 endometrial cancers (2)?

A
  • Clear cell carcinoma
  • Serous carcinoma
122
Q

What are the two main categories of risk factors for endometrial cancer?

A
  • Unopposed oestrogen
  • Family history / genetics
123
Q

What causes increased exposure to unopposed oestrogen (8)?

A
  • Nulliparous
  • Obesity (adipocytes produce oestrogen)
  • Early menarche
  • Late menopause
  • PCOS
  • Oestrogen only HRT
  • TAMOXIFEN
  • Increased age
  • T2DM
124
Q

What are two genes responsible for endometrial cancer (2)?

A
  • HNPCC (hereditary non-polyposis colorectal cancer/ Lynch syndrome)
  • PTEN
    Lynch is the most common inherited type of endometrial cancer (autosomal dominant)
125
Q

What is protective against endometrial cancer (5)?

A
  • COCP
  • IUS
  • Breastfeeding
  • Multiparity
  • SMOKING
126
Q

What are the signs/ symptoms of endometrial cancer (7)?

A
  • Postmenopausal bleeding
  • Postcoital bleeding
  • Intermenstrual bleeding
  • Dyspareunia
  • Pelvic mass
  • Anaemia
  • Abnormal vaginal discharge
127
Q

How should all postmenopausal bleeding be managed?

A

2 week wait referral
if > 12 months after last period

128
Q

What would endometrial cancer feel like on bimanual exam?

A

Large irregular uterus

129
Q

How is endometrial cancer investigated (2)?

A
  • TV USS = 1st
  • Hysteroscopy + biopsy (or pipelle biopsy) = gold standard
130
Q

What would a USS show for those with endometrial cancer?

A

Increased endometrial thickness > 5mm

131
Q

How is endometrial cancer staged?

A
  1. Confined to uterus
    • cervix
    • pelvis e.g. LN, ovaries, vagina
  4. Extrapelvic e.g. bladder, rectum
132
Q

How is endometrial cancer managed (2)?

A
  • Stages 1 + 2 = total abdominal hysterectomy + bilateral salpingo-oophorectomy
  • Stages 3/4 = radical hysterectomy + chemo/ radiotherapy
133
Q

What are the most common types of cervical cancer (2)?

A
  • Squamous cell carcinoma (80%)
  • Adenocarcinoma (10%)
134
Q

Who is the typical patient with cervical cancer?

A

Sexually active 30-45 y/o female

135
Q

What is the main risk factor for cervical cancer?

A

HPV!!!!!
human papilloma virus

136
Q

What are the types of HPV most commonly responsible for cervical cancer?

137
Q

How does HPV increase the risk of cervical cancer?

A

Inhibits two tumour suppressor genes P53 and pRb

138
Q

Other than HPV infection what are some risk factors for cervical cancer (8)?

A
  • Unprotected sex
  • Lots of sexual partners
  • Early sexual activity
  • Not participating in screening
  • Not vaccinated
  • COCP (for more than 5 years)
  • Smoking
  • HIV/ immunosuppressed
139
Q

When are HPV vaccines given?

A

12/13 year old

140
Q

What are the signs/ symptoms of cervical cancer (4)?

A
  • Intermenstrual bleeding
  • Post coital bleeding
  • Vaginal discharge
  • Deep dyspareunia
141
Q

How is cervical cancer investigated (2)?

A
  • Speculum = masses/ ulcerations
  • Colposcopy + biopsy
    smear not performed for suspected cervical cancer
142
Q

How is cervical cancer frequently identified?

A

Cervical smear test

143
Q

When are women screened for cervical cancer?

A
  • Every 3 years from 25-49
  • Every 5 years from 50-64
144
Q

What are some exceptions to the cervical screening programme (3)?

A
  • Pregnant women should wait until 12 weeks post party
  • HIV +ve patients have yearly screens
  • Women menstruating should wait until it is over
145
Q

How are smear tests analysed (2)?

A
  1. High risk HPV identified
    if high risk found…
  2. Cells examined
146
Q

How is an inadequate sample smear managed?

A
  1. Repeat smear again in 3 months
  2. Refer for colposcopy
147
Q

How is a HPV +ve smear managed?

A
  1. Repeat smear in 12 months
  2. Repeat smear in 12 months
  3. Refer for colposcopy
148
Q

What are premalignant changes in cervical cells known as?

A

Cervical intraepithelial neoplasia (CIN)

149
Q

What are the 3 types of CIN?

A
  • CIN 1 = mild dysplasia
  • CIN 2 = moderate dysplasia
  • CIN 3 = severe dysplasia (carcinoma in situ) - likely to progress to cancer
150
Q

How is CIN and cervical cancer distinguished between?

A

Cervical biopsy during colposcopy

151
Q

What are the two types of biopsy that can be done after an abnormal cervical screen result?

A
  • LLETZ (large loop excision of the transformation zone) - smaller number of cells removed
  • Cone biopsy - larger number of cells removed
152
Q

How is cervical cancer staged?

A
  1. = confined to cervix (A=microscopic; B=visible)
  2. = upper 2/3rds vagina or uterus
  3. = lower 1/3rd vagina or pelvic wall
  4. = bladder/ rectum/ extrapelvic
153
Q

How is cervical cancer and CIN managed (3)?

A
  • CIN = LLETZ/ cone biopsy
  • Stage 1-2A = radical hysterectomy + LN clearance (+/- chemo/radio) or radical trachelectomy
  • Stage 2B + = chemo (cisplastin)/ radio/ palliative care
154
Q

How is CIN 1 managed?

A

Usually just monitored as most regress

155
Q

What are the most common types of ovarian tumours (3)?

A
  1. Epithelial cell tumours
  2. Germ cell tumours
  3. Sex-cord stromal tumours
156
Q

What is the most common epithelial cell tumour in the ovaries?

A

Serous tumour

157
Q

What are the most common germ cell tumours in the ovary (2)?

A
  • Mature teratoma (dermoid cyst - benign, contain teeth/ hair)
  • Dysgerminoma = most common malignant
158
Q

What are two types of sex-cord stroll tumours in the ovaries?

A
  • Sertoli-leydig
  • Granulosa
159
Q

Is the prognosis good or bad for ovarian cancer?

A

Pretty bad
in 70% of women the cancer has spread beyond the pelvis

160
Q

What is a metastisy in the ovary known as?

A

Krukenberg tumour
usually from the GI tract

161
Q

What are some risk factors for ovarian cancer (5)?

A
  • Age (peaks at 60 y/o)
  • Smoking
  • Unopposed oestrogen (obesity, early periods, late menopause, etc.)
  • Family history/ genetics
  • Recurrent use of clomifene
    factors that increase number of ovulations
162
Q

What is clomifene?

A

Fertility medication

163
Q

What genes increase the risk of ovarian cancer?

A

BRCA 1 and 2

164
Q

What are some protective factors for ovarian cancer (3)?

A
  • COCP
  • Breastfeeding
  • Pregnancy
    factors that reduce number of ovulations
165
Q

What are the signs/ symptoms of ovarian cancer (8)?

A
  • Any new IBS-like symptoms
  • Abdo bloating
  • Early satiety/ loss of appetite
  • Weight loss
  • Pelvic pain
  • Urinary Sx (e.g. frequency/ urgency)
  • Abdo/ pelvic mass
  • Ascites
166
Q

What ovarian cancer symptoms should be referred under 2 week wait (3)?

A
  • Pelvic mass
  • Abdo mass
  • Ascites
167
Q

How is ovarian cancer investigated (3)?

A
  • 1st = CA-125 + TVUSS
  • Gold = pipelle biopsy
  • Staging = CT
168
Q

What extra investigations should be done for ovarian cancer in women under 40 (i.e. germ cell tumour suspected) (2)?

A
  • AFP (alpha-fetoprotein)
  • HCG (human chorionic gonadotropin)
169
Q

How is the risk of malignancy assessed in those with suspected ovarian cancer (3)?

A
  • CA-125
  • Postmenopausal
  • USS findings
170
Q

Other than ovarian cancer, what can cause a raised CA-125 (4)?

A
  • Endometriosis/ adenomyosis
  • Fibroids
  • Pelvic infection
  • Pregnancy
171
Q

How is ovarian cancer staged?

A
  1. Ovaries
    • pelvis
    • abdomen
  4. = distant mets
    FIGO criteria
172
Q

How is ovarian cancer managed (3)?

A
  • MDT with gynae-oncology
  • Hysterectomy + bilateral salpingo-oophrectomy
  • Chemo/ radio
173
Q

What bloods should be done pre surgery (for something like a hysterectomy + bilateral salpingo-oophrxectomy for ovarian cancer) (3)?

A
  • FBC = anaemic?
  • Group + save = for transfusion
  • Clotting screen = bleeding risk
174
Q

What are the most common types of vulval cancer (2)?

A
  • Squamous cell carcinoma (90%)
  • Melanoma (10%)
175
Q

Which part of the vulva is most commonly affected by cancer?

A

Labia majora

176
Q

What are the two types of person vulval cancer typically might affect?

A
  • Older woman (75+) with lichen sclerosis
  • Younger woman (35-45) with HPV infection
177
Q

What are the signs/ symptoms of vulval cancer (6)?

A
  • Vulvodynia (vulval pain)
  • Superficial dyspareunia
  • Ulcers
  • Bleeding
  • Itching
  • Lymphadenopathy (in region)
178
Q

What does vulval cancer typically look like?

A

Irregular, fungating lesion

179
Q

How is vulval cancer investigated (4)?

A
  • 2WW referral for suspected vulval cancer
  • Biopsy of lesion
  • Sentinel node biopsy
  • Further imaging (e.g. CT)
180
Q

How is vulval cancer managed (3)?

A
  • Wide local excision
  • LN removal
  • Chemo/ radio
181
Q

What is a precancerous lesion of the vulva associated with HPV infection?

A

Vulval intraepithelial neoplasia

182
Q

What is the cause of the majority of vaginal cancers?

A

Secondary to vulval cancer

183
Q

Who do ovarian cysts most commonly affect?

A

Premenopausal women

184
Q

Ovarian cysts signs/ symptoms (4)?

A
  • Pelvic pain
  • Bloating
  • Fullness
  • Pelvic mass
185
Q

How can ovarian cysts be categorised (3)?

A
  • Functional (from normal processes)
  • Neoplastic (overgrowth of abnormal cells e.g. endometriosis and ovarian cancers)
  • Non-functional (PCOS)
186
Q

What are the two types of functional cysts?

A
  • Follicular cyst
  • Corpus luteum cyst
187
Q

What are some complications of ovarian cysts (4)?

A
  • Cyst rupture
  • Cyst haemorrhage
  • Ovarian torsion
  • Meigs syndrome
188
Q

How do ovarian cyst rupture, haemorrhage and ovarian torsion present?

A

Severe acute pain

189
Q

What is Meig syndrome (3)?

A
  • Ovarian fibroma (benign ovarian tumour)
  • Pleural effusion
  • Ascites
    resolves after tumour removal
190
Q

What is ovarian torsion?

A

When the ovary twists in relation to the surrounding Fallopian tube and blood supply

191
Q

What age is ovarian torsion most common?

A

15 - 45 year old

192
Q

What are some risk factors for ovarian torsion (3)?

A
  • Ovarian cysts
  • Pelvic surgery
  • Pregnancy
193
Q

What are the signs/ symptoms of ovarian torsion (4)?

A
  • Sudden severe unilateral pelvic pain
  • N+V
  • Localised tenderness
  • Palpable mass
194
Q

How is ovarian torsion investigated (3)?

A
  • B-hCG
  • TV USS
  • Laparoscopic surgery = definitive
195
Q

What are the ultrasound finding of those with ovarian torsion (3)?

A
  • “Whirlpool sign”
  • Free fluid in pelvis
  • Ovary oedema
196
Q

How is ovarian torsion managed (2)?

A
  • Surgical detorsion
  • Oophrectomy (if dead)
197
Q

What are some complications of ovarian torsion (3)?

A
  • Infection –> abscess –> sepsis
  • Rupture
  • Peritonitis
198
Q

What are 3 key differential diagnoses for ovarian torsion?

A
  • Ectopic pregnancy
  • Appendicitis
  • Cyst rupture/ haemorrhage
199
Q

What is cervical ectropion?

A

Collumnar epithelium of the ednocervix extends into exocervix

200
Q

What is the transformation zone?

A

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

201
Q

What are some risk factors for cervical ectropion (3)?

A
  • Younger women
  • Pregnancy
  • COCP
    associated with high oestrogen levels
202
Q

What are the signs/ symptoms of cervical ectropion (3)?

A
  • Increased vaginal discharge
  • Post coital bleeding
  • Deep dyspareunia
203
Q

How is ectropion managed (3)?

A
  • Reassurance
  • Stop COCP –> POP
  • Surgical ablation
204
Q

What is pelvic organ prolapse?

A

Decent of the pelvic organs into the vagina

205
Q

What causes pelvic organ prolapse (3)?

A
  • Weakness/ lengthening of the ligaments/ muscles surrounding the bladder/ rectum/ uterus
  • Weakness of the vaginal wall (muscle)
  • Increased intrabdominal pressure
206
Q

What is the most common type of pelvic organ prolapse?

A

Cystocele (prolapse of bladder)

207
Q

What are the types of pelvic organ prolapse (5)?

A
  • Cystocele = MC
  • Uterine prolapse
  • Vault prolapse
  • Rectocele
  • Urethrocele (cystourethrocele)
208
Q

Which part of the vagina wall does each pelvic organ prolapse come through (3)?

A
  • Cystocele + urethrocele = anterior wall
  • Uterine prolapse + vault = apical prolapse (apex of vagina)
  • Rectocele = posterior vaginal wall
209
Q

What is a vault prolapse?

A

Women with a hysterectomy whose top of vagina descends into the vagina

210
Q

What are some risk factors for pelvic organ prolapse (6)?

A
  • Older age (50+)
  • Multiparity
  • Traumatic delivery
  • Obesity
  • Chronic cough
  • Chronic constipation
211
Q

What are the signs/ symptoms of pelvic organ prolapse (5)?

A
  • Feeling of ‘something coming down’
  • Dragging/ heavy sensation in vagina
  • Urinary Sx (incontinence, urgency, frequency, weak stream)
  • Bowel Sx (constipation, incontinence, urgency)
  • Sexual dysfunction (pain, reduced enjoyment)
212
Q

How is pelvic organ prolapse examined?

A

Sims speculum is used to hold wall of vagina out the way whilst prolapse is examined

213
Q

What are women often asked to do during examination of a pelvic organ prolapse?

A

Cough/ bear down

214
Q

How is the extent of a pelvic organ prolapse graded (4)?

A
  1. > 1 cm above the introitus
  2. 1 cm above or below introitus
  3. > 1 cm below the introitus
  4. Full decent with eversion of vagina
215
Q

What is the introitus?

A

Opening to the vagina

216
Q

What can a prolapse extending beyond the introitus be referred to as?

A

Uterine procidentia

217
Q

What are the 3 overarching ways to manage pelvic organ prolapse?

A
  • Conservatively
  • Pessary
  • Surgically
218
Q

What is the conservative management for pelvic organ prolapse (4)?

A
  • Physio (pelvic floor exercises)
  • Weight loss
  • Lifestyle changes for incontinence (e.g. less caffeine)
  • Treat associated symptoms e.g. constipation/ chronic cough
219
Q

What are the two main types of pessary?

A
  • Ring
  • Shelf/ Gellhorn - flat disc with stem coming down
    can’t have sex with shelf
220
Q

What is often inserted with a pessary?

A

Oestrogen cream to stop vagina drying out

221
Q

How often should a pessary be changed?

A

Every 4-6 months

222
Q

What are the surgical treatment options for pelvic organ prolapse?

A

Many including hysterectomy, pelvic floor repair

223
Q

What are some complications of pelvic organ prolapse surgery (4)?

A
  • Pain/ bleeding/ infection
  • Damage to bowel/ urinary tract
  • Recurrence of prolapse
  • Altered sensation of sex
224
Q

What is an outdated surgical technique that was used for pelvic organ prolapse, but now no longer recommended by NICE?

A

Mesh repair - refer patients for specialist management
caused chronic pain, urinary/ bowel Sx, dyspareunia, etc

225
Q

What is premenstrual syndrome (PMS)?

A

The psychological, behavioural and physical symptoms in the luteal phase of menstruation particularly in the days prior to menstruation

226
Q

What causes premenstrual syndrome?

A

Fluctuations in hormones during the menstrual cycle and the interaction with neurotransmitters serotonin and GABA (the exact cause is not known however)

227
Q

What are the signs/ symptoms of premenstrual syndrome (10)?

A
  • Low mood
  • Anxiety
  • Mood swings
  • Irritability
  • Bloating
  • Fatigue
  • Headaches
  • Breast pain
  • Reduced confidence
  • Lack of libido
228
Q

What is important to establish when taking a history of someone with premenstrual syndrome?

A

No symptoms before menarche, during pregnancy or after menopause

229
Q

How is premenstrual syndrome investigated (2)?

A
  • Symptom diary - must be present before menstruation for at least 2 cycles
  • GnRH analogues - temporarily induce menopause, Sx stop = definitive diagnosis
230
Q

How is premenstrual syndrome managed (4)?

A
  • Mild = lifestyle changes
  • COCP
  • SSRI + CBT
  • NSAIDs (for pain)
231
Q

What lifestyle modifications are recommended for those with premenstrual syndrome (3)?

A
  • Exercise
  • Good sleep hygiene
  • Regular small meals with complex carbohydrates
232
Q

Which COCP is recommended for those with premenstrual syndrome?

A

New generation e.g. drospirenone

233
Q

What is a severe form of premenstrual syndrome?

A

Premenstrual dysphoric disorder
can present with Sx such as psychosis

234
Q

What is the menopause?

A

Permanent end to menstruation

235
Q

When can a diagnosis of menopause be made?

A

When it has been at least 12 months since the last period
or 2 years if under 50

236
Q

What is the average age of the menopause?

A

51 years old
usually between 45-55 years

237
Q

What may cause women to go through the menopause prematurely (2)?

A
  • Any operation that removes both ovaries
  • Sheehans syndrome
238
Q

What is defined as premature menopause?

A

Menopause before 40
due to primary ovarian insufficiency

239
Q

What is defined as early menopause?

A

40-45 year olds

240
Q

What is the perimenopause?

A

12 months after menstruations finish in woman with vasomotor symptoms

241
Q

What is the physiology of the menopause?

A

Decreased functioning of the ovaries –> less oestrogen –> more LH+FSH –> low oestrogen causes the menopause symptoms

242
Q

What are the signs/ symptoms of the perimenopause (9)?

A
  • Hot flushes
  • Emotional fluctuations
  • Low mood
  • Night sweats
  • Irregular periods
  • Vaginal dryness/ atrophy
  • Reduced libido
  • Brain fog
  • Fatigue
243
Q

Which symptoms are vasomotor symptoms of the menopause (2)?

A
  • Hot flushes
  • Night sweats
244
Q

How is menopause investigated (2)?

A
  • Clinical retrospective diagnosis (no menstruation for 12 months and over 45 years)
  • Measure FSH > 30 (if woman under 45/ any doubt)
245
Q

How are menopausal symptoms managed (5)?

A
  • No treatment (if not wanted)
  • Lifestyle (e.g. regular exercise, sleep hygiene, weight loss)
  • HRT
  • Vaginal oestrogen cream
  • SSRI - fluoxetine (for vasomotor Sx)
246
Q

What are the HRT options available to treat the menopause (2)?

A
  • Oestrogen + progesterone transdermal patch
  • Oestrogen only (if hysterectomy as low chance of endometrial cancer)
247
Q

What are some contraindications to HRT (2)?

A
  • Breast cancer past or present
  • High VTE risk
248
Q

What are the risks associated with HRT (4)?

A
  • Increased VTE risk
  • Increased stroke + CVD risk
  • Increased breast
  • Ovarian cancer risk
    risk of dying from breast cancer however, not raised
249
Q

What are some risk factors for primary ovarian insufficiency (5)?

A
  • Cancer
  • Infection
  • Chemo
  • PCOS
  • Family history + fragile X syndrome
250
Q

What is a health benefit of taking HRT?

A

Decreased risk of osteoporosis

251
Q

What is the most common cause of post menopausal bleeding?

A

Atrophic vagina
don’t forget endometrial cancer

252
Q

How is atrophic vaginits managed (2)?

A
  1. Moisturisers/ lubricants
  2. Topical oestrogen
253
Q

What is the most common cause of postcoital bleeding (2)?

A
  • Cervical ectropion (young)
  • Atrophic vagina (older)
254
Q

What are the most common causes of superficial dyspareunia (4)?

A
  • Vulvodynia (pain in vulval area without an identifiable cause)
  • Vulval cancer
  • Lichen sclerosis
  • Atrophic vagina
255
Q

What are the most common causes of deep dyspareunia?

A
  • Endometriosis
  • Adenomyosis
  • Pelvic inflammatory disease
  • Cervical cancer
256
Q

What are the 5 types of incontinence?

A
  • Stress = MC
  • Urge/ overactive bladder = 2nd MC
  • Mixed
  • Overflow
  • Functional
257
Q

What is urge incontinence?

A

Overactivity of the detrusor muscle

258
Q

What is the presentation of someone with urge incontinence?

A

Sudden feeling of needing to urinate “key in door syndrome”, sometimes have nocturnal enuresis

259
Q

What is the typical patient affected by urge incontinence?

A

Younger female with UTI/ DM during pregnancy/ constipation

260
Q

What causes stress incontinence?

A

Weakness of the pelvic floor and sphincter muscles allowing urine to leak at times

261
Q

What is the presentation of stress incontinence?

A

Urine leakage when laughing/ coughing

262
Q

What are some risk factors for stress incontinence (4)?

A
  • Older age
  • Surgery
  • Multiple births
  • Obese
263
Q

What is mixed incontinence?

A

Symptoms of both urge and stress incontinence
must work out which are having the largest affect on the patients life

264
Q

What causes overflow incontinence?

A

Chronic urinary retention due to an obstruction to the outflow
more common in med due to enlarged prostates

265
Q

What are the signs/ symptoms of overflow incontinence (3)?

A
  • Poor stream
  • Incomplete emptying
  • Nocturnal Sx
266
Q

What are some risk factors/ causes for overflow incontinence (3)?

A
  • Traumatic surgery
  • Neurological condition e.g. MS
  • Tumours
267
Q

What is functional incontinence?

A

Lack of mobility means patient is unable to get to the toilet in time

268
Q

How should incontinence be investigated (4)?

A
  • Urinary diary
  • Vaginal examination (tone + prolapse)
  • Urine dip + MC&S
  • Urodynamics
269
Q

How is urge incontinence managed (3)?

A
  • Bladder retraining (minimum 6 weeks)
  • Antimuscarinics (M3 receptors) e.g. oxybutynin
  • Cystoplasty (bladder enlargement)/ botox injection
270
Q

How is stress incontinence managed (3)?

A
  • Pelvic floor ‘kegal’ exercises for 3 months
  • Surgery (mid urethral tape)
  • Duloxetine
271
Q

How is overflow incontinence managed?

A

Self catheterisation

272
Q

What is lichen sclerosus?

A

Chronic inflammation + fibrosis of superficial dermis –> scar tissue + white plaques

273
Q

How is typically affected by lichen sclerosus?

A

Elderly females
although males can get it too!!!

274
Q

Where does lichen sclerosus typically affect?

275
Q

What are the signs/ symptoms of lichen sclerosus (3)?

A
  • White patches that may scar
  • Itchy
  • Pain during sex
276
Q

How is lichen sclerosus investigated?

A
  • Clinically
  • Biopsy can be taken if doubt
277
Q

How is lichen sclerosus managed?

A

Potent topical steroids - clobetasol propionate (+emollients)

278
Q

What is a compilation of lichen sclerosus?

A

Squamous cell carcinoma (of the vulva)

279
Q

What is a similar condition to lichen sclerosus?

A

Lichen planus

280
Q

How can lichen planus be differentiated from lichen sclerosus (2)?

A
  • Appears purple not white
  • Lesions on mucous membrane of mouth found in lichen planus
281
Q

What is Ashermans syndrome?

A

Where adhesions form in the uterus for various reasons

282
Q

What can cause ashermans syndrome (2)?

A
  • Surgery (dilatation and curettage + c-section)
  • Repeated infections (endometritis/ PID)
283
Q

What are the signs/ symptoms of ashermans syndrome (4)?

A
  • Secondary amenorrhoea
  • Dysmenorrhoea
  • Lighter periods
  • Infertility
284
Q

How is ashermans syndrome investigated?

A

Hysteroscopy = gold standard

285
Q

How is ashermans syndrome managed?

A

Cut the adhesions during hysteroscopy

286
Q

What is bartholins cyst?

A

Blockage of bartholins gland resulting in collection of mucous + secretions at inside of labia majora

287
Q

What is a complication of bartholins cyst?

A

Bartholins abscess

288
Q

What organisms are most commonly found in bartholins abscess (3)?

A
  • E. coli
  • STIs (chlamydia, gonorrhoea)
  • Staph aureus
289
Q

How is bartholins cyst managed?

A

Good hygiene
can do surgical drainage if persisting

290
Q

What tumour in the head can cause a number of gynaecological symptoms?

A

Prolactinoma

291
Q

What are the signs/ symptoms of a prolactinoma in women (6)?

A
  • Amenorrhoea
  • Infertility
  • Galactorrhoea (breast milk production)
  • Osteoporosis
  • Headache
  • Bilateral hemianopia
292
Q

What is a genital tract fistula?

A

An abnormal connection between the vagina and adjacent organs such as the bladder and rectum

293
Q

What are the causes of genital tract fistula (4)?

A
  • (Obstetric) trauma
  • Pelvic surgeries
  • PID
  • Cancers
294
Q

What is the presentation of someone with a genital tract fistula?

A

Leakage of urine/ faeces into the vagina

Phase 3a conditions list flashcards (31 decks)

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