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Leeds MBCHB Year 4 GOSH > Z2F Gynaecology > Flashcards

Z2F Gynaecology Flashcards

1
Q

Primary vs secondary amenorrhoea

A

Primary have never developed periods

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2
Q

3 causes of primary amenorrhoea

A 
Imperformate hymen
Abnormal gonads (hypergonadotrophic hypogonadism)
Abnormal hypothalamus or P gland (hypogonadotrophic hypogonadism)
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3
Q

Periods should start by

A

13 if no signs of puberty

15 if signs of puberty

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4
Q

Order of puberty development in girls

A

Breasts -> pubic hair -> periods

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5
Q

What does kallman syndrome cause

A

Hypogonadotrophic hypogonadism (lack of FSH and LH)

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6
Q

2 key symptoms of kallman syndrome

A

Failure to start puberty

Absent sense of smell

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7
Q

Hypogonadotrophic hypogonadism effect on hormones

A

Low FSH and low LH

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8
Q

Hypergonadotrophic hypogonadism hormone levels

A

High FSH and LH

Low oestrogen

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9
Q

3 causes of hypergonadotrophic hypogonadism

A

Injury to gonads (cancer, mumps, torsion)
Congenital aplasia
Turners syndrom (XO)

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10
Q

Does turners syndrome cause Hypo or hypergonadotrophic hypogonadism

A

Hypergonadotrophic hypogonadism

Hypothalamus still making gnrh and p making FSH and LH
No oestrogen negative feedback

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11
Q

Androgen insensitivity syndrome presentation and cause

A

Unable to respond to androgens (testosterone)

Female phenotype with no female internal organs but vagina

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12
Q

Cyclical abdominal pain but no menorrhagia: dx

A

Structual issues

Inperformate hymen/ FGM/ transverse vaginal septum

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13
Q

Antibody test on girls aged 15 without periods

A

Anti TTG (coeliacs)

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14
Q

Treatment for kallman syndrome

A

Pulsitile GnRH +/- COOP

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15
Q

High isolated FSH suggests

A

Primary ovarian failure

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16
Q

High LH isolated suggests

A

PCOS

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17
Q

How to reduce risk of endometrial cancer in women with PCOS

A

Induce withdrawal bleed every 3-4 months

Either COOP use or medroxyprogesterone (DEPO as a pill) for 14 days

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18
Q

Other than ca, amenorrhoea associated with low oestrogen is a risk for

A

Osteoporosis

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19
Q

Treatment for PMS

A

Lifestyle
COOP - Yasmin/ contains drospierone
SSRI
CBT

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20
Q

Treatment for physical symptoms of PMS after COOP, lifestyle and SSRI tried

A

Spirolactone

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21
Q

Average menstrual blood loss

A

40mls

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22
Q

Management of painful heavy periods in women who want to conceive vs non painful

A 
Mefenamic acid (if pain)
TXA (if no pain)
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23
Q

Order of management of heavy periods in women who do not want to conceive

A

Mirena
COOP
Cyclical progesterones

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24
Q

Fibroids are sensitive to which hormone

A

Oestrogen (shrink after menopause)

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25
Q

4 types of fibroids

A

Submucosal - just below lining of uterus
Intramural - in myometrium (distort uterus)
Subsersosal - outer layer of uterus (grow into abdo)
Pedunculated - on a stalk

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26
Q

Most common presentation of fibroids

A

Heavy menstrual bleeding

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27
Q

Fibroids on examination present as

A

NON tender mass on PV/ abdominal exam

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28
Q

Management of fibroids depends on ??

A

Size (less than 3cm)

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29
Q

Fibroid less than 3cm the management is same as ??

A

same as heavy menstural bleeding

Mirena
TXA/ NSAIDS
COOP
Cyclical progesterones

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30
Q

Fibroids greater than 3cm management

A

refer to gynaecologist
Same as less than 3cm medically
Surgical - ablation, hysterectomy, uterine artery embolisation, myomectomy etc

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31
Q

Only known treatment to improve fertility in women with fibroids

A

Myomectomy

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32
Q

Myomectomy is used to treat

A

Fibroids

IN WOMEN WHO CANNOT CONCIEVE - only known treatment

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33
Q

Pregnant women with hx of fibroids presents with abdominal pain and low grade fever :dx

A

Red degeneration of fibroid (ischaemia due to lack of blood supply)

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34
Q

Red degeneration of fibroids risk factors

A

Greater than 5mm

2nd and 3rd trimester

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35
Q

Red degeneration of fibroids presentation

A

Severe abdo pain, low grade fever, tachycardia, vomiting

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36
Q

Chocolate cysts

A

Endometrial tissue in the ovaries

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37
Q

Adenomyosis

A

Endometrial tissue in myometrium

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38
Q

Gold standard endometriosis diagnosis

A

Laparoscopy

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39
Q

Management of endometriosis

A 
NSAIDS
COOP (back to back)
trial of other hormonal contraception
Adhesionlysis
Induce menopause like state - GnRH analogues
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40
Q

Adenomyosis is more common in which women

A

Multiparous and late reproductive years

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41
Q

Adenomyosis symptoms triad:

A

dysmenorrhoea, menorrhagia, dyspareunia

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42
Q

Adenomyosis on examination

A

Tender and enlarged uterus

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43
Q

First line investigation for adenomyosis

A

TVUSS

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44
Q

Treatment for adenomyosis?

A

Same as menorrhagia

Mirena
TXA/ NSAIDS
COOP
Cyclical progesterones

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45
Q

Effects of adenomyosis on pregnancy

A 
Bad things (same for endometriosis)
Infertility, miscarriage, PPROM, preterm labour, PPH
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46
Q

Menopause definition

A

12 months of amenorrhoea needed for dx but the menopause is the day of the last period

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47
Q

Premature menopause date

A

Before 40 years

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48
Q

Menopause hormone levels

A

Low oestrogen and progesterone

High FSH and LH

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49
Q

Low oestrogen and progesteron
High FSH and LH

Indicates what

A

Menopause

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50
Q

What age do women need to use contraception until

A

Two years without a period if under 50

One year without a period if over 50

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51
Q

Nice first line test for suspected menopause in under 45s

A

FSH blood test

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52
Q

COOP UKMEC after 40

A

UKMEC 2

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53
Q

Contraception that is not as good to use after 40 years

A

COOP - only UKMEC 2 age

(DEPO cause osteoporosis) shouldn’t use after 45

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54
Q

Max age for DEPO

A

45 - osteoporosis

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55
Q

Two key side effects of DEPO and unique contraindication

A

Weight gain, osteoporosis, (delay to fertility)

Over 45s

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56
Q

Average length of perimenopausal symptoms

A

2-5 years

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57
Q

Unique treatment for reduced libido at menopause

A

Testosterone cream

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58
Q

Unique treatment for vaginal dryness and atrophy after menopause

A

Vaginal oestrogen

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59
Q

Premature ovarian insufficiency diagnosis is made by:

A

Under 40, low oestrogen symptoms, high FSH on two occasions with a 4 week gap

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60
Q

Premature ovarian insufficiency treatment

A

HRT - important to reduce risk of CVD and OP. Increased risk of breast ca and VTE if used in under 50s but lower BP
OR
COOP - contraception is still possible in POI

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61
Q

Risks of HRT in under 50s in comparison to over 50s

A

Increased risk of breast ca and VTE if used in under 50s

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62
Q

Which type of HRT: no uterus

A

Oestrogen only

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63
Q

Which type of HRT: still having periods

A

Cyclical progesterone and regular break through bleeds

Until 12 months without a period

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64
Q

Which type of HRT: women with a uterus and 12 months without a bleed

A

Combined

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65
Q

Non HRT, menopausal drug treatment for vasomotor symptoms

A

Clonidine

CANNOT withdraw suddenly

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66
Q

Key benefits of HRT

A

Improved QOL

Reduced OP and fracture risk

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67
Q

What type of drug is clonidine

A

Alpha 2 adrengenic and imidazoline receptor agonist

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68
Q

Clonidine indications

A

Vasomotor symtom control
?PCOS
HTN

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69
Q

If women wanting HRT still have periods, what type of HRT must they have?

A

Cyclical HRT (with progesterone)

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70
Q

Cancer risks of HRT

A

Breast and endometrial

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71
Q

Non cancer risks of HRT

A

VTE, stroke, coronary artery disease

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72
Q

Oldest age for smears

A

65 unless 1 of last 3 abnormal

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73
Q

3 key questions in HRT counselling

A

Local or systemic symptoms?
Uterus or not?
Periods or not?

74
Q

How many years is Mirena coil licensed for in HRT endometrial protection

A

4 years (5 normally)

75
Q

Best way of delivering drugs in HRT

A

Oestrogen - patch (VTE risk lower)

Progesterone - coil (breast cancer and MI risk)

76
Q

How long for HRT to work

A

3-6 months

77
Q

Criteria for diagnosing PCOS

A

Rotterdam criteria

78
Q

PCOS definition by Rotterdam criteria

A

2/3 of:

Anovulation, hyperandrogegism (acne, hirsutism) and PCO on USS

79
Q

Skin change in PCOS

A

Acanthosis nigricans

80
Q

4 ddx other than PCOS of hirsutism

A

Medications (phenytoin, ciclosporin, testosterone and steroids)
Ovarian or adrenals tumours
Cushings syndrome
Congential adrenal hyperplasia

81
Q

SHBG levels in PCOS (sex hormone binding globulin)

A

Reduced

Insulin resistance -> increased insulin -> increased androgens

Insulin resistance -> increased insulin -> less negative feedback to SHBG -> less androgen blocking -> increased androgen levels

82
Q

Increased androgen levels in PCOS physiology

A

Insulin resistance -> increased insulin -> increased androgens

Insulin resistance -> increased insulin -> less negative feedback to SHBG -> less androgen blocking -> increased androgen levels

83
Q

TV USS appearance of PCOS

A

String of pearls

12 or more developing follicles per ovary or ovarian volume more than 10cm3

NOT reliable in adolescents

84
Q

Drug used to help weight loss in women with PCOS

A

Orlistat (lipase inhibitor)

85
Q

How to reduce risk of endometrial cancer in women with PCOS

A 
Mirena coil
Cyclical progesterones (or COOP) to induce withdrawal bleed
86
Q

Treatments for infertility in PCOS

A

Weight loss, clomifene, ovarian drilling, IVF

87
Q

Treatment for hirsutism in PCOS

A

Weight loss, COOP, topical eflornithine, spirolactone

88
Q

Management of acne in PCOS

A

COOP

Then standard acne treatments: retinoid, abx, azelaic acid

89
Q

Two types of functional ovarian cysts

A

Follicular: developing follicle that fails to rupture. Harmless and disappear after a few cycles

Corpus luteum: when luteum breaks down but fills with fluid. COMMON IN PREGNANCY

90
Q

Type of tumour associated with ovarian torsion

A

Dermoid cysts/ germ cell tumour (type of teratomas)

91
Q

Treatment for perimenopausal women with a simple cyst less than 5cm

A

No further investigation needed

92
Q

Epithelial ovarian masses

A

Serous cystadenoma

Mucinous cyst adenoma - can become huge

93
Q

Ovarian cancer tumour marker

A

Ca125

94
Q

Other causes of Ca125

A 
Endometriosis
Fibroids
Adenomyosis
PID
Liver disease
Pregnancy
95
Q

Risk of malignancy index takes what into account

A

Menopause status (older -> high risk)
Ca125
US findings

96
Q

Meig’s syndrome

A

Ovarian fibroma (benign)
Pleural effusion
Ascites

Removal of tumour resolves symptoms

97
Q

Dx: pleural effusion and ascites in a women with a ovarian tumour

A

Meigs syndrome (fibroma tumour)

98
Q

Most common type of ovarian torsion

A

An ovarian mass normally larger than 5cm twists

Can happen in young girls with longer infundibulopelvic ligaments

99
Q

Ovarian torsion presentation

A

Sudden onset severe unilateral pelvic pain - progressively gets worse and associated with N&V

100
Q

USS finding in ovarian torsion

A

Whirlpool sign with free fluid in the pelvis and oedema of the ovaries

Dooplers may show lack of blood supply

101
Q

Why can an ovarian torsion not be left

A

Becomes necrotic -> access -> sepsis/ peritonitis

102
Q

Ashermans syndrome

A

Adhesions within the uterus (synechiae) following damage

103
Q

When does Ashermans syndrome commonly occur after

A

Dilation and curettage procedures (removal of retained products), uterine surgery, pelvic infection

104
Q

Management of POF

A

COOP or Traditional combined HRT

105
Q

Ashermans syndorme presentation

A

Secondary amenorrhoea, lighter periods, dysmenorrhoea

Infertility

106
Q

Ashermans syndrome management

A

Dissecting adhesions during hysteroscopy

107
Q

Cell type of endocervix

A

Columnar epithelium

108
Q

Cell type of ectocervix

A

Stratified squamous epithelium

109
Q

Classical cervical ectropion presentation

A

Post coital bleeding

110
Q

Risk factors for cervical ectropion

A

Higher oestrogen levels - young women, COOP and pregnancy

111
Q

What is a nabothian cyst

A

fluid filled cyst on cervix

112
Q

Nabothian cyst pathophysiology

A

Columnar epithelium of endocervix produces mucus (normal). Minor trauma (birth or infection) causes squamous cells of ectocervix to slightly cover columnar cells, trapping the mucus

113
Q

Vault prolapse

A

Top of the vagina descends into the vagina in women who have had a hysterectomy

114
Q

Management of nabothian cyst

A

No treatment required as long as sure on dx

Can therefore biopsy

115
Q

How to grade uterine prolapse

A

POP-Q

Pelvic organ prolapse quantification system

0 normal
4 eversion of vagina

116
Q

3 types of management in pelvic prolapse

A

1: conservative
2: vaginal pessary
3: surgery

117
Q

What may you co-prescibe with a pessary

A

Vaginal oestrogen cream

Stops irritation of walls

118
Q

4 causes for overflow incontinence

A

Anti-cholinergic meds
Fibroids
Pelvic tumours
Neurological (MS, poor DM, spinal cord injuries)

119
Q

What sex is overflow incontience most common in

A

Men (very rare in women)

120
Q

Key management of stress incontinence

A

Avoid caffeine, diuretics and over filling bladder
Weight loss

Pelvic floor exercises for 3 months min
Surgery
DULOXETINE

121
Q

Key management of urge incontinence

A 
Bladder retraining for 6 weeks
Anticholinergic medication (oxybutynin)
121
Q

Key management of urge incontinence

A

Bladder retraining for 6 weeks
Anticholinergic medication (oxybutynin)
Mirabegron
Invasive procedures (botox and sacral nerve stimulation)

122
Q

Common side effects of anti-cholinergic medications

A

Dry mouth, dry eyes, retention, constipation, hypotension

123
Q

What is mirabegon and what is it used for

A

Beta 3 agonist
Used for urge incontinence when anti-ch is not tolerated

Contraindicated in HTN and BP must be monitored while on the drug

124
Q

What must be monitored in patients on mirabegon

A

BP

Risk of HTN crisis

Used for urge incontinence

125
Q

What is cause of atrophic vaginitis

A

Lack of oestrogen

126
Q

Treatment for atrophic vaginitis

A

Topical oestrogen

applied at night

127
Q

How is oestrogen cream commonly given

A

Once daily at night using a syringe into the vagina

128
Q

Role of bartholians gland

A

Produce mucus to help with vaginal lubrication

129
Q

Classic presentation of a bartholins cyst

A

Swelling in posterior vaginal introitus 1-4cm

130
Q

Treatment of bartholian cyst

A

Hygiene, analgesia and warm compress
Antibiotics (E.Coli most common cause)

Incision not used as often reoccur

131
Q

When may a biopsy be taken of a ?bartholian cyst

A

Older women not improving ?vulva cancer

Not used to drain as reoccur

132
Q

Difference between lichen simplex and lichen plants

A

Lichen simplex: chronic irritation by repeated scratching

Lichen planus: SKIN autoimmune disease that causes local chronic inflammation

133
Q

What is lichen sclerosus

A

White patches of skin over vulvua or penis

Itching, soreness, tightness, erosions

134
Q

What is the Koebner phenomenon

A

Signs or symptoms made worse my friction to skin

Seen in lichen sclerosus

135
Q

Management of lichen sclerosus

A

Cannot be treated

Follow up every 6 months as increased risk of cancer (5% risk of squamous cell)

Potent topical steroids (clobetasol)

136
Q

Do all cases of FGM need to be reported to police

A

ALL UNDER 18s

Not all over 18s. Review RCOG risk assessmemt

137
Q

Why do males not develop a uterus

A

Anti-mullerian hormone

138
Q

What do female genital organs develop from

A

Mullerian ducts

139
Q

Complications of a bicornuate uterus

A

Miscarriage, premature birth, malpresentation

140
Q

Why must a imperforate hymen be treated

A

Risk of retrograde menstruation which can lead to endometriosis

141
Q

Chromosome type of patient with androgen insensitivity syndrome

A

46XY i.e genetically male

142
Q

Young girl with an inguinal hernia and primary amenorrhoea

A

Androgen insensitivity syndrome

hernias = testicles

143
Q

What type of external genitalia do patients with androgen insensitivity syndrome have

A

Female external genitalia

No uterus, upper vagina, cervix, fallopian tubes or ovaries. Testes present

144
Q

4 hormone test results in androgen insensitivity syndrome

A

Raised LH
Raised (or normal) FSH

Raised oestrogen levels
Raised testosterone levels

145
Q

FSH and LH levels in menopause

A

Very high as no negative feedback from oestrogen

146
Q

Two most common types of cervical cancer

A

Squamous cell carcinoma (80%)

Adenocarcinoma

147
Q

Why does HPV lead to an increased risk of cervical cancer

A

Inhibit tumour suppressor genes P53 and pRb

148
Q

How long after pregnancy can you have a cervical smear

A

3 months

149
Q

What does LLETZ stand for

A

Large loop excision of the transformation zone

150
Q

What grade of CIN is cancer

A

None

CIN is dysplasia seen on colonoscopy (NOT SMEAR)

CIN 1 -3 are changes to cells which could progress to cancer

151
Q

Treatment for CIN 3

A

LLETZ or cone biopsy

Not cancer but high cancer of progression to cancer

152
Q

Treatment for Stage 1B - 2A cervical cancer

A

Radical hysterectomy

Chemotherapy and radiotherapy

153
Q

Cervical cancer stage 2B-4A

A

Chemo and radio only

154
Q

Cervical cancer staging system

A

FIGO

1-4

4 is bladder, rectum or beyond pelvis

155
Q

Two strains of HPV that cause genital warts

A

6 and 11

156
Q

Two main risk factors in UK for endometrial cancer

A

Obesity and diabetes

Age, no pregnancies, PCOS, late menopause

157
Q

How can non concerning endometrial hyperplasia be treated

A

Progesterones - IUS or mini pill

Careful follow up and monitoring

158
Q

Why is obesity a risk factor for endometrial cancer

A

Adipose tissue has aromatase
Converts testosterone into oestrogen
Unopposed oestrogen as no corpus letum to produce progesterone

159
Q

Why is it important to ask about breast cancer hx in an endometrial cancer hx

A

Tamoxifen has an anti-oestrogen effect on breast tissue only

160
Q

4 key cancers associated with Lyncc syndrome

A

Colorectal
Endometrial
Gastric
Ovarian

161
Q

How does smoking affect endometrial cancer risk

A

Increased pre menopause

May be protective after menopause as anti-oestrogen effects

162
Q

In women with endometrial cancer, what is the surgical treatment

A

TAH BSO

Total abdominal hysterectomy with bilateral salpingo-oophorectomy

163
Q

What type of tumour would show Signet Rings on histology

A

Krukenburg

Mets in ovary from a GI cancer

164
Q

Key RFs for ovarian cancer

A 
Age
BRAC
Obesity
Smoking
Use of clomifine

Increased number of ovulations

165
Q

Which guidelines for issuing contraception to young girls

A

Fraser

166
Q

Why may ovarian cancer cause hip or groin pain

A

Pressing on obturator nerve

167
Q

What does ovarian cancer RMI score use

A

Menopausal status
USS
CA125

168
Q

What additional blood tests do women under 40 with ?ovarian cancer need

A

Germ cell tumour bloods

AFP and bHCG

169
Q

Normal age of puberty in boys and girls

A

8-14 girls

9-15 boys

170
Q

Genetic condition causing hypogonadotrophic hypogonadism

A

Kallaman

Loses sense of smell!!

171
Q

What does congenital adrenal hyperplasia cause hormone levels to do

A

Low cortisol and aldosterone

172
Q

First line investigation in PMS

A

2 cycle diary of mood etc

173
Q

Drug used for physical symptoms of PMS

A

Spirolactone

174
Q

What are fibroids sensitive to

A

Oestrogen

175
Q

Over what size fibroid should women be referred to gynae

A

3cm

176
Q

What blood test would you do in women under 40 with menopausal symptoms

A

FSH

177
Q

Best imaging technique for adenomyosis

A

MRI

178
Q

Chickenpox exposure in pregnancy > 20 weeks and not immune

A

either oral antivirals or VZIG

179
Q

If cannot detect fetal hb on accus, what would you do next

A

USS

Leeds MBCHB Year 4 GOSH (10 decks)

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