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Finals revision > Gynaecology > Flashcards

Gynaecology Flashcards

1
Q

Name 4 risk factors for a prolapse

A

Prolonged 2nd stage labour
Instrumental delivery
Menopause
multiple vaginal delvieries
Older age
Obesity
chronic cough
chronic constipation

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2
Q

Name 4 symptoms of a prolapse

A

Heavyness
dragging sensation
urinary sx - frequency / urgency
bowel sx - constipation / incontinence
sexual dysfucntion - dysparerunia

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3
Q

What are the examination findings in a patient with a prolapse

A

Abdominal exam
Bimanulal exam - protrusion
- Ask patient to cough or bear down
- stress incontinence

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4
Q

Outline the management of a prolpase

A

Conservative
- Weight loss
- Pelvic floor exercises
- mx chronic risk factors

Medical
- Pessary
- vaginal oestrogen protects vaginal walls from irritation
Surgical repair

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5
Q

Name 5 risk factors for stress and urge urinary inconteinence

A

Urge
- high BMI
- Recurrent UTIs
- Older age
- Smoking

Stress
- Post childbirth
- Instrumental delivery
- Prolonged 2nd stage delivery
- Post hysterectomy
- Older age
- Prolapse
- Post-menopausal

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6
Q

What is stress incontinence

A

An increase in intrabdominal pressure leads to urine leakage due to weak pelvic floor

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7
Q

What investigations are required for incontinence

A

Urien dipstick and culture - infection / haematuria
Vaginal examination - R/O prolpase
Bladder diary
Urodynamic studies

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8
Q

What is the management of stress

A

1st - Keegle exercises / weight loss / reduce caffeine intake/ smoking cessation

2nd - Duloxetine / Burch cloposuspension

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9
Q

How is urge incontienence managed

A

1st line - bladder retraining

2nd line - Antimuscarinic
- Oxybutinin
- Tolteradine

3rd line - Botulinium toxin

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10
Q

Give 3 causes of delayed puberty

A

Athlete
ED
Chronic disease

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11
Q

How does ovarain torsion present - Sx and signs

A

Twisting of ovary on ligamentous supports - typically due to ovarian mass

Sudden onset Colicky abdominal pain
N+V
Fever

Adnexal tenderness and mass

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12
Q

How is ovarian torsion investigated and managed

A

1st line - TVUS - Whirlpool sign
2nd line - Doppler studies
Diagnostic and theraputic - Laparoscopy

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13
Q

What investigations are required in acute pelvic pain

A

Urinalysis + MSU
Pregnancy test
FBC / CRP / TFT / LFT
HVS + ECV
TVUS

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14
Q

What is a follicualr cyst

A

commonest ovarian cyst
non-rupture of dominant follicle
regresses after several menstrual cycles

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15
Q

Name to physiological cysts

A

Follicular
Corpus luteum

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16
Q

Name 3 pathological cysts

A

Endometrioma
PCO - ring of pearls
Theca luteum cyst - occurs in conditions with high B-Hcg

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17
Q

Name 3 benign epithelial neoplastic cysts

A

Epithelial - common in post menopausal women
serous cystadenoma
mucinous cystadenoma
Brenner

Germ cell - dermoid
Assosciated with torsion
Rokitansky protuberence

sex cord stromal - fibroma
Meigs syndrome

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18
Q

Name 4 sx assosciated with ovarian cysts

A

Asx
Dull ache abdominal pain
Dyspareunia
Irregular vaginal bleeding
bloating
fullness in abdomen

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19
Q

Name 4 Ix when suspecting ovarian cysts

A

Pregnancy test
Bloods
- FBC / Ca125
TVUS
Laparoscopy - diagnsotic

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20
Q

What additional blood tests are required in women <40 with an ovarian cyst

A

Teratoma
- LDH
- AFP
- HcG
- Inhibin

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21
Q

Name 4 causes of raised Ca125

A

Endometriosis
Ovarian cancer
Fibroids
Adenomyosis
Pregnancy

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22
Q

What indicates a 2ww referral in patients with an ovarian cyst

A

complex cysts
raised Ca125

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23
Q

What is endometreosis

A

Ectopic growth of endometrial tissue outside of uterine cavity

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24
Q

Name 4 common sites for endometriosis

A

Uterosacral ligaments
On ovaries
Pouch of douglas

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25
Q

Name 4 risk factors for endometreosis

A

early menarche
late menopause
nuliparity
FHx

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26
Q

Name 2 protective factors for endometreosis

A

multiparity
COCP

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27
Q

Name 4 sx of endometreosis

A

Cyclical pelvic pain
Secondary dysmenorrhoea - pain starts before bleeding
subfertility
dyspareunia
urgency
dyschezia

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28
Q

Describe signs / examianiton findings on a patient with endometreosis

A

endometrial tissue visible - posterior fornix
fixed retroverted uterus
tenderness in vagina / cervix / adexna

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29
Q

What investigations are required in endometriosis

A

TVUS - Endometrioma / chocolate cysts

Laparoscopy + biopsy - diagnostic

30
Q

Outline the management of endometriosis

A

C - Fluids / exercise

M -
1st line - NSAIDs / paracetamol

Not wanting to conceive
- COCP / POP / Depot / Implant / Mirena / GnRH agonist

S -
Not wanting to conceive - Hysterectomy + salpino-oophrectomy
wanting to conceive - Laparoscopy + adhesiolysis

31
Q

What causes infertility in endometreosis

A

adhesions
tubal + ovarian dysfunction
oocyte toxicity

32
Q

How do hormonal treatments manage endometriosis?

A

Stops ovulation and reduce endometrial thickening

33
Q

What is a fibroid

A

Benign smooth muscle tumour of uterus

34
Q

Name 4 RF for fibroids

A

Early menarche / Late menopause
Afro-caribbean
Obesity
Perimenopausal
FHx
Increasing age

35
Q

Name 3 protective factors for fibroids

A

POP
Pregnancy
Late puberty

36
Q

Name 4 sx of fibroids

A

Dysmenorrhoea
Menorrhagia
Deep Dyspareunia
Subfertility
Frequency / Urgency
Blaoting and feeling of fullness

37
Q

Name signs / examination findings of fibroids

A

Irregular shaped
Firm
Non-tender
Enlarged

38
Q

Outline the management of fibroids

A

Not wanting to conceive
- IUS
- COCP
- Injectable progesterone
- myomectomy
- uterine artery embolisation

Wanting to conceive
- NSAIDs
- Tranexamic acid
- ablation
- hysterectomy

39
Q

What is adenomyosis

A

Growth of endometrial tissue in myometrium
- more common in multiparous
- women > 40

40
Q

Name 3 sx of adenomyosis

A

Dysmenorrhoea
menorrhagia
dysparerunia
Infertility

41
Q

What is found on examination of adenomyosis

A

Bimanual - large, tender boggy uterus

42
Q

What Investigations are required for a patient with suspected adenomyosis

A

TVUS
MRI - if TVUS not suitable
Hysterectomy + histology - gold standard

43
Q

What is PID

A

Inflammation and infection of organs in pelvis caused by ascending spread of infection up through the cervix

44
Q

Name 3 causes for PID

A

Chlamydia
Gonorrhoea
Mycoplasma genitalium
Gardenella vaginalis

45
Q

Name 4 RF for PID

A

No barrier contraception
multiple sexual partners
early age of intercourse
IUD
Previous PID
Younger age
Existing STI

46
Q

How does PID present - sx

A

Chronic pelvic pain
abnormal vaginal discharge
IMB / PCB
Dysparerunia
Fever
Dysuria

47
Q

What examination findings are present in PID

A

Pelvic tenderness
vaginal discharge
cervicitis
cervical excitation

48
Q

What investigations are required in a patient with suspected PID

A

NAAT - Gonorrhoea / chlamydia
NAAT - Mycoplasma genitalium
HIV
Syphilis

HVS

Pregnancy test

Bloods - FBC / CRP

49
Q

Outline the different strains of HPV and what they cause

A

6+11 - genital warts

16+18 - cancer

50
Q

What other cancers does HPV cause

A

cervical
anal
vulval
penile
throat
mouth

51
Q

Name 3 protective factors for ovarian cancer

A

COCP
Parity
Breastfeeding
Early menopause

52
Q

Name 4 sx of ovarian cancer

A

Bloating
abdominal distension
abdominal pain
early satiety
change in bowel habit
urinary sx - urgency

53
Q

What is the diagnostic investigation

A

Laparoscopy

54
Q

Name 5 RF for endometrial cancer

A

Unopposed oestrogen
tamoxifen
Obesity
DM
PCOS
Early menarche
Nuliaprity
late menopause

55
Q

Name 2 protective factors for endometrial cancer

A

COCP
Multiparity

56
Q

What are the presenting sx of endometrial cancer

A

PMB
Pre menopausal - Menorrhagia / IMB

57
Q

What are the parameters for a 2ww referal for endometrial cancer

A

> 55 y/o + PMB

58
Q

What are the age ranges for cervical cancer scrrening

A

every 3 years: 25 - 49
every 5 years: 50-64

59
Q

Name 4 RF for cervical cancer

A

COCP
Early first intercourse
multiple sexual partners
HIV
Smoking
high parity

60
Q

Describe the staining used for colposcopy

A

Acetic acid - abnormal cells appear white

Iodine test - health cells stain brown and abnormal cells do not stain

61
Q

What is the most common form of cervical cancer

A

SCC
Adenocarcinoma - rising as screening identifies more SCC

62
Q

What are the sx of cervical cancer

A

PCB / IMB / PMB
Discharge
Dyspareunia

63
Q

What is ectopion

A

Eversion of columnar epithelium of cervix

64
Q

Name 3 RF for ectropion

A

Pregnancy
COCP
Puberty

65
Q

Name 4 features of PCOS

A

Infertility
Oligomenorrhoea
Hirsturism
Acne
Obesity
Acanthosis nigricans

66
Q

What investigations are required in a patient with suspected PCOS

A

Bloods
- Raised LH:FSH
- raised serum testosterone
- low sex hormone binding globulin

TVUS

67
Q

What criteria is used in PCOS

A

Rotterdam criteria
- Oligomenorrhoea
- Serum or phsyical signs of high testosterone
- TVUS
>12 Antral follicles
Ovarian volume > 10

68
Q

Name 4 complications of PCOS

A

DM
CVD
Endometrial cancer
OSA
Depression

69
Q

What are some sx of a polyp

A

Menorrhagia
Discharge
PCB
IMB

70
Q

Name 3 causes of PMB

A

Cancer
Polyp
HRT
Trauma
Vaginal atrophy

71
Q

What are the sx of atrophic vaginitis

A

vaginal dryness
dysparerunia
PCB
Polyuria
Nocturia

72
Q

Name 4 signs of atrophic vaginitis

A

decrease pubic hair
lack of vaginal folds
pale mucosa
thin skin
dry
Painful examination

Finals revision (17 decks)

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