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Lucy Knox - Year 2 > 204 - Gynae > Flashcards

204 - Gynae Flashcards

1
Q

What is menorrhagia?

A

Heavy menstrual bleeding
during regular cycles
>80mls

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2
Q

What should you comment about the uterus in a vaginal exam?

A 
Size
Shape
Position
Mobility
Tenderness
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3
Q

When would you be given an outpatient endometrial biopsy if you have menorrhagia?

A

If over 40

? endometrial malignancy

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4
Q

What are 4 main differentials of menorrhagia?

A

DUB - Dysfunctional uterine bleeding
Fibroids
Endometriosis
Adenomyosis

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5
Q

What is DUB?

A

Heavy bleeding not associalted with any organic disease

Normal sized uterus

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6
Q

What are fibroids?

A

Benign growths in the uterus that can cause regular, heavy periods
Can enlarge uterus
Confirmed on US

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7
Q

What are the types of fibroid location you get?

A

Subserous
Intramural
Submucous

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8
Q

What is endometriosis?

A

Endometiral tissue foudn outside the uterus
Causes - painful periods. Bleeds when period is - anywhere
Can cause subfertility

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9
Q

What is adenomyosis?

A

Ectopic endometrial tissue found int he myometrium (muscle) of the uterus
Painful periods

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10
Q

There are 6 main types of medical management of menorrhagia - what are they?

A

1) Tranexamic acid
2) Mefenamic acid
3) COCP - pill
4) Oral progesterones
5) Mirena coil
6) GnRHa or Progestogens

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11
Q

What surgical options are there for menorrhagia?

A

Endometrial ablation - destruction of endometrium to basalis layer - v effective
Hysterectomy

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12
Q

What is PMB?

A

Post-menopausal bleeding

Vaginal bleeding >12 months after LMP

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13
Q

Why is investigating PMB important?

A

10% due to endometrial cancer!

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14
Q

What is the majority of PMB caused by?

A

80% due to atropic vaginitis - low oestrogen so vagina dries out + bleeds

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15
Q

What investigations would you do in PMB? What would cause you to do more?

A

TV US

if endometrium is thickened >5mm - send for biopsy or hysteroscopy

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16
Q

What is HRT?

A

Hormone replacement therapy

For relief of symptoms of ovarian function cessation (menopause)

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17
Q

What are the 3 types of HRT course?

A

E2 only
Sequential
Continuous combined

18
Q

Why is sequential recommended if you have a uterus and are going through the menopause?

A

If you are peri-menopausal, you need progesterone to cause a withdrawal bleed, as oestrogen alone thickens the lining which can increase the risk of developing cancer. Continue until age 54 then go to continuous combined, as uterus will be atrophic by then.

19
Q

After 24 months, what is your natural chance of falling pregnant?

A

90%

20
Q

What are the 3 main categories of causes of sub-fertility?

A 
Ovulatory disorders (25%)
Tubal disease (20%)
Sperm dysfunction (30%)
21
Q

What ovulatory causes may cause sub-fertility?

A

PCOS, Hypo-pit-ovarian axis issue, endocrine issues

22
Q

What is PCOS?

A

Excess androgen production (and less oestrogen conversion) - causes anovulation or sometimes olgio-ovulation

  • Follicular development arrests causing cyst like appearance
  • causes sub-fertility
23
Q

What treatment is available for PCOS?

A

Ovulation induction - Oestrogen antagonists (to inhibit negative feedback loop so increase FSH + LH).
eg. Clomifen citrate, tamoxifen

Synthetic Gonadotropins (FSH + LH)

Ovarian drilling

24
Q

How is the hypo-pit-ovarian axis affected to cause sub-fertility?

A

Affected by stress, eating disorders, low BMI, Radiotherapy, prolactinomas or idiopathic.

25
Q

What can cause tubal disease leading to subfertility?

A

Infective: chlamydia, Gonorrhoea
Inflam: endometriosis
Post op: traume, sterilisation

26
Q

What causes of sperm dysfunction are there?

A

Azoospermia - no sperm in ejaculate

Primary - failure of production (congenital, drug induced…)

Secondary/obstructive - Congenital absence of Vas deferens, infective, vasectomy

Oligozoospermia - Reduced Sperm Concentration
Asthenozoospermia - Poor Sperm Motility
Teratozoospermia - Abnormal Shaped Sperm

27
Q

What are the types of assisted contraception technologies available?

A

IUI - Intrauterine insemination
IVF - In vitro fertilisation
ICSI - Intracytoplasmic sperm injection

28
Q

What is hyperemesis Gravidarum?

A

Excess vomiting in pregnancy

29
Q

What could vaginal bleeding early in pregnancy be due to?

A

Miscarriage / threatened miscarriage

Ectopic?

30
Q

What % of recognised pregnancies end in miscarriage?

A

15-20%

31
Q

Do you get pain in a miscarriage?

A

Not usually

32
Q

What investigations are done for a ? miscarriage?

A

FBC, group and save
HCG - still pregnant?
U/S - in foetus in utero? Is there a heartbeat?

33
Q

If the foetus is non-viable, what management options are there?

A

Expectant - wait and see if it miscarries naturally
Medically - Mifepristone orally + Misoprostol PV/orally - causes dilation of cervix, enables miscarriage to complete
Surgically - Evacuation, if medical doesn’t work

34
Q

What is an ectopic pregnancy?

A

The embryo implants outside the uterus

35
Q

What symptoms might you get in a ectopic?

A

Minimal brownish bleeding, pain + tenderness

36
Q

What are risk factors for an ectopic?

A

Previous ectopic
Chlamydia - pelvic infection - scars
PID
Merina coil

37
Q

Where are most ectopics?

A

95% in ampulla of fallopian tube

38
Q

What investigations are useful in an ectopic pregnancy?

A

HCG - +ve, but doesn’t double every 24hrs as it should

US - empty uterus!

39
Q

Why is an ectopic a surgical emergency?

A

Internal bleeding a big risk as it grows and may rupture tube/where it is

40
Q

What are the management options of an ectopic?

A

Expectant - watch and wait
Medical - Methotrexate injection, an antimetabolite to kill ectopic
Surgical - Laparoscopy/laperotomy - remove tube + ectopic or part of tube

41
Q

What is a molar pregnancy?

A

CTD - Gestational trophoblastic disease
A Non-viable pregnancy
Excess proliferation of the placenta due to a chromosomal issue
Could be malignant - choriocarcinoma

42
Q

What symptoms may you get in a molar pregnancy?

A

Bleeding
Pain
Very bad morning sickness (as high HCG levels)

Lucy Knox - Year 2 (17 decks)

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