Obs + Gynae Differentials Flashcards

1
Q

If a woman presented with early pregnancy bleeding, what would your differential diagnosis be?

A
  • Miscarriage
  • Ectopic pregnancy/PUL
  • Molar pregnancy
  • Implantation bleed
  • Genital tract trauma
  • Cervical pathology: - ectropion / polyp / malignancy
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2
Q

What are causes of antepartum haemorrhage?

A
  • Unexplained
  • Placenta praevia
  • Placental abruption
  • Local GI tract lesions
  • Vasa Praevia
  • Cervix - Cervical erosions/ectropion, Cervical Carcinoma, Cervical polyps, Cervicitis
  • Vulval varicosities
  • Anticoagulants
  • Bleeding diathesis
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3
Q

What are causes of primary PPH?

A

4 T’s - Tone, tissue, trauma, thrombin

  • Uterine atony
  • Genital tract trauma
  • Coagulation disorders
  • Large placenta
  • Abnormal placental site
  • Retained placenta
  • Uterine inversion
  • Uterine rupture
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4
Q

What are causes of intrapartum haemorrhage?

A
  • Placental abruption
  • Placenta Praevia
  • Uterine rupture
  • Vasa praevia
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5
Q

How would you distinguish placental abruption from placenta praevia asa a cause of antepartum haemorrhage?

A
  • Shock out of keeping with visible loss
  • Pain constant
  • Tender, tense uterus
  • Normal lie/presentation
  • Foetal heart distressed/abnormal
  • Coagulation problems
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6
Q

What might your differential diagnosis be for a pelvic mass?

A
  • Ovarian – ovarian cyst/benign tumour, ovarian cancer
  • Tubal – tubo-ovarian abscess, tubal malignancy (treat as ovarian)
  • Uterine – pregnancy, fibroids/benign tumour, uterine cancer
  • Urological – distended bladder, pelvic kidney, transplanted kidney
  • GI – the 6 Fs: fat, fluid, flatus, faeces, fetus, filthy big tumour
  • Other – primary peritoneal cancer, retroperitoneal sarcoma.
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7
Q

What would be your differential diagnosis for someone presenting with post-menopausal bleeding?

A
  • Trauma
  • Ovarian tumour
  • Endometrial causes - Endometrial atrophy, Endometritis/PID, endometrial polyps, endometrial hyperplasia, endometrial cancer
  • Cervical causes - cervicitis, cervical polyps, cervical cancer
  • Vulval causes - dermatitis, vulval dystrophy, cancer
  • Bleeding disorder
  • Metasatic cancer
  • GU/PR bleeding - rectal carcinoma, bladder cancer etc.
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8
Q

What are causes of post-coital bleeding?

A
  • Trauma
  • Ectropian
  • Cervicitis
  • Cervical/endometrial polyp
  • Cervical cancer
  • Vaginitis
  • Vaginal cancer
  • Vulval dermatitis
  • Vulval cancer
  • STI’s - gonorrhoea, chlamydia
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9
Q

What are causes of intermenstrual bleeding?

A
  • Physiological
  • Trauma
  • Ovarian tumour
  • Uterus - endometritis/PID, polyp, hyperplasia, cancer
  • Cervix - cervicitis, polyp, cancer
  • Vagina - vaginitis, cancer
  • Vulva - dermatitis, dystrophy, cancer
  • Pregnancy - miscarriage, ectopic, molar pregnancy
  • Systemic - bleeding disorder, metastatic cancer
  • Iatrogenic - IUCD, HRT, POP, depoprovera
  • STI’s - gonorrhoea, chlamydia
  • Bleeding from somewhere else - urethra, bladder, anus, rectum
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10
Q

What are causes of secondary dysmenorrhoea?

A
  • Adenomyosis
  • Endometriosis
  • PID
  • Fibroids
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11
Q

What is the most likely cause of primary amenorrhoea if secondary sexual characteristics are absent?

A

Most likely delayed puberty. Should also consider genetic causes - turner’s syndrome, androgen insensitivity

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12
Q

What can cause primary amenorrhoea?

A
  • Chromosomal problem - turner’s etc.
  • Hypothlalamic - Physiological delay, weight loss/anorexia, heavy exercise, GnRH deficiency
  • Pituitary - partial/total hypopituitarism, hyperprolactinaemia, adenoma, trauma
  • Ovarian - True agenesis, prem. ovarian failure, PCOS
  • Primary hypothyroid
  • Adrenal hyperplasia
  • Imperforate hymen
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13
Q

What are causes of secondary amenorrhoea?

A
  • Physiological - pregnancy, lactation, menopause
  • Hypothalamic - weight loss, heavy exercise, stress
  • Pituitary - hyperprolactinaemia, hypopituitarism
  • Ovarian - PCOS, prem. ovarian failure, surgery/radio/chemo, virilising ovarian tumours
  • Primary hypothyoridism
  • Adrenal hyperplasia/tumour
  • Hysterectomy
  • Endometrial ablation
  • Minera IUS
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14
Q

What are causes of menorrhagia?

A
  • Dyfunctional uterine bleeding
  • IUCD
  • Fibroids
  • Endometriosis
  • Adenomyosis
  • Pelvic infection
  • Polyps - endometrial, cervical
  • Hypothyroidism
  • Coagulation disorders
  • Endometrial carcinoma - post menopausal
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15
Q

What should you consider as differential diangosis for someone presenting with features of menopause?

A
  • Pregnancy
  • Hyperthyroidism
  • Hypothyroidism
  • Anorexia
  • Medications
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16
Q

What are causes of pruitis vulvae?

A
  • General pruritis
  • Skin disease - psoriasis, lichen planus
  • Infection - thrush
  • Allergy to detergents, fabric dyes
  • Infestation
  • Vulval dystrophy - lichen sclerosis, leukoplakia, carcinoma
17
Q

What are causes of vulval lumps?

A
  • Local varicose veins
  • Boils
  • Sebaceous cysts
  • Keratocanthoma
  • Viral warts
  • Primary chancre/Conylomata lata
  • Molluscum contagiosum
  • Bartholin’s Cyst/abscess
  • Uterine prolapse/polyp
  • Inguinal hernia
  • Varicocele
  • Carcinoma
18
Q

What can cause vulval ulcers?

A
  • Syphillis
  • HSV
  • Carcinoma
  • Chancroid
  • Lymphogranuloma venerum
  • Granuloma inguinale
  • TB
  • Behcet’s syndrome
  • Crohn’s Disease
19
Q

What are causes of vulvar bleeding?

A
  • Infection— STDs
  • Benign lesions — sebaceous (epidermal) cysts, condylomata, and angiokeratoma
  • Malignant and premalignant lesions
  • Vulvar cancer and VIN
  • Vulvar trauma - forceful sexual activity/assault or accidents
20
Q

What are causes of chronic pelvic pain?

A
  • Endometriosis
  • Adenomyosis
  • Ovarian cysts
  • Scar tissue and adhesions
  • IBS
  • Interstitial cystitis
  • Chronic PID
  • MSK - nerve entrapment
21
Q

What are causes of acute pelvic pain?

A
  • Gynae - ectopic pregnancy, miscarriage, acute PID, ovarian cyst - bleeding/rupture, ovarian torsion
  • GI - appendicitis, constipation, diverticular disease, IBS, intestinal obstruction
  • Urinary tract - UTI, calculi
  • Other - MSK