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REPRODUCTION > Gynaecological disorders > Flashcards

Gynaecological disorders Flashcards

1
Q

Define menorrhagia

A

Prolonged and increased menstrual flow

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2
Q

Define metrorrhagia

A

Regular intermenstrual bleeding

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3
Q

Define polymenorrhoea

A

Menses occurring at <21 day intervals

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4
Q

Define polymenorrhagia

A

Increased bleeding and frequent cycle

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5
Q

Define amenorrhoea

A

Primary = failure of menarche by age 16

Secondary = cessation of periods for >6 months in a patient who has previously menstruated

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6
Q

Define oligomenorrhoea

A

Menses at intervals >35 days / <9 times per year

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7
Q

What are some of the organic causes of menorrhagia?

A 
Fibroids 
Polyps  
Pelvic inflammatory disease 
Malignancy 
e.t.c
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8
Q

What are some of the systemic causes of menorrhagia?

A 
Endocrine disorders 
Liver disorders 
Renal disorders 
Disorders of haemostasis 
Drugs - anticoagulants
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9
Q

What is meant by ‘dysfunctional uterine bleeding’?

A

Menorrhagia in the absence of underlying pathology

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10
Q

Anovulatory DUB is more likely to occur in which patients?

A

Patients at the extremes of reproductive age and obese women

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11
Q

Ovulatory DUB is more likely to occur in patients of what age?

A

Women aged 35-35 years

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12
Q

What are some of the management options for DUB?

A

Medical therapy: Progestogens, COCP e.t.c

Progesterone releasing IUCD

Endometrial resection/ hysterectomy

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13
Q

Which micro-organisms are associated with causing endometriosis?

A

Neisseria

Chlamydia

TB

CMV

HSV

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14
Q

How do endometrial polyps present?

A

Usually ASYMPTOMATIC but may present with BLEEDING or DISCHARGE

Occurs around and after the menopause

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15
Q

What is adenomyosis and how does it present?

A

Endometrial glands and stroma within the myometrium

Menorrhagia and dysmenorrhoea

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16
Q

What is leiomyoma and how does it present?

A

Benign tumour of smooth muscle (can be found at locations other than the uterus)

Menorrhagia, infertility, mass effect and pain

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17
Q

Endometrial thickness can be determines by vaginal ultrasound. What thickness is an indication for biopsy to be performed?

A

> 4mm in postmenopausal women

16mm in premenopausal women

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18
Q

What is meant by the term vaginismus?

A

Involuntary tightening of the muscles around the vagina when penetration is attempted

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19
Q

What is meant by the term dyspareunia?

A

Pain during intercourse

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20
Q

What are the differentials for a uterine mass?

A

Endometrial cancer

Fibroids

Pregnancy

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21
Q

What are the differentials for a tubal swelling?

A

Ectopic pregnancy

Hydrosalpinx

Pyosalpinx

Paratubal cysts

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22
Q

What are the differentials for an ovarian mass?

A

Ovarian tumour/ cancer

Ovarian cysts

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23
Q

What are the differentials for an ACUTE presentation of a pelvic mass?

A

Cyst rupture

Fibroid degeneration

Ectopic pregnancy

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24
Q

What are endometrial polyps?

A

Benign outgrowths of stroma and glands

Often occur around the menopause

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25
Q

What hormone is responsible for endometrial hyperplasia?

A

Oestrogen causes endometrial proliferation

Progesterone usually causes shed at menstruation, so unopposed oestrogen causes hyperplasia

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26
Q

What is the biggest risk factor for endometrial hyperplasia?

A

Obesity

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27
Q

How is endometrial hyperplasia managed?

A

Mirena coil

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28
Q

What is the most common type of endometrial carcinoma?

A

Adenocarcinoma

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29
Q

What underlying conditions should you consider in young women presenting with endometrial cancer?

A

PCOS

Lynch syndrome - HNPCC

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30
Q

How does endometrial cancer present?

A

Post menopausal bleeding

Heavy or irregular bleeding in pre-menopausal women

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31
Q

What is the gold standard management for endometrial cancer

What other management options are there?

A

Hysterectomy

Chemo and radiotherapy

Hormonal therapy with progesterone only - mirena coil or oral progesterone

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32
Q

What are the 2 types of endometrial carcinoma?

A

Endometrioid carcinoma and serous carcinoma

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33
Q

What is the most common type of endometrial carcinoma?

A

Endometroid

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34
Q

Why is obesity a risk factor for endometrial carcinoma?

A

Adipocytes express aromatase which converts ovarian androgens to oestrogen

Oestrogen causes endometrial proliferation

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35
Q

What is Lynch syndrome?

A

Cancer predisposition syndrome

High risk of colorectal cancer and endometrial cancer in women

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36
Q

What are leiomyomas?

A

Fibroids

benign smooth muscle tumours on the uterus

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37
Q

When do fibroids get bigger and when do they get smaller?

A

Fibroids are oestrogen dependent and so enlarge in pregnancy and when on the OCP

They atrophy after the menopause

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38
Q

How do fibroids present?

A

Menorrhagia

Infertility

Pelvic mass

Pain/ tenderness

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39
Q

What investigations are done for fibroids?

A

US

MRI

Hb if bleeding is heavy

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40
Q

What is a leiomyosarcoma?

A

Malignant smooth muscle tumour

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41
Q

What is the most common uterine sarcoma?

A

Leiomyosarcoma

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42
Q

What is the prognosis like for leiomyosarcoma?

A

Poor - 14-25% 5 year survival rate

43
Q

What are functional ovarian cysts?

A

Follicular cysts or cysts from the corpus luteum

44
Q

How do functional cysts present?

A

Often asymptomatic

Menstrual disturbance, pain

45
Q

What is endometriosis?

A

Endometrial glands and stroma outside the uterine body (in the wrong place)

46
Q

How do endometriomas on the ovaries present?

A

Severe dysmenorrhoea and premenstrual pain

Dyspareunia

Subfertility

Tender mass

47
Q

How are ovarian tumours managed if they are benign vs malignant?

A

benign - removal/ drainage

malignant - surgery/ chemo

48
Q

What are the 4 main types of epithelial ovarian tumours?

A

Serous

Mucinous

Endometrioid

Brenner (transitional)

Clear cell

(serous and mucinous are the most common)

49
Q

What is the most common benign ovarian tumour?

A

Serous cyst adenomas

epithelial tumour

50
Q

Which ovarian tumour can become enormous?

A

Mucinous

epithelial tumour

51
Q

Chocolate cysts are what type of ovarian tumour?

A

Endometrioid

epithelial tumour

52
Q

What type of ovarian tumour is derived from transitional type epithelium?

A

Brenner

53
Q

What are the main types of germ cell tumours of the ovary?

A

Benign cystic teratoma

Malignant germ cell tumour (choriocarcinomas)

Dysgerminoma

54
Q

What is the most common ovarian tumour in young women?

A

Benign cystic teratoma?

55
Q

Which type of ovarian tumour is totipotential (capable of developing into any body cell type) and may have components of hair, teeth, thyroid tissue etc?

A

Benign cystic teratoma

56
Q

Which type of ovarian tumour occurs almost exclusively in children and young women?

A

Dysgerminoma

57
Q

What are the main types of sex chord/ stromal ovarian tumours?

A

Granulosa cell tumours

Sertoli-Leydig cell tumours

Fibromas

58
Q

Which ovarian tumour may cause hirsutism and virilisation?

A

Sertoli-Leydig cell tumours

59
Q

What 3 things make up Meig’s syndrome?

A

Ovarian fibromas

Ascites

Pleural effusions

60
Q

How does ovarian cancer present?

A

Bloating/ ascites

Abdominal pain

Weight loss / loss of appetite

61
Q

What are the genetic associations of ovarian cancer?

A

BRCA 1 & 2

HNPCC (Lynch syndrome)

62
Q

What are the risk factors and protective factors for ovarian cancer?

A

With each ovulation the ovary is damaged slightly - so things associated with more ovulation are risk factors and those associated with less are protective

Risk factors; increasing age, early menarche and late menopause, FH

Protective factors; OCP, pregnancy and breast feeding, tubal ligation

63
Q

What are the tumour markers for ovarian cancer?

A

CA 125

CEA

64
Q

What investigations are done for ovarian cancer?

A

Tumour markers

Cytology of pleural/ ascitic fluid

Imaging; US/ CT

65
Q

What are the treatment options for ovarian cancer?

A

Hysterectomy and bilateral salpingectomy

Chemotherapy; carboplatin + paclitaxel

Hormonal therapy; tamoxifen/ aromatase inhibitors

66
Q

What causes cervical cancer?

A

70% caused by HPV 16 and 18

30% caused by other strains of HPV or very rarely due to Peutz-Jeghers syndrome

67
Q

What are the risk factors for cervical cancer?

A

HPV
- Early age of intercourse/ many partners

Smoking

OCP

68
Q

How does cervical cancer present?

A

PCM/ IMB/ PMB

69
Q

How is ovarian cancer treated?

A

Surgery

Radiotherapy

Chemotherapy (cisplatin/ cargo-latin)

70
Q

What are the management options for an overactive bladder?

A

Bladder training

Antimuscarinics

B3 agonists

Desmopressin

Botox

71
Q

Give an example of an antimuscarinic drug which can be used in the management of overactive bladder

A

oxybutynin

72
Q

Give an example of a B3 agonist which can be used in the management of overactive bladder

How do B3 agonists work?

A

Mirabegron

Inhibit contractions and increase relaxation of bladder smooth muscle

73
Q

What are the management options for stress urinary incontinence?

A

Weight loss and pelvic floor exercises

Duloxetine

Surgery

74
Q

What are the symptoms of a prolapse?

A

Pressure and dragging sensation

Difficulty voiding/ defecating/ inserting a tampon

Pain on intercourse

75
Q

What is a cystocele?

A

Bladder herniates/ bulges into the vaginal wall

76
Q

What is a rectocele?

A

Rectum herniates/ bulges into the posterior wall of the vagina

77
Q

What is an enterocele?

A

Loops of intestine herniate/ bulge into the vaginal wall

78
Q

What is a uterine prolapse?

A

Protrusion of the uterus downwards into the vagina

79
Q

What is uterine providentia?

A

The uterus lies outside the vagina

80
Q

What are the management options for prolapse?

A

Weight loss

Pessary

Surgery

81
Q

When can topical oestrogens be used for OAB?

A

Topical oestrogens can be used for OAB if there is atrophy of the vaginal mucosa

82
Q

How is PCOS inherited?

A

Autosomal dominant inheritance

83
Q

2/3 of which criteria are needed for diagnosis of PCOS?

A

Chronic anovulation

Polycystic ovaries

Hyperandrogenism (clinical or biochemical)

84
Q

What are the biochemical/ hormone levels in a patient with PCOS?

A

Low progesterone

High LH and FSH

Normal oestrogen

85
Q

What are the treatment options for PCOS?

A

WEIGHT LOSS

Metformin

Oral contraceptive pill

Antioestrogens (clomifene citrate and tamoxifen)

Aromatase inhibitors

Laparoscopic surgery

86
Q

What is premature ovarian failure?

A

Cessation of menstruation eat <40 years of age

87
Q

What hormone levels are required for diagnosis of premature ovarian failure?

A

FSH> 30 on 2 separate occasions 1 month apart

88
Q

What are the biochemical/ hormone levels in a patient with premature ovarian failure?

A

High LH and FSH

Low oestrogen

89
Q

What is hydrosalpinx?

A

Distally blocked fallopian tube

90
Q

Where is the pain in a patient with ovarian torsion?

A

Left iliac fossa

Right iliac fossa; appendicitis

91
Q

Do lesbians who have never had sex with a male partner need to have cervical screening?

A

Yes

HPV can be transmitted through lesbian sex

92
Q

How often should women aged 50-64 have cervical smears taken?

A

Every 5 years

93
Q

What is the only definitive treatment for adenomyosis?

A

Hysterectomy

94
Q

What test should be performed in ALL women presenting with heavy menstrual bleeding?

A

FBCs

95
Q

What are the management options for menorrhagia in women who do not require contraception?

A

Mefenamic acid or tranexamic acid

both started on the first day of the period

96
Q

What are the management options for menorrhagia in women who do require contraception?

A

IUS (mirena coil) is first-line
COC
Long acting progestogens

97
Q

What condition presents with cyclical pain and development of secondary sexual characteristics, but no menstruation?

A

Inperforate hymen

98
Q

How can metformin be used to improve fertility in PCOS?

A

Metformin acts to increase peripheral insulin sensitivity

This is beneficial as most patients with PCOS have some degree of insulin resistance which affects the hypothalamic pituitary ovarian axis

99
Q

What are some of the risk factors and protective factors for endometrial cancer?

A

Risk factors

  • PCOS
  • Nulliparity
  • Oestrogen only HRT
  • Tamoxifen

Protective factors

  • COCP
  • Smoking
100
Q

What are the main red flags for ovarian cancer?

A

Bloating
Abdominal pain
Fluctuating bowel habit

101
Q

Which type of cervical cancer has better prognosis?

A

Squamous cell carcinomas have better prognosis than adenocarcinomas

102
Q

What are the treatment options for vulval cancer?

A

Radical vulvectomy

+/-

Inguinal lymphadenopathy

103
Q

Which type of ovarian cancer is the most associated with the BRCA mutation?

A

Serous epithelial ovarian cancer

104
Q

Why are progesterone only hormonal therapies used in the management of endometrial cancer?

A

To balance out the unopposed oestrogen

REPRODUCTION (12 decks)

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