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3A > Gynaecology > Flashcards

Gynaecology Flashcards

1
Q

Fibroids aetiology

A

Benign proliferation of smooth muscle
Oestrogen responsive

Enlarge during pregnancy
Calcify during menopause

RFs

  • Afro-Caribbean
  • Early menarche
  • Younger women
  • Family Hx
  • Genetic - Fumarate hydratase

Protective…

  • COCP
  • Late menarche
  • Parity
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2
Q

Fibroids presentation

A

Dysfunctional BLEEDING!

  • Menorrhagia
  • Dysmenorrhoea
  • Intermenstrual

Bloating
Urinary urgency
Suprapubic pain

SUBFERTILITY!

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3
Q

Fibroids investigations

A

O/E - BULKY UTERUS

TVUS

MRI - Adenomyosis?
FBC - Anaemia

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4
Q

Fibroids management

A
  1. MIRENA COIL

< 3cm + HMB

  • Tranexamic acid
  • NSAIDS
  • Progesterones
  • COCP

> 3cm + HMB

  • Ullipristal acetate
  • Surgery

Myomectomy - If looking to conceive

Ablation
Hysterectomy
Uterine artery embolisation

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5
Q

Fibroids complications

A

Subfertility

Degeneration

  • Hyaline
  • Cystic
  • Calcification

Red degeneration - Blood in fibroid

  • Occurs in pregnancy
  • N/V + Abdo pain + fever
  • NSAIDS + Rest

Torsion of pedunculated

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6
Q

Fibroids pregnancy complications

A

Premature labour
Obstructed labour

Malpresentation
PPH

Red degeneration

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7
Q

Adenomyosis aetiology / presentation / investigations / management

A

Endometrial tissue in the myometrium

RFs

  • Multiparous
  • Age ^^^

Boggy uterus
Dysmenorrhoea
Menorrhagia

Investigations - MRI

Management

  • GnRH analogue
  • Hysterectomy
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8
Q

Endometrial hyperplasia

A

Abnormal proliferation of endometrium outside normal menstrual cycle

Cancer risk!

Presentation - Dysfunctional bleeding

Management

  • Typical - High dose progesterones - MIRENA COIL
  • Atypical - Hysterectomy
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9
Q

Endometriosis aetiology + location

A

Endometrial tissue outside the uterine cavity

  • Uterosacral ligament
  • Ovaries

Cause - UNKNOWN

  • Retrograde menstruation
  • Impaired immunity
  • Genetic
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10
Q

Endometriosis presentation

A

Pain!

  • Deep dyspareunia
  • Cyclical dysmenorrhoea - Before period

Subfertility

Urinary symptoms

  • Dysuria
  • Urgency

Dyschezia

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11
Q

Endometriosis investigations + examination

A

O/E

  • Reduced organ motility
  • Tender modularity in posterior fornix
  • Fixed retroverted uterus

Laparoscopy and biopsy
- Endometrium outside the uterine cavity

TVUS - Look for ovarian cysts
Ca125
MRI - Adenomyosis

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12
Q

Endometriosis management

A

Analgesia

Stop cycle

  • COCP
  • Mirena coil
  • Progesterones

Secondary care

  • GnRH analogue
  • Surgery - Ablation
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13
Q

Endometriosis complications

A

Fibroids
Adhesions

Subfertility
Ectopic pregnancy

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14
Q

Endometrial cancer risk factors

A

75% post-menopausal

Unopposed oestrogen

Obesity
Diabetes

Early menarche
Late menopause
Nulliparity

Hereditary non-polyposis colorectal cancer - HNPCC
PCOS

Tamoxifen

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15
Q

Endometrial cancer types / presentation

A

Adenocarcinoma
Adenosquamous - Poor prognosis

PMB
PMB
PMB

Intermenstrual bleeding
Pain

Pyometra - Uterine infection

B-symptoms - Fatigue and weight loss

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16
Q

Endometrial cancer investigations

A

2WW REFERRAL!!!!

TVUS

Hysteroscopy and biopsy > 4mm thickness

CT/MRI staging

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17
Q

Endometrial cancer staging and management

A
  1. Confined to uterus - Hysterectomy and BSO
  2. Uterus and cervix - Radical hysterectomy*
  3. Uterus, cervix, serosa - Chemo and radiotherapy
  4. Distant mets - Chemo and radiotherapy
  • Radical hysterectomy
  • Uterus
  • Ligaments
  • 1” of vagina

Prognosis - Early detection - GOOD!

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18
Q

PMB DDx

A
  1. Endometrial cancer
  2. Vaginal atrophy

Endometrial hyperplasia

HRT spotting

Ovarian cancer
Ovarian cyst

Cervicitis
Cervical cancer

Vaginal cancer

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19
Q

Intrauterine cysts / polyps

A

Risk factors - OESTROGEN

  • Late menopause
  • Early menarche
  • Obesity
  • Nulliparity
  • Diabetes
  • PCOS

PC - Dysfunctional bleeding
Ix - TVUS
Rx - Curettage / Diathermy
Complications - Cancer and subfertility

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20
Q

Cervical histology

A

Uterus - Simple columnar

Endocervix - Glandular ciliated columnar - Adenocarcinoma

Transformational zone - Squamocolumnar junction - Malignancy risk

Ectocervix - Stratified squamous epithelium

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21
Q

Cervical screening age groups / method

A

< 25 - Not offered - Screening not shown to reduce number of cancers

25-49 - Every 3 years
50-64 - Every 5 years

Immunocompromised - Annually

Liquid based cytology - Examination of cervical cells

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22
Q

Cervical screening results and management

A

Normal - Repeat in 3/5 years

Inadequate

  • Repeat smear
  • If 2 inadequate - Refer for colposcopy

Borderline - Mild dyskaryosis

  • HPV test
  • Positive - Refer for colposcopy
  • Negative - Return to routine

Moderate or severe dyskaryosis
- 2ww colposcopy referral

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23
Q

CIN aetiology

A

Pre-malignant state
Atypical cells present in squamous epithelium

70% SCC
15% Adenocardinoma
15% mixed

HPV - 16, 18, 33

Sexual partners ^^^
Smoking
Immunosuppression

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24
Q

CIN presentation

A

Post-coital bleeding
Intermenstrual bleeding
Post-menopausal bleeding

Vaginal discharge

Asymptomatic?

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25
Q

CIN investigations / grading / management

A

Colposcopy
Punch biopsy

CT-PET

  1. Dyskaryosis in 1/3 epithelium
  2. Dyskaryosis in 2/3 epithelium
  3. Dyskaryosis in > 2/3 - Carcinoma in situ

Malignant - Invasion of basement membrane

LLETZ - Large loop excision of transformational zone

REPEAT SMEAR IN 6 MONTHS!

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26
Q

Cervical ectropion
RFs
Presentation
Management

A

Endocervix spreads to ectocervix - EVERSION

RFs - OCP and pregnancy

Presentation

  • PCB
  • Discharge

Management

  • Stop OCP
  • Cryotherapy
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27
Q

Cervicitis
Presentation
Management

A

Infection of the cervix

Presentation - Discharge

Management

  • Antibiotics
  • Antivirals
  • Antifungals
  • Cryotherapy
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28
Q

Cervical polyps
Presentation
Management

A

Aetiology

Benign tumour of the cervix

Presentation

  • IMB
  • PCB

Management - Avulsion

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29
Q

Cervical cancer staging

A
  1. Confined to cervix
    2a. Cervix and upper vagina
    2b. Cervix, upper vagina and parametrium
  2. Cervix, upper vagina, parametrium, lower vagina and pelvic wall
  3. Cervix, upper vagina, parametrium, lower vagina, pelvic wall, bowel, bladder and other structures
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30
Q

Cervical cancer management

A
  1. Cone biopsy

Pelvic nodes -ve - Hysterectomy
Pelvic nodes +ve - Radical hysterectomy

2a. Hysterectomy, radiotherapy, chemotherapy

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31
Q

Ovarian cyst types

A

Physiological

  • Follicular
  • Corpus luteum

Benign cell tumour - Dermoid cyst

Benign epithelial tumour

  • Serous cystadenoma
  • Mucinous

Benign sex cord tumour
Fibroma

32
Q

Ovarian cyst - Physiological

A

Follicular

  • Non-rupture of dominant follicle
  • Regress after a few menstrual cycles

Corpus luteum

  • Corpus luteum does not break down
  • Fills with blood or fluid
33
Q

Benign germ cell tumour

A

Dermoid cyst

Skin
Hair
Teeth

Seen in < 30

34
Q

Benign epithelial tumour

A

Serous cystadenoma

  • Seen in 40-50s
  • Can be malignant

Mucinous

  • Very large
  • May rupture to become pseudomyxoma peritonei
35
Q

Ovarian cyst presentation / investigations

A

Bloating
Lower back pain
Deep dyspareunia

Early satiety
Dyschezia
Urinary symptoms

TVUS

Ca125 - Rule out cancer
Laparoscopy - Aspiration
MSU
hCG

36
Q

Ovarian cyst management

A

Pre-menopausal < 5cm - Watch and wait
Pre-menopausal > 5cm - Laparoscopic ovarian cystectomy

Post-menopausal < 5cm - Watch and wait
Post-menopausal > 5cm - Bilateral oophorectomy

37
Q

Ovarian cyst complications

A

Torsion

  • Fever
  • Abdo pain
  • Vomiting

Rupture

  • Abdo pain
  • Shock

Haemorrhage
Peritonitis

38
Q

Ovarian torsion aetiology

A

Ovary twists on supporting ligaments
Blood supply is compromised

Fallopian tube involvement = Adnexal torsion

Ovarian cyst
Ovarian cancer
Pregnancy
Fertility treatments

39
Q

Ovarian torsion presentation / investigations / management

A

Fever
Colicky abdo pain
Vomiting
Adnexial mass

Examination - Adnexal tenderness

USS

  • Free fluid
  • Whirlpool sign

Management - Laparoscopy

40
Q

Ovarian cancer - Aetiology

Risk factors vs Protective factors

A

Oestrogen responsive
80% serous carcinoma

RFs - BRCA!!!

  • HNPCC
  • Nulliparity
  • Early menarche
  • Late menopause

Protective…

  • COCP
  • Pregnancy
41
Q

Ovarian cancer presentation / investigations

A

IBS symptoms

  • Early satiety
  • Abdo pain
  • Change in bowel habit

Urinary symptoms

  1. Ca125
  2. If > 35 - Urgent USS - Abdo and pelvis
  3. Laparotomy and biopsy to confirm
42
Q

Ovarian cancer risk of malignancy index

A

U x M x Ca125

U - USS findings - BAMMS
M - Menopausal status

Score > 125 - Requires MDT and staging

43
Q

Ovarian cancer - USS findings

A

BAMMS

Bilateral lesions 
Ascites 
Mets 
Multilocular cysts 
Solid areas
44
Q

Ovarian cancer staging and management

A
  1. Ovary
  2. Pelvic
  3. Abdo invasion
  4. Mets outside the abdomen

Surgery
Radiotherapy
Platinum based chemo

45
Q

Hyatidiform mole aetiology

A

Gestational trophoblastic disease

Implantation of non-viable foetus

Asian
Extremes of age
Previous HM

46
Q

HM presentation

A

hCG ^^^

Hyperemesis gravidarum
Painless menstrual bleeding - Obvs weird when they’re preggo

Hyperthyroid picture - hCG mimics T4

Proteinuria
HTN
Abdo pain

47
Q

HM investigations

A

hCG ^^^
Urine dip - Proteinuria
BP - HTN

USS

  • Snowstorm appearance
  • Bunch of grapes
  • Honeycomb
48
Q

Menorrhagia aetiology

A

Bleeding that patient deems to be excessive or abnormal

Idiopathic - 50%
Fibroids - 30%

Uterine

  • Fibroids
  • Polyps
  • Adenomyosis

Systemic

  • Thyroid
  • Bleeding disorders
  • Diabetes
  • Obesity

Iatrogenic

  • Anticoags
  • IUD - Copper coil
49
Q

Menorrhagia investigations

A

FBC

Other bloods if indicated…

  • TFT
  • Clotting
  • LFTs

TVUS - Fibroids?

50
Q

Menorrhagia management

A

Treat anaemia

Contraceptives…

  • Mirena coil
  • COCP

Non-contraceptives

  • Tranexamic acid
  • Mefenamic acid - Pain relief
51
Q

Dysmenorrhoea aetiology and management

A

Idiopathic - Normal?

Endometriosis

Adenomyosis
Fibroids
PID
Ovarian tumour

Management - Treat cause

  • Mefenamic acid
  • COCP
  • TENS
52
Q

PCB causes

A

Cervical ectropion
Cervical cancer

Cervicitis
Cervical polyps

Trauma

53
Q

IMB causes

A

Non-malignant

  • Fibroids
  • Uterine polyps
  • Adenomyosis
  • Ovarian cyst
  • PID

Malignant

  • Endometrial cancer
  • Ovarian cancer
  • Cervical cancer
54
Q

IMB investigations and management

A

FBC
TFT
Clotting

Cervical smear if due?

TVUS

Management

  • IUD
  • COCP
55
Q

Acute pelvic pain DDx

A

Woman of childbearing age - Ectopic until proven otherwise!

Mittleschmerz - Pain midway through menstrual cycle - Normal
Miscarriage

Ovarian cyst rupture
Ovarian torsion

PID
UTI
Appendicitis

56
Q

Chronic pelvic pain DDx

A

Go to answer - Endometriosis!

IBS/IBD
PID

Ovarian cyst
Adenomyosis
Uterine prolapse

Adhesions

Psychological - Previous abuse

57
Q

PID aetiology and presentation

A

STI

  • Chlamydia
  • Gonorrhoea

Pelvic pain
Deep dyspareunia
Cervical excitation

Fever
STI symptoms
RUQ pain
Dysfunctional menstrual bleeding

58
Q

PID investigations / management / complications

A

Triple swab

  • Endocervical chlamydia swab
  • Endocervical sample
  • High vaginal swab

TVUS - Rule out differentials

Management - Treat infection

  • PO ofloxacin + Met
  • IM Cef + PO doxy + PO met

Complications

  • Subfertility
  • Ectopic
  • Chronic pelvic pain
59
Q

Vaginal intraepithelial neoplasia

A

Usual

  • Common in 35-50
  • May develop into squamous cell carcinoma

Differentiated

  • More common in older women
  • Associated with lichen sclerosis
  • Higher risk of squamous cell carcinoma
60
Q

Vaginal intraepithelial neoplasia
Presentation
Investigations
Management

A

Presentation

  • Pruritus
  • Pain

Management

  • Local surgical excision
  • Imiquimod
61
Q

Vulval cancer aetiology and histology

A

Most common in > 65

Squamous cell carcinoma

Causes

  • HPV
  • VIN
  • Lichen sclerosis
  • Immunosuppression
62
Q

Vulval cancer presentation / investigations / management

A

Ulcer/mass in labia majora!

Bleeding
Pruritus
Discharge
Superficial dyspareunia

Investigations - Biopsy lesions

Management

  • Wide local excision
  • Groin lymphadenectomy
63
Q

Lichen simplex

A

Presentation

  • Itching
  • Thick labia majora

Risk factors
- Sensitive skin - Dermatitis and eczema

Management

  • Avoid irritant
  • Antihistamines
  • Steroid cream
64
Q

Lichen planus

A

Associated with AI disease

Presentation

  • Flat purple lesions
  • PO and PV
  • Painful
  • Erosive

Management - Steroid cream

65
Q

Lichen sclerous

A

Associated with AI disease

Presentation

  • Thin vulval epithelium
  • Pink and white papule - Parchment like skin
  • Itching
  • Dyspareunia

Associated with SCC

Management - Steroid cream and emollients

66
Q

Atrophic vaginitis

A

Post-menopausal women

Presentation

  • PMB
  • Vaginal dryness
  • Itching
  • Dyspareunia

TVUS - Rule out endometrial cancer

Management

  • Topical oestrogen
  • Lubricants
  • Creams
67
Q

Vaginal cancer

A

Squamous cell carcinoma
Clear cell carcinoma

Presentation

  • Dysfunctional menstrual bleeding
  • PMB
  • Discharge
  • Mass

Management - Radiotherapy

68
Q

Female genital mutilation

A

Partial or complete removal of external genitalia
Any injury to female organs

For non-medical reasons

  1. Removal of clitoris
  2. Excision - Removal of clitoris and labia
  3. Infibulation - Narrowing of the vagina
  4. Any other harmful procedure
    • Piercing
    • Incising
    • Scraping
69
Q

Prolactinoma

A

Pituitary adenoma - Benign tumour of the pituitary gland

Micro < 1cm
Macro > 1cm

Secretory/functioning - Excess of a particular hormone
OR
Non-secretory/functioning

70
Q

Excess prolactin symptoms

A

Women

  • Amenorrhoea
  • Infertility
  • Galactorrhea
  • Osteoporosis

Men

  • Impotence
  • Loss of libido
  • Galactorrhea
71
Q

Prolactinoma diagnosis and management

A

Diagnosis - MRI

Management…

Dopamine agonists - Inhibit release of prolactin

  • Cabergoline
  • Bromocriptine

Surgery?

72
Q

Prolapse aetiology

A

Age ^^^
Childbirth

Radiotherapy

Chronic pressure

  • Tumour
  • Constipation
  • Cough
  • Obestity
73
Q

Prolapse types

A

Anterior

  • Cystocele
  • Urethrocele
  • Cystourethrocele

Posterior

  • Enterocoele
  • Rectocele

Vault - Upper vagina drops down
Uterine - Uterus drops into vagina

74
Q

Prolapse presentation and grading

A

Dragging sensation
Heaviness

“Bearing down”

Urinary symptoms
Sexual difficulties

0 - No descent with strain 
1 - 1cm above hymen 
2 - Within 1cm of hymen 
3 - 1cm below hymen 
4 - Vaginal eversion
75
Q

Prolapse management

A

Conservative

  • Pelvic floor exercises
  • Weight loss

Ring pessary
Oestrogen cream - If menopausal

Surgery

  • Anterior colporrhaphy
  • Posterior colporrhaphy
  • Hysterectomy

3A (31 decks)

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