General gynaecology Flashcards Preview

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Flashcards in General gynaecology Deck (40):

DDx for intermenstural bleeding

- cervical malignancy
- cervical ectropion
- endocervical polyp
- atrophic vaginitis
- pregnancy
- irregular bleeding related to contraceptive pill


Drugs associated with hyperprolactinaemia (due to dopamine agonist effects)?

- metoclopramide
- phenothiazines (e.g. chlorpromazine, prochlorperazine, thioridazine)
- reserpine
- methyldopa
- omeprazole, ranitidine, bendrofluazide (rare)


Effects of premature menopause

Hypo-oestrogenic effects:
- vaginal dryness
- vasomotor symptoms (hot flushes, night sweats)
- increased cardiovascular risk

Psychological and social effects:
- infertility
- feeling of inadequacy as a woman
- feelings of premature ageing and need to take HRT
- impact on relationships


Treatment of anovulation?

Clomifene citrate


How is anovulation shown on investigations?

Progesterone level below 30nmol/L


What is a non-specific marker for ovarian carcinoma??



Typical presentations of fibroids

- menorrhagia
- abdominal mass
- pressure effect from pressure on the bladder, stomach or bowel
- infertility


What advice should you give after LLETZ procedure

- patient may have light bleeding for several days
- if heavy bleeding occurs, should return as secondary infection may occur and need treatment
- avoid sexual intercourse and tampon use for 4 weeks, to allow healing of the cervix
- fertility is generally unaffected by the procedure, though cervical stenosis leading to infertility has been reported. Mid-trimester loss from cervical weakness is rare


After LLETZ, when should the follow up smears be?

6 months, and then yearly smears for 10 years


What is dysfunctional uterine bleeding?

Excessive heavy, prolonged or frequent bleeding that is not due to pregnancy or any recognisable pelvic or systemic disease


What should always be measured in a woman with amenorrhoea?


May have a pituitary adenoma (prolactinoma).

NB levels up to 1000mu/L can be found as a result of stress, breast examination or PCOS. Above 1000mu/L is usually a pituitary adenoma


DDx of secondary amenorrhoea

- chronic illness
- anorexia
- excessive exercise
- stress
- hyperprolactinaemia (drugs, tumour)
- hypothyroidism
- breast feeding
- premature ovarian failure
- iatrogenic (chemo/radiotherapy, oophorectomy)
- long-acting progesterone contraception
- pregnancy
- Asherman's syndrome
- cervical stenosis


Causes of post-menopausal bleeding

PMB is considered to be caused by endometrial cancer until proven otherwise.
- endometrial/endocervical polyp
- endometrial hyperplasia
- atrophic vaginitis
- iatrogenic (anticoagulants, intrauterine device, HRT)
- infective (vaginal candidiasis)


Causes of dysmenorrhoea

- idiopathic
- premenstural syndrome
- pelvic inflammatory disease
- endometriosis
- adenomyosis
- subcostal pedunculated fibroids
- iatrogenic (e.g. intrauterine contraceptive device, or cervical stenosis after LLETZ


DDx of postcoital bleeding in a young woman

- cervical ectropion
- chlamydia or other STIs
- cervical maligancy
- complication of the COCP
- endocervical polyp


What consists of an STI screen?

- endocervical swab for chlamydia - 30 secs
- endocervical swab for gonorrhoea
- high vaginal swab for trichomonas (and candida)


Diagnosis of antiphospholipid syndrome

Presence of one of the clinical features:
- three or more consecutive miscarriages
- mid-trimester fetal loss
- severe early-onset pre-eclampsia, IUGR or abruption
- arterial or venous thrombosis
AND haematological features:
- anticardiolipin antibody or lupus anticoagulant detected on two occasions at least 6 weeks apart


What is antiphospholipid syndrome often secondary to?

Systemic lupus erythematosus (SLE)


What is the management of antiphospholipid syndrome?

Oral low dose aspirin and low-molecular-weight subcutaneous heparin from the time of a +ve pregnancy test, to improve the likelihood of a successful live birth


Causes of recurrent miscarriage

- parental chromosome abnormality
- antiphospholipid syndrome
- other thrombophilia (e.g. activated protein C resistance)
- uterine abnormality (intracavity fibroids, uterine septum)
- uncontrolled diabetes or hypothyroidism
- bacterial vaginosis (usually associated with second-trimester loss)
- cervical weakness ('incompetence', second-trimester loss only


How is prolapse categorised?

According to the level of descent of the cervix in relation to the introitus


What are the degrees of prolapse?

First degree: descent within the vagina
Second degree: descent to the introitus
Third degree: descent of the cervix outside the vagina
Procidentia: complete eversion of the vagina outside the introitus


Management of hypovolaemic shock with hypokalaemia?

- supportive management
- monitor electrolytes
- fluid restriction
- potassium supplementation
- ECG monitoring until K+ is normal
- HDU and oxygen
- monitor ABG


What should PMB be considered to be?

Endometrial carcinoma until proven otherwise


Risk factors of endometrial carcinoma?

- T2DM
- obesity
- nulliparity


Management of endometrial carcinoma?

- simple total abdominal hysterectomy and bilateral salpingoophorectomy
- 90% present in early stage


Stages of endometrial cancer:

histologically staged
- stage 1: confined to the body of the uterus
1a limited to endometrium
1b invasion only of the inner half of the myometrium
1c invasion to the outer half of the myometrium
- stage 2: involving the uterus and cervix only
- stage 3: extending beyond the uterus but not beyond the true pelvis
- stage 4: extending beyond the true pelvis into the bladder or rectum


What is the true pelvis?

pelvic inlet


Prognosis of endometrial carcinoma?

- >70% survival at 5y for stage 1 disease
- 10% survival at 5y for stage 4 disease


What is Fitz-Hugh-Curtis syndrome?

The presence of perihepatic adhesions in association with previous chlamydial or gonoccocal infection


How do you manage pelvic adhesions?

- laparoscopic adhesiolysis
- pain management: analgesics or possible uterosacral nerve ablation
- treat both partners for course of abx in case still infected


What are the long term complications of PID?

- chronic pain
- infertility - tubal
- ectopic pregnancy

nb can still have spontaneous pregnancy so stay on contraception if you don't wanna get pregger


How is Turner's syndrome managed?

Psychological etc family counselling ... etc
- human growth hormone to achieve full height potential
- oestrogen therapy with ethinyl estradiol to enable secondary sexual characteristics (breasts and pubic and axillary hair)
- cyclical progestrogens added later to induce withdrawal bleed (period) for social reasons and to protect endometrium from hyperplasia or malignancy in long run
- oestrogen therapy until menopause age to prevent early-onset osteoporosis
- options available with ovum donation and hormonal support


DDx of irregular bleeding with COCP if examination is normal

- poor compliance
- concurrent antibiotics
- diarrhoea or vomiting
- infection (chlamydia, gonorrhoea or candida)
- cervical ectropion
- bleeding diathesis
- drug interactions (e.g. antiepileptics


Management of endometrial polyp?

Avulsion in OPC under speculum examination

- polyp is grasped with forceps and twisted repeatedly until it detaches at base
- any remnant generally necroses and disappears
- always send for histological examination


What medication is effective in many women with PMS?



What are the possible treatment options for cervical carcinoma?

- radical hysterectomy (up to stage 1b)
- trachelectomy
- radiotherapy (beyond stage 1b and post menopausal)


Management of stress incontinence?

- lifestyle
- reduce weight
- stop smoking (cough)
- alter diet and consider laxatives to avoid constipation
- pelvic floor exercises

- transvaginal or transobturator vaginal tape
- colposuspension


What is precocious puberty?

Periods starting before the age of 9 years


Causes of precocious puberty?

- constitutional (90%)
- hypothyroidism
- CNS lesions (hydrocephaly, neurofibromatosis)
- ovarian tumour
- adrenal tumour
- exogenous oestrogens