gyn2 Flashcards by Doha SM Basiouni Ibraheem

how might ovarian cyst present?

swollen abdo
palpable pelvic mass
abdo pain
tender adenxae
dyspareunia
bloating, nausea

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how can ovarian cysts affect ureters?

hydronephrosis
recurrent UTI
haematuria

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how might ovarian cyst rupture present?

shock
peritonism
torsion - severe pain

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how might functional ovarian cyst present?

virilization
altered menstruation
post-menopausal bleeding

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how is ovarian cyst investigated?

TVUSS
CA125 in all post menopausal women
other basic: pregnancy, inc WCC in infection/torsion,
low Hb if bleed

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how is ovarian cyst managed?

conservative or surgical - cystectomy if wants kids

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surgical mgmt of cyst?

bilateral oophorectomy or cystectomy if wants kids

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what is the most common type of ovarian cancer?

cystadenocarcinoma (serous/mucinous)

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what are the symptoms of ovarian cancer?

abdo pain + distension
bloating
- new IBS in pts over 50
nausea
early satiety
weight loss

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what are the signs of ovarian cancer?

palpable pelvic mass

tender adnexae

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what are symptoms of metastatic ovarian cancer?

back pain
ascites
right pleural effusion
torsion/rupture
DVT

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what are the environmental risk factors for ovarian cancer?

oestrogen exposure:

early menarche
late menopause
HRT
nulliparity
obesity

smoking

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what are the genetic risk factors for ovarian cancer?

fam hx
BRCA1/2
HNPCC

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what reduces the risk of ovarian cancer?

breastfeeding
COCP
many pregnancies

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how is ovarian ca investigated?

TVUSS
Serum CA-125 >30 suggestive
RMI

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what does raised ALP suggest in a patient with Ov Ca?

liver mets

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how is ovarian cancer diagnosed?

histologically during surgery

- no needle biopsy as risk spreading

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what is figo staging for Ov Ca?

ovaries only
pelvis
early mets - superficial mets
distant mets - liver parenchyma

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how is ov ca treated?

surgery then adjuvant chemo

bilateral hystero-salpingo-oophorectomy (HSO), omentectomy, appendectomy

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what chemo is used for ov ca?

carboplatin + paclitaxel 6months

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how is ov ca prevented?

prophylactic surgery in brca1/2, high risk pts

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which lymph nodes for ovarian cancer?

paraortic

inguinal/femoral suggest other gynae cancer

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what is Pseudomyxoma peritonei

mucinous cystadenoma rupture in ov ca - mucin in peritoneum

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does being brca positive give you better prognosis if ov ca?

yes

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how does ovarian torsion present?

``` adnexal mass nausea/vomiting severe pelvic pain fever abnormal bleeding ```

how is ovarian torsion diagnosed?

TVUS

what is lichen sclerosus?

chronic inflammatory skin disease in anogenital region

what can lichen sclerosus become?

can progress to squamous cell carcinoma

how is lichen sclerosus treated?

steroids topical

what are the risk factors for endometriosis

``` early menarche fam hx short menstrual cycles long/heavy periods defects in uterus/fallopian tubes ```

symptoms of endometriosis?

``` cyclical pelvic pain dysmenorrhoea dyspareunia menorrhagia subfertility dyschezia (pain defecating) ```

what is the main dd for endometriosis?

PID, similar symptoms, subacute onset

what is gold standard diagnostic procedure for endometriosis?

laparoscopy

what are typical findings on laparoscopy in endometriosis?

chocolate cysts adhesions peritoneal cysts

what is the treatment for endometriosis?

- NSAIDS - COCP/Mirena to prevent ovulation and cause atrophy of lesions - surgery - hysterectomy and HRT

what is the benefit of using mirena over cocp in endometriosis?

lower dose of hormone?

aside from laparoscopy how is endometriosis investigated>

bimanual exam - fixed retroverted uterus - uterosacral ligament nodules

what is adenomyosis?

presence of endometrial tissue in the myometrium

how does adenomyosis present?

dysmenorrhoea menorrhagia deep dyspareunia irregular bleeding

what can cause adenomyosis?

myometrium coming in contact with endometrium: - pregnancy and childbirth - c-section - uterine surgery - surgical management of miscarriage/termination

how is adenomyosis diagnosed?

definitive - histological post-hysterectomy clinically: tvus

how is adenomyosis managed?

definitive - hysterectomy symptom: NSAIDs, hormone therapy for reduction of bleeding/cycle control uterine artery embolisation for those wanting kids

what hormonal therapies for adenomyosis?

COCP progestogens - mirena GnRH aromatase inhibitors

what is the aetiology of PCOS?

elevated LH - stimulates androgen production | insulin resistance

where is LH produced?

anterior pituitary

what are the risk factors for PCOS?

diabetes fam hx irregular periods

which criteria is used for diagnosing PCOS?

rotterdam, 2/3 minimum for diagnosis

what is the rotterdam criteria?

1. oligo/anovulation 2. clinical/biochemical signs of hyperandrogenism 3. polycystic ovaries on imaging

what blood tests for PCOS?

1. LH (high) 2. FSH (normal) 3. Sex-hormone binding globulin (SHBG) (Low) 4. Testosterone (high) 5. Progesterone (low)

what will FSH levels be like in PCOS?

normal!

what will shbg levels be like in pcos?

low

what will progesterone be like in pcos?

low

which levels will be high in PCOS?

LH and testosterone only

how do you prevent endometrial hyperplasia in PCOS?

inducing at least 3 bleeds per year - COCP - Dydrogesterone

how is pcos managed?

lifestyle - lose weight

how is subfertility in PCOS managed?

clomifene/metformin women with low BMI may have laparoscopic ovarian drilling.

what are the risks associated with clomifene

``` risk of multiple pregnancies ovarian hyperstimulation syndrome ovarian cancer (limited for 6 cycles) ```

with what is hirsutism treated?

antiandrogens: cyproterone spironolactone finasteride Eflornithine topical cream for facial hair

what type of amenorrhoea is caused by turner syndrome?

1 X chromosome - primary amenorrhoea

what are the characteristic features of turner syndrome?

short stature webbed neck broad chest wide carrying angle (cubitus valgus)

what do the ovaries look like in turner syndrome?

underdeveloped streak ovaries

what do the kidneys look like in turner's?

horseshoe

how do you induce puberty in turner's?

HRT

Name 3 congenital heart problems that are often associated with Turner syndrome.

1. coarctation of aorta 2. aortic stenosis 3. aortic dissection

what is tanner stage 1?

pre-pubertal

what is tanner stage 2?

breast buds form, few long hairs at labia

what is tanner stage 3?

breast buds larger, pubic hair continues, mainly central

what is tanner stage 4?

breasts in mound form, pubic hair in triangle adult shape, but smaller

what is tanner stage 5?

breasts fully formed, pubic hair adult

what does fixed retroverted uterus suggest?

endometriosis

what do Uterosacral nodularity and tenderness suggest?

endometriosis | may be accompanied by bladder symptoms

what is the first investigation that must be done in a woman with stress incontinence?

urinalysis to rule out UTI/diabetes

where to report FGM?

police

gyn2 Flashcards

(73 cards)