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Gynae Flashcards

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1
Q

causes of menorrhagia

A

endometriosis
adenomyosis
polyps
fibroids
coagulation disorders
thyroid issues
IUD
Malignancy

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2
Q

Causes of amenorrhoea

A

primary - no periods by 15. Turners, anorexia, imperforate hymen, congenital adrenal hyperplasia
secondary - 3-6months no period. Pregnancy, menopause, primary ovarian insufficiency, hypothyroidism, IUS, sheehans, excessive exercise, PCOS

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3
Q

Causes of dysmenorrhoea

A

primary - occurs in 50% of women, No cause identified. Treat with NSAIDs like mefanamic acid
secondary - endometriosis, adenomyosis, fibroids, PID, IUD

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4
Q

what is adenomyosis and features

A

deposition of endometrial tissue in myometrium resulting in dysmenorrhoea, menorrhagia and a boggy uterus

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5
Q

first line investigation for adenomyosis

A

TVUSS

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6
Q

rx of adenomyosis

A

definitive - hysterectomy
Otherwise can give tranexamic acid and GnRH agonists

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7
Q

causes of post coital bleeding

A

cervical or vaginal cancer
cervical ectropion
vaginal atrophy
trauma

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8
Q

rx of vaginal atrophy

A

vaginal lubricants and moisturisers. If doesn’t work, can give topical oestrogen cream

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9
Q

risk factors for cervical cancer

A

HPV!! (16,18,33)
age <40
multiple sexual partners
high parity
early first intercourse
lower socioeconomic status
HIV

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10
Q

cervical cancer screening

A

smear tests offered between ages 25-64 to detect HPV. Cytology offered if positive

25-49 - 3 year screening
49-64 5 year screening

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11
Q

cervical cancer screening and pregnancy

A

wait until 3 months post party

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12
Q

cervical screening - what to do if
- negative for HPV
- positive for HPV
- inadequate sample

A
  • recall to normal screening
  • perform cytology. If positive - colposcopy. If negative - repeat at 12 months
  • repeat sample in 3 months. I still inadequate, refer for colposcopy
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13
Q

Rx of CIN

A

LLETZ - large loop excision of transformation zone

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14
Q

Rx of cervical cancer
what about if want to maintain fertility

A

Gold standard - hysterectomy
Cone biopsy if want to maintain fertility

Can also do radiotherapy

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15
Q

Complications of hysterectomy/cone biopsy

A

Standard complications (e.g. bleeding, damage to local structures, infection, anaesthetic risk)

Cone biopsies and radical trachelectomy may increase risk of preterm birth in future pregnancies

Radical hysterectomy may result in a ureteral fistula

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16
Q

Risk factors of endometrial cancer

A

Unopposed oestrogen - early menarche, late menopause, nulliparous, oestrogen only HRT

Metabolic syndrome - obesity, diabetes
PCOS
Tamoxifen
Post menopausal

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17
Q

protective factors for endometrial cancer

A

multiparty
smoking
COCP

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18
Q

Referral criteria for endometrial cancer

A

> 55 with post menopausal bleeding

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19
Q

first line ix for suspected endometrial cancer
Rx of cancer

A

TVUSS for endometrial thickness. <4mm is good

hysterectomy ± radiotherapy

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20
Q

what does endometrial hyperplasia present like

A
  • presents with abnormal bleeding eg PCB, IMB, PMB
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21
Q

Rx of typical endometrial hyperplasia and rx of atypical

A

typical - high does prog. May use levonorgestrel IUS
atypical - hysterectomy

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22
Q

Features of endometriosis

A

dysmenorrhoea
chronic pelvic pain
infertility
deep dysparaunia
Non gynae - dysuria, haeamturia, urgency, Dyschezia - painful bowel movements

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23
Q

Pelvic exam findings endometriosis

A

tender posterior fornix
reduced organ motility

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24
Q

Gold standard Ix for endometriosis

A

laparoscopy

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25
first line rx of symptoms of endometriosis what if doesn't help what if want to maintain fertility
NSAIDs or paracetamol If not help - COCP or progesterones If doesn't help - GnRH analogues to induce pseudomenoause If want to maintain fertility - endometrial ablation
26
rx of menorrhagia - if want contraception and if don't want contraception
if want contraception - mirena first line, COCP second line if not want contraception - use mefanamic acid or tranexamic acid starting on first day of periods
27
common side effects of HRT
breast tenderness, nausea, fluid retention and weight gain
28
complications of HRT
VTE risk Oestrogen only - endometrial cancer in women with a uterus. Needs to be combined Breast cancer - increased risk with combined HRT Stroke risk IHD risk if taken for >10yrs
29
2 first line investigations for infertility
semen analysis serum progesterone 7 days prior to expected next period. For a typical 28 day cycle, this is done on day 21
30
interpreting day 21 serum progesterone
high level indicates ovulation has occurred
31
lifestyle advice for infertility
aim for bmi 20-25 folic acid regular sex every 2-3 days smoking/drinking advice
32
symptoms of menopause inc long term complications
irregular periods, dysfunctional uterine bleeding vasomotor sx - hot flushes, night sweats vaginak dryness and atrophy, urinary frequency anxiety and depression Long term - osteoporosis, IHD
33
Rx of menopause - lifestyle - HRT - non - HRT
Lifestyle - exercise, weight loss, sleep hygiene HRT - combined if have uterus or oestrogen only if not Non - HRT - vaginal lubricants or oestrogen cream. For vasomotor sx - fluoxetine or citalopram, CBT
34
Contraindications of HRT
Current or past breast cancer Any oestrogen-sensitive cancer Undiagnosed vaginal bleeding Untreated endometrial hyperplasia
35
RF of ovarian cancer
many ovulations - nulliparous, early menarche, late menopause BRCA1 or 2
36
Features of ovarian cancer
abdominal distension and bloating abdominal and pelvic pain urinary symptoms e.g. Urgency early satiety diarrhoea
37
main ix for ovarian cancer Rx of it
Ca125 and ultrasound Mostly palliative as advanced disease at presentation
38
features of complex cyst. What should they be referred on for
multiloculated, solid, irregular, >5cm. Any post menopausal woman with cyst should be referred to gynae should be biopsied to exclude malignancy
39
RF of ovarian torsion
ovarian mass: present in around 90% of cases of torsion being of a reproductive age pregnancy ovarian hyperstimulation syndrome
40
features of ovarian torsion
Sudden onset of deep-seated colicky abdominal pain. Associated with vomiting and distress fever may be seen in a minority (possibly secondary to adnexal necrosis) Vaginal examination may reveal adnexial tenderness
41
USS of ovarian torsion
whirlpool sign
42
life threatening complication of ovarian induction for infertility (particularly associated with PCOS)
Ovarian hyperstimulation syndrome - causes fluid shift resulting in Hypovolaemic shock Acute renal failure Venous or arterial thromboembolism
43
main causes of PID
top is chlamydia trachomatis Neisseria gonorrhoea Mycoplasma genitalium Mycoplasma hominis
44
Features of PID
deep pelvic pain dyspareunia dysuria and menstrual irregularities may occur vaginal or cervical discharge fever
45
IX of PID
high vaginal swab for gonorrhoea and chlamydia pregnancy test
46
Rx of PID
Abx - combination of: oral ofloxacin + oral metronidazole or intramuscular ceftriaxone + oral doxycycline + oral metronidazole
47
Complications of PID
perihepatitis - fitz hugh curtis chronic pelvic pain infertility increased risk of ectopic pregnancy
48
Rotterdam criteria for PCOS
2 out of 3 of: - infrequent or no ovulation - clinical and/or biochemical signs of hyperandrogenism (hirsutism, acne, elevated levels of total or free testosterone) - polycystic ovaries on ultrasound scan >12 follicles (measuring 2-9 mm in diameter) in one or both ovaries and/or increased ovarian volume > 10 cm3)
49
Features of PCOS
subfertility and infertility menstrual disturbances: oligomenorrhoea and amenorrhoea hirsutism, acne (due to hyperandrogenism) obesity acanthosis nigricans (due to insulin resistance) hyperinsulinaemia
50
Ix of PCOS
USS FSH, LH, testosterone (testosterone raised, raised FSH:LH ratio) Sex Hormone Binding Globulin (low in PCOS)
51
Rx of PCOS - general - hirsutism - infertility
General - weight loss, COCP Hirsuitism - cocp, topical eflornithine Infertility - clomiphene first line, may add in metformin as well
52
rx of endometrial hyperplasia
dilatation and curettage
53
definition of premature ovarian insufficiency
onset of menopausal symptoms and elevated gonadotrophin levels before the age of 40 years
54
causes of premature ovarian insufficiency
idiopathic - most common bilateral oophorectomy radiotherapy chemotherapy infection: e.g. mumps autoimmune disorders
55
rx of premature ovarian insufficiency
HRT - but won't cover for contraception in case spontaneous ovarian activity resumes
56
rx of PMS
mild - lifestyle - exercise, weight loss, smoking, alcohol moderate - COCP severe - SSRI
57
rx of urge incontinence
bladder retraining for at least 6 weeks - diary, monitoring input and output, resisting urge etc 1st line drug: oxybutynin or mirabegron in 'frail old ladies'
58
rx of stress incontinence
pelvic floor training - 8 contractions 3 times per day for a min of 3 months Surgery Duloxetine - stimulates muscles within the sphincter so stays closed
59
RF of prolapse
obesity multiparous increasing age
60
presentation of prolapse
pressure, heaviness, bearing down incontinence, frequency, urgency
61
Fibroids presentation
may be asymptomatic menorrhagia - may cause iron-deficiency anaemia bulk-related symptoms - lower abdominal pain, bloating urinary symptoms, e.g. frequency, may occur with larger fibroids subfertility
62
Ix of fibroids
TVUSS
63
Rx of fibroids - asymptomatic - menorrhagia - shrink/remove fibroids
- no treatment other then periodic review - LNG-IUS, mefanamic acid, tranexamic acid - GnRH agonists, myomectomy, uterine artery embolisation
64
What is red degeneration of fibroids
haemorrhage into tumour - commonly occurs during pregnancy
65
features of candidiasis
'cottage cheese', non-offensive discharge vulvitis: superficial dyspareunia, dysuria itch vulval erythema, fissuring, satellite lesions
66
rx of candidiasis
oral fluconazole 150 mg as a single dose first-line or clotrimazole pessary if contraindicated (eg in pregnancy)
67
compare dischare in candida, BV and trichomonas
candida - Cottage cheese' discharge, Vulvitis Itch BV - Offensive, thin, white/grey, 'fishy' discharge Trich - Offensive, yellow/green, frothy discharge, vulvovaginitis, s trawberry cervix
68
RF of vulval carcinoma
Human papilloma virus (HPV) infection Vulval intraepithelial neoplasia (VIN) Immunosuppression Lichen sclerosus
69
Presentation of vulval carcinoma
lump or ulcer on the labia majora inguinal lymphadenopathy may be associated with itching, irritation
70
ix for urnary incontinence
bladder diaries vaginal examination to exclude pelvic organ prolapse and ability to initiate voluntary contraction of pelvic floor muscles ('Kegel' exercises) urine dipstick and culture urodynamic studies
71
when can expectant management be used for an ectopic
An unruptured embryo 2) <35mm in size 3) Have no heartbeat 4) Be asymptomatic 5) Have a B-hCG level of <1,000IU/L and declining
72
Indicatiion for medical management in ectopic and what is it
<35mm unruptured nonsignificant pain no heart beat bHCG <1500 Give methotrexate, must be willing to come back for follow up
73
indication for surgical management in ectopic pregnancy and what is it
>35mm ruptured pain fetal heartbeat bHCG >5000 salpingectomy if no other risk factors for infertility slpingotomy if risk factors eg contralateral tube damage
74
primary ovarian insufficiency blood results
Raised FSH and LH Low oestrogen
75
COCP missed pill rules - if one pill - if 2 pills
if one - take when remember, no other measures needed 0-7 days - emergency contraception + barrier for 7 days wk 2 - take missed + 7 day barrier wk 3 - take missed. omit pill interval. + barrier for 7 days
76

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