Gynae Flashcards
(115 cards)
1
Q
MOA of tranexamic acid
A
competitive inhibitor of plasminogen activator (antifibrinolytic) - administer once menstruation has started
2
Q
when is tranexamic acid contraindicated
A
severe renal impairment, history of VTE, history of convulsions
3
Q
SE of tranexamic acid
A
GI, impaired colour vision and other visual disturbance
4
Q
SE of mefenamic acid (NSAID - prostaglandins are associated with increased menorrhagia)
A
Gi side effects and headache
5
Q
what % of menorrhagia is not yet classified
A
50%
6
Q
Stepwise Mx for menorrhagia
A
1) IUS
2) hormonal COCP / tranexamic acid / mefenamic acid
3) norethisterone - cyclical oral progesterone prescribed day 5-26
7
Q
what are the surgical options for menorrhagia
A
1) endometrial ablation (microwave or thermal balloon)
2) uterine artery embolisation
3) myomectomy
4) hysterectomy +/- BSO
8
Q
RF for endometriosis
A
FHx, early menarche, low BMI
9
Q
firstline relief for endometriosis
A
1) NSAIDs +/- paracetamol
2) COCP/POP/IUS
3) GnRH analogues
10
Q
Ix for fibroids
A
TV US
11
Q
when is surgery needed for fibroids
A
> 3cm
12
Q
how does red degeneration of fibroid present
A
ischaemia, infarction, necrosis of the fibroid in pregnancy - severe abdo pain, low grade fever, tachycardia, vomitting
13
Q
O/E of adenomyosis
A
enlarged, tender, boggy uterus
14
Q
what kind of cancer is 80% of cervical cancer
A
squamous
15
Q
how do HPV 16 and 18 cause cervical cancer
A
they produce proteins E6 and E7 which suppress p53 (TSG) and hence there is uncontrolled cellular proliferation)
16
Q
cervical screening is delayed until how many months PP
A
3
17
Q
surgical options for CINII/III
A
LLETZ or ablation + FU at 6 months
18
Q
if someone presents with symptoms of cervical cancer (PCB/IMB) what should they have done
A
speculum –> and if anything suspicious is seen then fast track to colposcopy
19
Q
if cervical cancer is caught early, what can be done
A
radical hysterectomy
20
Q
what procedure can be done if someone has cervical cancer and they want to preserve fertility
A
cone biopsy and close FU if 1A
radical trachelectomy if 1B
21
Q
if cervical cancer is locally advance IIb–>IV, what can be done?
A
chemo-radiation firstline
22
Q
what does the bartholin duct do?
A
secretes fluid to help lubricate the vagina
23
Q
what staging is used for all women’s gynae cancers
A
FIGO
0 - carcinoma in situ
1 - confined to the organ of origin
2 - invasion of surrounding organs or tissues
3 - spread to distant nodes / organs within the pelvis
4 - distant spread
24
Q
protective factors of ovarian cancer
A
COCP, breast feeding, hysterectomy
25
what is a krukenberg tumour
GI tumour which spreads to ovaries
26
Dx for ovarian cancer
normal exam --> do Ca125, if this is raised do urgent US of abdomen and pelvis (>35)
abnormal exam --> 2WW - may have imaging CT/MRI to investigate
but ultimately Diagnosis is done by diagnostic laparotomy
27
In PCOS what bloods do you do for androgens
total testosterone (normal/raised) - if very raised suspect another cause like leydig cell tumour
Free androgen index
SHBG (low/normal)
-cannot do these tests for someone on hormonal contraception, must wait 3 months before assessment
28
for someone with prolonged amenorrhoea with PCOS, what can you do
give cyclical progesteogens which induce a withdrawal bleed and then can assess endometrial thickness
29
what is the LH to FSH ratio like in PCOS
high LH, normal FSH
30
what is the triad in meigs syndrome
ovarian fibroma, ascites, pleural effusion
31
most common ovarian tumour in under 30s
teratoma !
32
what are the benign germ cell tumours that can occur in the ovaries vs benign epithelial tumours
dermoid
+ serous cystadenoma / mucinous adenoma
33
MX of premenopausal cysts
-do a TV US and look at size
-<5cm - discharge
-5-7cm - routine referral to gynae and yearly US
-7cm - MRI
-if complex cyst (multiloculated, contain thicker fluid or septations) - check tumour markers
34
MX of post menopausal cysts
calculated RMI
<200 = low risk (candidate for laparoscopic)
>200 = high risk
35
O/E of ectopic
pelvic/ abdo tenderness, adnexal tenderness, cervical exception
36
IX for ectopic
bHCG, urinanalysos, TV US, G+T
37
RF for miscarriage
increasing maternal age, number of previous miscarriage, APS
38
most common cause of miscarriage in first trimester
chromosomal abnormality
39
cause of miscarriage in second trimester
incompetent cervix
40
what should bHCG rise/fall by if pregnancy is progressing
rise by 63% in 48hr and fall by 50% in 48 hrs
41
surgical Mx of miscarriage
1) manual vacuum aspiration
2) surgical evacuation
-these are appropriate when there is significant bleeding or on patients who have retained products of conception
42
Tx for missed miscarriage
mifepristone and then misoprostol 48 hours later, with a preg test 3 weeks later to check for retained products
43
what does it mean if someone who is having a miscarriage keeps passing out
vasovagal response to having products of conception or clots lodged in the cervical canal which causes hypotension and tachycardia
44
complications of miscarriages
-infection
-retqained products of conception
-ashermans
45
what Ix may you do for recurrent miscarriage
-parenteral karyotyping
-cytogenetic analysis
46
MX of APS in preg
aspirin and LMWH in pregnancy
47
all women presenting with menorrhagia should have what done
FBC (only need other Ix if abnormal Ex / symptoms suggest a pathology like PCB)
48
Dx of oligospermia
<15 mil
49
Dx of teratosperma
<4% normal morphology
50
Dx of asthenospermia
<32% progressive motility
51
what % of infertility is due to male factor
30%
52
what % of infertility issue to ovulatory causes
25%
53
what % of infertility is tubal
20%
54
what % of infertility is uterine
10%
55
in how many people is the cause of infertility unidentifiable
25%
56
apart from D21 progesterone, what other Ix are done for female infertility
hysterosalpingogram and laparoscopy and dye for tubal patency
-+ check for STI
57
alcohol limits for fertility
1-2 units a day for females and 3-4 units a day for men
58
how does clomifene work
antioestrogen drug, so stop oestrogen binding to APG so no negative feedback and more LH and FSH produced so higher chance of ovulation
59
what other medications can be considered in infertility
dopamine agonists in hyperprolactinaemia
60
what must BMI be for IVF
<30
61
RF for OHSS
previous OHSS, PCOS, under 30
62
pathophysiology of OHSS
gonadotrophin used in IVF cause stimulation of ovaries, increased number of cysts and high oestrogen and progesterone but also high VEGF. This causes increase vascular permeability and fluid shift
63
stages of OHSS
mild - abdo bloat and pain
moderate - mild + N+V, US evidence of ascites
severe - moderate + clinical evidence of ascites, oliguria, hypoproteinemia
critical - severe + tense ascites, anuria, ARDS, VTE
64
MX of OHSS
-should get better in 7-10 days
-may need analgesia, thrombotic Tx and paracentesis
65
2WW for post menopausal bleeding
post menopausal bleeding and over 55
66
a woman over what age, with menopausal symptoms does not need investigated
45
67
when is cyclical HRT needed
if perimenopausal or within 12 months of last period
68
when is cyclical switched to continuous HRT
after 12 months if over 50, if after 24 months if under 50
69
contraindications to HRT
breast cancer (past or present), VTE, uncontrolled VTE
70
what is tibolone
separate class of HRT - synthetic steroid which stimulates oestrogen, progesterone and androgens so is good for libido
71
how can vasomotor symptoms of menopause be treated
fluoxetine, citalopram, venlafaxine, clonidine (a2 adrenergic agonist) help with vasomotor symptoms but can cause low HR and BP)
72
how long can the effects of HRT take to show
3-6 months (SE should settle at 3 months)
73
does hormonal contraception affect the menopause
no
74
Ix for ovarian torsion
TV US - whirlpool sign
definitive diagnosis = laparoscopic surgery
75
Tx for atrophic vaginitis
1) lubricants
2) topical oestrogens
76
lochia until how many weeks is normal
6 weeks
77
protective factors over endometrial cancer
parity, COCP, exercise, smoking!
78
stage 1 endometrial cancer Mx
TAH and BSO
79
stage 2 endometrial cancer MX
TAH and BSO and para-aortic LN clearance
80
stage 3/4 Mx
tumour debulking
81
how does tamoxifen act on the endometrium
as an ER antagonist
82
Mx of endometrial hyperplasia if there is no atypia
high dose daily progestagens, IUS, resample at 3/4 months
83
what does lichen sclerosis predispose to
squamous cell carcinoma (koebner phenomenon)
84
Mx of squamous cell carcinoma
topical dermovate and emollient
85
which skin condition causes wickhams striae
lichen planus
86
which is the best emergency contraception for someone who is breast feeding
levonorgestrel
87
if pregnant, how is thrush treated
only local treatments if preg!! (pessary of clotrimazole)
88
Mx of POF
HRT until age 50
89
causes for low FSH in amenorrhoea
constitutional delay, eating disorder, exercise induced
90
what is haematocolpos
imperforate hymen - structural cause of amenorrhoea
91
causes for POF
-idiopathic
-radiotherapy
-chemotherapy
-bilateral oophorectomy
92
demonstration of POF
elevated FSH on two blood samples 6 months apart
93
FGM classification
1 - clitoridectomy
2- partial or total removal of the clit + labia minor +/- labia major
3 - narrowing of vaginal orifice
4 - all other harmful practise for non medical practise
THE POLICE HAVE TO BE TOLD IN ANYONE UNDER 18
94
after how Many weeks does RhD prophylaxis need to be given?
10 weeks
95
what are some of the rules to abortion
two doctors must independently agree
-has to be performed in a license premises
-only a registered medical practitioner can perform an abortion
96
how is a medical abortion done
-before 9 weeks at home
-oral mifepristone followed by misoprostol 48 hours later
-afer 9 weeks, do this in hospital and may need repeat doses of misoprostol until the abortion occurs
97
what are the advantages of a medical abortion
mimics normal miscarriage, avoids surgery and good if the women has some uterine distortion
98
what FU is needed after an abortion
after 2 weeks need a pregnancy test to confirm that the pregnancy has ended - need to monitor level of HCG
-if still positive after four weeks this indicates trophoblastic disease or incomplete abortion
99
what are the surgical options for abortion
1) manual vacuum aspiration
2) electrical vacuum aspiration
3) dilatation and evacuation (after 14 weeks)
100
does anything need to be done before a surgical abortion
prime the cervix with mifepristone and misoprostol
101
causes for secondary dysmenorrhoea
fibroids, PID, ectopic pregnancy, ovarian cancer
102
RF for dysmenorrhea
earlier age of menarche, nulliparity, heavy menstrual flow, BMI <20, smoking
103
firstline MX for dysmenorrhoea
1) NSAID +/- paracetamol
2) hormonal contraception
3)heat
-secondary dysmenorrhoea --> always be referred to gynae
-primary dysmenorrhea --> refer after 3-6 months if no improvement
104
how is pelvic organ prolapse staged
may pelvic organ prolapse quantification (POP-Q)
105
what can cause a rectocele (defect in the posterior vagina wall)
constipation and faecal loading
106
symptoms to ask about in a prolapse Hx
dragging sensation, urinary symptoms, bowel symptoms, sexual dysfunction, lump
107
how often should vaginal pessary be replaced
every 4 months
108
what are the management options for pelvic organ prolapse
1) conservative
2) vaginal pessary
3) surgery - obliterative (colpocleisis where vagina is stitched) / reconstruction (sacrocolpopexy for vault prolapse)
109
definition of chronic pelvic pain
pelvic pain for 6 months which is not exclusively linked to pregnancy or menstruation
110
some Ddx for chronic pelvic pain
IBS, endometriosis, adenomyosis, MSK, PID
111
how does endometriosis present on laparoscopy
red flame lesions or powder burn deposits or scarring
112
any woman over what gestation, with bleeding, should be referred to EPAU
6 weeks
113
operation that can be done for stress incontinence
retropubic mid-urethral tape procedures (this is firstline to duloxetine!!!!)
114
RF for incontinence and prolapse
advancing age, obesity, number of children, traumatic births,
115
MX of symptoms in very early preg
-any pain, cervical motion tenderness --> need to go to EPAU
-if bleeding is the only thing and < 6 weeks --> manage expectantly, take a preg test in one week
-if over 6 weeks and bleeding, refer to the EPAU for an early preg scan
