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OBS and GYNAE > Gynae > Flashcards

Gynae Flashcards

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1
Q

Smear testing how often

A
  • Done every 3 years up until the age of 50 where it is done every 5 years

*HPV done every 5 years

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2
Q

Most common type of cervical cancer?

A

Squamous cell carcinoma

Adenocarcinoma 2nd

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3
Q

HPV high risk
Smear result management

A

HPV virus - 16,18, 33 malignancy

  • 1st repeat normal, 2nd repeat normal - back to routine smear
  • 2nd repeat abnormal - colposcopy

*Kids 12-13 are vaccinated against

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4
Q

Presentation of cervical cancer 4

A

Asymptomatic

Abnormal bleeding, discharge, pain, pelvic pain

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5
Q

Investigations for cervical cancer 2

A

Speculum and swabs - rule out infection
Urgent cancer referral for colposcopy

  • Screening done every 3 years 25-49 and every 5 years 50-64
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6
Q

Most common type of endometrial cancer

A

Adenocarcinoma

Oestrogen dependant cancer

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7
Q

Risk factors for endometrial cancer 6

A

Unopposed oestrogen (No progesterone):
increased age, early menstruation, late menopause, oestrogen only replacement, no pregnancies, obesity, POS, tamoxifen

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8
Q

Protective factors for endometrial cancer 4

A

Increased pregnancies, COCP, mirena coil, smoking

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9
Q

Presentation of endometrial cancer? 6

A

Post menopausal bleeding

Postcoital bleeding, intermenstrual bleeding, heavy bleeds, discharge, anaemia, high platelets

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10
Q

Investigations for endometrial cancer 3

A

Transvaginal US - endometrial thickness - normally <4mm
Pipelle biopsy
hysteroscopy

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11
Q

Management of endometrial cancer 2

A

2 week urgent cancer referral
total abdominal hysterectomy with bilateral salpingo-oophrectomy

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12
Q

Types of ovarian cancer 3

A

Epithelial cell
Dermoid/germ cell
sex cord-stomal

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13
Q

Risk factors for ovarian cancer 5

A

Smoking, diabetes, obesity, BRACA, increase ovulations

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14
Q

Protective factors for ovarian cancer 3

A

COCP, breastfeeding, pregnancy - reducing ovulations

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15
Q

Presentation of ovarian cancer 8

A

Non specific
Abdominal bloating, early satiety, reduced appetite, pelvic pain, urinary symptoms, weightloss, masses, ascities

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16
Q

Investigations for ovarian cancer 3

A

CA125 blood test
Pelvic US

CT, histology…

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17
Q

Management of ovarian cancer 2

A

urgent 2 week cancer referral

Surgery

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18
Q

Vulval cancer

A

90% squamous cell carcinomas

RF - old age, immunosuppression, HPV, lichen sclerosis** - 5% get VC

Sx - vulval lump, ulceration, bleeding, pain, itching, lymphadenopathy

Mx - 2 week urgent cancer wait
- biopsy
- sentinel node biopsy
- excision

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19
Q

Causes of primary amenorrhoea 5

A

*Not starting menstruation:
by 13 years with no evidence of pubertal development
by 15 years where there are other signs

Hypogonadotrophic hypogonadism (kallman)
Hypergonadotrophic hypergonadism
Adrenal hyperplasia
Androgen insensitivity
Stress or low body weight

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20
Q

Investigations for amenorrhoea 5

A

Full blood work up
Hormonal test - TFT, LH, FSH, Test, prolactin, IGF1

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21
Q

Management of amenorrhoea 4

A

Treat underlying cause
Replace hormones
COCP - when needed
GnRH - hypopituitarism

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22
Q

Secondary amenorrhoea causes 7

A
  • No menstruation for more than 3 months after previous regular menstrual periods

Pregnancy, menopause, contraceptives, pituitary pathology, POS, Thyroid, high prolactin

Anything that prevents the release of GnRH

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23
Q

Premenstrual syndrome

A
  • Psychological, emotional and physical symptoms that occur during the luteal phase

Cx - fluctuating hormone levels - drop in oestrogen and porgesterone

Sx - Low mood, anxiety, mood swings, irritability, bloating, fatigue, headaches, breast pain, reduced confidence, cognitive impairment, reduced libido

Mx - healthy lifestyle - mild
- COCP containing drospirenone 1st line (YASMIN)
- SSRI if severe

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24
Q

Causes of heavy menstrual bleeding 10

A

Fibroids, endometriosis, adenomyosis, PID, contraceptive (copper coil), anticoagulants, bleeding disorders, endocrine, endometrial hyperplasia or cancer, POS

**Blood loss more than 80ml

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25
Investigations for heavy menstrual bleeding 4
Speculum and bimanual - assess for fibroids and cancer FBC - anaemia Pelvic and transvaginal US Outpatient hysteroscopy
26
Management of heavy menstrual bleeding 5
Non contraception Tranexamic acid - antifibrinolytic Mefanamic acid - NSAID Contraception Mirena coil 1st COCP cyclical progestogens - norethisterone
27
What causes fibroids to grow 2
Idiopathic Oestrogen sensitive
28
Symptoms of fibroids 6
Asymptomatic Heavy bleeding, prolonged menstruation, abdominal pain, bloating, urinary sx, reduced fertility
29
Investigations of fibroids 2
Ultrasound - TVUS MRI when large
30
Management of fibroids 1
* levonorgestrel-releasing intrauterine system1st line *GnRH agonist - gopserlin Large fibroids - Myomectomy <3cm - same as heavy menstrual bleeding Mirena coil Tranexamaic and mefanamic acid COCP Cyclical oral progestogens
31
RED DEGENERATION
*History of fibroids* - Leads to ischaemia and necrosis - bleeding into tumour Sx - severe abdominal pain, fever, tachycardia Mx - supportive
32
Symptoms of endometriosis 6
Pelvic pain haematuria reduced fertility pain during sex painful periods cyclical bleeding
33
Investigations for endometriosis 2
Transvaginal US Diagnositic laparoscopy
34
Management of endometriosis 4
Pain management Hormonal contraceptives laparoscopic surgery/hysterectomy uterine artery ligation
35
Symptoms of adenomyosis 4
Pain during sex, during periods, heavy periods Infertility**
36
Investigations for adenomyosis 1
Transvaginal US
37
Management of adenomyosis 4
Symptomatic - tranexamic and mefanamic acid GnRH agonists utereine artery ligation hysterectomy
38
Menopause
* No periods for 12 months - permanent end Cx - lack of ovarian follicular stimulation Ix - oestrogen and progesterone levels are low - LH and FSH levels are high - absence of negative feedback Sx - hot flushes, low mood, premenstrual symptoms, irregular periods, joint pain, change in periods, dryness, reduced libido Mx - Lifestyle, HRT
39
Premature ovarian failure causes 5
Menopause before the age of 40 idiopathic iatrogenic autoimmune genetic infections
40
Symptoms of premature ovarian failure 5
Irregular menstrual periods and lack of periods flushes, dryness, night sweats
41
Investigations of premature ovarian failure 2
Raised LH and FSH Low oestrogen
42
Management of premature ovarian failure 1
HRT - reduces cardiovasular risk, osteoporosis, mood and cognitive impairment
43
Why is progesteron needed as well with HRT
Only if you have a uterus To reduce risks of endometrial hyperplasia and cancer due to unopposed oestrogen
44
Non hormonal treatment for menopause
Lifestyle,CBT Clonidine SSRI Venlafaxine Gabapentin Vaginal lubricant
45
How does clonidine work
Alpha 2 agonist in the brain and imidazoline receptors Lowers BP and HR Treats vasomotor symptom and hot flushes
46
Indications for HRT
Premature ovarian failure Reducing vasomotor sx improving low mood, decreased libido and poor sleep reducing osteoporosis risk
47
Risks of HRT 4
Increase in breast cancer (combined) increase in endometrial cancer - add progesterone increase in VTE - use patches rather than pills Increased stroke and coronary disease (combined)
48
Contraindications of HRT 8
Undiagnosed abnormal bleeding Endometrial Ca or hyperplasia breast cancer uncotrolled hypertension VTE Liver disease active angina or MI Pregnancy
49
How to give HRT - oestrogen
Give oestrogen in the form of patches to reduce the VTE risk
50
How to give HRT - progesterone
Give via IUS - mirena coil is best *Added benefit of contraception and reducing heavy periods
51
What HRT do you give if a woman has no uterus?
Oestrogen only pills - elleste Oestrogen only patches (best) - evorel
52
What HRT do you give perimenopausal women with periods or post menopausal
Cyclical combined tablets or patches Mirena coil plus oestrogen only patches or pills ***Need progesterone***
53
Features of POS
Multiple ovarian cysts infertility oligomenorrhoea Hyperandrogenism Insulin resistance
54
Criteria used for diagnosing POS 3
Rotterdam criteria 2/3 following for diagnosis: oligoovulation or an ovulation Hyperandrogenism PO on US
55
Presentation of an ovarian cyst 4
Asymptomatic Bloating, pelvic pain (can be severe), palpable pelvic mass
56
Most common type of an ovarian cyst 1
Follicular
57
Investigations for an ovarian cysts 2
Ultrasound - if <5cm just leave it Determine if malignant or not
58
Causes of raised CA125 8
Endometriosis, fibroids, adenomyosis, pelvic infection, liver disease, pregnancy, gynae cancer
59
Management of a simple ovarian cyst 3
<5cm - no follow up 5-7cm - yearly US >7cm - MRI or surgical evaluation
60
Meig's syndrome 3
Ovarian fibroadenoma pleural effusion ascities Mx - remove tumour
61
Ovarian torsion presentation
Sudden severe unilateral pelvic pain nausea and vomiting localised tenderness Palpable mass
62
Investigation of ovarian torsion
Ultrasound with doppler 1st
63
Management of ovarian torsion 1
Emergency lap surgery: untwist or remove
64
What is Asherman's syndrome?
Adhesions form within the uterus, following damage to the uterus Causing abnormal uterus function
65
When does Asherman's syndrome occur?
Post pregnancy related procedure - dilation and curettage (to remove placenta), uterine surgery such as infection
66
Presentation of Asherman's syndrome 5
Recent dilation and curettage secondary amenorrhea, lighter periods, dysmenorrhea infertility
67
Diagnosis and management of Asherman's syndrome
Hysteroscopy Surgery
68
What is cervical ectropion
When the columnar epithelium of the endocervix has extended to the ectocervix Columnar cells are more fragile and look different on speculum and are more likely to bleed
69
RF for cervical ectropion 4
High oestrogen, young women, COCP, pregnancy
70
Presentation of cervical ectropion
Asymptomatic Increased discharge, dyspareunia, post coital bleeding
71
Management and diagnosis of cervical ectropion
Management with cautery using silver nitrate or cold coagulation Diagnsosed on speculum
72
Nabothian cysts
Fluid filled cysts (blocked mucuos ducts) on the surface of the cervix - up to 1cm - harmless *Cannot see* Cx - idiopathic, trauma, child birth Px - Incidental on spculumn - if very large can cause fullness - white/yellow appearance *No pain or signs of infection* Mx - Reassurance - colposcopy if uncertain
73
Pelvic organ prolapse RF
Weak or stretched muscles and ligaments Multiple deliveries, instrumental and traumatic delivery, old age, obesity, chronic cough, chronic constipation causing strain
74
when does a vault prolapse occur 1
Women who have had a hysterectomy** Top part of vagina collapses into vaginal canal
75
When does a rectocele occur 1
Defect in posterior vaginal wall, allowing rectum to prolapse forwards Constipation***
76
When does a Cystocele occur 1
Defect in anterior abdominal wall, allowing bladder to prolapse backwards into the vagina
77
Management of prolapses
Conservative - oestrogen cream Pessaries - ring, donut... Surgery definitive - hysterectomy and mesh repairs *Mesh - chronic pain, bleeding side effects...
78
What is urge incontinence and the Mx
Overactive detrouser muscle Mx - 6 weeks pelvic floor exercises - antimuscarinics - oxybutynin
79
What is stress incontinence and the Mx
Leaking urine when coughing or laughing Mx - Pelvic floor training or surgical
80
What causes Atrophic vaginitis
Lack of oestrogen causing dryness and atrophy of mucosa - tissue becomes thin and easily irritated **Occurs at menopause due to lack of oestrogen**
81
Presentation of Atrophic vaginitis
Itching, dryness, bleeding, dyspareunia **Recurrent infection, stress incontinence and organ prolapse
82
Mx and CI of AV
Vaginal lubricants - estriol cream, pessaries, tablets, ring ^^ Breast cancer, angina, VTE, HRT
83
What is a Bartholin's cysts
- Glands that produce mucus for vaginal lubrication become blocked - 5 and 7 posiiton - can blead to abscess Sx - painful, unilateral, swollen, red, can become infeccted Mx - AB, drainage
84
Lichen sclerosis
Cx - Auto immune chronic inflammatory condition that presents as white shiny patches over labia, perineum or perianal region - can also affect men Sx - dryness, itching, thin, shining, raised Mx - topical steroids RF for SSC of vulva (5%)
85
What is Androgen insensitivity syndrome
X linked recessive - Cells are unable to respond to androgen hormones due to lack of receptors - extra androgens are converted to oestrogen, giving female characteristics
86
Presentation of androgen insensitivity syndrome
Inguinal hernia containing testes and amennorhea female phenotype and genitalia Increased risk of testicular cancer Infertility
87
Blood results in AIS
Raised LH, normal or raised FSH Normal or raised T for a male Raised oestrogen for a male
88
Management of AIS
Bilateral orchidectomy Oestrogen therapy Vagianl surgery
89
What is Ovarian hyperstimulation syndrome - sx and Mx
- Side effects of ovulation induction cause fluid to move into extravascular space causing hypovolaemia Sx - abdominla pian, nausea, bloating, rapid weight gain Mx - Fluid resus...
90
What is PID and cx
- Infection and inflammation of female pelvic organs - Most commonly chlamydia and gonorrhoea * Endometritis, salpingitis, oophoritis, peritonitis*
91
Sx of PID
-lower abdominal pain, fever, dysuria, vaginal discharge...
92
Ix for PID
- Pregnancy test - Vaginal swab and urine - NAAT
93
Mx of PID
-IM ceftriaxone, 14 day doxy and oral metronidazole
94
Complications of PID
Fitz-bugh curtis syndrome/perihepatitis - RUQ due to PID

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