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Gynae Flashcards

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1
Q

What are polys and what is the gold standard treatment?

A

The muscosal growths and the gold standard is polypectomy.

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2
Q

What type of bleeding may a patient experience?

A

.HMB
* IMB
* PCB
* PMB

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3
Q

What is ademoysis?

A

endrometrial like tissue growing in the muscle tissue causing enlarged womb. It more common in mutliparious women

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4
Q

Name some symptoms of ademyosis

A

-it may present asymptomatically
-heavy periods,
-prolonged periods
-painful periods
-pain during sex
-chronic pelvic pain

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5
Q

What is endometrosis?

A

Endometrial tissue outside the the uterus- is a estrogen dependent chronic inflammatory condition commonly causes delay in diagnosis.Can also asymptomatic

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6
Q

Name symptoms of endometriosis

A

*HMB
* Dysmenorrhoea/pelvic pain
* Dyspareunia
* Dyschezia

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7
Q

what is the gold standard investigation for endometrosis?

A

laparoscopy

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8
Q

What is leioyoma?

A

Leioyoma are begnin tumours that grow in the uterus and they are hormone sensitive. Common in 70-80% of >50yo

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9
Q

What are some symptoms with fibroids?

A

Dysmenorrhoea
* Abdominal distension
* Dyspareunia
* Pressure on bowel or bladder – urinary or bowel symptoms
* Subfertility

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10
Q

What are some investigations that are used for investigating fibroids.

A

TVUS
MRI

  • You will see and enlarged womb
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11
Q

What is endometrial cancer?

A

Cancer of the endometrium and it the 4th commonest cancer in females in the UK

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12
Q

What are some risk factors for endometrial cancer?

A

*Obesity
* Nulliparity
* Early menarche, late menopause
* PCOS
* Diabetes Mellitus
* Tamoxifen therapy
*Age
* Genetic factors – eg Lynch syndrome

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13
Q

What is the criteria for urgent referral for suspected endometrial cancer?

A

*Post menopausal bleeding after 12 months of no menastration and the patient is not on HRT
*Unscheuled bleedin for 4-6months after starting HRT
*Abnormal pelvic or abdominal USS suggestive of endometrial cancer

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14
Q

When is recommended to do TVUS

A

NICE recommend consider TVUS if >55y and
* Unexplained PV discharge – presenting for the first time/thrombocytosis/report haematuria
* Visible haematuria and low haemoglobin/thrombocytosis/high blood glucose levels

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15
Q

What is the treatment of endometrial cancer if is diagnosed early?

A

usually total abdominal hysterectomy and bilateral salpingo-oophorectomy

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16
Q

Name some symptoms of endometrial cancer

A

PMB
IMB
HBM
pelvic pain
Dyspaurenia
Discharge
Fatigue
weight loss

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17
Q

what type of bleeding may a patient experience with cervical cancer?

A

*PCB
* IMB
* (Vaginal discharge)

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18
Q

Name risk factors of cervical cancer

A

*Genital HPV infection
* Early age of first sexual intercourse
* Multiple sexual partners
* Lower socioeconomic status
* Smoking
* COCP use

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19
Q

what is the criteria for referal for cervical cancer

A

Cervial examination consistent with cervical cancer
with one of the symptoms below:
PCB
IMB
PMB
abnormal persistent vaginal discharge

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20
Q

What are possible causes of amnehoerra?

A

*Psychological stress
* Reduced oral intake / anorexia nervosa
* Excessive exercise
* Weight loss
* (or combination of these factors)

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21
Q

How can you investigate it is the hypothamlic piturary is the cause of amenoharra?

A

Medroxyprogesterone acetate 10mg for 7-10d
& check BMI

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22
Q

What two types of amenoherra are there?

A
  • Primary
  • Secondary
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23
Q

What is PCOS?

A

Its a hormonal disorder that affects women of reproductive ages.It’s characterized by irregular menstrual cycles, excess androgen levels(scne +hirtuism), and polycystic ovaries on ultrasound. The exact cause is unknown, but it’s believed to be a combination of genetic and environmental factors.

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24
Q

How is PCOS diagnosed?

A

Rotterdam criteria - 2-3
Hyperandrogenism Acne+ hirtuism
Oligomenorrhea
TVUS- PCO after 8 year of menarche

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25
What is the management of PCOS?
Patient education is key in everyone * Discussion around long-term risks (cardiovascular, endometrial) * Heathy weight management * Management of other CV risk factors * Obesity, diabetes, smoking, alcohol, diet, exercise * Emotional wellbeing * Discussion around subfertility/pregnancy concerns Lifestyle Weight management: medication, bariatric surgery * Consider HbA1c screening Menses * Hormonal contraception (eg CHC unless contraindicated) endometrial protection * Initial USS to assess endometrial thickness * Aim for 3-4 bleeds/year (unless on alternate contraception) Symptom management * Acne – CHC, anti-androgens, usual acne preps * Hirsutism – laser, topical eflornithine, anti-androgens Subferlity * Lower threshold for onward referral
26
What is the management for heavy bleeding?
1st line = LNG-IUS (as long as happy for contraceptive) * 2nd line = ̈ Non-hormonal Tranexamic acid +/ NSAID (eg mefenamic acid) Hormonal CHC POP PO implant cyclic PO injectable - (norethisterone) * If fibroids > 3cm – consider specialist referral – but offer a trial of treatment until appt
27
What is the atrophic vangtis and the treatment
Atrophic vaginitis, also known as vaginal atrophy, is a condition where the vaginal walls thin, dry, and become inflamed due to lower estrogen levels. This typically occurs during and after menopause as estrogen production decreases. Treatment - Good vulval care. Vaginal oestrogen: creams, pessaries, rings etc
28
What are the red flags PMB?
* Atrophic vaginitis * Endometrial / cervical polyps * Bleeding on HRT * Vaginal trauma
29
What are the infective causes of vaginal discharge?
*Bacterial Vaginosis * Candida * Trichomonas * Chlamydia * Gonorrhea
30
What is bacterial vaginosis and name some risk factors?
This is caused by a disturbance to the vaginal bacteria. PH-4.5 Being sexually active * Douching * Genital hygiene * Menstruation * Copper Coil
31
What is the management for BV?
Metronidazole 400mg BD for 5-7 day (preferred) Or * Metronidazole 1 applicatorful OD for 5 days, dose to be administered at night * Self management: avoid vaginal douching, bubble baths, water-based lubricants, harsh soaps
32
What is thrush?
Overgrowth of Candida yeasts in mucosa of female genital tract: - Candida Albicans - Candida Glabrata
33
What are causes of thrush?
Recent antibiotic use * Scented soaps/washes * Immunosuppression * Uncontrolled diabetes * Pregnancy
34
Name symptoms of thrush
Non offensive * white * Cottage cheese like Vulva or Vaginal itching Vulval or Vaginal soreness Dysuria Dyspareunia (superficial) No abdominal pain No systemic features No abnormal bleeding
35
What is the management of Thrush?
Fluconazole 150mg oral single dose or * Clotrimazole 500mg intravaginal pessary single dose Vulva symptoms Clotrimazole 1% or 2% cream applied TDS Self management: avoid irritant soap/bubble baths/douching/tight fitting clothing
36
What is trichmonastis?
Sexually transmitted infection caused by Trichomonas Vaginalis flagellated protozoan. * Can lead to cervicitis, vaginitis, urethritis in women
37
Name some symptoms of trichmonasis
Yellow/green frothy discharge Offensive smell +/- vulval soreness +/- vulval itching +/- dysuria +/- lower abdominal pain O/E strawberry cervix
38
What is the mangement is trichomonastis?
Ideally treat via GUM/ Sexual health clinic * Metronidazole 400mg BD oral for 7 days Offer full STI screen if not done already Contact Tracing Sexual abstinence
39
What is chlamydia?
Sexually transmitted infection caused by Chlamydia Trachomatis * Infection of the urogenital tract targets Urethra in men and cervix and/or Urethra in women * Infect conjunctiva, rectum and nasopharynx
40
Name some risk factors of chlamydia
*Age under 25 years * Two or more sexual partners in a year * Lack of barrier protection * New sexual partners
41
Name symptoms of chlamydia
*70% of women are asymptomatic *Purulent discharge *Post coital bleeding *Deep Dyspareunia *Dysuria *Pelvic pain or tenderness On O/E Cervical tenderness Cervix inflamed Contact bleeding
42
what are the IVx for chlamydia?
Nucleic Acid Amplification Tests (NAATs) - Endocervical swab - First catch urine
43
What is the management for chylmadia?
Strongly recommend treatment via GUM/ Sexual health clinic * Doxycycline 100mg BD for 7 days Or * Azithromycin 1g single dose Day 1 followed by 500mg OD for 2days Offer full STI screen if not done already Contact Tracing Sexual abstinence Chlamydia screening
44
What is gonorrhea?
Sexually transmitted infection caused by gram negative bacterium Neisseria gonorrhoeae * Uncomplicated gonorrhea infection affects mucosal membrane urethra, endocervix, rectum, pharynx and conjunctiva
45
What are the symptoms of gonorrhea?
50% of women are asymptomatic Altered vaginal discharge Lower abdominal pain Intermenstrual bleeding (rare) Deep Dyspareunia Dysuria O/E - may have purulent discharge
46
What investigations would you do for a patient with suspected gonorrhea?
- Nucleic Acid Amplification Tests (NAATs) - Vulvovaginal swab - First catch urine
47
What is the management for gonorrhea?
. Ceftriaxone 1g IM single dose (when susceptibility not known) Or * Ciprofloxacin 500mg orally single dose Offer full STI screen if not done already Contact Tracing Sexual abstinence Test of cure recommended 1 week post treatment
48
What is PID?
Pelvic inflammatory disease, this is an infection of the ovaries,uterus and ovarian tube. It is commonly caused by gonrrhoea and chlamydia and other bacterias. Also non- infective causes retained products e.g tampons,lubricants etc,physiological or malignancy
49
What are some clinical features?
Pelvic or lower abdominal pain Deep Dyspareunia Abnormal Vaginal bleeding (IMB, PCB) Abnormal vaginal discharge +/-fever +/- N&V
50
what can be seen on examination of a patient that has PID?
O/E Febrile Lower abdominal tenderness Adnexal tenderness Cervical excitation contact bleeding
51
Name some investigations that you will do if patient is suspected of PID?
First line ceftriaxone 1 g as a single intramuscular (IM) dose, followed by oral doxycycline 100 mg twice daily plus oral metronidazole 400 mg twice daily for 14 days
52
whatis the average age for menopause?
51
53
what is perimenopause?
54
what are possblie causes of premature ovarian insufficency?
55
Names gynae symptoms of menopause
UTIs Vagnial atropy dyspranueria prolaspe irregular periods
56
Name some physical symptoms
Muscle aches Hair loss Vasomotor symptoms joint aches weight gain
57
Name psychological symptoms of menopause
Mood changes Irritability Anxiety Brain fog/memory sleeping issues Fatigue
58
What are some risk when starting a patient on HRT?
VTE Incresed risk Breast cancer Increased CVS diseases stroke Increased risk of Ovarian cancer
59
Names some contraindication when starting a patien on HRT?
Uncontrolled hypertension Previous or current VTE rterial thromboembolic disease (eg angina, MI) * Thrombophilic disorder * Current, past or suspected breast cancer * Current or suspected oestrogen-dependent cancer * Undiagnosed vaginal bleeding * Untreated endometrial hyperplasia * Liver disease / abnormal LFTs
60
What is the criteria for endometrial cancer 2ww?
2ww endometrial cancer, NOT on HRT * >55y with post-menopausal bleeding (>12m after LMP) * Consider if <55y with post-menopausal bleeding
61
When a patient is on HRT when will you consider to investigat bleeding?
If on HRT * Unscheduled PV bleeding in first 3m is normal * Any abnormal bleeding after 6m needs urgent investigations * Sequential HRT – increase in heaviness or duration of bleeding or if bleeding regular * Continuous HRT – any bleeding after 6m
62
What do you do if a patient meets the 2ww creiteria fo breast cancer and they are on a HRT?
If fulfil 2ww criteria, stop HRT and only restart if breast cancer excluded
63
How do you manage a patient that is on HRT but has irreggular bleeding between 3-6 months?
Alter HRT regime (eg switch back to sequential regime or different progesterone – if appropriate). Stop HRT and refer if not stopped >4w after altering regime. * Stop HRT and refer * Stop HRT, refer if not stopped >4w after stoppin
64
What are different types of HRT?
Oestrogen Oestrogen and progesterone Trandermal- patches, spray and gels Vaginal- ring,pessary,cream and gel Mirena coil Utrogestan capsules (oral or vaginal)

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