GYNAE 2: IMB, PCB, Pruritus Vulvae, STIs, Urinary Sx Flashcards

Question

What questions should you ask when seeing a person seeking emergency contraception?

Answer 1

- how many days since UPSI? - do you normally take hormonal contraception? - do you breastfeed? - what is your weight/BMI? - PMHx of asthma? Counselling = return to GP if vomiting

Answer 2

COCP: - contraindicated before 6w if breastfeeding - avoid in first 3w due to increased VTE risk - UKMEC2 if breastfeeding for 6w to 6mths - use additional contraception for first 7d POP: - can start any time post partum - after day 21 use additional contraception for first 2d IUD/IUS: - can be inserted within 48hrs of birth OR after 4w Lactational amenorrhoea: - fully breastfeeding + amenorrhoea + <6mths post partum

Answer 3

Abnormal proliferation of endometrium - assoc. w/HPV 16, 18 and 33 Types inc. simple, complex, simple atypical and simple complex Features inc. abnormal vaginal bleeding e.g. IMB

Answer 4

- PO or local IUS for 6mths - continuous progestogens for women who decline IUS - hysterectomy - bilateral salpingo-oophorectomy added for postmenopausal women

Answer 5

Laparoscopic total hysterectomy Bilateral salpingo-oophorectomy should be added for post menopausal women

Answer 6

EXCESS OESTROGEN: - nulliparity - early menarche - late menopause - unopposed oestrogen e.g. HRT - metabolic syndrome e.g. obesity, diabetes, PCOS - tamoxifen - HNPCC

Answer 7

Suspected cancer pathway if >55yo w/PMB TVUSS Hysteroscopy w/endometrial biopsy

Answer 8

LOCALISED = total abdominal hysterectomy w/BSO HIGH RISK = post op radiotherapy

Answer 9

- cervical cancer - cervical ectropion - atrophic vaginitis - PID - polyps

Answer 10

Larger area of columnar epithelium present on ectocervix caused by elevated oestrogen levels Transformation zone = area between native and unaffected columnar epithelium of the endocervical canal and native squamous epithelium Squamo-columnar junction = abrupt change from columnar cells to squamous cells (hence SCC most common type of cervical cancer) Location depends on age, hormonal status, birth trauma, contraceptives, pregnancy

Answer 11

Ix = speculum Mx = no treatment, but if symptomatic can cauterise w/silver nitrate or cold coagulation

Answer 12

CIN = abnormal changes of cells that line the cervix with mild/moderate dyskaryosis CIN 1 = 1/3 depth of surface of cervix CIN 2 = 2/3 depth of surface of cervix CIN 3 = whole thickness of surface of cervix

Answer 13

If CIN 2/3 = LLETZ, cone biopsy If CIN 1 = watch and wait, screen again in 12 months

Answer 14

Highest incidence in people aged 25-29yo SCC = 80% Adenocarcinoma = 20%

Answer 15

- HPV 16&18 - smoking - HIV - early first intercourse - many sexual partners - high parity - lower SES - COCP

Answer 16

Screening programme = HPV first system - 25-49 = 3yrly screening - 50-64 = 5yrly screening Delayed until 3mths post partum Can opt out if never sexually active

Answer 17

-ve HPV = return to normal recall +ve HPV = check cytology normal = repeat in 12 months abnormal = colposcopy, then mx inadequate sample = repeat in 3 months NOTE: HPV strains inc. 16, 18, 33

Answer 18

Stage IA1 = microinvasive disease - loop electrosurgical excision and conization - simple hysterectomy if no wish for fertility Stage IA2 - IB2 = early stage disease - radical hysterectomy and bilateral salpingectomy and/or bilateral oophorectomy w/bilateral pelvic lymphadenectomy - may consider adjuvant chemo/radio if high risk Stage IB3 - IVA (locally advanced disease) - external beam radiotherapy, intracavity brachytherapy, concomitant chemotherapy - surgency not recommended Stage IVB (spread to distant organs) - systemic chemotherapy Recurrent/metastatic disease = salvage surgery or chemo/radiotherapy

Answer 19

Most prevalent STI in UK, incubation period 7-12d Sx = asymptomatic in most, may have discharge, bleeding, dysuria Ix = NAATs using urine, vulvovaginal swab or cervical swab, 2w post exposure Screening open to everyone 15-24 Mx = 7d doxycycline (if pregnant: azithromycin, erythromycin, amoxicillin), partner notification w/offer of treatment

Answer 20

PID, endometritis, ectopic, infertility, reactive arthritis, perihepatitis

Answer 21

Organism = gram-negative diplococcus, Neisseria gonorrhoea Sx = cervicitis (abnormal discharge) Complications = dissemination, damage to urethral structures, salpingitis Dissemination - most common cause of septic arthritis, initially tenosynovitis, migratory polyarthritis, dermatitis. Later = septic arthritis, endocarditis, perihepatitis Mx = IM ciprofloxacin 1g, 2nd line = oral cefixime 400mg + oral azithromycin

Answer 22

Organism = flagellated protozoan parasite Sx = frothy, yellow-green discharge, vulvovaginitis, strawberry cervix, pH >4.5 Ix = microscopy of wet mount - motile trophozoites Mx = oral metronidazole 5-7d

Answer 23

PID = infection of female pelvic organs and surrounding peritoneum. Ascending infection from endocervix. Most common cause = chlamydia trachomatis Sx = dysmenorrhoea, fever, deep dyspareunia, dysuria, abnormal discharge, cervical excitation, violin string appearance, RUQ pain

Answer 24

Pregnancy test, high vaginal swab, screen for chlamydia and gonorrhoea Mx = IM ceftriaxone 1g, PO doxycycline 100mg BD, PO metronidazole 400mg BD for 14d + consider removing IUD/IUS

Answer 25

Fitz-Hugh Curtis syndrome Infertility Chronic pelvic pain Ectopic pregnancy

Answer 26

BV = overgrowth of anaerobic organisms e.g. Gardnerella vaginalis Sx = fishy offensive discharge, asx in 50%, vaginal pH >4.5 Dx = Amsel's criteria 3/4 - grayish, white discharge coating vaginal walls - vaginal pH >4.5 - +ve whiff test - clue cells on wet prep Mx = asx no mx, sx = oral metronidazole for 5-7d

Answer 27

Atrophic vaginitis Lichen sclerosus

Answer 28

- thinning and drying of vaginal walls Sx = vaginal dryness, dyspareunia, occasional spotting Ix = speculum, pale and dry vaginal wall Mx = vaginal lubricants and moisturisers, topical oestrogen cream (if menopausal/post menopause w/other sx consider HRT clinic referral)

Answer 29

Inflammatory condition leading to atrophy of epidermis and white plaque formation. Sx = white patches, itching, dyspareunia, dysuria Ix = speculum + external genitalia exam Mx = topical steroids and emollients, f/u due to increased risk of vulval cancer - 1st line = topical clobetasol propionate - 2nd line = topical tacrolimus (only initiated in specialist clinics)

Answer 30

Overactive bladder/urge incontinence = bladder oversensitivity from infection or neurologic disorders Stress incontinence = relaxed pelvic floor, increased abdo pressure Mixed incontinence Overflow incontinence = urethral blockage, bladder unable to empty properly

Answer 31

Detrusor overactivity Sx = urge to urinate followed by uncontrollable leakage Ix = bladder diaries for 3d, vaginal exam, urine dip and culture, urodynamic studies Mx = bladder retraining for min. 6w, bladder stabilising drugs e.g. antimuscarinics (oxybutynin, tolterodine, darifenacin), beta-3-agonist (mirabegron) if frail and elderly

Answer 32

Leakage of urine with increased intra-abdominal pressure RFs = childbirth, hysterectomy, FHx, advancing age, high BMI Ix = bladder diaries for 3d, vaginal exam, urine dip and culture, urodynamic studies Mx = pelvic floor muscle training (8 contraction 3x/day for 3 months), duloxetine, surgical procedures

Answer 33

Cystocele Uterine prolapse Rectocele Enterocele

Answer 34

Descent of a pelvic organ, leading to protrusion on the vaginal walls RFs = increased age, multiparity, vaginal deliveries, obesity Sx = pressure, heaviness, bearing down, urinary sx Ix = bimanual/speculum, bladder diaries for 3d, urine dip and culture, urodynamic studies Mx = asx no mx, conservative - weight loss, pelvic floor muscle exercise, ring pessary, surgery (cystocele = anterior colporrhaphy; vaginal vault prolapse = sacrocolpopexy)

GYNAE 2: IMB, PCB, Pruritus Vulvae, STIs, Urinary Sx Flashcards

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