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gynae Flashcards

(49 cards)

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1
Q

how to gnrh analogues work?

A

pulsatile buserelin, goserelin stimulates AP to secrete LH + FSH

continuous downregulates AP → decreased LH + FSH release → decreased oest + progest → amenorrhoea; fibroids shrink

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2
Q

what are effects of oestrogen?

A 
bone + muscle growth
endometrial growth
maintains female 2° characteristics
maintains breasts
low conc - inhibits LH
high conc - stimulates LH
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3
Q

oligo/amenorrhoea - investigations

A

pregnancy test

FSH + LH:
low - HT/AP pathology
normal - oocytes present but problem with folliculogenesis eg PCOS
high - concerning - few oocytes - eg POF

AMH:
best predictor of oocyte reserve

oestradiol: ovarian function
prolactin: ?pituitary problem
testosterone: ?PCOS

USS

TFTs

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4
Q

hypothalamic ovulatory dysfunction - findings

A

FSH + LH low
oestradiol low
GnRH deficiency
weight loss

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5
Q

pituitary ovulatory dysfunction - findings

A

FSH + LH low
oestradiol low
hyperprolactinaemia

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6
Q

ovarian ovulatory dysfunction - PCOS findings (bloods)

A

FSH + oestradiol normal

LH high - problem with final stage of folliculogenesis

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7
Q

ovarian ovulatory dysfunction - premature ovarian failure findings (bloods)

A

FSH + LH high

oestradiol low

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8
Q

how can you test for ovulation + ovarian reserve?

A

regular cycle confirms ovulation - if not do serum progesterone 7d after ovulation

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9
Q

male infertility - investigations

A

semen analysis x 2 - abstain 2-5d

if 1st sample abnormal, reassess after 3mo

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10
Q

female infertility - advice

A

smoking + drugs
BMI 20-25
sex every 2-3 days
folic acid + vit D - NTDs

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11
Q

female subfertility - investigations

A

bloods - FSH, LH, oestrogen, prolactin, AMH
transvaginal USS
imaging for patency of fallopian tubes

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12
Q

PCOS - investigations

A 
pelvic USS - ovaries > 10mm, cysts++
LH - raised (↑LH:FSH)
FSH - low 
prolactin - poss slight↑
testosterone - poss slight↑
glucose tolerance
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13
Q

PCOS - symptoms

A

irregular/amenorrhoea
hirsutism
acne
obesity

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14
Q

PCOS - diagnostic criteria

A

2 of:
irregular menses
androgen excess on bloods/examination - hirsutism, acne (not obesity)
PCO - >10cm3

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15
Q

PCOS - mgmt

A

COCP
weight loss
fertility - clomiphene +- metformin

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16
Q

how does clomiphene work?

A

helps induce ovulation

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17
Q

endometriosis - symptoms

A

dysmenorrhoea + dyspareinuria - main 2
dysmenorrhoea often starts days before bleeding
dyschesia + haematochaesia, urinary symptoms

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18
Q

how does endometriosis cause infertility?

A

endometrial lesions cause inflammatory reaction - scarring + adhesions - distorted pelvic anatomy

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19
Q

endometriosis - management

A

1st line - NSAIDs +- paracetamol +- COCP (pregnancy-like state of endometrium) or progestogen eg the injection

2° - refer to gynae:
GnRH analogue - short term (fake menopause - night sweats + hot flushes; osteoporosis risk)

3° - lap excision/laser/cauterisation of lesions; lysis of adhesions; H + BSO

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20
Q

subfertility in PCOS - mgmt

Study These Flashcards
A

1st line - weight loss

2nd - clomiphene - induce ovulation. then USS to check follicle development + reduce multiple pregnancies

21
Q

subfertility due to tubal problems - causes + management

Study These Flashcards
A

infection, adhesions from surgery, endometriosis

IVF

22
Q

subfertility due to sperm problems - mgmt

Study These Flashcards
A

lifestyle

IVF + ICSI (intracytoplasmic sperm injection)

23
Q

what is a complication of IVF? how does it present, findings + mgmt?

Study These Flashcards
A

ovarian hyperstimulation syndrome

severe lower abdo pain
vomiting
distended + tender abdo

USS - enlarged, cystic ovaries, ascites, pleural effusion

oral fluids
thromboprophylaxis
paracentesis

24
Q

definition of secondary amenorrhoea

Study These Flashcards
A

menstruation stopped for at least 6mo

25
secondary amenorrhoea - causes
``` hypothalamic - stress, exercise PCOS hyperprolactinaemia premature ovarian failure thyrotoxicosis ```
26
primary dysmenorrhoea - management
1st line - NSAIDs (mefenamic acid, ibuprofen) - inhibit PG production 2nd line - COCP
27
secondary dysmenorrhoea - when does it occur? causes? what should the GP do?
usually develops years after menarche starts 3-4d before period onset endometriosis / adenomyosis PID IUD fibroids refer to gynae
28
endometriosis - investigation
laparoscopy refer to gynae if symptoms significant USS may show free fluid
29
young lady with abdo pain - partic investigations
VE urine preg test ?abdo + pelvic USS
30
ovarian torsion - presentation, diagnosis + management
sudden onset colicky abdo pain; vomiting; adnexal tenderness on VE USS - free fluid laparoscopy - diagnostic + therapeutic
31
PID - presentation
``` bilateral low abdo pain + discharge dysuria RUQ pain (chlamyd) fever deep dyspareunia cervical excitation ```
32
PID - investigation
chlamyd + gonn test FBC - leucocytosis preg test high vaginal + urethral swabs
33
infertility - investigations
semen analysis | serum progesterone 7 days before period due date
34
serum progestogen interpretation (in context of infertility)
< 16 - repeat. if low again then refer 16-30 - repeat >30 - indicates ovulation
35
menorrhagia - causes
``` DUB - no underlying pathology fibroids IUD hypothyroid PID bleeding disorder eg VWD ```
36
menorrhagia - investigations
FBC | transvaginal USS if symptoms suggest structural pathology - eg pressure/unusual bleeding
37
menorrhagia - management
doesn't need cc: 1° - mefenamic acid / tranexamic acid from day 1 of period 2° - no improvement: try other + refer needs cc: 1° - IUS 2° - COCP 3° - long-acting progestogen eg the injection
38
PID - management
oral ofloxacin + metronidazole or oral doxy + metronidazole + IM ceftriaxone IUDs - may leave in if mild but removal may improve outcome
39
PID - complications
infertility - 10-20% chronic pelvic pain ectopic
40
pelvic pain - acute differentials
``` dysmenorrhoea mittelschmerz ectopic - recent amenorrhoea UTI appendicitis PID ovarian torsion miscarrriage - recent amenorrhoea ```
41
pelvic pain - chronic differentials
endometriosis IBS ovarian cyst - unilat dull ache, intermittent +- bloating/bladder/torsion/rupture urogenital prolapse
42
what is rovsing's sign?
more pain in RIF than LIF when palpating LIF
43
prolapse - symptoms
pressure sensation | urinary symptoms incl incontinence
44
post-coital bleeding - causes
no reason - 50% ectropion - 33% chlamyd, cervical ca, polyps, trauma
45
vaginal candidiasis - predisposing factors
diabetes abx + steroids pregnancy immunosuppression
46
vaginal candidiasis - features
cottage cheese vulvitis - dyspareunia, dysuria itch vulval erythema, fissuring
47
vaginal candidiasis - management
clotrimazole pessary stat or oral itraconazole or fluconazole stat (CI if preg)
48
recurrent vaginal candidiasis - management
check compliance confirm with hi vag swab + exclude ddx eg lichen sclerosus exclude predisposing factors consider induction-maintenance regime
49
discharge - differentials + associated symptoms
physiological candida - cottage cheese, vulvitis, itch trichomonas - offensive, yellow/green, frothy, vulvovaginitis, strawberry cervix BV - offensive, thin, white/grey less common - chlamyd, gonn, ectropion, foreign body, cervical ca

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