Gynae Flashcards

Question

Endometrial cancer

Answer 1

Epidemiology - Post menopausal women - 75% ``` Aetiology Unopposed oestrogen - like Br - COCP protective - Early menarche, late menopause, nulliparity - Age - Obesity - PCOS - Tamoxifen - HNPCC ``` Pathophysiology - Adenocarcinoma Presentation - PMB - MAIN Other - IMB, systemic eg weight loss Pyometra ANY PMB IN >55 - go for TVUS to assess endometrial thickness Investigations TVUS - endometrial thickness >4mm --> urgent biopsy CT staging Staging + Management FIGO I - endometrium Hysterectomy + BSO II + cervix Radical hysterectomy III + serosa, para-aortic, pelvic nodes Hysterectomy + Radio/ chemo IV - bowel/ bladder/ distant mets Hysterectomy + radio/chemo

Answer 2

Vaginal atrophy - MOST COMMON HRT - can --> spotting Endometrial cancer - MOST WORRYING Endometrial hyperplasia ovarian cancer ovarian cyst Cervical cancer Cervicitis

Answer 3

Like fibroids grow in response to oestrogen - Obesity Present: dysfunctional bleeding Can cause subfertility Rx - Curettage - Diathermy

Answer 4

Uterus Endocervix - ciliated columnar Transformational zone - most prone to malignant ∆ - squamocolumnar junction Ectocervix - Squamous Vagina

Answer 5

Infection eg chlamydia Presentation: PCB Management: Rx infection eg abx Cyrotherapy

Answer 6

Endocervix --> ectocervix --> PCB Culprit - COCP, pregnancy Management - swap contraception Cyrotherapy

Answer 7

IMB/PCB Avulsion

Answer 8

25-49 - 3 yearly 50-64 - 5 yearly Inadequate - repeat up to 3 times then send to colp Borderline - HPV test - if -ve - back to normal routine, if +ve, colp CIN I (mild) or above --> urgent colp If treated for CIN I or above --> repeat smear in 6 months If they are immunocompromised - annual smear

Answer 9

6 months time

Answer 10

25-49 - 3 years | 50-64 - 5 years

Answer 11

Cervical intraepithelial neoplasia Atypical cells found within the epithelium - SQUAMOUS RF - HPV 16,18,33 Smoking, immunocompromised, ^sexual partners Presentation - PCB Grading I - 1/3 II 2/3 III >2/3- Carcinoma in situ Invasion of basement membrane --> MALIGNANCY Investigations - Punch biopsy Management - LLETZ

Answer 12

16, 18, 33

Answer 13

Aetiology HPV - see CIN Pathophysiology Squamous cell carcinoma Presentation PCB Investigations Colposcopy ``` Staging and management I - cervix IIa + upper vagina IIb + parametrium III + pelvic wall IV + bowel + bladder ``` ``` Management Iai - cone biopsy Iaii - 2a - wertheim's hysterectomy Pelvic nodes? - hysterectomy + chemo/radio 2a + - Hysterectomy radio, chemo ```

Answer 14

``` Main Physiological - Follicular - MAIN TYPE Common in childbearing age - CL ``` Benign germ cell dermoid cyst Benign Sex cord Benign epithelial - Serous cystadenoma - solid 40-50y/o can be malignant - mucosal Fibroma

Answer 15

Mass effect - Bloating - Early satiety - Constipation - Back pain - Dyspareunia - Urinary symptoms - PCB

Answer 16

TVUS - main Laparotomy + FNA to confirm

Answer 17

Pre menopausal <5cm Watch and wait >5cm Laparoscopic ovarian cystectomy Post menopausal <5cm Watch and wait >5cm Hysterectomy

Answer 18

Torsion Rupture --> peritonitis Haemorrhage

Answer 19

Aetiology Pregnancy Cancer Cyst Presentation Fever Abdo pain Vomiting Investigation TVUS - free fluid - whirlpool sign Laparoscopy is diagnostic and therapeutic Management - laparoscopy

Answer 20

Adenomyosis

Answer 21

``` Aetiology Same as breast BRCA - Unopposed oestrogen culprits - HNPCC - Obesity ``` Histology Serous carcinoma ``` Presentation Mass effect - Dyspareunia - Bloating/ early satiety - Urinary symptoms PCB ``` Investigations Ca125 if >35 ---> urgent USS RMI Biopsy/ CT ``` Staging + Management I - ovary II - Pelvis III - bowel bladder IV - distant mets ``` management - Surgery, platinum chemo + radio WOMEN WITH NEW IBS >50 --> CA125

Answer 22

``` U x M x 125 U BAMMS Multi-ocular cysts - 1 Ascites - 3 Bilateral lesions - 3 Mets - 3 Solid areas - 3 ``` M - pre - 1 - post - 3 >250 --> MDT + CT

Answer 23

sent for URGENT referral - TVUS - to look at endometrial thickness

Answer 24

I - ovary II - pelvis III - bowel/bladder IV - mets outside abdomen

Answer 25

Aetiology/ RF Extreme age, asian, previous Presentation - Hyperemesis gravidarum - Painless bleeding Thyroid^ (bhCG mimics) Proteinuria HTN ``` Investigations - b-hCG ^^^ - Proteinuria - HTN USS - snowstorm, honeycomb, bunch of grapes ``` Management - Methotrexate - Surgical TOP Complications - Choriocarcinoma

Answer 26

ANY woman >55 with PMB should get urgent TVUS to assess thickness of endometrium Vaginal atrophy HRT Endometrial cancer Endometrial hyperplasia Ovarian Ca Ovarian cyst Cervical cancer Cervicitis Vulval cancer

Answer 27

``` Causes Idiopathic - 50% Uterine - Fibroids - 30% - Polyps ``` Systemic - thyroid, bleeding disorders, diabetes Drugs - Anticoags - IUD ``` Investigations ALL should have an FBC Then others if indicated in the Hx eg TVUS TFT Coag screen LFTs ``` ``` Management Do they want to conceive No: Mirena coil COCP ``` Yes: - TXA/ Mefenamic acid for pain Other: surgery - UAEmbolisation - Ablation - hysterectomy

Answer 28

``` Endometriosis Adenomyosis Idiopathic Fibroids Ovarian cyst/Ca PID / adhesions Copper IUD ``` Management - Rx cause - Medfanamic acid - TENS - COCP

Answer 29

``` Fibroids Polyps Adenomyosis Ovarian cyst Endometrial/cervical/ovarian cancer ``` Rx - COCP

Answer 30

RF - HPV + friends - LICHEN SCLEROSUS Histology - SCC Presentation - Itch - Bleed - Dyspareunia - Ulcer/mass - Discharge Investigations - Biopsy Management - Surgical excision +/e groin lymphadenopathy / radio/chemo

Answer 31

Chronic inflammatory skin contrition itching Inflamed thick labia majora RF - dermatitis/atopy Rx steroid, antihistamines

Answer 32

Associated with autoimune conditions Purple Oral and genital Painful not itchy Rx steroids

Answer 33

Autoimmune association Paper white/grey thin skin Itching and dyspareunia associated with SCC Rx steroids

Answer 34

SCC Painful, discharge, dyspareunia Rx - radio/chemo

Answer 35

In menopause due to less oestrogen ``` Itching Painful Dryness Dyspareunia PMB ``` Rx Lubricants Topical oestrogen

Answer 36

``` Ectopic (until proven otherwise) Ovarian torsion Ovarian cyst rupture Miscarriage PID UTI Appendicitis ``` Ectopic - cervical excitation, period of amenorrhoea, PV bleed - brown Ovarian torsion - fever, vomiting Ovarian cyst rupture Miscarriage PID - cervical excitation, symptoms of STI, deep dyspareunia UTI - urinary symptoms Appendicitis - rebound tenderness + friends

Answer 37

``` Endometriosis Adenomyosis Ovarian cyst Adhesions PID IBS/IBD Psychological ```

Answer 38

Aetiology - STI - usually chlamydia Presentation - Pelvic pain - Fever - STI symptoms - Deep dyspareunia - RUQ pain if FHCS - Cervical excitation O/E!!! Investigations - HVS Others if indicated in Hx Management Ceftriaxone, oral doxy + oral metronidazole Complications - ectopic - subfertility - chronic pelvic pain

Answer 39

Definition Permanent cessation of periods for 12 months due to follicle end Symptoms 1) Vasovagal Hot flushes/ night sweats/ mood swings 2) Vaginal Dryness/ itching/ irregular cycle/ DMB 3) UROGEN Incontinence/ prolapse/ freq etc ^UTI ``` Long term (/risks) 1) Osteoporosis 2) CV events 3) Psych/neuro Dementia/depression/ anxiety ```

Answer 40

<50 - 24 months >50s for 12 months After last period

Answer 41

When - <40 - atypical symptoms - Consider in 40-45 FSH^ taken 2-5 day of cycle - 2 samples, 4 weeks apart AMH ^ - taken at any time other TFT Catecholamines LH oestradiol

Answer 42

``` Understand the information Will continue to have sex Has tried to persuade to tell her parents Her health might be at risk In her best interests ```

Answer 43

MoA Inhibits ovulation Thickens cervical mucus Thins endometrium ``` Advantages Reversible Reduced risk of endometrial ca ovarial ca colon ca Reduces menorrhagia/ dysmenorrhoea Reduces acne ``` Disadvantages Risk of VTE Breast cancer Oestrogen effects - breast tenderness, headaches Not protective against STIs Drug interactions - AED, Abx Not effective after D+V

Answer 44

AED | some abx

Answer 45

MoA Thickens cervical mucus Thins endometrium Decreased tubular motility --> ectopic! Advantages No oestrogen effects eg breast tenderness reversible Can use in difficult population - Age, BMI, migraine HTN ``` Disadvantages Risk of ectopic Risk of ovarian cysts not protective against STIs Can have irregular bleeding ```

Answer 46

MoA Inhibits ovulation (+thickens C mucus) Advantages Can --> amenorrhoea Reversible Long acting Disadvantages Irregular bleeding minor procedure no STI protection

Answer 47

MoA Inhibits ovulation Advantages long acting can cause amenorrhoea ``` Disadvantages Bone density weight gain Amenorrhoea for --> 12m after stopping Not immediately reversible injection ```

Answer 48

MoA Spermicide - decrease sperm motility Advantages Non hormonal Long acting Immediate affect - can be emergency contraception ``` Disadvantages Risk of menorrhagia and dysmenorrhoea Risk of perforation/ expulsion Risk of PID in first 20 days Risk of ectopic ```

Answer 49

MoA thickens cervical mucus etc Advantages Reversible Long acting Can cause cessation of periods / reduce dysmenorrhoea/menorrhagia Disadvantages Irregular bleeding ^ risk PID (20), expulsion, perforation

Answer 50

MoA Barrier + can contain spermicide Advantages Barrier - protect against STI Non hormonal Disadvantages Need to leave in 6 hrs Can be dislodged Have to put in before sex

Answer 51

IUD - immediate POCP - 2 days All others - 7 days

Answer 52

All need within 72 hrs Ellaone Levonelle Progesterone IUD - 5 days after or 5 days after likely ovulation date

Answer 53

COCP - NO <6w - cat2 if <6m all others yes IUD obvs least worry as no hormones

Answer 54

Hysterectomy Essure - coil - not reversible Tubal ligation - not reversible on NHS

Answer 55

1) Lifestyle Sleep hygiene, meditation 2) HRT Uterus? - O + P No uterus? - Oestrogen 3) Non HRT Rx symptoms Eg vaginal dryness with creams/ topical oestrogen Rx depression - SSRI

Answer 56

Benefits Reduces symptoms Reduces risk of long term things like osteoporosis ``` Risks - ^CV - Breast - VTE Others, Gall bladder disease, ``` Oestrogen specific endometriosis ovarian

Answer 57

definition <40 Aetiology - Idiopathic - Chromosomal - Iatrogenic - Infection - Autoimmune Investigations FSH >25 + 4 months amenorrhoea Management COCP/mirena

Answer 58

Hypothalamus Stress, anorexia, exercise, Kallmanns FSH + LH are LOW Anterior pituitary Prolactinoma - ^prolactin Thyroid - TSH ^ T4 low Adrenals CAH - ^testosterone Tumour - CT Cushings OGTT ``` Ovaries PCOS - ^testosterone, LH/FSH ratio ^ Androgen insensitivity syndrome POF Turners ``` ``` Uterus - USS/MRI Uterine abnormalities Imperforate hymen Transverse vaginal septum Ashermans ```

Answer 59

Aetiology - Unknown - may be due to underlying insulin resistance Insulin resistance + cysts --> ^ free floating androgens ``` Presentation TRIAD - Multiple cysts on USS - Androgen excess eg acne/hirsutism - Irregular periods ``` Other - Acanthosis nigricans - Subfertility - Weight gain - Insulin resistance Investigations LH/FSH ratio ^^^ Testosterone ^ USS - cysts Others - ^ prolactin - Insulin ^ ``` Management Non conceiving Rx hirsutism + acne COCP Spironolactone/ finasteride, eflornithine ``` ``` Conceiving help Clomifene Metformin (combination or alone) GnRH IVF ```

Answer 60

Where hormone secreting neurones do not migrate to anterior pituitary X linked Anosmia Amenorrhoea Micropenis Undescended testis Low FSH and LH Management - HRT

Answer 61

X linked There is resistance to testosterone Amenorrhoea Normal pubic hair Undescended testis Absence of uterus/vagina Investigations Buccal smear Management Remove testis (as ^ risk T cancer) HRT

Answer 62

Drugs - SSRI, steroids, smoking, chemo, BB ED dysfunction - diabetes, neuro CF Decreased sperm count/ motility/ morphology Hypospadias hyperprolactinaemia Klienfelters Varicocoele hydrocele retrograde ejaculation Autoimmune disease Infection - gonorrhoea etc

Answer 63

USS Urology Vasogram

Answer 64

See amenorrhoea Pelvic Adheisons Infections

Answer 65

Egg stimulation GnRH agonist then FSH everyday until folic 18-20mm then hCG administration (this causes OHSS) Egg collection Sperm collection Culture Embryo transfer

Answer 66

more follicles --> more oestrogen --> increased vascular permeability ``` Presentation Vascular compartment - Thrombosis - Hypotension --> shock - Hypoalbuminaemia - oliguria Tissue compartment - ascites - hydrothorax - ovarian cysts - weight gain ```

Answer 67

1) Partial/total removal of clitoris 2) Excision: partial/total removal of clitoris + labia minora +/- majora 3) Infibulation – narrowing of the vagina without excision of clitoris 4) Any other harmful procedure, piercing, incising, scraping

Answer 68

adenocarcinoma

Answer 69

Abolish cyclicity - COCP/ mirena/progesterones, GnRH Ablation/ SO Hysterectomy

Answer 70

Ofloxacin and metronidazole IM Cef, oral doxy and oral metronidazole if suspect gonorrhoea

Answer 71

IUD - 5 days after or 5 days after likely ovulation date

Answer 72

``` Idiopathic Foetal anomaly Multiple pregnancy Maternal – diabetes/ renal Oesophageal atresia ```

Answer 73

HTN | Dyspnoea

Answer 74

Edinburgh screening

Answer 75

``` Low SE status Smoking Single mum domestic violence Neonatal illness Multiple pregnancy ```

Answer 76

Financial status Family Breastfeeding

Gynae Flashcards

(103 cards)