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gynae Flashcards

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1
Q

menopause symptoms

A

due to falling oestrogen levels
menstrual irregularity
vasomotor disturbance - sweats, palpitations, flushes
osteoporosis
vaginal dryness from vagina atrophy - causing infection, UTIs, dyspareuria

if dont want HRT, can be given SSRI

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2
Q

HRT
benefits
risks

A

Benefits
Relief of menopause symptoms
Bone mineral density protection
Possibly prevent long term morbidity

Risks
Breast cancer
VTE - risk with oral HRT
Cardiovascular disease - only when started in women over 60
Stroke
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3
Q

HRT
uterus
no uterus

A

uterus - combined HRT (oestrogen and progesterone)

no uterus - oestrogen only

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4
Q

Premature Ovarian Insufficiency (POI)

A

Menopause <40 yrs
Natural or Iatrogenic
Majority of cases – idiopathic
Other Chromosome abnormalities, FSH receptor gene polymorphisms
Diagnosis FSH >25IU/l – 2 samples >4 weeks apart + 4 months of amenorrhoea

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5
Q

endometriosis what is it

A

endometriotic tissue outside the uterus
cause unknown
hormonally (oestrogen) driven

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6
Q

endometriosis cause theories

A

retrograde menstruation - leads to adherence, invasion and tissue growth
metaplasia of mesothelial cells

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7
Q

endometriosis presentation

A

cyclical pain - due to endometrial tissue responding to menstrual cycle
constant pain - due to adhesions from chronic inflammation
dysmenorrhoea
dyspareunia

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8
Q

endometriosis treatment

A

combined OCP, or progesterones, or mirena
GnRH agonists (goserelin) - down regulate the pituitary gland (less FSH/LH) have menopausal SE so add HRT
hysterectomy - last resort

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9
Q

adenomyosis
what is it
symptoms
treatment

A 
endometrial tissue in myometrium
Cyclic pain, Dysmenorrhoea, Dyspareunia 
Progesterone IUS (mirena), hysterectomy
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10
Q

fibroids
what are they
location

A 
oestrogen dependent benign smooth muscle tumours of the uterus
can be:
subserosal - visceral peritoneum
intramural
submucosal - under the endometrium
pedunculated
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11
Q

fibroids presentation

A

many asymptomatic
menorrhagia (+/- anaemia)
fertility problems - submucosal interfere with implantation (infertility / miscarriage)
pain - torsion from pedunculated fibroids
Dysmenorrhea

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12
Q

fibroids management

A

myomectomy - to preserve fertility
GnRH analogues to reduce size before surgery (goserelin)
will shrink and calcify at menopause, HRT may cause them to grow
Ulipristal acetate
may cause pregnancy problems - malpresentation
hysterectomy - only cure, for those who have completed their family

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13
Q

heavy menstrual bleeding definition

A

Menstrual blood loss that is subjectively considered to be excessive by the woman and interferes with her physical, emotional, social and material quality of life

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14
Q

Menorrhagia definition

A

Heavy Menstrual Bleeding that occurs at expected intervals of the menstrual cycle

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15
Q

Heavy Menstrual Bleeding causes

A 
Uterine fibroids (20-30%)
Uterine polyps (5-10%)
Adenomyosis (5%)

women >45 think endometrial carcinoma

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16
Q

menorrhagia investigations

A 
FBC
transvaginal US
bimanual vaginal exam and speculum            
Endometrial biopsy if >45yrs and:
IMB
Unresponsive to treatment
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17
Q

menorrhagia treatment

A 
mirena
Antifibrinolytics (Tranexamic acid) - Inhibits tissue plasminogen activator
NSAID - Mefenamic acid
endometrial abalation - completed family
reassurance
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18
Q

infertility - ovarian reserve testing hormones (3)

A

FSH, Antral Follicle Count (AFC), Antimullerian Hormone (AMH)

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19
Q

infertility
ovulating hormones
ovarian reserve testing
tubual patency investigations

A

LH and progesterone

Ovulation / ovarian function
Semen Quality
Tubal Patency (+ Uterus)

hysterosalpingogram
USS

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20
Q

infertility - semen quality

A

Count (>15m/ml)
Motility (>40%)
Morphology (>4%)
Total >39m

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21
Q

male infertility treatment

A

Mild - Intrauterine Insemination (IUI)
Moderate abnormality - IVF
Severe – Intracytoplasmic Sperm Injection (ICSI)

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22
Q

polycystic ovarian syndrome diagnosis

A

2/3 of:
hyperandrogenism
oligomenorrhoea
polycystic ovaries on US

causes increased insulin and LH levels hyperandrogenism (testosterone)

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23
Q

polycystic ovarian syndrome management

A

clomifene citrate or tamoxifen - Oestrogen receptor modulators, induces ovulation (increases FSH). risk of ovarian cancer and multiple pregnancies

weight loss/metformin - improves insulin sensitivity

laproscopic ovarian drilling to those non responsive to above

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24
Q

IVF risks

A

Multiple Pregnancy
Miscarriage
Ectopic

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25
endometrial cancer pathology
andenocarcinomas of columnar endometrial gland cells
26
endometrial cancer staging
1 - body of uterus only 2 - body and cervix only 3 - advancing beyond the uterus but not the pelvis 4 - outside the pelvis
27
endometrial cancer treatment
total hysterectomy with bilateral salpingo-oophorectomy Adjuvant radiotherpay progesterone therapy
28
cervical polyps definition and symptoms
benign tumours of endocervical epithelium | may cause increased mucus discharge and postcoital bleeding
29
cervical cancer risk factors
High risk HPV (16, 18) Early age intercourse (<16 years) Multiple sexual partners STDs
30
persistent HPV associated with ...
cervical intra-epithelial neoplasia which is pre invasive stage for cervical cancer
31
cervical intra-epithelial neoplasia 1,2 and 3 | teatment
CIN 1 - lower basal 1/3 of cervical epithelium CIN 2 - 2/3 CIN 3 - >2/3 invasive basal cell carcinoma when crosses the basement membrane treatment - large loop excision of the transformation zone (LLETZ)
32
cervical cancer staging
1 - confined to the cervix a) microscopic b) macroscopic 2 - a) to upper 2/3 vagina b) if to parametria 3 - a) extended to lower 1/3 of vagina b) or pelvic wall 4 - a) spread to bladder or rectum b) distant organs
33
cervical cancer symptoms
``` vaginal bleeding (post-coital) watery discharge ureteric obstruction ```
34
vulval cancer symptoms
``` Vulval itching Vulval soreness Persistent ‘lump’ Bleeding Pain on passing urine ```
35
vulval cancer staging
I <2cm (79% 5 yr survival) II >2cm (59% 5 yr survival) III Adjacent organs / Unilateral Nodes (43% 5 yr survival) IV Bilateral nodes / Distant mets
36
lichen sclerosis presentation | can predispose to ...
autoimmune elastic tissue turns to collagen intensely itchy can be a predisposing cause of vulval cancer
37
lichen sclerosis management
clobetasol propionate cream
38
vulval cancer pathology
squamous cell carcinoma
39
ovarian cancer presentation
``` asymptomatic / vague Bloating / ‘IBS’ like symptoms Abdominal pain/discomfort Change in bowel habit Urinary frequency Bowel obstruction ```
40
ovarian cancer aetiology
``` epithelial cell (carcinoma) e.g. Serous cystadenocarcinomas Endometrioid carcinoma ```
41
ovarian cancer risk factors protective factors
``` nulliparity early menarche / late menopause ovarian cysts BRCA 1 / 2 mutations HNPCC (lynch syndrome) ``` pregnancy COCP
42
ovarian cancer investigations tumour marker
``` FBC,UE,LFT transvaginal US CXR CT abdo/pelvis CA125 ```
43
suspected ovarian cancer risk of malignancy | RMI formula
risk of malignancy index RMI = US x M x CA125 US score - 1 less than one abnormal feature of cyst on USS, 3 more than one abnormal feature of cyst on USS M - menopause status 1 pre 3 post 250+ = refer
44
ovarian torsion presentation
venous return is occluded severe lower abdominal pain and vomitting pain improves after 24 hours as ovary starts to die whirl pool sign on TV US
45
pelvic inflammatory disease symptoms
lower abdominal pain - uni or bilateral / constant or intermittent dyspareunia vaginal discharge
46
pelvic inflammatory disease management investigations
ceftriaxone and metronidazole and doxycycline Inflammatory markers are raised USS excludes abscess and ovarian cyst
47
ashermans syndrome what is it cause complications
scar tissue in the womb often a result if miscarriage can cause infertility, amenorrhoea
48
prolactinoma presentation
menstrual disturbance amenorrhoea / oligomenorrhoea raised prolactin causes hypogonadism, infertility
49
menopause investigations
anti-Müllerian hormone | FSH
50
FIGO staging of ovarian cancer
1 - limited to one or both ovaries 2- limited to pelvis 3 - limited to abdomen 4 - distant metastases outside abdominal cavity
51
Amenorrhoea – Investigations
``` Pregnancy test if appropriate FSH/LH levels Prolactin levels Total testosterone and sex-hormone binding globulin levels karyotyping - possible turners syndrome ```
52
Primary amenorrhoea Secondary amenorrhoea Oligomenorrheoa definitions
Primary amenorrhoea: periods have not started by age of 16 Secondary amenorrhoea: periods stop for 6 months or more Oligomenorrheoa: Infrequent periods (more than every 35 days for 6 months)
53
Irregular Menstruation and Intermenstrual Bleeding investigations
``` Assess effect of blood loss- FBC TFT/clotting if clinically indicated FSH/LH levels if menopause suspected Cervical smear if required US of uterine cavity Women > 35 Younger if medical treatment failed ```
54
fibroids investigations
Abdominal/bimanual pelvic examination US (transvaginal and transabdominal) Hysteroscopy/hysterosalpingogram FBC
55
cervical / intrauterine polyps presentation Diagnosis Management
asymptomatic Menorrhagia IMB US Hysteroscopy Resection with cutting diathermy or avulsion
56
endometrial cancer risk factors
Exogenous oestrogen - Unopposed oestrogen therapy Endogenous oestrogen excess - PCOS with prolonged amenorrhea, Late menopause T2DM HNPCC / lynch syndrome
57
endometrial cancer symptoms and signs
Postmenopausal bleeding (most common) Premenopausal patients - Irregular/IMB, Occasionally recent onset menorrhagia Atrophic vaginitis may coexist
58
endometrial cancer investigations
tranvaginal US endometrial biopsy MRI abdo/pelvis CXR
59
cervical Intraepithelial Neoplasia Screening guidlines investigations
All females from age 25 or first intercourse, whichever comes last Repeat every 3 years until 49 From age 50-64 Every 5 years From age 65 Only those not screened since 50 or have had abnormal tests cervical smear colposcopy
60
cervical cancer pathology
squamous cell carcinoma (70%)
61
polycystic ovarian syndrome presentation
Stereotypical patient Obese, acne, excess body hair Oligo- or amenorrhoea Miscarriage
62
endometriosis investigations
laparoscopy and biopsy - Only way to be certain transvaginal USS to visualise chocolate cysts MRI if adenomyosis is suspected
63
prolapse management
Pessary | surgery
64
common causes of pelvic pain
* Pelvic inflammatory disease occuring after the insertion of IUCD (common complication of this) but PID is usually more bilateral than unilateral * Uterine perforation * Acute PID – due to STI infection * Ectopic pregnancy
65
secondary amenorrhoea causes
hypothalamic-pituitary-ovarian causes - stress, exercise, weight loss hyperprolactinaemia ovarian causes - polycystic ovarian syndrome uterine causes - pregnancy
66
cervical cancer treatment
radical hysterectomy +/- chemoradiotherapy may be able to do local excision (fertility sparing)
67
ovarian cyst features
multilocular cyst solid areas metastases ascities

obs and gynae (4 decks)

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