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Gynae Flashcards

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1
Q

4 causes of secondary amenorrhoea

A

Premature menopause
hypothalamic hypogonadism
hyperprolactinaemia
PCOS

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2
Q

treatment hyperprolactinemia

A

bromocriptine, cabergoline, surgery

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3
Q

causes of AUB (acronym)

A 
Polyps
Adenomyosis
Leiomyoma
Malignancy
Coagulopathy
Ovulatory dysfunction
Endometrial
Iatrogenic
Not yet specified
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4
Q

indications for endometrial biopsy in women with menorrhagia or IMB

A 
>40 with recent onset
non responsive to tx
endometrial thickness >10
polyps suspected
with IMB
RF for cancer (nulliparity, FHx, PCOS, obesity, DM)
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5
Q

Menorrhagia medical treatment
1st line
2nd line
3rd line

A

1st: IUS
2nd: tranexamic acid or mefanamic acid (NSAIDS), COC
3rd: progestogens, GnRH

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6
Q

menorrhagia surgical tx options

A
  • polyp removal
  • endometrial ablation techniques
  • transcervical resection of fibroid
  • myomectomy
  • hysterectomy
  • uterine artery ablation (for fibroids, avoid surgery)
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7
Q

IMB Ix

A
  • Hb
  • smear
  • ultrasound if <35 and not responded to treatment or >35
  • endometriosis biopsy if meet criteria
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8
Q

ectropion tx

A

cryotherapy

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9
Q

polyps causing IMB tx

A

avulsed and sent history

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10
Q

treatment precocious puberty

A

GnRH agonists to inhibit sex hormone secretion

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11
Q

what are common association with secondary dysmenorrhoea and what ix useful

A

deep dyspareunia, menorrhagia/oligomenorrhagia

ix: pelvic US and laparoscopy

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12
Q

ss difference between primary and secondary dysmenorrhea

A

primary coincides with menstruation and responds to NSAIDS or ovulation suppression
secondary pain precedes and can be relieved by menstruation

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13
Q

define precocious puberty

A

menstruation before 10 or secondary characteristics before 8

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14
Q

causes of precocious puberty

A
  • most no cause found
  • increased GnRH (central cause): men, encephalitis, hydrocephaly, CNS tumours, hypothyroidism (tx GnRH ag)
  • increased oestrogen secretion: ovarian/adrenal tumours, McCune-Albright syndrome (tx anti-androgenic progesterone)
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15
Q

what is congenital adrenal hyperplasia

A 
increased androgen function in a genetic female
AR
cortisol production defective as 21-hydroxylase deficiency. ACTH excess -> increased androgen
ambiguous genitalia (large clitoris, amenorrhoea)
glucocorticoid deficiency -> addisonian crisis
tx = mineralocorticoid replacement
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16
Q

androgen insensitivity syndrome

A

reduced androgen function in a genetic male. converted to oestrogen. appear female. present when ‘she’ presents with amenorrhoea. uterus absent. rudimentary testes (need removal).

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17
Q

PMS key feature of SS

A

CYCLICAL (luteal phase). ss tension, irritable, breast pain, depression, loss control, aggression, GI

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18
Q

treatments for PMS

A

continuous oral contraceptive
SSRIs
HRT oestrogen patch
GnRH and add-back oestrogen (pseudomenopause, only in severe cases)
endometrial ablation (reduces hormones?)
?bilat oophorectomy but add back coc or HRT
supplements: evening primrose oil, pyridaxime (B6), Vitex Agnus, CBT

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19
Q

what are the ovaries attached to

A

ovarian fossa overlying ureters
attached to broad ligament by mesovarium
pelvic side wall by infundibulopelvic ligament
uterus by ovarian ligament

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20
Q

blood supply ovary

A

ovarian artery and anastomosis with branches of uterine artery in the broad ligament

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21
Q

outer layer of ovary is

A

germinal epithelium

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22
Q

what cells secrete oestrogen

A

theca cells and granulose cells of growing follicles in the cortex

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23
Q

most common cause of gonadal dysgenesis (one of the problems of gonadal development)

A

Turners syndrome

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24
Q

investigations for ovarian cyst

A

CA125
TVUSS
?CT

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25
management ovarian cyst emergency
laparotomy (or laparoscopy) fluid resus if rupture, abscess or PID broad spec Abs
26
ovarian carcinoma with worst prog
clear cell carcinoma (type of epithelial)
27
types of ovarian cyst in 1) premonopausal 2) postmenopausal
1) GC tumours (do hCG, AFP), follicular, lutein, benign epi tumours, endometriosis 2) benign epi or malignancy
28
5 year survival for ovarian cancer
<50%
29
investigations for ovarian cyst
CA125 TVUSS ?CT
30
management ovarian cyst emergency
laparotomy (or laparoscopy) fluid resus if rupture, abscess or PID broad spec Abs
31
ovarian carcinoma with worst prog
clear cell carcinoma (type of epithelial)
32
where are batholin's glands and what infects them
behind labia minor, e.coli/staph
33
5 year survival for ovarian cancer
<50%
34
lichen simplex appearance
thickened, hypo/hyperpigmented, often lava major
35
investigation and management of lichen sclerosis
lichen sclerosus: biopsy as can -> scc carcinoma. ultra potent steroid cream eg clobetasol
36
management vulvodynia/vulvar dysaethesia
can be provoked or spontaneous, generalised or local (vestibular). gabapentin or amitriptyline
37
treatment bartholin's
incision and drainage, may do marsupialisation
38
what are the two types of vulval intraepithelial neoplasia, present with pruritus or pain
1) usual type. common. warty, basaloid mixed. very varied appearance. HPV 16, CIN, smoking and IS ass. 2) differentiated type. rarer. ass lichen sclerosis. older. unifocal ulcer or plaque. risk progression ca high. link keratinising SCC vulva
39
percentage of genital tract carcinomas made up of 1) vulval carcinoma 2) vagina malignancies
5% | 2%
40
vulval carcinoma aetiology
de no vo (although VIN is pre Mal stage) lichen sclerosis, IS, smoking, Paget's disease of vulva 95% SCC
41
ss vulval carcinoma
pruritus, discharge, bleeding, ulcer, mass
42
key mx points vulval carcinoma
1a: wide local excision, no inguinal lymphadenectomy other stages: <4cm not suspicious SLNB if can't do, bigger or pos mets in nodes -> wide local excision and groin lymphadenectomy can add radio reconstructive surgery
43
prognosis vulval carcinoma | prognosis vaginal carcinoma
vulval: stage 1 90%, 3-4 40% | primary carcinoma vagina: 50% 5yr average
44
what is clear cell carcinoma of vagina ass with
in utero exposure to DES (50s-70s)
45
emergency investigations for pelvic infection
triple swabs FBC, CRP, WCC Pelvic USS Laparoscopy with fibril biopsy and culture GS
46
emergency management for pelvic infection
analgesia IM ceftriaxone + po doxycycline and metronidazole or ofloxacin with metronidazole febrile do IV review 24hrs if no improvement -> laparoscopy abscess -> drainage under US or lap treat sexual partners
47
how do uterine sarcomas (v rare) present
irreg or post menopausal bleeding tx hysterectomy + chemo/radio 30% 5 yr survival
48
which is the most common genital tract carcinoma
endometrial carcinoma 1% cumulative risk by 75 peak 60, rare pre menopausal
49
most common type of endometrial cancer
90% low grade adenocarcinoma of columnar endometrial glands
50
RF endometrial cancer
unopposed oestrogen: | obesity, PCOS, tamoxifen use, ovarian granulose cell tumour, DM, Lynch type 2 syndrome
51
management of endometrial hyperplasia
hysterectomy or progestogens (IUS/continuous), 3-6m hysteroscopy and endometrial biopsy
52
ss endo carcinoma:
post meno bleed irreg or IMB recent onset menorrhagia
53
investigation endo cancer
USS Endo biopsy or hysteroscopy. biopsy for dx MRI estimate Myometrial invasion or if higher risk histology CXR exclude pulmonary spread fitness for surgery: FBC, renal, glucose, CXR, ECG
54
when is recurrence endo ca most likely and where
vaginal vault within 3 years
55
poor prognostic factors
older, advanced clinical stage, adenosquamous, high grade, deep myo invasion
56
management endometrial cancer
hysterectomy | if high risk and ?LN involvement -> external beam radiotherapy, vaginal vault radio (chemo limited)
57
causes and ix/mx
antiphospholipid syndrome - Antiphospholipid AB screen (repeat 6weeks if pos), aspirin and LMWH TFTs uterine ab - pelvic USS, HSG, MRI amniocentesis/CVS PCOS Chr ab - karyotype fetal tissue then parents
58
chorioamnionitis mx
IV ABX and deliver asap (CS)
59
gestational trophoblastic disease types
hydatiform mole - complete mole (no fetal tissue just proliferation swollen cv) - partial mole (variable fetus, triploid) malignant change - invasive mole - choriocarcinoma gestational trophoblastic carcinoma (fast increase hCG)
60
ix/mx GTD
- USS snowstorm, high serum hCG - Management suction curettage, hits confirm, serial monitor hCG - Register supra regional centre - OC after ERPC - avoid pregnancy til after monitoring
61
which types of miscarriage is os open
inevitable and incomplete | closed for threatened (uterus normal for date), complete (uterus non-gravid) and missed (uterus small for date)
62
define spontaneous miscarriage and how common is it
fetus dies before 24 completed weeks of pregnancy (15% pregs). Most before 12 weeks
63
IX spontaneous miscarriage
- USS (TVUSS if <7 weeks), FHR from 6/40, beat from 22 days, see on TVUSS 1 week after) - hCG over 48hrs. more than 50% decrease non viable - FBC, RH status, G and S. give if surgically managed
64
what do you have to do before allowing a complete miscarriage home
check uterus empty. not heavy bleeding.
65
which types of miscarriage is os open
inevitable and incomplete | closed for threatened, complete and missed
66
management of miscarriage
light bleeding - expectant or medical management (pv/po misoprostol) heavy bleeding - IM ergometrine, ERPC read notes
67
management for TOP
1) bloods, Hb, G and S, Rh status, test haemoglobinopathies 2) Rh -ve, give anti-D within 72 hours 3) chlamydia screen, risk assess for others and screen if need 4) discuss contraception 5) medical: mifepristone and misoprostol (KCL if after 22 weeks) surgical: 7-13 weeks suction curettage. >14 weeks dilatation and evacuation (preop misoprostol and ABX)
68
Ectopic presentation
``` abdo pain colicky to constant bleed collapse cervical excitation adnexal tenderness Uterine small for date and Os closed ```
69
ectopic hCG levels
between 60% increase and 50% decline over
70
indications for surgical management of ectopic
>35mm, >5000IU hCG, significant pain, ?coexisting preg

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