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Phase 3a Medicine > Gynae > Flashcards

Gynae Flashcards

(44 cards)

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1
Q

What are the 2 main types of incontinence, their causes, diagnosis, and the steps in their management?

A

Stress: urethral sphincter weakness.
Urodynamic studies (cystometry) to confirm stress incontinence.
- 1st: Pelvic floor exercises 3/12.
- 2nd: surgery (vaginal tape.)
- 3rd: decline or can’t have surgery = Duloxetine.

Urge: overactive bladder (detrusor muscle.)

  • 1st: bladder drill.
  • 2nd: drugs = oxybutinin.
  • 3rd: surgery.
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2
Q

Define early menopause.

Define premature ovarian insufficiency.

Ix and findings for menopause?

Risks of HRT?

What should contraception use around the menopause be?

A
  • 40-45.
  • <40.
  • Day 2 and 5 FSH high (>40).
  • Breast cancer, VTE, IHD and stroke (if over 60!!) T2DM.
  • Use contraception for 2 years if menopause <50, or 1 if menopause >50.
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3
Q

Which cancers do oestrogen and progesterone increase the risk of?

A

Oestrogen: endometrial and ovarian.

Progesterone: breast and cervical.

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4
Q

Explain the pathology in hypothalamic causes of amenorrhoea and list the causes.

A

Reduction in GnRH release due to anorexia, dieting, athletes, stress.
Kallmann’s syndrome: GnRH secreting neurones fail (+anosmia.)

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5
Q

Explain the pathology in pituitary causes of amenorrhoea and list the causes.

A
  • Hyperprolactinaemia inhibits GnRH release: anti-psychotic meds, pituitary adenoma.
  • Sheehan’s syndrome: massive PPH = necrosis of ant. pituitary = no LH and FH is released from it.
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6
Q

Explain the pathology in thyroid causes of amenorrhoea and list the causes.

A

Hyper or hypothyroidism.

Low T3 and T4 leads to negative feedback and increased TRH (hypothalamus) and so TSH (anterior pituitary).

The increased TRH = more prolactin = supress GnRH.

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7
Q

Explain the pathology in adrenal causes of amenorrhoea and list the causes.

A
  • CAH.

- Tumours = increased androgen production.

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8
Q

Explain the pathology in ovarian causes of amenorrhoea and list the causes.

A

PCOS (not true.)

Premature ovarian syndrome.

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9
Q

Explain the pathology in genetic causes of amenorrhoea and list the causes.

A

Turner’s (45XO) = underdeveloped gonads (dysgenesis) = normal GnRH, FSH, LH, but no oestrogen from ovaries.

Idiopathic gonadal dysgenesis.

Androgen insensitivity syndrome: XY resistant to androgens so develops female characteristics.

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10
Q

Explain the pathology in structural causes of amenorrhoea and list the causes.

A

Imperforate hymen.
Transverse vaginal septum.

Asherman’s = 2ndary

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11
Q

List the commonest causes of menorrhagia

A

Fibroids.
Polyps.
Adenomyosis.

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12
Q

List the Tx options for primary menorrhagia.

A
  1. Mirena IUS.
  2. Tranexamic acid.
  3. Mefenamic acid (NSAID.)
  4. COCP.
  5. Progestogens.
  6. Endometrial ablation/ hysterectomy.
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13
Q

Mx of primary dysmenorrhoea

A
  1. Lifestyle.
  2. Analgesia (NSAIDS +/- paracatemol.)
  3. IUS/COCP 3-6 month trial.
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14
Q

Sx and Tx or fibroids

A

Menorrhagia.
Pressure Sx.
Subfertility.
Red degeneration in pregnancy.

Tx:
1. Mirena IUS.
2. Tranexamic acid. Mefenamic acid (NSAID.)
3. GnRH and transcervical resection of fibroids (TCRF).
or myomectomy
or hysterectomy.

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15
Q

Define polyps, when are they common, Sx, Ix and Tx.

A

Benign tumours that grow into uterine cavity.

Common in post-menopausal women.

Menorrhagia, IMB.

USS/hysteroscopy for Ix of bleeding

Recetion by cutting diathermy or avulsion due to carcinoma risk.

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16
Q

When investigating menorrhagia, when should you a) not offer Ix and just treat, b) offer hysteroscopy and c) offer TVUS?

A

a) if no other Sx.
b) if other Sx but suspect they are small.
c) palpable uterus, pelvic mass, difficult e.g. obese.

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17
Q

Diagnosis of adenomyosis?

A

TVUS.

MRI.

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18
Q

List the causes of recurrent miscarriage

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A

Antiphospholipid antibodies (thrombosis in uteroplacental circulation.)

Chromosomal abnormalities.

Anatomical issues such as uterine abnormalities or cervical incompetence.

Infection.

19
Q

What happens in antiphospholipid Ab?, and what is the Tx?

Study These Flashcards
A

thrombosis in the uteroplacental circulation. Tx is Aspirin and LMWH.

20
Q

What are the types of management for miscarriage and when would they be used?

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A
  1. Refer to early pregnancy assessment unit.
  2. Give anti-D if >12 weeks or severe and painful bleeding.
  • Expectant: as long as mother happy and no signs of infection. Has 24/7 access to gynae services.
  • Medical: Vaginal Misoprostol.
  • Surgical: ERPC under anaesthetic. If preferred by Px, heavy bleeding, signs of infection (add Abx if so.)

Repeat scans 2/3 weeks later.

21
Q

What blood test should be done in suspected miscarriage and what would the results be?

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A

Serum b-hCG: increase bu >66% in 48hrs if viable intrauterine pregnancy.

22
Q

What are the investigations for a suspected ectopic?

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A
  1. Pregnancy test in any woman of childbearing age.
  2. TVUS: intrauterine pregnancy? If none = pregnancy of unknown location.
  3. Repeat serum hCG 48 hours apart. If <1500 IU/mL:
    - Increase of 66% in 48hrs = early viable.
    - Decrease >50% in 48 hrs = complete miscarriage.
    - Between this = ectopic.
23
Q

What would high hCG levels, but an empty uterine sac be suggestive of?

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A
  • <5 weeks viable intrauterine pregnancy.
  • Complete miscarriage.
  • Ectopic pregnancy.
24
Q

What is the management for a suspected ectopic and the criteria for each?

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A

Expectant:

  • hCG <1000 and falling.
  • Small and unruptured.
  • No heartbeat.

Medical:

  • Unruptured and no pain.
  • No heartbeat.
  • hCG <1500.
  • IM Methotrexate.

Surgical:

  • Ruptured.
  • Large.
  • Lot of pain.
  • Visible heartbeat.
  • hCG >1500.
  • Perform laparoscopic salpingectomy.
  • Or salpingostomy to remove just the ectopic if other tube is damaged, to preserve fertility.
25
What is the triad of endometriosis Sx, the diagnostic Ix, and Tx pathway?
- Infertility, dysmenorrhoea, dyspareunia. - Laparoscopy. Medical: - Analgesia. - COCP, or Mirena IUS. - Progestogens. - GnRH analogue to induce temporary menopause. Surgical: - Laparoscopic diathermy. - Hysterectomy with BSO.
26
What is the Tx pathway for PID?
IM Ceftriaxone. Doxycycline and Metronidazole. After 24 hours if no improvement = laparoscopy.
27
Commonest type of endometrial cancer? Risk factors? Clinical features? Ix?
Adenocarcinoma. Unopposed oestrogen (i.e. anovulation.) PMB, rarely IMB in younger. TVUS, thickness >5mm (or >4mm if postmenopausal) = biopsy.
28
Describe the staging for endometrial cancer
1: confined to uterus a = less than half myometrial invasion. b - more than half myometrial invasion. 2: extend to cervix. 3: beyond uterus but confined to pelvis. a - ovaries. b - vaginal. c - lymph nodes. 4a - bladder/bowel b - distant mets.
29
Describe the Tx for endometrial cancer
Total hysterectomy with bilateral salpingo-oophorectomy. Adjunct chemo then radio.
30
Commonest type of ovarian cancer? Risk factors? Clinical features?
Epithelial subtype. More ovulations = increased risk. Non-specific, bloating, change in bowel/urinary habits (IBS), dyspareunia.
31
What are the investigations for ovarian cancer?
- Under 40 = rule out germ cell tumour with lactate, alphafetoprotein, hCG. RMI (risk of malignancy index) USS * Menopause * CA125 USS: cysts, solid areas, metastases, ascites, bilateral lesions. 1 point if 1, 3 points if 2+. Menopause: 1 for pre, 3 for post. CA125 (cancer antigen.) RMI >250 = refer.
32
Describe the staging of ovarian cancer.
1: confined to ovaries. a - one effected. b - 2 effected. c - 1 or 2, but capsule not intact. 2: beyond ovaries, confined to pelvis. 3: beyond pelvis, confined to abdomen. 4: distant mets.
33
Treatment of ovarian cancer?
- Midline laparotomy for staging. - Total hysterectomy with BSO and omentectomy. - 2+ = remove retroperitoneal LN. - 1c+ = chemo.
34
# Define CIN. What are the types and peak age? What causes it?
Cervical intraepithelial neoplasia. Presence of dyskaryotic cells within squamous epithelium of the ectocervix. Types 1, 2 and 3, peak age for 3 in <45. Caused by HPV (16 and 18 commonly associated with cervical cancer.)
35
What age and frequency for cervical screening? If first is inadequate? If 2 are inadequate? If HPV -ve? If HPV +ve? Possible outcomes? Treatment?
25-49 = every 3 years. 50 - 64 = every 5 years. 65+ if no smear since 50. Repeat in 3 months. Refer to colposcopy. Return to routine screening. Do cytology. Changes seen = refer to colp. Normal = repeat after 1 year. -ve HPV = return to normal. +ve = repeat in 1 year. ``` -ve = return to nromal. +ve = refer. ``` LLETZ (large loop excision of transformation zone.)
36
What is the majority of cervical cancer? Cause and risk Fx? Clinical features? Investigation?
Squamous cell carcinoma. Persistent HPV infection: - early intercourse. - multiple sexual partners. - STDs. - smoking. Abnormal vaginal bleeding. STI tests. Colposcopy referral + biopsy.
37
Staging for cervical cancer?
0 - in-situ carcinoma. 1 - confined to cervix. a: microscopic. b: macroscopic. 2 - beyond cervix but no pelvic wall or lower 1/3 of vagina. a: upper 2/3 vagina. b: parametrial involvement. 3 - pelvic side wall, lower 1/3 of vagina, hydronephrosis. a: lower 1/3 of vagina. b: pelvic side wall and/or hydronephrosis. c: pelvic LN or para-aortic LN. 4a - bladder/rectum b - distant mets.
38
Cervical cancer Tx?
1a - cone biopsy. 1b - Laparoscopic radical hysterectomy. (trachelectomy to preserve fertility.) 2 onwards = with chemoradiation.
39
List and explain the types of prolapse.
Urethrocele. Cystocele - bladder bulges into front (anterior) wall of vagina. Uterine - uterus, cervix, vagina prolapse. Enterocele - upper posterior vaginal wall, creates a pouch containing loops of small bowel. Rectocele - lower posterior vaginal wall, rectum pushes through.
40
Management of prolpase?
Pessary, esp if unfit for surgery, changed every 6-9 months. Surgery
41
Describe the aetiology of PCOS.
Excess LH = more androgens. Insulin resistance = supresses sex hormone binding globulin = higher levels of free androgens. Both leads to supressed LH surge and anovulation, so follicles remain in ovary as cysts. Also leads to the Sx seen.
42
What are the criteria for PCOS? Name and list them.
Rotterdam Criteria: 2/3 = diagnosis. - Oligo or amenorrhoea. - Clinical and/or biochemical signs of hyperandrogenism. - PCO on US (12+)
43
What are the important Ix in PCOS?
LH:FSH ratio = raised.
44
Management of PCOS?
- Reduce weight. - COCP. - Want to conceive: Clomifene and metformin. Laparoscopic ovarian drilling (diathermy.)

Phase 3a Medicine (4 decks)

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