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Gynae / GUM Flashcards

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1
Q

Syx of candidal vulvovaginitis

A

Soreness
Itching
Red skin - possible peeling, pustules or apples
White discharge

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2
Q

When to refer candidal vulvovaginitis

A

Unclear diagnosis
No improvement despite tx
Immunocompromised patient
Systemic tx needed

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3
Q

Tx of candidal vulvovaginitis

A

Topical imidazole e.g clotrimazole, ketoconazole, econazole
Alternative = topical terbinafine

If problematic itch/ inflammation add mild steroid cream

If tx ineffective try - oral fluconazole 50mg 2-4 wks

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4
Q

Which COCP may also help with acne

A

Dianette - shouldn’t be used only for contraception

Yasmin

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5
Q

What syndrome is caused by 45XO

A

Turners syndrome - absence of one X chromosome in a female

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6
Q

What is the SRY gene

A

Sex determining region of the Y chromosome

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7
Q

Clinical features of Turners Syndrome

A

Female
Short stature
Webbed neck
Wide carrying angle of elbow

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8
Q

Associated medical conditions of Turners Syndrome include

A 
Coarctation of the aorta 
IBD
Sensorineural and conduction deafness 
Renal anomalies
Endocrine dysfunction - autoimmune thyroid disease
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9
Q

What patients have streak ovaries

A

Turners Syndrome

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10
Q

How does Turners Syndrome get detected

A

At birth - clinical appearance
Childhood - short stature
Adolescence - delayed puberty

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11
Q

Is pregnancy possible in Turners Syndrome

A

Yes - usually requires egg donation

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12
Q

What is XY gonadal dysgenesis

A

XY karyotype but gonads don’t develop in testis
Phenotypically Female
Genotypically Male
Pregnancy may be possible with egg donation

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13
Q

What is 46XY disorder of sex development

A

Complete androgen insensitivity syndrome.
Testes form due to SRY gene action.
Testes secrete AMH –> regression of Müllerian ducts.
Phenotypically F - F external genitalia - no uterus.
Breast development, minimal public hair.
Short vagina

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14
Q

Genital effects of congenital adrenal hyperplasia

A

Virilization of F foetus
Enlarged clitoris
Labia fused + scrotal in appearance

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15
Q

What is Mayer-Rokitansky-Kuster-Hauser syndrome

A

Müllerian agenesis - absent / rudimentary uterus + upper vagina.
Primary amenorrhea after normal pubertal development.

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16
Q

What age defines precocious puberty

A

Before 8 in F

Before 9 in M

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17
Q

2 categories of precocious puberty

A

Central (gonadotropin dependent - 75% cause unknown.)

Peripheral (always pathological)

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18
Q

Causes of central precocious puberty

A

75% unknown

25% due to CNS malformation or brain tumour

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19
Q

Causes of peripheral precocious puberty

A

Always pathological

Oestrogen secretion - e.g. Hormone producing tumour, exogenous ingestion

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20
Q

Age definition of delayed puberty

A

No secondary sexual characteristics by age 14

Due to - hypogonadotrophic hypogonadism
- hypergonadotrophic hypogonadism

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21
Q

What causes hypogonadotrophic hypogonadism

A 
Constitutional 
Anorexia nervosa
Excessive exercise 
Diabetes 
Renal failure
(Pituitary tumour, kalman's syndrome) - rare
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22
Q

What causes hypergonadotrophic hypogonadism

A

Turner syndrome
XX gonadal dysgenesis
Premature ovarian failure
Following chemo or radio therapy for child cancers.

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23
Q

What does gonadotropin releasing hormone do

A

Controls pituitary hormone secretion
GnRH secreted in a pulsatile way to stimulate LH and FSH
GnRH at constant high dose reduces LH and FSH secretion.

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24
Q

What are buserelin and goserelin

A

GnRH agonists

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25
What is the effect of oestrogen on LH
Low oestrogen inhibits LH production. | High oestrogen increases LH production.
26
Effect of progesterone on LH and FSH
Low progesterone levels increase LH and FSH productions. | High progesterone levels decrease LH and FSH productions.
27
Causes of heavy menstrual bleeding
``` Fibroids Endometrial polyps Coagulation disorders PID thyroid disease Drug tx - warfarin Copper coil Endometrial ca Cervical ca ```
28
What is the new name for dysfuntional uterine bleeding
Bleeding of endometrial origin | Diagnosis of exclusion
29
Investigation for heavy menstrual bleeding
``` FBC - anaemia Coagulation screen Pelvic USS - fibroid, endometrial polyp, cancer Vaginal / endocervical swabs - PID Endometrial biopsy - endometrial cancer TFTs ```
30
Management of heavy menstrual bleeding
``` Mefenamic acid (NSAID) Tranexamic acid COCP Norethisterone - taken from day 6 to 26 Mirena coil GnRH agonists - short term Endometrial ablation Hysterectomy ```
31
What is endometrial ablation / how is it done
Day case Through the vagina and cervix Hysteroscopy before + after Full thickness of endometrium abated
32
Causes of dysmenorrhea
``` No cause found Endometriosis Adenomyosis PID Cervical stenosis Haematometra ```
33
Diagnosis of endometriosis
Laparoscopy
34
Treatment of endometriosis
COCP (continuously is best) Mirena Surgical laser ablation, diathermy or excision
35
Complication of endometriosis
Adhesions 'Chocolate' ovarian cysts = endometriomas Infertility
36
What is adenomyosis
Ectopic endometrial tissue within myometrium
37
Management of dysmenorrhea
``` NSAIDS - ibruprofen, mefenamic acid COCP Mirena Low fat diet Exercise GnRH anaologues Heat ```
38
Causes of dyspareunia
``` PID Endometriosis Ovarian cysts STIS Thrush Vaginal atrophy / lack of lubrication ```
39
Define primary amenorrhea
Failure to menstruate by age 16
40
Define secondary amenorrhea
Absence of menstruation for >6m that isn't due to pregnancy, lactation or menopause
41
Causes of secondary amenorrhea
``` Obesity BMI <18.5 Excessive exercise Severe anxiety Pituitary tumour Chemotherapy Antipsychotic drugs Thyroid overactivity PCOS POF Ashermans syndrome ```
42
Causes of primary amenorrhea
``` Anatomical - cervical stenosis - imperforate hymen - Müllerian agenesis - transverse vaginal septum Hypothalamic-pituitary dysfunction - Anorexia - Chronic illness - excessive exercise - head injury Ovarian failure - Turners syndrome - POF - chemotherapy - pelvic irradiation Hypothyroidism Hyperthyroidism ```
43
Investigation of amenorrhea
``` Pregnancy test Blood - LH, FSH, Testosterone Prolactin level TFT USS of ovaries Hysteroscopy if ashermans / cervical stenosis ```
44
Clinical manifestations of PCOS
``` Menstrual irregularity - oligomenorrhoea / amenorrhea Hirsutism Subfertility Recurrent miscarriage (50%) Obesity High LH insulin resistance Acanthosis nigricans ```
45
Diagnosis of PCOS
2+ of: - amenorrhea / oligomenorrhoea - hyperandrogenism - polycystic ovaries on USS
46
Management of PCOS
``` COCP Cyclical oral progesterone Metformin Clomiphene Weight reduction Exercise ```
47
Management of hirsutism
``` Eflornithine cream Cyproterone acetate (Dianette) Metformin GnRH analogues Laser / electrolysis ```
48
Causes of post menopausal bleeding
``` Atrophic vaginitis Endometrial polyps Endometrial hyperplasia Endometrial carcinoma Cervical carcinoma ```
49
Investigation of post menopausal bleeding
TV USS of endometrial thickness (<3mm) Endometrial biopsy Hysteroscopy (+curettage of polyps)
50
Management of atrophic vaginitis
Topical oestrogen cream Oestrogen pessaries Oestrogen ring pessaries
51
Management of simple or complex endometrial hyperplasia
Oral progesterone | Mirena
52
Management of atypical endometrial hyperplasia
Total abdominal hysterectomy - risk of progression to malignancy
53
Management of endometrial cancer
Total abdominal hysterectomy + BSO + washing +/- adjuvant therapy
54
Management of pre-menstrual syndrome
``` Stress reduction Exercise Alcohol and caffeine reduction COCP / oestrogen patches / mirena SSRIs CBT GnRH analogues Hysterectomy + BSO ```
55
Types of candida species
``` Candida albicans Candida tropicalis Candida glabrata Candida krusei Candida parasilosis ```
56
Common species involved in bacterial vaginosis
Gardnerella vaginalis Mycoplasma hominis Bacteroides Mobilincus
57
Which STI is a flagellate Protozoan
Trichomonas vaginalis
58
Symptoms of Trichomonas vaginalis
Vulval soreness + itching Foul smelling discharge - may be frothy / green Dysuria Abdo discomfort Strawberry cervix (punctate haemorrhages)
59
Diagnosis of Trichomonas vaginalis
Microscopy of vaginal discharge
60
Treatment of Trichomonas vaginalis
Metronidazole (2g) single dose | Tx both partners
61
Symptoms of bacterial vaginosis
Malodorous fishy discharge Assymptomatic carriers More prominent during menstruation Cream / grey discharge - commonly adheres to wall of vagina
62
What do clue cells suggest
Bacterial vaginosis | Clue cell = epithelial cell covered in bacteria
63
Management of bacterial vaginosis
Metronidazole 2g single dose | Or as a gel
64
Problems with bacterial vaginosis in pregnancy
In 1st T can --> second trimester miscarriages or preterm labour Tx with metronidazole
65
Which STI is a gram -ve diplococcus
Neisseria gonorrhoea
66
Symptoms of gonorrhoea
``` Asymptomatic Increased vaginal discharge Abdo / pelivic pain Dysuria Urethral discharge Proctitis / rectal bleeding Cervical bleeding on contact Cervical excitation ```
67
Causes of cervical excitation
Ectopic pregnancy PID gonorrhoea
68
Treatment of gonorrhoea
Cephalosporins - cefixime oral 400mg single dose - cefriaxinine IM 250mg single dose
69
Which STI is an obligate intracellular pathogen
Chlamydia
70
Symptoms / signs of chlamydia infection
``` Asymptomatic Vaginal discharge Lower abdo pain Intermenstrual bleeding Cervical discharge Post-coital (contact) bleeding Dysuria Urethral discharge ```
71
Complications of chlamydia
``` PID Fitz-Hugh-Curtis syndrome =peri-hepatitis Neonatal conjunctivitis Neonatal pneumonia Adult conjunctivitis Reiters syndrome = reactive arthritis ```
72
Treatment of chlamydia
Azithromycin 1g orally single dose (safe in pregnancy) | Doxycycline 100mg oral BD 7d
73
What is PID
Inflammation and infection arising from endocervix Leading to endometritis, salpingitis, oophoritis and pelvic peritonitis. Often due to chalmydia, gonorrhoea or BV
74
Symptoms / signs of PID
``` Abdo / pelvic pain Dyspareunia Pyrexia >38 Heavy bleeding Intermenstrual bleeding Pelvic tenderness and cervical excitation on examination Tubal damage ```
75
Outpatient treatment of PID
Ofloxacin oral 400mg BD 14d | AND metronidazole 400mg BD 14d
76
When is hospitalisation indicated for PID
``` Severe infection Adnexal mass ? Abscess Sepsis Poor response to tx Severe pain requiring strong analgesics ```
77
Symptoms of herpes simplex
Painful vesicles Ulcerations Urine retention
78
Treatment of herpes simplex
Acyclovir 200mg 5xd | Analgesics
79
What virus causes genital warts
HPV 6 + 11
80
Treatment of genital warts
Podophyllin - local application 2x/wk Surgical excision Laser Cryotherapy
81
What causes Syphillis
Treponema pallidum
82
Symptoms of primary Syphillis
Painless ulcer on vulva / cervix | Englarged groin / inguinal lymph nodes
83
Symptoms of secondary Syphillis
Maculopapular rash on palms and soles | Mucous membrane ulcer
84
Treatment of Syphillis
Procaine Penicillin I.M. daily 12d | Benzathine penicillin IM 2x 7 days apart
85
Symptoms of generalised Syphillis
Lymphadenopathy | Arthritis
86
Symptoms of neuro Syphillis
Meningitis Stroke Tabes dorsalis
87
Symptoms of congenital Syphillis
Intrauterine death Interstitial keratitis VIII nerve deafness Abnormal teeth
88
Symptoms of genital TB
Amenorrhoea Infertility Acute / chronic pelvic pain Frozen pelvis due to adhesions
89
What does haemophilus ducreyi cause
Chancroid
90
Symptoms of Chancroid
Painful shallow multiple ulcers | Regional lymphadenopathy + suppuration
91
What causes granuloma inguinale
Klebsiella granulomatosis
92
Failure rate of COCP per 100 women years
0.1-1 %
93
Failure rate of POP per 100 women years
1-3%
94
Failure rate of mirena per 100 women years
0.5%
95
Failure rate of depo prova per 100 women years
0.1-2%
96
Failure rate of condom per 100 women years
2-5%
97
Mechanism of action of COCP
Inhibition of ovulation Atrophic endometrium Thickened cervical mucus
98
Absolute CI to COCP use
``` 15 cigarettes / day Hypertension >160 / 100 Hx of DVT / PE / stroke Major surgery + prolonged immobilisation IHD / valve disease Migraine with aura Migraine without aura >35 yo Current breast cancer Diabetes >20 yrs Viral hepatitis / cirrhosis / liver tumours ```
99
SE of COCP
``` Low mood Mood swings Headache Loss of libido Nausea Weight gain Bloatedness Breakthrough bleeding Vaginal discharge Breast pain ```
100
Benefits of COCP
``` Lighter less painful periods Regular bleeds Improved pre-menstrual syndrome Reduced risk of PID Protect against ovarian and endometrial cancer ```
101
Mechanism of action of progesterone methods
Thickened cervical mucus | Thin endometrium
102
Common SE of progesterone only methods
Irregular / absent menstrual bleeding Simple ovarian cysts Breast tenderness Acne
103
Risk of depo provera
Loss of bone mineral density Weight gain (2-3kg in 1st yr) Delay in return of fertility Irregular / absent menstruation
104
Mechanism of action of copper IUD
Toxic to egg and sperm
105
SE of copper IUD
Heavier periods Increased menstrual pain Increased spotting
106
Duration of action of depo, implant, mirena, copper coil
Depo = 12 weeks Implant = 3 years Mirena = 5 years Copper coil = 10 years
107
CI to intrauterine contraception
``` Current STI PID malignant trophoblastic disease Unexplained vaginal bleeding Endometrial cancer Cervical cancer Malformation of uterus Copper allergy ```
108
Techniques to calculate the fertile period
Change in basal body temp Change in cervical mucus Track cycle days Combination of above
109
Types of emergency contraception
Levonelle EllaOne Copper IUD
110
Early medical termination - drugs used + gestation
Mifepristone oral + gameprost pessary | 4-9weeks
111
Later medical termination - drugs used + gestation +opiates | 12-24weeks
Mifepristone oral + gameprost pessary every 3-6 hours
112
surgical termination - technique used + gestation
Suction 4-6 weeks Suction under GA 6-14 weeks Dilation and evacuation 12-24weeks
113
Complications of termination
Incomplete abortion Infection / tubal damage Uterine perforation / cervical trauma Psychological
114
Factors decreasing fertility
``` Increasing age Smoking Less frequent sex Alcohol Obesity NSAIDs Chemotherapy ```
115
Presentation of ectopic pregnancy
Abdo pain Vaginal bleeding +ve pregnancy test Cervical excitation
116
Investigation of ectopic pregnancy
``` obs - BP, HR, RR, temp Hb Group + save Beta-HCG TVUSS ```
117
Management of ectopic pregnancy
IM methotrexate | laparoscopy - salpingectomy / salpingotomy
118
Define threatened miscarriage
Vaginal bleeding | Os closed
119
Define inevitable miscarriage
Vaginal bleeding | Os open
120
Define incomplete miscarriage
Vaginal bleeding | Os open, products of conception in os
121
Define complete miscarriage
Pain and bleeding resolved So closed No retained products on USS
122
Define missed miscarriage
Fetal pole present on USS - no heart beat Or Gestational sac present but no fetal pole No pain or bleeding
123
Management of miscarriage
Expectant Medical - oral misoprostal + gameprost pessary Surgical - ERPC
124
Define cervical ectropion
Benign condition Columnar epithelium on vaginal aspect of cervix. Transforms to squamous epithelium
125
Define nabothian follicle
Mucus filled cyst within the ectocervix - not significant - no tx needed
126
Causes of cervical ectropion
Puberty Pill Pregnancy
127
Causes of cervical stenosis
Usually iatrogenic Cervical cone biopsy / LLETZ Endometrial ablation devices
128
What is asherman's syndrome
Endometrial cavity fibrosis and adhesion
129
What is a uterine fibroid
Benign tumour of uterine smooth muscle = leiomyoma
130
Risk factors for uterine fibroids
Nulliparity Obesity Family history African origin
131
Symptoms of uterine fibroids
Pelvic mass Menstrual disturbance Pressure symptoms - urinary frequency
132
Management of fibroids
``` Watch and wait if asymptomatic Medical tx for heavy menstrual bleeding Uterine artery embolisation Myomectomy Hysterectomy ```
133
Cell types of endo and ecto cervix
``` Endocervix = canal = columnar glandular epithelium Ectocervix = external = squamous epithelium ```
134
Symptoms and causes of acute cervicitis
``` Irritation, mucus/pus discharge Dyspaerunia Post coital bleeding Inter-menstrual bleeding STIs ```
135
Cell type of cervical polyp
Endocervical = columnar (glandular) epithelium
136
symptoms of cervical polyp
Asymptomatic Intermenstrual bleeding Post coital bleeding Rarely >1cm
137
What is cervical dysplasia
Cervical intraepithelial neoplasia. | Atypical cells in the squamous epithelium
138
If untreated what % of CIN develop cancer over 10 years
1/3 with CIN II or III | CIN Commonly regresses - can progress to CIN II or III
139
What age is CIN most common
90% <45yo | Peak incidence 25-29
140
Aetiology of cervical cancers
HPV 16, 18, 31, and 33 most common. HPV vaccine is for 16 and 18 Oral contraceptives (all COC, POP, depot) Smoking
141
Biggest risk factor for the development of cervical cancer
Non-attendance for cervical screening
142
Who is invited for cervical screening + how often
25-64 Every 3 years until 50 then 5 yearly until 65. Screen >65s if abnormal result or no screening since age 50 If abnormal screen again in 6m 2x more then return to routine recall. Post-colposcopy yearly screening for 10 years
143
Describe colposcopy
Speculum ex + microscope magnification 10-20x Acetic acid stain + iodine + biopsy
144
What is a LLETZ procedure + what's it for
Large loop excision of the transformation zone | For CIN II or III
145
Possible complications of LLETZ
Haemorrhage Cervical stenosis Slight increased risk of preterm delivery
146
Peak incidence of cervical carcinoma
2 peaks -30s and 80s
147
Types of cervical carcinoma
90% squamous malignancies | 10% adenocarcinomas (worse prognosis)
148
What organism causes chancroid
Hawmophilus ducreyi
149
Presentation of chancroid (STI)
Ulcerative Small papule, ulcerates Forms a single or multiple painful superficial ulcers Inflammation can lead to phimosis Enlargement and suppuration of inguinal LN may occur --> bubo formation
150
Features of acute PID
Pelvic pain Pyrexia Cervical excitation Adnexal tenderness
151
Presentation of bacterial vaginosis
Creamy-grey discharge Fishy odour No itch
152
What do clue cells on microscopy indicate
Bacterial vaginosis
153
What is Stress incontinence
Involuntary leakage of urine on effort / exertion /sneezing / coughing. Due to an incompetent sphincter. May be associated with genitourinary prolapse.
154
What is Urge incontinence
Involuntary urine leakage Accompanied by/ immediately preceded by urgency. Due to detrusor instability or hyperreflexia leading to involuntary detrusor contraction.
155
What is Mixed incontinence
Involuntary leakage of urine associated with urgency and exertion/effort/sneezing/ coughing.
156
What is Overactive bladder syndrome (OAB)
Urgency with or without urge incontinence + usually frequency and nocturia. +/- Incontinence
157
What is Overflow incontinence
Due to chronic bladder outflow obstruction. Often due to prostate disease in M. Can be due to a neurogenic bladder.
158
What is True incontinence
continuous urine leakage | May be due to a ureto/urethro/bladder-vaginal fistula
159
Treatment of PCOS
COCP | Metformin
160
What is tranexamic acid
Anti-fibrinolytic
161
Cause of a single painless ulcer on genital area
Primary Syphilis
162
Multiple painless maculopapular ulcers with lymphadenopathy following a primary genital answer is due to what
Secondary syphilis
163
What is 3rd degree uterine prolapse?
Uterine descent with cervical protrusion beyond the introitus
164
Is 3rd degree uterine prolapse painful?
No. Unless ulcerated
165
Does 3rd degree uterine prolapse cause difficulty defecating?
Yes it can - by pressure on the anterior wall of the rectum.
166
Can 3rd degree uterine prolapse cause urinary incontinence?
Yes. | Or retention
167
Possible symptoms of endometriosis
``` Ovulation pain Mid cycle lower abdominal pain Heavy menstruation Dysmenorrhoea Dysparunia Dysuria Haematuria ```
168
What is primary vulvodynia?
Chronic vulval pain of more than 3 months dating from 1st sexual experience or tampon use
169
What is secondary vulvodynia?
Chronic vulval pain of more than 3 months developing after previous pain free sexual intercourse
170
Associations with vulvodynia
Change in sexual partner Thrush STI Depression
171
Most common cause of vaginal discharge
Bacterial vaginosis
172
Effect of bacterial vaginosis (BV) on vaginal PH
Loss of normal vaginal acidity. | PH increases to greater than 4.5.
173
Symptoms of BV
50% are asymptomatic. | Fishy-smelling vaginal discharge
174
Non infective causes of abnormal vaginal discharge?
``` Retained foreign body, Iflammation due to allergy or irritation, Tumours, Atrophic vaginitis, Cervical ectopy, Cervical polyps ```
175
Drugs for heavy menstrual bleeding
``` Mefenamic acid Tranexamic acid Norethisterone day 15 or 19 - 26 Levornagesterel IUD Danazol ```
176
How frequent should HIV +Ve women have cervical smears?
Yearly. | regardless of CD4 count or VL
177
What is the recommended frequency of cervical smears for women aged 25-49?
3 yearly | In England
178
What is the recommended frequency of cervical smears for women aged 50-64?
5 yearly | In England
179
What is Ashermans syndrome?
Interuterine adhesions ranging from complete obliteration to minimal adhesions
180
What is Sheehan syndrome
Intrapartum pituitary haemorrhage causing pituitary necrosis. Leads to hypopituitarism
181
Does smoking affect the menopause?
Yes, makes it earlier
182
Define postmenopausal bleeding
PV bleeding occurring at least 12 months after the cessation of menstruation
183
Causes of postmenopausal bleeding include
``` Vulvovaginal atrophy Endometrial carcinoma Endometrial hyperplasia Cervical cancer Ovarian cancer Liver cirrhosis ```
184
A retroverted uterus may be associated with what symptoms
Backache | dyspareunia
185
Characteristics of lichen sclerosis
Thickened skin and accentuated markings of the vulva | Itching and pain
186
What is the malignant potential of lichen sclerosis in %
Potential of squamous cell carcinoma of the vulva in 2 - 5%
187
Treatment of lichen sclerosis
Topical steroids Bland emollient Avoid irritants, heat and allergens
188
What may koilocites on a cervical smear suggest
Human papilloma virus infection
189
Possible presentation of antiphospholipid syndrome
``` Recurrent miscarriage Arterial or venous thrombosis Livedo reticularis rash Stroke Adrenal haemorrhage Migraine Myelitis Myocardial infarction Multi-infarct dementia ```
190
Antibodies found in antiphospholipid syndrome
anti-phospholipid antibodies | Anti-cardiolipin antibodies
191
What is premenstrual syndrome
Physical and/or psychological symptoms affecting some women up to 10 days prior to menstruation. Acne, breast tenderness, bloating, fatigue, nervousness, irritability, emotional disturbance, headache, mood changes. Usually resolves with or after menstruation .
192
When and how often is cervical smear screening offered in England
25-49 3 yearly | 49-64 5 yearly
193
When should women be referred to colposcopy
3 consecutive inadequate smears 3 abnormal smears of any grade within 10 years 1 moderate or severe dyskaryosis 1 borderline or mild dyskaryosis with +ve HR HPV 1 smear with possible invasion / glandular neoplasia
194
What happens to CIN on colposcopy when acetic acid and iodine are applied
Aceto-white change | Failure of iodine staining
195
Symptoms of cervical ectropion
Asymptomatic Mucoid discharge PCB
196
Causes of dysparunia
``` Vulvovaginitis (esp thichomoniasis and candida) Vaginal cysts Infected bartholins gland Post menopause / vaginal atrophy Congenitally small ostium / thick hymen Deep retroverted uterus Chronic pelvic infection Endometriosis Adenomyosis Pelvic tumours Ectopic pregnancy ```
197
What kind of organism is trichomonas vaginalis
Flagellated protozoan
198
How is trichomonas vaginalis best diagnosed?
Swab from the posterior fornix of the vagina observed under a microscope as a wet prep. Send NAATs
199
Symptoms of trichomonas vaginalis
Malodorous frothy discharge
200
What STI is a flagellated protozoan?
trichomonas vaginalis
201
What STI is an intercellular diploccocus
Neisseria gonorrhoea
202
What type of organism is neisseria gonorrhoea
Gram negative intracellular diplococcus
203
What is phthiriasis pubis
Pubic lice
204
How is phthiriasis diagnosed?
Pubic lice - Can be seen by the naked eye.
205
Treatment of phthiriasis
alathion lotion or permethrin cream. All body hair should be treated. All bedding should be washed at high temperatures. Sexual partners need treatment.
206
How is Candida albicans diagnosed?
Culture | Or presence of hyphae, pseudo hyphae and spores on microscopy.
207
Is Candida albicans sexually transmitted?
No
208
What is the name of the pox virus?
Molluscum contagiosum
209
what is Molluscum contagiosum caused by?
A poxvirus
210
appearance of Molluscum contagiosum
small, raised, pink lesions with a central punctum. Occasionally itch or sore. Single or in groups
211
How is molluscum contagiosum transmitted?
Skin to skin contact
212
Can herpes cause an asymptomatic infection?
Yes
213
Is genital herpes in pregnancy a risk to the fetus?
Primary herpes in the 3rd trimester can be transmitted to the fetus at birth
214
Diagnostic criteria of bacterial vaginosis
Amsel criteria (3/4 of): 1) Thin, white, yellow, homogeneous discharge 2) Clue cells on microscopy 3) pH of vaginal fluid >4.5 4) Release of a fishy odor on adding alkali—10% potassium hydroxide solution.
215
World wide incidence of sexual assault
1 in 5 women. | Often not reported
216
What genital infection is a diploid fungus?
Candida albicans
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Symptoms of Candida albicans
``` Vulval itching / soreness Thick curd like discharge Dysuria Dyspareunia Vulval oedema Vulval excoriation/erythema ```
218
Predisposing factors for genital thrush
``` Pregnancy COCP Immunosuppression Broad spectrum antibiotics DM HRT HIV ```
219
Effect of thrush ion on pregnancy
No adverse effect in pregnancy. Can be treated with topical imidazoles. Cannot have oral imidazoles.
220
What organism is commonly associated with PID in association with an IUCD?
Actinomyces Israelii
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Management of bacterial vaginosis
No treatment or Metronidazole (or clindamycin gel)
222
% of F with BV who are asymptomatic
50%
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Treatment of BV | And treatment in pregnancy
Metronidazole 400mg BD 5-7/7 (avoid STAT dose if possible) | Clindamycin gel pregnancy
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risks of surgical termination of pregnancy
``` Haemorrhage Cervical trauma Placental perforation Endometritis Ashermanns syndrome Tubal blockage regret / psychological effect ```
225
Most common cell type of endometrial cancer
adenocarcinomas
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Risk factors for endometrial cancer
``` Nulliparity Late menopause early menarche Oestrogen treatment Obesity Diabetes Lack of exercise Increased age PCOS / anovulation High fat diet Endometrial hyperplasia Familial history tamoxifen Personal hx of breast or ovarian cancer Previous pelvic irradiation ?tibolone ```
227
Progression from normal cervical epithelium to invasive carcinoma takes at least how long?
On average 15 years
228
In what cancers is alpha-feto protein raised
``` Ovary Testis Liver Pancreas Lung Stomach Colon ```
229
Common symptoms of ovarian cancer
Abdominal distension / blaoting Abdominal discomfort / pain Ascites
230
What is Ca 125 a marker for?
Ovarian cancer
231
Presentation of endometrial carcinoma
Postmenopausal bleeding | Premenopausal menstrual irregularity
232
When CIN is found in the deeper layers of the cervical epithelium (lower 1/3) what grade of CIN would this be?
CIN 1 | Undifferentiated cells confined to lower 1/3
233
When CIN is found in the lower 2/3 of the cervical epithelium what grade of CIN would this be?
CIN 2 | More marked nuclear abnormalities than CIN 1
234
When CIN is found throughout the thickness of the cervical epithelium what grade of CIN would this be?
CIN 3
235
Which HPV viruses are most associated with cervical cancer
16 and 18 (33, 31)
236
Risk factors for female genital tract neoplasia
``` Increased number of sexual partners Persistent HPV infection Immune compromise Cigarette smoking Low socioeconomic status Prolonged use of the OCP Higher number of pregnancies ```
237
What are the most common symptoms of cervical cancer
Abnormal vaginal bleeding / discharge | Discomfort during intercourse
238
How is high dose brachytherapy for cervical cancer delivered?
Applicators are put in the cervix and connected to an afterloading machine which delivers radiation at a high dose rate for a few minutes. Often repeated several times, a few days apart, on an outpatient basis
239
What is topotecan used to treat
Advanced cervical cancer Ovarian cancer Small cell lung cancer
240
How does topotecan chemotherapy work
Prevents DNA replication in cancer cells by inhibiting the enzyme topoisomerase I.
241
What is DySIS?
digital video colposcope using dynamic spectral imaging to evaluate the blanching effect of applying acetic acid to the epithelium. It measures the rate, extent and duration of the acetowhitening.
242
What is the annual incidence of cervical cancer in the UK
The annual incidence of cervical cancer in the UK is estimated to be 9.7 per 100,000 population.
243
What is the annual mortality rate for cervical cancer in the UK?
The annual mortality rate for cervical cancer in the UK is 3.9 per 100,000 population (2001)
244
How is liquid based cytology carried out
Samples collected using a brush. The head is rinsed / broken off in a vial of preservative. Samples mixed to disperse the cells. Cellular debris/ blood/ mucus is removed. A thin layer of cervical cells put on a slide and stained.
245
What does a Radical hysterectomy involve
Surgical removal of the uterus, supporting ligaments, upper vagina and pelvic lymph nodes +/- para-aortic lymph nodes.
246
What approaches are possible for a radical hysterectomy
standard approach = abdominal incision. Laparoscopic radical hysterectomy
247
What is the extent of stage 1 cervical cancer
stage I cervical cancer is confined to the cervix
248
What is the extent of stage 2 cervical cancer
Stage IIA - tumour invades the cervix with endocervical glandular involvement only. Stage IIB - Tumour has spread upward into tissues around the cervix but not into the pelvic wall.
249
Characteristics of stress incontinence
Leakage of urine when abdominal pressure raised - coughing, sneezing, lifting.
250
Cause of stress incontinence
Weak pelvic floor muscles causing impaired urethral support
251
Characteristic of urge incontinence
Involuntary urinary voiding following an episode of desiring to pass urine.
252
Mechanism of urge incontinence
Uninhibited bladder contraction - detrusor activity
253
Possible causes of urge incontinence
Spinal stenosis Stroke Neurological disease
254
When is treatment of vaginal prolapse with a ring pessary indicated
Temporary measure Women wishing to become pregnant Patients declining / postponing operative treatment
255
Investigations for a 30-year-old F with a amenorrhoea and galactorrhoea
``` Urine pregnancy test Serum prolactin Serum oestradiol Serum LH Serum FSH ``` MRI/CT head
256
What percentage of circulating testosterone is derived from conversion of androstenedione
70%
257
What percentage of circulating testosterone is free?
1% | Remainder bound to sex hormone binding globulin
258
By what mechanisms does the COCP cause increase risk of thrombosis
``` Increased platelet count Increased platelet adhesiveness Decreased antithrombins Increased clotting factors Increased prothrombin Increased fibrinogen ```
259
Mechanism of action of the levornogestrel emergency contraceptive pill
Delay ovulation by inhibiting the LH surge No evidence of impeding implantation. May interfere with sperm function
260
Mechanism of action of the emergency IUCD
Prevents implantation | toxic to egg and sperm
261
What are the 3 phases of the menstrual cycle
1. Follicular (pre-proliferative) 2. Ovulation 3. Luteal phase
262
What happens to oestrogen levels in the first 14 days of the cycle
Rise and peak on day 14
263
Average menstrual blood loss
40-80ml
264
Mechanism of action of progesterone only methods
Thicken cervical mucus Lesser effect on tubal motility and endometrium DMPA / desogestrel / implant suppresses ovulation
265
Ideal use failure rate of POP
2%
266
Ideal use failure rate of DMPA
0.3%
267
Ideal use failure rate of IUS
0.2%
268
Disadvantages of progesterone only methods
Irregular bleeding hormone side effects DMPA delays return of fertility DMPA can cause weight gain

MBBS / MBChB finals (25 decks)

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