Gynae Peer Teaching Flashcards
(127 cards)
1
Q
When is the first day of the menstrual cycle?
A
The first day of menstruation
2
Q
What happens to the endometrium during menstruation?
A
The spiral arteries vasoconstrict
Necrosis/shedding of the endometrium
Contraction of the myometrium (causing pain)
3
Q
What phase is between day 5-13?
A
Proliferative phase
4
Q
What happens in the proliferative phase (day 5-13)
A
FSH rises and stimulated the follicles to mature
Follicles produce estradiol (which inhibits FSH) and the endometrium reforms
There is an LH surge
5
Q
What phase is between 14 and 28 days?
A
Luteal phase
6
Q
What happens in the luteal phase (14-28#0
A
The follicle becomes the corpus luteum which produces progesterone
7
Q
What changes occur in the endometrium during the luteal phase?
A
stromal cells enlarge
glands swell
Epithelial cell vacuolation
8
Q
What happens at the end of the luteal phase if pregnancy does not occur?
A
Corpus luteum begins to fail - causing the progesterone and estrogen levels to fall
Endometrium begins to break down
9
Q
What is the age of normal menarche?
A
11-16 years
10
Q
When is normal menopause?
A
Over 45 years
11
Q
How long is the normal menstrual period?
A
Less than 8 days
12
Q
What causes menopause?
A
Loss of ovarian follicular activity
13
Q
When is perimenopause?
A
Starting with the first features of menopause and ending 12 months after the last period
14
Q
When is premature menopause?
A
Before 40
15
Q
Name 3 conditions which early menopause increases the risk of occurring.
A
Osteoporosis
Cardivascular disease
Dementia
16
Q
What are the urogenital problems associated with menopause?
A
Vaginal atrophy
Urinary problems e.g. infection, incontinence
Dyspareunia
17
Q
List 2 investigations for menopause and when they should be undertaken:
A
FSH between days 2-5 and is ELEVATED in menopause
Anti-mullerian hormone any day
18
Q
Which cancer risk is increased with combined HRT and oestrogen only HRT?
A
Combined = breast cancer
Oestrogen onle = endometrial
19
Q
Name 3 risks of HRT
A
VTE
CVS disease
gall bladder disease
(endometrial and breast cancer)
20
Q
Give 2 causes of premature menopause
A
chemo and radiotherapy
hysterectomy
21
Q
What would the blood tests reveal in someone going through premature menopause?
A
Low Oestrogen (<20) and high FSH >40IU
22
Q
Treatment for premature menopause:
A
HRT
Fertility
Androgen replacement e.g. testosterone gel
23
Q
Menorrhagia is….
A
Blood loss >80mL or blood loss that interferes with a woman’s daily quality of life
24
Q
How to know if menstrual bleeding is more than 80mL?
A
Ask about flooding and passage of clots
25
Investigations for menorrhagia
Transvaginal ultrasound - assess endometrial thickness and exclude fibroid/ovarian mass
26
When is an endometrial biopsy indicated for women with menorrhagia?
- endometrial thickness >10mm in premenopausal women or >4mm in postmenopausal women
- suspected polyp
- intermenstrual bleeding
27
What is the initial investigation of menorrhagia?
Pelvic bimanual examination
Menstrual charting
Anaemia
TFT, coagulopathies excluded
28
What is the first line management of menorrhagia?
IUS
29
What is the management of menorrhagia in women trying to conceive?
Tranexamic acid or NSAIDs
30
Name 2 surgical managements for menorrhagia? (George had 1)
Endometrial ablation
| Uterine artery embolisation
31
What does tranexamic acid do?
It is an anti fibrinolytic that Inhibits the conversion of plasminogen to plasmin may reduce blood loss by 50%
32
If your periods have not started by age 16 this is called...
Primary amenorrhoea
33
If your periods have stopped for more than 6 months this is called...
Secondary amenorrhoea
34
If your menstrual cycle is more than 35 days for 6 months this is called...
Oligomenorrhoea
35
Name 4 investigations in amenorrhoea
Pregnancy test
FSH and LH
Prolactin (TWICE)
Total testosterone and sex-hormone binding globulin levels
36
If you suspect PCOS what is the investigation?
Pelvic ultrasound
37
What is secondary dysmenorrhoea?
Pain BEFORE onset of menstruation
38
Name some fatures associated with secondary dysmenorrhoea
Depp dyspareunia
| Heavy and irregular menstrual flow
39
What may cause secondary dysmenorrhoea?
fibroids, endometriosis, ovarian tumours
40
Investigations for secondary dysmenorrhoea?
Pelvic ultrasound
examination
Swabs if STI risk
41
When do you have anovulatary ccycles?
During the early and late reproductive years
42
List 3 non malignant causes of irregular menstrual bleeding.
Fibroids
Uterine polyps
Adenomyosis
43
How do cervical pathologies commonly present?
Post coital bleeding
44
Name the ligaments which support the uterus at the cervix
uterosacral ligaments and cardinal ligaments
45
What is the fold of peritoneum that covers the uterus, fallopian tubes and ovaries called?
The broad ligament
46
Name the 3 parts of the broad ligmanent
Mesovarium
Mesosalpinx
Mesometrium
47
Which arteries run through the broad ligament?
Ovarian and uterine arteries
48
Which ligaments run through the broad ligament
Round ligament of the uterus
ovarian ligament
suspensory ligament of uterus
49
Name the branches from the internal iliac artery to the endometrium (UARBS)
internal iliac artery > uterine artery > arcuate artery > radial artery > basal artery > spinal artery
50
What is a fibroid?
Benign tumour of the myometrium
51
Describe the protective factors for fibroids.
Anything that stops periods - pregnancy, late puberty and taking the pill.
More pregnancies = less risk
52
What do you see on histology of a fibroid?
Wholled appearance
53
What is the difference between a subserosal fibroid and a submucosal fibroid?
Subserosal fibroids extend into the peritoneal cavity, submucosal fibroids extend into the uterus
54
Subserosal fibroids may cause pressure symptoms suc as...
urinary frequency
hydronephrosis
infertility
55
What are the consequences of fibroids during pregnancy?
Malpresentation, transverse lie, PPH, obstructed labour
56
How would you investigate a fibroid?
Bimanual pelvic exam
| Pelvic ultrasound
57
What are some medical treatments of uterine fibroids?
Tranexamic acid
Ulipristal acetate
Mifepristone
58
Whaat is adenomyosis?
Presence of endometrium in the myometrium
59
What would you find on examination of someone with adenomyosis?
A large, tender uterus
60
How is adenomyosis best diagnosed? When is it usually diagnosed?
Best: MRI
Usually: diagnosed on histology post hysterectomy
61
Name 3 medical and 1 surgical treatment for adenomyosis.
1. IUS
2. COCP
3. GnRH analogue (zoladex)
1. Hysterectomy
62
How is a polyp removed?
avulsion
63
What causes congenital uterine abnormalities?
Failure of fusion of the Mullerian ducts at 9 weeks gestation
64
Congenital uterine abnormalities cause problems with pregnancy such as....
recurrent miscarriage, transverse lie, malpresentation, retained placenta
65
What is the most common endometrial cancer?
Adenocarcinoma
66
What are the risk factors for endometrial cancer?
Nulliparity, late menopause, unopposed oestrogen therapy and tamoxifen therapy
67
What is the most common symptom of endometrial cancer? And in pre-menopausal women?
post-menopausal bleeding
| intermenstrual bleeding
68
What investigation must be performed in suspected endometrial cancer?
TRANSVAGINAL pelvic ultrasound to measure the thickness of the endometrium
69
What are the indications for an endometrial biopsy?
Endometrium >4mm thick in post menopausal women
Endometrium >10mm thick in premenopausal women
Multiple episodes of post menopausal bleeding
70
Give 2 differentials for PMB
Atrophic vaginitis
| Cervical carcinoma
71
What is a cervical ectropion?
Columnar cells visible as redness around the Os due to the cervix everting
72
What is a risk factor for an ectropion?
Oral contraceptive pill and pregnancy
73
What is the main symptom of an ectropion?
Post coital bleed
74
What is the premalignant condition of the cervix called?
Cervical intraepithelial Neoplasia
75
Which HPV strains carry the highest risk of cervical cancer/intraepithelial neoplasia?
16, 18
76
What is the treatment for cervical intraepithelial neoplasia?
Large loop excision of the transition zone
77
What is the treatment of CIN if the abnormal area extends to the cervical canal?
Cone biopsy
78
What is the most common kind of cervical cancer?
Squamous cell carcinoma
79
What are the symptoms of cercival cancer?
Post coital bleeding, intermenstrual bleeding, abnormal discharge
80
What is the treatment for the earliest stage cervical cancer?
Cone biopsy
81
What is the treatment for cervical cancer stage 1aii-2a
Wetheim's hysterectomy or chemo-radiotherapy
| Check for lymph node involvement
82
What is the treatment for cervical cancer 2b+?
Palliative chemo-radiotherapy
83
What is wetheim's hysterectomy?
Total hysterectomy includin upper third of vagina, ovaries, fallopian tubes and cervix
84
slide 60
beautiful
85
What hormone triggers ovulation?
LH - Lutenising hormone
86
What is the triad of PCOS?
Polycystic ovary appearance on ultrasound
hirsuitism
irregular periods/oligomenorrhoea
87
What is "polycystic ovary" on ultrasound?
multiple small follicles on an enlarged ovary
88
What is clinical and biochemical hirsutism?
```
Clinical = acne/excess body hair
Biochemical = raised testosterone levels
```
89
What would you see in the blood of someone with PCOS?
Raised LH, raised insulin and raised androgens
90
What would the TSH, prolactin and FSH look like in PCOS?
Normal
91
How to treat PCOS?
weightloss advice
| Combined pill
92
How would you treat someone with PCOS if they wanted to conceive?
clomiphene
93
What is clomiphene?
Infertility treatment for women who do not ovulate - it is an ovulatory stimulant
94
Which cancer is increased in women with PCOS?
endometrial cancer
95
What is a chocolate cyst?
endometrioma caused by endometriosis: accumulation of blood in the ovary forming a dark brown chocolate coloured cyst
96
Urinary frequency and abdominal pain and distension could be...
An ovarian cyst pressing on the bladder
97
What is the first line investigation for suspected ovarian rupture/torsion?
Pelvic ultrasound
98
What must you rule out if someone comes with a suspected ovarian cyst/torsion/rupture? And what investigations would rule them out?
Cancer - CA125
Ectopic pregnancy - pregnancy test
Urinalysis
99
Who gets ovarian cancer?
Women over 50, most aged 80-84
100
Name 3 genes associated with ovarian cancer?
HNPCC, BRCA 1 and 2
101
What, broadly, increases your risk of ovarian cancer? (Give examples)
More ovulation
- Nulliparity
- early menarche and late menopause
102
Name 2 cancers the pill is protective for
ovarian and endometrial cancer
103
Females with IBS who are over 50 should all have....
CA125 - Ovarian cancer presents like IBS:
- bloating
- loss of appetite
- urinary frequency/urgency
104
How are women with a family history of ovarian cancer managed?
Yearly ultrasounds and CA125
105
how is the Risk of Malignancy Index (RMI) calculated in ovarian cancer?
menopausal status (1-3) x ultrasound features x serum ca 125
106
What are low, medium and high RMI scores?
< 25 = low
25-250 = medium
>250 = high
107
What is the premalignant condition in vulval cancer?
Vulval Intraepithelial Neoplasia
108
Give 3 risk factors for vulval cancer
HPV
Smoking
immunosuppression
109
Where are 2 common sites for endometriosis?
On/behind ovaries
| Uterosacral ligament
110
What is "frozen pelvis"?
When endometriosis causes organs in the pelvis to adhese
111
What is the gold standard investigation of endometriosis?
Laparoscopy and biopsy
112
Risk factors for prolapse
vaginal delivery
menopause
congenital factors
113
What is the proper name for thrush?
Candida albicans
114
What can cause candida albicans?
Diabetes
Washing with soap
Antibiotics
Pregnancy
115
What is the treatment for thrush?
Fluclonazole
116
What are the symptoms of thrush?
Itching
cottage cheese discharge
superficial dyspareunia
117
What are the symptoms of BV?
Grey-white discharge
| fish smelling discharge
118
Treatment for BV?
Metronidazole or clindamycin cream
119
Risk factors for STIs
under 25
prostitute
multiple parnters
no condom use
120
What is the treatment of chlamydia?
Azithromycin
121
What is the treatment for gonorrhoea?
IM ceftriaxone
122
What are the 2 ways of getting pelvic inflammatory disease?
Ascending infection from the endocervical region OR descending infection from the abdomen
123
Pelvic pain, deep dyspareunia, irregular bleeding and discharge are symptoms of what?
Pelvic inflammatory disease
124
List 3 investigations for PID
1. Endocervical swabs for chlamydia and gonorrhoea
2. Blood test raised inflammatory markers
3. Ultrasound to exclude abscess/cyst
125
What antibiotics are used to treat PID?
Ceftriaxone and doxycycline
126
Complications of PID?
Ectopic pregnancy, infertility, chronic pelvic pain
127
What do you visualise on ultrasound and laproscopy of PID?
fluid collections on ultrasound, adhesions on laproscopy
