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cOGtext > Gynaecological Problems > Flashcards

Gynaecological Problems Flashcards

1
Q

What is the average menstrual cycle length?

A

28 days (but normal if between 21-35 days)

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2
Q

How long does the luteal phase usually last?

A

14 days

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3
Q

What is the normal cycle length range for the follicular stage?

A

10 to 16 days

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4
Q

What does gonadotropin-releasing hormone (GnRH) control?

A

pituitary hormone secretion

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5
Q

What are the 3 events/phases that occur in the menstrual cycle called?

A

follicular phase, ovulation and luteal phase

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6
Q

Which two types of cells within the follicle are responsible for oestrogen and progesterone synthesis? and what do these cells respond to?

A 
theca cells (respond to LH)
granulosa cells (respond to FSH)
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7
Q

What are the 3 most important hormones that are needed to generate a normal menstrual cycle?

A

FSH, LH and oestrogen

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8
Q

As the follicles grow, there is a ____ feedback by both oestrogen and _____ on the pituitary to decrease ____ secretion.

A

negative
inhibin
FSH

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9
Q

Which follicle is most likely to survive as FSH levels drop during the negative feedback loop?

A

the follicle with the most efficient aromatase activity and highest concentration of FSH-induced LH receptors.

This follicle will become the dominant follicle and continue its development towards ovulation.

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10
Q

What does activin do?

A

Works to increase FSH binding in the follicles

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11
Q

How do the ovaries prepare for ovulation?

A

FSH induces LH receptors on the granulosa cells to compensate for lower FSH levels.

Production of oestrogen increases until it exerts a positive feedback loop which causes the LH surge.

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12
Q

What principle is used in ovulation predictor tests?

A

LH surge is the best predictor of imminent ovulation

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13
Q

How long after the LH surge does ovulation happen?

A

12 hours

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14
Q

What happens to the remaining granulosa and theca cells after release of the oocyte?

A

they form the corpus luteum

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15
Q

which hormone does the corpus luteum secrete?

A

progesterone

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16
Q

what do high levels of progesterone do?

A

suppress FSH and LH secretion

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17
Q

What happens to the corpus luteum in the absence of beta human chorionic gonadotrophin?

A

it will undergo luteolysis and regress. this results in a decrease in progesterone secretion which results in the endometrium shedding and menstruation happening.

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18
Q

What test is used to check for ovulation?

A

mid-luteal progesterone level - this test is done 7 days before expected menses

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19
Q

What does menorrhagia mean?

A

prolonged or increased (>80ml per period) menstrual flow

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20
Q

which does metrorrhagia mean?

A

regular intermenstrual bleeding

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21
Q

what does polymenorrhea mean?

A

menses occurring at <21 day intervals

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22
Q

what does polymenorrhagia mean?

A

increased bleeding and frequent cycle

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23
Q

what does menometrorrhagia mean?

A

prolonged menses and intermenstrual bleeding

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24
Q

what does amenorrhea mean?

A

absence of menstruation >6months

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25
Q

what does oligomenorrhea mean?

A

menses at intervals of >35 days or presence of five or less menstrual cycles a year.

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26
Q

what are some causes of menorrhagia/heavy menstrual bleeding?

A

Fibroids, Adenomyosis, Endocervical or endometrial polyp, Endometrial hyperplasia
,Intrauterine contraceptive device (IUCD), Pelvic inflammatory disease (PID),
Endometriosis, Malignancy of the uterine or cervix
,Hormone producing ovarian tumours, Arteriovenous malformation, systemic causes

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27
Q

What is dysfunctional uterine bleeding?

A

menorrhagia in the absence of pathology

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28
Q

what are some investigations which can be performed in the presence of menorrhagia?

A

FBC, TFT, coagulation screen, renal/liver tests, transvaginal US, endometrial sampling, cervical smear

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29
Q

What are the management options for dysfunctional uterine bleeding?

A
  1. progesterone releasing IUCD (Mirena IUS)
  2. COCP
  3. antifibrinolytics (tranexamic acid)
  4. NSAIDs (e.g. mefenamic acid)
  5. oral progestogens
  6. GnRH analogue/agonists
  7. Danazol

if all else fails then consider surgery (endometrial resection/ablation) or hysterectomy

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30
Q

What are some causes of intermenstrual bleeding?

A

cervical ectropion, PID and STD, polyps, cancer, pregnancy, hyatidiform molar disease

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31
Q

what is premenstrual syndrome?

A

occurrence of cyclical somatic, psychological and emotional symptoms that occur in the luteal phase of the menstrual cycle and resolve by the time menstruation ceases

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32
Q

What are the clinical features of premenstrual syndrome?

A 
bloating
cyclical weight gain
mastalgia (breast pain)
abdominal cramps
fatigue
headache
depression
changes in appetite and increased cravings
irritability
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33
Q

What are the treatment options for PMS?

A
  • severe symptoms may be treated with SSRIs
  • CBT
  • lifestyle changes
  • COCP, transdermal oestrogen, short-term GnRH Analogues
  • last resort = surgery
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34
Q

What are some causes of post-coital bleeding?

A 
cervical ectropion
cervical carcinoma
trauma
atrophic vaginitis
cervicitis secondary to STD
polyps
idiopathic
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35
Q

What are the causes of post-menopausal bleeding?

A 
atrophic vaginitis,
endometrial polyps
endometrial hyperplasia
endometrial carcinoma
cervical carcinoma
ovarian cancer
vaginal cancer
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36
Q

What is the first-line investigation for post-menopausal bleeding?

A

transvaginal ultrasound

37
Q

What are the treatment options for atrophic vaginitis?

A

topical oestrogen and vaginal lubricants. can also consider HRT

38
Q

How is endometrial hyperplasia treated?

A

dilatation and curettage, progesterone treatment (mirena IUS first line)

39
Q

What is the most common cause of menstrual irregularities?

A

polycystic ovarian syndrome (PCOS)

40
Q

What are the 3 key features of PCOS we use to diagnose?

A
  1. clinical/biochemical evidence of hyperandrogenism
  2. polycystic ovaries on USS
  3. oligo/amenorrhea
41
Q

What are the clinical features of PCOS?

A 
obesity/overweight
hypertension
acanthosis nigricans
acne
hirsutism
alopecia
insulin resistance
irregular periods
42
Q

What are the hormonal changes seen in PCOS?

A

increased LH:FSH ratio

LH levels high and FSH levels low or normal

43
Q

What are the treatment options for PCOS patients who are infertile?

A 
lifestyle advice
clomifene 
metformin
ovarian drilling
gonodotrophin injections
44
Q

What is the medical term for painful periods?

A

dysmenorrhea

45
Q

What are some causes of dysmenorrhea?

A 
primary dysmenorrhea (no underlying cause, just physiological)
endometriosis
adenomyosis
PID
intrauterine devices
fibroids
46
Q

Which condition would be indicated if a patient had a ‘bulky uterus’?

A

adenomyosis

47
Q

What investigations could be used for dysmenorrhea?

A

High vaginal and endocervical swabs
pelvic USS
diagnostic laparoscopy

48
Q

What are management options for dysmenorrhea?

A

NSAIDs
COCP
levonogestrel intrauterine system
GnRH analogues

49
Q

What is primary amenorrhea?

A

failure of menstruation by 16 years of age

50
Q

what are some causes of primary amenorrhea?

A 
genital tract abnormalities
mullerian agenesis
premature ovarian failure
genetic causes
hypothalamic disorders
iatrogenic
autoimmune
endocrine 
pituitary disorders
51
Q

what are some causes of secondary amenorrhea?

A 
hypothalamic disorders
autoimmune
pituitary
iatrogenic
endocrine abnormalities
ashermann's syndrome
physiological causes
52
Q

What investigations should be performed if patient presents with amenorrhea?

A

general examination,
visual field tests, examination of external genitalia
urine or serum bHCG

53
Q

What is the climateric period?

A

the period around the beginning of the menopause (also called perimenopause)

54
Q

At what age is menopause considered premature?

A

under 45 years

55
Q

What are the physical effects of menopause?

A 
vasomotor symptoms 
joint pains
dry and itchy skin
hair changes
vaginal dryness
recurrent UTI
urogenital prolapse
osteoporosis 
cardiovascular disease
dementia
56
Q

what are the psychological effects of menopause?

A

labile mood, anxiety, tearfulness, loss of concentration, poor memory, loss of libido

57
Q

what is the main management option for menopause?

A

HRT

58
Q

Side effects of HRT?

A 
breast enlargement
leg cramps
dyspepsia
fluid retention 
nausea
headaches
fluid retention
breast tenderness
acne 
mood swings
depression
irritability
constipation
increased appetite
59
Q

What risks are associated with HRT?

A

breast cancer
venous thromboembolism
endometrial cancer

60
Q

What are absolute contraindications of HRT?

A 
suspected pregnancy
breast cancer
endometrial cancer
active liver disease
uncontrolled hypertension
known VTE
known thrombophilia
otosclerosis
61
Q

What are some causes of vulval pruritus?

A 
skin conditions (eczema, psoriasis etc)
lichen sclerosus
lichen planus
infection
extramammary paget's disease of the vulva
62
Q

How does lichen sclerosis present?

A
  • pruritus
  • skin irritation on the vulva
  • hypopigmentation
  • atrophy of the skin
  • hair loss in affected area
  • affected area bleeding
  • pinpoint vessels visible
  • white polygonal papules that coalesce to form plaques
63
Q

what are some complications of lichen sclerosis?

A

atrophy and fusion of the labia
stenosis of the introitus
difficulty defecation
development of vulvar intraepithelial neoplasia (VIN)

64
Q

What are the treatment options of lichen sclerosis?

A

topical high-dose steroids and emollients

65
Q

what does normal vaginal discharge look like?

A

clear and appears white/pale yellow and typically odourless

66
Q

which microorganism is part of the normal vaginal flora?

A

lactobacilli

67
Q

what are some causes of abnormal discharge?

A

bacterial vaginosis
vulvovaginal candidiasis
STD
trichomoniasis

68
Q

what are the risk factors associated with pelvic infection?

A
  • age <25years
  • multiple sex partners
  • unprotected sex
  • recent insertion of IUD
  • recent change in sexual partner
69
Q

How might a pelvic infection due to PID present?

A
  • irregular menstrual bleeding
  • abnormal vaginal discharge
  • chronic pelvic pain
  • infertility
70
Q

what signs on examination may you find with pelvic infection?

A

cervical motion tenderness

adnexal tenderness

71
Q

How are pelvic infections treated?

A
  • if acutely unwell then sepsis 6
  • partner notification
  • oral ofloxacin + oral metronidazole + IM ceftriaxone + doxycycline
72
Q

what is the most common type of ovarian cyst?

A

functional ovarian cysts (follicular, corpus luteal and theca luteal cysts)

73
Q

what are bartholin cysts/abscesses?

A

when the bartholin glands become infected and enlarged (located at the 5 and 7 o’clock position next ti vagina entrance)

74
Q

How are bartholin cysts treated?

A

antibiotics

surgical procedure called marsupialization

75
Q

what should be your first step if a female patient of reproductive age presents with acute abdominal pain?

A

pregnancy test

76
Q

what are the signs and symptoms of uterine fibroids?

A
  • asymptomatic
  • menorrhagia and dysmenorrhea
  • lower abdominal pain during menstruation
  • subfertility
  • pressure symptoms
77
Q

how are uterine fibroids diagnosed?

A

transvaginal ultrasound

78
Q

How are uterine fibroids managed?

A
  • mirena IUS
  • myomectomy
  • hysterectomy
  • short-term GnRH analogues
  • uterine artery embolisation
79
Q

what are the signs and symptoms of endometriosis?

A
  • dysmenorrhea
  • deep dyspareunia
  • subfertility
  • dysuria
  • urgency
  • dyschezia
80
Q

How is endometriosis diagnosed?

A
  • via laproscopy

- on pelvic exam - tender nodularity on posterior fornix

81
Q

how is endometriosis managed?

A
  • symptomatic relief (NSAIDs)
  • COCP or progestogens
  • surgery
82
Q

What are the signs and symptoms of ovarian torsion?

A
  • sudden onset of deep colicky pain
  • vomiting and distress
  • adnexal tenderness/ acute abdomen
83
Q

how is ovarian torsion diagnosed?

A

USS will show classical whirlpool sign

84
Q

how is ovarian torsion managed?

A

laparoscopy to untwist ovary and remove cyst. if ovary necrotic then removed.

85
Q

what are the signs and symptoms of PID?

A

vaginal discharge

bilateral lower abdominal pain

86
Q

what investigations are used to diagnose PID?

A

FBC

high vaginal or endocervical swabs

87
Q

How is PID managed?

A

antibiotics

88
Q

what are the signs and symptoms of mittelsczmerz?

A

mid cycle pain

often (every cycle)

cOGtext (11 decks)

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