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Gynaecology Flashcards

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1
Q

HORMONES

What is the main function of oestrogen

A

steroid sex hormone

Promotes secondary sexual characteristics

  • Breast tissue development
  • Growth of vulva/vagina/uterus
  • Development of endometrium
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2
Q

HORMONES

What is the function of progesterone

A

Acts on tissues previously stimulated by oestrogen to:

  • Thicken and maintain endometrium
  • Thickens cervical mucus
  • Increases body temp
  • Spiral artery formation
  • Decreases myometrial excitability
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3
Q

HORMONES

What structures produce progesterone

A

Not pregnant
- Corpus luteum after ovulation

pregnancy
Placenta - from 10 weeks

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4
Q

INCOTINENCE

Describe stress incontinence

A

Increase in abdominal pressure leads to urine leakage

due to urethral sphincter weakness

  • post childbirth
  • post prostatectomy
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5
Q

INCOTINENCE

Name 4 risk factors for stress incontinence

A 
age 
obesity 
prolonged vaginal childbirth 
Hysterectomy 
pelvic trauma 
post-menopausal (oestrogen)
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6
Q

INCOTINENCE

What investigations are required for Stress incontinence

A

Pelvic exam - determine if there is loss of tone

Urinalysis - Exclude UTI

  • MSU
  • MC&S

Bladder diary
shows frequent voiding of small volumes

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7
Q

INCOTINENCE

What is the management of stress incontinence

A

1st line

  • weight loss
  • smoking cessation
  • caffeine reduction
  • 3m Keegle exercises

2nd line -
Pharmacological
- Duloxetine

3rd line
- Burch colposuspension

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8
Q

INCOTINENCE

What is urge incontinence

A

sudden urge to void due to detrusor instability

leads to frequent urination and nocturia

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9
Q

INCOTINENCE

Name 3 risk factors for urge incontinence

A

recurrent UTIs
High BMI
Age
Smoking

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10
Q

INCOTINENCE

What investigations are required for a suspected urge incontinence

A

1st line
- MSU / Urinalysis

2nd line

  • Urodynamics
  • Bladder diary
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11
Q

INCOTINENCE

What is the management of urge incontinence

A

1st line - lifestyle

  • Bladder retraining
  • weight loss
  • caffeine reduction
  • smoking cessation

2nd line - Pharmacological

  • Oxybutynin
  • Mirabegron

3rd line
- Botox

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12
Q

INCOTINENCE

What is Mirabegron

A

Beta 3 agonist used if concerned about Anti-Ach effects of incontinence management in frail elderly patients

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13
Q

INCOTINENCE

Name 4 neurological causes on inconteincen

A

DM

Autonomic neuropathy - decreases detrusor excitability

Parkinson’s

Dementia

MS

Prostatectomy

Hysterectomy

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14
Q

PROLAPSE

Name 4 preventative methods of reducing the risk of a prolapse

A

recognising obstructed labour

avoid long 2nd stage labour

pelvic floor exercises post birth

weight reduction

Tx of chronic cough

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15
Q

PROLAPSE

Name 4 risk factors for a prolapse

A 
Multiple vaginal deliveries 
Instrumental deliveries 
prolonged deliveries 
advanced age 
post menopausal 
chronic constipation
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16
Q

PROLAPSE

Name 2 anterior wall prolapses

A

Cystocele - bladder

Urethrocele

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17
Q

PROLAPSE

What is a vaginal vault prolapse and what increases its risk

A

Prolapse of uterus / cervix / upper vagina

Hx of hysterectomy

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18
Q

PROLAPSE

Name 2 posterior wall prolapses

A

Rectocele

Enterocele - Pouch of Douglas

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19
Q

PROLAPSE

What is a cystocele

A

prolapse of anterior vaginal wall including bladder

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20
Q

PROLAPSE

What is a rectocele

A

Prolapse of lower posterior vagina involving anterior wall of rectum

associated with constipation and urinary retention

palpable lump in vagina

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21
Q

PROLAPSE

Name 4 causes of a prolapse

A

vaginal delivery

congenital factors
- Ehlers Danlos syndrome

Menopause
- Deterioration of collagenous connective tissue occurring following oestrogen withdrawal

Iatrogenic
- Hysterectomy

Cough

obesity

constipation

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22
Q

PROLAPSE

How does a prolapse present

A

Dragging sensation - worse at end of day or after prolonged standing
sensation of a lump
Stress incontinence
dyspareunia

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23
Q

PROLAPSE

What investigations are required for a suspected prolapse

A

Abdominal examination

bimanual pelvic exam

Sims speculum
- ask patient to cough

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24
Q

PROLAPSE

How is a prolapse managed

A

conservative

  • weight reduction
  • pelvic floor exercises

Medical
- Pessaries

surgical
- surgery

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25
PROLAPSE | Describe a pessary
acts as artificial pelvic floor changed every 6m topical oestrogen provided
26
PROLAPSE | What are the adverse effects of a pessary
pain urinary retention infection fall out
27
PUBERTY | What are the age ranges of puberty in males and females
F: 8 - 14 M: 9 - 15
28
PUBERTY | What is aromatase
enzyme found in adipose tissue that converts androgens into oestrogens
29
PUBERTY | What does FSH do during the early stages of puberty
Increase in oestrogen synthesis oogenesis initiation in females onset of sperm production in males
30
PUBERTY | What does LH do during the early stages of puberty
Increase in production of progesterone increase in testosterone production
31
PUBERTY | How are the stages of puberty assessed
Tanner scale - based on secondary sexual characteristics
32
PUBERTY | Describe the 1st stage of puberty
Thelarche - breast bud development occurs at around 9 - 10
33
PUBERTY | Describe the 2nd stage of puberty
Pubarche - pubic hair growth hair becomes coarse and dark
34
PUBERTY | Describe the 3rd stage of puberty
Menarche occurs 3yrs following thelarche average age - 13
35
PUBERTY | What is precocious puberty
Appearance of secondary sexual characteristics before age of 8 or age of 9 in boys
36
PUBERTY | Name 4 causes of precocious puberty
Iatrogenic - exposure to oestrogens - creams Pathologies increasing GnRH secretion - Meningitis - CNS tumour - Hydrocephaly - Ovarian tumour - Adrenal tumour
37
PUBERTY | How is precocious puberty managed
GnRH agonists | - Arrest sexual development
38
PUBERTY | Name 4 genetic conditions leading to delayed puberty
Turners syndrome - 45X0 Klinefelter syndrome - 47XXY Androgen insensitivity syndrome Kallaman syndrome
39
PUBERTY | In males what do Leydig and Sertoli cells do
Leydig - Testosterone synthesis Sertoli - Sperm production
40
OVARIAN TORSION | Name 2 causes of ovarian torsion
Ovarian mass > 5cm Long infundibulopelvic ligaments - common in young girls before menarche
41
OVARIAN TORSION | How does ovarian torsion present
sudden onset unilateral pelvic pain Pain radiates to loin, groin and back Pain waxes and wains N+V Pain may improve after 24hrs - ovary dead
42
OVARIAN TORSION | How does ovarian torsion present on pelvic and vaginal examination
vaginal - adnexal tenderness pelvic - palpable mass
43
OVARIAN TORSION | What investigations are required for suspected ovarian torsion
1st line - TVUS - shows free fluid - Whirlpool sign - potential volvulus 2nd line - Doppler studies - shows lack of blood flow
44
OVARIAN TORSION | What is the diagnostic investigation for ovarian torsion
Laparoscopic surgery diagnostic and therapeutic
45
OVARIAN TORSION | How is ovarian torsion managed
Laparoscopic surgery - Detorsion - Oophorectomy
46
OVARIAN TORSION | Name 3 risk factors for ovarian torsion
ovarian mass reproductive age pregnancy ovarian hyperstimulation syndrome
47
MITTELSCHMERZ | What is mittelschmerz
Periovulatory unilateral pain experienced by women
48
MITTELSCHMERZ | Name 4 features consistent with mittelschmerz
Mid cycle pain - associated with ovulation - occurs 14 days prior to ovulation sharp onset pain recurrent epsioes settles over 24-48hrs
49
MITTELSCHMERZ | What investigations are required for mittelschmerz
USS - Shows free fluid
50
MITTELSCHMERZ | What is the management of mittelschmerz
conservative - Analgesia - Paracetamol - NSAIDs
51
CHRONIC PELVIC PAIN | Give a definition of chronic pelvic pain
Intermittent or constant pain in lower abdomen/pelvis for minimum 6m not occurring excessively with menstruation or intercourse
52
CHRONIC PELVIC PAIN | Name 4 gynaecological causes of chronic pelvic pain
dysmenorrhoea endometriosis adenomyosis PID Ovarian cyst pelvic organ prolapse pelvic congestion syndrome fibroids
53
OVARIAN TUMOURS | What are the 4 main types of ovarian tumours
Surface derived - epithelial (Most common) germ cell sex cord stromal Metastases
54
OVARIAN CYSTS | What is a simple ovarian cyst
contains fluid only
55
OVARIAN CYSTS | Name 2 functional cysts
follicular cyst corpus luteum cyst
56
OVARIAN CYSTS | What is a follicular cyst
functional cyst < 3cm represents developing follicle in first 1/2 of of cycle cyst fails to rupture and release egg disappears after a few menstrual cycles
57
OVARIAN CYST | What is the appearance of a functional cyst on US
Thin wall appearance no internal structures
58
OVARIAN CYST | What is protective against functional cysts
COCP - Prevent ovulation
59
OVARIAN TUMOURS | What is a corpus luteum cysts
functional cyst < 5 cm occurs in luteal phase after corpus luteum fails to breakdown seen in early pregnancy
60
OVARIAN TUMOURS | Name 3 pathological cysts
Endometrioma PCO Theca lutein cyst
61
OVARIAN TUMOURS | What is a theca lutein cyst
increased ovarian cysts due to increased hCG | Eg: Molar pregnancy
62
OVARIAN TUMOURS | What ovarian masses are common in premenopausal women
follicular / letein cysts dermoid cysts endometriomas benign epithelial tumours
63
OVARIAN TUMOURS | Which ovarian masses are common in postmenopausal women
benign epithelial tumours | malignancies
64
OVARIAN TUMOURS | Name 5 benign ovarian tumours
serous cystadenoma Mucinous cystadenoma Brenner dermoid cyst fibroma
65
OVARIAN TUMOURS | What is a serous cystadenoma
Epithelial benign tumour - Bilateral - Have septations - Cysts lined by ciliated cells
66
OVARIAN TUMOURS | Describe a mucinous cystadenoma
Epithelial benign tumour - can grow to be very large - Unilateral - Lined by mucous secreting epithelium
67
OVARIAN TUMOURS | Describe a brenner tumour
epithelial beingn tumour - unilateral - solid grey / yellow appearance - Coffee bean nuclei - Contain Walthard cell rests
68
OVARIAN TUMOURS | Describe a dermoid cyst
Benign germ cell tumour - Associated with premenopausal women - Bilateral - Large - Asymptomatic - Common in pregnancy - Associated with torsion - Contain complex cystic structures (teeth / hair)
69
OVARIAN TUMOURS | What does the histopathological analysis of a dermoid cyst show
Rokitansky's protuberance
70
OVARIAN TUMOURS | What can rupture of a mucinous cystadenoma lead to
Pseudomyxoma peritonei
71
OVARIAN TUMOURS | Describe a fibroma tumour
Sex cord stromal tumour - Presents with Meig's syndrome - pulling sensation in pelvis - Typically occurs around menopause
72
OVARIAN TUMOURS | What is Meig's syndrome
Triad: - Ascites - Ovarian mass - R sided pleural effusion
73
OVARIAN TUMOURS | What are the indicators for malignancy in a cyst
Irregular boarders ascites septations
74
OVARIAN TUMOURS | What does the histopathological analysis of a serous cystadenoma show
Psammoma bodies - collection of calcium
75
OVARIAN CYST | Name 3 risk factors for ovarian cysts
``` obesity tamoxifen therapy early menarche Infertility Family hx - dermoid ```
76
OVARIAN CYST | How does an ovarian cyst present
``` Pain - dull ache - Lower back pain - Lower abdomen pain Dysparerunia Irregualr vaginal bleeding Pressure sx - urinary frequency - bowel disturbance ```
77
OVARIAN CYST | What are the effects of ovarian cysts on pregnancy
urinary retention increased risk of miscarriage increased risk of pre term delivery Torsion - 1st trimester Cyst haemorrhage
78
OVARIAN CYST | What investigations are required for ovarian cysts
pregnancy test FBC - Infection / haemorrhage Ca125 - Important for post meopausal women with complex cysts - calculate RMI - Other tumour markers in women < 40 (LDH/AFP/HcG) TVUS Laparoscopy - Diagnostic
79
OVARIAN CYST | How do you calculate RMI
USS x Ca125 x Menopausal status
80
OVARIAN CYST | What is the management of a simple ovarian cysts in a premeopausal woman
< 5 cm --> Resolves in 3 cycles 5 - 7cm --> Yearly USS follow up >7cm --> MRI / Surgery
81
OVARIAN CYST | What do all post menopausal women with suspected ovarian cysts require
Ca125 levels
82
OVARIAN CYST | What indicates a 2ww referral
complex cyst or raised Ca125
83
OVARIAN CYST | Name 3 causes of raised Ca125
``` ovarian cancer endometriosis fibroids adenomyosis pelvic infection liver disease pregnancy ```
84
ENDOMETREOSIS | What is endometriosis
extrauterine implantation and growth of endometrial tissue
85
ENDOMETREOSIS | What is a chocolate cyst
endometrioma in ovary - common in women aged 30 - 45 endometrioma - lump of endometrial tissue outside uterus
86
ENDOMETREOSIS | When does the endometrium regress
pregnancy menopause
87
ENDOMETREOSIS | What are the common sites for endometriosis
``` uterosacral ligaments on or behind ovaries pouch of Douglas bladder peritoneum vagina rectum lung brain muscle ```
88
ENDOMETREOSIS | State the 3 theories associated with endometreosis
Sampson Halban's Meyers
89
ENDOMETREOSIS | What is Sampson's theory
retrograde menstruation with adherence invasion and growth
90
ENDOMETREOSIS | What is Halban's theory
Lymphatic / haematogenous system spread
91
ENDOMETREOSIS | What is meyers theory
cell metaplasia
92
ENDOMETREOSIS | What is protective for endometriosis
pregnancy
93
ENDOMETREOSIS | Name 4 risk factors for endometriosis
``` early menarche late menopause nulliparity short menstrual cycle family hx previous surgery to uterus ```
94
ENDOMETREOSIS | What is infertility in endometriosis liked to
``` adhesions inflammation tubal dysfunction ovarian dysfunction oocyte toxicity ```
95
ENDOMETREOSIS | How does endometriosis present
chronic cyclical pelvic pain dysmenorrhoea deep dyspareunia - indicates uterosacral ligament involvement Infertility pain on passing stools dysuria and urgency
96
ENDOMETREOSIS | What are the presentation findings in endometriosis
Bimanual pelvic exam - tenderness - adnexal mass - nodules and tenderness in uterosacral ligaments and posterior vaginal fornix - fixed retroverted uterus
97
ENDOMETREOSIS | What investigations are required in endometriosis
Examination Transvaginal USS - trial medication prior to diagnostic Laparoscopy and biopsy =- DIAGNOSTIC
98
ENDOMETREOSIS | What is the medical management of endometriosis
1st line - NSAIDs / Tranexamic acid - Paracetamol 2nd line - ovulation suppression - COCP - Depot 3rd line - medical menopause - GnRH analogues 4th line - surgery - Laparoscopic laser ablation - Hysterectomy
99
ENDOMETREOSIS | How long are GnRH analogues taken for and what are the adverse effects
Goserlin Zoladex 6m - bone demineralisation hot flushes night sweats osteoporosis
100
ENDOMETREOSIS | Why is suppressing ovulation beneficial
reduces endometrial associated pain as endometrium does not thicken however pain associated with adhesions persists
101
FIBROIDS | What is a fibroid
Benign smooth muscle tumour of the uterus Leiomyoma
102
FIBROIDS | What is the histological appearance of a fibroid
Whorled smooth muscle cells
103
FIBROIDS | name 3 protective factors for fibroids
Oestrogen and progesterone sensitive pregnancy POCP Late puberty
104
FIBROIDS | Name 4 risk factors for fibroids
``` obesity peri-menopausal early menarche increasing age family hx COCP Afro-Caribbean ```
105
FIBROIDS | Which is the most common classification of fibroid
Intramural - growth changes shape of and distorts the uterus
106
FIBROIDS | Describe the presentation of fibroids
dysmenorrhoea menorrhagia subfertility - submucosal prevents implantation deep dyspareunia pressure sx - frequency / urgency - incontinence
107
FIBROIDS | How do fibroids present on examination
Bimanual - irregular shape - enlarged firm non tender uterus - mass can be moved
108
FIBROIDS | What investigations are required for fibroids
FBC - Anaemia Imaging 1st line - USS + TVUS 2nd line - Hysteroscopy 3rd line - Laparoscopy DIANGOSTIC
109
FIBROIDS | Describe the management of fibroids
Asymptomatic - Observation Manage menorrhagia - Mirena coil - COCP / POP shrink fibroids - GnRH analogues - Ulipristal acetate Surgery - Endometrial ablation - Hysterectomy Fertility - NSAIDs / Tranexamic acid - Uterine artery embolization - Myomectomy
110
FIBROIDS | What is the MOA of upilistral acetate
Selective progesterone receptor modulator used to shrink fibroids
111
FIBROIDS | Name 4 indications for myomectomy
excessive enlarged uterine size pressure sx present medical management not controlling sx subfertility
112
FIBROIDS | What is red degeneration
uterine fibroids increase in size during pregnancy and it outgrows its blood supply leading to necrosis and pain
113
FIBROIDS | when does red degeneration typically occur
between 12th and 22nd week
114
FIBROIDS | Describe the presentation of red degeneration
constant abdominal pain low grade pyrexia tachycardia vomiting
115
FIBROIDS | How is red degeneration managed
Analgesia - self limiting condition
116
ADENOMYOSIS | What is adenomyosis
presence of endometrial tissue in the myometrium
117
ADENOMYOSIS | Who is adenomyosis common in
Women - 40y/o who have had children
118
ADENOMYOSIS | How does adenomyosis present
cyclical dysmenorrhoea dyspareunia infertility
119
ADENOMYOSIS | What are the pregnancy related complications of adenomyosis
miscarriage pre-term birth small for gestational age PPH
120
ADENOMYOSIS | What does examination in adenomyosis show
Bimanual - Enlarged - Boggy - Tender uterus
121
ADENOMYOSIS | What investigations are required in adenomyosis
1st line- TVUS 2nd line - DIAGNOSTIC Hysterectomy and biopsy
122
ADENOMYOSIS | What is the management of adenomyosis
Dependent on fertility wishes conservative - NSAIDs Medical - IUS - COCP Surgical - Hysterectomy
123
PELVIC INFLAMMATORY DISEASE | Name 4 causes for PID
Chlamydia - most common Gonorrhoea Gardnerella vaginalis - B.V association E.Coli - Associated with UTI
124
PELVIC INFLAMMATORY DISEASE | Name 4 risk factors for PID
Previous PID No barrier protection during intercourse Multiple sexual partners younger age existing STIs IUD - Copper coil
125
PELVIC INFLAMMATORY DISEASE | How does PID present
Bilateral lower abdo pain abnormal vaginal discharge - purulent abnormal vaginal bleeding - IMB - PCB Dysuria Deep dyspareunia
126
PELVIC INFLAMMATORY DISEASE | How does PID present on examination
Cervical excitation - motion tenderness Adnexal tenderness - bilateral Fever
127
PELVIC INFLAMMATORY DISEASE | What investigations are required for PID
1st line - Pregnancy test - rule out ectopic 2nd line - HVS 3rd line - Endocervical swabs --> NAAT and MC&S - Chlamydia - Gonorrhoea 4th line - Laparoscopy with fimbria biopsy GOLD STANDARD
128
PELVIC INFLAMMATORY DISEASE | How is PID managed
contact tracing - referral to GUM Antibiotics - IM ceftriaxone - Doxycycline - Metronidazole
129
MALIGNANCY | How do cells limit the number of divisions possible
Shortening of telomeres at end of each chromosome malignant cells lengthen the telomeres
130
MALIGNANCY | What is the action of TSG
Control cell growth - Cancers cause TSG to stop functioning
131
MALIGNANCY | How do oncogenes work
AD - only 1 copy of the gene needs to be mutated to elevate cancer risk stimulate the development of cancer
132
MALIGNANCY | What is the mechanism of HPV causing cancer
HPV inhibits TSG P53 and pRb are TSG HPV produces oncogenes which inhibit TSH HPV 16 --> E6 --> p53 HPV 18 --> E7 --> pRb
133
MALIGNANCY | what strains does the HPV vaccine protect against
6 / 11 / 16 / 18 3 doses required
134
MALIGNANCY | What does HPV 6 and 11 cause
genital warts
135
MALIGNANCY | What does HPV 16 and 18 cause
cervical cancer
136
MALIGNANCY | What other cancers does HPV cause
``` Penile vulval cervical anal vaginal mouth throat ```
137
MALIGNANCY | What age group is cervical cancer common in
70 - 80 years old
138
MALIGNANCY | what is the most common histological subtype of ovarian cancer
Epithelial tumours | - Serous adenocarcinoma
139
MALIGNANCY | Describe Germ cell tumours in ovarian cancer
Common in younger women < 35 - associated with torsion and rupture - Raised AFP - Raised Beta-HcG
140
MALIGNANCY | Describe a Krukenverg tumour in ovarian cancer
Mets from GI tract cancer characteristic signet ring on histology
141
MALIGNANCY | Name 4 risk factors for ovarian cancer
Increased ovulations = increased risk ``` Old age - > 60 Family hx - BRAC1/2 and HNPCC Nulliparity Clomiphene Early menarche Late menopause HRT Obesity Smoking ```
142
MALIGNANCY | Name 4 protective factors for ovarian cancer
``` Parity Breastfeeding Lactation early menopause COCP ```
143
MALIGNANCY | What investigations are required for ovarian cancer
1st line - Ca125 - > 35IU/ml raised - USS and urgent referral 2nd line - USS abdomen and pelvis 3rd line - Laparotomy DIAGNOSTIC
144
MALIGNANCY | what is the most common gynaecological cancer in the UK
Endometrial cancer
145
MALIGNANCY | Which age group is endometrial cancer most common in
50 - 60
146
MALIGNANCY | what is the most common histological subtype of endometrial cancer
1st - Adenocarcinoma 2nd - Adenosquamous carcinoma
147
MALIGNANCY | Name 4 risk factors for endometrial cancer
exposure to oestrogens ``` obesity early menarche late onset menopause Nulliparity PCOS Lynch syndrome ``` Unopposed oestrogen HRT Tamoxifen T2DM
148
MALIGNANCY | How does having T2DM increase the risk of endometrial cancer
increased insulin stimulates endometrial cells
149
MALIGNANCY | Name 3 protective factors for endometrial cancer
COCP Pregnancy Smoking
150
MALIGNANCY | Describe the presentation of endometrial cancer
PMB Premenopausal - Irregular or intermenstrual bleeding weight loss fatigue night sweats
151
MALIGNANCY | What is the criteria for a 2ww referral for endometrial cancer
> 55 years old and PMB
152
MALIGNANCY | what investigations are required for suspected endometrial cancer
1st line - TVUS - Assess endometrial thickness - >4mm requires endometrial sampling 2nd line - Biopsy DIAGNOSTIC - Endometrial pipelle biopsy - Hysteroscopy and biopsy
153
MALIGNANCY | What is the eligibility criteria for cervical cancer screening
3 yearly for women aged 25 - 49 5 yearly for women aged 50 - 64
154
MALIGNANCY | How long should individuals receiving treatment for CIN wait for their next smear
6m
155
MALIGNANCY | What does cell cytology during cervical cancer screening check for
Dyskaryosis - Precancerous cells squamous epithelial cell cytologic changes characterised by hyperchromatic nuclei
156
MALIGNANCY | Describe what occurs during colposcopy
Acetic acid applied to cervix - coagulates and clears mucus - triggers precipitation of nuclear proteins - abnormal cells have more nuclear proteins and appear ACETOWHITE Schiller's iodine test Healthy cells stain Brown Abnormal cells do not stain Allows for see and treat - LEETZ
157
MALIGNANCY | What age group is cervical cancer most common in
reproductive years - < 35
158
MALIGNANCY | What histology is most common in cervical cancer
Squamous cell carcinoma
159
MALIGNANCY | Name 2 causes of cervical cancer
CIN Persistent infection with hrHPV
160
MALIGNANCY | Name 4 risk factors for cervical cancer
Multiple sexual partners not engaging with screening smoking immunosuppression COCP - > 5 years Increased number of full term pregnancy Family hx
161
MALIGNANCY | Describe the presentation of cervical cancer
Abnormal vaginal bleeding - IMB - PMB - PCB Offensive vaginal discharge dyspareunia
162
MALIGNANCY | What investigations are required for cervical cancer
1st line - | Colposcopy +/- Punch biopsy
163
MALIGNANCY | Name 4 risk factors for vaginal cancer
Age > 75 Pelvic radiotherapy HPV Immunosuppression
164
MALIGNANCY | Name 3 causes of vulval cancer
High grade VIN Lichen sclerosis High risk HPV
165
MENSTRUAL CYCLE DISORDERS | What is primary amenorrhoea
Failure to establish menstruation by: 15 - secondary sexual characteristics 13 - No secondary sexual characteristics
166
MENSTRUAL CYCLE DISORDERS | What is secondary amenorrhoea
Previously normal menstruation stops for > 6m
167
MENSTRUAL CYCLE DISORDERS | Describe the effects of hypo / hyperthyroidism on the menstrual cycle
Hypo - decreased T3/4 causes upregulation of TSH - Stimulates prolactin secretion - LH/FSH inhibited Hyper - Increased sex hormone binding globulin secretion due to high T3/4 - reduced amount of free bound oestrogen to trigger LH spike
168
MENSTRUAL CYCLE DISORDERS | Name 5 causes of primary amenorrhoea
secondary sexual characteristics present Genito-urinary malformations - Imperforate hymen Endocrine - Hypo/Hyperthyroidism - Hyperprolactinaemia - Cushing's - CAH secondary sexual characteristics not present constitutional delay Turners syndrome - 25X0 Kallaman syndrome Androgen insensitivity
169
MENSTRUAL CYCLE DISORDERS | What is Kallaman syndrome and what is it associated with
Primary GnRH defciency due to X linked recessive disorder failure of GnRH cells to migrate Associations - Anosmia
170
MENSTRUAL CYCLE DISORDERS | What investigations are required for primary amenorrhoea
1st line - Pregnancy test 2nd line - Bloods - FSH / LH - Prolactin - TFTs - Testosterone levels Others - USS (PCOS/ Structural abnormality) - Karyotyping
171
MENSTRUAL CYCLE DISORDERS | What is Androgen insensitivity syndrome
X linked recessive condition causing mutation leading to end organ resistance to testosterone Genotypically male children have female phenotype 46XY
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MENSTRUAL CYCLE DISORDERS | Describe the pathophysiology of Androgen insensitivity syndrome
mutation leads to resistance in target tissues testis develop normally but testosterone dependent wolfiann ducts do not AMH secreted by foetal testis causes regression of mullerian ducts conversion of additional testosterone to oestrogen allows for secondary sexual charecteristics
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MENSTRUAL CYCLE DISORDERS | What structures do the wolfiann ducts form
epididymis vas deferens seminal vesicles
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MENSTRUAL CYCLE DISORDERS | What structures do the Mullerian ducts form
``` ovaries fallopian tubes uterus upper part of vagina cervix ```
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MENSTRUAL CYCLE DISORDERS | Describe the presentation of androgen insensitivity syndrome
Infancy - inguinal hernias containing testis Puberty - Primary amenorrhoea - Breast development - Lack of pubic hair / facial hair / male type muscle development (testosterone)
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MENSTRUAL CYCLE DISORDERS | Describe the clinical features of androgen insensitivity syndrome
female external genitalia short blind ending vagina absent uterus and fallopian tubes normal breast development lack of pubic and axillary hair
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MENSTRUAL CYCLE DISORDERS | What investigations are required for suspected androgen insensitivity syndrome
Bloods - Raised LH - Normal or raised FSH - Normal or raised testosterone levels - Raised oestrogen levels for male Chromosomal analysis Pelvic USS
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MENSTRUAL CYCLE DISORDERS | How is androgen insensitivity syndrome managed
Bilateral oridectomy Oestrogen therapy counselling
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MENSTRUAL CYCLE DISORDERS | Where are prolactinomas commonly seen in
Pregnant women
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MENSTRUAL CYCLE DISORDERS | What are the features of prolactinoma
Amenorrhoea - interferes with pulsatile GnRH secretion Oligomenorrhoea Galactorrhoea Headache Bitemporal hemianopia Diabetes insipidus
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MENSTRUAL CYCLE DISORDERS | What investigations are required for suspected prolactinoma
Bloods - prolactin levels MRI scan
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MENSTRUAL CYCLE DISORDERS | How is a prolactinoma managed in a woman that is NOT pregnant
Dopamine agonists - Cabergoline - Bromocriptine
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MENSTRUAL CYCLE DISORDERS | How is a prolactinoma managed in a pregnant woman
visual field testing Bromocriptine may be started if concerns of tumour growth

Phase 3A (12 decks)

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