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obgyn > Gynaecology > Flashcards

Gynaecology Flashcards

1
Q

what are the levels of LH+FSH and gonadotropins (oes+test) in hypogonadotropic hypogonadism?

A

low LH + FSH

low oestrogen + testosterone

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2
Q

causes of hypogonadotropic hypogonadism

A

abnormal functioning of hypothalamus or pituitary gland

eg hypopituitarism, damage, chronic conditions, kallman syndrome, prolactinoma

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3
Q

what is kallman syndrome?

A

genetic condition
causes hypogonadotropic hypogonadism
failure to start puberty
absent sense of smell

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4
Q

what are LH+FSH and gonadotropin levels in hypergonadotropic hypogonadism?

A

high FSH + LH

low gonadotropin levels

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5
Q

what is hypergonadotropic hypogonadism caused by?

A 
damage to gonads eg torsion, cancer, mumps
congenital absence of ovaries
turners syndrome
AIS
CAH
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6
Q

what is congenital adrenal hyperplasia? what enzyme is deficient? what is inheritance pattern?

A

deficiency of 21-hydroxylase enzyme

AR inheritance

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7
Q

symptoms of congenital adrenal hyperplasia?

A 
tall for age
facial hair
primary amenorrhoea
deep voice
early puberty
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8
Q

assessment of primary amenorrhoea

A 
FBC, ferritin - anaemia
UE - CKD 
anti TTG, anti EMA 
LH, FSH - hypo/hypergonadotropic hypogonadism 
TFT
ILGF-1 - GH deficiency 
prolactin - hyperprolactinaemia 
testosterone - PCOS, AIS, CAH 
genetics - turners syndrome
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9
Q

management of primary amenorrhoea

A 
depends on cause 
> weight gain, CBT
> treat endocrine condition
> pulsatile GnRH, COCP in HH 
> COCP in PCOS
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10
Q

what is androgen insensitivity syndrome? what is inheritance pattern? what are patients genetically? XX or XY?

A

cells can’t respond to androgens as there are no androgen receptor. extra androgens –> oestrogen
X linked recessive
XY

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11
Q

AIS features?

A 
external female genitalia and breasts
testes in inguinal canal / abdomen 
infertile 
primary amenorrhoea
inguinal hernia
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12
Q

AIS hormone results - LH, FSH, testosterone, oestrogen

A

LH increased
FSH increased / normal
testosterone increased
oestrogen increased

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13
Q

management of AIS

A

bilateral orchidectomy (avoid testicular tumours)
oestrogen therapy
vaginal surgery
support and counselling

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14
Q

levels of testosterone in CAH + AIS?

A

increased testosterone

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15
Q

CAH pathophysiology?

A

no 21-hydroxylase enzyme
this enzyme converts progesterone into ald+cortisol.
extra progesterone –> testosterone

result = high test, low cortisol + aldosterone

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16
Q

CAH presentation

A 
virilised genitalia (ambiguous) 
enlarged vlitoris 
primary amenorrhoea 
tall for age, deep voice, early puberty 
HYPERPIGMENTATION!!!!!(increased acth)
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17
Q

CAH treatment? key features?

A

hyperpigmentation
cortisol replacement - hydrocortisone
aldosterone replacement - fludrocortisone
corrective surgery

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18
Q

when to investigate secondary amenorrhoea?

A

if normally regular = 3-6 months

if irregular = 6-12 months

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19
Q

causes of primary amenorrhoea

A 
kallman syndrome
turners syndrome
damage to pituitary - surgery, radiation
hypopituitarism
damage to gonads - surgery, mumps, torsion
20
Q

causes of secondary amenorrhoea?

A 
pregnancy 
menopause and premature ovarian failure
contraception
PCOS
sheehan syndrome
hypo/hyperthyroidism
pituitary - tumours, failure 
excessive exercise, low body weight
21
Q

investigations in secondary amenorrhoea

A 
beta HCG
LH, FSH 
prolactin
TSH
testosterone
22
Q

management of secondary amenorrhoea

A

hormone replacement

if PCOS - medroxyprogesterone for 14d

23
Q

what causes urge incontinence

A

overactive detrusor muscle

24
Q

what causes stress incontinence

A

weak pelvic floor muscles

25
Q

causes of overflow incontinence

A

chronic urinary retention due to obstruction of urine outflow

anticholinergic medication
fibroids
pelvic tumours
neurological conditions - MS, diabetic nephropathy

common in men

26
Q

3 risk factors for urinary incontinence

A 
older age
post menopausal
increased BMI
previous vaginal deliveries
pelvic organ prolapse
pelvic floor surgery
neuro conditions eg MS
27
Q

assessment of incontinence

A

medical history
risk factors - caffeine, alcohol, meds, BMI
severity
examinations

28
Q

examinations to do for incontinence

A

assess pelvic tone - ask to squeeze finger

look for prolapse, masses

29
Q

investigations in incontinence

A 
bladder diary
vaginal examination
urine dipstick!!!!!
post void residual bladder volume
urodynamic testing
30
Q

management of stress incontinence

A

pelvic floor muscle training

surgery options - TVT

31
Q

management of urge incontinence

A
  1. bladder retaining
  2. anticholinergic medication - solifenacin, oxybutynin
  3. mirabegron (alternative to anticholinergics. watch BP!!!)
32
Q

SE of anticholinergic medication

A

dry mouth and eyes, urinary retention, constipation, blurry vision

cognitive decline !! in elderly

33
Q

what is adenomyosis?

A

endometrial tissue in the myometrium

34
Q

presentation of adenomyosis

A

painful periods
secondary dysmenorrhoea
dyspareunia

enlarged, tender uterus

35
Q

diagnosis of adenomyosis

A

transvaginal USS

36
Q

management of adenomyosis

A

does woman want contraception?

a) no = tranexamic / mefenamic acid
b) yes = mirena coil, COCP

37
Q

what is ashermans syndrome?

A

adhesions form in the uterus after it is damaged

eg after DIC, RPOC, myomectomy, endometritis

38
Q

presentation of ashermans syndrome

A

secondary amenorrhoea
light periods
dysmenorrhoea
infertility

39
Q

diagnosis of ashermans syndrome

A

hysteroscopy (gold)

40
Q

where is bartholins gland?

A

pair of glands either side of the posterior part of the vaginal Introits
normally pea sized and not palpable
help vaginal lubrication

41
Q

where does bartholins cyst occur?

A

in the duct of bartholins gland
posterior aspect of the vaginal Introitus
5 + 7 o’clock

42
Q

treatment of bartholin cyst

A

good hygiene
warm compress
analgesia
biopsy if malignancy needs excluded

43
Q

treatment of bartholin abscess

A

antibiotics
swab! to check sensitivities
may need surgery
- marsupialisation

44
Q

what is cervical ectropion?

A

columnar epithelium of endocervix extends out to ectocervix

45
Q

risk factors for cervical ectropion?

A

high oestrogen levels

young women, COCP, pregnancy

46
Q

presentation of vaginal ectropion

A 
asymptomatic
PV discharge
PV bleeding
dyspareunia
post coital bleeding

obgyn (3 decks)

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