Gynaecology Flashcards
(143 cards)
1
Q
Sx fibroids
A
Often asymptomatic
Can present as suprapubic mass and menorrhagia
2
Q
Ix fibroids
A
Transvaginal US and bimanual exam
3
Q
Treatment for fibroids <3cm
A
Mirena coil and NSAIDs
4
Q
Tx fibroids >3cm
A
surgery
5
Q
Sx endometriosis
A
Cyclical abdo pain
6
Q
Ix endometriosis
A
Laparoscopy
7
Q
Tx endometriosis
A
Analgesics and COCP
8
Q
Sx ectopic pregnancy
A
Sholder tip pain
Unilateral pelvic pain
Vaginal bleeding
9
Q
Ix ectopic pregnancy
A
Transvaginal US
10
Q
Stress incontinence
A
Leaking of urine when intra-abdominal pressure increases
11
Q
Tx stress incontinence
A
Pelvic floor exercises
Fluoxetine
12
Q
Urge incontinence
A
Sudden loss of urine
13
Q
Tx urge incontinence
A
Bladder training
Anticholinergics - oxybutynin
14
Q
What is primary amenorrhoea?
A
Absence of periods in >15 girls with secondary sexual features or >13 without secondary sexual features
15
Q
Causes of primary amenorrhoea
A
Turner’s, anorexia, malformed genital tract etc
16
Q
Tx primary amenorrhoea
A
HRT
17
Q
What is secondary amenorrhoea
A
No menstruation for 3-6 months if previously normal menses or 6-12 months if previous oligomenorrhoea
18
Q
Causes of secondary amenorrhoea
A
Exercise, PCOS, hyperprolactinaemia, Sheehan’s/Asherman’s
19
Q
When do you do artificial insemination?
A
Poor sperm or difficulty having sex
20
Q
When do you do IVF?
A
If woman is <43 y/o, can screen genetics
21
Q
What is a bartholin’s abscess?
A
Infected bartholin’s glands
22
Q
treatment bartholin’s abscess
A
ABx and marsupialization
23
Q
what is a bartholin’s cyst?
A
The duct becomes blocked, which leads to a build up of mucus
24
Q
Sx bartholin’s cyst
A
- Normally painless
- Large cysts cause pain sitting etc
- Unilateral
- Soft, painless lump
25
treatment bartholin's cyst
asymptomatic = no intervention
26
Cause of 1st trimester bleeding
- Miscarriage
- Ectopic pregnancy (+ve test with abdo pain, pelvic/cervical tenderness)
- Implantation bleeding
27
Management bleeding >6 weeks pregnant
early pregnancy assessment
28
Management bleeding <6 weeks + no ectopic sx
manage expectantly and safety net
29
Symptoms ectopic pregnancy
- bHCG>1500
- Lower abdo pain - constant and unilateral
- Vaginal bleeding - dark brown and little amount
- Amenorrhoea for 6-8 weeks
- Dizziness/syncope
30
What is dyspareunia?
Pain during/after sexual intercourse
31
Causes of superficial dyspareunia
Lack of arousal. vaginal atrophy
vaginitis/vaginismus
32
Causes of deep dyspareunia
PID
endometriosis/adenomyosis
33
What is dysmenorrhoea
painful periods
34
Primary dysmenorrhoea
Usually in younger pts as periods start, no underlying pathology, due to excess prostaglandins
35
Mx primary dysmenorrhoea
NSAIDs to reduce prostaglandin production
36
what is secondary dysmenorrhoea
Usually in older patients due to pathology
37
Management secondary dysmenorrhoea
gynae referral
38
What does a blue cervix indicate?
Chadwick's sign for early pregnancy
39
Cervical ectropion
Columnar epithelialium extends into ectocervix and causes post-coital bleeding
40
How to differentiate ruptured ovarian cyst vs ovarian torsion
Ovarian cyst has symptoms in the past
41
Signet-ring cell on biopsy
Ovarian cancer metastases from stomach
42
Treatment Bartholin's abscess/cyst
Word catheter, normally e.coli
43
How to differentiate between adenomyosis and endometriosis
adenomyosis uterus feels enlarged
44
most treatable cancer
choriocarcinoma
45
Management bleeding >6 weeks of pregnancy
Refer to early pregnancy unit
46
Management of bleeding <6 weeks of pregnancy
manage expectantly and safety net
47
sx ectopic pregnancy
bHCG >1500
Lower abdo pain
Dark brown vaginal bleeding
Amenorrhoea
48
Management primary dysmenorrhoea
NSAIDs to reduce prostaglandins
49
Management secondary dysmenorrhoea
Gynae referral
50
Risk factors for endometrial cancer
Obesity, nulliparity, increased oestrogen exposure
51
Sx endometrial cancer
post-menopausal bleeding
52
Ix endometrial cancer
>55 with bleeding needs 2ww and trans-vaginal US
53
management endometrial cancer
hysterectomy with bilateral salpino-oophorectomy
54
what is fibroid degeneration?
fibroids are sensitive to oestrogen so grow in pregnancy. if they out-grow supply then they can degenerate
55
sx fibroid degeneration
pain, fever, vomiting
56
management fibroid degeneration
analgesia, self resolves <1 week
57
Investigations for heavy periods
FBC and trans-vaginal US
58
treatment for heavy bleeding if contraception needed
Mirena coil IUS
COCP
59
treatment for heavy bleeding if no contraception needed
tranexamic/mefenamic acid if pain
60
HRT side effects
nausea, tender breasts, weight gain, increased risk of breast/endometrial cancer and VTE
61
When do you normally see hyperemesis gravidarum?
8-12 weeks
62
Protective factor for morning sickness
Smoking
63
Diagnosis morning sickness
Dehydration, electrolyte imbalance and 5% weight loss
64
Management hyperemesis gravidarum
antihistamine (cyclising) or ondansetron/metocloprmaide
65
side effect ondansetron
increased risk of cleft palate
66
side effect metoclopramide
EPSEs
67
main cause of infertility
male factor
68
investigations for infertility
semen analysis and progesterone 7 days before period expected
69
progesterone results infertility
>30 means ovulating
16-30 needs repeat
<16 needs repeat and referral
70
management of post-menopausal woman with cyst
urgent gynaecology referral
71
RF endometrial cancer
increased oestrogen
72
treatment for localised endometrial cancer
hysterectomy + bilateral salpino-oophorectomy
73
Types of HRT
oestrogen alone or oestrogen + progesterone
74
When should you prescribe combined HRT?
If woman has a uterus (just oestrogen increases endometrial cancer risk) give combined
75
What is the point of HRT?
A drop in oestrogen (menopause) is associated with vasomotor symptoms (flushing, insomnia, headaches) so this counteracts that
76
Indications for HRT
Indications include vasomotor symptoms (headaches, flushing, insomnia) and premature menopause (continue until ≥50 to reduce osteoporosis risk
77
When do you favour transdermal over oral HRT
if at high risk of VTE (smoker, obese, past stroke etc)
78
what does oestrogen increase your chances of getting?
endometrial and breast cancer and VTE
79
A 50-year-old woman attends requesting hormone replacement therapy (HRT). She has been experiencing hot flushes, night sweats, mood swings, vaginal dryness and reduced libido.
Her last period was 10 months ago and her uterus is intact. She is obese but has no other risk factors and has been counselled on the risks and benefits.
What HRT regimen would be most appropriate?
transdermal cyclical regimen - continuous should not be used within 12m of LMP
80
What is VIN?
pre-squamous cell vulval carcinoma
81
RF for vulval cancer
HPV 16 and 18, HSV 2
82
lesions vulval cancer
itchy/burning, raised, inguinal lymphadenopathy
83
tx vulval cancer
surgery, chemo and radio
84
diagnosing fibroids
TVUS
85
Urge incontinence
Overactive detrusor - sudden urge and then urine passes
86
mx urge incontinence
oxybutynin and bladder re-training >6w
87
stress incontinence
Increased abdo pressure causes urine to leak
88
mx stress incontinence
duloxetine, pelvic floor retraining (8 exercises TDS for >3m)
89
Up to how many weeks can you abort a baby?
24
90
TOP <9 weeks
mifepristone followed by misoprostol (a prostaglandin to induce contractions) 48h later
91
TOP <13 weeks
surgical dilation and evacuation
92
TOP >15 weeks
surgical dilation and evacuation to induce mini labour
93
define recurrent miscarriage
>3 consecutive and spontaneous miscarriages, often due to anti phospholipid syndrome, endocrine disorders, uterine abnormality etc
94
cause of pruritus vulvae
irritation - commonly condoms
95
mx pruritus vulvae
take showers not baths, wash once a day
96
pruritus vulvae vs ani
ani is perianal area, vulvae is vulval area
97
sx pruritus vulvae
itching
98
How long is follicular phase?
ALWAYS 14
99
What happens during follicular phase (hormones)
Egg (ovum) is developing inside follicle
Hypothalamus secretes GnRH which acts on ant.pituitary to secrete FSH and LH
FSH stimulates a few follicles
The granulosa cells surrounding these follicles secrete oestrogen
Oestrogen has -ve feedback on hypothalamus = less FSH and LH
Dip in ovulation as cells mature means FSH and LH spike = ovulation
100
What happens during luteal phase (hormones)
Successful follicle releases ovum and collapses to form CL
CL secretes progesterone
If pregnant, placenta takes over progesterone production from 12 weeks to maintain lining and thicken cervical mucus
Cells also make oestrogen
if not pregnant, CL degenerates = less oestrogen and progesterone (menstruation)
This means no negative feedback
FSH and LH rise again
101
Hormonal changes in menopause
low oestrogen (which means less -ve feedback), high LH and FSH
102
What is premature ovarian insufficiency?
Onset of menopausal sx and increased gonadotrophin levels before 40 yo
103
Causes of premature ovarian insufficiency
idiopathic, bilateral oophorectomy, radio/chemo
104
Sx menopause
night sweats/hot flushes, infertility, secondary amenorrhoea, hormonal changes
105
what is PMS
emotional (stress, fatigue, anxiety, mood swings) and physical (bloating and breast pain) changes that occur in the luteal phase of an ovulatory cycle
106
management for PMS (mild, mod and severe)
mild = lifestyle changes and frequent, small, carb-heavy meals
mod = COCP
severe = SSRI
107
cervical excitation is a sign of
PID
108
urogenital prolapse sx
pressure/heaviness, incontinence, 'bearing down'
109
Sx ovarian torsion
Colicky deep abdo pain, sudden onset, N and V, whirlpool USS
110
Tx ovarian torsion
laparoscopy
111
threatened miscarriage
os closed, painless bleeding with viable foetus
112
missed miscarriage
os closed, no viable foetus, light bleeding/discharge with sx of pregnancy disappearing
113
inevitable miscarriage
os open, heavy bleeding
114
incomplete miscarriage
open os, products of conception partially expelled
115
Average age of menopause
51
116
For how long should women use contraception if menopausal sx >50?
12m
117
For how long should women use contraception if <50
24m
118
sx menopause
- Change in cycle length
- Hot flushes
- Night sweats
- Vaginal dryness
- Psychological SEs
119
mx menopause
- Lifestyle changes
- Vasomotor sx can be treated with fluoxetine/citalopram
- If woman has uterus, give her transdermal combined HRT (oestrogen alone increases risk of cancers)
- Vaginal oestrogen may be required for life for urogenital atrophy
120
rapid acting treatment for heavy vaginal bleeding
Norethisterone 5 mg tds
121
sx ectropion
vaginal discharge
post-coital bleeding
122
mx ectropion
ablation
123
what is cervical ectropion?
On the ectocervix, the transformation zone is where the stratified squamous epithelium meets the columnar epithelium of endocervix. High oestrogen levels result in a larger area of columnar epithelium being present on the ectocervix
124
How should you refer women >55 with post-menopausal bleeding
2ww
125
management endometriosis
NSAIDs/paracetamol
COCP
126
intermenstrual bleeding
endometrial hyperplasia
127
type 1 FGM
clitoridectomy
128
type 2 FGM
removal of clitoris and labia minor, +/- labia major
129
type 3 FGM
Narrowing of vaginal orifice with creation of covering seal using the labia minora/majora (infundibulation)
130
type 4
all other harmful procedures to female genitalia
131
how to postpone periods
norethisterone to be taken 3 days before the onset of her periods until when you want period to be, will not offer contraception
132
treatment of thrush if pregnant
topical
133
when do you do a HVS for thrush?
if symptoms are unclear - if clinical diagnosis is clear, treat straight away
134
tests if recurrent candidiasis
diabetes and HVS
135
most common cause of recurrent first trimester miscarriage
anti-phospholipid syndrome
136
what is antiphospholipid syndrome?
arterial/venous thromboses, recurrent foetal loss and thrombocytopenia
137
management anti-phospholipid syndrome
aspirin once pregnancy confirmed on urine dip
heparin once fetal heart seen -> 34 weeks
138
treatment for severe PMS
SSRI in luteal phase
139
how many episodes of candidiasis in a year for it to be classed as recurrent?
4
140
Low oestrogen, high FSH and LH
premature ovarian insufficiency
141
example muscarinic antagonist for urge incontinence
tolterodine
142
PROM happens before how many weeks?
37
143
Stillbirth is defined after how many weeks?
24
