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Med Finals - Womens Health > Gynaecology > Flashcards

Gynaecology Flashcards

1
Q

Define primary amenorrhoea

A

Not starting menstruation:
By 13 when there is no evidence of pubertal development
By 15 when there are signs of puberty - breast bud development

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2
Q

Define androgen insensitivity

A

Condition where the tissues are unable to respond to androgen hormones so male sexual characteristcs do not develop - results in femal phenotype wo

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3
Q

Define secondary amenorrhoea

A

Defined as no menstruation for more than 3 months after previous regular menstrual periods.

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4
Q

Causes of secondary amenorrhoea

A

Pregnancy!
Menopause
Premature ovarian failure
Hormonal contraception
Hypothalamic or pituiraty pathology
Polycystic ovarian syndrome
Asherman’s syndrome - uterine pathology
Thyroid pathology
Hyperprolactinaemia

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5
Q

Management of hyperprolactinaemia

A

Dopamine agonists - cabergoline

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6
Q

Presentation of premenstrual syndrome

A

Low mood
Anxiety
Mood swings
IRritability
Bloating
Fatigue
Headaches
Breast pain
Reduced confidence
Cognitive impairment
Clumsiness
Reduced liibido

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7
Q

Define menorrhagia

A

Heavy menstrual bleeding - >80ml
Changing pads 1-2 hours, lasting more than 7 days, passing large clots,

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8
Q

Causes of menorrhagia

A

Dysfunctional uterine bleeding
Extremes of reproductive age
Fibroids
Endometriosis
PID
Contraceptive - copper coil
Anticoagulation
Bleeding disorders
Endocrine disorders
Connective tissue disorders
Endometrial hyperplasia
Cancer
PCOS

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9
Q

Management of menorrhagia

A

Tranexamic acid
Mefenamic acid

Mirena coil
COCP
Cyclical progesterone

Ablation
Hysterectomy

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10
Q

Define fibroids

A

Benign tumours of the smooth muscle of the uterus - common, oestrogen sensitive

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11
Q

Types of fibroids

A

Intramural - within myometrium
Subserosal - just below outer layer of uterus (grow outwards and can become very large)
Submucosal - just below lining of the uterus endometrium
Pedunculated - on a stalk

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12
Q

Presentation of fibroids

A

Menorrhagia
Prolonged menstruation
Abdominal pain
Bloating
Urinary or bowel symptoms - increased pressure
Deep dyspareunia
Reduced fertility
Palpable pelvic mass

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13
Q

Investigations in fibroids

A

Hysteroscopy
Pelvic ultrasounds
MRI scan

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14
Q

Management of fibroids

A

<3 cm - mireena, symptomatic control, COCP, cyclical progesterone, endometrial ablation, resection, hysterectomy

> 3cm - mirena, COCP, POP, uterine artery embolisation, myomectomy, hysterectomy

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15
Q

Define endometriosis

A

A condition where there is sctopic endometrial tissue outside the uterus.

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16
Q

Presentation of endometriosis

A

Cyclical abdominal pelvic pain
Deep dydpareunia
Dysmenorrhoea
Infertility
Cyclical bleeding from other sites
Urinary symptoms
Bowel symptoms

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17
Q

Investigations in endometriosis

A

Pelvic ultrasound
Laparoscopic exploration - gold standard

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18
Q

Management of endometriosis

A

Analgesia - NSAIDS
Hormonal management - COCP, POP, Mirena,
Laparoscopy
Hysterectomy

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19
Q

Define adenomyosis

A

Refers to endometrial tissue inside the myometrium - common in older multiparous women.

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20
Q

Presentation of adenomyosis

A

Dysmenorrhoea
Menorrhagia
Dyspareunia
Infertility
Complications in pregnancy

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21
Q

Investigations in adenomyosis

A

Transvaginal ultrasound
MRI
Histological examination - post hysterectomy

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22
Q

Management of adenomyosis

A

Tranexamic acid
Hormonal control
Uterine artery ablation
Hysterectomy

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23
Q

Complications in pregnancy of adenomyosis

A

Infertility
Miscarriage
Preterm birth
Small for gestational age
Preterm rupture of membranes
Malpresentation
C section
Post partum haemorrhage

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24
Q

Define menopause

A

Point at which menstruation stops - no periods for 12 months

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25
Q

Define premature menopause

A

Menopause occuring becfore the age of 40 - results from premature ovarian insufficiency

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26
Q

Perimenopausal smptoms

A

Hot flushes
Emotional lability
Low mood
Premenstrual syndrome
Irregular periods
Joint pains
Heavier or lighter periods
Vaginal dryness and atrophy
Reduced libido

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27
Q

Management of perimenopausal symptoms

A

No treatment
HRT
Clonidine
CBT
SSRI
Testosterone
Vaginal oestrogen
Tibolone - steroid acts as continuous HRT
Vaginal moisturisers

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28
Q

Define premature ovarian insufficiency

A

Define as menopause before the age of 40 - results from the decline in the normal activity of the ovaries

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29
Q

Causes of premature ovarian failure

A

Idiopathic
Iatrogenic - oophrectomy
Autoimmune - coeliac, adrenal, TIDM, thyroid disease
Genetic - turner’s syndrome
Infections - mumps, tuberculosis, cytomegalovirus

30
Q

Presentation of premature ovarian failure

A

Irregular menstrual periods
Low oestrogen levels
Perimenopausal symptoms

31
Q

Management of premature ovarian failure

A

HRT

32
Q

When is progesterone given in HRT

A

When women still have a uterus - require protection from endometrial hyperplasia and cancer - unopposed oestrogen

33
Q

Non-hormonal management of perimenopausal symptoms

A

Lifestyle
CBT
Clonidine
SSRI
Venlafaxine
Gabapentin

34
Q

Risks of HRT

A

Increased risk of Breast and endometrial cancer
VTE
Stroke
Coronary artery disease

35
Q

Contraindications to HRT

A

Abnormal bleeding
Endometrial hyperplasia or cancer
Breast cancer
Uncontrolled hypertension
Venous thromboembolism
Liver diseae
Active angina or MI
Pregnancy

36
Q

Types of HRT available

A

Oestrogen only or combined with progesterone
Cyclical or continuous
Local or systemic

37
Q

Define poly cystic ovarian syndrome

A

Common condition causing metabolic and reproductive problems in women - multiple ovarian cysts, infertility, oligomenorrhea, hyperandrogenism and insulin resistance

38
Q

Define anovulation

A

Absence of ovulation

39
Q

Define oligoovulation

A

Irregular infrequent ovulation

40
Q

Define amenorrhoea

A

Absence of menstrual periods

41
Q

Define oligomenorrhoea

A

Irregular or infrequent periods

42
Q

Define hirsutism

A

Growth of thick dark hair often in a male pattern - facial hair

43
Q

What is the criteria for PCOS diagnosis

A

Rotterdam criteria
Oligoovulation or anovulation
Hyperandrogenism - hirsutism, acne
Polycystic ovaries on ultrasound.

44
Q

Presentation of PCOS

A

Oligomenorrhoea or amonorrhoea
Infertility
Obesity
Hirsutism
Acne
Hair loss in male pattern

Insulin resistance and diabetes
Acanthosis nigricans
CVD
Hypercholesterolaemia
Endometrial hyperplasia and cancer
Obstructive sleep apnoea
Depression and anxiety
Sexual problems

45
Q

Investigations in PCOS

A

Testosterone, sex hormone-binding globulin, FSH, Prolactin, thyroid stimulating hormone
High LH compared to DSH
Pelvic ultrasound - 12 or more developing follicles, ovarina volume >10 cm3

46
Q

Management of PCOS

A

Lifestyle - prevent diabetes
Fertility
Hirsutism and acne

47
Q

Define ovarian torsion

A

Condition where the ovary twists in relation to the surrounding connective tissue, fallopian tube and blood supply

48
Q

Presentation of ovarian torsion

A

Sudden onset seveere unilateral pain
Nausea an vomiting
Localised tenderness and palpable mass

49
Q

Investigations in ovarian torsion

A

Ultrasound - whirlpool sign
Laparoscopic exploration

50
Q

Management of ovarian torsion

A

Laparoscopic surgery - untwist or removal

51
Q

Define Asherman’s syndrome

A

Where adhesions form within the uterus following damage - usually after pregnancy

52
Q

Presentation of Asherman’s syndrome

A

Secondary amenorrhoea
Lighter periods
Dysmenorrhoea

53
Q

Investigations in asherman syndrome

A

Hysteroscopy
Hysterosalpingography
Sonohysterography
MRI

54
Q

Management of ashermans syndrome

A

Dissection of adhesion during hysteroscopy

55
Q

Define cervical ectropion

A

When columnar epithelium of the endocervix extends out to the ectocervix, becomes visible and easily iritated

56
Q

Presentation of cervical ectropion

A

Increased vaginal discharge
Vaginal bleeding
Dyspareunia
Postcoital bleeding
Well-demarcated border between redder, velvety columnar epithelium extending from the os vs the pale pink squamous epithelium of the ectocervix

57
Q

Management of cervical ectropion

A

No treatment required
Problematic bleeding can be cauterised

58
Q

Risk factors for prolapse

A

Multiple vaginal deliveries
Instrumental prolonged or traumatic delivery
Advanced age
Postmenopausal status
Obesity
Chronic respiratory condition - coughing
Chronic constipation - straining

59
Q

Presentation of prolapse

A

Sense of something coming down
Dragging sensation
Urinary symptoms - incontinence, urgency, frequency, weak stream, retention
Bowel symptoms - constipation, incontinence, urgency
Sexual dysfunction
Identified lump

60
Q

Management of prolapse

A

Conservative - physio, weight loss, lifestyle
Pessary
Surgery - mesh repairs.

61
Q

Define urge incontinence

A

Caused by overactivity of the detrusor muscle of the bladder. Feel sudden urge to pass urine.

62
Q

Define stress incontinence

A

Weakness of the pelvic floo and sphincter muscle allows urine to leak at times of high pressure - laughing, coughing, jumping.

63
Q

Risk factors for incontinence

A

Increase age
Postmenopausal
Increased BMI
Previous pregnancies
Vaginal deliveries
Prolapse
Pelvic floor surgery
Neuro conditions - MS
Cognitive impairment

64
Q

Investigations in incontinence

A

Bladder diary
Dip stick
Post void residual volume
Urodynamic testing

65
Q

Management of stress incontinence

A

Avoid caffeine
Avoid excessive fluid
Weight loss
Pelvic floor exercises
Surgery
Duloxetine

66
Q

Management of urge incontinence

A

Bladder retraining
Anticholinergics - oxybutinin
Mirabegron
Surgery - botox,

67
Q

Define atrophic vaginitis

A

Refers to dryness and atrophy of the vaginal mucosa related to lack of oestrogen - occurs when entering the menopause

68
Q

Presentation of atrophic vaginitis

A

Itching
Dryness
Dyspareunia
Bleeding due to localised inflamamtion
Recurrent UTI
Stress incontinence
Pelvic organ prolapse

69
Q

Management of atrophic vaginitis

A

Lube
Oestrogen creams

70
Q

Define lichen sclerosus

A

Chronic inflammatory condition that presents with atches of shiny “porcelain-white” skin - commonly affecting labia, perineum and perianal skin in women.

71
Q

Presentation of lichen sclerosus

A

Itching
Soreness
Skin tightness or changes
Painful sex - superficial
Erosions
Fissures

72
Q

Management of lichen sclerosus

A

Topical steroids
Emollients

Med Finals - Womens Health (10 decks)

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