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Gynaecology Flashcards

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1
Q

Definition of primary amenorrhea

A

By 13 years with no other evidence of pubertal development
By 15 years with some other signs of puberty

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2
Q

Age of puberty onset in girls

A

8-14 years

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3
Q

Age of puberty onset in boys

A

9-15 years

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4
Q

Structural causes of amenorrhoea

A

Imperforate hymen
Transverse vaginal septae
Vaginal agenesis
Absent uterus
FGM

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5
Q

Causes of secondary amenorrhoea

A

Pregnancy
Menopause
Hormonal contraception
Hypothalamic/pituitary pathology
PCOS
Ashermann’s syndrome
Thyroid pathology
Hyperprolactinaemia

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6
Q

Hormone tests for secondary Amenorrhoea

A

bHCG
FSH - high in primary ovarian failure
LH - high in PCOS
Prolactin
TFTs
Testosterone - PCOS, androgen insensitivity, congenital adrenal hyperplasia

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7
Q

Causes of menorrhagia

A

Dysfunctional uterine bleeding
Extremes of reproductive age
Fibroids
Endometriosis
PID
Copper coil
Anticoagulants
Bleeding disorders
PCOS
Connective tissue disorders

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8
Q

Management of menorrhagia

A

Tranexamic acid
Mefenamic acid
Mirena coil
COCP

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9
Q

Types of uterine fibroid

A

Intramural
Subserosal
Submucosal
Pedunculated

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10
Q

Presentation of uterine fibroids

A

Asymptomatic
Heavy menstrual bleeding
Abdominal pain, worse during menstruation
Bloating
Urinary/bowel symptoms
Deep dyspareunia
Reduced fertility

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11
Q

Management of fibroids <3cm

A

Mirena coil
Symptomatic management
COCP
Endometrial ablation
Resection during hysteroscopy

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12
Q

Management of fibroids >3cm

A

Symptomatic management
Mirena coil
Uterine artery embolisation
Myomectomy

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13
Q

Complications of uterine fibroids

A

Heavy menstrual bleeding
Reduced fertility
Miscarriage
Premature labour
Constipation
Urinary outflow obstruction
Torsion of fibroid

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14
Q

Potential aetiologies for endometriosis

A

Retrograde menstruation
Embryonic cells remaining outside the uterus
Lymphatic spread of endometrial cells

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15
Q

Presentation of endometriosis

A

Cyclical pelvic pain
Deep dyspareunia
Dysmenorrhoea
Infertility
Urinary symptoms
Bowel symptoms

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16
Q

Examination findings in endometriosis

A

Endometrial tissue visible on speculum examination
Fixed cervix
Tenderness in vagina, cervix & adnexa

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17
Q

Gold standard diagnostic investigation for endometriosis

A

Laparoscopy

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18
Q

Management of endometriosis

A

Analgesia
COCP
Medroxyprogestrone acetate injection
GnRH agonists
Laparoscopic ablation
Hysterectomy

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19
Q

Sex hormone profile in menopause

A

Oestrogen & progestrone low
LH & FSH high

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20
Q

Risks of HRT

A

Breast cancer
Endometrial cancer
VTE
Stroke & CAD

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21
Q

Contraindications for HRT

A

Undiagnosed abnormal bleeding
Endometrial hyperplasia
Breast cancer
Uncontrolled HTN
VTE
Liver disease
Active angina
Pregnancy

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22
Q

Which type of HRT for peri-menopausal women

A

Cyclical combined

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23
Q

Which type of HRT in post-menopausal women

A

Continuous combined

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24
Q

Types of ovarian cyst

A

Follicular cyst
Corpus luteum cyst
Serous cystadenoma
Mucinous cystadenoma
Endometrioma
Dermoid cyst
Sex cord-stromal tumour

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25
Risk factors for ovarian malignancy
Increased age Postmenopause Early menarche Late menopause Nulliparity Obesity HRT Smoking BRCA1/BRCA2
26
Causes of raised CA125
Endometriosis Fibroids Adenomyosis Pelvic infection Liver disease Pregnancy
27
Meig's Syndrome triad
Ovarian fibroma Pleural effusion Ascites
28
What is Asherman's Syndrome
Adhesions that form within the uterus
29
Presentation of Asherman's Syndrome
Post recent dilatation & curettage, uterine surgery to endometriosis Secondary amenorrhoea Significantly lighter periods Dysmenorrhoea
30
Gold standard investigation for Asherman's syndrome
Hysteroscopy
31
What is cervical ectropion
Columnar epithelium of the endocervix extends out into the ectocervix
32
Presentation of cervical ectropion
Increased vaginal discharge Vaginal bleeding Dyspareunia Postcoital bleeding
33
Management of cervical ectropion
Cautery with silver nitrate if problematic bleeding
34
What is vault prolapse
Occurs in women that have had a hysterectomy. The top of the vagina descends into the vagina
35
What is rectocele
Defect in the posterior vaginal wall that allows the rectum to prolapse forward into the vagina
36
What is cystocele
Defect in the anterior vaginal wall, allowing the bladder to prolapse backwards into the vagina
37
Risk factors for pelvic organ prolapse
Multiple vaginal deliveries Instrumental/traumatic delivery Advanced age Obesity Chronic respiratory disease Chronic constipation
38
Presentation of pelvic organ prolapse
Dragging sensation in the pelvis Feeling of something coming down into the vagina Incontinence Urgency Retention Constipation Reduced sexual enjoyment Altered sexual sensation Painful intercourse
39
Grade 1 uterine prolapse
The lowest part is more than 1cm above the introitus
40
Grade 2 uterine prolapse
The lowest part is within 1cm of the introitus
41
Grade 3 uterine prolapse
The lowest part is more than 1cm below the introitus, but not fully descended
42
Grade 4 uterine prolapse
Full descent with eversion of the vagina
43
Conservative management of pelvic organ prolapse
Physiotherapy Weight loss Reduced caffeine intake Vaginal oestrogen cream
44
Pathophysiology of urge incontinence
Overactivity of the detrusor muscle of the bladder
45
Symptoms of urge incontinence
Sudden need to pass urine Having to rush to the bathroom Not making it to the toilet in time Avoidance of activities that reduce bathroom access
46
Symptoms of stress incontinence
Urinary leakage when coughing, laughing or surprised
47
Risk factors for urinary incontinence
Increased age Postmenopausal status Increased BMI Previous pregnancy Previous vaginal delivery Pelvic organ prolapse Pelvic floor surgery Multiple sclerosis Dementia
48
Investigations for urinary incontinence
Bladder diary Urine dipstick Post-void bladder scan Urodynamic testing
49
Non surgical management of stress incontinence
Avoid caffeine & diuretics Avoid excessive fluid intake Weight loss Supervised pelvic floor exercises Duloxetine
50
Surgical management of stress incontinence
Tension free vaginal tape Intramural urethral bulking Colposuspension
51
Non-surgical management of urge incontinence
Bladder retraining Oxybutynin Tolterodine Mirabegron
52
Surgical management options for urge incontinence
Botox injections Percutaneous sacral nerve stimulation Augmentation cystoplasty
53
Presentation of atrophic vagintitis
Postmenopausal women Itching Dryness Dyspareunia Bleeding Recurrent UTI
54
Features of atrophic vaginitis on examination
Pale mucosa Thin skin Reduced skin folds Erythema & inflammation Dryness Sparse pubic hair
55
Management of atrophic vaginitis
Vaginal lubricants Estriol cream Estriol pessaries
56
Which diseases are associated with Lichen Sclerosus
Type 1 diabetes Alopecia Hypothyroid Vitiligo
57
Presentation of lichen sclerosus
Itching Soreness Skin tightness Painful sex Erosions Fissures
58
Appearance of lichen sclerosus
Porcelain white Shiny Tight Thin Slightly raised Papules/plaques
59
Management of lichen sclerosus
Referral to dermatology/gynaecology Dermovate Emollients
60
Complications of lichen sclerosus
Squamous cell carcinoma of the vulva Sexual dysfunction Narrowing of vaginal/urethral openings
61
Type 1 FGM
Removal of part or all of the clitoris
62
Type 2 FGM
Removal of part or all of the clitoris and labia minora
63
Type 3 FGM
Narrowing or closing of the vaginal space
64
Type 4 FGM
All other unnecessary procedures to the female genetalia
65
Short term complications of FGM
Pain Bleeding Infection Swelling Retention Urethral damage Incontinence
66
Inheritance pattern of androgen insensitivity syndrome
X-linked recessive
67
Features of androgen insensitivity syndrome
Genetically male Female phenotype Female external genitalia & breast tissue Abdominal/inguinal testes Taller than average Infertile
68
Hormone test results in androgen insensitivity syndrome
Raised LH Normal/raised FSH Normal/raised testosterone Raised oestrogen
69
Management of androgen insensitivity syndrome
Bilateral orchidectomy Oestrogen therapy Vaginal dilators
70
Most common subtype of cervical cancer
Squamous cell carcinoma
71
Which types of HPV are associated with cervical cancer
16 & 18
72
Risk factors for developing cervical cancer
Early sexual activity Increased number of sexual partners Unprotected sex Non-engagement with cervical screening Smoking HIV Increased number of full term pregnancies Family history
73
Cervical appearance consistent with cervical cancer
Ulceration Inflammation Bleeding Visible tumour
74
CIN 1?
Mild dysplasia, 1/3 thickness of epithelial layer Likely to return to normal spontaneously
75
CIN II?
Moderate dysplasia, 2/3 thickness of epithelial layer Likely to progress to cancer if untreated
76
CIN III?
Severe dysplasia Very likely to progress to cancer
77
Management of CIN / early stage cervical cancer
LLETZ Cone biopsy
78
Management of stage 1B-2A cervical cancer
Radical hysterectomy + lymph node removal Chemotherapy Radiotherapy
79
Management of stage 2b - 4A cervical cancer
Chemotherapy Radiotherapy
80
Which strains of HPV cause genital warts
6 & 11
81
Risk factors for endometrial cancer
Increased age Early onset of menstruation Late menopause Oestrogen only HRT No/few pregnancies Obesity PCOS Tamoxifen T2DM Lynch syndrome
82
Protective factors against endometrial cancer
COCP Mirena coil Increased pregnancies Smoking
83
Presentation of endometrial cancer
Postcoital bleeding Intermenstrual bleeding Heavy menstrual bleeding Abnormal vaginal discharge Haematuria Anaemia Raised platelet count
84
Investigating suspected endometrial cancer
Transvaginal US for endometrial thickness (<4mm) Pipelle biopsy Hysteroscopy with endometrial biopsy
85
Stages of endometrial cancer
1 - Confined to uterus 2 - Invades cervix 3 - Invades ovaries, fallopian tubes, vagina or lymph nodes 4 - Invades bladder, rectum or beyond pelvis
86
Management for endometrial cancer
Total abdominal hysterectomy with bilateral salpingo-oophorectomy
87
Types of ovarian cancer
Serous tumours Endometrioid carcinomas Clear cell tumours Mucinous tumours Undifferentiated tumours Teratomas Sex cord stromal tumours
88
Risk factors for ovarian cancer
Age (peaks at 60) BRCA1/BRCA2 Obesity Smoking Recurrent clomifene Early onset of periods Late menopause Nulliparity
89
Protective factors against ovarian cancer
COCP Breast feeding Pregnancy
90
Presentation of ovarian cancer
Abdominal bloating Early satiety Loss of appetite Pelvic pain Urinary symptoms Weight loss Abdominal/pelvic mass Ascites Referred hip/groin pain
91
Which tumour markers are relevant for ovarian cancer
CA125 a-FP HCG
92
Stage 1 ovarian cancer
Confined to the ovary
93
Stage 2 ovarian cancer
Spread past the ovary but confined to the pelvis
94
Stage 3 ovarian cancer
Spread past the pelvis but within the abdomen
95
Stage 4 ovarian cancer
Distant metastases
96
Most common subtype of vulval cancer
Squamous cell carcinoma
97
Risk factors for vulval cancer
Advanced age Immunosuppression HPV Lichen sclerosus
98
Management of vulval intraepithelial neoplasia
Watch & wait Wide local excision Imiquimod cream Laser ablation
99
Presentation of vulval cancer
Vulval lump Ulceration Bleeding Itching Pain Groin lymphadenopathy

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