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Phase 3a - Obs & Gynae > Gynaecology > Flashcards

Gynaecology Flashcards

1
Q

What is a cyst?

A

A fluid-filled sac.

If premenopausal MC benign
If postmenopausal MC malignant

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2
Q

When would an ovarian cyst be considered a PCOS?

A

Ovarian cysts + the following:
Hyperandrogenism
Polycystic ovaries on USS
Anovulation

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3
Q

Sx for ovarian cyst

A

Mostly aSx but can present with:
1. Pelvic pain (acute pelvic pain usually occurs if there is ovarian torsion, haemorrhage or rupture)
2. Abdominal fullness - early satiety
3. Palpable pelvic mass
4. Bloating

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4
Q

What are the two types of most common functional ovarian cysts?

A
  1. Follicular cysts: MC
    Cysts grow on ovaries = called follicles → release oestrogen and progesterone → release egg during ovulation → monthly growing follicle = functional cyst
  2. Corpus luteum cysts:
    Doesn’t breakdown during menstrual period + gets filled with fluid - commonly occurs in early pregnancy
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5
Q

Which sx would suggest malignancy in ovarian cysts?

A

Abdominal distension *
Decreased appetite
Weight loss
Abdominal bloating
Ascites
Urinary Sx
Lymphadenopathy

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6
Q

What are the RF for malignancy of ovarian cysts?

A

Obesity
Smoking
HRT
Late menopause
Early menarche
Breastfeeding (protective)
Fhx of BCA1or BCA2*
** Increased number of ovulation

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7
Q

What is the tumour marker for ovarian cancer?

A

CA125 - however it’s not sensitive

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8
Q

What enzyme markers should be measured in all women under 40 due to the possibility of germ cell tumours?

A

Lactate dehydrogenase
Alpha-fetoprotein
hCG

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9
Q

What investigation is done to diagnose ovarian cyst rupture?

A

1st line - Transvaginal USS
Definitive - laparoscopy

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10
Q

What are the non-malignant causes of a raise in the tumour marker CA125? (4)

Hint: Think of things that can cause peritoneal inflammation.

A

Fibroids
PIDs and Adenomyosis
Endometriosis
Menstruation
Pregnancy
Liver disease/ascites
IBD

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11
Q

Describe management for ovarian cysts in premenopausal and postmenopausal women

A

Premenopausal:
If acute pain consider ovarian torsion
<5 cm = Resolves on it’s own
5-7 cm = Yearly USS
>7 cm = MRI scan to rule out cancer

Postmenopausal:
Raised CA125 = 2 week cancer referral
If <5cm = USS every 4-6 months

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12
Q

What’s Meig’s syndrome and how does it present?

A

Triad:
Benign ovarian cyst + pleural effusion + ascites

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13
Q

What are factors that reduce the number of ovulations experienced?

A

Late menarche
Early menopause
Pregnancies
Use of COCP pills

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14
Q

What is ovarian torsion?

A

When ovaries or fallopian tubes twist on connective tissues that support adnexa (blood supply)

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15
Q

What will most likely cause an ovarian torsion?

A

Ovarian mass >5cm - benign tumours/cysts
Pregnancies

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16
Q

How can ovarian torsion also happen in younger girl before menarche?

A

Girls have longer infundibulopelvic ligaments that can twist more easily

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17
Q

Describe the progression of an ovarian torsion and how it’s an emergency.

A

Twist on ovaries and blood supply → ischaemia → persistence → necrosis of ovaries + loss of function

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18
Q

Sx of ovarian torsion

A

SUDDEN ONSET SEVERE UNILATERAL PELVIC PAIN
N + V
LOC

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19
Q

Diagnosis of ovarian torsion

A

1st line - Pelvic USS (whirlpool sign - free fluid and oedema in pelvis)
GS (definitive) - laparoscopic surgery

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20
Q

Tx of ovarian torsion

A

Detorsion
if severe - oophorectomy (removal of ovary)

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21
Q

What is the main Ddx for ovarian torsion?

A

Ovarian cyst rupture

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22
Q

What is Pelvic Inflammatory Disease (PID)?

A

Inflammation and infection of organs surrounding the pelvis which spreads from vagina up to cervix leading to tubular infertility.

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23
Q

Define the following:

  1. endometritis
  2. Salpingitis
  3. Oophoritis
  4. Parametritis
A
  1. Infl. of the endometrium (inner lining of the uterus)
  2. Infl. of the fallopian tubes
  3. Infl. of the ovaries
  4. Infl. of the connective tissue surrounding the uterus.
24
Q

What are the STI causes and non STI causes for PID?

A

STI: MC
1. Chlamydia Trachomatis*
2. Neisseria Gonorrhoea
3. Mycoplasma Genitalium

Non STI:
1. Gardnerella Vaginalis
2. H. Influenzae
3. E. Coli

25
Q

RF for PID

A

Multiple sexual partners
Non protective sex
Currently have STI
Previous PID’s
Younger age
IUD (e.g. copper coil)

26
Q

Sx for PID+ examination findings

A

Bilateral lower abdominal pain
Abnormal vaginal discharge
Abnormal bleeding (post-coital)
Dysuria
Dyspareunia
Fever

On examination:
Pelvic tenderness
Cervical motion tenderness (during bi-manual examination)

27
Q

Ix for PID

A

NAAT swab
Pregnancy test - rule out ectopic pregnancy
Vaginal and cervix swab - Pus cells
ESR and CRP

28
Q

Tx of PID

A

IM Ceftriaxone 1 dose 1g
+
Metronidazole 400mg BD 14 days
+
Doxycycline 100 mg BD 14 days

29
Q

Name 3 complications for PID?

A

Chronic pelvic pain (40%)
Infertility (15%)
Ectopic pregnancy (1%)

30
Q

What is Fitz-Hugh-Curtis Syndrome?

A

A complication of PID - Inflammation + infx of liver cells → adhesion of liver to peritoneum. Causes RUQ pain.

31
Q

What is the Rotterdam Criteria for PCOS?

A

Polycystic ovaries on USS + hyperandrogenism (hirsutism + acne) + anovulation (irregular/absent menstrual cycle)

32
Q

Sx of PCOS

A

Oligomenorrhoea/amenorrhoea
Hirsutism
Acne
Obesity
Infertility
Insulin resistance
Acanthosis nigricans

33
Q

What are different conditions that can cause hirsutism?

A

Meds (steroids, testosterone)
Cushing’s syndrome
Ovarian and adrenal tumours

34
Q

How does insulin resistance occur in PCOS?

A

Insulin = increases androgen levels and suppresses SHBG (sex hormone-binding globulin = binds to androgens)

Therefore, inc. insulin in blood = inc. androgen and decreased SHBG which also further increases androgens+ stops follicle development in ovaries therefore anovulation occurs

35
Q

Ix for PCOS:

  1. Blood tests + results
  2. Other tests
A

1.
Testosterone ↑
SHBG ↓
LH ↑
FSH normal/low
LH : FSH ↑
Insulin ↑

  1. 1st line - pelvic USS (not reliable in adolescents)
    GS - intravaginal USS: string of pearls appearance, 12 or more developing cysts, ovarian volume > 10 cm³
36
Q

Conservative management of PCOS

A

** weight loss - use orlistat for this (lipase inhibitor)
Diet
Stop smoking

37
Q

Why is there a risk of endometrial cancer in patients with PCOS and how would you manage it?

A

PCOS → no ovulation → dec. progesterone and inc. oestrogen → endometrial lining proliferate without regular shedding → endometrial hyperplasia (abnormal thickening of endometrium) → inc. cancer risk

Tx: Mirena coil or induce bleeding using cyclical progestogens or COCP - helps with endometrial hyperplasia

38
Q

How would you manage infertility in patients with PCOS?

A

Weight loss
Clomiphene + can be taken with metformin
Surgery - Laparoscopic ovarian drilling

39
Q

How would you manage hirsutism in patients with PCOS?

A

Weight loss
Co-cyprindiol (COCP) - SE = inc. VTE risk

40
Q

How would you manage acne in patients with PCOS?

A

Co-cyprindiol (COCP) - SE = inc. VTE risk
Topical retinoids and antibiotics

41
Q

Why do overweight girls tend to enter puberty at an earlier age?

A

Aromatase → enzyme found in adipose tissue (fat) → increases oestrogen creation

Overweight = inc. adipose tissue = inc. enzyme secretion = inc. oestrogen production

42
Q

What is the process of puberty development in girls?

A

Breast buds → pubic hair formation → start of menstrual period (aka menarche)

43
Q

What is lichen sclerosus?

Describe what it is and which parts of the body it affects.

A

A chronic inflammatory skin condition that presents with itchy, porcelain white patches.

Most common in:
1. Women - inner vulva, labia, perineum, perianal skin
2. Men - foreskin and glans
3. Both - can present in axilla and thighs

Commonly affects females age from 45-60

44
Q

Causes of lichen sclerosus

A

Unknown but said to possibly be autoimmune, genetic or even hormonal factors. Also possibly previous trauma.

45
Q

Difference between lichen sclerosus, lichen simplex and lichen planus.

A
  1. Lichen sclerosus = chronic inflammatory skin condition
  2. Lichen simplex = chronic irritation caused by repeated scratching and itching
  3. Lichen planus = autoimmune skin condition with shiny, purplish, flat topped raised patches with white striae across surface
46
Q

Sx of lichen sclerosus

A
  • Itching (vulval itching)
  • Shiny, porcelain white, tight, thin, slightly raised patches
  • Superficial dyspareunia
  • Erosions
  • Fissures
47
Q

Mx of lichen sclerosus

A

Has no cure
Can use potent topical steroids (e.g. Clobetasol propionate 0.5% dermovate)
Emollients used on a regular basis
Followed up every 3-6 months

48
Q

Complications of lichen scleorus

A

Squamous cell carcinoma risk
Sexual dysfunction
Bleeding

49
Q

What is atrophic vaginitis? What causes it to happen?

A

Dryness + atrophy of the vaginal mucosa due to low concentrations of osetrogen

Oestrogen = maintains epithelial lining of vagina + urinary tract = thicker, more elastic and produce secretions

Low oestrogen = thinner, dec. elasticity, dry

Most commonly occurs in menopausal women

50
Q

Sx of atrophic vaginitis

A

Dryness
Itchy
Superficial dyspareunia
Bleeding (post-coital)
Recurrent UTI

51
Q

What would examination of the labia + vagina demonstrate?

A

Thin
Pale
Lack of pubic hair
Dry
Reduced skin folds
Erythema (inflammation)

52
Q

Tx of atrophic vaginitis

A

1st step - two week referral for suspected endometrial cancer (if over 55yrs)
Lubricants
Topical oestrogen :
* Estriol pessary
* Estriol cream
* Estradiol tablets
* Estradiol rings

CI for topical oestrogen = breast cancer, angina, VTE

53
Q

What is Asherman’s syndrome? When does it commonly occur?

A

When adhesions form in the uterus following damage in the uterus.

Usually occurs after:
- pregnancy-related dilatation and curettage procedure (i.e. removing remaining placental tissue after birth)
- Uterine surgery
- Several PID

54
Q

What does having asherman’s syndrome (adhesions) lead to?

Describe how they have a negative effect on the body.

A

They form physical obsturction and distort pelvic organs resulting in menstruation abnormalities, infertility and recurrent miscarriages.

55
Q

Sx of Asherman’s syndrome

A
  • Secondary amenorrhoea (absent periods)
  • Significantly lighter periods
  • Dysmenorrhoea (painful periods)
  • Infertility
56
Q

Ix for Asherman’s syndrome

A

GS - hysteroscopy
Hysterosalpingography
Sonohysterography
MRI scan

57
Q

Mx of Asherman’s syndrome

A

Dissect adhesions during hysteroscopy

Phase 3a - Obs & Gynae (8 decks)

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