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Gynaecology 2 Flashcards

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1
Q

Contraception in menopausal women

A

> 50yo 12 months post last period
<50 24 months post last period

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2
Q

Average age of menopause
Average length of menopausal symptoms

A

51yo
7 years

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3
Q

Menopause Mx Classification (3)

A

Lifestyle
Hormonal
Non-hormonal

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4
Q

Lifestyle mx of menopause
Hot flushes (3)
Sleep disturbance (2)
Mood (3)
Cognitive symptoms (2)

A

Hot flushes
Regular exercise, weight loss and reduce stress

Sleep disturbance
Good sleep hygiene, avoid late evening exercise

Mood
Regular exercise, good sleep hygiene and relaxation

Cognitive symptoms
Regular exercise and good sleep hygiene

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5
Q

HRT CI (4)

A

Breast ca
Oestrogen sensitive ca
Undiagnosed vaginal bleeding
Untreated endometrial hyperplasia

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6
Q

HRT with a uterus, without

A

Combined PO or transdermal
Oestrogen only

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7
Q

Non HRT Mx of menopause
Vasomotor (3)
Vaginal dryness (2)
Psychological sx (3)
Urogenital sx (1)

A

Fluoxetine, citalopram, venlafaxine
Lubricant/ moisturiser
Self help, CBT, antidepressants
Vaginal oestrogen

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8
Q

How long should HRT be taken?

A

2-5 years

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9
Q

Menopause long term complications (2)

A

Osteoporosis
Increased risk of ischaemic heart disease

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10
Q

Menorrhagia can be caused by hyper or hypothyroidism?

A

Hypo

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11
Q

Menstrual cycle
Explain the cycle/ phases in a 28 day cycle
(Split into 4)

A

Days:
1-4 menstruation
5-13 follicular phase
14 ovulation
15-28 luteal phase

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12
Q

What happens to the basal body temperature during the menstrual cycle?

A

Falls prior to ovulation and rises following ovulation due to high prog

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13
Q

What happens during the follicular phase?
Endometrium
Ovary
Hormones
Mucus
Temperature

A

Endometrial proliferation
Increasing follicles with one becoming dominant
Increased FSH + oestradiol and LH surge leading to ovulation
Thick mucous, just prior to ovulation it becomes clear and stretchy
Falls prior to ovulation

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14
Q

What happens during the luteal phase?
Ovary
Hormones
Mucus
Temperature

A

Corpus luteum
Prog secreted by corpus luteum and rises
Oestrodial also increases
If corpus luteum degenerates then prog falls
Mucous thick and scant
Temp rises post ovulation

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15
Q

Ovarian ca RF (4)

A

FH
Early menarche
Late menopause
Nulliparity

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16
Q

Cervical ca RF

A

Increased number of sexual partners
High parity
HPV
Smoking
HIV

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17
Q

Endometrial ca RF

A

Nulliparity
Early menarche
Late menopause

Obesity
Unopposed oestrogen
DM
Tamoxifen
PCOS
Hereditary colorectal ca

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18
Q

Features of ovarian ca (6)

A

Abdominal distension
Bloating
AP/ pelvic pain
Urinary symptoms
Early satiety
Diarrhoea

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19
Q

Ovarian ca Ix (2)

A

Ca125
US

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20
Q

VIN what is it?

A

Vulval intraepithelial neoplasia
Pre cancerous lesion of the vulva

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21
Q

RF for VIN (4)

A

HPV 16 & 18
Smoking
Herpes simplex virus 2
Lichen planus

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22
Q

VIN features (2)
Describe the lesions

A

Itching
Burning
Raised, well defined skin lesions

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23
Q

RF for vulval ca (4)

Study These Flashcards
A

VIN
HPV
Immunosuppression
Lichen sclerosus

23
Q

RF for vulval ca (4)

Study These Flashcards
A

VIN
HPV
Immunosuppression
Lichen sclerosus

24
Inguinal lymphadenopathy Itching Irritation Lump/ ulcer on the majora =
Vulval ca
25
Offensive, thin, white/grey, fishy discharge
BV
26
Offensive, yellow, green, frothy, strawberry cervix, vulvovaginitis
TV
27
Mx candidiasis 1st line 2nd line If there are vulval sx
Oral fluconazole 150mg Clotrimazole pessary 500mg Topical imidazole
28
Definition of recurrent vaginal candidiasis Ix (2)
4 or more episodes HVS for MCS HbA1c
29
Mx recurrent candidiasis Induction Maintenance
Induction PO fluconazole every 3 days for 3 doses Maintenance PO fluconazole weekly for 6 months
30
What is the most common ovarian cyst?
Follicular cyst
31
Most common benign ovarian tumour in women under 30yo
Dermoid cyst
32
Cysts on premenopausal women mx
Conservative if: especially if <35yo and <5cm and reported as simple Repeat US 8-12 weeks
33
Cysts on postmenopausal women mx
Refer to gynae
34
Whirlpool sign on USS =
Ovarian torsion
35
Ovulation induction for PCOS mx First line 2nd line (medical) (2)
1. Weight loss 2. Letrozole, clomiphene
36
What is letrozole? (MOA)
Aromatase inhibitor
37
Clomiphene MOA
Oestrogen receptor modulator
38
What treatment can be used in hypogonadotropic hypogonadal anovulation
Gonadotropin therapy
39
OHSS features/ life-threatening complications (3)
Hypovalaemic shock Acute renal failure VTE
40
Most common cause of PID (2)
N. gonorrhoeae Mycoplasma genitalium
41
Mx PID (2)
PO ofloxacin, metro OR IM cef, PO doxy, PO metro
42
What is Fitzy Hugh Curtis Syndrome
Perihepatitis with PID/ post PID
43
PID complications (4)
Fitz Hugh Curtis Infertility Chronic pelvic pain Ectopic pregnancy
44
What is mittelschmerz?
Pain the middle of menstrual cycle secondary to ovulation
45
Mx of PMS Mild Mod Severe
Mild lifestyle advice Moderate COCP e.g Yasmin Severe SSRI either continuous or just during day 15-28
46
Baseline Ix for PCOS (7) bloods
FSH, LH, prolactin, TSH, testosterone, sex hormone binding globulin Raised LH:FSH Raised testosterone Prolactin elevated SHBG low HbA1c/ impaired glucose tolerance
47
What is the Rotterdam criteria for PCOS
2 out of 3 for diagnosis Infrequent or no ovulation/ menstruation Clinical or biochemical signs of hyperandrogenism PCO seen on US >= 12 follicles measuring 2-9mm OR increase ovarian volume >10
48
PCOS Mx General (2)
Weight reduction COCP
49
PCOS mx Infertility (4)
Infertility Weight loss Clomiphene Metformin Gonadotrophins
50
PCOS hirsutism and acne (2)
COCP Topical eflornithine
51
Classification of urinary incontinence (5) Explain/ examples
Overactive bladder/ urge - detrusor overactivity Stress - coughing/ laughing Mixed - urge and stress Overflow e.g obstruction such as prostate enlargement Functional e.g dementia, sedating meds etc
52
Ix urinary incontinence (4)
Bladder diaries for 3/7 VE to r/o prolapse Urine dipstick + culture Urodynamic studies
53
Mx urge (5) Hint 4 are medication examples
1. Bladder retraining - 6 weeks (gradually increase intervals between voids) Antimuscarinics 2. Oxybutynin IR 3. Tolterodine 4. Darifenacin Beta 3 agonist 5. Mirabegron
54
Mx stress (3)
1. Pelvic floor muscle training 8 contractions performed 3 times per day for a minimum of 3 months 2. Surgery (midurethral tape procedures) 3. Duloxetine

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