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GOSH > Gynaecology > Flashcards

Gynaecology Flashcards

1
Q

what is a threatened miscarriage?

A

Symptoms of bleeding/pain but pregnancy continues.

Cervical os closed & uterine size normal for dates

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2
Q

what is an inevitable miscarriage?

A

Presents in the process of miscarriage although fetes may still be alive. Cervical os is open

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3
Q

in a complete miscarriage what can be seen on examination?

A

cervical os is Closed

Uterus no longer enlarged

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4
Q

at how many weeks by transvaginal ultrasound will the fetal heartbeat be detected?

A

6+ weeks

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5
Q

when is the yolk sac visible by TV ultrasound?

A

5.5 weeks

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6
Q

what drugs are used in the medical management of miscarriage?

A

Prostaglandins (misoprostol) +/- Antiprogesterones (mifepristone)

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7
Q

how to prostaglandins and antiprogesterones work to assist in medical management of miscarriage?

A

Induce uterine contractions to expel remaining POC.

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8
Q

what is a recurrent miscarriage?

A

> 3 miscarriages in succession

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9
Q

how are antiphospholipid antibodies managed as a cause of recurrent miscarriage?

A

Aspirin and LMWH

*likely thrombosis in uteroplacental circulation

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10
Q

what is the most common site of ectopic pregnancy?

A

Fallopian tube (95%)

cannot be viewed on USS

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11
Q

on examination what is the size of the uterus and status of the cervical os in ectopic pregnancy?

A

Uterus - smaller than expected

Cervical os - closed

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12
Q

what is the difference in timings between a transvaginal and abdominal ultrasound?

A

On abdominal ultrasound landmarks will not be seen until a week later

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13
Q

what is the surgical management of ectopic pregnancy?

A

Salpingectomy = removal of affected tube.

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14
Q

what is a salpingostomy?

A

Removal of ectopic from the tube

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15
Q

what drug is used in the medical management of ectopic pregnancy?

A

Methotrexate

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16
Q

what is a molar pregnancy?

A

Trophoplastic tissue (which is part of the blastocyst that normally invades the endometrium) proliferates in a more aggressive way than normal.

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17
Q

what is the classic appearance on ultrasound in molar pregnancy?

A

‘SNOWSTORM’ appearance of swollen villi with complete moles

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18
Q

what is hyperemesis gravidarum?

A

Excessive nausea and vomiting of pregnancy such that the individual is unable to maintain adequate hydration & endangers fluid, electrolyte and ; nutritional status.

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19
Q

what is the definition of post-menopausal bleeding?

A

Vaginal bleeding occurring atleast 12 months after the last menstrual period

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20
Q

In PMB when is endometrial biopsy +/- hysteroscopy indicated?

A

If the endometrium is >4mm or multiple bleeds

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21
Q

what are fibroids?

A

Benign tumours of the myometrium

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22
Q

why do fibroids regress after the menopause?

A

Due to a reduction in circulating oestrogen

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23
Q

what are the pressure effects of fibroids?

A

Bladder - frequency, retention, hydronephrosis

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24
Q

On examination what is the classic finding in a patient with fibroids?

A

Solid mass may be palpable - arise from the pelvis and be continuous with the uterus
Multiple small fibroids - knobbly enlargement.

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25
Q

how do GnRH agonists work in treatment of fibroids?

A

Cause temporary amenorrhoea and fibroid shrinkage by inducing a temporary menopausal state

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26
Q

which phase of the menstrual cycle is constant?

A

Luteal phase (last 14 days)

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27
Q

when is the proliferative phase of the menstrual cycle and which hormone is responsible?

A

Proliferative phase = days 5-14

Oestrogen produced by Follicles

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28
Q

when is the secretory phase of the menstrual cycle and which hormone is responsible?

A

Secretory phase: day 14-28

corpus luteum produces PROGESTERONE -

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29
Q

from where are FSH and LH secreted?

A

Anterior Pituitary

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30
Q

From where is Gonadotrophin-Releasing hormone (GnRH) produced?

A

Hypothalamus

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31
Q

from where is oestrogen released?

A

Ovary

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32
Q

which hormone is responsible for ovulation?

A

LH (causes ovulation 36 hours after surge)

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33
Q

what is a Graffian follicle?

A

An almost mature follicle

*corpus haemorrhagicum = ruptured follicle

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34
Q

what hormones are secreted by the corpus luteum?

A

PROGESTERONE

*also oestradiol

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35
Q

when do progesterone levels peak?

A

Day 21

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36
Q

what effect does progesterone have on the endometrium?

A

Causes secretory changes in the endometrium, increased lipids and glycogen, glands swell and there is an increased blood supply

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37
Q

how thick is the endometrium at ovulation?

A

2-3mm

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38
Q

how thick is the endometrium in the secretory phase?

A

4-6mm

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39
Q

on what day is the optimal condition for implantation?

A

day 20-22: stable, vascular, nutrient rich

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40
Q

what are the characteristics of the cervix mid cycle?

A

Strongly and runny (spinnbarkeit)

Facilitates sperm access at ovulation to promote the chances of fertilisation taking place

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41
Q

what are the characteristics of the cervix in the luteal phase?

A

Tenacious and inelastic (due to progesterone). Prevents microbial ingress, protects developing embryo. Critical to maintenance of pregnancy (mucus plug)

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42
Q

what is menorrhagia defined as?

A

Blood loss >80mL in an otherwise normal menstrual cycle

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43
Q

what investigation can be used to assess endometrial thickness?

A

TV ultrasound

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44
Q

in which women would you perform an endometrial biopsy if they present with menorrhagia?

A

Endometrial thickness >10mm
suspected polyp
>40 years recent onset

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45
Q

what are the common anatomical causes of menorrhagia?

A

Fibroids
Polyps
Adenomyosis
Tumours

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46
Q

in which situation would you to uterine artery embolisation instead of a myomectomy for the treatment of fibroids?

A

For woman who want to retain the uterus and avoid surgery

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47
Q

what is the definition of oligomenorrhoea?

A

menstruation that occurs every 35 days to 6 months

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48
Q

what is primary amenorrhoea?

A

Where menstruation has not begun by age 16

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49
Q

what is secondary amenorrhoea?

A

Where previous normal menstruation ceases for >6months

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50
Q

what is asherman’s syndrome?

A

Asherman syndrome (AS) or Fritsch syndrome, is a condition characterized by adhesions and/or fibrosis of the endometrium particularly but can also affect the myometrium

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51
Q

which of hypo or hyperthyroidism can lead to amenorrhoea?

A

Both

52
Q

Does turner’s syndrome result in primary or secondary amenorrhoea?

A

Primary

53
Q

what are the commonest causes of secondary amenorrhoea?

A

Premature menopause/ovarian failure
Polycystic ovary syndrome (PCOS)
Hyperprolactinaemia

54
Q

what hormone levels would you expect in hypothalamic hypogonadism?

A

Decreased GnRH, LH, FSH and estradiol

55
Q

what is Sheehan’s syndrome?

A

are condition where severe postpartum haemorrhage causes pituitary necrosis and varying degrees of hypopituitarism

56
Q

in hypothyroidism are the prolactin levels reduced or raised?

A

Raised

57
Q

what genotype is present in Turner’s syndrome?

A

45 XO

58
Q

What stature do you expect in Turner’s syndrome?

A

Short stature and poor secondary sexual characteristics

59
Q

what is haematocolpos?

A

Menstrual flow accumulates in the vagina

*Haematometra = accumulates in uterus

60
Q

What is rokitansky’s syndrome?

A

Absence of vagina with or without a functioning uterus

61
Q

how are cervical ectropions commonly managed?

A

Cryotherapy

62
Q

in secondary dysmenorrhoea is pain relieved or aggravated by the onset of menstruation?

A

Relieved (pain precedes menstruation)

63
Q

Is PMS caused by fluctuation of hormones in the 1st or 2nd half of the cycle?

A

2nd half

64
Q

what are the treatment options for severe PMS?

A

SSRIs (continuous or in 2nd half of cycle)
100ug oestrgoen HRT patch
Combined oral contraceptive
GnRh agonists + add back oestrogen therapy –> pseudo menopause
Bilateral oophorectomy (require combined HRT or COC for bone and endometrial protection)

65
Q

how many women are affected by PCOS?

A

5%

and causes 80% of anovulatory infertility
*20% of women have PCO but majority have regular ovulatory cycles. May develop PCOS if put on weight.

66
Q

what are the criteria for diagnosing PCOS?

A

Diagnosis of PCOS requires 2/3 of:

1) PCO on ultrasound
2) Irregular periods (>35 days apart)
3) Hirsutism: clinical (acne or excess body hair) &/or biochemical (raised serum testosterone)

67
Q

raised insulin levels in PCOS have what effect on the adrenal glands and the liver?

A

Increased LH and insulin on PCO –> increased ovarian androgen production
Increased adrenal androgen production and reduce hepatic production of steroid hormone binding globulin (SHBG) –> increased free androgen levels

68
Q

what is the effect of increased intraovarian androgens?

A

Disruption of folliculogenesis

69
Q

why do changes in weight modify the phenotype and alter the severity of PCOS?

A

Increased body weight –> increased insulin –> increased androgen

70
Q

what is a normal LH:FSH ratio?

A

LH:FSH = 1:1

If 2:1 or 3:1 supporting evidence for diagnosing PCOS

71
Q

What is another name for fibroids?

A

Leiomyomata - benign tumour of the myometrium

72
Q

What is Meig’s syndrome?

A

Meig’s syndrome:
Benign ovarian cyst (usually a fibroma)
Ascites
Pleural effusion

73
Q

What is the most common ovarian cyst in women of a reproductive age?

A

Follicular cyst

74
Q

what is elforinithine?

A

Topical anti androgen used for facial hirsutism

75
Q

what must be avoided in patients taking anti androgens cyproperone acetate spironolactone?

A

Conception

76
Q

how many women with PCOS develop type 2 DM?

A

50%

77
Q

how many women with PCOS develop GDM?

A

30%

78
Q

Transversely what is the appearance of a fibroid?

A

whorled appearance. Smooth muscle and fibrous elements

79
Q

are fibroids more common in parous or non-parous women?

A

Non-Porous

80
Q

which type of fibroid can form intracavity polyps?

A

Submucosal fibroids

81
Q

why do fibroids regress after the menopause?

A

Reduction in circulating oestrogen

82
Q

what type of fibroid degeneration is common in pregnancy?

A

Red degeneration - pain & uterine tenderness, haemorrhage and necrosis risk

83
Q

what type of fibroid degeneration is common postmenopausally?

A

Calcification

84
Q

what complications can fibroids cause in pregnancy?

A 
Premature labour
Malpresentation
Transverse lie
Obstructed labour
Postpartum haemorrhage
85
Q

what is adenomyosis?

A

Presence of endometrial tissue within the myometrium

86
Q

why might an Hb level be high in someone with fibroids?

A

Fibroids secrete erythropoietin

*Hb can be low - vaginal bleeding or high (EPO)

87
Q

why might GnRH treatment be used before transcervical resection of fibroids?

A

GnRH agonists shrink fibroid, reduce vascularity, thin endometrium making resection easier and safer

88
Q

what is a chocolate cyst?

A

Ovarian endometrioma.

Develop in women with endometriosis and can enlarge up to 6-8cm.

89
Q

is a mature solid teratoma or immature solid teratoma malignant?

A

Immature solid teratoma

90
Q

what score is used to determine risk in ovarian cyst presentation?

A

Risk of malignancy index = U (Ultrasound score) x M (menopausal score) x CA125 (IU/ml)

91
Q

what is sheehan’s syndrome?

A

Sheehan’s syndrome/postpartum hypopituitarism= hypopituitarism (decreased functioning of the pituitary gland), caused by ischemic necrosis due to blood loss and hypovolemic shock during and after childbirth

92
Q

why do some menopausal women experience dyspareunia?

A

Atrophic vaginitis

93
Q

what does CIN II signify?

A

Atypical cells in lower 2/3 of the epithelium

94
Q

which strains of HPV are most commonly associated with cervical cancer?

A

16,18 (also 31,33)

95
Q

for which types of cancer is the combined pill protective?

A

Ovarian, Uterine

96
Q

for which types of cancer is the combined pill a risk factor?

A

Breast, Cervical

97
Q

what two stains are used at colposcopy to determine abnormality of cells in the transformation zone?

A
  1. Schillers Iodine

2. Acetic acid

98
Q

in cancerous/CIN cells what happens to the schillers iodine used at colposcopy?

A

It is not taken up by cancerous cells as they contain low amounts of glycogen and high amount of protein.

Normal cells - appear brown

99
Q

in cancerous/CIN cells what happens to the acetic acid used at colposcopy?

A

Cancerous/CIN cells appear white

100
Q

if a cervical tumour presses on the ureters what stage is it?

A

Stage 3

101
Q

if a cervical tumour invades the bladder what stage is it ?

A

Stage 4

102
Q

what is the imaging modality of choice for assessing spread of cervical cancer?

A

MRI

103
Q

what is the difference between stage 1a and stage 1b cervical cancer?

A

Stage 1a - microscopic

Stabe 1b - clinically visible

104
Q

what is the difference between stage 2a and stage 2b cervical cancer?

A

Stage 2a - involvement of 2/3 of the vagina without the parametrium
Stage 2b - invasion of parametrium

105
Q

above what stage cervical cancer is chemo-radiotherapy performed alone and surgery not an option?

A

Stage >2b

2b - involvement of parametric and 2/3 of vagina

106
Q

what is a trachelectomy?

A

Removal of the cervix

*radical trachelectomy includes removal of the parametrium

107
Q

above what stage cervical cancer is chemo-radiotherapy performed alone and surgery not an option?

A

Stage >2b

2b - involvement of parametric and 2/3 of vagina

108
Q

what type of cancer is cervical cancer?

A

Squamous cell carcinoma (80%)

109
Q

what type of cancer is endometrial cancer?

A

adenocarcinoma (90%)

  • of columnar endometrial gland cells
110
Q

what are some of the causes of endogenous oestrogen excess?

A

PCOS
Oestrogen secreting tumours
Nullipairty
Late menopause

111
Q

what are some of the causes of exogenous oestrogen excess?

A

Unopposed oestrogen therapy

Tamoxifen therapy

112
Q

why is bilateral salpingoopherectomy performed in endometrial cancer but not cervical cancer?

A

Endometrial ca = hormone dependent

Cervical cancer - not hormone dependent

113
Q

is chemotherapy a routinely used treatment in endometrial cancer?

A

No

114
Q

what is the most common type of ovarian cancer?

A

serous cystadenocarcinoma

115
Q

if there are bilateral masses is it more or less likely to be malignant ovarian cancer?

A

More likely

Other features of malignancy: rapid growth, ascites, solid/septate on USS, increased vascularity

116
Q

what is the staging of ovarian cancer if the disease is beyond the pelvis but confined to the abdomen?

A

Stage 3

117
Q

what is the staging of ovarian cancer if the disease is beyond the abdomen? eg. in the lungs

A

Stage 4

118
Q

what is the staging of ovarian cancer if the disease is beyond the ovaries but confined to the pelvis?

A

Stage 2

119
Q

what CA125 result would warrant a pelvic and abdominal ultrasound?

A

> 35IU/ml

120
Q

at what risk of malignancy index score would you refer to a specialist MDT?

A

RMI >250

121
Q

what should be done for investigations of ascites in ovarian cancer?

A

Paracentesis of ascites

122
Q

which condition is associated with carcinoma of the vulva?

A

Lichen sclerosis

123
Q

what treatment is offered to women with >Stage 1b vulval cancer?

A

Triple incision radical vulvectomy

124
Q

what symptom is indicative of tubal cancer?

A

Florid discharge

125
Q

which speculum should be used in the examination of urinary incontinence?

A

Sim’s speculum

Look for cystocele or uretherocele

126
Q

which drug is licensed for the treatment of urinary stress incontinence?

A

Duloxetine (SNRI)

127
Q

what is the difference between overactive bladder and detrusor overactivity?

A

OAB: urgency with or without incontinence, usually with frequency or nocturne
Detrusor overactivity: urodynamic diagnosis - involuntary detrusor contraction during the filling phase which may be spontaneous or provoked

*can have symptoms of OAB without detrusor overactivity and vice versa

GOSH (3 decks)

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