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Year 4 Obs and Gynae > Gynaecology > Flashcards

Gynaecology Flashcards

(71 cards)

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1
Q

What is the purpose of normal menstruation?

A

produce oocyte, facilitate fertilisation and optimise endometrium for implantation

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2
Q

What are the names of your first and last period?

A

menarche and menopause

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3
Q

What are the hormonal changes in the follicular/proliferative phase?

A 
FSH high (mature follicle)
Oestrogen causes proliferation
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4
Q

What hormone change causes ovulation?

A

LH surge

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5
Q

What produces progesterone in the luteal/proliferative phase of menstruation?

A

Corpus luteum

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6
Q

What affect does progesterone have on the endometrium during the luteal phase of the menstrual cycle?

A

stabilised endometrium and makes it secretory

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7
Q

Where is GnRH produced?

A

Hypothalomus

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8
Q

GnRH secretion can be affected by what?

A

stress
time zone
weight loss
anxiety

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9
Q

Where does GnRH produce a response and what is released?

A

anterior pituitary which stimulates production of FSH and LH

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10
Q

What is the function of FSH?

A

stimulates follicular activity and promotes estradiol production

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11
Q

What is the function of LH?

A

triggers release of egg from follicle, promotoes development of corpus luteum and production of progesterone

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12
Q

Where to FSH and LH trigger the production of oestrogen and progesterone?

A

ovaries

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13
Q

If there is no fertilisation of an egg, what happens to the corpus luteum?

A

degenerates becoming the corupus albicans –> drop in progesterone levels leading to endometrial shedding

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14
Q

Describe the endometrium during the follicular/proliferative phase?

A

thickens, increased glands and blood vessels

thickness 2-3mm

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15
Q

Describe the endometrium curing the secretory/luteal phase?

A

increased secretions, lipids, glycogen and blood supply

4-6mm thick

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16
Q

Define primary dysmneorrhoea

A

painful periods with no underlying pelvis pathology

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17
Q

What is the difference between primary and secondary amenorrhoea?

A

primary - never started periods

secondary - absence of periods after >6 months menarche

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18
Q

What are some common causes of oligomenorrhoea?

A 
PCOS
contraceptive methods
perimenopause
thyroid disease
DM
eating disorders
medications
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19
Q

What is the acoronym for for causes of abnormal bleeding (and what are the causes)?

A

PALM (structural) COEIN (non-structural)

  • polyp
  • adenoymyosis
  • leiomyoma (fibroids)
  • malignancy
  • coagulopathy
  • ovulatory dysfunction
  • endometrial
  • iatrogenic
  • not yet classified
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20
Q

What investigations are important to perform in someone with heavy menstrual bleeding?

A 
PT
USS
Bloods - FBC (anaemia), TFTs, hormonal screen, coagluopathy/clotting screen
smear up to date??
hysteroscopy +/- biopsy
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21
Q

Which out of IMB and PCB is more likely to be endometrial or cervical problems?

A

IMB - endometrial
PCB - cervical
(more likely causes, but not always)

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22
Q

What are some cervical causes of abnormal bleeding?

A

infection (chlamydia/gonorrhoea)
cervical polyp
cervical ectropion

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23
Q

What are some endometrial causes of abnormal bleeding?

A

fibroid
endometrial polyp
malignant/pre-malignant
endometriosis

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24
Q

What are the genera hormonal treatments that may be of use in abnormal menstrual bleeding?

A

COCP, POP, mirena coil

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25
What are the general non-hormonal treatments that may be of use in abnormal menstrual bleeding?
tranexsamic acid and mefanamic acid
26
What is premenstrual syndrome?
distressing, psychological, physical and/or behavioural symptoms occuring in the luteal phase of the menstrual cycle
27
What percentage of women experience no symptoms from PMS?
15%
28
What are the hormonal abnormalities in PCOS?
Essentially always in follicular phase (where oestrogen predominates) therefore consistently high levels of oestrogen High levels of LH, which never reach a surge (no ovulation) insulin resistance
29
What are the signs and symptoms of PCOS?
``` infertility amenorrhoea/oligomenorrhoea acne hirsutism obesity chronic pelvic pain depression ```
30
What are the Rotterdam criteria?
Diagnosis of PCOS with 2 out of 3: - oligo- or an-ovulation - clinical or biochemical signs of hyperandrogenism - polycystic ovaries on scan
31
What is the management of PCOS?
stabilise menses (COCP) council on obesity metformin (for insulin resistance) Eflornithine (cream to reduce hair growth) Clomifene (helps fertility) Gonadotrophin injections (FSH/LH) but can lead to ovarian hyperstimulation syndrome (OHSS)
32
Suggest some gynaecological and non-gynaecological causes of ACUTE PELVIC PAIN
GYNAE: - ectopic pregnancy - ovarian cyst accident - primary dysmenorrhoea NON-GYNAE: - appendicitis - IBS/IBD - strangulated hernia - UTI
33
Suggest some gynaecological and non-gynaecological causes of CHRONIC PELVIC PAIN
GYNAE: - PID - pelvic adhesion - Asherman's syndrome - Dysmenorrhoea NON-GYNAE: - constipation - IBS/IBD - Hernia - interstitial cystitis
34
When can you diagnose menopause?
12 months after LMP
35
What hormonal changes occur in menopause?
Rise in FSH (and LH) due to falling oestrogen levels (no negative feedback loop)
36
What are some early symptoms of menopause?
``` vasomotor period changing insomnia mood swings cognitive function impairment thinning of skin and hair joints and muscle aches fat redistribution ```
37
What are some longer term symptoms of menopause?
vaginal dryness bladder changes (frequency, urgency, UTIs) osteoporosis increased risk of cardiovascular disaese
38
What treatment can be offered for menopause?
explanation diet and lifestyle advice HRT (discuss pros and cons) Non-hormonal alternatives
39
What is endometriosis?
chronic condition where endometrial tissue lies outside of the uterine cavity
40
What is adenomyosis?
Endometriosis where the ectopic tissue is in the myometrium
41
What are risk factors associated with endometriosis?
``` early menarche FHx short menstrual cycles long duration of menstrual bleeding heavy menstrual bleeding defects in uterus/tubes ```
42
What are the symptoms of endometriosis?
``` cyclical pelvic pain subfertility dysmenorrhoea dyschezia dyspareunia dysuria may get more localised symptoms depending on site ```
43
What signs would be present on bimanual examination of someone with endometriosis?
fixed retrograde uterus uterosacral ligament nodes general tenderness
44
What investigations are used to assess/diagnose endometriosis?
laparoscopy (gold standard) | pelvis USS
45
What findings on laparoscopy are indicative of endometriosis?
chocolate cysts adhesions peritoneal deposits
46
What is the management of endometriosis?
NSAIDs (for pain) COCP/mirena (suppress ovulation for 6-12 months -> can cause atrophy of ectopic tissue) GnRH analogues (chemically induce menopause) laser ablation or hysterectomy (only if extreme)
47
What is pelvis inflammatory disease?
chronic pelvic pain due to upward tracking of infection of vagina/cervix leading to inflammation of the uterus, fallopian tubes and ovaries
48
What are the most common causes of PID?
chlamydia trachomatis neisseria gonorrhoea streptococcus
49
What percentage of PID is caused by STIs?
25%
50
What are the clinical criteria for diagnosing PID?
``` lower abdo pain + one of (pyrexia >38/leucocytosis/ESR>15) + one of (adnexal pain/cervical motion tenderness/adnexal mass) ```
51
What are risk factors associated with PID?
``` sexually active age 16-24 recent partner change unprotected sex history of STIs ```
52
What are the symptoms of PID?
``` lower abdo pain (often bilateral) deep dyspareunia menstrual abnormalities post-coital bleeding dysuria abnormal vaginal discharge possible fever ```
53
What signs would present on vaginal examination in someone with PID?
tender uterus/adnexae cervical motion tenderness palpable mass mucopurulent discharge
54
What investigations would you do in someone with suspected PID?
``` Full STI screen inc. swabs (VVS, HVS) pregnancy test urine dip TV USS laparoscopy ```
55
What is the management for PID?
``` 14 days broad spec abx (doxycycline, ceftriaxone or metronidazole) avoid sexual intercourse until abx complete (in both partners) analgesia hospital admission if: -risk of ectopic -severe symptoms -signs of pelvic peritonitis -unresponsive to oral abs -need for emergency surgery ```
56
What are some complications of PID?
``` ectopic pregnancy infertility (1 in 10 with PID) tubo-ovarian abscess chronic pelvic pain Fitz-Hugh-Curtis syndrome (per-hepatitis) ```
57
Define miscarriage
loss of pregnancy before 24wks
58
What is the definition of early and late miscarriages?
early - up to 13wks | late - 13-24wks
59
What is a threatened miscarriage?
symptoms of miscarriage (pain and bleeding) but pregnancy still viable on USS
60
What is a missed miscarriage?
no symptoms of miscarriage but pregnancy found to have terminated on USS
61
What is an incomplete miscarriage?
Some of the symptoms of miscarriage but some retained POC on USS
62
What is a complete miscarriage?
severe symptoms (pain and bleeding) of miscarriage and uterus completely empty on USS
63
What risk factors are associated with miscarriage?
``` maternal age >35 previous miscarriage obesity chromosomal abnormalities smoking uterine anomalies previous uterine surgery anti-phospholipid syndrome coagulopathies ```
64
What investigations should be performed with a suspected miscarriage?
PT TV USS - assess for fetal cardiac activity serum bHCG - serial testing to differentiate between ectopic assess bleeding - FBC, rhesus status, CRP
65
What is the management of miscarriage?
For anyone rhesus -ve >12 wks --> anti-D prophylaxis Conservative 'watchful waiting': - allows POC to pass naturally - if unsuccessful, will need intervention - follow-up: repeat scan and PT 3wks later - contraindicated if infection or high risk of haemorrhage Medical: - use vaginal misoprostol to stimulate cervical ripening and contraction - may be preceded by mifipristone - SE of meds (N&V and diarrhoea) - follow up: scan and PT 3wks later Surgical: - manual vacuum aspiration with local anaesthetic <12wks - evacuation of retained POC under GA if >12wks - necessary if haemodynamically unstable - associated with surgical risks
66
What is an ectopic pregnancy?
pregnancy implanted anywhere outside of uterine cavity
67
Where is the most common site of ectopic pregnancy?
ampulla of fallopian tube
68
What risk factors are associated with ectopic pregnancy?
- previous ectopic - PID - endometriosis - IUD/IUS, POP, tubal ligation - previous pelvic surgery - IVF
69
What is the presentation of ectopic pregnancy?
PAIN - lower abdo/pelvic with assoc shoulder tip pain brownish vaginal discharge ?PV bleeding with history of amenorrhoea
70
How would you investigate suspected ectopic pregnancy?
-PT - if +ve, pelvic USS/TV USS -if nothing seen on USS but PT +ve = PREGNANCY OF UNKNOWN LOCATION -serum bHCG >1500 = ectopic until proven otherwise <1500 - repeat after 48 hrs if increasing lots = v early normal pregnancy if decreasing lots = miscarriage if relatively stable = ectopic
71
What is the management of ectopic pregnancy?
if clinically unstable, A-E Conservative: - allow ectopic to resolve naturally - only if patient very stable - monitor bHCG every 48hrs - may rupture if wait too long Medical: - IM methotrexate - monitor bHCG (may need repeat dose) - SEs: abdo pain, myelosuppression, v teratogenic (no unprotected sex for 3 mnths) Surgical: - laparoscopic salpingectomy (for tubal ectopic) - bHCG levels after surgery - definite cure

Year 4 Obs and Gynae (2 decks)

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