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Gynaecology Flashcards

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1
Q

What is the treatment for PID

A

IM 500mg Ceftrixone (STAT)
100mg BD Doxyclcyine
400mg BD Metronidozole
For two weeks

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2
Q

Potential side effect of the COCP

A

Cervical polyp due to the action of the oestrogen on the squamous epithelium.
Weight gain
Mood changes
Breakthrough bleeding

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3
Q

Define prolapse and the clinical features associated with it

A

Protrusion of an organ or a structure outside its normal anatomical state

Clinical features

  • Falling down sensation
  • Lump/discomfort
  • Sexual symptoms
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4
Q

State the muscles and ligaments of the pelvis

A

Muscles

  • Levator ani muscles
  • Internal obturator muscles
  • perineal muscles

Ligaments

  • Transverse cervical ligament
  • Uterosacral ligament
  • Round ligament
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5
Q

Management of prolapse

A

Conservative
- Persaries (shelf and ring pesaries)

Surgical

  • Mesh repair
  • Colposuspension
  • Sacrospinous fixation
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6
Q

Discuss Ashermann’s syndrome in relation to causes, clinical features and treatment

A

Causes:
Intrauterine adhesions, scarring at the front and the back of the uterus wall stuck together

Clinical features:
Scanty absent periods
Pain
Infertility

Treatment:
Dilleete & cutrage

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7
Q

Ovarian stromal hyperthecosis

A

Hyperplasia of the ovarian storm
Clusters of lutenising cells within the storma

Increase in androstertenedione and testosterone

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8
Q

Clinical features of ovarian stromal hyperthecosis

A 
Hirutisim 
Virulism
Hyperoestrogenic state            
Endometrial hyperplasia
Abnormal uterine bleeding
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9
Q

Discuss the clinical features of PCOS

A 
Oligomenorrhaea 
Infertility 
Acne 
Hirutism
Alopecia 
Obesity
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10
Q

Pathophysiology of POCS

A

Disordered LH production
Peripheral insulin resistance leading to increased insulin
Increase in both LH and insulin = Increase in ovarian androgens production
- Disrupts follicilogenesis: irregular periods

Increase in insulin= Increase in adrenal androgens and decreases production of SHBG

Increase in free androgens levels

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11
Q

Criteria used when diagnosing PCOD

A

Rotterdam Criteria

  • irregular/absent cycle ( >42 days period free)
  • Clinical or biochemical signs of hyperandrogpns
    1) acne
    2) Hirsutism
    3) Alopecia
  • PCOS ovaries on USS (>12 antral follicles on one vary
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12
Q

List potential differential diagnosing PCOS and the subsequent treatment options that are available

A 
Dx: Hypotharyoidism
Hyperprolactinaemia 
Cushing's sysndrome 
Acromegaly 
CAH

Treatment: (If not planing pregnancy)
Co-coypril (Acne or hirsutism)
COCP (menstrual regulation)
Metformin started in secondary care)
Elformithne (hirsutism)
Olistat (wt mamagement)

Treatment (if planning pregnancy)
Clomifene to induce ovulation
Metaformin ( as above)
Laparoscopic ovarian drilling

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13
Q

Define amenorrhea and classify the different types

A

Absences of menstruation

Primary: menstruation has not commenced by ~16years
Secondary: Previously normal menstruation ceases for 6 months or more

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14
Q

List the causes of the primary amenorrhea

A

+ve 2 sexual characteristics

  • Constitutional delay
  • GU malformation
  • Testicular femenisation (androgen resistance and XY karotype)
  • Hyper prolactinoma
  • Pregnancy
  • ve 2 sexual characteristics
  • Ovarian failure
  • Tumours
  • Kallamanns
  • Congenital adrenal hyperplasia
  • Turners
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15
Q

List the causes of secondary amenorrhea

A
  • ve androgen excess
  • Pregnancy
  • Lactation
  • Premature ovarian failure
  • Radiotherapy
  • Contraception
  • BMI <19
  • Hyperprolactinaemia
  • Sheehans syndrome
  • Thyroid disease
  • Post pill
  • Iatrogenic

+ve androgen excess

  • PCOS
  • Cushings syndrome
  • Late onset CAH
  • Adrenal carcinoma
  • Ovarian carcinoma
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16
Q

List the clinical features associated with androgen excess

A 
Hiritusism 
Acne 
Temporal balding 
Thyroid disease 
Cushing's disease
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17
Q

Define menorrhagia

A

Heavy menstrual bleeding that interferes with a women physical, emotional, social quality of life

Possible causes 
Endometriosis 
Fibroids 
Malignancy 
Thyroid disease 
Haemostatic disorder
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18
Q

Define puberty

A

Onset of sexual maturity, marked by the development of secondary sexual charachteristics
~ @13years

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19
Q

State the endocrine axis and the hormones involved in the control of puberty

A

Controlled centrally by the hypothalamic-pituitary axis

GnRH pulses increase in amplitude and frequency

Oestrogen = development of 2 charachteristics (adrenarche and thelarche

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20
Q

Define menopause

A

Cessation of the menstrual period. Retrospective diagnosis made following one year of amenorrhoea

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21
Q

Define perimenopause

A

period leading up to the menopause , irregular periods and menopausal symptoms

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22
Q

Discuss the investigation which would help confirm the diagnosis of menopause

A

FSH: increases (few oocytes remaining)
TFT’s: exclude other causes of irregular periods
Glucose: exclude DM
Antimullerian: decrease AMH, decrease oocytes
Blood cholesterol: exclude any CV risk factors

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23
Q

Menopausal symptoms

A

Short term

  • Hot flushes
  • Night sweats
  • Mood change
  • Irritability
  • Loss of memory
  • Headaches
  • Dry skin

Medium term

  • Recurrent UTI’s
  • Dysparenuria
  • Bleeding
  • Reduced libido
  • Vaginal atrophy

Long term

  • Osteoporosis (>2.5)
  • Fractures of wrist, hip and spine
  • CV disease
  • Dementia
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24
Q

Discuss the clinical features of fibroids

A
  • 30-50 yrs women
  • Menorrhagia
  • Intermittent bleeding
  • Pelvic pain
  • Subfertility
  • Dysmenorrhae
  • Palpable mass
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25
List possible differential dx for intermittent bleeding
``` Dysfunctional uterine bleeding Endometrial Ca Endometrial lesion PID Ovarian tumor ```
26
List the types of urinary incontinence
Overactive bladder: sphincter muscles work as normal, increased bladder pressure above maximal urethral closure pressure Stress incontinence: sphincter weakness
27
List the clinical features of overactive bladder
``` Urgency Urinary incontinence Frequency Nocturia Key in door Handwashing Intercourse ```
28
List the clinical features of stress incontinence
Involuntary leakage Coughing Lifting Exercise
29
What is the innervation of the bladder
Parasympathetic: sacral nerve
30
List the investigations you would carry out to investigate urinary incontinence
Frequency volume chart Urinanalysis (rule out STI,UTI) Residual urine measurement EPAQ questionnaire
31
Management of incontinence
``` Stress incontinence: Physio- Pelvic floor strengthen Weight loss Quit smoking Decrease caffeine ``` Medical Anticholinergics (Oxybutin) Mirabegron BOTOX Surgery Calposuspension Tension free vaginal T
32
Discuss the different grades of the Pelvic Organ Prolapse Quantification (POPQ)
``` Grade 0:No prolapse Grade 1: Prolapse halfway to the hymen Grade 2: To the hymen Grade 3: Halfway passed the hymen Grade 4: Maximum descent ```
33
List the risk and protective factors for ovarian cancer
RISK - BRCA 1/2 - HPNCC - Nulliparity - Early menarche - Late menopause PROTECTIVE - Pregnancy - COCP - Lactation
34
Pathology of ovarian cancer
Epithelial - Clear cell adenomas - Cystadenomas Germ cell - Teratomas
35
Clinical features of ovarian cancer
``` Vauge ( IBS/ DIVERTICULITS) Abdominal distentsion Bloating Early satiety Loss of appetite Urgency/ Frequency Weight loss ```
36
List the factors involved in the risk of malignancy index score
Uss findings CA125 Level Menopausal stauts
37
List the stages in CIN
I: Lower 1/3 of the epithelium II: Lower 2/3 of eptihelium III: Full thickness of the epithelium If it invades the basement membrane = cancer
38
Risk factors for CIN
Cx: HPV OCP Smoking Immunocompromised
39
Explain the protocol of the national cervical screening programme
>25yrs Smear every three years 50-64 Smear every 5 yrs Normal: return to screening programme Borderline: HPV triage * -ve HPV: return to screening * +ve HPV: colposcopy Moderate : urgent colposcopy
40
Pathology of cervical carcinoma
Squamous cell carcinoma Mixed pattern Adenocarcinoma HPV cause all
41
Management of CIN
Large loop excision of transformational zone (LLETZ) Cone biopsy Cryotherapy
42
Clinical features of cervical carcinoma
Post coital bleeding Offensive vaginal discharge IMB/PMB Bladder symptoms
43
Management of cervical carcinoma
I: Local excision II: Werthlien hysterectomy, chemotherapy III: Chemo and radiotherapy (PALLIATIVE)
44
List the risk factors for endometrial cancer
``` Unopposed oestrogen therapy Tamoxifen PCOS Obesity Nulliparity Late menopause Ovarian granuloma TIIDM ```
45
Clinical features of endometrial cancer
Postmenopausal bleeding Irregular/IMB Atrophic vaginitis Cervical smear ( will show abnormal columnar cells)
46
Investigations for endometrial cancer
``` Transvaginal USS Biopsy if - Endometrim is >4cm in PM - Endometrium is >10cm in Premen MRI for staging ```
47
Management of endometrial cancer
I: Hysterectomy and BS II: Radical hysterectomy III: Debulking surgery
48
Pathology of vulval cancer
Squamous cell carcinoma Presentation - Unepxlained lump - Pruritus - Bleeding - Discharge Treatment - Local excision - May required lymph node removal
49
Pathology of lichen sclerosis
Autoimmune disorder | Elastic tissue becomes collagen
50
Clinical features and treatment of lichen sclerosis
Clinical features - Bruised red purpuric signs - Vulvae becomes white , flat and shiny Treatment - Clobetasol propionate
51
Clinical features of ovarian torsion
Pain | May be intermittent as the ovary torts and releases
52
Features of ovarian haemorrhage
Shock
53
Treatment of a ovarian torsion
Surgery | If operated on within 6hrs tissue will remain viable
54
List the type of benign breast lumps
1. Breast cyst - >35 yrs - Fluid filled - Rounded lump - Not fixed - Rx: needle aspiration 2. Fibroadenoma - <40yrs - Overgrowths of collagenous mesenchyme of the breast lobule - Firm, smooth, mobile lump - Painless - Rule of thirds (regress, stay the same, get bigger) - Rx mammogram to examine lump 3. Intraductal papilloma - Warty lesion behind the areola - Small lump - Sticky blood stained discharge - Rx: Fine needle aspiration 4. Fat necrosis - Large fatty breast lump - Calcification of the lump - Rx: refer for triple assessment
55
Breast cancer screening programme
Screen women every three years aged 50-70
56
Risk factors for breast cancer
``` Family hx Age Uninterrupted oestrogen exposure HRT BRCA Obesity ```
57
Clinical features of breast cancer
Lump Nipple discharge Nipple change Skin contour changes
58
Explain the triple assessment of breast cancer
Clinical examination Radiology (mammogram, ultrasound) Histology or cytology
59
Management of breast cancer
STAGE 1/2 ( breast only) - Surgery - Radiotherapy - Endocrine agents ( ER Tamoxifen, Aromatase inhibitors) STAGE 3/4 - Radiotherapy - DEXA scan - Bisphosphanates - Hormone treatments Must carry out immunohistochemistry Oestrogen +ve, HER +ve cancers Treatment of HER2+ve cancers with perception watch the cardiac function
60
Pagets disease of the nipple
Rare malignancy of the nipple | Eczematous lesion of the nipple and is often associated with an underlying in-situ or invasive carcinoma of the breast

Obs & Gynae (2 decks)

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