Gynaecology Flashcards
(125 cards)
1
Q
Adenomyosis
- def
- pres
- tx
A
Endometrial tissue in myometrium
Painful periods
menorrhagia
GnRH agonists
Hysterectomy
2
Q
Primary amenorrhoea causes
A
Turners
Congenital adrenal hyperplasia
3
Q
Secondary amenorrhoea (prev menstruation has now stopped for 6 months)
A
EXCLUDE PREG Stress PCOS Premature ovarian failure Ashermans (intrauterine adhesions) Sheehans
4
Q
What is Sheehans
A
Postpartum hypopituitary)
Caused by ischaemic necrosis in pituitary
5
Q
Atrophic vaginitis
- Who
- Pres
- Tx
A
Post-Menopausal
Vaginal dryness, painful intercourse
Lubricants, topical oestrogen
6
Q
Cervical cancer
- Features
- Cause
- RF
A
Vignal bleeding (postcoital, intermenstrual, postmenopausal) Abnormal Dicharge
HPV 16, 18, 33
Smoking, HIV, High parity, early 1st intercourse, many partners
7
Q
Cervical cancer pathophys
A
HPV 16, 18 make oncogenes E6 and E7
These inhibit p53 / RB tsgs
8
Q
Screening regimen cervical cancer
A
25-64
25-49 3 yearly
50-64 5 yearly
Smear sent for cytology testing for HPV
9
Q
What isn’t detected by cervical cancer screening
A
Adenocarcinoma (15% of cervical cancer)
10
Q
Using result from cervical screening
A
If positive for HPV 16/18/33 refer to colposcopy to visualise transformation zone and swab it
11
Q
What is ectropion
A
Larger area of columnar epithelium (from cervical canal) present on ectocervix
12
Q
Ectropion causes
A
COCP
Elevated oestrogen (ovulatory phase)
Pregnancy
13
Q
Dysmenorrhoea
- Def
- Primary vs secondary
- Causes
A
Pain during menstrual period
Primary: no pelvic pathology, pain few hours pre-period (due to rise in PGs)
Secondary due to:
Endometriosis, adenomyositis, PID, Intruterine device (copper), fibroids
14
Q
Treating dysmenorrhea
A
NSAIDs (Mefanic acid & Ibuprofen) - inhibit prostaglandins (thought to be reason)
COCP second line
15
Q
Typical site ectopic
A
Fallopian tube: ampulla
16
Q
Tx ectopic
A
Surgery: salpingectomy or salpingotomy
Medical: Methorexate
17
Q
RF ectopic preg
A
Damage to tubes (surgery, salpingitis - PID) Prev Endometriosis IUCD IVF
18
Q
Most dangerous ectopic site
A
Pouch of Douglas
19
Q
Endometrial cancer
- RF
- Features
- Ix
- Tx
- Prognosis
A
Obesity, Nulliparity, Early menarche, Late menopause, Unopposed oestrogen (eliminated if given with Progesterone), Tamoxifen, PCOS
Post-menopausal bleeding, intermenstrual bleeding
Transvaginal USS (endometrium under 4mm negative predictor) Hysteroscopy with endometrial biopsy
Hysterectomy (Progesterone in older women)
20
Q
Protective for endometrial cancer
A
Oral contraception pill
21
Q
Endometriosis
- def
- features
- Ix
- tx
A
Endometrial tissue outside of uterine cavity
chronic pelvic pain, dysmenorrhoea, sub fertility, dysuria, painful defecation
Vaginal lesions may be seen
Laparoscopy is gold standard
NSAIDs ± Para
COCP
secondary care: GnRH analogues (induce negative feedback), Surgery (excision of cysts may improve fertility)
22
Q
PID
- Features
- Investigation
A
Lower abdo pain, vaginal discharge, Perihepatic inflammation (Fitz-hugh curtis) RUQ pain
Fever over 38
FBC (Leukocytosis)
Not preg
High vaginal and urethral swabs
23
Q
HRT
- def
- SE
- complications
A
Alleviate menopausal symptom with Oestrogen+Progesterone therapy
Nausea, Breat tenderness, weight gain
Breast cancer (inc with progesterone), endometrial cancer (progesterone lowers risk), Ovarian cancer VTE, Stroke, Coronary heart disease
24
Q
Menopause
- Def
- Age
- Criteria
A
Cessation of menstruation due to loss of follicular activity
Average around 51 (perimenopause before this)
12 months from last period in over 50, 24 months if under 51
25
Menopause symptoms
Inc length of menstrual cycles
Vasomotor: Hot flush, night sweats
Urogenital: dryness, atrophy, urinary freq
Psych: anxiety and depression in 10%, short term memory
Osteoporosis, Inc risk IHD
26
Menopause management
Lifestyle modification
- exercise (mood, cognitive, flushes)
- good sleep hygiene (cog, sleep dist)
HRT (2-5yrs)
- Oral or transdermal combined therapy
Non-hormone replacement therapy
- Fluoxetine, citalopram (vasomotor, psych)
- dryness: lubricant
- Psych: self help, CBT
27
CI HRT
Current or past breast cancer
Any oestrogen-sensitive cancer
Undiagnosed vaginal bleeding
Untreated endometrial hyperplasia
28
Ovarian cancer
- Cell type + site
- RF
- Pres
90% epithelial
Distal end of fallopian tube
FH, BRCA1/2, many ovulations (early menarche, late menopause, nuliparity)
```
Abdo distension & bloating
Abdo pain
Urinary symptoms (e.g. urgency)
Early satiety
Diarrhoea
```
29
Ovarian cancer
- Investigations
- Management
- Prognosis
CA125 initially (endometriosis, cysts, menstruation also raise it)
USS abdo/pelvis if raised CA125
80% advanced with peritoneal mets at pres, 45% 5 yr survival
30
Ovarian cysts:
- common type
- Ix (benign vs malignant)
- Management (pre/postmenopause)
Follicular
USS
- benign: simple unilocular
- Malig: complex, multilocular
Premen: conservation, rescan in 8 weeks
Postmen: physiological cysts unlikely, refer to gynae
31
Ovarian torsion
- Def
- Pres
- Ix
- Tx
Twisting of ovary on ligaments compromising blood supply
Deep colicky pain, vomiting, adnexal tenderness on vaginal exam
USS
Laparoscopy is diagnostic and therapeutic
32
PID
- Def
- Causative organisms
- Pres
Infection/inflammation of female pelvic organs (uterus, fallopian tubes, ovaries)
Ascending infection from endocervix
```
Chlamydia trachomatis (commonest)
Neisseria gonorrhoea
```
Lower abdo pain, fever, dyspaerneuria, discharge
Perihepatitis (RUQ pain - Fitz-Hugh Curtis syndrome) in 10%
33
PID
- Ix
- Tx
Screen for chlamydia and Gonorrhoea (first catch urine)
Oral Ofloxacin + Metronidazole (OR IM ceftriaxone + MEtronidazole + Doxy)
34
PID complications
Infertility
Chronic pelvic pain
Ectopic pregnancy
35
Fertility in endometriosis
Reduced
36
Commonest cause of pelvic pain
Dysmenorrhoea
37
Hormone abnormalities seen in PCOS
Hyperinsulinaemia
| High LH
38
PCOS Pathology
Vicious cycle with high LH made worse by high Oestrogen giving higher LH.
Low FSH gives amenorrhoea
High androgens due to inc production from ovary, inc secretion release from adrenal and aromatisation to oestrogen by peripheral fat
39
Features of PCOS
Subfertility and infertility
Menstrual disturbance (oligomenorrhoea, amenorrhoea
Hirtuism, acne (hyperandrogegism)
Obesity (insulin resistance, high insulin)
40
Diagnosis of PCOS
2 out of
Oligo/Anovulation
Excess androgen activity
Polycystic ovaries on sonograph
41
PCOS Tx
- General
- Hirtuism
- Infertility
General
- weight loss
- metformin (insulin resistance)
- COCP helps regulate cycle
Hirtuism
- COCP
Infertility
- weight reduction
- metformin, clomifene (alone or combo) to stimulate ovulation
42
Differentials of postcoital bleeding
Chlamydial cervicitis
Cervical cancer
Polyps
Trauma
43
Differentials for postmenopausal bleeding
Vaginal atrophy (most common)
HRT
Endometrial hyperplasia (abnormal thickening - precursor for Ca)
Cancers: endometrial, cervical, ovarian, Vaginal
Trauma
44
Investigating Post-menopausal bleeding
History and examination of vagina + abdo
CA125
If 2 week wait, transvaginal USS
45
Preg minor symptoms
Amenorrhoea
N&V
Tired
MSK pains
46
Causes of premature ovarian failure (menopause + elevated Gonodatropins - FSH/LH pre 40)
Idiopathic
Chemo
Autoimmune
Radiation
47
Features of premature ovarian failure
Hot flush, night sweats
Infertility
Secondary amenorrhoea
Raised FSH and LH
48
Premenstrual syndrome
- def
- sympt
Emotional/physical symptoms women may feel prior to menstruation. (PMS)
Anxiety
Stress
Fatigue
Mood Swings
49
Causes of recurrent miscarriage
```
Antiphospholipid syndrome
Endocrine disorders (DM, Thyroid disorders, PCOS)
Uterine abnormality (adhesion, septum)
Chromosomal abnormalities
Smoking
```
50
Termination of preg date
Upper limit is 24 weeks
51
Termination of preg Method
- less than 9 weeks
- less than 13 weeks
- more than 15 weeks
Mifepristone (anti-progesterone) and PGs - Misoprostol 48 hrs later to stimulations Uterine contractions
Surgical dilation and suction of uterine contents
Surgical dilation and evacuation of uterine contents (late abortion)
52
Urinary incontinence
- RF
- Classification
Age, preg, high BMI, hysterectomy
Overacitve bladder/Urge: detrusor overactivity
Stress: leaking when laugh/cough (weak pelvis floor)
Overflow: outlet obstruction (e.g. BPH
Mixed )Urge & Stress)
53
Investigating incontinence
Bladder diaries
Vaginal exam
Urine dipstick & Culture
54
Management incontinence
Bladder training, bladder drugs (antimuscarinic - Oxybutinin)
Pelvic floor muscle training (8, 3x a day)
Surgery: retropubic mid-urethral tape
55
Urogenital prolapse
- Types
- RF
- Pres
- Tx
Cystocele
Rectocele
Uterine prolapse
(enterocoele - pouch of douglas = less common)
Inc age, multiparty, vaginal delivery, Obesity, Spina bifida
Pressure, heaviness.
Urinary: incontinence, frequency, urgency.
asympt/mild - conservative tx (weight loss, Kegels)
Ring pessary
Surgery - hysterectomy, colposuspesion
56
What are fibroids?
What causes them?
RF?
Smooth muscle tumours of the uterus
Occur in reproductive years, develop in response to oestrogen.
RF: Afrocaribbean
FH
Early puberty
Advancing age
57
Fibroids types
Submucosal
Intramural
Subserosal
58
Fibroids
- Pres
- Diagnosis
```
Menorrhagia (inc SA)
Lower abdo pain (cramping, worse at menstruation)
Bloating
Urinary sympt (frequency)
Subfertility
```
Transvaginal USS
59
Management fibroids
Levonorgestrel-releasing intrauterine device 1st line (Mirena)
Tranexamic acid, COCP
GnRH short term (overstimulation = desensitisation and suppression of reproductive axis)
Surgery: Myomectomy, endometrial ablation, hysterectomy, uterine artery embolisation
60
Vaginal candidiasis
- RF
- Features
- diagnosis
- Tx
Diabetes
Antibiotics, steroids
Preg
Immunosuppression: HIV, iatrogenic
White, non-offensive discharge
Vulvitis (pain on urination and sex)
ITCH
Vulval erythema
Clinical, High vaginal swab (not routine)
Local clotrimazole
Oral itraconazile
61
Discharge for
- Candida
- Trichomonas
- BV
Cottage cheese
Offensive, yellow/green, frothy
Offensive, thin, white/grey, fishy (whiff test)
62
Causes of discharge
Common
- BV, Candida, Trichomonas, Physiological
Less common
- Gonorrhoea, Chlamydia, ectropion, cancer
63
What is Turners syndrome?
| Pres?
45XO
Amenorrhoea, neck webbing, short
64
Secondary amenorrhoea causes
```
Premature failure/menopause
Stress
Exercise
Hyperprolactinaemia Iatrogenic (some contraceptives)
PCOS
```
65
What is Kallmann syndrome
Hypogonadotrpic hypogonadism
delayed or absent puberty
66
Investigating amenorrhoea
```
FSH/LH, hCG (preg), TFT
Serum androgens (PCOS)
```
67
Amenorrhoea, raised FSH and LH. Cause?
Ovarian failure/menopause commonest
weight loss, anorexia, pituitary tumour
68
Causes of high prolactin?
| Drug to Tx?
PRolactinoma, Hypothyroid, Anti-psychotics, some antiemetics
Bromocriptine (D-agonist)
69
What causes inc in testosterone in women?
Cogenital adrenal hyperplasia
Cushings
Androgen secreting tumour
70
Presentation of Menopause
```
Hot flushes,
night sweats,
vaginal dryness,
vaginal atrophy,
sleep disturbance,
irritability
```
71
What is seen on ovaries during laparoscopy in endometriosis
Chocolate cysts
72
Menorrhagia causes
Uterine:
Fibroids, endometriosis/adenomyosis, polyps, malignancy
Systemic:
Coag disorders, hypothyroid, DM
Anticoag Tx
73
What is menorrhagia
Over 80ml menstrual loss
AND/OR
Over 7 days of bleeding
74
Common benign functional ovarian cysts
Corpus luteal
Follicular cysts
75
Ovarian cyst rupture (mid cycle commonly)
Pres?
Ix? (rule out what)
Tx?
Acute abdo pain
PV bleeding
N&V
Urinary hCG to rule out ectopic
FBC, USS
Analgesia
surgery if circulatory collapse
76
Most common ovarian Ca
Epithelial serous adenocarcinoma
77
Tamoxifen receptor relationship
Antagonist in great but agonist in uterus
78
Cervical Cancer Prevention
Screening
Gardasil Vaccine in 12/13 y.o. girls
79
Treatment of moderate dysplasia in cervix at colposcopy
Cone biopsy
Laser therapy
Cryotherapy
80
% of couples who conceive in 1 yr? 2 yr?
80%, 90%
81
Causes of sub fertility (unable to conceive in 1 year)
Male factors 25%
Ovulatory, tubal, uterine disorders
Factors in both
82
PCOS DDx
Cushings
Hyperprolactinaemia
Hypothyroid
Acromegaly
83
Female infertility causes
- Ovarian
- Tubes & uterus
- Other
PCOS, Pituitary tumours, Sheehans, Hyperprolactinaemia
Premature failure of ovaries, Turners
PID, Ashermans, Fibroids Endometriosis
CAH, Cushings
84
When sexual characteristics present what can cause primary ammenhorea?
Usually GU malformation
- imperforate hymen
- vaginal septum
85
Cause of CAH?
21-hydroxylase deficiency
Reduces efficiency of cortisol synthesis.
Hyperplasia of adrenal cortex, inc ACTH release and inc inc adrenal androgen/testosterone prod (from progesterone and DHEA inc)
86
Pres of CAH
severe may give salt wasting (adrenal cortex)
Genital ambiguity
87
Physiological amenorrhoea
Preg
LActation
Menopause
88
Gonadotropin in menopause
Gonadotrpin levels (FSH, LH elevate
89
What is beta-HCG
this is a subunit of HCG.
90
Drugs causing female infertility
Spironolactone
Chemo/cytotoxics
Recreational drugs
91
Causes of spermatic failure
Chemo of testis
Maldescent
Klinefeltners (47XXY)
Varicocele
92
What is used to induce ovulation
Clomifene
Methotrexate
(Risk of ovarian overstimulation syndrome)
93
First line to stimulate ovulation
Clomifene
94
What is significance of mid-luteal Progesterone and on what day
Day 28
Shows ovulation as progesterone produced by Corpus Luteum
95
Cardiac abnormality assoc with TUrners
Aortic stenosis ± coarctation of aorta
96
CAH investigation
17-a-hydroxyprogesterone
97
Ovarian cancer staging
1) confined to ovaries
2) both ovaries / pelvic extension
3) Peritoneal ± retroperitoneal LNs
4) Distant mets
98
What is female sexual dysfunction
Disorder of:
- Sexual desire
- Arousal
- Orgasm
Sexual pain (dysparenuria, vaginismus)
99
Effect of sexual dysfucntion
significant personal distress and reduced QoL
100
Causes of female sexual dysfunction
Psych
- trauma/abuse
- body image
- depression/anxiety
Social
- relationship concerns
- stress
- pressure to perform
Organic
- DM
- vascular (atherosclerosis)
- hormone imbalance
- neurological (e.g. cauda equina, MS, paralysis)
Drugs:
- SSRIs
- Beta-blockers
101
Superficial dysperenuria causes
Thrush
Herpes
Vaginismus (pelvic floor spasm)
102
Deep dysparenuria causes
PID
Endometriosis
Lubrication
103
Psychological therapy for sexual dysfunction
Sensate focus (increasing touching)
Personal sexual growth programme
CBT
Psychodynamic therapy (talk through unconscious thought processes, unresolved conflicts, past dysfunctional relationships)
104
Physical additions to Psychological therapy
Sex toys
Lubricant
Kegel exercises
Treat any medical causes
Oestrogen replacement (if menopausal)
105
Causes of erectile dysfunction?
Organic
- neuro disease
- CVD
- androgen deficiency
- prolactinaemia
- veno-oclusive
Psychological
- depression
- performance anxiety
- relationship problems
drugs:
- Intoxication/substance abuse
- SSRIs
- Alcohol
106
Define rapid ejaculation
inability to control ejaculation to allow both partners to enjoy sex
107
Rapid ejaculation causes
Penile hypersensitivity
Anxiety
Early learned experience
Lack of sexual experience
108
Rapid ejaculation tx
Local anaesthetic spray
Couples therapy
Kegels
109
Low libido causes
```
Chronic disease
CVD
Anaemia
DM
Obesity
Androgen deficient
Hyperprolatinaemia
```
Psychological (previous abuse, relationship problems, body image)
110
4 Types of couples therapy
CBT (focus on dysfunctional beliefs and behaviours)
Psychodynamic (link between current and past issues explored)
Systemic therapy
Integrative therapy (understanding and intervention from more than 1 approach)
111
What is syndrome related to Chlamydia?
Reiters syndrome:
- Urethritis
- Uveitis
- Reactive arthritis
112
Trichomonas:
- Type of organism
- Features on Ix
Protazoa
Green/Grey discharge
Wet film shows polymorphonuclear leukocytes (Neutrophils)
113
Investigating STI
```
1st void
Urine CT/GC (Chlam/Gonorr)
NAAT - nucleic acid amp (Chlam)
HIV serolog
Urethral swab
Endocervical/high vaginal swabs
```
114
Additional Investigation for MSM
Pharyngeal/Rectal swab for NAAT
| Hep B serology
115
What is NAAT?
Nucleic acid amplification test for viral/bacterial DNA e.g. Chlamydia
116
Thrush/Candida Tx
Oral Fluconazole
Topical Clotrimazole
117
Herpes simplex symptoms
Painful blisters on external genitalia
Viral illness
Recurrence after latent period
(Oral acyclovir and abstain from sex until cleared)
118
Syphilis Primary, Secondary and Tertiary disease
Primary:
- Painless chancre lesion
Secondary:
- Palmar/sole rash (maculopapular)
- Flu-like symptoms
Tertiary:
- Neuro, CV, Gummatous symptoms
119
Can cold sore give genital herpes
Yes
Both HSV 1 and HSV 2 can cause genital lesions
120
Causes of delayed ejaculation
Psych (performance pressure, trust/relationship issues, lack of stimulation)
Medications (SSRI, antipsychotics),
Radiotherapy
Pelvic surgery/trauma, diabetic neuropathy, MS
Low testosterone, High prolactin
121
Delayed ejaculation Ix
Physical exma
Bloods + PSA/Prolactin/Testosterone
Urine sample
Swabs
122
Delayed ejaculation Tx
Couples therapy
Sensate focus
CBT
Kegels
123
Blood investigations of low libido in women
```
OEstrogen
LH, FSH
GnRH
Testosterone
TSH
Prolactin
HbA1c
FBC
```
124
Sexual dysfunction impact on partner
Low self esteem
Rejection
Pressure on relationship
Break up of relationship
Own sexual problems
125
Female reduced desire Tx:
Sensate focus
Sexual growth programme
Oestrogen (vaginal dryness)
Masturbation
Individual and couple psychodynamic therapy
Kegals
