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Gynaecology Flashcards

(63 cards)

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1
Q

PCOD causes + criteria for diagnosis

A

Rotterdam criteria: 1) irregular or absent periods 2) hyperandrogenism = acne, body hair, alopecia, raised testosterone 3) polycystic ovaries on USS Caused by genetics, insulin resistance, obesity

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2
Q

PCOS + insulin relationship

A

Disordered LH production, peripheral insulin resistance, raised insulin levels

Raised LH + insulin = increased androgen production

Raised insulin = reduced hepatic production of steroid hormone binding globulin (SHBG) = increased free androgens

Increased androgens = disrupt folliculogenesis = small ovarian follciles/ cysts + absent periods

Increased peripheral androgens = hirsutism

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3
Q

S+S PCOS

A

Asymptomatic Acne, hirsutism, alopecia

Obesity Irregular/ absent periods

Infertility

Recurrent miscarriage

Acanthosis nigricans

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4
Q

Long term health consequences of PCOS

A

IHD DM2 GDM Endometrial hyperplasia + carcinoma (due to unopposed oestrogen from 2’ amenorrhoea)

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5
Q

Investigations for PCOS

A

TVUSS

FSH raised in ovarian failure, low in hypothalamic disease + normal in PCOS

LH - raised in PCOS

Testosterone

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6
Q

Management of PCOS

A

Diet, exercise COCP + metformin Anti-androgens Clomifene or gonadotrophins for fertility

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7
Q

Menopause + perimenopause

A

Menopause = permanent cessation of menstruation after 12 months of amenorrhoea (this period is perimenopausal)

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8
Q

Climaceric phase

A

Phase from transition from reproductive state to non-reproductive

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9
Q

S+S menopause

A

Hot flushes, night sweats Sexual dysfunction Depression, anxiety, irritability, mood swings

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10
Q

Long term effects of menopause

A

Osteoporosis CV disease Urogenital atrophy

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11
Q

HRT - which to use + SE

A

Hysterectomy = oestrogen alone Uterus still intact = oestrogen + progesterone SE of oestrogen: fluid retention, bloating, breast tenderness, nausea, headaches, leg cramps, dyspepsia SE of progesterone: fluid retention, breast tenderness, headache, mood swings, depression, acne, backache Combined: irregular bleeding, weight gain

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12
Q

Benefits of HRT

A

Reduced vasomotor + urogenital symptoms Reduced risk of osteoporosis + colorectal cancer

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13
Q

Risks of HRT

A

Risk of breast cancer (greatest with combined) Risk of endometrial cancer with unopposed oestrogen Risk of VTE + gallbladder disease

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14
Q

PMS - what is it, treatment

A

Symptoms during luteal phase of cycle Regression with onset of period Psychological, physical + behavioural Use COCP, oestrogen, GnRH analogues, SSRIs + CBT

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15
Q

Endometriosis pathology + investigations

A

Presence of endometrial tissue outside uterine cavity

Oestrogen dependant

Adenomyosis = ectopic endometrial tissue within myometrium

Investigations: laporoscopy

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16
Q

Endometriosis S+S

A

Secondary dysmenorrhoea, deep dysparaeunia, pelvic pain, infertility

Cyclical pain, can get bleeding from other organs (haematuria)

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17
Q

Endometriosis complications

A

Fibrosis, scarring, infertility, endometroma (chocolate cysts)

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18
Q

Endometriosis O/E findings

A

Adnexal masses Nodules in posterior vaginal fornix Thickening behind uterus Fixed retroverted uterus Rectovaginal nodules Investigate with laparoscopy

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19
Q

Management of endometriosis

A

Expectant 1st line

COCP, GnRH analogues, POP 2nd line

Surgery: ablation, resection, TAHBSO

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20
Q

Treatment of subfertility in endometriosis

A

Remove endometriomas surgically

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21
Q

PID causes

A

Infection which has spread from cervix to pelvis Usually STD, TOP or dilatation + curettage

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22
Q

RF for PID

A

Young, previous STD, new sexual partner, postpartum endometritis

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23
Q

S+S PID

A

Asymptomatic Lower abdo pain Discharge Deep dyspareunia Adnexal tenderness

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24
Q

PID complications

A

Fitz-Hugh-Curtis syndrome - perihepatitis (RUQ pain) Tubero-ovarian abscess Ectopic pregnancy Infertiltiy

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25
PID treatment
Ceftriaxone IM + oral doxycycline + metronidazole Partner to have doxycycline for 1 week
26
Fibroids - what are they?
Benign tumours from the myometrium of the uterus Usually made of smooth muscle
27
Types of fibroids
Submucus: \>50% projection into endometrial cavity Intramural = within myometrium Subserous: \>50% of fibroid mass extends outside the uterus
28
Endometrial polyps - what are they, treatment
Adenoma Focal overgrowth of the endometrium - treatment is resection
29
S+S fibroids
Asymptomatic Dysmenorrhoea Menorrhagia Pressure symptoms (frequency) Pelvic pain Infertility Pain in pregnancy - from growth
30
Management of fibroids
GnRH (ulipristal acetate) shrink fibroids pre surgery Myomectomy Hysterectomy Uterine artery embolisation
31
Types of ovarian cyst
Enlarged follicular or corpus luteum cysts (functional cysts) Benign cystic teratomas = arise from germ cells Endometriomas = chocolate cysts
32
RF for ovarian cysts
Obesity Infertility Hypothyroidism Early menarche Tamoxifen therapy
33
S+S ovarian cysts
Chronic dull ache Pressure on organs - bowel disturbance or frequency Dyspareunia Bleeding, torsion, rupture Mass in abdo
34
Investigations for ovarian cysts
USS + CA125 = RMI
35
Management of cysts
Analgesia Laparotomy if acute abdo, ?torsion, rupture, haemorrhage
36
Overflow incontinence - what is it, investigations
Bladder is large + flaccid, little detrusor tone Usually due to injury Diagnosed when urinary residual is more than 50% of bladder capacity Bladder leaks when full
37
Continuous urinary incontinence - causes
Continuous leakage due to fistula or congenital abnormality
38
Management of stress incontinence
Weight reduction, stop smoking, reduce caffeine Pelvic floor for 3 months Duloxetine - enhances urethral sphincter activity. SE: nausea Periurethral injections Transvaginal tape
39
Management of urge incontinence
Anticholinergic drugs (oxybutynin) SE: dry mouth, constipation, dry eyes, urinary retention Imipramine (TCAs) Surgery Botulinum toxin A - injected into detrusor
40
Types of prolapse
Urethrocele (anterior, involves urethra) Cystocele (anterior, involves bladder) Apical (uterus, cervix + vagina) Enterocele (posterior, pouch of douglas) Rectocele (posterior, anterior wall of rectum)
41
Grading of prolapse
0 = no descent of pelvic organs 1 = surface of prolapse does not descend below 1cm above the hymenal ring 2 = extends from 1cm above to 1cm below the hymenal ring 3 = extends more than 1cm below the hymenal ring 4 = vaginal completely everted
42
Management of prolapse
Physio = pelvic floor Pessary Surgical repair
43
What are teratomas?
Dermoid cysts Benign neoplasms derived from germ cell layers Include skin, hair, blood, fat, teeth etc Have Rokitansky's protuberance
44
Most common causes of recurrent miscarriage
Antiphospholipid syndrome (15% of women with recurrent miscarriages) Endocrine disorders eg diabetes, thyroid disorders, PCOS Uterine abnormality Chromosomal abnormalities Smoking
45
What is tolterodine?
Muscarinic antagonist Used for urge incontinence
46
First line pain relief for periods
NSAIDs d
47
Causes of primary amenorrhoea
Turners Testicular feminisation Congenital adrenal hyperplasia Congenital malformations of repro system
48
Causes of secondary amenorrhoea
PCOS Hypothalamic amenorrhoea (stress, excess exercise) Hyperprolactinaemia Premature ovarian failure Thyroid issues Sheehans (excessive blood loss causing ischaemic nerosis) Asherman's (intrauterine adhesions)
49
Symptoms of Sheehan's
Agalactorrhoea Amenorrhoea S+S of hypothyroidism + hypoadrenalism
50
Lichen planus vs sclerosus
Sclerosus - intense itching, white plaques, postmenopausal commonly Increased risk of squamous cell carcinoma Lichen planus = itchy red-brown rash Both treated with topical steroids
51
Managment of cervical ectropion
Cryotherapy with AgNO3
52
What are condyloma lata?
Wart like lesions on genitals, sign of secondary syphilis
53
How to do a smear?
Rotate clockwise 5 times
54
What is the average age of menopause, and what blood test is used if needed?
52 - FSH \>30 indicates menopause
55
What is the rASRM score?
Grading for endometriosis - takes into account location, size, depth, adhesions
56
When is clomifene given to improve fertility + how does it work?
Days 2-6 - increases FSH levels via negative feedback
57
What is normal semen volume, concentration + motility?
\>2ml \>50% \>15 million sperm
58
What is urodynamics?
measuring pressure/ volume relationship during filling + voiding + straining. Combined with ambulatory urodynamic monitoring
59
Management for HMB
Mefenamic acid, TXA or IUS 1st line Endometrial ablation 2nd line
60
What investigations to do in HMB?
FBC USS Hysteroscopy if irregular or thickened Endometrial biopsy using Pipelle
61
When should a intrauterine pregnancy show on USS?
bhCG \>1500 TVUSS before 7 weeks
62
Adenomyosis S+S
Picked up on scan as incidental finding
63
S+S ovarian cysts
Unilateral pain, intermittent When ruptured: sudden, lower abdo pain, afebrile, bleeding, increased urinary frequency

OBGYN (18 decks)

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