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Gynaecology Flashcards

1
Q

RFs of endometrial cancer?

A

excess endogenous oestrogen:

  • nulliparity
  • obesity
  • PCOS
  • early menarche/ late menopause
  • oestrogen-secreting tumour
  • tamoxifen
  • Lynch II syndrome
  • diabetes mellitus
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2
Q

protective factors for endometrial cancer?

A

smoking
COCP
grand-parity
breast feeding

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3
Q

RFs of cervical cancer?

A 
smoking
HPV 16,18,31,33
immunocompromised
increased number of sexual partners
COCP
no vaccinated/screened
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4
Q

protective factors for cervical cancer?

A

vaccination
screening
barrier contraception

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5
Q

RFs for ovarian cancer?

A

continuous ovulations:

  • nulliparity
  • early menarche/ late menopause
  • BRCA 1 and 2
  • lynch II syndrome
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6
Q

protective factors for ovarian cancer?

A

interrupting ovulation:

  • pregnancy
  • breast feeding/ lactation
  • COCP
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7
Q

what to think if post-menopausal bleeding?

A

endometrial cancer

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8
Q

causes of endometrial cancer?

A

most are adenocarcinomas, related to unopposed oestrogen

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9
Q

features of endometrial cancer?

A

PMB
pre-menopausal women who have heavy or irregular periods
PV discharge and pyometra

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10
Q

diagnosis of endometrial cancer?

A

TV USS shows endometrial thickness >4mm
hysteroscopy with biopsy
CT/MRI

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11
Q

staging of endometrial cancer?

A 
FIGO staging
I- uterus only
II- uterus and cervix
III- beyond uterus but within pelvis
IV- extending outside the pelvis e.g. bowel and bladder
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12
Q

tx of endometrial cancer?

A

hysterectomy +/- pelvic lymph nodes with bilateral salpingo-oophrectomy
radiotherapy
progesterone therapy if not fit for surgery

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13
Q

what to suspect of post-coital bleeding?

A

cervical cancer

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14
Q

where is cervical cancer most common?

A

squamo-columnar junction (transformation zone) is predisposed to malignant change

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15
Q

types of cervical cancer?

A

SCC (most common)

adenocarcinoma

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16
Q

peaks of incidence of cervical cancer?

A

2 peaks-
30-39 years
>70 years

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17
Q

screening of cervical cancer?

A

smear test
25-49 -> 3-yearly screening
50-64 -> 5-yearly screening
sexually active women

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18
Q

what are the different types of CIN (cervical intra-epithelial neoplasia)?

A

CIN 1- bottom 1/3 of squamous epithelium
CIN 2- bottom 2/3 of squamous epithelium
CIN 3- full thickness dysplasia

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19
Q

what are the different results of a smear test?

A

normal - repeat in 3 years
inflammatory- repeat in 6 months, colposcopy after 3 abnormal results
borderline (20-30% CIN II-III)- HPV +ve refer for colposcopy, HPV -ve repeat in 3 years
moderate (50-75% CIN II-III)- refer for urgent colposcopy
severe (80-90% CIN II-III)- refer for urgent colposcopy
inadequate 3x smear tests- colposcopy

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20
Q

features of cervical cancer?

A

abnormality in bleeding- PCB, IMB, PMB
watery vaginal discharge
incidental finding
later changes- weight loss, heavy vaginal bleeding, ureteric obstruction, bowel disturbance, vesico-vaginal fistula, pain

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21
Q

Ix of cervical cancer

A

colposcopy and biopsy
bloods
CT abdo and pelvis
MRI pelvis

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22
Q

mx of cervical cancer?

A

LLETZ- large loop excision of the transformation zone if CIN II-III
hysterectomy
lymphadenectomy
chemo-radiotherapy

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23
Q

types of ovarian cancer?

A

surface derived tumours (epithelial)
germ cell tumours
sex cord- stromal tumours
mets

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24
Q

when does genetic testing need to be done with ovarian cancer?

A

two 1st degree relatives with OC

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25
Q

features of ovarian cancer?

A 
subtle and non-specific
bloating and distension, pain, ascites, abdo mass
bowel obstruction
dyspareunia
early satiety
diarrhoea/constipation
B symptoms
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26
Q

when to refer for ovarian cancer?

A

Risk of Malignancy Index= CA125 x USS score x post-menopausal status
>250= 2 week-wait
post-menopausal status-> 1 if pre-, 3 if post-
CA125 -> number
USS score-> 1 if 0-1 features, 3 if 2+ features

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27
Q

features on USS score for ovarian cancer?

A 
bilateral disease
solid
septations on the tumour
fluid (ascites)
abdo pathology
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28
Q

ix of ovarian cancer?

A 
FBC, U&E, LFTs
CA125
If <40 -> AFP, LDH, hCG (could be germ cell tumour)
TVS
CXR
CT abdo/pelvis
MRI
sample ascites
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29
Q

FIGO staging for ovarian cancer?

A

1= confined to ovary
2= outside ovary but in pelvis
3= outside pelvis but in abdomen
4- distant mets

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30
Q

tx for ovarian cancer?

A

surgery- full staging laparotomy

chemotherapy

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31
Q

what is vulval cancer?

A

most are squamous cell carcinomas and occur in women >65 years

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32
Q

RFs for vulval cancer?

A 
HPV
vulval intraepithelial neoplasia
HIV
lichen sclerosis
smoking
Paget's disease of the vulva
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33
Q

features of vulval cancer?

A

lump on ulcer on labia majora

itching, irritation, bleeding, discharge

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34
Q

tx of vulval cancer?

A

wide local excision

groin lymphadenopathy if tumour <1mm deep

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35
Q

what is hydatidiform mole?

A

a tumour producing lots of hCG giving rise to exaggerated pregnancy symptoms and strongly positive pregnancy tests

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36
Q

USS feature of hydatidiform mole?

A

snow-storm appearance

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37
Q

features of hydatidiform mole?

A

early pregnancy failure- failed miscarriage (painless vaginal bleeding) or signs on USS
severe morning sickness or 1st trimester pre-eclampsia are rarer presentation
can cause hyperthyroidism so present with symptoms similar to thyrotoxicosis

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38
Q

tx of hydatidiform mole?

A

molar tissue is removed from uterus by suction
give anti-D if Rh -ve
pregnancy should be avoided until hCG is normal for 6 months
can metastasise to lung, vagina, brain, skin or liver

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39
Q

acute causes of pelvic pain in women?

A 
ectopic pregnancy
UTI
appendicitis
PID
ovarian torsion
miscarriage
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40
Q

chronic causes of pelvic pain?

A

endometriosis
IBS
ovarian cyst
urogenital prolapse

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41
Q

what is an ectopic pregnancy?

A

implantation of a fertilised ovum outside of the uterus

most are in the ampulla of the Fallopian tube

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42
Q

when to consider ectopic pregnancy?

A

positive pregnancy test with empty uterus

high b-hCG

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43
Q

RFs for ectopic pregnancy?

A

slowing ovum’s passage to the uterus

  • damage to the tubes (salpingitis, PID, tubal surgery)
  • prev ectopic
  • IVF
  • IUCD in situ
  • Failed sterilisation
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44
Q

features of ectopic pregnancy?

A
  • 6-8 weeks amenorrhoea
  • lower abdo pain usually constant and unilateral
  • vaginal bleeding: may be dark brown in colour
  • peritoneal bleeding can cause shoulder tip pain and pain on defecation/urination
  • cervical excitation
  • adnexal mass
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45
Q

Ix of ectopic pregnancy?

A 
positive pregnancy test
TVUS- empty uterus, free fluid in adnexae/pouch of Douglas
slow falling bHCG
serum progesterone
bloods- cross match
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46
Q

mx of ectopic pregnancy?

A

Rh -ve women should receive anti-D immunoglobulin

  1. Expectant- small and ruptured, hBG <200, clinically stable
  2. Medical- size <35mm, unruptured, no pain, no foetal HR, serum hCG <1500
    - methotrexate- IM by USS or laparoscopic visualisation
  3. Surgical- size >35mm, severe pain, potentially ruptured, hCG >1500
    - salpingectomy- remove affected tube
    - salpingotomy- remove the pregnancy and reconstruct the tube
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47
Q

how many weeks gestation is a miscarriage classed as?

A

less than 24 weeks gestation

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48
Q

how to diagnose a complete miscarriage?

A

TV USS demonstrating a crown-rump length greater than 7mm with no cardiac activity

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49
Q

types of miscarriage?

A 
threatened
missed
inevitable
inomplete
complete
miscarriage with infection
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50
Q

what is a ‘blighted ovum’ showing?

A

missed miscarriage

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51
Q

causes of miscarriage?

A
  • genetic abnormalities
  • endocrine factors- poorly controlled DM, thyroid, PCOS
  • maternal illness and infection
  • maternal drugs- NSAIDs and antidepressants
  • smoking, alcohol, drugs
  • abnormalities of the ueris e.g. bicornuate uterus
  • cervical incompetence
  • antiphospholipid syndrome
  • thrombophilia- anti-thrombin III, protein C, protein S
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52
Q

how is antiphospholipid syndrome diagnosed?

A

vascular thrombosis and 3+ consecutive miscarriages <10 weeks or 1 foetal death >10 weeks

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53
Q

mx of antiphospholipid syndrome?

A

aspirin and heparin

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54
Q

Ix of suspected recurrent miscarriage?

A 
parental blood for karyotyping
cytogenic analysis of products of conception
pelvic USS
thrombophilia screening
LA or aCL antibodies
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55
Q

what does a thrombophilia screen include?

A

FBC and clotting screen - Activated Protein C resistance
protein C - Factor V Leiden (if APCR positive)
protein S - prothrombin gene mutation
antithrombin
lupus anticoagulant - anticardiolipin antibodies

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56
Q

mx of miscarriage?

A

Rh -ve women to receive anti-D Ig for >12 weeks pregnancy
1. conservative- used for incomplete miscarriages where uterus is small

  1. medical- <12 weeks- misoprostol (prostaglandin analogue)
    >12 weeks- mifepristone (antiprogesterone) followed by misoprostol
  2. surgical- ERPC- evacuation of retained POC
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57
Q

what are fibroids?

A

benign smooth muscle tumours of the uterus

oestrogen dependent- enlarge in pregnancy and COCP and atrophy after menopause

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58
Q

RFs for fibroids?

A

menopause
afro-caribean ethnicity
FH
nulliparous

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59
Q

features of fibroids?

A 
asymptomatic
menorrhagia
fertility problems
lower abdo pain- may be due to torsion or red degeneration
mass
frequency of urine
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60
Q

what is red degeneration?

A

when thrombosis of capsular vessels is followed by venous engorgement and inflammation, causing abdo pain and localised peritoneal tenderness- usually in the last half of pregnancy

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61
Q

mx of red degeneration

A

bed rest and analgesia

resolves within 4-7 days

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62
Q

diagnosis of fibroids?

A 
pelvic exam- bulky, non-tenderous uterus
USS- TVS or abdo US
hysteroscopy
laparoscopy
biopsy
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63
Q

complications of fibroids?

A 
enlargement
torsion
degeneration
leiomyosarcoma
transformation (malignant)
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64
Q

mx of fibroids?

A

medical tx for fibroids <3cm
1st line= IUS, tranexamic acid or COCP for meorrhagia
- GnRH analogues e.g. goserelin
-Ullipristal acetate- Esmya (can be taken for 3-6 months to shrink fibroids prior to surgery)
-Surgery- myomectomy, hysterectomy, emdometrial ablation
-Uterine artery embolisation- recommended for women with large fibroids (not of child-bearing age)

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65
Q

how does a GnRH analogue work?

A

injection that stops the pituitary gland producing oestrogen
can only be used for 6 months due to demineralisation of bone risk
can induce menopause-like side effects

66
Q

causes of menorrhagia?

A
  • dysfunctional uterine bleeding
  • fibroids
  • endometriosis and adenomyosis
  • PID
  • IUCD
  • hypothyroidism
  • bleeding disorders
  • in women >45 years with failed medical management- consider endometrial carcinoma
67
Q

Ix of menorrhagia?

A 
exclude pregnancy
bloods- FBC, haematinics, TSH
cervical smear if due
STI screen
speculum examination
if high risk- TVUS
68
Q

mx of menorrhagia if requires contraception?

A
  1. mirena IUS
  2. COCP
  3. Depo-provera
69
Q

mx of menorrhagia if doesn’t require contraception?

A
  1. tranexamic acid (anti-fibrinolytics)
  2. NSAIDs e.g. mefenamic acid taken during days of bleeding. CI= peptic ulceration

short-term management- norethisterone (IM progestogens)

70
Q

surgical mx of menorrhagia?

A

endometrial ablation

hysterectomy

71
Q

mx of primary dysmenorrhoea (pain w/o organic pathology)?

A

NSAIDs inhibit prostaglandins e.g. mefenamic acid during menstruation
Paracetamol
Hycoscine butylbromide is a smooth muscle anti-spasmodic
COCP for ovulatory pain

72
Q

what is endometriosis?

A

the presence of endometrial tissue outside the uterine cavity
hormonally drive by oestrogen so affects women of child-bearing age

73
Q

what is adenomyosis?

A

the presence of endometrial tissue within the myometrium
happens in older women who have had children
causes a BULKY UTERUS

74
Q

3 theories of endometriosis?

A

1) retrograde menstruation
2) metaplasia of mesothelial cells
3) impaired immunity

75
Q

features of endometriosis?

A
  • classic triad- dysmenorrhoea, cyclical pelvic pain, deep dyspareunia (from involvement of uterosacral ligaments)
  • subfertility
  • LUTS
  • ruptured endometriomas- cause sudden intesnse pain
76
Q

examination of endometriosis?

A

may be normal if there is minimal disease
fixed retroverted uterus on bimanual examination
adnexal masses or tenderness

77
Q

common sites for endometriosis?

A 
uterosacral ligaments
ovaries (chocolate cyst)
rectum
vagina
bladder
lungs
78
Q

ix of endometriosis?

A

gold standard= laparoscopy with biopsy
TVS is useful for diagnosing ovarian endonmetriotic cysts
MRI if bowel involvement

79
Q

tx of endometriosis?

A
  1. NSAIDs/paracetamol for pain
  2. Suppression of menstruation- COCP, mirena IUS, implant, depot, progestogens
  3. GnRH analogues e.g. goserelin can be used <6 months to suppress oestrogen
  4. Surgery- laparoscopic excision and laser treatment of endometriotic ovarian cysts may improve fertility
80
Q

complications of endometriosis?

A

infertility
adhesions
tubal/ovarian dysfunction

81
Q

what is lichen sclerosus?

A

an inflammatory condition which affects the genitalia and more common in elderly females
leads to atrophy of the epidermis with white plaques forming

82
Q

main symptom of lichen sclerosus?

A

itch

83
Q

diagnosis of lichen sclerosus?

A

skin biopsy done if clinical diagnosis can not be made

84
Q

mx of lichen sclerosus?

A

topical steroids and emolliants

85
Q

complication of lichen sclerosus?

A

increased risk of vulval cancer

86
Q

pathophysiology of PCOS?

A
  • disordered LH production
  • peripheral insulin resistance
  • causes increase ovarian androgen production
  • excess small ovarian follicles and irregular/absent ovulation
  • raised peripheral androgens -> hirsutism
87
Q

rotterdan criteria for PCOS?

A

2/3 of:

  1. multiple small follicles in an enlarged ovary- on TVUS
  2. irregular periods
  3. hirsutism
    - clinical- acne/excess body hair
    - biochemical- raised serum testosterone
88
Q

other features of PCOS?

A

Subfertility and infertility
menstrual disturbances- oligomenorrhoea and amenorrhoea
hirsutism, acne
obesity
acanthesis nigricans (due to insulin resistance)

89
Q

ix of PCOS?

A

TVUS
Bloods- FSH, prolactin, TSH, total and free testosterone, sex hormone binding globulin, LH
Impaired glucose tolerance

90
Q

mx of PCOS?

A

General- weight reduction, COCP to regulate periods
Hirsutism- COCP, topical eflornithine, cyproterone
Infertility- weight loss, metformin (improves insulin sensitivity), clomifene citrate, ovarian drilling

91
Q

how does comifene citrate work?

A

induces ovulation, it should only be used for women with BMI <35 and for no more than 6 cycles due to risk of ovarian cancer

92
Q

long term consequences of PCOS?

A

Gestational diabetes
T2DM
CV disease
endometrial cancer

93
Q

what’s the HPO cycle for the menstrual cycle?

A

hypothalamic-pituitary-ovarian axis

hypothalamus-> (GnRH)-> anterior pituitary-> (FSH/LH) -> ovary-> oestrogen and progesterone (oestrogen positive feedback and progesterone is negative feedback)

94
Q

what causes release of an egg?

A

LH

95
Q

what does FSH do?

A

causes the maturation of an egg in the ovary

follicle produces oestrogen

96
Q

what does oestrogen and progesterone do?

A

oestrogen causes proliferation of the endometrium and causes a surge in LH for ovulation at 14 days

progesterone maintains it, formed by the corpus luteum

97
Q

when is primary amenorrhoea classified?

A

failure to start menstruating in a 16 year old, or a 14 year old without breast development

98
Q

causes of primary amenorrhoea?

A

constitutional delay
congenital malformation of the genital tract
hypothalamic failure-> anorexia, kallman’s syndrome (GnRH deficiency)
gonadal failure-> turner’s syndrome

99
Q

features of turner’s syndrome?

A 
45XO
(should be considered in any girls with short stature or primary amenorrhoea)
neck webbing
obesity
CV problems
poor breast developement
congenital heart defects
renal malformations
hearing loss
100
Q

what is congenital adrenal hyperplasia?

A

females born with ambiguous genitalia from exposure to excess androgens in foetal life
babies -> salt losers and very unwell
teenagers-> severe hirsutism and acne

101
Q

causes of secondary amenorrhoea?

A

normal menstruation ceases of >6 months

  1. HPO-> stress, exercise, weight loss
  2. Pituitary-> hyperprolactinaemia, sheehan’s syndrome
  3. Adrenal-> hyper/hypothyroidism
  4. Ovary-> PCOS, premature ovarian failure
  5. Acquired-> asherman’s syndrome
102
Q

causes of ovarian failure?

A

secondary to chemo, radiotherapy, surgery
menopause symptoms, infertile
FSH/LH raised, O+P low
rx= HRT, IVF

103
Q

what is sheehan’s syndrome?

A

post partum hypopituitarism
PPH results in ischaemic necrosis of pituitary gland
decreased FSH/LH -> anovulation
Rx= hormone replacement, corticosteroids, levothyroxine

104
Q

what is asherman’s syndrome?

A

intrauterine adhesions

most commonly after dilatation and curettage after miscarriage

105
Q

Ix of secondary amenorrhoea?

A 
exclude pregnancy
gonadotrophins- low levels show hypothalamic cause
prolactin
androgen levels (PCOS)
Oestradiol
TFTs
106
Q

mx of secondary amenorrohea?

A

treat cause

can do progesterone cause to see if endometrium sheds

107
Q

what causes PID?

A

Ascending infection from the endocervix

  • chlamydia
  • gonorrhoea
  • mycoplasma genitalium
  • mycoplasma hominis
108
Q

features of PID?

A 
Lower abdo pain
fever
deep dyspareunia
dysuria and menstrual irregularities
vaginal or cervical discharge
cervical excitation
perihepatitis (Fitz-hugh curtis syndrome)
109
Q

ix of PID?

A

Screen for chlamydia and gonorrhoea

110
Q

mx of PID?

A

Oral ofloxacin and oral metronidazole OR

IM ceftriaxone and oral doxycycline and oral metronidazole

111
Q

features of menopause?

A

change in periods
vasomotor symptoms- hot flushes, night sweats
urogenital changes- vaginal dryness and atrophy, urinary frequency
psychological- anxiety and depression, short-term memory loss
long-term complications- OP, increased risk of IHD

112
Q

mx of menopause?

A
  1. lifestyle modifications- good sleep hygiene, regular exercise, weight loss, reduce stress
  2. HRT- unopposed oestrogens or O+P
  3. Non-hormone replacement therapy- fluoxetine, citalopram, vaginal lubricant, vaginal oestrogen, CBT etc
113
Q

CI to HRT?

A

Current or past breast cancer
any oestrogen-sensitive cancer
undiagnosed vaginal bleeding
untreated endometrial hyperplasia

114
Q

what is ovarian torsion?

A

occurs unilaterally in combination with a pathologically enlarged ovary

115
Q

RFs for ovarian torsion?

A

pregnancy
malformations
tumours
previous surgery

116
Q

features of ovarian torsion?

A

severe lower abdo pain
N&V
fever

117
Q

management of ovarian torsion?

A 
rule out ectopic- hCG
urine dip
FBC
USS- may show free fluid
laparoscopy-diagnostic and therapeutic
analgesia
118
Q

name a benign germ cell tumour?

A

dermoid cyst (mature cystic teratoma)

119
Q

name a physiological cyst?

A

follicular cyst- due to non-rupture of a dominant follicle or failure of atresia in a non-dominant follicle
commonly regress after several menstrual cycles

120
Q

causes of male infertility?

A 
30% of causes of infertility
surgery
STI
varicocele
systemic illness
abnormal genitalia examination
121
Q

female causes of infertility?

A

unexplained
ovulation failure
tubal damage
other causes

122
Q

basic investigations for infertility (male and female)

A

semen analysis
serum progesterone 7 days prior to expected next period- usually day 21 (>30 indicates ovulation)
chlamydia screening
day 2-5 FSH and LH
TSH, prolactin, testosterone, rubella status

123
Q

secondary care investigations for infertility?

A

TVUS
HSG- hysterosalpingogram
HyCoSy
laparoscopy and dye test is gold standard

124
Q

mx of infertility?

A
  1. lifestyle modification- weight loss, folic acid, regular sexual intercourse, smoking/drinking advice
  2. ovulation induction- clomifene citrate (6-8 cycles), laparoscopic ovarian drilling (used in patients with PCOS), gonadotrophins, metformin (PCOS)
  3. SURGERY- tubal catheterisation, treat endometriosis, adhesolysis
  4. IVF-screen for HIV, Hep B and C
125
Q

what is the NHS assisted contraception criteria?

A 
no children
non-smokers
BMI <30
under 42 years of age
don't require gamete donation
126
Q

contraindications to COCP?

A 
>35 and smoke >15 a day
migraine with aura
history of VTE, stoke, IHD
breast feeding <6 weeks post-partum
uncontrolled hypertension
breast cancer
major surgery
127
Q

name some types of emergency contraception?

A

levonorgestrel (stops ovulation and inhibits implantation- must be taken within 72 hours)
Ulipristal (inhibits ovulation- no later than 120 hours after unprotected sex)
IUCD- must be inserted within 5 days

128
Q

what is the fraser guidelines?

A

used to assess if patient who has not reached 16 years of age is competent to consent to treatment
criteria:
-the person understands the advice
-can’t be persuaded to tell their parents
-likely to begin or continue having sex
-without it, their physical or mental health is likely to suffer
-their best interests require them to receive contraceptive advice or treatment with or without parental consent

129
Q

what nerves are involved in controlling continence?

A

parasympathetic (cholinergic)- S3-5 -> drive detrusor activity in voiding
sympathetic (noradrenergic)-> urethral contraction, inhibition of detrusor contraction

130
Q

RFs for incontinence?

A 
advancing age
prev pregnancy and childbirth
high BMI
hysterectomy
FH
131
Q

types of urinary incontinence?

A

overactive bladder (urge incontinence)- detrusor overactivity
stress incontinence- leaking when laughing/coughing etc
mixed incontinence
overflow incontinence- due to bladder outlet obstruction e.g. BPH

132
Q

Ix of urinary incontinence?

A

bladder diaries should be completed for a minimum of 3 days
vaginal exam to exclude pelvic organ prolapse and ability to initiate voluntary contraction of pelvic floor muscles e.g. kegal exercises
urine dipstick and culture- rule out UTI and DM
Urodynamic studies

133
Q

mx of stress incontinence?

A

pelvic floor muscle training

surgery- retropubic mid-urethral tape procedures

134
Q

mx of urge incontinence?

A

bladder retraining
antimuscarinics- oxybutynin, tolterodine
mirabegron

135
Q

name some types of prolapse?

A

cystocele- anterior wall of vagina and bladder
rectocele- lower posterior wall with the rectum
enterocele- vaginal wall with loops of intestine from Pouch of Douglas
uterine prolapse- protrusion of uterus downwards into the vagina

136
Q

grading of prolapse?

A

1st grade- down to introitus
2nd grade- down to introitus, and through the introitus on training
3rd grade- outside vagina
4th grade- the uterus lies outside the vagina

137
Q

mx for prolapse?

A

weight loss, pelvic floor muscle exercises
ring pessary
surgery- colporrhaphy, colposuspension, hysterectomy, sacrocolpoplexy

138
Q

what is thrush?

A

vaginal candidiasis

139
Q

predisposing factors for thrush?

A

DM, abx, steroids, pregnancy, immunosuppression

140
Q

features of throush?

A

‘cottage cheese’, non-offensive discharge
itch
vulval erythema, fissuring, satellite lesions

141
Q

mx of thrush?

A

clotrimazole pessary

itraconazole or fluconazole orally

142
Q

what is trichomonas vaginalis?

A

flagellated protozoan parasite

143
Q

features of trichomonas vaginalis?

A

green,frothy, smelly discharge
vulvovaginitis
strawberry cervix
pH >4.5

144
Q

ix of trichomonas?

A

microscopy shows motile trophozoites (high vaginal swab)

145
Q

mx of trichomonas?

A

oral metronidazole

AVOID ALCOHOL

146
Q

what is bacterial vaginosis?

A

overgrowth of anaerobic organisms such as Gardnerella vaginalis

147
Q

features of bacterial vaginosis?

A

grey, white discharge withy fishy smell
positive whiff test
CLUE cells on microscopy

148
Q

mx of BV?

A

oral metronidazole for 5-7 days

149
Q

features of chlamydia trachomatis?

A

asymptomatic in 70% of women and 50% of men
women- cervicitis (discharge, bleeding), dysuria
men- urethral discharge, dysuria

150
Q

Ix of chlamydia and gonorrhoea?

A

NAAT- urine (first void urine sample), vulvovaginal swab or cervical swab
should be carried out 2 weeks after exposure

151
Q

mx of chlamydia?

A

doxycycline (7 days) or azithromycin (single dose)

contact tracing

152
Q

what is gonorrhoea?

A

gram negative diplococcus

Neisseria gonorrhoea

153
Q

features of gonorrhoea?

A

males- urethral discharge, dysuria

females- cervicitis e.g. leading to vaginal doscharge

154
Q

mx of gonorrhoea?

A

a single dose of IM ceftriaxone 1g

ciprofloxacin if CI’d

155
Q

what is cervical ectropion?

A

the columnar epithelium of the endocervix is displaced on the ectocervix and is visible on speculum

caused by increased oestrogen levels

can cause discharge or post-coital bleeding

156
Q

mx of cervical ectropion

A

silver nitrate or diathermy

157
Q

what is meig’s syndrome?

A

Occurs in older women. The ovarian tumour is a fibroma that generates the associated pleural effusion and ascites.

158
Q

triad of meig’s syndrome?

A

Pleural Effusion
Ascites
Benign ovarian tumour

159
Q

general advice to women trying to get pregnant?

A

The woman should be taking 400mcg folic acid daily
Aim for a health BMI
Avoid smoking and drinking excessive alcohol
Have intercourse 2-3 times a week.
“Timed intercourse” to coincide with ovulation is not necessary or recommended

160
Q

Ix of infertility?

A 
BMI
Semen analysis
Serum LH and FSH on day 2-5. High FSH suggests poor ovarian reserve, high LH suggests PCOS / ovarian failure.
Serum progesterone on Day 21 of the cycle. A rise indicates that ovulation has occurred and the corpus luteum has formed and started secreting progesterone.
Anti-Mullarian hormone
USS pelvis
Hysterosalpingogram
Laparoscopy and dye test
161
Q

what is Anti-Mullarian hormone?

A

Anti-Mullarian hormone can be measured at any time during the cycle and is the most accurate maker of ovarian reserve (the number of follicles that the woman has left in her ovaries). It is released by the granulosa cells in the follicles and falls as the eggs are used up. A high level indicates a good ovarian reserve.

finals (14 decks)

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