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Flashcards in Gynaecology Deck (64):
1

What is the most common type of epithelial cell tumour?

serous cystadenoma

2

what is endometrial hyperplasia?

an abnormal proliferation of the endometrium in excess of the normal proliferation that occurs during the menstrual cycle

3

What are the 4 types of endometrial hyperplasia?

simple
complex
simple atypical
complex atypical

4

what are the presenting features of endometrial hyperplasia?

abnormal vaginal bleeding e.g. intermenstrual

5

what is the management of endometrial hyperplasia?

simple without atypia: high progestogens with repeat sampling in 3-4months
atypical: hysterectomy

6

atypical endometrial hyperplasia in a post menopausal woman management ?

total hysterectomy with bilateral sapling-oophorectomy due to the risk of malignant progression

7

What is HRT?

hormone replacement therapy involving a small dose of oestrogen (combined with progesterone in women with a uterus) to help alleviate menopausal symptoms which are due to decreasing oestrogen levels

8

what are some S/E of HRT?

nausea
breast tenderness
fluid retention and weight gain

9

what are some potential complications of HRT?

increased risk of Br Ca, endometrial Ca, VTE, stroke and IHD.

10

when should a woman be prescribed cyclical combined HRT?

if their LMP was less than 1 year ago

11

When should a woman be prescribed continuous HRT?

if they have:
taken cyclical combined for at least 1 year, it has been 1 year since their LMP or it has been at least 2 years since their LMP if they had premature menopause (menopause below the age of 40.

12

what are some risk factors that may predispose you to vaginal candidiasis?

DM
drugs such as abc, steroids
pregnancy
immunosuppression: HIV, iatrogenic

13

what are the features of vaginal candidiasis?

cottage cheese, non offensive discharge
vulvitis: dyspareunia, dysuria
itch
vulval erythema, fissuring, satellite lesions

14

What is the management of vaginal candidiasis?

clotrimazole pessary (clotrimazole 500mg PV stat)
Itraconazole 200mg PO BD for 1 dy or fluconazole 150mg PO stat
if pregnancy NB oral options are contraindicated

15

Who gets endometrial cancer?

mainly postmenopausal women

16

does endometrial cancer have a good or bad prognosis?

good prognosis

17

what are some RF for endometrial cancer?

obesity
nulliparity
early menarche
late menopause
unopposed oestrogen (HRT)
DM
tamoxifen
polycystic ovarian disease
hereditary non-polyposis colorectal carcinoma

18

what are the features of endometrial cancer?

PMB
intermenstrual bleeding in premenopausal women
pain and discharge are unusual.

19

what is the 1st line investigation for suspected endometrial cancer?

trans-vaginal US looking at the endometrial thickness (normal thickness <4mm)

after this a hysteroscopy and biopsy can be done

20

what is the management of localised endometrial cancer?

total abdominal hysterectomy with bilateral sapling-oophorectomy
patients with high risk disease may have post op radiotherapy

21

How would you treat a frail elderly woman with endometrial cancer not suitable for surgery?

progesterone therapy

22

name 2 protective factors of endometrial cancer

COCP and smoking

23

does a screening programme for ovarian cancer exist in the UK?

no

24

what is endometriosis?

presence of ectopic endometrial tissue outside the uterine cavity

25

what are the clinical features of endometriosis?

chronic pelvic pain
dysmenorrhoea
deep dyspareunia
sub fertility
non gynaecological: urinary symptoms e.g. dysuria, urgency, haematuria
pyschezia (painful bowel movements)

26

what is the gold standard investigation for endometriosis?

laparoscopy

27

explain the management for endometriosis

NSAIDs and or paracetamol 1st line
COCP or progestogens e.g medroxyprogesterone acetate if analgesia not worked
IUS siren can also be used
If analgesia/hormonal treatment does not improve symptoms or if fertility is a priority the patient should be referred to secondary care. Secondary treatments include:
GnRH analogues - said to induce a 'pseudomenopause' due to the low oestrogen levels
drug therapy unfortunately does not seem to have a significant impact on fertility rates
surgery: some treatments such as laparoscopic excision and laser treatment of endometriotic ovarian cysts may improve fertility

28

what is the most likely location of an ectopic pregnancy?

ampulla of the fallopian tube

29

Fact for you: For patients with uterine fibroids, GnRH agonists may reduce the size of the fibroid but are typically useful for short-term treatment
It can be used to reduce the size of the fibroids before surgery

you get it right just by reading it :)

30

Whats the diagnosis?
A 29-year-old woman presents with suprapubic pain, irregular periods, dysuria and pain during intercourse. There is cervical excitation on examination.

Pelvic inflammatory disease

31

Whats the diagnosis?
A 24-year-old woman presents with mild, crampy suprapubic pain and light vaginal bleeding. Her last period was 10 weeks ago. Vaginal examination shows a small amount of blood around the cervix but is otherwise unremarkable.

Threatened miscarriage

32

Whats the diagnosis?
A 67-year-old woman presents with a heavy, dragging sensation in the suprapubic region. She also has frequency and urgency.

urogenital prolapse

33

Who should be offered human papilloma virus vaccination for the first time?

All 12- and 13-year-olds (girls AND boys) in school Year 8 will be offered the human papillomavirus (HPV) vaccine.

34

who gets atrophic vaginitis?

post menopausal women

35

what is the first line traetment of atrophic vaginitis?

vaginal lubricants and moisturisers
(if these do not work you can use topical oestrogen cream

36

What is the most appropriate investigation to diagnose premature ovarian failure?

FSH
(this will be raised significantly in menopausal pts)

37

what is the main type of cervical cancer?

squamous cell cancer (80%)

38

What is the most important aetiological factor causing cervical cancer?

Human papillomavirus (HPV), particularly serotypes 16,18 & 33 is by far the most important factor in the development of cervical cancer.

39

other than HPV what are some other risk factors of cervical cancer?

smoking
human immunodeficiency virus
early first intercourse, many sexual partners
high parity
lower socioeconomic status
combined oral contraceptive pill*

40

Following termination of pregnancy how long does the urine pregnancy test remain positive?

Urine pregnancy test often remains positive for up to 4 weeks following termination. A positive test beyond 4 weeks indicates incomplete abortion or persistent trophoblast

41

what is the course of action if there have been 3 inadequate smears in a row?

routine referral to gynaecology for colposcopy

42

what is the only definitive treatment of adenomyosis?

hysterectomy

43

what is a cervical ectropion?

On the ectocervix there is a transformation zone where the stratified squamous epithelium meets the columnar epithelium of the cervical canal. Elevated oestrogen levels (ovulatory phase, pregnancy, combined oral contraceptive pill use) result in larger area of columnar epithelium being present on the ectocervix

44

what features occur in cervical ectropion?

vaginal discharge
post coital bleeding

45

Why is there infertility in PCOS?

The majority of patients with polycystic ovarian syndrome have a degree of insulin resistence which in turn can lead to complicated changes in the hypothalamic-pituitary-ovarian axis.

46

what is the first line treatment for dysmenorrhoea?

ibuprofen

47

whats the diagnosis?
Usually sudden onset unilateral lower abdominal pain. Onset may coincide with exercise.
Nausea and vomiting are common
Unilateral, tender adnexal mass on examination

ovarian torsion

48

Medical management of a miscarriage involves giving misoprostol alone.
true or false?

true

49

What does a Rokitansky's protuberance mean the likely diagnosis is?

teratoma (dermoid cyst)

50

first line treatment for urge incontinence?

bladder retraining

51

first line treatment for stress incontinence?

pelvic floor muscle training

52

A 31-year-old woman with a history of normal smear results has a routine smear.
Result: normal smear
whats the appropriate action?

repeat smear in 3 years

53

A 31-year-old woman with a history of normal smear results has a routine smear.
Result: moderate dyskaryosis
whats the appropriate action?

refer for urgent colposcopy within 2 weeks

54

A 31-year-old woman with a history of normal smear results has a routine smear.
Result: borderline dyskaryosis (HPV negative)
whats the appropriate action?

repeat smear in 3 years

55

whats the diagnosis?
A 25-year-old woman presents 5 months after having dilation and curettage for a miscarriage. Since this procedure she has not had a period. A pregnancy test is negative. Hysteroscopy is performed which reveals the diagnosis.

Asherman's syndrome (intrauterine adhesions)

56

whats the diagnosis?
A 26-year-old woman presents 3 months after giving birth to her first child. During labour she had a large post-partum haemorrage. She did not breastfeed but has not had a period since.

Sheehan's syndrome

57

whats the diagnosis?]A 28-year-old woman presents because she has not had a period for the past 9 months. She also describes fluid leaking from her nipples.

Prolactinoma

58

what is the 1st line NON-hormonal treatment for menorrhagia?

Tranexamic acid is the first-line non-hormonal treatment for menorrhagia
then mefenamic acid

59

what is the 1st line hormonal treatment (ie contraception needed too) for menorrhagia?

IUS

60

What definition is used to classify bleeding as 'abnormally heavy'?

an amount that the woman considers to be excessive

61

How is premature ovarian failure defined?

Premature ovarian failure is defined as the onset of menopausal symptoms and elevated gonadotrophin levels before the age of 40 years.

62

drug of choice for medical management of ectopic pregnancy

methotrexate

63

what is the 1st line treatment for urge incontinence?

urge incontinence: bladder retraining

64

what is the 1st line treatment for stress incontinence?

stress incontinence: pelvic floor muscle training