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CP2 OBGYN > Gynaecology > Flashcards

Gynaecology Flashcards

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1
Q

What is considered a regular menstrual cycle?

A

28 days +/- 6 days

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2
Q

What is the average age of menarche?

A

13

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3
Q

What happens during days 1-4 of the menstrual cycle?

A

Menstruation
Endometrium shed
Myometrial contractions occur (painful)

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4
Q

What happens during days 5-13 of the menstrual cycle?

A

Proliferative phase
Hypothalamus releases GnRH - acts on receptors
FSH is released
Follicular recruitment due to FSH
Thecal layer follicle stim’d by FSH –> testosterone –> oestradiol
Oestradial thickens endometrium by incr mitotic activity

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5
Q

What happens during days 14-28 of the menstrual cycle?

A 
Secretory phase 
LH released day 14 - ovulation 
FOllicle --> CL - prod O + P
CL relies on LH to survive - if egg not fertilised dies - < O + P 
Endometrium starts to break down
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6
Q

Causes of Abnormal Uterine bleeding - PALM-COEIN

A 
Polyps 
Adenomyosis 
Leiomyomas 
Malignancy 
Coagulopathy 
Ovulatory dysfunction 
Endometrial 
Iatrogenic 
Not specified
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7
Q

Causes of IMB (7)

A 
Anovulatory cycles 
Fibroids 
Polyps 
Adenomyosis 
Ovarian cysts 
Chronic pelvic infection 
Malignancy
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8
Q

Ix IMB (4)

A

Hb
Cerivcal smear
USS (if >35)
Endometrial biopsy

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9
Q

Drug Mx IMB - 1st line

A

IUS/COCP

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10
Q

Drug Mx IMB - 2nd line

A

Progestogens

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11
Q

Drug Mx IMB - 3rd line

A

HRT (if perimenopause)

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12
Q

Surgical Mx IMB

A

Hystoscope - polyp removal/fibroid/ablation

Radical - hysterectomy/myomectomy

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13
Q

Def post-coital bleeding

A

Bleeding following intercourse that is NOT menstrual loss

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14
Q

Causes of post-coital bleeding (5)

A 
Cervical carcinoma 
Cervical ectropion 
Cervical polyps 
Cervicitis/vaginitis 
Atrophy
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15
Q

Mx post-coital bleed (4)

A

Inspect cervix + smear
If polyp - avulse + send histology
If ectropion - cryo
If neither - colposcopy - excl maligancy

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16
Q

Def post-menopausal bleeding

A

Vaginal bleeding > 12 months post menopause

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17
Q

FSH levels menopause

A

> 30

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18
Q

Most common cause PMB

A

Atrophic changes to vaginal tract

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19
Q

Causes of PMB - ovarian (2)

A

Carcinoma of ovary

Oestrogen secreting tumour

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20
Q

Causes of PMB - uterine body (4)

A

Myometrial submucosal fibroid
Endometrium - atrophy
Polyp
Hyperplasia

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21
Q

Causes of PMB - cervical (4)

A

Atrophic changes
Malignancy
Squamous carcinoma
Adenocarcinoma

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22
Q

Causes of PMB - vaginal

A

Atrophic changes

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23
Q

Causes of PMB - urethral (2)

A

Urethral caruncle

Haematuria

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24
Q

Causes of PMB - vulval (3)

A

Vulvitis
Dystrophies
Malignancy

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25
Local Sx of oestrogen deficiency - PMB (3)
Vaginal dryness Vaginal soreness Superficial dyspareunia
26
Ix PMB
Full gynae + abdo exam USS pelvis Hysteroscopic exam uterine cavity Endometrial biopsy
27
Def dysmenorrhoea
Pain associated with menstruation
28
What is 1' dysmenorrhoea
Occurs from menarche
29
What is 2' dysmenorrhoea
Either occurs in women who has had previously painless periods, or 2' to pathology
30
RF dysmenorrhoea (5)
``` Early menarche Long menstrual phase Heavy periods Smoking Nulliparity ```
31
CF dysmenorrhoea (5)
``` Lower abdo pain radiating to lower back Crampy, 48-72h Worst @ onset menses Assoc w/ malaise, N+V+D, dizziness Uterine tenderness ```
32
DDx dysmenorrhoea (6)
``` 2' dysmenorrhoea Endometriosis Adenomyosis PID Adhesions Non gynae - IBS/IBD ```
33
Ix dysmenorrhoea (2)
High vag/endocervical swab | If mass palp'd --> TVUS
34
Mx dysmenorrhoea
``` Lifestyle - stop smoking NSAIDS + paracetamol = 1st line Local apply heat TENS 2nd line = 3-6m COCP/mirena ```
35
Causes of 2' dysmenorrhoea (5)
``` Fibroids Endometriosis Adenomyosis PID Ovarian tumours ```
36
Ix 2' dysmenorrhoea (2)
USS | Diagnostic laparoscopy
37
Def precocious puberty (2)
Either menstruation before 9 | Or 2' sex characteristics before 8
38
What is the majority of cause of precocious puberty?
No cause (80%)
39
Mx of precocious puberty b/c no pathological cause
GNRH agonist
40
Central causes of precocious puberty (5)
``` Meningitis encephalitis CNS tumour Hydrocephaly Hypothyroidism ```
41
Mx of central causes of precocious puberty
GNRH agonist
42
Ovarian/adrenal causes of precocious puberty
Hormone prod tumour in ovary/adrenals | Mc-Cune-Albright syndrome (bone + ov cysts)
43
Mx of ovarian/adrenal causes of precocious puberty
Tumour excision | Cyproterone acetate
44
What is cortical adrenal hyperplasia
Defective cortisol production --> decr ACTH hence decr androgen secretion
45
PS cortical adrenal hyperplasia
Ambiguous genitalia
46
Mx CAH
Cortisol + mineralcorticoid replacement
47
What is androgen insensitivity syndrome
Cells receptors are insensitive to androgens, hence peripheral conversion of androgens to oestrogens
48
PS androgen insensivity syndrome
Appears F | But amenorrhoea + absent uterus
49
Mx androgen insensitivity syndrome
``` Remove testes (b/c can --> malignant) Oestrogen replacement ```
50
Def chronic pelvic pain
Pain that persists >6M
51
Causes of chronic pelvic pain - GYNAE (MOT CheckP)
``` Menstrual - adenomyosis Ovaries Tubes - PID Cervix - herpes/malig Pelvic wall - endometriosis Perineum - Barthrolins cysts ```
52
Sx of Pelvic congestion syndrome
Pain, much better in AM | Watery non-odourous discharge
53
When does pelvic congestion syndrome tend to occur?
Post pregnancy --> valvular insufficiency --> incr varicosity pelvis
54
Non-gynae causes of chronic pelvic pain (5)
``` Urinary stones GIT esp IBS MSK - OA Neurological Psychological ```
55
Assoc Sx chronic pelvic pain (7)
``` Dysmenorrhoea Dyspareunia Dyschezia Haematuria Abdo bloating Diarrhoea/constipation Urinary Sx ```
56
What do 30% of women w/ chronic pelvic pain have aHx of
sexual abuse
57
O/E chronic pelvic pain
``` Pain mapping on physical exam Abdo palpation General exam Vulval/vaginal inspection Bimanual exam - tenderness, mass ```
58
DDx - tenderness on bimanual palp - chronic pelvic pain (3)
Generalised - PID Unilateral - ov cyst/ectopic pregnancy Tender noduls - endometriosis?
59
DDx - mass on bimanual palp - chronic pelvic pain (4)
Tubo-ovarian abscess Ovarian cyst Endometriotic cyst Fibroid
60
Ix chronic pelvic pain
``` DIP urine FBC Swabs/speculum/biopsy USS/CT abdo Prengnacy test Laparoscopy = gold standard ```
61
Common causes of acute pelvic pain (7)
``` Ectopic pregnancy Ovarian cysts PID Sepsis Acute bleed Vulva Haemorrhagic cyst ```
62
Superficial dyspareunia - congenital causes (2)
Vaginal atresia | Vaginal septum
63
Superficial dyspareunia - infective cause
Vulvovaginitis
64
Superficial dyspareunia - post surgical cause (2)
Childbirth | Pelvic floor repair
65
Superficial dyspareunia - vulval cause (30
Bartholin's cyst Vulval dystrophies Carcinoma of vulva
66
Superficial dyspareunia - psychosexual cause
Vaginismus
67
Deep dyspareunia - congenital causes (2)
Incomplete vaginal atresia | Vaginal septum
68
Deep dyspareunia - infective cause
PID
69
Deep dyspareunia - post-surgical causes (2)
Relating to childbirth | Pelvic floor repair
70
Deep dyspareunia - pelvic disease causes (3)
Endometriosis Fibroids Ovarian cyst/tumours
71
Deep dyspareunia - pelvic prolapse cause (3)
Endometriosis Fibroids Ov cysts/tumours

CP2 OBGYN (21 decks)

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