Gynaecology Flashcards

Question

What is the cause of androgen insensitivity syndrome?

Answer 1

AIS is caused by genetic defects on the X chromosome. These defects make the body unable to respond to testosterone that produce a male appearance

Answer 2

**Complete AIS** Penis and other male body parts fail to develop * *Partial AIS** - Failure of one or both testes to descend into the scrotum - Hypospadias, a condition in which the opening of the urethra is on the underside of the penis, instead of at the tip - Reifenstein syndrome (also known as Gilbert-Dreyfus syndrome or Lubs syndrome)

Answer 3

1. Genotype is MALE but appearance is FEMALE 2. A person with complete AIS appears to be female but has no uterus 3. They have very little armpit and pubic hair. 4. At puberty, female sex characteristics (such as breasts) develop. 5. However, the person does not menstruate and become fertile.

Answer 4

1. Often not diagnosed in the child * Gowth is found in the abdomen which is found to be a testicle 2. **Buccal smear** or **chromosomal analysis** to reveal 46XY genotype 3. FSH and LH levels

Answer 5

1. Removal of the undescended testicle 2. Eostrogen therapy is prescribed after puberty 3. Psycological therapy - can result in gender dysphoria

Answer 6

Menopause occurs when a woman hasn’t menstruated in 12 consecutive months and can no longer become pregnant naturally. It usually begins between the ages of 45 and 55, but can develop before or after this age range.

Answer 7

It happens when your ovaries stop producing as much of the hormone oestrogen and no longer release an egg each month. **Examples are:** Naturally declining reproductive hormones Surgery that removes the ovaries (oophorectomy) Chemotherapy and radiation therapy Primary ovarian insufficiency

Answer 8

1. Hot flushes 2. Night sweats 3. Vaginal dryness and discomfort during sex 4. Difficulty sleeping 5. Low mood or anxiety 6. Reduced sex drive (libido) 7. Problems with memory and concentration

Answer 9

1. Cardiovascular disease 2. Osteoporosis 3. Urinary incontinence 4. Sexual function 5. Weight gain

Answer 10

1. Mostly diagnosed through the signs and symptoms of the individual 2. **First line investigation - FSH levels increase** 3. Oestrogen levels decrease 4. TSH and underactive thyroid can mimic symptoms

Answer 11

HRT Vaginal oestrogen creams CBT Healthy, balanced diet and exercising regularly

Answer 12

Thinning, drying and inflammation of the vaginal walls Occurs with less estrogen. Vaginal atrophy occurs most often after menopause.

Answer 13

Natural menopause or oophorectomy. Anti-oestrogenic treatments - eg, tamoxifen, aromatase inhibitors. Radiotherapy or chemotherapy. It can also occur postpartum or with breast-feeding, due to reduced oestrogen levels.

Answer 14

Vaginal dryness Dyspareunia Occasional spotting

Answer 15

**Vaginal examination** 1. Thin mucosa with diffuse erythema 2. Occasional petechiae or ecchymoses 3. Dryness 4. Lack of vaginal folds **Urine test** **Acid balance test** 1. More alkaline

Answer 16

Vaginal lubricants and moisturisers Topical oestrogen cream

Answer 17

Is the first menstural cycle, or first menstrual bleeding

Answer 18

1. Attainment of a sufficient body mass (typically 17% body fat) 2. Disinhibition of the GnRH pulse generator in the arcuate nucleus of the hypothalamus 3. Secretion of oestrogen by the ovaries in response to pituitary hormones. 4. Over an interval of about 2 to 3 years, oestrogen stimulates growth of the uterus 5. Oestrogen stimulates growth and vascularity of the endometrium, the lining of the uterus. 6. Fluctuations of hormone levels can result in changes of adequacy of blood supply to parts of the endometrium 7. Death of some of the endometrial tissue from these hormone or blood supply fluctuations leads to deciduation, a sloughing of part of the lining with some blood flow from the vagina

Answer 19

No, the majority of menarches are anovulatory for the first year

Answer 20

**Chornic illness** Asthma Coeliac disease Diabetes **Conditions and disease states** **Effects of stress and social environment**

Answer 21

Uterine polyps, also called endometrial polyps, are small, soft growths on the inside of a woman’s uterus, or womb. They come from the tissue that lines the uterus, called the endometrium.

Answer 22

Exact cause is unknown Rising and falling oestrogen levels thought to play a role in the normal cycle **You are more at risk if:** Obesity High blood pressure The breast cancer drug tamoxifen

Answer 23

1. Irregular menstrual bleeding 2. Bleeding between menstrual periods 3. Excessively heavy menstrual periods 4. Vaginal bleeding after menopause 5. Infertility

Answer 24

1. Transvaginal ultrasound 2. Hysteroscopy 3. Endometrial biopsy

Answer 25

1. **Watchful waiting** 2. **Medications** Progestins and gonadotropin-releasing hormone agonists (gonadorelin) 3. **Surgical removal**

Answer 26

A condition which affects how the ovaries work

Answer 27

Exact cause is unknown, factors thought to play a role are: Excess insulin - causing excess androgens Low-grade inflammation Heredity Excess androgen

Answer 28

**Irregular periods** – which means your ovaries do not regularly release eggs (ovulation) **Excess androgen** – facial or body hair **Polycystic ovaries** – your ovaries become enlarged and contain many fluid-filled sacs 2/3 necessary to be diagnosed

Answer 29

1. **Pelvic ultrasound**: multiple cysts on the ovaries 2. **FSH, LH** 3. **Prolactin** * Normal or mildly elevated 4. **TSH** 5. **Testosterone** * Normal or midly elevated 6. Check for impaired glucose tolerance

Answer 30

No specific treatment for PCOS but can control the symptoms 1. **Lifestyle changes to lose weight** 2. **Combination birth control pills** * Control bleeding 3. **Progestin therapy** 4. **Help you ovulate** * Letrozole * Clomiphene * Metformin 5. **Prevent exessive hair growth** * Birth control pills * Spironolactone * Eflornithine

Answer 31

X chromosomes (sex chromosomes) is missing or partially missing

Answer 32

**Monosomy** The complete absence of an X chromosome **Mosaicism** This results in some cells in the body having two complete copies of the X chromosome **X chromosome abnormalities** Abnormal or missing parts of one of the X chromosomes can occur **Y chromosome material**

Answer 33

1. short stature 2. shield chest, widely spaced nipples 3. webbed neck 4. bicuspid aortic valve (15%), coarctation of the aorta (5-10%) 5. primary amenorrhoea 6. cystic hygroma (often diagnosed prenatally) 7. high-arched palate 8. Underdeveloped ovaries 1. Normally diagnosed at 8 - 14 years old

Answer 34

1. **In mother** * Chorionic villus sampling * Amniocentesis 2. **In child** * Raised FSH and LH * Low Oestrogen * Abscence of Barr body * 45, XO karyotype

Answer 35

1. Growth hormone - increase height 2. Oestrogen therapy - promote breast development and increase uterus size

Answer 36

Asherman’s syndrome is an acquired condition that refers to having scar tissue in the uterus or in the cervix This scar tissue makes the walls of these organs stick together and reduces the size of the uterus

Answer 37

1. Scar tissue from uterine surgery like dilation and curettage (D&C). (This is the cause of more than 90% of IUA.) 2. Scar tissue after a Cesarean section or from sutures used to stop hemorrhages 3. Endometriosis 4. Infections of the reproductive organs 5. Radiation treatment

Answer 38

1. Having very light periods (hypomenorrhea) 2. Having no periods (amenorrhea) 3. Having severe cramping or pain 4. Being unable to get or stay pregnant

Answer 39

1. Hysteroscopy 2. Hysterosalpingography 3. Saline infusion sonography

Answer 40

**Hysteroscopy** Cutting the adhesions with very small scissors, lasers

Answer 41

Sheehan's syndrome is a complication of severe postpartum haemorrhage (PPH) In which the pituitary gland undergoes ischaemic necrosis which can manifest as hypopituitarism.

Answer 42

Lack of postpartum milk production and amenorrhoea following delivery.

Answer 43

Inadequate **prolactin and Gonadotropin** stimulation tests in patients with a history of severe PPH.

Answer 44

**Replacement of hormones** 1. Corticosteroids 2. Levothyroxine 3. Oestrogen

Answer 45

Noncancerous tumor of the pituitary gland, causes the pituitary to produce to much prolactin

Answer 46

Exact cause is unknown

Answer 47

**Men** Impotence Loss of libido Galactorrhoea **Women** Amenorrhoea Infertility Galactorrhoea Osteoporosis

Answer 48

**Blood tests** Raised prolactin and whether levels of other hormones controlled by the pituitary are within the normal range. Women of childbearing age also will have a pregnancy test. **Brain imaging (MRI)** Pituitary tumor on an image generated

Answer 49

**Return the production of prolactin to normal levels Restore normal pituitary gland function** Dopamine analogue - bromocriptine, cabergoline **Surgery** Nasal surgery Transcranial surgery

Answer 50

Pelvic inflammatory disease (PID) is an infection of the female reproductive organs It most often occurs when sexually transmitted bacteria spread from your vagina to your uterus, fallopian tubes or ovaries.

Answer 51

Gonorrhea Chlamydia

Answer 52

**Chlamydia trachomatis** + the most common cause Neisseria gonorrhoeae Mycoplasma genitalium Mycoplasma hominis

Answer 53

1. Pain 2. Abnormal or heavy vaginal discharge/unpleasant odor 3. Abnormal uterine bleeding, especially during or after intercourse, or between menstrual cycles 4. Pain during intercourse 5. Fever, sometimes with chills 6. Painful, frequent or difficult urination

Answer 54

1. A pregnancy test should be done to exclude an ectopic pregnancy 2. High vaginal swab * These are often negative 3. Screen for Chlamydia and Gonorrhoea

Answer 55

1. **Antibiotics** - Oral ofloxacin + oral metronidazole - Or intramuscular ceftriaxone + oral doxycycline + oral metronidazole 2. **Treatment for your partner** 3. **Temporary abstinence**

Answer 56

**Perihepatitis (Fitz-Hugh Curtis Syndrome)** It is characterised by right upper quadrant pain and may be confused with cholecystitis 1. Infertility 2. Chronic pelvic pain 3. Ectopic pregnancy

Answer 57

Premenopause is when you have no symptoms of perimenopause or menopause

Answer 58

Changes in your period cycle Hot flashes Sleep disturbances Mood swings

Answer 59

Normally blood tests and history

Answer 60

Changes to your hormone therapies Things which improve your mental well-being

Answer 61

1. Uterine fibroids are noncancerous growths of the uterus that often appear during childbearing years. 2. Also called leiomyomas (lie-o-my-O-muhs) or myomas, uterine fibroids aren't associated with an increased risk of uterine cancer and almost never develop into cancer.

Answer 62

1. Heavy menstrual bleeding 2. Menstrual periods lasting more than a week 3. Pelvic pressure or pain 4. Frequent urination 5. Difficulty emptying the bladder 6. Constipation 7. Backache or leg pains

Answer 63

Fibroids are generally classified by their location. Intramural fibroids grow within the muscular uterine wall. Submucosal fibroids bulge into the uterine cavity. Subserosal fibroids project to the outside of the uterus.

Answer 64

1. Genetic changes 2. Hormones 3. Growth factors e.g. insulin-like growth factors 4. Extracellular matrix (ECM)

Answer 65

1. Uterine fibroids are frequently found incidentally during a routine pelvic exam. 2. **Uterine fibroid - Transvaginal ultrasound**

Answer 66

**If \<3cm then managed medically** 1. **Progestin-releasing intrauterine device (IUD/IUS)** 2. **Transexamic acid** * ****Best for when trying to convieve 3. **Medications which can shrink the fibroids** e. g. Gonadotropin-releasing hormone (GnRG) e.g. Triptorelin - blocks production of oestrogen and progesterone SHORT TERM **\>3cm or causing significant problems** 1. **Surgery** * Myomectomy - adhesions common Endometrial ablation Hysterectomy

Answer 67

1. Physiological cysts 2. Benign germ cell tumours 3. Benign epithelial tumours 4. Benign sex cord stromal tumours

Answer 68

Endometriotic cyst

Answer 69

**Follicular cysts** 1. Commonest type of ovarian cyst 2. Due to non-rupture of the dominant follicle or failure of atresia in a non-dominant follicle 3. Commonly regress after several menstrual cycles **Corpus luteum cyst** 1. During the menstrual cycle if pregnancy doesn't occur the corpus luteum usually breaks down and disappears. If this doesn't occur the corpus luteum may fill with blood or fluid and form a corpus luteal cyst 2. More likely to present with intraperitoneal bleeding than follicular cysts

Answer 70

**Dermoid cyst** 1. Also called mature cystic teratomas. Usually lined with epithelial tissue and hence may contain skin appendages, hair and teeth 2. Most common benign ovarian tumour in woman under the age of 30 years 3. Median age of diagnosis is 30 years old 4. Bilateral in 10-20% 5. Usually asymptomatic. Torsion is more likely than with other ovarian tumours

Answer 71

**Serous cystadenoma** 1. The most common benign epithelial tumour which bears a resemblance to the most common type of ovarian cancer (serous carcinoma) **Mucinous cystadenoma** 1. Second most common benign epithelial tumour 2. They are typically large and may become massive 3. If ruptures may cause pseudomyxoma peritonei

Answer 72

1. Bleed or burst 2. Torsion of the ovary 3. Press on nearby structures 4. Some can develop into cancer

Answer 73

Most have no symptoms so are found on a routine examination Ultrasound CA125 test - does not rule out cancer if normal

Answer 74

Observation Operation

Answer 75

Ovarian torsion (adnexal torsion) occurs when an ovary becomes twisted around the tissues that support it. Sometimes, the fallopian tube may also become twisted. This painful condition cuts off blood supply to these organs.

Answer 76

Severe, sudden pain in the lower abdomen Cramping Nausea Vomiting These symptoms usually present suddenly and without warning.

Answer 77

1. Ovarian mass: present in around 90% of cases of torsion 2. Being of a reproductive age 3. Pregnancy 4. Ovarian hyperstimulation syndrome

Answer 78

1. **Transvaginal ultrasound** * Whirpool 2. **Pelvic exam** 3. **Blood and urine tests** to rule out infection, ovarian abscess, ectopic pregnancy, appendicitis

Answer 79

Laparoscopy Laparotomy Oophorectomy Salphingo-Ooporectomy

Answer 80

Inflammatory condition which usually affects the genitalia and is more common in elderly females. Leads to atrophy of the epidermis with white plaques forming Postmenopausal women are more at risk

Answer 81

1. Redness Itching (pruritus), which can be severe 2. Discomfort or pain 3. Smooth white patches on your skin 4. Blotchy, wrinkled patches

Answer 82

Unknown Overactive immune system and hormone imbalances are thought to play a role

Answer 83

1. A physical examination 2. Biopsy

Answer 84

1. **Corticosteroids - Dermovate, clobetasol propionate** 2. Tacrolimus (Protopic)

Answer 85

Cervical cancer starts in the cells lining the cervix

Answer 86

Endocervix (Glandular cells) Exocervix (squamous cells) Transitional zones

Answer 87

1. **HPV 16, 18 & 33** 2. Smoking - two fold increase 3. Human immunodeficiency virus 4. Early first intercourse, many sexual partners 5. High parity 6. Lower socioeconomic status 7. Combined oral contraceptive pill\*

Answer 88

1. Squamous cell carcinoma (9 out of 10) 2. Adenocarcinoma 3. Mixed carcinomas (uncommon)

Answer 89

Human papillomavirus (HPV)

Answer 90

1. Mostly none in the early stages 2. Pain when you have sex 3. Abnormal bleeding, such as after sex or between periods

Answer 91

Smear test Colposcopy

Answer 92

**1A** Hysterectomy Cone biopsy is wanting children **1B** Radiotherapy then chemo (cisplatin) **2+3** Radiotherapy **4** Radiotherapy then chemo Pallative

Answer 93

Endometrial hyperplasia may be defined as an abnormal proliferation of the endometrium in excess of the normal proliferation that occurs during the menstrual cycle. A minority of patients with endometrial hyperplasia may develop endometrial cancer

Answer 94

Abnormal vaginal bleeding e.g. intermenstrual

Answer 95

1. simple endometrial hyperplasia without atypia: high dose progestogens with repeat sampling in 3-4 months. The levonorgestrel intra-uterine system may be used 2. atypia: hysterectomy is usually advised

Answer 96

Type of cancer that begins in the uterus Endometrial cells which line the uterus

Answer 97

1. Vaginal bleeding after menopause 2. Bleeding between periods 3. Pelvic pain

Answer 98

1. Obesity 2. **Oestrogen Increasing Reasons** Nulliparity Early menarche Late menopause Unopposed oestrogen 3. Diabetes mellitus 4. **Tamoxifen** 5. Polycystic ovarian syndrome 6. Hereditary non-polyposis colorectal carcinoma

Answer 99

Women \>= 55 years who present with postmenopausal bleeding should be referred using the suspected cancer pathway 1) **Trans-vaginal ultrasound** - a normal endometrial thickness (\< 4 mm) has a high negative predictive value 2) **Hysteroscopy with endometrial biopsy**

Answer 100

1. Localised disease is treated with **total abdominal hysterectomy with bilateral salpingo-oophorectomy** 2. Patients with high-risk disease may have post-operative radiotherapy 3. Progestogen therapy is sometimes used in frail elderly women not consider suitable for surgery

Answer 101

Excessive vaginal bleeding

Answer 102

What a woman considers to be excessive

Answer 103

1. Dysfunctional uterine bleeding: this describes menorrhagia in the absence of underlying pathology. This accounts for approximately half of patients 2. Anovulatory cycles: these are more common at the extremes of a women's reproductive life 3. Uterine fibroids 4. Hypothyroidism 5. Intrauterine devices\* 6. Pelvic inflammatory disease 7. Bleeding disorders, e.g. von Willebrand disease

Answer 104

1. A full blood count should be performed in all women 2. **Routine transvaginal ultrasound** scan if symptoms (for example, intermenstrual or postcoital bleeding, pelvic pain and/or pressure symptoms) suggest a structural or histological abnormality. Other indications include abnormal pelvic exam findings.

Answer 105

**Does not require contraception** 1. either **tranexamic acid - first line** or **mefenamic acid.** Both are started on the first day of the period 2. if no improvement then try other drug whilst awaiting referral **Requires contraception, options include** 1. intrauterine system (Mirena) should be considered first-line 2. combined oral contraceptive pill 3. long-acting progestogens

Answer 106

CA 125 Ovarian cancer CA 19-9 Pancreatic cancer CEA Bowel cancer AFP Liver cancer and germ cell tumours (e.g. testicular) HER2 Breast cancer receptor

Answer 107

**Secondary metastatic Cancer** Most common primary is: **Squamous cell carcinomas**. 80% of vulval cancers Most cases occur in women over the age of 65 years

Answer 108

1. Lump or ulcer on the labia majora 2. May be associated with itching, irritation

Answer 109

**Class 1 (hypogonadotropic hypogonadal anovulation)** - notably hypothalamic amenorrhoea (5-10% of women) **Class 2 (normogonadotropic normoestrogenic anovulation)** - polycystic ovary syndrome (80% of cases) **Class 3** (**hypergonadotropic hypoestrogenic anovulation)** - premature ovarian insufficiency (5-10% of cases). In this class, any attempts at ovulation induction are typically unsuccessful and therefore usually require in-vitro fertilisation (IVF) with donor oocytes to conceive

Answer 110

1. Current or past breast cancer 2. Any oestrogen-sensitive cancer 3. Undiagnosed vaginal bleeding 4. Untreated endometrial hyperplasia

Answer 111

Oestrogen only If they have ovaries oestrogen alone can increase risk of cancer

Answer 112

Cyclical combined HRT

Answer 113

Continuous combined HRT

Answer 114

Squamous cell carcinoma

Answer 115

1. Post-coital bleeding 2. Later followed by offensive watery discharge

Answer 116

1. FIRST LINE - Trans-vaginal ultrasound 2. Speculum examination

Answer 117

1. Radiation or surgery

Answer 118

Benign tumour arising from the trophoblast

Answer 119

1. Previous molar pregnancy - increases risk 40 fold 2. Age - more common among mothers less than 20 and older than 40 years 3. Racial origin - more common among Asian and Taiwanese mothers than Caucasian 4. Diet -Low consumption of folic acid

Answer 120

Usually 46 XX karotype but with both X chromosomes derived from the father

Answer 121

**_Symptoms_** 1. Painless heavy or irregular vaginal bleeding, usually after 6-12 weeks of amenorrhoea 2. Hyperemesis gravidarum - excessive nausea and vomiting 3. Pre-eclampsia - irritability, dizziness, photophobia **_Signs_** 1. Enlarged uterus 2. Ovarian enlargement 3. Hypertension

Answer 122

**_Normally clinically diagnosed_** 1. Bleeding after a prolonged period of amenorrhoea 2. Early pre-eclampsia 3. Hyperemesis gravidarum 4. Large uterus **_Investigations include_** 1. Ultrasound - 'snow-storm' pattern/echoes with numerous small anechoic spaces 2. Abnoramlly high serum hCG 3. Negative results with foetal doppler

Answer 123

1. **Cross-match blood** 2. Arrange for an evacuation of the uterus under GA w **oxytocin** to reduce blood loss 3. Monitor **beta-hCG** levels 4. Rarely needs a hyterectomy

Answer 124

1. Premature ovarian insufficiency is defined as the **onset of menopausal symptoms and elevated gonadotrophin levels before the age of 40 years**. 2. It occurs in around 1 in 100 women.

Answer 125

1. Idiopathic * the most common cause * there may be a family history 2. bilateral oophorectomy * having a hysterectomy with preservation of the ovaries has also been shown to advance the age of menopause 3. radiotherapy 4. chemotherapy 5. infection: e.g. mumps 6. autoimmune disorders 7. resistant ovary syndrome: due to FSH receptor abnormalities

Answer 126

1. climacteric symptoms: hot flushes, night sweats 2. infertility 3. secondary amenorrhoea 4. raised FSH, LH levels * e.g. FSH \> 40 iu/l * elevated FSH levels should be demonstrated on 2 blood samples taken 4–6 weeks apart 5. low oestradiol * e.g. \< 100 pmol/l

Answer 127

1. hormone replacement therapy (HRT) or a combined oral contraceptive pill should be offered to women until the age of the average menopause (51 years) * it should be noted that HRT does not provide contraception, in case spontaneous ovarian activity resumes

Answer 128

**Primary** 1. No underlying pathology **Secondary** 1. Endometriosis 2. Adenomyosis 3. Pelvic inflammatory disease 4. Intrauterine devices\* 5. Fibroids

Answer 129

**Primary** 1. Pain typically starts just before or within a few hours of the period starting 2. Suprapubic cramping pains which may radiate to the back or down the thigh **Secondary** 1. Pain usually starts 3-4 days before the onset of the period

Answer 130

**1st Line** 1. **NSAIDs** Mefanamic acid Ibruprofen They work by inhibiting prostaglandin production **2nd Line** 2. **Combined oral contraceptive pills**

Answer 131

Refer to gynaecology for investigation

Answer 132

Premenstrual syndrome (PMS) describes the emotional and physical symptoms that women may experience in the luteal phase of the normal menstrual cycle.

Answer 133

1. PMS only occurs in the presence of ovulatory menstrual cycles - it doesn't occur prior to puberty, during pregnancy or after the menopause. 2. **Emotional symptoms include:** * anxiety * stress * fatigue * mood swings 3. **Physical symptoms** * bloating * breast pain

Answer 134

Options depend on the severity of symptoms 1. **Mild symptoms can be managed with lifestyle advice** * apart from the usual advice on sleep, exercise, smoking and alcohol, specific advice includes regular, frequent (2–3 hourly), small, balanced meals rich in complex carbohydrates 2. **Moderate symptoms may benefit from a new-generation combined oral contraceptive pill (COCP)** * examples include Yasmin® (drospirenone 3 mg and ethinylestradiol 0.030 mg) 3. **Severe symptoms may benefit from a selective serotonin reuptake inhibitor (SSRI)** * this may be taken continuously or just during the luteal phase (for example days 15–28 of the menstrual cycle, depending on its length)

Answer 135

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

Answer 136

1. Vaginal discharge 2. Post-coital bleeding

Answer 137

Combined oral contraceptive pill

Gynaecology Flashcards

(169 cards)