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Gynaecology II Flashcards

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1
Q

Common types of genital tract infections

A 
Chlamydia
Gonorrhoea
Warts
Herpes
Shyphilis
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2
Q

Symptoms of Chlamydia

A

Asymptomatic

discharge, bleeding dysuria

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3
Q

Investigations of Chlamydia

A

NAAT on vuvlovaginal or endocervical swab

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4
Q

Management of Chlamydia

A

Azithromycin 1g single dose or doxycycline 7 day course

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5
Q

Complications of chlamydia

A

PID
Reiters
Ascending infection

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6
Q

Types of genital warts

A

6+11 are common 16,18,33 increase CIN

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7
Q

How do genital warts present?

A

Fleshy protuberances, slightly pigmented, may bleed or itch

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8
Q

How are genital warts investigatioed?

A

diagnosed clinically or if non-wart HPV it is dx via appearance on cervical cytology (smear tests) or colposcopy (whitening on application of acetic acid)

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9
Q

What is the management of genital warts?

A

1st line: topical podophyllum or cryotherapy depending on the type of lesion

Multiple, non-keratinised warts are generally best treated with topical agents

Solitary, keratinised warts respond better to cryotherapy
2nd line: Imiquimod is second line topical cream

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10
Q

Presentation of herpes

A

Primary infection is worse –
Prodrome (tingling/itching of skin in affected area).
Flu-like illness +/– inguinal lymphadenopathy.
Vulvitis and pain (may cause urinary retention).
Small, characteristic vesicles on the vulva, but can be atypical with fissures, erosions, erythema of skin.

Multiple painful ulcers developed from vesicular lesions (mouth or genitals), which eventually crust over 
Tender lymphadenopathy
Local oedema
Dysuria
Systemic Sx: Fever and myalgia
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11
Q

How is herpes investigated?

A

clinical exam
viral culture/pcr
can scrape vesicle ulcer

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12
Q

What is the management of herpes?

A

Aciclovir (oral)

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13
Q

How does gonorrhoea present?

A

Discharge, dysuria

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14
Q

How is gonorrhoea diagnosed?

A

NAAT - endocervical or vulvovaginal swab

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15
Q

What is the management of gonorrhoea?

A

Ceftriaxone 500mg IM stat + azithromycin to cover for chlamydia

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16
Q

presentation, investigation and management of trichomonas

A

Vaginal discharge, vuvlovagintiis, strawberry cervix, pH >4.5, men usually asymptomatic.

Micropscopy -wet smear motile trophozoites

One off metronidazole 2g

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17
Q

Presentation, investigation and management of Bacterial vaginosis

A

Asymptomatic. Discharge - fishy offensive smell.

Amsels criteria: 3/4
thin homogeneous discharge, pH >4.5, positive whiff, clue cells on microscopy

Oral metronidazole 5-7 days

Often seen in sexually active women

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18
Q

What predisposes to vaginal candidiasis?

A 
DM
Immunosuppresion
Steroids
Pregnancy
HIV

Yeast - Candida albicans etc

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19
Q

What are the features of vaginal candidiasis?

A

Cottage cheese discharge
Non offensive
vulvitis, dyspareunia, d dysuria, itch
erythema - satellite lesions, fissuring

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20
Q

Diagnosis of vaginal candidiasis

A

Appearance

Culture - high vaginal swab

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21
Q

managent for vaginal candidiasis

A

Clotrimazole pessary or oral itroconazole/fluconzaole

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22
Q

What is PID?

A

Infection and inflammation of female pelvic organs due to ascending infection from the endocervix

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23
Q

What increases the risk of PID?

A 
Young
STIs
many partners
uterine instrumentation
post partum endometritis
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24
Q

How does PID present?

A 
pain
fever
deep dyspareunia
dysuria
menstrual issues
discharge
cervical excitation
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25
Management of PID
Analgesia Oral ofloxacin + metronidazole or c ceftraixone + doxycycline + metronidazole
26
What are the causes of subfertility?
Male Ovulation failure Unexplained Tubal damage
27
What is the management of DUB?
Progesterone (IUS) | COCP or tranexamic acid
28
What is the management of menopause?
lifestyle Hormonal - HRT O+/- P Vaginal oestrogen topical for atrophy HRT to prevent symptoms but avoid long term use.
29
In HRT, what is required if a woman has a uterus?
Progesterone to protect from endometrial cancer
30
What are the risks and benefits of HRT?
+ Symptoms Reduces OP and heart disease Lowers risk of colorectal cancer - increases risk of breast cancer, VTE, stroke Endometrial cancer if oestrogen only
31
What are the risks and benefits of HRT?
+ Symptoms Reduces OP and heart disease Lowers risk of colorectal cancer - increases risk of breast cancer, VTE, stroke Endometrial cancer if oestrogen only
32
What are the causes of anovulation?
``` APrimary ovarian failure: Premature ovarian failure Genetic Autoimmune Surgery/chemo ``` ``` Secondary: PCOS Excess weight Hypopituitarism Kallmans Hyperprolactinaemia ```
33
What is Kallmans syndrome?
Anosmia | Hypogonadotrophic hypogonadism
34
How is female sub fertility investigated?
STI Baseline hormones - FSH, LH, TSK, prolactin, testosterone Rubella Mid luteal progesterone CONFIRMS Ovulation >30
35
How can we manage female subfertility?
``` Ovulatory: Clomiphene pulsatile GnRH or gonadotrophin Laparoscopic diathermy Insulin sensitisers surgery IVF/IUI/oocyte donation ```
36
What are causes of male sub fertility?
``` Reduced sperm count (idiopathic, drug exposure - esp. alcohol, smoking and anabolic steroids) Varicocoele Anti-sperm antibodies Disorders of the H-P axis Retrograde ejaculation ```
37
How is male sub fertility investigated?
Semen analysis FSH Karyotype CF screen
38
How do we manage hyperprolactinaemia?
Bromocriptine or cabergoline
39
What is PCOS
Common cause o infertility, hyperinsulinaemia, high LH, overlaps with metabolic syndrome
40
What is the Rotterdam criteria?
Irregular or absent ovulation (cycle >42 days) Clinical signs of hyperandrogegism: acne, hirsutism, alopecia PCO on USS >12 antral follicles
41
What do you need to exclude with post menopausal bleeding?
ENDOMETRIAL CANCER
42
Causes of PMB
``` Vaginal atrophy HRT Endometrial: ca, hyperplasia, polyps Cervical: ca, polyps, cervisiti Vaginal ca Ovarian ca ```
43
Investigations for PMB
``` 2 week referral examination Smear USS Biopsy - hysteroscopy with endometrial biopsy ```
44
Presentation of Prolapse
Sensation of fullness, pressure, heaviness Sensation of bulge/protrusion Difficulty retaining tampons Spotting Urinary Sx - esp need to change position to start voiding Dyspareunia, loss of vaginal sensation Bowel symptoms
45
How is prolapse managed?
Weight, physio Pessary - Surgery
46
Define urge incontinence
Involuntary bladder contraction
47
Investigations for urge incontinence
Urine dip Diary 3 days Post micturition USS Urodynamics
48
Management of urge incontinence
Bladder retraining 6w | Antimuscarinic drugs - oxynbutynin first line but avoid in frail older ladies
49
Management of stress incontinence
Pelvic muscle training | Surgical tape
50
Management of stress incontinence
Pelvic muscle training | Surgical tape
51
Cervical screening programme
Smear test 25-49 3yrly 50-64 5yrly
52
Cervical screening result
Borderline or mild Test for HPV (16, 18, 33) -ve routine +ve colposcopy Moderate CIN II - colposcopy referral Severe 2W colposcopy Suspected invasive ca - urget colposcopy 2w Inadequate - repeat. 3x inadequate- colposcopy
53
Cervical screening result
Borderline or mild Test for HPV (16, 18, 33) -ve routine +ve colposcopy Moderate CIN II - colposcopy referral Severe 2W colposcopy Suspected invasive ca - urget colposcopy 2w Inadequate - repeat. 3x inadequate- colposcopy
54
Main thing to exclude with pelvic mass
Ovarian cancer
55
Causes of pre-menopausal pelvic masses
``` pregnancy functional ovarian cyst benign tumour fibroid rare - endometriosis, ectopic, abscess, malignancy ```
56
Causes of post-menopausal pelvic masses
Cancer Benign tumour fibroid Abscess, GI tumour
57
Define uterine fibroid
Benign smooth muscle tumours
58
Symptoms of fibroids
``` Asymptomatic Menorrhagia Cramps, bloating Urinary Subfertility ```
59
Management of fibroids
Mirena IUS Tranexamic, COCP GnRH Surgery - myomectomy
60
Methods of assisted conception
IUI | IVF
61
Describe IVF
embryo harvested outside of uterus and transferred back. 2 weeks of FSH for follicular development with LH block to prevent ovulation Collect enough and give LH artificially then collect 48-72 hrs and transfer Fertilise via culture 5-6 days. transfer 2 embryos
62
Descrive IUI
Wash sperm and inject into the intrauterine cavity | Need normal tubes, regular menstrual cycle
63
Use of clomiphene for ovulation induction
Anti-oestrogen it blocks FSH/LH receptors causing increased please due to lack of oestrogen given at the start of the cycle for 5 days to help follicles grow SE: flushes and mood changes
64
Use of GnRH for ovulation induction
FSH(+LH) given by SC injection to stimulate follicular growth Monitor follicle size with USS When good, LH or BHCG
65
Side effects of ovulation induction
Mood Flushes multiple pregnancy Ovarian hyperstimulation - follicles large and painful
66
Causes of hypogonadotrophic hypogonadism
Congenital Kallmans, mutations in FSH/LH protein Acquired Structural - tumours, trauma, radiation, steroids, diet
67
Causes of hypergonadotrophic hypogonadism
Congenital Turners, klinefelters Enzyme changes FSH/LH receptor mutation Acquired: mumps, drugs (Steroids)
68
Type of vulval cancer
most are skin cancer, 90% squamous
69
Presentation of vulval cancer
lump or ulver on labia majora itch/bleed dysuria, dyspareunia
70
Risk factors for vulval cancer
``` lichen sclerosis immunosuppression HPV Age VIN ```
71
Ix and mx for vulval cancer
biopsy and FIGO staging | Local excision or radio/chemo
72
Type of vaginal cancer
Most are mets | Squamous
73
Risk factors for vaginal cancer
Gynae cances inflammation LT due to pessary HPV radiotherapy in plevis
74
Presentation of vaginal cancer
Asymptomatic, usually picked up on gynaecological examination bleeding, dysuria, pan, dyspareunia
75
Ix and mx of vaginal cancer
Colposcopy to biopsy and FIGO | Surgery and radiotherapy
76
Main type of cervical cancer
Squamous 80% | Adenocarcinoma 20%
77
Risk factors for cervical cancer
``` CIN HPV COCP Many partners Smoking ```
78
Presentation of cervical cancer
PCB, IMB, PMB Screening Discharge
79
Management of cervical ancer
Surgery, chemo
80
Main type of endometrial cancer and risk factors
80% adenocarcinoma ``` RF: Obesity Nulliparity Oestrogen DM Tamoxifem PCOS ```
81
Presentation of endometrial cancer
PMB | menstruqal bleeding other
82
Investigations for endometrial cancer
TVUS | MRI
83
Management for endometrial cancer
Total abode hysterectomy woith bilateral salpingoophorectomy Progesterone can be used in frail older women not suitable for surgery
84
Types of ovarian tumours
Surface derived Germ cell Sex cord stromal Mets
85
Risk factors for ovarian cancer
FH BRAC1/2 Ovulations high Lynch/CRC
86
Presentation of ovarian cancer
``` Abdo bloating/distension Mass Pelvic pain Urinary Early stately Diarrhoea ```
87
Management of ovarian cancer
Surgery/chemo

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