Gynecology 2 Flashcards by John Darlington

What is the main causes of intermenstrual bleeding?

Cervical

Ectopy
CIN
Cancer

Uterine

polyps
fibroids

Infections

Hormonal

contraception *breakthrough bleed
Tamoxifen

Vaginal adenosis

How well did you know this?

Not at all

Perfectly

What are the differentials for post-menopausal bleeding?

HRT

Atrophic vaginitis

Endometrial cancer

Cervical cancer

Infection

How well did you know this?

Not at all

Perfectly

What are some differentials for a pelvic mass?

Ovarian tumour/ cyst

Uterine fibroids

Pelvic abscess

Pregnancy

Bowel

Faecal loading
Carcinoma

How well did you know this?

Not at all

Perfectly

What are the symptoms of an ovarian mass?

Abdominal bloating/ distention

Pain

Torsion
Rupture
Haemorrhagic cyst

Bowel obstruction

Altered menstrual cycle

Hormonal changes

How well did you know this?

Not at all

Perfectly

What are some risk factors for prolapse?

Pelvic floor weakness

Multiparity

Oestrogen deprivation
- weakness of the vagina

Increased intrabdominal pressure

How well did you know this?

Not at all

Perfectly

What are the differentials for a painful/ itchy vulo-vagina?

Infection

HSV
Gonorrhoea

Atrophic vaginitis

Lichen sclerosis

Vulvodynia

Vulva carcinoma

How well did you know this?

Not at all

Perfectly

What are the main causes of infertility?

Anovulation 
Tubal pathology 
Male factors 
Endometriosis 
Unexplained

How well did you know this?

Not at all

Perfectly

What are the main investigations into subfertility?

Females:
1
- FSH levels (day 3 of cycle)
- Anti-mullerian hormone

- Pelvic ultrasound/ TVS (fibroids, mass, cysts of ovaries)
- Day 21 progesterone
- tubal patency (hystro-salpingo contrast sonography/ Blue dye test)

Males:
- semen analysis (count, motility, morphology)

How well did you know this?

Not at all

Perfectly

What are the main causes for a recurrent miscarriage?

Chromosomal abnormalities of the fetus

Immunological causes
- phospholipid syndrome

Endocrine factors

hypo/hyperthyroidism *hypo more common
PCOS

Uterine abnormalities

Bicornate
Separate Uteri

Infections

rubella
CMV

Environmental factors

How well did you know this?

Not at all

Perfectly

Where are the locations for ectopic pregnancy?

Tubal - 99% of cases - Ampulla 
Ovarian 
Cervical 
Peritoneal 
Pregnancy of unknown location

How well did you know this?

Not at all

Perfectly

By how much should hCG not rise by to suspect ectopic pregnancy?

66%

How well did you know this?

Not at all

Perfectly

What are the complications of PID?

Subfertility

Recurrent pain

Ectopic pregnancy

Tubo-ovarian abscess

How well did you know this?

Not at all

Perfectly

What are the top causes for a raised ca125?

Ovarian cancers (epithelial)

Other cancers:

endometrial
G.I
Lung
Breast

Endometriosis

Pregnancy

Peritoneal inflammation
- ascites

How well did you know this?

Not at all

Perfectly

What is called when there is onset of symptoms causing
- physical
- psychological
- behavioural
symptoms during the menstrual cycle and when do they typically begin?

Pre- menstrual syndrome

during the luteal phase.

How well did you know this?

Not at all

Perfectly

What are the management options for primary dysmenorrhoea?

Pain that starts in the first two years of menarche

NSAIDs

Mefenamic acid
ibuprofen

Combined oral contraceptive

Mirena coil

Injectable progesterone

How well did you know this?

Not at all

Perfectly

What signs would you look for in cervical carcinoma?

Mass
Lymphadenopathy
Irregular discharge - blood stained
Ulceration

How well did you know this?

Not at all

Perfectly

How is endomitosis descried as on laparoscopy?

burnt match heads
- areas of puckered redness

Chocolate cysts within the ovaries

Hemosiderin with peritoneum covering

Scarring

How well did you know this?

Not at all

Perfectly

Which type of HRT is most appropriate for perimenopausal women?

Cyclical HRT

- if periods are still present then cyclical is best as it has predictable withdrawal bleeds`

How well did you know this?

Not at all

Perfectly

List some causes of vaginal discharge:

Infections:

Bacterial vaginosis
Candida albicans
Trichomonas vaginlis

Cervical infections:

Chlamydia trachomatis
N. Gonorrhoeae

Cervical ectopy

Retained tampons

How well did you know this?

Not at all

Perfectly

What is the tests done into premature ovarian failure?

FSH levels 1-5 days into menstrual cycle. Usually levels should be starting to increase. In failure they will be very high.

other tests can include:

Anti - Mullerian hormone
Ultrasound of ovaries

How well did you know this?

Not at all

Perfectly

What are the initial investigations that should be conducted into female infertility?

Bloods:

FSH
LH
Oestradiol
Anti-Mullerian hormone
progesterone test for ovulation

Tubal patency testing:

laparoscopic hydrotubation
hysterosalpingo- contrast sonography

How well did you know this?

Not at all

Perfectly

What are the major causes of female infertility?

Premature ovarian insufficiency/ ovarian reserve deficiency

Anovulation

PCOS
Amenorrhoea (primary/ secondary)

Tubal patency

PID
Endometriosis
Adhesions

Structural

fibroids
Adhesions
Vaginal septum

How well did you know this?

Not at all

Perfectly

What are the methods to promote ovulation used?

Study These Flashcards

Clomiphene
- induces ovulation

Exogenous gonadotrophins 
(exogenous hCG is used to promote LH surge)

Laparoscopic ovarian drilling

What are the various techniques used for assisted conception?

Study These Flashcards

Intrauterine insemination

In vitro fertilisation

Intracytoplasmic sperm injection

What are the contraindications to HRT?

Previous breast cancer/ current breast cancer Oestrogen sensitive tumour Undiagnosed PV bleeding Endometrial hyperplasia Previous DVT

What are the risks of HRT?

Breast cancer VTE Stroke Ovarian/ endometrial cancer

What are some non-hormonal treatments for menopause?

SSRIs for vasomotor symptoms - fluoxetine Vaginal moisturisers CBT/ support groups - psychological symptoms Satellite ganglion blockage

List some cause of post menopausal bleeding:

Vaginal atrophy - most common cause Endometrial cancer - 10% of cases HRT - often causes small spotting etc Cervical cancer Ovarian Cancer - especially oestrogen secreting Bleeding disorders

What age group should be immediately referred for post menopausal bleeding and what age is this?

>55 years should be referred within 2 weeks - TVS (>5mm) - Hysteroscopy - Endometrial biopsy with pipelle +/- MRI

What are the typical symptoms of urogenital prolapses?

Sensation of heaviness in the vagina Dragging/ something coming down in the vagina Urinary symptoms - UTIs - Frequency - Dysuria Dyspareunia

What is the management options for prolapses?

Lifestyles changes - weight loss Pelvic floor exercises Ring pessaries Surgery - Anterior Colporrhaphy/ colposuspension (Cystoceles) - Utero-sacral ligament suspension Hysterectomy / sacrohysteropexy (Uterine) - Posterior Colporrhaphy (rectocele)

List some causes of primary amenorrhoea:

Turner's syndrome Testicular feminisation Congenital adrenal hyperplasia Congenital malformations of genital tract - imperforate hymen - absent uterus - vaginal atresia * these the female will have normal secondary characteristics

Name a muscarinic inhibitor used for urge incontinence:

Oxybutynin

What investigations should be done into urinary incontinence?

Urinalysis Bladder diary - can help narrow down the type Cystoscopy - if haematuria - recurrent STIs Urodynamic studies

In someone with incontinence, where voiding diaries have been done and there is diagnostic uncertainty what would be the most appropriate next investigation?

Urodynamic studies

How can you differentiate between a vulva intra epithelium neoplasia and vulva carcinoma?

Carcinoma tends to ulcerate whereas VIN tends to be white or plaque like

What action should be undertaken when you discover someone to have had female genital mutilation?

Medical team and police

What is the most appropriate surgical treatment for vaginal vault prolapse?

Sacrocolpopexy

What score is used to establish the likely hood of malignancy in a cyst? and how do yo calculate it?

RIsk of Malignancy Index (RMI) Ultrasound score x Menopausal status x Ca125 RMI >250 = 75% risk of cancer

Highlight some of the clinical symptoms and features of ovarian cyst, and how are they investigated?

- Asymptomatic (picked up incidentally) - Dull ache - Bloating - Irregular bleeding - intestinal obstruction +/- - osteogen/ androgen effects +/- - torsion Pelvis mass Abdominal mass Ascites Pleural effusion Bloods: - FBC - Ca125 +/- CEA, AFP, hCG Imaging: - TVS - MRI

What is the management of ovarian cysts?

Premenopausal: * Low RMI and <5cm - Rescan 6 weeks * High RMI or >5cm - Cystectomy Postmenopausal: * Low RMI - 3-6 monthly Ca125 * Intermediate RMI : - Bilateral oophorectomy (with follow on if cancerous) * High risk RMI >250 - Referral to cancer centre - laparotomy

Define primary and secondary dysmenorrhoea and highlight the treatment for primary:

Primary Dysmenorrhoea: - painful periods, uncomfortable periods - starts within 2 years of menstrual cycle - no underlying pathology Secondary dysmenorrhoea: - underlying pathology Treatment of primary: - Mefenamic acid (NSAID) - COCP - Mirena coil - Progesterone pill

List the causes of heavy menorrhagia and highlight the investigations:

Dysfunctional uterine bleeding - no underlying pathology Uterine fibroids Endometriosis Endometrial polyps Hypothyroidism Bleeding disorders Investigations: - FBC - TFTs - Oestrogen/ FSH/ LH - Coagulation Imaging: - TVS +/- - Hysteroscopy +/- biopsy

List the management options for menorrhagia:

Hormonal: - Mirena - GnRH Analogues - Progesterone Non-hormonal: - Tranexamic acid - Mefenamic acid Surgical: - endometrial ablation - hysterectomy

What are the two major classes of endometrial cancer?

Adenocarcinoma - glandular from over over stimulation - comes off atypical hyperplasia Serous carcinoma - sporadic

What are the main ovarian cancer genetics?

BRCA1 BRCA2 HNPCC

What staging is used for ovarian cancers?

``` FIGO I - limited to ovaries II - Limited to pelvis III - limited to abdomen including lymph nodes IV - distant metastases out of abdomen ```

What are the clinical appearances of cervical cancer on speculum?

Exophytic lesion Infiltrating tumour Ulcerative mass

What are the two major histological types of cervical cancer and What is the stating of cervical cancer?

Squamous Adenocarcinoma Ia - Identifiable microscopically Ib - Identifiable macroscopically II - Beyond cervix but within pelvic wall and may involve upper 1/3rd of vagina III - Extends beyond pelvic wall and may involve upper 1/3rd of vagina IV - Extends to bladder/ rectum/ metastasis

What investigations should be done into suspected cervical cancer?

STI screen Colposcopy + biopsy Pelvic MRI CT chest/ Abdo/ Pelvis Bloods: - FBC - LFTS (early mets) - U&Es

What are the leading differentials for a patient presenting with severe pelvic pain during their menstrual cycle?

Endometriosis PID

What are the leading differentials for post coital bleeding?

Cervical ectropion Cervical polyp Cervical carcinoma Vaginitis

What are type of cancer is contraindicates the use of HRT?

Oestrogen dependent breast cancer Endometrial - by undiagnosed PV bleeding

What are some alternatives to HRT?

Vasomotor symptoms: - SSRIs - clonidine Osteoporosis - Bisphosphonates - Vitamin D Vaginal dryness - Lubricants - local oestrogen Diet and exercise CBT

What are the benefits of HRT?

improved genital urinary symptoms Reduced osteoporosis Reduced risk of colorectal cancer * may offset Alzheimer's * may reduce cardiovascular disease

When are women considered not at risk of pregnancy during the menopause?

<50 years - 2 years since last period >50 years - 1 year since last period

What monitoring is needed when on HRT?

Breast BP Weight Abnormal bleeding

Gynecology 2 Flashcards

(57 cards)