Gynecology Flashcards
(57 cards)
Define Primary and secondary amenorrhoea:
Primary:
- Absence of Menses by age 16 years.
- with secondary sexual characteristics
(imperforated hymen, Mullerian agenise, Transvaginal septae)
- Absence of menses by age 14 years
- without secondary sexual characteristics
(Turner’s syndrome, Kalmann’s syndrome, testicular feminisation syndrome)
Secondary:
- >3 months in a female who previously had regular cycles
- > 6 months in a female who previously had irregular cycles
What would you want to establish in this history of someone with heavy menstrual bleeding?
- regularity of bleeding
- amount
- how long they last
- date of last period
What are some investigations into heavy menstrual bleeding?
Bloods: - FBC \+/- - Hormones - TFTs - Coagulation
Orifices:
- Urine dipstick
- Hysteroscopy
X-rays:
- Transvaginal ultrasound scan
Special tests:
- Endometrial biopsy
**biopsy always in persistent bleeding and >45 years old.
What are the treatment options for heavy menstrual bleeding?
Non-hormonal:
- Mefenamic acid
- Tranexamic acid - used 5 days during menstrating
Hormonal:
- Combined pill
- Progesterone
- levonorgestrel releasing intra-uterine device - 1st line
GnRH analogues
Surgical:
- endometrial ablation
- Hysterectomy
+/-
- Uterine artery ablation for fibroids
What examination should be done into heavy menstrual bleeding?
Abdominal examination
Bimanual examination
Speculum
What is the criteria for PCOS?
Rotterdam Criteria:
- clinical evidence of high androgens
- Oligomenorrhoea
- Ultrasound of Cysts
How should intermenstrual bleeding be investigated?
Cervical smear
Bimanual examination and Speculum
+ Abdominal examination
STD Screen + treatment
Urine pregnancy test
TVS incase of endometrial pathology
How should post menopausal bleeding be investigated?
Transvaginal ultrasound
- Biopsy if Endometrium >4mm
- Biopsy if endometrium >8mm and on HRT
- Biopsy if on tamoxifen
**remember that this measurement is a double thickness layer. i.e. both sides of the endometrium are measured.
What staging is used for endometrial cancer?
International Federation of Obs and Gyn
What is the definition of PID?
Infection of the upper female reproductive organs which includes:
- uterus
- Fallopian tubes (salpingitis)
- ovaries (salpingo- oophoritis)
What are some risk factors for PID?
History of STIs
Multiple sexual partners
Lack of protection
What are the complications of PID?
Tubo-ovarian Abscess
Hydro-salpinx
Fitz- Hugh Curtis Syndrome
Subfertility
Ectopic pregnancy
How is PID treated?
Ceftriaxone 500mg IM STAT
followed by:
- Doxycycline
- Metronidazole
What is it called when there is fluid build up in the fallopian tube?
Hydro-salpinx
What are the classical symptoms of endometriosis?
Cyclical pain
- dysmenorrhoea
- dyspareunia
- dysuria
- dyschezia
- subfertility
Bleeding at distant sites. i.e.
- haemothorax
What things may be noted on a bimanual examination of the uterus in a patient with endometriosis?
Fixed retroverted uterus
Uterosacral ligament nodules
General tenderness
What are the differentials for endometriosis?
PID
Ectopic Pregnancy
Fibroids
IBS
What is the definitive diagnosis for endometriosis and what findings may be seen?
Laparoscopy
- Chocolate cysts
- Adhesions
- Peritoneal deposits
What is the normal position of the uterus?
Anteverted
- where it sits leaning forward
What are the markers for ovarian cysts/ tumours and which one’s specifically for teratomas?
Ca125
CEA
Alpha fetal protein
hCG
What are the genes associated with ovarian cancer?
BRCA -1
BRCA -2
Lynch syndrome -II / HNPCC
What staging is used for ovarian cancer?
FIGO staging
1 - limited to ovaries
2 - limited to pelvis
3 - limited to abdomen, including lymph nodes
4 - distant mets
What investigations should be conducted into suspected ovarian cancer?
Bloods:
- FBC
- LFTs
- U&Es
Tumour markers:
- Ca125
- CEA
- AFP
- LDH
- hCG
X-rays:
- TVS / Pelvic ultrasound
- MRI
- CT C/A/P
What is the treatment for ovarian cancer?
Full staging laparotomy
