Miscellaneous gynae Flashcards
(30 cards)
What is adenomyosis?
The presence of endometrial tissue within the myometrium.
What is the most common demographic of adenomysois?
Usually seen in multiparous women towards the end of their reproductive years.
What are the clinical features of Adenomyosis?
Dysmenorrhoea
Menorrhagia
Enlarged “boggy” uterus
What is androgen insensitivity syndrome?
An X-linked recessive condition due to end organ resistance to testosterone. This means that men (XY) have the phenotypic appearance of a woman.
What are the clinical features of androgen insensitivity syndrome?
- primary amenorrhoea
- Undescended testes
- Breast development may occur
What is the management for androgen insensitivity syndrome?
- counselling - the child is raised as female
- bilateral orchidectomy as undescended testes increases risk of testicular cancer
- oestrogen therapy
What is atrophic vaginitis and how does it present?
atrophy of the vagina that occurs in post menopausal women.
Clinical features include: dyspareunia, vaginal dryness, a pale vagina on speculum, and occasional spotting.
What is the management for atrophic vaginitis?
Vaginal lubricants and moisturisers. If this doesn’t work then topical HRT (oestrogen) can be prescribed.
What is a molar pregnancy?
Also known as trophoblastic disease, it is where trophoblast cells proliferate too quickly occupying the space where the embryo develops.
partial mole: where two sperm fertilise one egg and there is too much.
complete mole: one or two sperm fertilise an egg with no genetic material inside.
What are the clincial features of a molar pregnancy?
- Vaginal bleeding
- Uterus larger than expected for gestational age
- Abnormally high hCG.
- USS: snowstorm appearance on ultrasound.
Describe the WHO classification for female genital mutilation (FGM)?
Type 1: Partial or total removal of the clitoris
Type 2: Partial or complete removal of the clitoris and labia minora, with or without the removal of the labia majora
Type 3: Narrowing of the vaginal orifice with the creation of a seal.
Type 4: All other harmful procedures to the female genitalia for non medical purposes.
What is the cause of fibroid degeneration?
Uterine fibroids are more sensitive to oestrogen and if they outgrow their blood supply they will degenerate.
How does uterine fibroid degeneration usually present?
Low grade fever, pain and vomiting. This is usually treated conservatively and should resolve within 4-7 days.
What is pelvic inflammatory disease and what are the most common causative organisms?
It is inflammation of the female pelvic organs and surrounding peritoneum. The most common causative organisms are:
- Chlamydia trachomatis
- Neisseria gonorrhoea
What are the clinical features of pelvic inflammatory disease?
- deep dyspareunia
- pelvic pain
- dysuria and menstrual abnormaltiies
- cervical excitation
- abnormal discharge
- fever
How should pelvic inflammatory disease be investigated?
- A pregnancy test to rule out ectopic pregnancy
- High vaginal swab
- Screen for Chlamydia and Gonorrhoea
What is the management for PID?
IM Ceftriaxone + oral doxycycline + oral metronidazole
What are the complications of PID?
Fitz-Hugh Curtis syndrome: presents as RUQ pain
Infertility
Chronic pelvic pain
Higher incidence of ectopic pregnancy
What is the differential diagnosis for acute pelvic pain?
1) Ectopic pregnancy
2) Miscarriage
3) UTI
4) Appendicitis
5) PID
6) Ovarian torsion
What is the differential diagnosis for chronic pelvic pain?
1) Endometriosis
2) Genital prolapse
3) Endometriosis
4) IBS
What are the causes of post-coital bleeding?
- Idiopathic in 50% of cases
- Cervical ectropion is the most common cause secondary to this
- Cervicitis as a result of infection - e.g. Chlamydia.
- Cervical cancer
- Trauma
- Polyps
What are uterine fibroids?
Benign tumours of the smooth muscle in the uterus that occur in 20% of caucasian women and 50% of afro-carribean women. They usually present in the later reproductive years.
What are the clinical features of uterine fibroids? + how are they diagnosed?
- Abdominal cramping
- Menorrhagia - as a result iron deficiency anaemia can occur.
- Urinary symptoms - e.g. Frequency can present in larger fibroids
- Bloating
- Subfertility
Diagnosis: transvaginal ultrasound
What is the management for menorrhagia secondary to fibroids?
- NSAID’s - e.g. Mefanamic acid/Tranexamic acid
- IUS can help with menorrhagia
- COCP, POP or depo-provera can also be used.
