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Other O&G Flashcards

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1
Q

When do you get pain from ovarian cysts?

A

Mid-cycle

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2
Q

What is Asherman syndrome?

A

Intrauterine adhesions, most commonly forming after intrauterine surgery

Rare

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3
Q

Which strains of HPV cause 95% of genital warts?

A

6 and 11

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4
Q

What is a grade 1 prolapse?

A

Organ is > 1cm above the hymen (halfway descent to the hymen)

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5
Q

What is a grade 2 prolapse?

A

Organ is <1 cm to the hymen

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6
Q

What is a grade 3 prolapse?

A

Organ is > 1cm below the hymen but does not protrude out more than 2cm less the vaginal length

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7
Q

What is a grade 4 prolapse?

A

The vagina is completely everted

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8
Q

What are 3 clinical features of Sheehan syndrome?

A

Low prolactin → failure of lactation

Low LH → amenorrhoea

Low ACTH → low androgens → loss of pubic and axillary hair

Low ACTH → low cortisol → adrenal insufficiency → vomiting, hypotension, hypoglycaemia

Low FSH → hypothyroidism

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9
Q

Urethral hypermobility and an intrinsic sphincter deficiency cause which type of incontinence?

A

Stress

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10
Q

Neurological conditions such as Parkinson disease are most likely to cause which type of incontinence?

A

Urge

Due to sensory and/or motor dysfunction

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11
Q

Pelvic floor exercises, lifestyle changes and pessaries are used to treat which type of incontinence?

A

Stress

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12
Q

Anticholinergics are used to treat which type of incontinence?

A

Urge

→ block parasympathetic → decreased detrusor overactivity → reduced voiding

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13
Q

What is overflow incontinence?

A

Urinary retention and bladder distension caused by outlet obstruction (e.g., prostatic enlargement) or detrusor underactivity

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14
Q

UTIs, bladder cancer and renal stones are likely to cause which type of incontinence?

A

Urge

Local irritation → detrusor instability

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15
Q

What is functional incontinence?

A

Urine loss associated with difficulty reaching a toilet when needed i.e. impaired physical or cognitive functioning

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16
Q

Why might alpha blockers aggravate patients with stress incontience?

A

Decreased sphincter tone

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17
Q

What is the difference between detrusor instability/overactive bladder and urge incontinence?

A

People with overactive bladder are not necessarily incontinence but have urgency

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18
Q

Name 2 anticholinergics which can be used for urinary incontinence

A
  1. Oxybutynin
  2. Tolterodine
  3. Solifenacin
  4. Darifenacin
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19
Q

What are 3 side effects of anticholinergics?

A
  1. Dry eyes
  2. Dry mouth
  3. Constipation
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20
Q

Name 2 drugs other than anticholinergics that can be used for urinary incontinence

A
  1. Duloxetine (SNRI)
  2. Imipramine (TCA)
  3. Mirabegron (beta 3 adrenergic agonist)
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21
Q

What is the first-line surgical procedure for stress incontinence?

A

Midurethral sling

Reduces bladder neck hypermobility

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22
Q

What are two procedures that can be performed for urge incontinence?

A
  1. Botulinium toxin
  2. Sacral nerve stimulation
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23
Q

What are 4 lifestyle interventions for incontinence?

A
  1. Pelvic floor exercises
  2. Reduce caffeine intake
  3. Smoking cessation
  4. Bladder training (urge)
  5. Weight loss (stress)
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24
Q

Rank the prevalence of stress, urge and mixed incontinence

A
  1. Stress
  2. Mixed
  3. Urge
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25
What is detrusor sphincter dyssnergia?
Simultaneous contractions of the detrusor muscle and involuntary activation of the internal urethral sphincter → blockage of bladder outlet → small amounts of urine are pressed through the contracted sphincter muscle ## Footnote *Seen in MS or spinal cord injury*
26
- Irregular, small volume incontinence with urinary retention - No associated urge to void - Spinal cord injury/MS is characteristic of which type of incontinence?
Detrusor sphincter dyssynergia Detrusor contraction with internal urethral sphincter activation
27
What are the two main mechanisms of stress incontinence?
1. Urethral hypermobility 2. Intrinsic sphincter deficiency
28
Why does urethral hypermobility cause incontinence?
Weak pelvic floor → insufficient support for the urethra and bladder neck → hypermobility Weak pelvic floor → increases in intra-abdominal pressure cannot be transmitted to the urethra, causing closure
29
Why is decreased oestrogen a risk factor for incontinence?
→ atrophy of the superficial and intermediate layers of the urethral mucosal epithelium → atrophic urethritis, diminished urethral mucosal seal, loss of compliance, irritation
30
- Dribbling of urine in the absence of urge - Incomplete bladder emptying is characteristic of which type of incontinence?
Overflow
31
What are the two causes of overflow incontinence?
1. Detrusor underactivity 2. Bladder outlet obstruction
32
Which receptor is targeted in anticholinergics for incontinence?
M3
33
What is the first line treatment for lichen sclerosis?
Topical corticosteroids
34
How do corpus luteum cysts form?
1. Failure of involution of the corpus luteum (by day 28) 2. Surrounding blood vessels bleed into the corpus luteum 3. The corpus luteum continues to produce progesterone, which may delay menses
35
Which type of ovarian cyst is haemorrhagic?
Corpus luteum
36
How do theca lutein cysts form?
Excessive hCG stimulation
37
What are some of the causes of theca lutein cysts?
Gestational trophoblastic disease Multiple gestation Diabetes mellitus PCOS
38
How do follicular cysts form?
Failure of the follicle to rupture at day 14 of the menstrual cycle
39
What is a cervical ectopion?
May cause PV bleeding due to exposure of the fragile columnar epithelium to the acidic environment of the vagina
40
What are fibroids?
Benign tumours of the myometrium.
41
What is the histological appearance of fibroids?
Spiralled bundles of smooth muscle
42
What are the risk factors for developing fibroids?
African-Caribbean Increasing age Nulligravidity Obesity
43
What are the medical therapies used as adjuncts to surgery in the management of fibroids?
GnRH analogues NSAIDs Tranexamic acid Androgenic agonists e.g., danazol (suppress fibroid growth)
44
What is the difference between small for gestational age and intrauterine growth restriction?
SGA: fetus is small for expected size at certain gestation, but continues to grow at a normal rate IUGR: fetus is small or normal sized for expected size at a certain gestation, but the growth rate slows down as the pregnancy advances
45
What are the causes of symmetrical IUGR?
Chromosomal abnormalities Fetal alcohol syndrome Intrauterine infections
46
What are the 5 stages of twin-twin transfusion syndrome?
I - Oligohydraminos and polyhydramnios 2. Donor bladder is not visualised 3. Abnormal Doppler indices 4. One or both fetuses show signs of hydrops 5. One or both fetuses have died
47
How is Chlamydia treated?
Doxycycline or azithromycin
48
How is gonorrhoea treated?
Ceftriaxone PLUS Azithromycin
49
How is bacterial vaginosis diagnosed?
Amsel's criteria: 3/4 of the following on vaginal discharge sample Whiff test - 1-2 drops of 10% KOH intensifies fishy odour Vaginal pH \> 4.5 No leukocytes on microscopy Clue cells: vaginal epithelial cells covered with bacterial identified on wet mount preparation
50
How is bacterial vaginitis treated?
Oral metronidazole
51
What pathogen causes bacterial vaginitis?
Overgrowth of *Gardnerella vaginalis*
52
What is the primary risk factor for bacterial vaginitis?
Sexual intercourse (but not an STD)
53
Curd-like vaginal discharge is characteristic of which disease?
Vulvovaginal candidiasis
54
Malodourous, fish-smelling vaginal discharge is characteristic of which infection?
Bacterial vaginosis (Gardnerella vaginalis)
55
Purulent, malodorous discharge, which may be accompanied by burning, pruritus, dysuria, frequency, and/or dyspareunia is characteristic of which condition?
Trichomoniasis
56
What are the steps in performing a pelvic exam?
1. Light lower abdominal palpation 2. Speculum and CST 3. Bi manual 4. Pelvic floor test Optional - High vaginal swab - Endocarvical smear - Breast examination
57
Prior to a speculum examination, why is a light abdominal palpation performed?
'ice breaker' for the patient Scars, masses, tenderness Raised lymph nodes (infection or malignancy)
58
When is terbutaline used in O&G?
Tocolysis
59
How is lichen sclerosus treated?
Topical corticosteroids
60
Which conditions are associated with lichen sclerosis?
Autoimmune e.g., thyroid, pernicious anaemia, alopecia, DM, vitiligo
61
What genitalia (external and internal) is present in people with androgen insensitivity syndrome?
External: female Internal: male Karotype: 46 XY
62
What type of ovarian cyst is classically bilateral?
Theca lutein ## Footnote *Due to excessive hCG stimulation - GTD, multiple gestation, DM, PCOS*
63
How is trichominiasis treated?
Metronidazole
64
What cause(s) of vulvovaginitis are sexually transmitted?
Trichomoniasis ## Footnote *Not candidasis or bacterial vaginosis*
65
What does a strawberry cervix suggest?
Trichomoniasis ## Footnote *Petechiae on the vagina and cervix*
66
What should be avoided with metronidazole therapy?
Alcohol consuption
67
What is condylomata lata?
Broad-based, wart-like papular erosions in secondary syphilis
68
Where do you swab when testing for chlamydia/gonorrhoea?
Cervix
69
What are 3 complications of chlamydia?
1. PID 2. Ectopic pregnancy 3. Fitz-High-Curtis syndrome 4. Reactive arthritis 5. Chronic pelvic pain 6. Perinatal infection (conjunctivitis, pneumonia)
70
What are 2 complications of congenital chlamydia?
1. Conjunctivitis 2. Pneumonia
71
How can HPV warts be treated?
Podopyllotoxin cream Imiquimod cream Cryotherapy Excision
72
What are the potential complications of syphilis?
Gumma: destructive granulomatous lesions with a necrotic centre (can affect any organ) Cardio: aortic aneurysm, dilated aortic root Neurosyphilus: tabes dorsalis, general paresis
73
What organisms cause bartholin gland abscesses?
Anaerobes + polymicrobial ## Footnote *E. coli, Staphylococcus, Streptococcus, N. gonorrhoea, C. trachomatis*
74
What is toxic shock syndrome?
Multi-organ failure to due S. aureus exotoxin
75
What is an endometrioma?
Ovarian cyst secondary to endometriosis
76
What are some of the complications of lichen sclerosis?
Secondary infection Increased risk of STI due to open excoriations and fissures Increased SCC risk Labial fusion
77
How is a diagnosis of lichen sclerosis confirmed?
Punch biopsy
78
Which drugs are associated with hyperprolactinemia?
1st generation antipsychotics Risperidone Metoclopramide/domperidone Methyldopa
79
In which populations is ectropion most common?
Adolescents Pregnant women COCP
80
What microbiological testing is done for PID?
Endocervical (+/- high vaginal) swab ## Footnote * Chlamydia trachomatitis* * Neisseria gonorrhoea* * Mycoplasma genitalium*
81
What are the risks of lichen sclerosis?
5% risk of SCC over 20 years Secondary infections Labial fusion Increased STI risk due to open excoriations and fissures
82
What are the risks of oestrogen-only HRT?
Endometrial cancer
83
What are the risks of combined HRT?
Breast cancer ## Footnote * But oestrogen only increases risk of endometrial cancer* * Use over oestrogen-only HRT in any woman with an intact uterus*
84
What AFP, hCG and PAPP-A results are found in Down syndrome?
AFP - low hCG - high PAPP-A - low
85
Which antifungal drug is contraindicated in pregnancy?
Fluconazole

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