Week 204 - Gynaecology Flashcards by Tom Lawson

Week 204 - Gynaecology: Give a definition of menorrhagia and give the objective definition.

Excessive loss of blood during menstruation.

* >80ml

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Week 204 - Gynaecology: Give a definition of dysmenorrhea.

Painful menstrual periods.

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Week 204 - Gynaecology: What is primary and secondary dysmenorrhea?

Primary - no associated with organic disease or psychological cause.
Secondary - A cause can be found (e.g. endometriosis, PID)

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Week 204 - Gynaecology: What is Dyspareunia?

Pain during sexual intercourse.

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Week 204 - Gynaecology: What are the three differentials for menorrhagia?

Dysfunctional uterine bleeding.
Uterine leiomyomas (Fibroids).
Endometriosis or Adenomyosis.

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Week 204 - Gynaecology: What is the common name for uterine leiomyomas?

• Fibroids

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Week 204 - Gynaecology: What is dysfunctional uterine bleeding?

This is heavy menstrual bleeding that is not associated with organic disease of the genital tract.

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Week 204 - Gynaecology: What are fibroids? What is the medical term for them?

Uterine Leiomyomas.

* Benign growths in the uterus which can cause heavy menstrual bleeding.

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Week 204 - Gynaecology: What is endometriosis?

This is where endometrial tissue is found outside of the uterus. It can cause heavy bleeding, persistent pain and infertility.

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Week 204 - Gynaecology: What is adenomyosis?

This is where endometrial tissue grows within the myometrium.

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Week 204 - Gynaecology: What key feature of examination is used to distinguish between fibroids and dysfunctional uterine bleeding?

The size of the uterus.

* DUB will typically be a normal sized uterus whilst fibroids will lead to an enlarged uterus.

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Week 204 - Gynaecology: On examination you feel an enlarged uterus, what is your initial investigation?

• USS, this is to determine whether there are fibroids or an ovarian cyst.

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Week 204 - Gynaecology: A 25yr olf lady presents with heavy menstrual bleeding? Is an endometrial biopsy required? When is a biopsy indicated?

No, this is normally only performed in patients over 40, since the risk of endometrial cancer increases after 40. It may indicated in a younger woman if she fails to respond to treatment.

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Week 204 - Gynaecology: What initial investigation should be offered to women who experience heavy menstrual bleeding?

FBC - to identify anaemia.

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Week 204 - Gynaecology: What are the five medical treatments for menorrhagia?

Tranexamic Acid
Mefenamic Acid
Combined Oral Contraceptive Pill
Oral Progesterones.
Mirena IUS

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Week 204 - Gynaecology: What is the role of Tranexamic acid in the treatment of menorrhagia?

Antifibrinolytic.

* Taken during menstruation and can reduce blood loss by 50%.

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Week 204 - Gynaecology: What is the role of Mefenamic Acid in the treatment of menorrhagia?

NSAID
Useful for dysmenorrhoea and also reduces blood loss.
Can be used in conjuction with Tranexamic acid.

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Week 204 - Gynaecology: What is the role of the oral contraceptive pill in the treatment of menorrhagia?

Reduces blood loss by 10-20%, and also helps with dysmenorrhoea.

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Week 204 - Gynaecology: What impact does the Mirena IUS have on menorrhagia?

• Reduces blood loss by 90% and at 1 year 30% are amenorrhoeic.

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Week 204 - Gynaecology: In patients who are very anaemic or constantly bleeding what is the treatment aim? And what treatments are used?

To achieve Amenorrhoea rapidly.
GnRHa - Inhibits release of Gonadotrophins so inhibits the release of oestrogen and androgen.
High dose progesterones.

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Week 204 - Gynaecology: When is the use of surgery indicated in the treatment of menorrhagia and what are the options?

Failure of medical treatment and when family is complete.
Endometrial ablation - destruction of endometrium.
Hysterectomy.

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Week 204 - Gynaecology: Where are the six locations for an ectopic pregnancy and which is the most common?

Study These Flashcards

Interstitial/Cornual
Isthmic Tubal
Infundibular Tubal
Ovarian
Abdomial
Ampullar Tubal (Most common, due to narrowing of fallopian tube).

Week 204 - Gynaecology: What are the risk factors for developing fibroids?

Study These Flashcards

Age (Later reproductive years)
Menarche (Early onset)
Race (African)
Hypertension / CV risk
Family History
Obesity
Tamoxifen

Week 204 - Gynaecology: Which drug, used in the treatment of breast cancer, is a risk factor for developing fibroids?

Study These Flashcards

Tamoxifen

Week 204 - Gynaecology: What are the five locations of fibroids? Give a brief description of each.

* Intramural - This is completely enclosed in the endometrium. * Submucosal - This is where it protrudes into the uterus but is covered by a layer of mucosa. * Subserosal - Opposite of a submucosal, protrudes out the external wall of the uterus, but it covered by serosa. * Pedunculated - Both subserosal and submucosal. Look like pendulums.

Week 204 - Gynaecology: What are the symptoms of fibroids?

* Asymptomatic - 50% * Heavy menstrual bleeding. * Haematological disorders. * Dysmenorrhoea. * Infertility.

Week 204 - Gynaecology: What investigations should be performed for suspected fibroids?

* FBC - Hb * Tumour Markers - Ca125, CEA * USS * Endometrial biopsy (Women over 40) * Hysteroscopy/Laparoscopy

Week 204 - Gynaecology: What are the medical treatments available for fibroids?

* Esmya * GnRH agonists. - Shrink fibroid and reduce vascularity. * Mirena IUS

Week 204 - Gynaecology: How does Esmya treat fibroids?

Three modes of action- • Acts on the fibroid by reducing progesterone receptors which reduces cell proliferation and induces apoptosis. • Acts on the pituitary to reduce Gonadotrophin secretion.. • Acts on the endometrium to have a direct affect to reduce bleeding.

Week 204 - Gynaecology: What are the surgical options for the treatment of fibroids?

* Myomectomy - Surgical removal of fibroids. * Hysterectomy * Uterine Artery Embolisation - cut's off blood supply to fibroid.

Week 204 - Gynaecology: What are the complications of ovarian cysts?

* Pain * Torsion * Rupture * Haemorrhage * Malignancy * Hormone Secretion

Week 204 - Gynaecology: What are the main types of ovarian cysts?

* Physiological - Follicular + Luteal * Endometriomas * Polycystic Ovaries * Germ cell tumours * Epithelial tumours * Sex cord stromal tumours

Week 204 - Gynaecology: What is the Risk of Malignancy Index (For ovarian cysts)

* This is calculation that identifies the risk of a cyst developing into a cancer. * RMI = U x M x CA125 * U is uss features. (Either 0,1or3) * M is menopause (1 if pre, 3 if post) * CA125 (Serum level in IU/ml)

Week 204 - Gynaecology: What are the USS features for RMI? How do they score?

* Multiolocular cysts, Solid Areas, Metastases, Ascites, Bilateral lesions. * The presence of one scores one point. * The presence of 2 or more scores three points.

Week 204 - Gynaecology: According to WHO in 2009, what should a good semen sample be? (Mls,Count,Motility,Normal)

Volume - 1.5ml to 6ml Count - >15x10(6)/ml Motility - >40% Normal- >4%

Week 204 - Gynaecology: What is the definition of subfertility?

Involuntary failure to conceive.

Week 204 - Gynaecology: What are the causes of subfertility?

* Ovulation Disorder - 25% * Sperm Dysfunction - 30% * Tubal disease - 20% * Endometriosis - 10% * Coital failure, uterine abnormalities - 10%

Week 204 - Gynaecology: The menstrual cycle is divided into which three phases?

* Follicular phase * Ovulatory phase * Luteal phase

Week 204 - Gynaecology: What occurs during the Follicular phase of the menstrual cycle?

* FSH slowly decrease, LH slowly increases. * The follicle matures. * Oestradiol slowly increase, progesterone remains at a low level. * The endometrium breaks down and begins to build up again.

Week 204 - Gynaecology: What occurs during the ovulatory phase of the menstrual cycle?

* LH spikes, FSH has a slight increase. * Ovulation * Oestradiol peaks and then drops off, progesterone slightly rises. * The endometrial wall is at its peak.

Week 204 - Gynaecology: What occurs during the Luteal phase of the menstrual cycle?

* LH and FSH starts low and slowly decreases. * The corpus luteum forms. * Progesterone reaches it's peak and then drops off, Oestradiol slowly decreases. * The endometrium begins to breakdown.

Week 204 - Gynaecology: Ovulation disorders can arise due to a disruption of the hypothalamus-pituitary-ovarian axis, in what ways?

* Hypothalamus - Eating disorders, stress, exercise, underweight. * Pituitary - Prolactinomas, Sheehans, Craniopharyngomas, hypophysectomy, radiotherapy, idiopathic. * Ovarian - PCOS, Primary ovarian failure.

Week 204 - Gynaecology: What is the medical treatment of ovulatory disorders?

* Oestrogen antagonists. | * Gonadotrophins - FSH + LH

Week 204 - Gynaecology: What are the leading pathological causes of tubal disease?

* Infective - Chlamydia Trachomatis, Neisseria gonorrhoea. | * Inflammatory - Endometriosis

Week 204 - Gynaecology: What are the indications for assisted conception?

* Dysfunctional sperm * Tubal disease * Endometriosis * Prolonged unexplained infertility (>2yrs) * Preimplantation genetic diagnosis * Failed fertility treatments

Week 204 - Gynaecology: Describe in vitro fertilisation.

* Oocyte is recovered transvaginally. * Fertilised. * Cultured 2-5days. * Embryo transfer. * Freezing of remaining embryos.

Week 204 - Gynaecology: What are the risks of assisted contraception?

* Ovarian hyperstimulation syndrome - Massive ovarian cysts, ascites, pleural and pericardial effusion, hypovolaemia. * Multiple pregnancy. * Pelvic/ovarian sepsis. * Ovarian torsion.

Week 204 - Gynaecology: What is a molar pregnancy?

This is overgrowth of the placenta, also known as trophoblastic disease.

Week 204 - Gynaecology: If you were to have a woman with a +ve pregnancy test with an empty uterus on USS what are your differentials?

* Ectopic pregnancy * Very early pregnancy * Complete miscarriage

Week 204 - Gynaecology: What is the management of miscarriage?

* Expectant * Medical with mifepristone and misoprostol * Surgical

Week 204 - Gynaecology: In an intrauterine pregnancy what would you expect the HCG to rise by?

• >60% within 48hrs, if there is a suboptimal rise, suspect an ectopic pregnancy.

Week 204 - Gynaecology: What are the three regimens of HRT?

1) E2 only - for hysterectomised women only. 2) Sequential - E2 every day with progesterone for 14days/month, have monthly withdrawal bleed. 3) Continuous combined - E2 and progesterone daily, only give if LMP >1yr ago. No bleed.

Week 204 - Gynaecology: What are some of the risks of HRT?

• Slight increase in risk of breast cancer and venous thromboembolism.

Week 204 - Gynaecology Flashcards

(53 cards)