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MRCP Part 1 > Women's Health: Gynaecology > Flashcards

Women's Health: Gynaecology Flashcards

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1
Q

How do the cancers present in terms of pain

A

Endometrial painless
Rest painful

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2
Q

How do the cancers compare in terms of bleeding

A

Endo: Post-menopausal
Ovarian: None
Cervical: Intermenstrual, postcoital, post-menopausal
Vulval: Bleeds

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3
Q

Early fullness and diarrhoea is most associated with which cancer?

A

Ovarian

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4
Q

Who gets urgent referral for endometrial cancer?

A

PMB > 12 months after last period
US if >55yrs with unexplained discharge or haematuria

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5
Q

Who gets urgent referral for ovarian cancer?

A

Ascites/mass/raised CA-125 (if symptoms)

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6
Q

Who gets urgent referral for cervical cancer?

A

Changes on colposcopy

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7
Q

Who gets urgent referral for vulval cancer?

A

Where suspected

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8
Q

What is the first line and gold standard investigation for endometrial cancer?

A

1st: TVUS
GS: Hysteroscopy with biopsy

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9
Q

What is the first line and gold standard investigation for Ovarian cancer?

A

1st: US
GS: Diagnostic laparotomy

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10
Q

What is the first line and gold standard investigation for cervical cancer?

A

Punch biopsy is both

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11
Q

Where is LLETZ used in cervical cancer?

A

Where CIN is found on colposcopy
NOT used for cervical cancer as can cause bleeding

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12
Q

Endometrial and ovarian cancers cause
x menarche
y menopause
z parity

A

Early menarche
Late menopause
Nulliparity

‘Longest time (gap between menarche and menopause) without having kids (nulliparity)’

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13
Q

Which cancer is associated with high parity?

A

Cervical

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14
Q

Unopposed oestrogen is most associated with which cancer?

A

Endometrial

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15
Q

Which cancer is associated with the BRCA genes?

A

Ovarian

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16
Q

How do you treat endometrial cancer if it is
Localised
High risk
Unsuitable for surgery

A

Local: Hysterectomy + bilateral salpingo-oophrectomy
High risk: surgery + adjuvant radiotherapy
Unsuitable: Progesterone therapy

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17
Q

How is cervical cancer treated if its
Local (IA/B)
Cervix-pelvic wall (II-III)
Beyond pelvis

A

Local: Hysterectomy + node clearance
Cervix-pelvis wall: Radio + chemo
Beyond pelvis: Radiation and chemo

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18
Q

What should be done if multifocal cysts are found on US?

A

Biopsied
Check for ovarian cancer

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19
Q

What ages and intervals should cervical smears be offered?

A

25-49: every 3 years
50-64: Every 5 years

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20
Q

hrHPV -ve

A

Normal recall

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21
Q

hrHPV +ve

A

Cytology

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22
Q

Cytology -ve

A

repeat in 12 months

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23
Q

12 month repeat HPV +ve but cyto -ve

A

Repeat in another 12 months

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24
Q

24 month repeat -ve

A

Normal recall

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25
24 month repeat +ve
Colposcopy
26
Inadequate sample
Repeat 3 months
27
3 month sample repeat inadequate
Colposcopy
28
What is the definition of secondary amenorrhea?
3-6 month cessation in previously normal menstruation 6-12 months cessation if Hx oligomenorrhea
29
What is the definition of primary amenorrhea?
Failure to menstruate by 13 if no secondary sexual characteristics
30
What is the first line investigation for amenorrhea?
urinary/serum B-HCG to exclude pregnancy
31
How can you broadly group secondary amenorrhea?
Without or with androgen excess: body hair, acne, female pattern hair loss
32
How do you distinguish POF from PCOS in terms of Presentation FSH/LH Oestrogen Testosterone
PCOS // POF Hairy, acne // night sweats, vaginal dryness High // High Normal // Low High // normal \*PCOS is high testosterone, POF is low oestrogen\*
33
How do you treat the following features of PCOS Oligo/amenorrhea Acne Hirsuitism Infertility
Oligomenorrhea 14 days progestogen inc withdrawal bleed then TVUS for endometrial thickness. Refer if \>10mm if normal: progestogen every 1-3m/low dose COC/IUS Acne 1. COC +/- topical retinoids, Abx as per acne treatment line Hirsutism COC Infertility Clomifene, metformin TLDR: POP 14 days then COC +/- acne treatment +/- clomifene or metformin
34
What is the treatment for POF?
HRT COC pill if \<50yrs for breast Ca and VTE risk
35
What ultrasound finding is in keeping with PCOS?
\>=12 follicles (2-9mm) and/or volume \>10cm3
36
What do the following hormone tests indicate State FSH LH Prolactin Testosterone 1 Normal/low Normal/low High Normal 2 High High Normal Normal 3 Low/normal Low/normal Normal Normal 4 Normal/increased Normal/increased Normal/increased Normal/moderate increase
1. Prolactinoma: High prolactin causes -ve feedback of FSH/LH 2. POF: High FSH/LH due to low oestrogen 3. Hypothalamic: Low or normal FSH/LH without any causes of -ve feedback --\> low pituitary action 4. PCOS: FSH/LH tries to reverse high testosterone
37
How do you distinguish between Asherman's and Sheehan's syndrome clinically?
Asherman's // Sheehan's Increased secretions, sore abdo + breasts, low mood and appetite // post-partum low BP \*Shee-has a baby now\*
38
What lab findings are seen in Sheehan's syndrome?
Low glucose, thyroid + pituitary symptoms
39
How do you distinguish between androgen insensitivity syndrome and congenital adrenal hyperplasia?
AIP // CAH Undescended testes +/- breasts // Tall, beardy, deep voiced females
40
How do you distinguish between Turner's syndrome and Kallman's... Clinically Gonadotrophins Genetically
Turners // Kallman's Short, wide chest, webbed neck // delayed puberty, lack of smell FSH/LH high // low 45XO OR 45X // X-linked recesive
41
In oligomenorrhea/amenorrhea, who do you refer to?
Primary: Gyanecology Secondary Gynae // Endo Elevated FSH/LH // Low PCOS, infertility, cervix or uterine Ca Hx // High testosterone outside PCOS, Cushing's features
42
What is menorrhagia?
Regular heavy menstrual blood loss affecting the woman's life
43
What is primary and secondary dysmenorrhea?
Primary: pain 1-2 years after menarche, usually within a few hours from period onset Secondary: Pain many years after menarche
44
How do you differentiate between endometriosis, adenomyosis and fibroids in terms of Pain Bleeding (outside heavy) Associated features
Endo // Adeno // fibroids cyclical, deep sex, toileting // periods + intercourse // lower abdo pain during period haematuria // no // no subfertility // Hx multiparity // bloating, mass, AC women
45
What cause of dysmenorrhea is most associated with fever, discharge and cervical excitation?
Pelvic inflammatory disease
46
What cancers should you rule out in menorrhagia?
Cervical: painful Uterine: Painless
47
What is the general approach to investigating dysmenorrhea and menorrhagia?
Bimanual and speculum exam: Look for fibroids, ascites and cancer FBC: iron deficiency anaemia If structural pathology 1st line: TVUS for endo and adeno GS: Surgical exploration
48
How does referral work for dysmenorrhea and menorrhagia?
Pelvic mass/ascites --\> urgent Pelvic mass + cancer features --\> witihin 2 weeks All secondary dysmenorrhea needs referred
49
What is the first line management for menorrhagia?
Contraceptive: mirena coil --\> COC pill --\> long progestogens Non cnotraceptive: Mefenamic if painful, transexamic if not
50
Following inital therapy, what is the specific management for Adenomyosis Endometriosis Fibroids
Adeno: GnRH agonists (-relins) Endo: Ablation, hysterectomy Fibroids: Myomectomy to remove +/- GnRH before to shrink
51
What is the treatment for PID?
SEPSIS 6 oral oflaxacin + metronidazole OR IM ceftriaxone + oral dox + oral metronidazole
52
How can you differentiate between Ovarian torsion, ectopic pregnancy and mittelschmirz since all cause pain without bleeding? Pain Tenderness US Treatment
Torsion // Ectopic // Mittelschmirz Deep, colicky pain // sharp pain // mid cycle, sharp Yes // yes // no Whirpool // no pregnancy // free fluid Laparoscopy // laparoscopy + salpingectomy // conservative
53
What is the process of the menopause
Declining ovarian development leads to Reduced oesotrogen Increased FSH/LH Causing permanent cessation of menstruation
54
How do you diagnose perimenopause and menopause clinically?
_Clinically_ \>=45yrs + Perimenopause: vasomotor + irregular periods Menopause: \>12 months amenorrhea without contraception OR symptoms if no uterus Investigationally Use FSH in women 40-45yrs with menopausal symptoms AND cycle changes \<40yrs with suspected POF
55
What lifestyle changes can help with these menopausal symptoms Hot flushes Sleep problems
Hot flushes: Exercise, cooling rooms and clothes. Avoid caffeine, alcohol, spice and smoking Sleep: Avoid caffeine and late exercise
56
What HRT and other drugs are available for the menopausal symptoms of Vasomotor Urogenital symptoms Mood disorder
_Vasomotor_ HRT: TD/PO; combined if uterus, oesotrogen if not Other: SSRIs/SNRIs/clonidine/Gabapentin _Urogenital_ HRT: Vaginal oestrogens Other: Lubricants, moisturisers _Mood_ HRT Personal choice Self help/CBT/anti-depressants
57
What are the 4 contraindications to HRT
- Breast cancer history - Oestrogenergic cancers - Undiagnosed vaginal bleeding - Untreated endometrial hyperplasia
58
What are the complications of the following HRT methods All Oral Combined
All: Ovarian cancer Oral: VTE, stroke if oestrogen Combined: CHD, Breast Ca
59
What follow up is needed on commencement or change of HRT?
3 month check in then yearly review
60
How is stress and urge incontinence managed by Lifestyle Drugs
Urge // Stress Bladder training 6 weeks // Pelvic floor training (8/day 3 months) Anti-muscarinics (oxybutinin, tolteridone) // Taping or duloxetien
61
What do you give for HRT where Oral is contraindicated patient is still menstruating
Topical or patches cyclical not continuous therapy
62
Pregnant patient presents with low grade fever, pain and vomiting. TVUS shows normal pregnancy and large fibroids
Red degeneration of fibroid Fever + pain + vomiting Manage conservatively
63
Rergarding ovarian cysts which... require biopsy to exclude malignancy are the most common likely to have intraperitoneal bleeding have other organ system tissues Is associated with pseudomyxoma peritonei
Multi-locuated cysts Follicular Corpus luteum (failure of CL to break down) Dermoid cysts mucinous cystadenoma
64
What is the most common type of ovarian tumour
Serous carcinoma
65
Old woman with labial lump and raised nodes
Vulval carcinoma Associated with HPV, VIN, IC
66
When are smears performed in pregnancy
3 months post-partum Unless missed or previously abnormal
67
What are the 3 most common pathogens of pelvic inflammatory disease?
C. trachomatis N. gonorrheae M. genitalium
68
How do you manage premenstrual syndrome that is... Mild Moderate Severe
Mild: 2-3hrly complex carb meals Mod: new-gen combined pill (eg drospirenone + ethinylestradiol) Severe: SSRI
69
What size of fibroid can you try medical treatment in?
\<3cm with no distortion
70

MRCP Part 1 (32 decks)

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