A: Finals: Women's problems
Card Set Information
A: Finals: Women's problems
breast uterine ovarian vaginal
Breast, uterine, ovarian and vaginal disease
What main questions about a gynaecological feature should be asked?
: menstrual/gyne/obs history
When do women receive cervical screening?
Between ages 20 and 64
20+ is every 3 years
50+ is every 5 years
What management is required with the various findings of a cervical smear?
: Consistent with CIN1. Repeat in 6 months and if still present refer for colposcopy
What features are suggestive of cervical cancer?
No intermenstrual bleeding
Give 6 risk factors for cervical cancer
HPV infection risks (age of first intercourse, sexual partners, inadequate protection_
What management options are available for CIN and cervical cancer
Large loop excision of transformation zone via colposcopy (most common)
Total abdominal hysterectomy
Give 5 causes of post-menopausal bleeding
Atrophy - vaginitis or endometrial
Neoplasia of vulva/vagina/cervix/endometrium
What investigations are available for PMB?
When is the HPV vaccination received and what does it prevent?
3 doses over 6 month period
6, 11, 16, 18 HPV types
Carcinogenic + wart types
Give a brief outline of the menstrual cycle until ovulation
GnRH pulses stimulate LH and FSH release
LH promotes androgen production by thecal cells
FSH causes follicle development and androgen/oestrogen conversion by ovaries
Low dose oestrogen causes uterine proliferation
Eventual high dose oestrogen causes LH sensitivity to GnRH and positive feedback
LH surge causes ovum release
Describe the processes which occur after ovulation
After ovulation, follicle become corpus luteum
Secretion of progesterone begins
If implantation occurs
- hcG produced by trophoblast maintains C.L
- Progesterone maintains endometrium
- Eventually placenta develops oestrogen/progesterone
If implantation does NOT occur:
- Luteum regresses and oestrogen/progesterone levels fall
- Constriction of spiral arteries and endometrial death
- Dilation of arteries causes flushing of uterus
- Negative feedback of GnRH and FSH stop, beginning cycle
What features are suggestive of endometriosis?
Recurring pelvic pain, typically around menstruation
"Tugging" if adhesions present
Give 5 complications of endometriosis
What management options are available for endometriosis?
Conservative: Pain management (NSAIDS) and wait till menopause
- Progesterone prevents menstruation/pain and inhibits oetrogen/endometrial growth (POP, depot, mirena, implant)
: Prevents menstruation
- Laparoscopic diagnosis, with ablation and adhesion devision if required
- Hysterectomy (not curative)
Give a brief description of the following drugs:
: Cyproterone acetate + ethinylestradiol. Acne/Hirsutism
: Progestogen. Endometriosis
: Oestrogen agonist. HRT + endometriosis
: Prevents oestrogen -ve feedback of GnRH. Induces ovulation
: Antimuscarinic. Urinary incontinence
What is adenomyosis?
Uterine thickening when endometrium moves into outer muscular walls of uterus
Due to uterine trauma breaking the endo/myo barrier
Childbirth, termination, C-Section
What features suggest adenomyosis?
Intense pain, particularly on menstruation
Pressure on bladder
Large blood clots in menstruation
How do fibroids typically present?
Abnormal bleeding with bloating
What features suggest an endometrial polyps?
Continued bleeding after menopause
How is a diagnosis of endometrial polyps confirmed and how are they managed?
Hysteroscopy with curettage
Hysterectomy an option if cancerous cells detected
Outline 6 risk factors for endometrial adenocarcinoma
History of polyps/breast/ovarian cancer
High oestrogen exposure (nulliparity, PCOS, early menarche, late menopause)
Outline the staging of endometrial adenocarcinoma
: +/-Inner myometrium involvement
: Outer myometrium involvement
2: Stromal involvement
: Pelvic/para-aortic lymph nodes
4: Bladder/bowel mucosa or distant metastases
What main points should be given when describing a hysteroscopy to a patient?
Performed in clinic, not surgery
Best performed after menstruation for thinner endometrium
Lidocaine injection into cervix
Misoprostol may be required
Endoscope inserted via vagina into uterus
Distended with gas/fluid
Ablation/fibroid/polyps resection also an option
Sent for pathology
Complications; bleeding, perforation, infection
Cramping/spotting for 1-2 weeks normal
Follow up at 2-4 weeks
What are the main points of a endometrial biopsy when informing a patient?
Performed in outpatient clinic
Diagnoses and assesses infertility, endometrial hyperplasia and adenocarcinoma
Speculum inserted and cervix cleaned, similar to smear
Local anaesthesia (lidocaine injection)
Forceps holds cervix
Biopsy curette inserted into uterus and fundus scraped
Bleeding/cramping for 1-2 weeks is normal
Give 6 risk factors for pelvic organ prolapse
Connective tissue disease
What forms of prolapse exist and what organs are involved?
: Cervix/uterus drops
Give 5 management options available for a vaginal prolapse
Symptom control, e.g. dryness
What are the main urodynamic studies and what do they determine?
Post-void residual volume
: High = UTI, overflow incontinence
: Bladder muscle weakness, obstruction
What are the characteristics of an overactive bladder?
Urgency (sudden necessity to urinate)
Urinary frequency (>8)
Give 4 management strategies for OAB
: Fluid restriction/caffeine avoidance
: Bladder re-training
: Antimuscarinics, alpha-adrenergic blockers
: Botulinum injection
What is stress incontinence?
Incontinence when intra-abdominal pressure increases
Coughing, sneezing, exercise
Caused by weak pelvic floor (or possibly sphinctre)
Give 5 management strategies for Stress incontinence
: Weight loss
: Incontinence pads
: Especially if prolapse present
: Urethropexy (vaginal tape)
What features are suggestive of ovarian cancer?
Pressure in abdomen, causing pain
GI symptoms with no other cause
Ascites (poor prognosis)
Typically late presentation (70% present >3 staging)
Describe the pathogenesis of PCOS
Multiple small ovarian cysts with excess androgen production
Closely related to the metabolic syndrome
Precise link is unknown
What is the metabolic syndrome?
- Central obesity
- Elevated fasting glucose
- High triglycerides
- Low HDL levels
Give 4 causes of virilisation
Ovarian hyperthecosis (perimenstrual)
Give 5 clinical features of PCOS
Virilisation (clitoromegaly, balding, male phenotype)
What investigations are of use in suspected PCOS?
: Elevated but non-specific vs other virilising tumours
: LH hypersecretion
: Multiple small cysts and hyperechogenic stroma
How is PCOS managed?
: Hair removal/electrolysis
: Non-adrogenergic progesterone/oestrogen
Give 6 clinical features of PID
Lower abdominal pain
What are the 3 most common causes of PID?
Give 5 of the most worrying complications of PID
Chronic pelvic pain
Describe why fibrocystic changes occur in the breast
Menstrual hormones cause cyclical hypertrophy and hyperplasia
Numerous small, fibrous or cystic areas are created due to dysplasia
These cells have a greater likelihood of becoming atypical
What is a phyllodes tumour?
A large, fast growing mass composed of periductal stromal cells.
Has a high likelihood of becoming malignant
What is a fibroadenoma?
A discrete, mobile lump of both stromal and epithelial tissue
Normally found in young women
Outline the pathological changes in duct ectasia and give 4 features seen on examination
Secretory stasis causes dilation of a lactiferous duct
Squamous metaplasia and fibrosis results
Describe the index used to determine breast cancer prognosis
Nottingham prognostic index
Grade (1-3) + Stage (0 or 3) + 0.2 x cm
<3.4 = 85% at 5 years
<5.4 = 70%
>5.4 = 50%
What is the cause of periductal mastitis, and what are its clinical features? Give 4
Lactiferous duct inflammation due to bacteria, e.g. S. Aureus
- Nipple retraction
- Abscess on palpation
What is an intraductal papilloma and how does it present?
Benign epithelial tumour caused by hyperplasia
Can cause bloody discharge