Medical Gynaecology Flashcards Preview

MFSRH part 2 > Medical Gynaecology > Flashcards

Flashcards in Medical Gynaecology Deck (24)
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1
Q

First line treatment of lichen sclerosus is

A

typically with ultra potent topical steroids

such as clobetasol proprionate

2
Q

What is Lichen sclerosus (LS) and what are it’s associations?

A

an inflammatory dermatosis of unknown aetiology

Associations:
Increased frequency of autoimmune disorders

3
Q

Signs & Symptoms of lichen sclerosus

A
Pale white atrophic areas.
Purpura are common
Fissuring
Erosions
Hyperkeratosis
Narrowed Introitus
Pruritus
Soreness/dyspareunia
4
Q

Histological features of lichen sclerosus

A

Histological features:
Epidermal atrophy (or thinning)
Hydropic degeneration of the basal layer (sub-epidermal hyalinisation)
Dermal inflammation

5
Q

Complications of lichen sclerosus

A

Complications of LS

Risk of developing squamous cell carcinoma (<5%)
Clitoral pseudo cyst
Sexual dysfunction
Dysaesthesia

6
Q

Possible causes of PCB

A
Cervical polyps
Ectopion
Cervical cancer
STIs
Vaginal atrophy
7
Q

Possible causes of deep desparunia

A
PID / STI
Endometriosis 
Ectopic pregnancy
Ovarian cyst / cancer
Chronic pelvic
Pain
8
Q

Incidence of turners syndrome

A

1 in 2000 births

9
Q

Causes of haemolytic anaemia

A

Autoimmune haemolytic anaemia

Haemolysis associated with mechanical heart valves

G6PD deficiency

Hereditary spherocytosis

10
Q

Steps in managing a patient with PCB

A

History - sexual, contraceptive, menstrual & LMP
Speculum and Pelvic Examination
Any suspicion of cervical cancer - refer to colposcopy
Treat any local cause - cervical polyp, ectropion, cervicitis, warts
Test for STIs

11
Q

Steps in managing a patient with IMB

A

History - sexual, contraceptive, menstrual & LMP
If suspected contraceptive problem consider modifying contraception and review in 6-8 weeks
If ongoing IMB
Speculum and Pelvic Examination
Any suspicion of cervical cancer - refer to colposcopy
Treat any local cause - cervical polyp, ectropion, cervicitis, warts
Test for STIs

12
Q

what is metrorrhagia

A

bleeding at irregular intervals, particularly between expected menstrual periods.

13
Q

what is menometrorrhagia

A

combination of metrorrhagia and menorrhagia.
prolonged or excessive uterine bleeding
occurs irregularly and more frequently than normal

14
Q

What is polymenorrhoea

A

Polymenorrhea is a term used to describe a menstrual cycle that is shorter than 21 days

15
Q

Symptoms of endometriosis

A
Cyclical pelvic pain, 
dysmenorrhea 
dyspareunia 
chronic pelvic pain,
cyclical intestinal complaints (bloating, diarrhoea or constipation) 
fatigue/weariness 
infertility
16
Q

Empirical treatment options for suspected endometriosis

A

Analgesia - NSAIDs
and/or hormonal treatment - COCP / desogestrel / DMPA / IUS
or oral Medroxyprogesterone / norethisterone.
support such as Endometriosis UK

17
Q

treatment options for confirmed endometriosis

A

laparoscopic ablation or resection
+/ - Hormonal suppression

Specialist fertility referral if required

GnRH analogues- short term - or with addback HRT
Radical surgery - TAH BSO

18
Q

most common cause pruritus vulvae?

A

Contact dermatitis
inflammatory reaction
Lichenification + hyperpigmentation when dermatitis chronic.
can be caused by:
creams (esp containing LA), Topical antibiotics,
Barrier contraception, lubricants, Perfume, soaps, bubble baths, wet wipes, Detergents, fabric conditioners, bleaches, dyes.

19
Q

possible causes of pruritus vulvae?

A
Contact dermatitis 
Candida / BV / TV / HSV
Pediculus pubis / Scabies (Sarcoptes scabiei) 
Psoriasis
Lichen simplex
Lichen planus 
Lichen sclerosus 
SCC / VIN / pagets
Seborrhoeic dermatitis (rare)
20
Q

features of vulval psoriasis

A

Due to the moisture and friction, the classic psoriatic lesion is replaced with a poorly demarcated, erythematous plaque
minimal scale
shiny texture
Typical psoriasis lesions occur elsewhere on the body
Genital skin affected in 29–46% of people with psoriasis.

21
Q

features of vulval Lichen sclerosus

A

Inflammatory skin condition
often >50 yo
Any area from clitoral hood to perianal area affected - classically figure eight pattern
vagina not affected.

Lesions hypopigmented-to-white,
crinkled, fragile plaques
Bruises / blood blisters / ulcers appear after scratching / minimal friction.
Scarring + loss of vulvar architecture / resorption of labia minora, fusing in midline + burying of clitoris.
small risk SCC developing = (less than 5%).

22
Q

features of vulval Lichen simplex

A

localized plaque - chronic eczematous inflammation
created by repeated rubbing / scratching
Can affect entire vulva /perianal area

skin leathery or lichenified or pale and wrinkled.
May be labial swelling + erythema / hair loss due to scratching

23
Q

features of vulval Seborrhoeic dermatitis

A

ill-defined border
some scaling,
with or without involvement of other sites,
Rarely affects the vulva.

24
Q

features of vulval Lichen planus

A

chronic inflammatory condition
affects skin / mucosal surfaces
may appear erosive, glazed or glossy erythematous plaques;
or bluish-purple, shiny, flat-topped papules + small white dots or lines (Wickham’s striae);
or uniformly white hyperkeratotic plaques.

May be loss of vulvar architecture.
small risk SCC developing of <3%