Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

* FINALS: Obs and Gynae (My Cards) > Benign Gynaecology (See Cancer Care for Gynae Oncology) > Flashcards

Benign Gynaecology (See Cancer Care for Gynae Oncology) Flashcards

1
Q

What can present with a whirlpool sign on pelvic USS?

A

Ovarian torsion!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

When would you see cervical excitation?

A

PID

Ectopic pregnancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is cervical excitation also known as?

A

Cervical motion tenderness or The chandelier sign

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is cervical excitaton?

A

Significant pain or manipulation of the cervix

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

How many times can you repeat a smear test if the sample is inadequate?

A

3 times!!

Refer for colposcopy after a third inadequate smear

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Continuous dribbling incontinence after labour ?

especially in areas with limited obstetric services

A

Vesicovaginal fistula

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Describe the screening routine for cervical cancer in the UK

A

First invitation aged 25
3 yearly smear tests 25-50
5 yearly smear tests 50-65

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Differentials for lower abdo pain in a young woman?

A 
GYNAE-
Ectopic pregnancy
PID
Ovarian torsion
Endometriosis

BOWEL-
Acute appendicitis
IBS / IBD

BLADDER-
UTI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is dysmenorrheoa and list some differentials

A

Painful periods (+/- Nausea + Vomiting)

May be primary (pain without pathology) or secondary (pain with pathology)

Differentials:

  • Fibroids
  • Endometriosis
  • Adenomyosis
  • PID
  • Pelvic adhesions
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is adenomyosis

A

Endometrial tissue which grows into the myometrium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is oligomenorrhoea and list some differentials

A

Irregular periods (>35 days between periods)

Differentials:

  • PCOS
  • Contraceptives
  • Prolactinoma
  • Stress
  • Extreme weight loss
  • Thyroid disease
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is amenorrhoea and list some causes

A

Absence of menstruation in a woman of reproductive age

Primary: failure to start menstruating …

  • Late puberty
  • Structural defect (imperforate hymen, absent uterus, absent or short vagina)
  • Genetic defect (Turner’s syndrome, androgen insensitivity syndrome)
  • Anorexia nervosa / extreme stress (hypothalamus doesn’t produce GnRH)

Secondary: periods stop for > 6 months (not due to pregnancy)

  • Stress
  • Extreme exercise
  • Hyperprolactinaemia
  • PCOS
  • Ovarian failure (premature menopause)
  • Asherman’s syndrome (adhesions form in uterus)
  • Sheehan’s syndrome (Pituitary Necrosis)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is menorrhagia and list some causes

A

Heavy menstrual bleeding impacting a patient’s quality of life (>80 ml or menses lasting >7 days)

Causes:

  • Dysfunctional Uterine Bleeding
  • Fibroids
  • Polyps
  • Endometrial adenocarcinoma
  • Coagulation disorder
  • Infection
  • IUD
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What other symptoms might a patient with menorrhagia complain of?

A

Signs of anaemia

Tiredness, pallor, headache, SOB, tinnitus etc

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is dysfunctional uterine bleeding?

A

Heavy and irregular bleeding in the absence of a pelvic pathology - thought to be related to hormone dysfunction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Ix dysfunctional uterine bleeding

A

Bedside tests:

  • Pregnancy test
  • STI swabs (vulvovaginal, endocervical and high vaginal)

Bloods - FSH, LH, Oestrogen, Progesterone, testosterone, prolactin, TFTs, clotting, FBC)

Imaging - TV USS

Hysteroscopy +/- endometrial biopsy (rule out other causes of menorrhagia)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Mx of dysfunctional uterine bleeding / menorrhagia

A

Medical Mx:

  • Mirena IUS (releases levonorgestrel locally to cause atrophy of endometrium)
  • Tranexamic acid (anti-fibrinolytic)
  • Mefenamic acid (NSAID: inhibits prostaglandins)
  • COCP
  • IM Progesterone

Surgery:

  • Endometrial ablation
  • Myomectomy (if family incomplete)
  • Hysterectomy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What are the 3 types of oestrogen

A

Estradiol
Estrone
Estriol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Where are oestrogen and progesterone (& inhibin) secreted from?

A

Oestrogen & Inhibin released from granulosa cells (under influence of FSH)

Androgens released from theca cells (under influence of LH)

Progesterone is released from the corpus luteum (follicle which has leutinised after ovulation due to the LH surge)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is endometriosis?

A

Presence of endometriotic tissue outside of the uterus (uterosacral ligaments, peritoneum, ovaries, bladder and rarely the colon)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

How may endometriosis present

A

PAIN:

  • Cyclical (endometrial tissue responds to menstrual cycle)
  • Constant (adhesions secondary to chronic inflammation)
  • Deep dyspareunia (uterosacral ligaments involved)
  • Dysuria (bladder involvement)
  • Dyschezia (pain on defecation)

Subfertility

Asymptomatic (many cases are now being detected due to development of laparoscopic surgery)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What will endometriosis feel like on a bimanual examination?

A

Fixed, retroverted uterus !

may also feel adenxal mass or tenderness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What is the gold standard investigation for endometriosis

A

Laparoscopy and biopsy!!

May also do:

  • MRI pelvis to assess extent in severe disease
  • Pelvic USS (may not visualise endometriomas though)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

How is endometriosis treated?

A

Medical:

  • NSAIDs (Mefenamic acid)
  • COCP
  • Mirena IUS
  • GnRH analogues
  • Danazol (synthetic modified testosterone )

Surgical:

  • Laparoscopy for excision / ablation
  • Hysterectomy (last resort)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What phenomenon is sometimes seen after removing endometriotic lesions in mild - moderate endometriosis ?

A

Spontaneous pregnancy rates increase

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What is a common complication / sequela of endometriosis?

A

Chronic pelvic pain

  • Refer to endometriosis specialist for input from specialist nurse and chronic pain team
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Who does endometriosis affect ?

A

Women of reproductive age (oestrogen driven)

- increased risk if nulliparious, early menarche, late menopause or FMH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What are fibroids also known as ?

A

Leiomyomas

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What are fibroids ?

A

Benign tumours arising from the myometrium (benign smooth muscle tumour)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What are the 4 types of fibroids

A

Intramural (in uterine wall)
Subserosal (under visceral peritoneum)
Submucosal
Pedunculated (on a stalk)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

How may uterine fibroids present ?

A

Menorrhagia

Pain (torsion of a pedunculated fibroid or red degeneration)

Pelvic Mass

Subfertility (especially if submucosal, interferes with implantation)

Increased urinary frequency (if pressing on the bladder)

Oedematous legs and varicose veins (if compressing veins)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Who is likely to get fibroids?

A

Women of reproductive age (oestrogen dependent)

Risk factors:
Increasing age
More common in Afro-Caribbean women 
FMH 
Mutation in fumarate hydratase gene
Renal cell carcinomas (rare)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

What can cause fibroids to enlarge?

A

Pregnancy or COCP as fibroids are oestrogen dependent

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

What is red degeneration ?

A

Sudden degeneration of a fibroid in pregnancy due to thrombosis of capsular veins of fibroid

Thrombosis -> Venous engorgement -> inflammation and pain -> low grade fever -> degeneration
“ GROW BIG, TENDER AND DIE “

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

What are womb stones ?

A

Calcified fibroids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Mx of fibroids

A

Medical:

  • GnRH analogues (goserelin) (shrinks fibroids prior to surgery)
  • Ullipristil acetate (shrinks fibroids prior to surgery)

Surgical:

  • Some submucosal fibroids can be resected trans-cervically
  • Myomectomy (if haven’t completed family)
  • Hysterectomy
  • Uterine artery embolisation (neuroses uterus)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

What is PCOS

A

Polycystic Ovarian Syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

What are the diagnostic criteria for PCOS ?

A

Rotterdam criteria- must have 2 of…

  • Polycystic ovaries on USS
  • Oligoovulation or anovulation / oligomenorrhoea
  • Clinical or biochemical hyperandrogenism
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

What do polycystic ovaries look like on USS ?

A

String of pearls

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

What is PCOS associated with ?

A

Metabolic syndrome (dyslipidaemia, insulin resistance, obesity and hypertension)

  • This is important as part of the management of PCOS is yearly screening for T2DM and CVS disease
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

What is the pathophysiology of PCOS

A

Unknown -

Thought that increased insulin drives production of LH -> continuously high LH = no ovulation / no LH surge -> cyst forms and irregular periods

High levels of LH = high levels of androgen production, too much that some aren’t converted to oestrogen = hyperandrogenism

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

Signs / Symptoms of PCOS

A 
Oligomenorrhoea
Hirsutism 
Weight gain 
Male pattern baldness
Acne
Subfertility 
Acanthosis nigracans (hyperinsulinaemia)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

Investigating PCOS ?

A

Bloods- FSH, LH, Prolactin, Androgens, TFTs and cortisol

TVS (USS)

Imaging -> if excessively high testosterone, may want to look for an androgen secreting tumour

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

Mx of PCOS

A

Lifestyle modifications -

  • lose weight
  • stop smoking
  • shaving / waxing for hirsutism

Medical/ Surgical

  • metformin (thought to improve insulin sensitivity)
  • clomifene citrate (induces ovulation as it is an oestrogen receptor antagonist)
  • COCP (reduces risk of unopposed oestrogen on the endometrium and helps regulate bleeding)
  • Cyproterone for hirsutism
  • Ovarian drilling

Preventive:

  • Screen for T2DM, GDM and CVS disease yearly (and when pregnant)
  • Higher risk of endometrial hyperplasia and carcinoma (due to actions of unopposed oestrogen)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

What is pre-menstrual syndrome (PMS) ?

A

Distressing physical, psychological or behavioural symptoms occurring in the absence of organic or psychiatric disease

  • In the luteal phase of menstruation and showing significant improvement by the end of menses
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

How is PMS diagnosed

A

Symptom diary over 2 consecutive cycles

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

What symptoms are associated with PMS?

A 
Mood swings
Irritability
Depression
Bloating
Headache
Breast tenderness / mastalgia
Increased appetite
48
Q

Mx of PMS

A

Lifestyle modifications:

  • Weight loss
  • Increase exercise
  • Improve diet
  • Stop smoking

CBT (first line!!)

Medical:

  • Vit B6
  • COCP
  • Fluoxetine (low dose or in luteal phase, if moderate disease may give high dose or continuously)
  • Estradiol patches and Progesterone (PO or Mirena IUS)
  • GnRH analogues (and bone protection)

Surgical:
- TAH and BSO

** 5% women report severe symptoms which cause a major disruption to their lives

49
Q

What happens during the follicular phase of the ovarian cycle (menstruation) ?

A

DAY 1 - 14

A follicle matures ready to release an oocyte. FSH and LH are released as inhibin and oestrogen levels are low. This causes a rise in oestrogen and inhibin.

As inhibin levels rise, FSH drops which means only one follicle survives (the rest become polar bodies).

Oestrogen continues to rise and when levels are high this causes positive feedback on the HPG axis and there is an LH surge

LH surge drives ovulation (day 14)

50
Q

What happens during the luteal phase of the ovarian cycle (menstruation) ?

A

DAY 14 - 28

Granulosa cells express LH receptors and the follicle is leutinised.

The corpus luteum secretes oestrogen and progesterone to maintain conditions for fertilisation. This causes negative feedback on the HPG axis (as oestrogen and progesterone now present) and FSH and LH levels drop.

If there is no fertilisation (no bHCG production) the corpus luteum regresses spontaneously. This leads to menses as there is a reduction in oestrogen and progesterone production.

51
Q

What happens in the proliferative phase of the endometrial cycle (menstruation)

A

DAY 1 - 14 (preparation for fertilisation)

Oestrogen (released from granulosa cells) causes thickening of the endometrium, growth of the myometrium and the cervix to produce a thin, alkaline mucus (for sperm passage)

52
Q

What happens in the secretory phase of the endometrial cycle (menstruation)

A

DAY 14 - 28 (preparation for implantation)

Progesterone released by the corpus luteum causes the endometrial glands to become convoluted. The myometrium is thickened further. The cervix produces a thick acidic mucus to prevent polyspermy.

53
Q

What is the normal duration of the menstrual cycle?

A

21 - 35 days

54
Q

What is the normal amount of blood lost during menses ?

A

20 - 80ml

55
Q

What is the normal duration of menses?

A

2 - 7 days

56
Q

What is PID

A

Pelvic Inflammatory Disease

An acute, ascending infection from the endocervix causing endometritis, salpingitis, tubo-ovarian abscess and sometimes peritonitis

57
Q

Common organisms in PID

A 
Chlamydia Trachomatis (40-60%)
Neisseria Gonorrhoeae (15-18%)
Anaerobes (3-5%)
Mycoplasma hominis (10-15%)
58
Q

Causes of PID

A

STIs
Post-partum
Iatrogenic (IUCD insertion, TOP, hysteroscopy)
Acute appendicitis (infection can descend to the gynae tract)

59
Q

Risk factors for PID

A

Young age
Multiple sexual partners
Previous STIs

60
Q

How may PID present

A 
Lower abdo pain 
Dysmenorrhoea
Deep dyspareunia 
PV discharge (purulent)
Fever
IMB or PCB (bleeding)
61
Q

Protective factors for PID

A

COCP
Mirena IUS
Barrier contraception

62
Q

What signs may PID produce on examination ?

A

Cervical excitation / cervical motion tenderness
Adenexal tenderness
Discharge

** May also have raised ESR or CRP

63
Q

Ix for PID

A

Swabs (vulvovaginal, endocervical) / MC + S
Pregnancy test
Urine dip

FBC, cultures, CRP if acutely unwell

TVS if querying a tubo-ovarian abscess

64
Q

Mx of PID

A

Eduction and contract tracing
Avoid sexual intercourse until settled

Antibiotics:

  • Doxycycline PO 14 days
  • Metronidazole PO 14 days
  • Ceftriaxone IM STAT / one off dose
65
Q

What are the potential complications of PID

A 
Ectopic pregnancy
Tubo-ovarian abscess
Fitz-Hugh-Curtis syndrome (Chlamydia)
Recurrent PID / chronic 
Subfertility due to Fallopian tube blockage
66
Q

what is fitz-Hugh-Curtis syndrome

A

Inflammation of the liver capsule with perihepatic adhesions (due to chlamydia infection)

67
Q

What is chronic PID

A

Unresolved, unrecognised or inadequately treated infection

Chronic inflammation -> fibrosis -> adhesions between pelvic organs

Fallopian tubes may become distended with pus (pyosalpinx) or fluid (hydrosalpinx)

68
Q

How is chronic PID management different to acute PID

A

Abx often not helpful

Focus on chronic pelvic pain mx - Difficult to manage pain

69
Q

Causes of post coital bleeding

A

Benign-

  • Ectropion
  • STIs

Malignant-

  • Cervical cancer
  • Vaginal cancer (v rare)
70
Q

What is a cervical ectropion?

A

The soft columnar cells of the endocervix appear in the ectocervix where there is usually stratified squamous epithelium.
(LOOKS LIKE A RED RING AROUND THE OS ON SPECULUM)

Can be caused by oestrogen moving the transitional zone in puberty (physiological) or can be related to COCP or pregnancy

71
Q

Mx of cervical ectropion

A

If asymptomatic does not require management

  • Swap to non-hormonal contraception
  • Cautery as an outpatient (silver nitrate)
72
Q

Causes of inter-menstrual bleeding

A

Physiological:

  • Spotting around ovulation
  • Pregnancy

Benign:

  • STIs (cervicitis)
  • cervical ectropion
  • fibroids
  • endometriosis
  • adenomyosis
  • breakthrough bleed after starting new contraception (POP, COCP, IUS)

Malignant:

  • cervical cancer
  • endometrial cancer
  • vaginal cancer (rare)
73
Q

What is Meig’s syndrome

A

Triad of:

  • Ascites
  • Benign ovarian tumour (often a fibroma)
  • Pleural effusion (often right sided)

** Typically resolves after resection of the tumour

74
Q

What type of benign ovarian cyst is most likely to tort and why?

A 
Dermoid cyst
(largest and most dense, often have long pedicle due to their weight which can tort)
75
Q

What gives a ‘‘snowstorm appearance’’ on USS

A

Hydatidiform mole (gestational trophoblastic disease)

76
Q

What 2 acts are involved in the legality behind TOP

A

The abortion act of 1967

The human fertilisation and embryology act of 1990

77
Q

What are the legal clauses for a TOP

A

A- risk to mothers life if the pregnancy continues
B- termination necessary to prevent permanent grave injury to the mothers mental or physical health
C - continuance risks injury to the mental or physical health of the mother that is greater than if terminated
D - continuance risks injury to the mental or physical health of existing children that is greater than if terminated
E- Substantial risk that if the child was born they would suffer physical or mental abnormalities / be seriously handicapped

78
Q

How can a TOP be legally consented/agreed?

A

HSA1 certificate signed by 2 doctors

79
Q

What should be done prior to a TOP?

A
  • Counselling
  • USS (confirm gestation, location and viability of the pregnancy)
  • STI screening (+/- prophylactic Abx)
  • Contraception advice / discussion
  • If rhesus negative give Anti-D
  • Blood tests: rhesus and ABO antibodies, FBC, BBV screen, haemoglobinopathy screen (not necessary to cross match all women)
80
Q

What comprises a medical termination of pregnancy

A

Mifepristone (anti-progesterone) AND Misoprostol (prostaglandin: stimulates oxytocin release and uterine contraction and ripens/softens and dilates the cervix)

NSAID analgesia

Feticide (intra-cardiac potassium chloride, given if the fetus is >21 weeks + 6 days as must ensure that the fetus is born dead)

81
Q

Complications of an abortion?

A

Retained products of conception and potential infection/sepsis

Failure

Haemorrhage

Uterine rupture / perforation

Cervical trauma

82
Q

Timescales for medical and surgical termination of pregnancy?

A

Medical abortion can be done <63 days and up to 24 weeks

Surgical abortion can be done at any time however vacuum aspiration can be done up to 14 weeks and dilatation and evacuation can only be done after 14 weeks

83
Q

What comprises a surgical termination of pregnancy

A

If up to 14 weeks = vacuum aspiration

If >14 weeks = dilation and evacuation, this requires cervical priming (misoprostol or osmotic dilator)

NSAID analgesia

84
Q

What is a pelvic organ prolapse?

A

Passage of pelvic tissue through the pelvic floor and into the introitus of the vagina

85
Q

What are the types of pelvic organ prolapse ?

A

Anterior - cystocele/urethrocystocele (bladder/urethra prolapse)

Posterior - rectocele / enterocele (rectum or small bowel)

Middle / Uterine - cervix / uterus / vaginal vault prolapse

86
Q

How is the severity of a prolapse graded?

A

1st degree: lowest part of the prolapse extends 1/2 way down to the introitus

2nd degree: lowest part of the prolapse extends to the level of the introitus and through introitus on straining

3rd degree: lowest part of the prolapse through the introitus and out vagina

4th degree: uterus is outside of the vagina (procidentia)

87
Q

Symptoms of a pelvic organ prolapse

A

Urinary (if bladder has prolapsed):

  • Urgency
  • Frequency
  • Retention
  • Incontinence (especially stress)
  • Haematuria
  • Recurrent infections

Bowel:

  • Constipation
  • Incomplete emptying
  • May have to push prolapse by pushing posterior vaginal wall to defecate

Back pain
Dyspareunia
Dragging sensation / feeling of a lump coming down

88
Q

Mx of a pelvic organ prolapse

A

Conservative:

  • lose weight
  • pelvic floor exercises
  • stop smoking / avoid chronic cough
  • Constipation management
  • Stop heaving lifting

Medical:

  • Topical oestrogen cream
  • Pessary (change every 6 months)

Surgical:

  • Pelvic floor repair
  • Sacrocolpoplexy
  • Hysterectomy
  • Colpocleisis (last resort, close vagina off if very poor physical health or many failed operations)
89
Q

What is urinary incontinence?

A

Involuntary, spontaneous leakage of urine that occurs with either stress or is associated with uncontrollable sense of urgency or both

90
Q

What are the different types of incontinence and how do they present ?

A

Stress: leakage of urine when laughing, sneezing, coughing or on exertion. Caused by an increase in intra-abdominal pressure and destrusor pressure exceeds urethral pressure.

Urge: leakage of urine with or followed by urgency

Mixed: mixture of both the above

Overactive Bladder: frequency, nocturia and urgency with or without being incontient (due to detrusor overactivity)

Continuous: continuous leakage of urine (e.g vesicovaginal fistula)

Nocturnal: involuntary loss of urine during sleep

Overflow: leakage of urine from an overdistended bladder

91
Q

Mx of stress incontinence

A

Conservative:

  • Lose weight
  • Pelvic floor exercises
  • Stop smoking / reduce chronic cough
  • Modify fluid intake

Medical: duloxetine (increases sympathetic activity in Onuf’s nucleus)

Surgical:

  • Tension free vaginal taping (CURRENTLY NOT RECOMMENDED)
  • Periurethral injection of a bulking agent
  • Culposuspension
92
Q

Mx of an OAB / Urge Incontinence

A

Conservative:

  • Cut down on caffeine and alcohol
  • Bladder retraining exercises
  • Lose weight
  • Modify fluid intake

Medical:
- Anti-cholinergics (Oxybutynin or Mirabegron if older woman)

Surgical:

  • Botulinum toxin type A injections
  • Cystoplasty
93
Q

Discuss control of urine storage

A

Controlled by the sympathetic nervous system:

Pontine continence centre signals to the sympathetic nuclei in the spinal cord.

Signals then sent via the hypogastric nerve stimulate the detrusor muscle to relax (B3 receptors) and the internal urethral sphincter to contract (a1 receptors)

The external urethral sphincter is under voluntary control by the pudendal nerve. It remains contracted due to nAch receptor activation)

As the bladder fills the ruggae flatten and the bladder wall distends to maintain intravesicular pressure < urethral pressure. This is known as receptive relaxation.

Bladder can store around 300-550mls

94
Q

Discuss micturition control

A

Under parasympathetic nervous system control:

When the bladder reaches >400ml full, the afferent receptors signal to the pontine micturition centre.

If the pontine micturition centre and cortex voluntarily decide to urinate the pons sends parasympathetic signals to the sacral preganglionic neurons. The pons also inhibits Onuf’s nucleus to reduce sympathetic innervation to the internal urethral sphincter via the hypogastric nerve.

This sends signals via the pelvic nerve which releases Ach to cause detrusor contraction (M3 receptors). The inhibition of the SNS causes the internal sphincter to relax.

Once intravesicular pressure > intraurethral pressure due to detrusor contraction, the external sphincter relaxes via pudendal nerve and you get urination

95
Q

What are normal urine flow rates in men and women

A 
Men = 20-25 mls/s
Women = 25-30mls/s
96
Q

What can cause urinary incontinence?

A
  • Increase in intra-abdominal pressure (laughing, exertion, coughing)
  • Damage to pelvic floor muscles, pudendal and pelvic nerves (childbirth, Genito-urinary surgery)
  • UMN lesions (MS, stroke)
  • Neurological damage in the cortex / pons (Parkinson’s disease)
  • Radiation exposure
  • Drugs (ACE inhibitors, diuretics)
97
Q

What are the normal values for semen analysis?

A 
Volume: >1.5ml
Concentration: >15 x 10(6)
Motility (total): 40%
Motility (progressive): 32%
Normal morphology: 4%
98
Q

List some causes of subfetility

A 
Anovulation (21%)
Tubal factors (15-20%)
Endometriosis (6-8%)
Male factors (25%)
Unexplained (28%)
99
Q

Define primary and secondary subfertility

A

Primary: failure to conceive despite having >12 months regular UPSI with the female never having conceived before

Secondary: failure to conceive despite having >12 months regular UPSI with the female having conceived before

100
Q

List some anovulatory causes of subfertility

A 
PCOS
Genetics (e.g. 45X)
Ovarian failure (premature)
Prolactinoma
Sheehan's syndrome (anterior pituitary necrosis)
101
Q

List some tubal factors causing subfertility

A 
PID
Endometriosis
Asherman's syndrome (adhesions due to repeated D+C)
Fibroids 
Tubal ligation / sterilisation
102
Q

List some male factors causing subfertility

A

Absent sperm
Low sperm count
Abnormal sperm
Immotile sperm

Causes:
Genetic (47XXY)
Previous orchiditis, e.g. Mumps
Testicular cancer
Anabolic steroid use
Alcohol 
Smoking
STIs
Varicocele
Vasectomy
Undescended testes
103
Q

What % of couples having regular UPSI conceive within 1 year?

A

84%

104
Q

How many eggs does a woman have to start with, how many by 30 and how many by 40 y/o

A

300,000 to start with

12% by 30 y/o

3% by 40 y/o

105
Q

What Ix would you do for someone presenting with infertility

A

Height and weight
Day 21 progesterone (marker of ovulation)
Oestrogen, LH, FSH, Testosterone, Prolactin
USS uterus
Hysterosalpingogram (tubal patency using injected contrast)
Laparoscopy and Methylene blue dye (tubal patency gold standard)
Semen analysis
STI screens (male and female)

106
Q

What is the gold standard investigation for assessing tubal patency?

A

Laparoscopy with methylene blue dye

107
Q

What test would you do to check for ovulation ?

A

Day 21 progesterone (or 6 days prior to cycle ending ??)

108
Q

What are the mx options for subfetility

A

Male:
Reduce alcohol and smoking
Take a multivitamin with zinc, vit c and selenium
Recheck sperm analysis in 3/12

Female:
Folic acid
Induce ovulation:
- clomiphene citrate = antioestrogen which increases FSH
- ovarian drilling (to reduce LH, only if PCOS)
- metformin if PCOS
Surgery: unblock tubes (dilation and curretage), adhesionlysis

Assisted conception:
IVF (in-vitro fertilisation)
ICSI (intracytoplasmic sperm injection)
IUI (intrauterine insemination) 
Sperm donation
Egg donation
109
Q

What is OHSS

A

OVARIAN HYPERSTIMULATION SYNDROME

Usually occurs 3-7 days after hCG given in IVF or 12-17 days after pregnancy ensured in IVF

It is a systemic disease where vasoactive products are released and causes increased capillary permeability. This causes an increase in fluid leaving the intra-vascular space.

110
Q

How might OHSS present

A

N+V
Abdo pain and distension
SOB

DUE TO:
Pleural effusion
Ascites
VTE
Renal failure
Pulmonary failure
111
Q

Mx of OHSS

A

Supportive:

  • analgesia
  • anti-emetics
  • restrict fluids
  • LMWH to reduce thrombosis risk
  • paracentesis of ascites + albumin replacement
112
Q

Pathophysiology of endometriosis?

A

Three theories:

  • Retrograde menstruation
  • Metaplasia of mesothelial cells
  • Impaired immunity means that cells from retrograde menstruation fail to be destroyed by the immune system
113
Q

Types of miscarriage

A

Threatened - os is closed, painless bleeding

Missed - os is closed, no symptoms of expulsion and a sac with a dead fetus seen on USS

Complete - os is closed, pain and bleeding with tissue passed, empty intrauterine cavity seen on USS

Inevitable - os is open, painful heavy bleeding with clots

Incomplete - os is open, painful bleeding, some products remain

114
Q

Management of a miscarriage

A

3 methods:

EXPECTANT
- Wait 7-14 days for products of conception to pass naturally

MEDICAL

  • Misoprostol given vaginally (prostaglandin analogue given to cause myometrial contractions)
  • Give analgesia and antiemetics with this
  • Wait up to 24h for bleeding to start

SURGICAL

  • If medical management fails OR evidence of infection or increased risk of haemorrhage
  • Vacuum aspiration under local anaesthetic
  • Theatre for evacuation of retained products of conception
115
Q

When would you opt for surgical management of a miscarriage > medical/expectant management?

A

Evidence of infection

Increased risk of haemorrhage

116
Q

How long post-termination will the urinary pregnancy test remain positive

A

4 weeks

* FINALS: Obs and Gynae (My Cards) (4 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions