common gynae presentations Flashcards
What are the main categories of primary amenorrhea?
Genetic causes (e.g., Intersex, hormonal deficiencies)
Congenital anatomical abnormalities:
- Mullerian agenesis
- Mullerian anomalies (e.g., imperforate hymen)
- Ovarian dysgenesis/agenesis
What are the physiological causes of secondary amenorrhea?
Pregnancy
Lactation
Perimenarchal period
Perimenopausal period
What are the contraception-related causes of amenorrhea?
Oral contraceptives
Injectable contraceptives
IUCD-induced amenorrhea
Post-cessation IMI (up to 9 months)
What are the central causes of amenorrhea?
Tumors/lesions compressing hypothalamus/pituitary/stalk
Hypothalamic causes:
- Stress
- Under-nutrition
- Post infarction/surgery/irradiation
Pituitary causes:
- Hyperprolactinemia (with galactorrhea)
- Pharmacological (e.g., antipsychotics)
- Functional pituitary tumors
What are the pregnancy-related causes of abnormal vaginal bleeding?
Miscarriage
Ectopic pregnancy
Gestational trophoblastic disease
What are the types of dysfunctional uterine bleeding?
Anovulatory:
- Perimenarchal
- Perimenopausal
Ovulatory:
- Abnormal prostaglandin system
- Abnormal fibrinolytic system in endometrium
What are the genital tract pathologies that can cause abnormal bleeding?
Congenital uterine abnormalities
Trauma
Infection
Endometriosis/adenomyosis
Benign tumors:
- Polyps
- Fibroids
- Endometrial hyperplasia
Malignancies:
- Endometrial
- Cervical
- Uterine sarcoma
- Hormone-secreting tumors
What are the benign causes of post-menopausal bleeding?
Atrophic vaginal epithelium
Polyps (cervical/endocervical/endometrial)
HRT
Infections (e.g., TB/schistosomiasis)
What are the malignant causes of post-menopausal bleeding?
Cervical cancer
Endometrial cancer
Sarcoma
What are the gynecological causes of pelvic/abdominal pain?
Congenital: haematocolpos
Trauma: coital injury
Iatrogenic: post-surgery problems (adhesions)
Contraception-related: IUCD-induced dysmenorrhea or displacement
Functional ovarian cysts: torsion, hemorrhage, rupture
Infective: PID, Bartholin cyst abscess
Endometriosis
What are the non-gynecological causes of pelvic/abdominal pain?
Medical causes:
- UTI/pyelonephritis
- Irritable bowel syndrome
- Porphyria
- DKA
Surgical causes:
- Appendicitis
- Diverticulitis
- Volvulus
- Mesenteric thrombosis
What are the types of normal and infectious vaginal discharge?
Physiological:
- Normal daily discharge
- Increased during ovulation
Infectious:
- STIs: PID/cervicitis (chlamydia/gonorrhea/trichomonas)
- Vaginitis (bacterial vaginosis)
- Candida
- Infected vulval warts
What malignant condition should be considered with postmenopausal discharge?
Infected cervical/vaginal cancer
What are the main categories of causes for infertility?
Anatomical defects (congenital or acquired)
Genital tract infection (especially PID)
Psychological factors (stress, depression, relationship problems)
Medication (antidepressants, drugs causing hyperprolactinemia)
Substance abuse (smoking, alcohol, drugs)
Previous surgery (abdominal or pelvic adhesions)
Medical conditions:
- Endocrine dysfunction (thyroid, adrenals, pituitary, PCOS)
- Chronic renal/liver disease
- Hypothalamic pathology
What are the pregnancy-related causes of pelvic mass?
Intrauterine pregnancy
Ectopic pregnancy
Gestational Trophoblastic Disease
What are the gynecological causes of pelvic mass?
Ovarian:
- Benign: Functional ovarian cyst, endometrioma
- Malignant: Ovarian carcinoma
Uterine:
- Benign: Fibroid
- Malignant: Sarcoma
Other:
- Tubal carcinoma (rare)
- Pelvic wall endometriosis
What are the non-gynecological causes of pelvic mass?
Benign:
- Distended bladder
- Impacted feces
- Diverticular disease
- Appendix abscess
- Hydatid disease
- Pelvic kidney
Malignant:
- Bowel cancer
- Bladder cancer
What are the psychological and medical causes of sexual dysfunction?
Psychological:
- Depression
- Marital/relationship discord
- Stress
- Poor body image
- Negative attitudes to sex
Medical:
- Peripheral neuropathy (e.g., diabetes)
- Spinal cord disease/trauma
- Post-radiation for pelvic cancer
- Endocrine disorders (thyroid, pituitary)
- Conditions causing pelvic pain/dyspareunia
- Menopause (vaginal atrophy and dryness)
- Pregnancy-related issues
- Post-partum problems
What are the types of infective vulval lesions?
Raised lesions:
- Warts (condylomata accuminata - HPV)
- Syphilis (gumma, condylomata lata)
- Molluscum contagiosum
Ulcerative:
- Herpes simplex
- Syphilitic chancre
- Lymphogranuloma venereum
What are the causes of vulval pruritus?
Infective:
- Tinea
- Candida
- Scabies
- Threadworm
- UTI
Non-infective:
- Skin disorders (allergic/irritant dermatitis, psoriasis, lichen planus)
- Vulval dystrophy (lichen sclerosis, squamous cell hyperplasia)
- Atrophy (post-menopausal)
- Premalignant/malignant conditions (VIN, carcinoma, melanoma)
- Other (foreign body, psychological causes)
