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Repro > Conditions > Flashcards

Conditions Flashcards

1
Q

Development.

Describe effects of exogenous androgens if female.

Androgen insensitivity syndrome.

5a reductase deficiency?

A

No testis - no MIH - Müllerian ducts develop
Androgens cause wolfian ducts to develop
Double ducts

Testis so MIH and androgens
No testosterone means no wolfian ducts
MIH means no Müllerian ducts

Ambiguous genitalia
Genital tubercle doesnt fully elongate
Scrotum remains split (bindi scrotum)
Urethral opening on the underside of the penis - hypospadias

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2
Q

Why can excess testosterone lead to infertility?

Give two overall effects of capacitiaiton. ,,,,,,

A

Negative feedback on the hypothalamus and anterior pituitary gland leading to less LH and FSH production. Meaning less androgen binding protein is produced and also less testosterone.

Destabilisation of the acrosomal head
Increased mobility of tail

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3
Q

Describe the difference in onset of puberty between males and females.

A

9-13 females

10-14 males

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4
Q

What is classified as oligomenorrhea?

In mullerian agenesis why would estrogen be normal?

Compare axillary and pubic hair in AIS and mullerian agenesis.
T level?

A

Infrequent menstruation of more than >35days.

Ovaries are not formed from the Müllerian duct.

MA - they will have - AIS - very little

MA - normal T - AIS - high T due to testis

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5
Q

Premature ovarian failure.

Give a cause.

Give some symptoms/ signs.

Why may some women still manage to get pregnant?

What would you look for on blood tests?

A

Turner’s syndrome

Hot flashes, night sweats and vaginal dryness leading to dyspareunia

Decreased estrogen -> CVD and osteoporosis risk

Due to intermittent ovarian function

Low estrogen and high FSH and LH

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6
Q

Swyer syndrome.

Why XY but no testis?

External genitalia?

Why streak gonads?

Puberty?

A

SRY mutation meaning testes do not form.

Female - failure to virilise

Because not XX so indifferent gonad doesn’t become ovaries.

No puberty

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7
Q

Menorrhagia.

When should endometrial cancer be suspected?

What classifies as menorrhagia?

A

Mid to late 40s with sudden onset of heavy bleeding which was previously normal.

80ml<

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8
Q

Ectropia,

Difference in epithelium of endocervix and ectocervix?

Name for junction?

What causes cervix to evert?

What is the transformation zone defined as?

A

Endocervic - columnar
Ecto - stratified squamous

Squamocolumnar junction

Oestrogen

The area between the original SCJ and new SCJ.

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9
Q

Dysmenorrhea.

Primary?

Secondary?

A

Response of uterus to local PGs causing painful contractions secondary to HMB.

Endometriosis/ obstructed menses.

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10
Q

What is the purpose of the fern test?

What is spinnbarkeit mucus?

A

Test for the presence of amniotic fluid - detect onset of labour.

Stringy and stretchy mucus just prior to ovulation.,

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11
Q

Give some causes for ED.

Tx?

Why can nitrates be used in Tx?

A

Psychological
Tears in corpora cavernous a
Atherosclerosis
Drugs

Viagra (Sildenafil)

More NO production - means more stimulation of gauntly love cyclase -

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12
Q

Fertile window.

How long are sperm viable in the female reproductive tract?

Oocyte?

A

48-72hours

6-24 hours

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13
Q

Contraception.

What can fertility awareness methods be based on?\

What cancers does COCP increase and decrease the risk of?

Advantge of Depo Provera compared to COCP? Disadvantage?

What is another high dose and low dose progesterone contraception?

Difference in primary action of IUS vs IUD?

Give two disadvantages.

A

Cervical mucus
Basal body temperatures
Length of menstrual cycle

Decrease ovarian and endometrial
Increased cervical and breast

IM injection every 12 weeks - therefore reliable as long as appointments are attended
Delay in fertility returning (10months)
Appointments needed every 12 weeks.

High dose - implant
Low dose - progestogen pill

IUS - prevents implantation through reduced endometrial proliferation
IUD - copper toxic to sperm and ovum

Uterine perforation
Insertion may be unpleasant
Menstrual irregularity

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14
Q

Infertility

Give two testicular causes for infertility.
Pre-testicular?

Post-testicular?

A

Klinefelter syndrome
Cryptorchidism
Torsion
Varicocele

Hyperprolatinaemia
Diabetes

Erectile dysfunction
Ejaculatory failure

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15
Q

Amenorrhea.

Give some causes of primary amenorrhea.

Secondary.

A

Mullerian agenesis
Vagina atresia

Swyer syndrome
Turner syndrome

Asherman’s syndrome
PCOS 
Stress, eating disorders
Hyperprolactinaemia 
Anovulation
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16
Q

Endometriosis

Typical symptom?

Main pathophysiological theory?

Mullerian abnormalities.

Give 3.

A

Chronic pelvic pain

Retrograde menstraution from uterus into Fallopian tubes and peritoneum.

Bicornuate uterus 
Didelphys - dupilcation of the uterus cervix and vagina
Septate uterus 
Uterine hypoplasia 
Agenesis
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17
Q

What are some blood tests to carry out in someone who is experiencing subfertility?

What can be used to test tubal patency?

When should referral to a fertility clinic be made?

A

Follicular phase LH
Luteal phase progesterone
Prolactin, androgens, TFTs

Hysterosalpingogram

Reproductive age women who has not conceived after 1 year of unprotected vaginal sex intercourse.

Early is they are over 36 years old

18
Q

Preeclampsia.

What is eclampsia?

Why hypertension occurs?

Two complications of severe preeclampsia.

Where is pain?
Why elevated liver enzyme?

Pathophysiology behind HELLP syndrome?

Why may seizures develop?

Tx?

A

Preeclampsia + seizures

Pro-inflammatory molecules are released form non-functional placenta leading to endothelial dysfunction and increased salt retention.

haemorrhagic stroke
Placenta abruption

RUQ pain due to swelling and injury to the liver as a result of vasospasm occurring.
Elevated liver enzymes as a result of this

Haemolysis due to small microthrombi forming

Cerebral edema occurs

Delivery of foetus and placenta

19
Q

Why do you get a respiratory alkalosis in pregnancy?

Why does TV increase?

A

TV increased more CO2 breathed off - gradient formed for CO2 removal from the foetus.

Progesterone effects on central respiratory centre
Oxygen consumption and CO2 production increased

20
Q

Foetal heart rate decelerations.

Response to uterine contraction.

Response to uteroplacental insufficiency.

Variable decelerations occur when?

Why does deceleration occur in response to hypoxia?

A

Early deceleration

Late deceleration

Cord compression.

Redistribution of flow to protect heart and brain reducing supply to limbs GIT etc.

21
Q

What three foetal factors are important in the second stage of labour?

What is the optimal foetal presentation?

What is foetal station?
Where is “0” station?

What many fourth stage of labour be defined as?

What are some things that can induce labour?

Give three ways in which the human body controls bleeding post-parturition.

A

Foetal attitude
Foetal lie
Foetal presentation

Vertex (cephalic) - head fully flexed.

Degree of descent of the foetus
Ischial spine level

Adaptations to reducing foetal blood loss
Uterine involution begins

Synthetic oxytocin
Prostaglandins artificial
Anti-progesterone agents
Stimulation of PG release.

Interlacing muscle fibres - constrict myometrial blood vessels
Walls of contracted uterus exert pressure on uterus walls
Pro-thrombotic factors resales

22
Q

Menopause.

What is the period of a women’s life in which there is a decline in ovarian function called?

Why are follicles no longer maturing?

Give some examples of dysfunction uterine bleeding?

Why depression/ insomnia?
Why decreased libido?

Why is androgen secretion maintained?

Why osteoporosis?

Non-hormonal treatment.

A

Climacteric

FSH rising too high causing follicles to become densititised to FSH.

Spotting between cycles
Extreme heavy bleeding
Longer and shorter cycles

Because reduced sleep due to night sweats
Decreased libido due to vaginal dryness

Because LH and FSH production is high.

Reduced oestrogen leads to increased osteoclast activity.

Dress light colours
Eat less spicy food 
Less caffiene 
Less alcohol 
Less fat
Exercise
23
Q

PID.

Give two complications.

What three ABX used?

A 
Reiter syndrome
Fitz-Hugh Curtis syndrome
Ectopic pregnancy 
Infertility 
Chronic pelvic pain

Ceftriaxone
Doxycyline
Metronidazole

24
Q

Pelvic organ prolapse.

Why is it more common post-menopause?

How would enterocoele present?

Uterine prolapse?

What system is used to assess degree of prolapse?

Management?

A

Vaginal and uterine atrophy and wearing of ligaments

Abdominal pain with vaginal protrusion and decreased bowel movements

Vague symptoms of increased pelvic pressure/pain - increased when standing - better with laying down.

POP-Q

Kegel exercises
Pessaries
Colporrhaphy (anterior/ posterior)
Vaginal hysterectomy

25
Q

OASIS.

Give two non-ways in which OASIS can be prevented.

Most common cause of SUI in males?

FGM.

Give some consequences.

What is anismus?

A

Perineal protection at delivery
Encourage mother not to push as much
Episiotomy (medio-lateral cut)

Prostatectomy

Haematocolpus
Urinary outflow obstruction
PTSD

Failure of normal relaxation of the pelvic floor muscles during attempted defecation

26
Q

Post natal period.

What can be visualised in the cervix?

Give rectus abdominal change.

Lochia.

What does greenish/ offensive Lochia indicate?

What can retained Lochia lead to?

When is clot passage normal?

Are elevated GGT/AST and ALT abnormal?

A

Transformation zone withdrawing back into endocervix.
Internal OS closure

Reversal of diastasis of recti

Chlamydia/ saprophyticus infection

Lochiametra - distension of uterus

D3-4

No tend to elevate but resolve

27
Q

PPH.

Why may someone with urinary retention be more at risk of PPH? Tx?

What is another 2 causes of uterine atony?
Tx?

Give two causes of tissue retention?

A

Enlarged bladder compresses the uterus interfering with the uterine contractions
Catheter

Multiparity
Overstretching from twins and triplets

Fundal massage

Placenta accreta
Umbilical cord traction

28
Q

Placenta abruption.

What is it?

Difference between apparent or concealed?

Risk factors.

Give 2 complications.

Diagnosis based on?

A

Premature seperation of the placenta (decidua basalis) from the uterine wall

Apparent - margin of placenta - vaginal bleeding occurs
Concealed - pocket of blood forms due to central abruption.

Trauma, domestic violence
Methamphetamines
Cocaine 
Multiparity 
Previous abruption (strongest factor)

Sheehan syndrome
Hypovolemia shock
Renal failure
DIC (decidua basalis has lots of thromboplastin which is released)

Imaging - look for haemorrhage/ haematoma

29
Q

Chlamydia trachomatis.

Give two eye infections.

Give two signs in LGV.

Diagnosis women/men?

Tx?

Who is it more common in?

A

Trachoma (Chronic infections of eye)
Neonatal conjunctivitis

Grove sign
Perirectal lymph node swelling

Women - vulvovaginal/ first catch urine - men

Doxycycline/ azithromycin
Erythromycin/ olfloxacin

Doxycycline for rectal chlamydia (DAEO)

Women

30
Q

Gonorrhea.

Gram stain?

Vertical transmission?

Tx?

Swab where?

Two virulence factors.

A

Gram -ve diplococcus

Opthalmia neonatorum (trouble opening eyes)

Ceftriaxone and Azithromycin

Vulvovaginal in females
Urethral in males

Pili
IgA protease

31
Q

Treponema pallidum.

Gram stain?

Two skin lesions seen in secondary syphilis.

Other things that can be seen?

Where does latent syphillis lie?

Give some features of tertiary syphillis.

Two lab investigations?

Serological testing?

Tx - early, late latent (or CVS, gummaout)and neuro.

A

Gram negative bacilli

Maculopapular rash
Condylomata

Meningitis
Hepatitis
GN

In small capillaries

Tabesdorsalis
Brain affected
Gummatous lesions
End artrietis leading to aortitis and AAA

Dark field microscopy
PCR

TPPA
TPEIA
VDRL
RPR

Ben Pen G
Ben Pen G x3
Procaine penicillin (+Probenecid 14 days)

32
Q

Herpes.

What type of virus?

Reactivation of oral herpes causes blisters to form where?

What is herpetic whitlow?
What does it enable?

What is herpes gladiatorum?

Burn injuries and atopic dermatitis?

Eye infection?

CNS infection?

Acyclovir MOA?

A

Enveloped, double stranded DNA viruses

Vermillion border

Herpes infection of a the finger near the nail bed
Autoinoculation.

Infection of the trunk, extremities and head

Eczema herpeticum

Keratoconjuctivitis

Meningitis, encephalitis

Thymidine kinase inhibition

33
Q

Trichmonas vaginalis.

Women symptoms?

Tx?

Type of organism?

A 
Yellow frothy vaginal discharge 
Strawberry cervix 
Vulvitis 
Vaginitis 
Itchiness 
Dysuria

Metronidazole

Flagellated Protozoa

34
Q

Scabies.

Infestation by?

Immunocomprimised?

Tx?

Public lice.

Infestation by?

Treatment?

A

Sarcoptes scabiei

Crusted scabies

Permethrin

Phthirus pubis

Malathion (AChEi)

35
Q

HPV.

Vaccine name?

Type of virus?

A

GARD Asia

Icosahedral, double stranded non-enveloped.

36
Q

BV.

What cells do you look for?

RFs?

Where do you sample?

RFs for vulvovaginal candidiasis.

A

Gardnerella vaginalis coating epithelial cells (clue cells)

Douching, black, smoking, receptive oral sex

High vaginal

Immunosupression 
Oestrogen contraceptive pills
Diabetes 
Atopy 
Pregnancy 
ABx use
37
Q

What causes chancroid?

Donovanosis?

A

Haemophilus ducreyi

Klebsiella granulomatis

38
Q

Vulval cancer.

Distinguish between age of onset of VSCC/ VIN due to HPV and lichen sclerosus.

3 ways in which they can spread?

A

HPV 16 related - 60s
Lichen sclerosus related - 80s

Direct extension (anus vagina or bladder) 
Lymph nodes (Inguinal, para-aortic iliac) 
Distant mets (lung and liver)
39
Q

Give some risk factors for HPV exposure.

Some other risk factors for CIN and cervical carcinoma.

CIN1 Tx vs CIN 2 and 3.

Treatment of advanced invasive cervical cancer.

A

Sexual partner with HPV
Multiple partners
Early age of first intercourse

Early first pregnancy 
Multiple births
Smoking
Low socio-economic class
Immunosupression

CIN 1 - often regress spontaneously - monitor
CIN2/3 - LLETZ

Hysterectomy.
Lymph node dissection
Chemoradiotherapy

40
Q

Endometrial hyperplasia.

Defined as?

What type of tumour can cause it?

Condition that can cause it?

What should worry you?

What is serous endometrial cancer associated with?

What can be seen deposited on the peritoneum?

Sx?

Where do leiomyosarcomas commonly met?

A

> 11mm

Granulosa cell (estrogen secreting)

PCOS

Vaginal bleeding in a postmenopausal women

Atrophic endometrium.

Psammoma bodies - collections of calcium

Hysterectomy
bilateral salpingooopherectomy
lymph node dissection
Chemoradiotherapy

Lungs

41
Q

Ovarian cancer.

name two other things ovarian endometriosis tumours may be associated with?

What can theca and granulosa cell tumours cause in young girls?
Adults?

Give some cancers that met to ovaries?

A

Endometrial endometrioid adenocarcinoma
Endometriosis

Precocious puberty
Endometrial hyperplasia
Endometrial cancer
Breast cancer/tenderness

GI (krukenberg tumour that is usually gastric)
Breast
Gynae (endometrial, Fallopian tube)

42
Q

Test tumour.

Risk factor.

Age range?

Who do yolksac tumours commonly occur in?

Why can Choriocarcinoma be associated with gyno and hyperthyroidism?
What type of lesion does it leave on the lungs?

A

Cryptorchidism.

Young men 15-35

<3 yo

bHCG has a similar structure to LH FSH and TSH.

Cannon ball mets

Repro (22 decks)

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