Conditions Flashcards
Development.
Describe effects of exogenous androgens if female.
Androgen insensitivity syndrome.
5a reductase deficiency?
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
Why can excess testosterone lead to infertility?
Give two overall effects of capacitiaiton. ,,,,,,
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
Describe the difference in onset of puberty between males and females.
9-13 females
10-14 males
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?
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
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?
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
Swyer syndrome.
Why XY but no testis?
External genitalia?
Why streak gonads?
Puberty?
SRY mutation meaning testes do not form.
Female - failure to virilise
Because not XX so indifferent gonad doesn’t become ovaries.
No puberty
Menorrhagia.
When should endometrial cancer be suspected?
What classifies as menorrhagia?
Mid to late 40s with sudden onset of heavy bleeding which was previously normal.
80ml<
Ectropia,
Difference in epithelium of endocervix and ectocervix?
Name for junction?
What causes cervix to evert?
What is the transformation zone defined as?
Endocervic - columnar
Ecto - stratified squamous
Squamocolumnar junction
Oestrogen
The area between the original SCJ and new SCJ.
Dysmenorrhea.
Primary?
Secondary?
Response of uterus to local PGs causing painful contractions secondary to HMB.
Endometriosis/ obstructed menses.
What is the purpose of the fern test?
What is spinnbarkeit mucus?
Test for the presence of amniotic fluid - detect onset of labour.
Stringy and stretchy mucus just prior to ovulation.,
Give some causes for ED.
Tx?
Why can nitrates be used in Tx?
Psychological
Tears in corpora cavernous a
Atherosclerosis
Drugs
Viagra (Sildenafil)
More NO production - means more stimulation of gauntly love cyclase -
Fertile window.
How long are sperm viable in the female reproductive tract?
Oocyte?
48-72hours
6-24 hours
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.
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
Infertility
Give two testicular causes for infertility.
Pre-testicular?
Post-testicular?
Klinefelter syndrome
Cryptorchidism
Torsion
Varicocele
Hyperprolatinaemia
Diabetes
Erectile dysfunction
Ejaculatory failure
Amenorrhea.
Give some causes of primary amenorrhea.
Secondary.
Mullerian agenesis
Vagina atresia
Swyer syndrome
Turner syndrome
Asherman’s syndrome PCOS Stress, eating disorders Hyperprolactinaemia Anovulation
Endometriosis
Typical symptom?
Main pathophysiological theory?
Mullerian abnormalities.
Give 3.
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
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?
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
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?
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
Why do you get a respiratory alkalosis in pregnancy?
Why does TV increase?
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
Foetal heart rate decelerations.
Response to uterine contraction.
Response to uteroplacental insufficiency.
Variable decelerations occur when?
Why does deceleration occur in response to hypoxia?
Early deceleration
Late deceleration
Cord compression.
Redistribution of flow to protect heart and brain reducing supply to limbs GIT etc.
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.
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
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.
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
PID.
Give two complications.
What three ABX used?
Reiter syndrome Fitz-Hugh Curtis syndrome Ectopic pregnancy Infertility Chronic pelvic pain
Ceftriaxone
Doxycyline
Metronidazole
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?
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
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?
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
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?
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
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?
Enlarged bladder compresses the uterus interfering with the uterine contractions
Catheter
Multiparity
Overstretching from twins and triplets
Fundal massage
Placenta accreta
Umbilical cord traction
Placenta abruption.
What is it?
Difference between apparent or concealed?
Risk factors.
Give 2 complications.
Diagnosis based on?
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
Chlamydia trachomatis.
Give two eye infections.
Give two signs in LGV.
Diagnosis women/men?
Tx?
Who is it more common in?
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
Gonorrhea.
Gram stain?
Vertical transmission?
Tx?
Swab where?
Two virulence factors.
Gram -ve diplococcus
Opthalmia neonatorum (trouble opening eyes)
Ceftriaxone and Azithromycin
Vulvovaginal in females
Urethral in males
Pili
IgA protease
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.
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)
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?
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
Trichmonas vaginalis.
Women symptoms?
Tx?
Type of organism?
Yellow frothy vaginal discharge Strawberry cervix Vulvitis Vaginitis Itchiness Dysuria
Metronidazole
Flagellated Protozoa
Scabies.
Infestation by?
Immunocomprimised?
Tx?
Public lice.
Infestation by?
Treatment?
Sarcoptes scabiei
Crusted scabies
Permethrin
Phthirus pubis
Malathion (AChEi)
HPV.
Vaccine name?
Type of virus?
GARD Asia
Icosahedral, double stranded non-enveloped.
BV.
What cells do you look for?
RFs?
Where do you sample?
RFs for vulvovaginal candidiasis.
Gardnerella vaginalis coating epithelial cells (clue cells)
Douching, black, smoking, receptive oral sex
High vaginal
Immunosupression Oestrogen contraceptive pills Diabetes Atopy Pregnancy ABx use
What causes chancroid?
Donovanosis?
Haemophilus ducreyi
Klebsiella granulomatis
Vulval cancer.
Distinguish between age of onset of VSCC/ VIN due to HPV and lichen sclerosus.
3 ways in which they can spread?
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)
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.
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
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?
> 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
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?
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)
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?
Cryptorchidism.
Young men 15-35
<3 yo
bHCG has a similar structure to LH FSH and TSH.
Cannon ball mets
