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GOSH > Core conditions 2 > Flashcards

Core conditions 2 Flashcards

1
Q

What is PPROM, SROM, ARM defined as?

A

PPROM: Premature rupture of membranes <37weeks. 80% labour within 7days
SROM: Spont rupture of membranes 90% labour within 48hours
Prolonged SROM: >24hours
ARM: Artificial rupture of membranes as part of induction/augmentation

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2
Q

What can cause PPROM?

A

Infection
Trauma
Overstretching

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3
Q

What are RFs for PPROM?

A 
Smoking
Lower GU infection
Prev preterm delivery
Vaginal bleeding
\+ve amniotic fluid culture
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4
Q

How is PPROM diagnosed?

A

Pooling of amniotic fluid on sterile speculum when lying for 30mins (check liquor & umbilical cord)

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5
Q

How is PPROM managed?

A

DO NOT perform necessary PV exam
Abx: Erythromycin
Hospital referral
Prophylactic steroids: Betamethasone

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6
Q

What are the types of ovarian cysts? How do they develop?

A

Follicular cysts: Response to gonadotrophic stimulation ?dominant follicle fails to rupture
Corpus luteum cysts: Evolve from mature Graafian follicles 2-4days after ovulation

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7
Q

What are the RFs for ovarian cysts?

A 
pre-menopausal
Early menarche
1st trimester pregnancy
Inc intrinsic/extrinsic gonadotrophin
Personal Hx of infertility/PCOS
Tamoxifen
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8
Q

What are the causes of ovarian cysts?

A 
Genetic mutation
Physiological processes
Normal/increased hormone production
Pluripotent stem cells lacking normal growth regulation
Extrinsic gonadotrophin
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9
Q

How are ovarian cysts investigated?

A

TVUS

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10
Q

How are ovarian cysts managed?

A

Acute: laparoscopy, resus & hem support, borad spec Abx
Ongoing: Conservative, laparoscopy, gynae oncology referral

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11
Q

Define endometriosis

A

The presence of endometrial glands and stroma outside the endometrial cavity and uterine musculature.
Can lead to infertility, adhesions & fibrosis

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12
Q

What are the causes of endometriosis?

A 
Retrograde menstruation
Mullerian rests
Deficient cell-mediated immune response
Vascular &amp; lymphatic dissemination
Genetics
Inc level of inflammatory &amp; angiogenic mediators
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13
Q

What is endometriosis dependent on?

A

Oestrogen- cyclical symptoms

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14
Q

What is adenomyosis?

A

Endometrial tissue within the myometrium

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15
Q

What are the signs of endometriosis?

A 
Dysmenorrhoea
Dyspareunia
Sub-fertility
Uterosacral ligament modularity
Pelvic mass
Fixed, reteroverted uterus
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16
Q

How is endometriosis diagnosed?

A

Laparoscopy- Gold standard

TVUS

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17
Q

How is endometriosis managed?

A 
OCPs (take packets back to back)
NSAIDs: Ibuprofen
GnRH agonists + HRT
Mirena coil
Laparoscopy: Ablation, resection, cystectomy, oophorectomy
Progestogens: Medroxyprogesterone
Androgens: Danazol
Total abdominal Hysterectomy
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18
Q

Where are the main sites of endometriosis?

A 
Retrograde
Peritoneum
Pouch of Douglas
Ovary/tubes
Ligaments
Bladder
Myometrium
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19
Q

How is the menopause defined?

A

The cessation of menses for at least 12 consecutive months, without some other reason for amenorrhoea (such as pregnancy, hormone therapy, or other medical condition).

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20
Q

What is the pathophysiology of the menopause?

A

Result of ovarian failure
Oestrone derived from estradiol metabolism in the liver& androstenedione in adipose tissue becomes dominant oestrogen

21
Q

What are menopausal symptoms related to?

A

Decreasing estradiol levels

22
Q

What are the long-term risks implicated with the menopause?

A

Osteoporosis

CV disease

23
Q

How is the menopause managed?

A

Lifestyle changes
Conjugated oestrogen
Irregular periods: Oestrogen & Progestin

24
Q

What is premenstrual syndrome (PMS)?

A

cyclical physical and behavioural symptoms occurring in the luteal phase of the menstrual cycle.

25
Q

How is PMS diagnosed?

A

Symptom diary

26
Q

How is PMS managed?

A

Mild: Lifestyle advice
Moderate: COC (Yasmin), CBT, analgesia
Severe: Tx for mild & SSRI

27
Q

What is hyperemesis gravidarum?

A

Severe nausea & vomiting in pregnancy

28
Q

When is hyperemesis gravidarum most likely to occur?

A

4-7weeks gestation peaks at 9-16weeks and resolves by around week 20

29
Q

What are the RFs for hyperemesis gravidarum?

A 
Multiple pregnancy
GTD
Triploidy
Trisomy 21
Hydrops Fetalis
Fhx/prev Hx
30
Q

How is hyperemesis gravidarum diagnosed?

A 
N&amp;V on symptoms alone
If weight loss;
Bloods (U&amp;Es+, TFTs: TSH-, T4 n
Metabolic panel (hyperNA, hypochloraemia)
Urinalysis- Ketones+++
31
Q

What are the signs that N&V is hyperemesis and not just early pregnancy related?

A

> 5% weight loss
Dehydration
Electrolyte imbalance
Ketonuria

32
Q

How is hyperemesis managed?

A

Rest & IV hydration
Food: Plain biscuits/crackers, small frequent meals
Antiemetics: Cyclizine/Promethiazine/Prochlorperazine reassess after 24hours Ondansetron 2nd line (not for >5days)
Corticosteroids (IV Methylpred)

33
Q

What are the complications of hyperemesis?

A 
Pre-eclampsia
Mallory-Weiss tear
Splenic avulsion
IUGR
Fetal mortality
Oesophageal rupture
34
Q

What are the causes of uterine prolapse?

A 
Vaginal delivery
Genetics
Elevated intra-abdominal pressure
CT disorders
Decreased Levator Ani tone
35
Q

What are the signs & symptoms of a prolapse?

A 
Dragging sensation
Back pain
Vaginal bulge/protrusion
Constipation
Urinary incontinence
36
Q

How is a prolapse investigated?

A

Assess post-void residual urine volume
Urinalysis
Urodynamics

37
Q

How is a prolapse treated?

A 
Pelvic floor exercises
Weight loss
Avoid heavy lifting
Pesery-ring
Surgery: Suturing, hysterectomy, sacrospinus fixation
38
Q

What are uterine fibroids?

A

Leiomyomata

Benign tumours of myometrium usually composed of smooth muscle & fibrous CT

39
Q

What causes uterine fibroids?

A

Mutatuon of single uterine myometrial cell
OE & Progesterone
De novo

40
Q

What is the pathophysiology of uterine fibroids?

A

Arise from myometrial layer or uterine cervix
May remain within musclar layer or protrude outwards becoming subserosal
May protrude inwards towards uterine cavity becoming submucous

41
Q

Which type of uterine fibroids most commonly cause bleeding?

A

Submucous fibroids

Bleeding caused by distortion of the endometrial lining

42
Q

What are the signs & symptoms of uterine fibroids?

A

Asymptomatic-depends on size & location
Menorrhagia/dysmenorrhoea
Irregular firm central pelvic mass
Pelvic pain/discomfort
Pressure symptoms: Frequency, hydronephrosis (compression of ureters),
Bloating
Infertility/miscarriage

43
Q

When should a woman with fibroids be referred? What tests will be done?

A 
Symptoms not improved with treatment 
Complications (compressive symptoms)
Obs/fertility issues
Clinical/radiological suspicion of malignancy
>12cm or palpable abdominally
Ix: USS, Endometrial biopsy
44
Q

How are uterine fibroids treated?

A 
Asymptomatic= leave
<3cm w/menorrhagia: IUS, Tranexamic acid/NSAID (3m then refer), COCP, PO injection
>3cm w/menorrhagia: Ulipristal acetate
Fertility desired: 
GnRH: Leuprorelin IM/ monthly <3months
Mifepristone 3-6months
Ulipristal Acetate
Myomectomy +/- UEA
Fertility NOT desired: 
UAE/myomectomy
Hysterectomy
Leuprorelin IM/monthly <3months
45
Q

What are the different types of uterine fibroids?

A

Submucous: Below mucosal surface of uterus
Subserous: Below serosal layer of uterus
Intramural: Within uterine wall

46
Q

What are the causes of a cervical ectropion?

A

Hormonal changes: Puberty, Pregnancy, OCP

47
Q

What are the signs & symptoms of a cervical ectropion?

A

Asymptomatic
Persistent vaginal discharge
Postcoital bleeding

48
Q

How is a cervical ectropion treated?

A

Asymptomatic- leave

Normal smear- Diathermy, cryocautery

GOSH (17 decks)

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