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GOSH > Core Conditions > Flashcards

Core Conditions Flashcards

1
Q

What are the causes of miscarriage?

A 
Loss of pregnancy <24weeks
Most common: Unknown cause
2. Foetal abnormalities (Chr/structural)
-Primary embryonic disease
-Embryonic malformation
-Maternal systemic illness
-Maternal genital tract dysfunction
-Maternal exposure to high dose toxins
-Trans-placental fetal infection
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2
Q

How is a miscarriage investigated?

A

Pregnancy test
TVUS/abdoUSS
beta hCG: falling titre
Progesterone: Low titre

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3
Q

How is a threatened/complete miscarriage managed?

A

Analgesic
Counselling
Anti-D immunoglobulin

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4
Q

How is an inevitable/missed/ incomplete miscarriage managed?

A

Analgesia
Misoprostol: 800micro vaginally
Anti-D immunoG
LA/GA manual vacuum evacuation of retained POC

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5
Q

What does Climacteric mean?

A

The time within which the transition occurs from pre-post menopausal

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6
Q

How does the menstrual cycle of a woman change in the early & late menopausal transition?

A

Early: Variabe cycle length >7days different from normal
Late: >2 skipped cycles & an interval of amenorrhoea (>60days)

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7
Q

How is the menopause triggered?

A

LH & FSH levels increased by falling oestrogen levels

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8
Q

What are the early symptoms of the menopause?

A
  • Vasomotor
  • Periods altered
  • Insomnia: Tiredness, irritability, poor concentration
  • Mood swings
  • Cognitive function: Coping
  • CT/loss of collagen: Skin, hair, joint/muscle aches
  • Fat redistribution
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9
Q

What are the medium term symptoms of the menopause?

A
  • Vaginal: Dryness, soreness
  • Dyspareunia
  • Bladder: Frequency, urgency, dysuria, UTIs
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10
Q

How is dyspepsia caused during pregnancy?

A
  • Inc level of hormones has relaxing effect on duodenal sphincter
  • Size of the foetus causes increased pressure on the stomach
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11
Q

What makes someone more likely to get gestational dyspepsia?

A

Prev dyspepsia in pregnancy

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12
Q

What are the signs of gestational dyspepsia?

A

Symptoms come and go not present all the time
Usually more frequent/severe in 3rd trimester
Symptoms disappear quickly after birth

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13
Q

Why is constipation common in pregnancy?

A

Bowels are more relaxed so increased transit time due to stretched abdominal muscles, hormones & growing uterus putting pressure on the bowels

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14
Q

What is PCOS?

A

a syndrome of polycystic ovaries, in association with systemic symptoms causing reproductive, metabolic and psychological disturbances. These most commonly present with infertility, amenorrhoea, acne or hirsutism

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15
Q

What are the causes of PCOS?

A

Genetics

Defects in hypothalamic-pituitary axis

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16
Q

When should PCOS be suspected?

A

One or more:

  • Infrequent/no ovulation (infertility, ameno/oligomenorrhoea)
  • Adolescents <18 2 years of irregular cycles
  • After menarche/1year of irregularity on OCP
  • Hyperandrogenism
17
Q

How is PCOS investigated?

A 
Testosterone: ↑
SHBG: ↓
Free androgen: n/-
LH &amp; FSH: ++
Prolactin: +
Pelvic USS
18
Q

What is the Rotterdam criteria?

A

Diagnose PCOS if 2-3 of the following:

  • Infrequent/no ovulation
  • Clinical/biochemical signs of hyperandrogenism/elevated levels of total/free testosterone
  • Polycystic ovaries on USS (>12 follicles in one ovary OR large ovary >10cm diameter)
19
Q

What are the complications of PCOS?

A
  • Pregnancy complications
  • CVD
  • NAFLD
  • Malignancy
  • DM2
  • Infertility
20
Q

What are the causes of chronic pelvic pain?

A

Gynae: Endometriosis, Physical/sexual abuse, fibroids, cervical stenosis, Asherman’s, adhesions,
Non-Gynae: Interstitial cystitis, pelvic adhesions, Multifactorial, constipation, IBS/IBD, hernias, calculi

21
Q

How is chronic pelvic pain investigated?

A 
Urinalysis &amp; MSU
(Sterile UTI consider interstitial cystitis)
TVUS
STI screen
Bloods: FBC, CRP, Ca125
22
Q

How is chronic pelvic pain managed?

A 
Trial of OCP/GnRH analogues
Antispasmodics
Analgesia
Refer to pain clinic
Laparoscopy
23
Q

What are acute causes of pelvic pain?

A

Gynae: Ectopic, ovarian cyst, 1. dysmenorrhoea, Mittleschmerz
Non-gynae: UTI, strangulated hernia, calculi, IBS/IBD, appendicitis

24
Q

What are the types of incontinence? What are there mechanisms?

A

Stress: Leakage on effort, increased intra-abdominal pressure
Urge: Leakage accompanied by urgency to urinate
Mixed: Stress & urge
Overflow: Leakage from over-distended bladder

25
Q

Describe the normal mechanism of urine storage

A

1) Internal & external urethral sphincters closed & bladder relaxed
2) Involuntary & voluntary input to nerves & musculature= increase in outlet resistance to maintain urinary continence
3) Voiding= coordination between urethral sphincter relaxation & bladder contraction by parasympathetic NS

26
Q

What nerves control the internal & external urethral sphincters?

A

I: Sympathetic nerves = contraction
E: Somatic nerves = contraction, pudendal nerve= relaxation

27
Q

How is the bladder supported?

A

Lateral vaginal wall on either side
Levator Ani muscle & fascia
Ligamentous attachments

28
Q

What are the causes of urinary incontinence?

A

Weakened muscles (loss of pelvic floor support)
Stretched muscles
Pudendal & pelvic nerve damage
Chronic urinary retention
Involuntary contractions of the detrusor (OAB)

29
Q

How is incontinence diagnosed?

A

Pelvic exam
Assess pelvic floor muscle contractions
Urodynamics

30
Q

How are pelvic floor muscle contractions graded?

A 
0= No contraction
1= Flicker/pulsation
2= Weak, inc in tension detected without lift
3= Moderate, lifting of muscle belly &amp; elevation of post vaginal wall
4= Good, inc tension &amp; good contraction elevation of post vaginal wall against resistance 
5= Strong, strong resistance applied, examiner's finger squeezed &amp; drawn into the vagina
31
Q

How is stress incontinence managed?

A 
Lifestyle
Pelvic floor training for 3months
Mid-urethral/TV tape
Artificial urinary sphincter
Urethral bulking agents
Colposuspension
32
Q

How is urge incontinence managed?

A 
Lifestyle
Bladder drill
Antimuscarinics: Oxybutynin
Botulism injection
Percutaneous nerve stimulation
Other: nocturne- Desmopressin vaginal atrophy- intravaginal OE therapy
33
Q

How is PCOS managed?

A

Clomiphene Citrate
Metformin
Hirtuism: OCP & hair removal
Restoration of regular periods: Mirena/OCP

GOSH (17 decks)

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