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Year 4 - 1. Reproductive Health > Differentials and risk factors - gynae presentations > Flashcards

Differentials and risk factors - gynae presentations Flashcards

1
Q

State some male factors for infertility (pre-testicular, testicular and post-testicular)

A

Pre-testicular:
- Problems with hypothalamus or pituitary
- HPA axis suppression e.g. stress

Testicular:
- Damage from infection e.g. mumps, radio/chemotherapy, trauma, undescended testes
- Genetic conditions e.g. Klinefelter syndrome

Post-testicular (obstruction):
- Damage to passage e.g. radio/chemotherapy trauma
- Scarring from infection e.g. chlamydia
- Absence vas deferens
- Retrograde ejaculation

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2
Q

State some female factors for infertility

A

Anovulation:
- PCOS
- Premature menopause / menopause
- Endocrine disorders e.g. thyroid imbalance

Uterine factors:
- Polyps
- Fibroids
- Endometriosis / adenomyosis
- Abnormally shaped uterus
- Damage from previous surgery

Tubal factors:
- Scarring from PID, surgeries

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3
Q

State some causes of urinary incontinence

A
  • Weak pelvic floor muscles (stress incontinence)
  • Overactive bladder (urge incontinence)
  • Pelvic organ prolapse
  • Neurological e.g. MS, diabetes, Parkinson’s
  • Overflow incontinence
  • UTI infection
  • Constipation
  • Functional incontinence (unable to reach bathroom in time)
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4
Q

State some risk factors for prolapse

A
  • Previous prolapse
  • Multiple vaginal deliveries
  • Instrumental delivery / traumatic delivery
  • Obesity
  • Chronic cough
  • Chronic straining
  • Connective tissue disorders
  • Advanced age / postmenopausal
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5
Q

Outline some differentials for a patient presenting with superficial vaginal pain

A
  • STI
  • Candida infection
  • Herpes simplex
  • Foreign body
  • Systemic conditions e.g. eczema, psoriasis
  • Trauma e.g. tear, sexual abuse, childbirth
  • Vaginal atrophy
  • Vaginismus
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6
Q

Outline some differentials for a patient presenting with dysmenorrhoea

A

Primary:
- No underlying cause

Secondary:
- Fibroids
- Endometriosis / adenomyosis
- IUD device
- Ectopic pregnancy / miscarriage
- Malignancy e.g. ovarian, endometrial, cervical
- PID

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7
Q

Outline some differentials for a patient presenting with menorrhagia

A

Primary:
- No underlying cause

Secondary:
- Fibroids
- Endometrial polyps
- Endometriosis / adenomyosis
- Coagulopathy / liver disease
- PCOS
- PID
- Copper IUD
- Ectopic pregnancy / miscarriage
- Malignancy e.g. ovarian, endometrial, cervical
+ some medications

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8
Q

Outline some differentials for a patient presenting with deep pelvic pain (dyspareunria)

A
  • PID
  • Endometriosis / adenomyosis
  • Cervicitis
  • Recent change of partner
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9
Q

Outline some differentials for a patient presenting with post-coital bleeding

A
  • Trauma / poor lubrication
  • Cervicitis / cervical ectropion
  • Cervical polyps
  • Malignancy (cervical mainly)
  • Vaginal atrophy
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10
Q

Outline some differentials for a patient presenting with intermenstrual bleeding

A
  • Cervical ectropion
  • Polyps (cervical or endometrial)
  • Fibroids
  • Malignancy (cervical, uterine)
  • PCOS
  • Secondary to contraception e.g. Mirena coil
  • Implantation bleeding / miscarriage / pregnancy
  • STI
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11
Q

Outline some differentials for a patient presenting with vaginal discharge

A

Physiological

Infection:
- Thrush / bacterial vaginosis
- STI e.g. chlamydia, gonorrhoea, trichomoniasis

Non-infective:
- Foreign body (retained tampon, condom, or postpartum swab)
- Malignancy (any part of the genital tract)
- Atrophic vaginitis (blood-stained)
- Cervical ectropion or endocervical polyp
- Fistulae (urinary or faecal)

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12
Q

Outline some differentials for a patient presenting with vaginal itching

A
  • Contact with irritants e.g. fabric softener, perfumes
  • Thrush
  • Genital warts
  • STIs e.g. trichomoniasis
  • Threadworms (worse at night)
  • Scabies (worse at night)
  • Secondary to dermatological conditions e.g. eczema, psoriasis, lichen simplex, lichen planus
  • Vaginal atrophy
    + secondary to urinary incontinence
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13
Q

Outline some differentials for a patient presenting with postmenopausal bleeding

A
  • Perimenopausal
  • Malignancy (endometrial mainly)
  • Endometrial hyperplasia
  • Endometrial / cervical polyps
  • Vaginal atrophy
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14
Q

Outline some differentials for a patient presenting with urinary incontinence (different types)

A
  • Stress
  • Urge
  • Mixed
  • Overflow
  • Overactive bladder
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15
Q

Outline some differentials for a patient presenting with ‘something coming down’ (different types)

A

Vaginal prolapse:
- Anterior vaginal wall prolapse (urethrocele, cystocele)
- Posterior vaginal wall prolapse (rectocele, enterocele)

Other prolapse:
- Cervical prolapse
- Uterine prolapse
- Vault prolapse (only after hysterectomy)

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16
Q

Outline some differentials for a patient presenting with vaginal bleeding before 12 weeks pregnancy

A
  • Implantation bleeding
  • Ectopic pregnancy
  • Subchorionic haemorrhage
  • Molar pregnancy
  • Non-pregnancy related causes e.g. cervical ectropion, polyps, cancer

Types of miscarriage:
- Threatened
- Incomplete / complete
+ Retained products of conception

17
Q

Outline some differentials for a patient presenting with abdominal pain (known pregnant) before 12 weeks pregnancy

A
  • Can be normal part of pregnancy
  • Benign e.g. constipation
  • Ectopic pregnancy
  • UTI
  • Chorioamnionitis
  • Molar pregnancy
  • Non-pregnancy related causes e.g. appendicitis

Types of miscarriage:
- Threatened
- Incomplete / complete
+ Retained products of conception

18
Q

List some differentials for primary and secondary amenorrhoea

A

Primary amenorrhea:
Structural:
- Absent uterus
- Absent vagina
- Imperforate hymen
- Transverse septum
Endocrine:
- Dysfunctioning hypothalamus / pituitary
- Dysfunctioning gonads
- Genetic issues e.g. Turner’s syndrome

Secondary amenorrhea:
- Pregnancy
- Menopause
- PCOS
- Functional amenorrhoea
- Cushing’s
- Thyroid issues
- Contraception / iatrogenic
- Medications

19
Q

List some differentials for acute pelvic pain (non-pregnancy related)

A

Gynae:
- Endometriosis flare
- Ectopic pregnancy
- Ovarian cyst torsion / rupture
- PID / abscess
- Mittelschmerz

Non-gynae:
- UTI
- Appendicitis
- IBS / IBD
- Diverticulitis
- Renal stones
- Bowel obstruction
- Urinary retention

20
Q

List some gynae differentials for chronic pelvic pain

A
  • PID
  • Endometriosis / adenomyosis
  • Pelvic adhesions
  • Fibroids
  • Pelvic floor disorders / prolapse
21
Q

List some differentials for acute pelvic pain if undergoing fertility treatment

A
  • Ectopic pregnancy
  • Ovarian hyperstimulation syndrome
  • Ovarian follicular cyst
  • Ovarian torsion

Year 4 - 1. Reproductive Health (7 decks)

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