Disorders of female repro and urinary Flashcards
What questions would you ask when taking a full gynaecological Hx?
- Presenting complaint
- Menstrual Hx
- Symptoms
- Obstetric history
- Contraception
- Sex/relationships
- History of infections
- General health
- Gynaecological operations
- Date and result of last PAP test
What symptoms do you look out for in a gynaecological Hx?
- Change in discharge (colour, amount, smell, itchy, duration, rash)
- Pain or discomfort (duration, type, alleviating, aggravating, radiation, relation to cycle, bowel, dyspareunia)
- Urinary symptoms (leak, cloudy, hematuria, dysuria, hesitancy, frequency, stranguary, stress incontinence)
- Possibiliy of pregnancy?
- Partner symptoms
What questions would you ask when discussing a patient’s menstrual Hx?
- Last menstrual period (LMP) - date of first day of bleeding
- Cycle length and frequency
- Heaviness of bleeding? (# tampons/clots)
- Intermenstrual bleeding (IMB).
- Postcoital bleeding(PCB).
- Age of menarche/menopause
- Post-menopausal bleeding (PMB)
What questions would you ask when discussing a patient’s obstetric Hx?
- parity and gravity
- details of pregnancy, labour, delivery, birthweights
- babies health
- miscarriages/terminations
- postnatal problems (depression)
- conception difficulties/subfertility
What questions would you ask when discussing a patient’s contraception Hx?
- recent unprotected sex
- reliability of method and user
- potential contraindications
- permanent or temporary
What questions would you ask when discussing a patient’s infection Hx?
- past PID (quality of treatment)
- known STI
- risk of HIV and hepatitis
What is a dipstick test?
- paper strip with patches impregnated with chemicals that change colour when constituents of urine are present at certain concentrations
- dipped into urine sample for few seconds
- then compare colour change to standards chart
What does a standard urinalysis using a reactor strip (eg. dipstick) usually measure?
- pH
- protein (usually none)
- glucose (none)
- ketones (none)
- specific gravity
- casts or crystals (none)
- bilirubin (none)
- nitrites (none)
- urobilinogen (none)
- RBC (<2)
- WBC (<4)
List the different forms of miscarriage
- Early, Late
- Spontaneous
- Induced, Therapeutic
- Threatened, Inevitable
- Incomplete, Complete
- Habitual
- Missed
- Septic
Early vs Late miscarriage?
Early: first 12 weeks
Late: 12-20 weeks
Spontaneous miscarriage?
nothing done or happened in order to miscarry
Induced vs Therapeutic miscarriage?
Induced: caused by trauma, chemical agents, scraping
Therapeutic: intentional, if risk to baby or mother, personal choice
Incomplete vs Complete miscarriage?
Incomplete: some contents remain in uterus
Complete: all contents expelled from uterus
Habitual miscarriage
repeated loss of pregnancies
Missed miscarriage
not aware of pregnancy and also not aware of miscarriage
Septic miscarriage
Sepsis in uterus
• fever
• very ill
• risk to mother
What are the causes of low back pain classified by pathologies?
- traumatic
- structural alterations
- inflammatory
- infections
- degenerative
- hormonal
- metabolic alterations
- activity related
- neoplastic
- psychogenic
- malingering, idiopathic, iatrogenic
What are the causes of low back pain classified by anatomy?
Disorders of the: • vertebral column • paravertebral muscle and/or myofascial tissue • anterolateral abdominal wall • digestive system • reproductive system • urinary system • cardiovascular system • nervous system
What are the causes of hirsutism?
- racial
- familial
- idiopathic
- drugs (adrenal steroids, androgenic hormones, dilantin)
- PCOS
- Cushing’s syndrome
- tumours of adrenal gland or ovary
- acromegaly
- hyperprolactinaemia
What are the causes of weight gain?
- Intake greater than expenditure
- Fluid retention
- psychological disturbance (bulimia nervosa, depression)
- Endocrine disorders
- Organ enlargement
- Excess muscle
- pregnancy
- menopause
- drug related
- abnormal fat distribution
What are the fluid retention causes of weight gain?
- cardiac failure
- liver failure
- renal failure
- nephrotic syndrome
- hypoalbuminaemia
- ascites
- lymphoedema
What are the endocrine causes of weight gain?
- Cushing’s disease/syndrome
- PCOS
- insulinoma
- hypothyroidism
- insuline resistance
- hypopituitarism
- hypothalamic disorders
What are causes for a high blood glucose?
- post high carb meal
- acute stress
- overweight
- diabetes mellitus
- Cushing’s
- PCOS
What are causes of nocturia?
- excess fluid, alcohol, caffeine before bed, diuretic meds,
- pregnancy / prostatic
- stress/anxiety
- infections
- hypercalcaemia, hyperparathyroid, Addison’s disease, diabetes insipidus, mellitus
- cardiac, liver, renal failure
- urinary retention with overflow
What are the causes of dysmenorrhea?
Primary: ovulatory (PMS) - too much prostaglandins
Secondary:
• endometriosis
• congestive (pelvic infection)
• uterine (fibroids, adenomyosis, inflammation, IUDs)
What is the pathophysiology of primary dysmenorrhea?
Excess prostaglandin F increases:
• contraction of myometrium
• vasoconstriction in endometrial vessels
What is the pathophysiology of dysmenorrhea in endometriosis?
- bleeding from ectopic endometrial cells
- inflammation surrounding
- scarring makes pain worse
What is the pathophysiology of dysmenorrhea in uterine fibroids?
fibroid protrudes into lumen and uterus tries to expel it by increase in contraction
What are common causes of irregular menstruation?
- excess androgens
* genetic
What are causes of irregular vaginal bleeding?
- Hormonal (contraceptive pill not adjusted, perimenopausal, PCOS)
- Complications of pregnancy
- Ovarian cysts, tumours
- Anatomic abnormal repro tract
- Repro tract infections
- Uterine (endometriosis, fibroids, endometrial hyperplasia, endometrial polyps, carcinoma, IUD, trauma)
- Cervix dysplasia, carcinoma, trauma
- Vagina tumours, atrophic vaginitis, trauma
- Bleeding tendency, drugs
What are the causes of secondary amenorrhea?
- Normal ovarian hormones: pregnancy, uterine dysfunction
- Increased ovarian hormones: ovarian tumours, PCOS
- Decreased ovarian hormones: menopause, stress, starvation, excess exercise, anorexia nervosa, hyperprolactinaemia, hypothalamic or pituitary disease, oral contraceptive pill
What is primary and secondary amenorrhea?
Primary: no first period at 14 if no 2nd sex characteristics or no first period until 16
Secondary: cessation of period
What is the weight distribution in Cushing’s disease?
- lemon on tooth pics
- buffalo hump
- moon face
What are causes of hypertension?
- endocrine (Cushing’s, Conn’s, phaeochromocytoma, hyperthyroidism)
- renal (glomerulonephritis, chronic pyelonephritis, diabetic nephropathy, polycystic, renal vascular disease, obstruction, collagen disease)
- pregnancy
- coarctation of aorta
- neurogenic (increased ICP, hypothalamic lesions, head injury, brain stem disorder)
- insect bite
- concurrent use of meds (anti-inflammatories, steroids, salt tablets)
- high salt diet
Virilisation
development of male physical characteristics
Why would an examiner check for signs of moon face, buffalo hump, central obesity or violaceous striae?
those are signs of Cushing’s disease
What are the stigmata of hypothyroidism?
- flat affect
- dry skin
- dressed warmly (feels cold)
- slow speech, mentation
- cool skin
- low BP, HR
- maybe goitre
What are common causes of striae?
- rapid weight gain
* low collagen
Why do we examine the eyes of a patient with irregular periods, headaches, fatigue, fainting, nocturia, high BP and a family Hx of stroke and diabetes mellitus?
- maybe pituitary tumour
- she has headaches
- look for eye consequences of high BP
Why do we check plasma cortisol and testosterone in a patient with irregular periods, headaches and fatigue?
check for PCOS
Why do we do chest and head x-ray in a patient with high BP, headaches, nocturia, and fatigue?
Maybe find:
• enlarged heart from high BP
• pituitary tumour in skull
What is the difference between Infertility and Subfertility?
Infertile: trying for > 1yr
Subfertile: can conceive at least once
What are causes of subfertility?
Female: • tubes (chronic pelvic inflam. disease) • endometriosis • ovulation (PCOS, hyperprolactinaemia, hyper-/hypo-thyroidism • implantation • antisperm antibodies
Male: • genito-urinary infections • undescended testes • genetic • testicular tumours • radiotherapy • active sperm • conception
Miscarriage
lost products of conception > 20wks
What are some common causes of miscarriage?
- infection
- diabetes
- thyroid disease
- chromosomal abnormalities
- incompetent cervix
- PCOS
- lifestyle (drugs, cigarettes, alcohol)
What questions do you ask a patient about her vaginal discharge?
- Is there a change in your normal discharge?
- What is a “normal” discharge for you?
- Where are you in your cycle?
- Have you recently changed detergent, soap, underwear, contraception?
- How many sexual partners, safe sex, contraception?
- Itchyness, STI, partner’s STI, chance of pregnancy?
What is meant by “pelvic pain”?
Pain in area of pelvis
• urinary tract
• GIT
• female repro
What are the causes of pelvic pain?
- msk, trauma
- digestive, lower urinary tract disorder
- tumours, infection, calculi
- vascular disorder, neurogenic
- inguinal or femoral hernia
Female: • pelvic inflam. disease • ovarian cysts, torsion • endometriosis, adenomyosis • dysmenorrhea • postpartum
Male:
• phimosis, paraphimosis
• prostate disease
• torsion of testes
