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Diagnostic Sciences > Disorders of female repro and urinary > Flashcards

Disorders of female repro and urinary Flashcards

1
Q

What questions would you ask when taking a full gynaecological Hx?

A
  • Presenting complaint
  • Menstrual Hx
  • Symptoms
  • Obstetric history
  • Contraception
  • Sex/relationships
  • History of infections
  • General health
  • Gynaecological operations
  • Date and result of last PAP test
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2
Q

What symptoms do you look out for in a gynaecological Hx?

A
  • 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
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3
Q

What questions would you ask when discussing a patient’s menstrual Hx?

A
  • 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)
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4
Q

What questions would you ask when discussing a patient’s obstetric Hx?

A
  • parity and gravity
  • details of pregnancy, labour, delivery, birthweights
  • babies health
  • miscarriages/terminations
  • postnatal problems (depression)
  • conception difficulties/subfertility
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5
Q

What questions would you ask when discussing a patient’s contraception Hx?

A
  • recent unprotected sex
  • reliability of method and user
  • potential contraindications
  • permanent or temporary
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6
Q

What questions would you ask when discussing a patient’s infection Hx?

A
  • past PID (quality of treatment)
  • known STI
  • risk of HIV and hepatitis
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7
Q

What is a dipstick test?

A
  • 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
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8
Q

What does a standard urinalysis using a reactor strip (eg. dipstick) usually measure?

A
  • pH
  • protein (usually none)
  • glucose (none)
  • ketones (none)
  • specific gravity
  • casts or crystals (none)
  • bilirubin (none)
  • nitrites (none)
  • urobilinogen (none)
  • RBC (<2)
  • WBC (<4)
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9
Q

List the different forms of miscarriage

A
  • Early, Late
  • Spontaneous
  • Induced, Therapeutic
  • Threatened, Inevitable
  • Incomplete, Complete
  • Habitual
  • Missed
  • Septic
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10
Q

Early vs Late miscarriage?

A

Early: first 12 weeks

Late: 12-20 weeks

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11
Q

Spontaneous miscarriage?

A

nothing done or happened in order to miscarry

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12
Q

Induced vs Therapeutic miscarriage?

A

Induced: caused by trauma, chemical agents, scraping

Therapeutic: intentional, if risk to baby or mother, personal choice

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13
Q

Incomplete vs Complete miscarriage?

A

Incomplete: some contents remain in uterus

Complete: all contents expelled from uterus

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14
Q

Habitual miscarriage

A

repeated loss of pregnancies

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15
Q

Missed miscarriage

A

not aware of pregnancy and also not aware of miscarriage

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16
Q

Septic miscarriage

A

Sepsis in uterus
• fever
• very ill
• risk to mother

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17
Q

What are the causes of low back pain classified by pathologies?

A
  • traumatic
  • structural alterations
  • inflammatory
  • infections
  • degenerative
  • hormonal
  • metabolic alterations
  • activity related
  • neoplastic
  • psychogenic
  • malingering, idiopathic, iatrogenic
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18
Q

What are the causes of low back pain classified by anatomy?

A 
Disorders of the:
• vertebral column
• paravertebral muscle and/or myofascial tissue
• anterolateral abdominal wall
• digestive system
• reproductive system
• urinary system
• cardiovascular system
• nervous system
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19
Q

What are the causes of hirsutism?

A
  • racial
  • familial
  • idiopathic
  • drugs (adrenal steroids, androgenic hormones, dilantin)
  • PCOS
  • Cushing’s syndrome
  • tumours of adrenal gland or ovary
  • acromegaly
  • hyperprolactinaemia
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20
Q

What are the causes of weight gain?

A
  • Intake greater than expenditure
  • Fluid retention
  • psychological disturbance (bulimia nervosa, depression)
  • Endocrine disorders
  • Organ enlargement
  • Excess muscle
  • pregnancy
  • menopause
  • drug related
  • abnormal fat distribution
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21
Q

What are the fluid retention causes of weight gain?

A
  • cardiac failure
  • liver failure
  • renal failure
  • nephrotic syndrome
  • hypoalbuminaemia
  • ascites
  • lymphoedema
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22
Q

What are the endocrine causes of weight gain?

A
  • Cushing’s disease/syndrome
  • PCOS
  • insulinoma
  • hypothyroidism
  • insuline resistance
  • hypopituitarism
  • hypothalamic disorders
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23
Q

What are causes for a high blood glucose?

A
  • post high carb meal
  • acute stress
  • overweight
  • diabetes mellitus
  • Cushing’s
  • PCOS
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24
Q

What are causes of nocturia?

A
  • 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
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25
Q

What are the causes of dysmenorrhea?

A

Primary: ovulatory (PMS) - too much prostaglandins

Secondary:
• endometriosis
• congestive (pelvic infection)
• uterine (fibroids, adenomyosis, inflammation, IUDs)

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26
Q

What is the pathophysiology of primary dysmenorrhea?

A

Excess prostaglandin F increases:
• contraction of myometrium
• vasoconstriction in endometrial vessels

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27
Q

What is the pathophysiology of dysmenorrhea in endometriosis?

A
  • bleeding from ectopic endometrial cells
  • inflammation surrounding
  • scarring makes pain worse
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28
Q

What is the pathophysiology of dysmenorrhea in uterine fibroids?

A

fibroid protrudes into lumen and uterus tries to expel it by increase in contraction

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29
Q

What are common causes of irregular menstruation?

A
  • excess androgens

* genetic

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30
Q

What are causes of irregular vaginal bleeding?

A
  • 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
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31
Q

What are the causes of secondary amenorrhea?

A
  • 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
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32
Q

What is primary and secondary amenorrhea?

A

Primary: no first period at 14 if no 2nd sex characteristics or no first period until 16

Secondary: cessation of period

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33
Q

What is the weight distribution in Cushing’s disease?

A
  • lemon on tooth pics
  • buffalo hump
  • moon face
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34
Q

What are causes of hypertension?

A
  • 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
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35
Q

Virilisation

A

development of male physical characteristics

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36
Q

Why would an examiner check for signs of moon face, buffalo hump, central obesity or violaceous striae?

A

those are signs of Cushing’s disease

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37
Q

What are the stigmata of hypothyroidism?

A
  • flat affect
  • dry skin
  • dressed warmly (feels cold)
  • slow speech, mentation
  • cool skin
  • low BP, HR
  • maybe goitre
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38
Q

What are common causes of striae?

A
  • rapid weight gain

* low collagen

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39
Q

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?

A
  • maybe pituitary tumour
  • she has headaches
  • look for eye consequences of high BP
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40
Q

Why do we check plasma cortisol and testosterone in a patient with irregular periods, headaches and fatigue?

A

check for PCOS

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41
Q

Why do we do chest and head x-ray in a patient with high BP, headaches, nocturia, and fatigue?

A

Maybe find:
• enlarged heart from high BP
• pituitary tumour in skull

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42
Q

What is the difference between Infertility and Subfertility?

A

Infertile: trying for > 1yr
Subfertile: can conceive at least once

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43
Q

What are causes of subfertility?

A 
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
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44
Q

Miscarriage

A

lost products of conception > 20wks

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45
Q

What are some common causes of miscarriage?

A
  • infection
  • diabetes
  • thyroid disease
  • chromosomal abnormalities
  • incompetent cervix
  • PCOS
  • lifestyle (drugs, cigarettes, alcohol)
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46
Q

What questions do you ask a patient about her vaginal discharge?

A
  • 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?
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47
Q

What is meant by “pelvic pain”?

A

Pain in area of pelvis
• urinary tract
• GIT
• female repro

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48
Q

What are the causes of pelvic pain?

A
  • 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

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49
Q

What questions would you ask in order to determine the source of pelvic pain?

A
  • Where are you in your menstrual cycle?
  • Unilateral, any muscle guarding?
  • Any dyspareunia?
  • Colicky, starting proximal and moving into pelvis
  • Any fever?
  • Increasing over months, waking at night, no relation to menstrual cycle, with weight loss and anaemia?
  • Exacerbated by movement?
  • Relieved by flatus?
  • Any frequency, poor stream, hesitancy, dribbling, nocturia?
  • Dysuria, frequency?
50
Q

What are the causes of increased normal vaginal secretions?

A
  • increased oestrogen (ovulation, oral contraceptive, pregnancy, cervical ectopic columnar epithelium
  • increased vaginal transudate (irritation, sexual excitement)
  • uterine secretions (premenstrualy, following menstruation
51
Q

What are the causes of abnormal vaginal secretions?

A
  • infections
  • cervicitis
  • atrophic vaginitis
  • childhood vaginitis
  • foreign bodies
  • chemicals
  • radiation
  • trauma
  • pelvic congestion
52
Q

Thick yellow vaginal discharge

A

gonococci or chlamydia

53
Q

Frothy yellow-green, offensive vaginal discharge

A

Trichomonas vaginalis

54
Q

Cheesy-white vaginal discharge

A

Vaginal mycosis

• candida albicans

55
Q

Grey-white vaginal discharge with fishy odour

A

gardnerella vaginalis

56
Q

Foul smelling vaginal discharge

A
  • gardnerella vaginalis
  • trichomonad vaginalis
  • bacterial vaginitis
  • foreign body
57
Q

Watery vaginal discharge

A
  • endocervical orcervical stricture
  • malignancy of upper genital tract
  • reaction to radiation therapy
58
Q

Bloody vaginal discharge

A
  • endometrial or cervical polyps
  • marked cervicitis
  • endometriosis
  • cervical or upper repro tract malignancy
  • myoma of uterus
59
Q

What is vulvovaginitis?

A
  • inflammation of vaginal mucosa and vulva
  • vaginal discharge and pruritis

FROM:
• STI
• yeast (candida)
• bacteria (chlamydia, gardnerella, gonorrhoea, E.coli)

60
Q

What is cervicitis?

A
  • inflammation of cervix
  • FROM: STI, childbirth trauma, instrumentation
  • red, swollen, ulceration on cervix
  • vaginal discharge, no symptoms, infertility
61
Q

What is pelvic inflammatory disease?

A
  • past cervix: uterus, tubes, ovaries
  • may lead to peritonitis, tube scar tissue
  • lower abdominal pain
  • dyspareunia
  • menstrual disturbance
  • fever
  • change in discharge (odour, colour, consistency)
62
Q

What is pelvic congestion syndrome?

A
  • years of pelvic inflammatory disease
  • pelvic pain, bloating
  • pain before period
63
Q

Is it possible to have vulvovaginitis, cervicitis or pelvic infection, without attaining it from a sexual partner?

A
  • Yes
  • if immunosuppressed
  • backstreet abortion
  • allergy to soap
64
Q

What is the hallmark symptom of an STI?

A

burning on urination

65
Q

What is the significance of tender costovertebral angles on examination?

A

indicates peritonitis

66
Q

What is the significance of abdominal tenderness, rebound tenderness and muscle guarding in a patient with vaginal discharge, pelvic pain, and a Hx of abortion?

A

means there is inflammation and the peritoneum is involved

67
Q

What is the significance of mucopurulent discharge from the cervix os?

A
  • bacterial (gonorea or chlamydia)

* pelvic inflammatory disease

68
Q

What is the significance of bilateral tenderness with cervical motion?

A

cervix inflammed, infected

69
Q

What is an adnexal mass?

A

mass on the uterine tube

70
Q

What are the possible causes of an adnexal mass?

A
  • ectopic pregnancy

* enlarged ovary

71
Q

What is a uterine fibroma?

A
  • also called fibromyoma or fibroids
  • benign tumour of uterus of smooth muscle and fibrous tissue
  • symptomless
  • or high flow (anaemia), colicky uterine pain, obstruction (ditension, frequency, varicose veins)
72
Q

What is endometriosis?

A
  • functional endometrial tissue outside of uterus
  • infertility
  • dysmenorrhoea, abnormal menstruation
  • dyspareunia
  • frequency, malaise
  • haematuria
73
Q

What is a functional ovarian cyst?

A
  • follicular or corpus lutteur
  • asymptomatic
  • or menstrual irregularities
74
Q

What is endometrial carcinoma?

A
  • malignancy of endometrium
  • most common in post menopausal women
  • irregular bleeding
  • discharge
  • mild hypogastric pain
75
Q

What is cervical dysplasia?

A
  • bening growth of cervix cells
  • asymptomatic
  • can lead to malignancy
76
Q

What is cervical carcinoma?

A
  • invasive malignant growth from cervix
  • early: asymptomatic
  • later: general malignancy symptoms
77
Q

What is ovarian carcinoma?

A
  • menopausal or post-menopausal women
  • symptoms only late
  • abdominal discomfort, bloating, back pain
  • dyspepsia
  • frequency
  • ankle swelling
  • anorexia
78
Q

Describe the pain in primary dysmenorrhoea? vs secondary dysmenorrhoea?

A

Primary: starts with period, max on days 1-2

Secondary: before period

79
Q

What is a yeast infection?

A
  • candida albicans
  • white cheesy discharge
  • pruritus, pain
80
Q

What is congestive dysmenorrhoea?

A
  • secondary dysmenorrhea caused by pelvic congestion (from + blood supply from disease of pelvis)
  • abdominal distension
81
Q

What is the difference between menorrhagia and metrorrhagia?

A

Menorrhagia: heavy menstrual bleeding

Metrorrhagia: abnormal bleeding not during menstruation

82
Q

What is the DDx of a 48yr old female with 6/7 heavy vaginal bleeding with her last menstrual period 7 weeks earlier?

A
  • perimenopause
  • endometrial carcinoma
  • pregnant
  • miscarriage
  • fibroids & stress
  • adenomyoma & stress
83
Q

What question would you ask a 48yr old female with 6/7 heavy vaginal bleeding with her last menstrual period 7 weeks earlier?

A
  • Any hot flashes, weight gain, previous episodes, disturbed sleep, mood swing, low sex drive?
  • Unplanned weight loss, post-menopausal, bleeding, post coital bleed, fatigue?
  • Trying to get pregnant, unsafe sex?
84
Q

What do you think of when faced with a 33 year old female patient coming in with a reproductive problem?

A
  • chance of pregnancy
  • less chances of malignancies
  • PCOS (starts at 12 usually)
85
Q

dyspareunia

A

painful or difficult coitus

86
Q

What is the DDx of a 33yr old female with 3/12 Hx of spotting between regular periods, post-coital bleeding?

A
  • STI
  • pelvic inflammatory disease
  • PCOS
  • HPV
  • cervical carcinoma
  • change in contraceptive method
87
Q

What questions do you ask a 33yr old female with 3/12 Hx of spotting between regular periods, post-coital bleeding?

A
  • Any fever, discharge, pruritus, dysuria?
  • Diagnosed with PCOS? or signs of PCOS?
  • Any unplanned weight loss, fever, fatigue?
88
Q

What investigations would you do for a 33yr old female with 3/12 Hx of spotting between regular periods, post-coital bleeding?

A 
• pap smear
• ultrasound of ovaries, uterus
• blood test for ESR
• urine culture
(can't rule out with just questions, DDx too broad)
89
Q

What is the classic presentation of primary dysmenorrhoea?

A
  • 30 fish year old
  • chronic Hx of dysmenorrhoea
  • max pain on day 1-2 of period bleeding
  • no premenstrual pain
  • heavy bleeding
  • nulliparous
90
Q

Nulliparous

A

woman who has never given birth either by choice or for any other reason

91
Q

What are the consequences of being nulliparous?

A

Increases risk for:
• primary dysmenorrhoea
• endometriosis

92
Q

What increases a patient’s risk for developing a UTI?

A
  • immune suppressed (HIV, stress, infectious mono, pregnancy, low nutrition)
  • diabetes mellitus
  • excess cortisol (stress, Cushing’s, corticosteroids)
  • oral contraceptive
93
Q

What is the classic presentation of endometriosis?

A
  • 38 yr old female
  • 6/12 Hx of dysmenorrhoea
  • pain commencing 3-4 days prior to onset of period bleeding
  • peak intensity on days 2-3 of period
  • gradually subsides over next 2 days
  • low fertility
94
Q

How does endometriosis lead to decreased fertility?

A
  • endometrium outside uterus

* scarring of surrounding structures (tubes and ovaries)

95
Q

What are risk factors for endometriosis?

A
  • high socioeconomic status

* nulliparous

96
Q

What are the consequences of being pregnant with endometriosis?

A 
Increased risk of:
• pre-eclampsia
• ectopic
• early birth
• miscarriage
• placenta previa
97
Q

What is the DDx of a 17yr old female with irregular periods, with nothing else? What investigations?

A
  • PCOS (#1)
  • iron deficiency
  • excess exercise with low fat
  • contraceptive pill
  • hyper-/hypo-thyroidism
  • stress

Investigations:
• ultrasound
• blood

98
Q

How many weeks is a term pregnancy?

A

40wks (38-42wks)

Post-mature > 40wks

Pre-mature: 36-37wks

99
Q

What is the difference between gestational hypertension, mild pre-eclampsia and severe pre-eclampsia?

A

Gestational hypertension: BP > 140/90 at >27wks (never had high BP before)

Mild pre-eclampsia: high BP + proteinuria (albumin)

Severe pre-eclampsia: high BP + proteinuria + one other symptom
• vascular dysturbance
• CNS (blur, vision, headache, - cognition)
• liver
• terrible oedema

100
Q

What could cause right iliac fossa pain?

A
  • appendicitis

* meckles diverticulum

101
Q

What can cause left iliac fossa pain?

A

• diverticular disease (elderly)

102
Q

What questions would you ask a 22yr old female with acute left iliac fossa pain (getting worse), with Hx of unprotected sex? and what investigations

A
  • Any early signs of pregnancy (nausea, low energy, tender breasts or growing, emotions, missed period)
  • where did the pain begin?
  • urine test for pregnancy
  • ultrasound for ectopic pregnancy
103
Q

Who is especially at risk of ectopic pregnancy?

A

Scarring from:
• pelvic inflammatory disease
• endometriosis

104
Q

What are some symptoms of an ectopic pregnancy?

A
  • unilateral iliac fossa pain
  • vaginal bleeding
  • symptoms and signs of pregnancy
  • fever, tachycardia
  • muscle spasm over iliac fossa
105
Q

What is the DDx of a new breastfeeding mother with chills, headache, arthralgia, myalgia, fever and a very painful right breast?

A
  • Acute mastitis (#1) -most likely from staph aureus (skin) through a cracked nipple
  • breast cancer
106
Q

Can a mother with acute mastitis still breastfeed?

A

yes if on antibiotics

107
Q

What are the aetiologies of acute mastitis?

A
  • breastfeeding (systemically ill)

* chaffing clothing (would not be systemically ill)

108
Q

Why do pregnant women get low back pain?

A
  • centre of gravity displaced anteirorly
  • increased weight
  • increased joint laxity
  • increased lordosis
  • increased anterior pelvic tilt
109
Q

What are the consequences of pre-eclampsia?

A

Mother:
• seizures -> brain damage)
• kidney damage

Baby:
• low nutrients -> dysmaturity
• early delivery
• placenta abrupture

110
Q

What are the consequences of gestational diabetes?

A
  • overweight baby
  • baby at risk for hypoglycaemia, seizures
  • mother at risk for diabetes later in her life
111
Q

What is the hormone they check for in pregnancy test?

112
Q

Should you worry if a 36wks pregnant women has vaginal bleeding?

A

yes. might be:
• placenta praevia
• placenta abrupture
• he show

-straight to hospital

113
Q

Differentiate between placenta abrupture, placenta praaevia and show

A

Abrupture: detached from uterus wall

Praaevia: positioned over the cervix

Show: mucus plugging the cervix

114
Q

What are Braxton-Hicks contractions?

A

normal contractions in late pregnancy

115
Q

What is the DDx of a small lump in the breast?

A
  • fibroadenoma
  • fibroadenosis
  • cyst

• breast carcinoma

116
Q

Where are the most common sites for a breast cancer to be located?

A

upper outer quadrant

117
Q

Why do people die from breast cancer, even when it is removed surgically?

A
  • metastasis

* recurrents

118
Q

When is a breast lump suspicious (think its cancer)?

A
  • rapid growth
  • hard, irregular, fixed
  • patient with high risk (smoking, gene, >40, early monarch, late menopause)
  • peau d’orange
  • en cuirasse
119
Q

Where are the most common sites for breast cancer to spread?

A
  • liver
  • lung
  • bone
  • brain
  • adrenals
120
Q

What is the DDx of a 40yr off female with “lumpy” breasts with nodules with discomfort worse prior to her periods? How would you confirm Dx?

A
  • fibroadenosis (hormonal causes)
  • chronic mastitis

• mammograms + ultrasound + biopsy

121
Q

What is the risk with a patient with fibroadenosis?

A
  • does not get malignant itself

* BUT is hard to notice if a breast carcinoma were to develop (would just be another lump among many lumps)

Diagnostic Sciences (7 decks)

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