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
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
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)
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
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
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
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
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)
9
Q
List the different forms of miscarriage
A
- Early, Late
- Spontaneous
- Induced, Therapeutic
- Threatened, Inevitable
- Incomplete, Complete
- Habitual
- Missed
- Septic
10
Q
Early vs Late miscarriage?
A
Early: first 12 weeks
Late: 12-20 weeks
11
Q
Spontaneous miscarriage?
A
nothing done or happened in order to miscarry
12
Q
Induced vs Therapeutic miscarriage?
A
Induced: caused by trauma, chemical agents, scraping
Therapeutic: intentional, if risk to baby or mother, personal choice
13
Q
Incomplete vs Complete miscarriage?
A
Incomplete: some contents remain in uterus
Complete: all contents expelled from uterus
14
Q
Habitual miscarriage
A
repeated loss of pregnancies
15
Q
Missed miscarriage
A
not aware of pregnancy and also not aware of miscarriage
16
Q
Septic miscarriage
A
Sepsis in uterus
• fever
• very ill
• risk to mother
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
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
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
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
21
Q
What are the fluid retention causes of weight gain?
A
- cardiac failure
- liver failure
- renal failure
- nephrotic syndrome
- hypoalbuminaemia
- ascites
- lymphoedema
22
Q
What are the endocrine causes of weight gain?
A
- Cushing’s disease/syndrome
- PCOS
- insulinoma
- hypothyroidism
- insuline resistance
- hypopituitarism
- hypothalamic disorders
23
Q
What are causes for a high blood glucose?
A
- post high carb meal
- acute stress
- overweight
- diabetes mellitus
- Cushing’s
- PCOS
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
25
What are the causes of dysmenorrhea?
Primary: ovulatory (PMS) - too much prostaglandins
Secondary:
• endometriosis
• congestive (pelvic infection)
• uterine (fibroids, adenomyosis, inflammation, IUDs)
26
What is the pathophysiology of primary dysmenorrhea?
Excess prostaglandin F increases:
• contraction of myometrium
• vasoconstriction in endometrial vessels
27
What is the pathophysiology of dysmenorrhea in endometriosis?
* bleeding from ectopic endometrial cells
* inflammation surrounding
* scarring makes pain worse
28
What is the pathophysiology of dysmenorrhea in uterine fibroids?
fibroid protrudes into lumen and uterus tries to expel it by increase in contraction
29
What are common causes of irregular menstruation?
* excess androgens
| * genetic
30
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
31
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
32
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
33
What is the weight distribution in Cushing's disease?
* lemon on tooth pics
* buffalo hump
* moon face
34
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
35
Virilisation
development of male physical characteristics
36
Why would an examiner check for signs of moon face, buffalo hump, central obesity or violaceous striae?
those are signs of Cushing's disease
37
What are the stigmata of hypothyroidism?
* flat affect
* dry skin
* dressed warmly (feels cold)
* slow speech, mentation
* cool skin
* low BP, HR
* maybe goitre
38
What are common causes of striae?
* rapid weight gain
| * low collagen
39
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
40
Why do we check plasma cortisol and testosterone in a patient with irregular periods, headaches and fatigue?
check for PCOS
41
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
42
What is the difference between Infertility and Subfertility?
Infertile: trying for > 1yr
Subfertile: can conceive at least once
43
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
```
44
Miscarriage
lost products of conception > 20wks
45
What are some common causes of miscarriage?
* infection
* diabetes
* thyroid disease
* chromosomal abnormalities
* incompetent cervix
* PCOS
* lifestyle (drugs, cigarettes, alcohol)
46
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?
47
What is meant by "pelvic pain"?
Pain in area of pelvis
• urinary tract
• GIT
• female repro
48
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
49
What questions would you ask in order to determine the source of pelvic pain?
* 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
What are the causes of increased normal vaginal secretions?
* increased oestrogen (ovulation, oral contraceptive, pregnancy, cervical ectopic columnar epithelium
* increased vaginal transudate (irritation, sexual excitement)
* uterine secretions (premenstrualy, following menstruation
51
What are the causes of abnormal vaginal secretions?
* infections
* cervicitis
* atrophic vaginitis
* childhood vaginitis
* foreign bodies
* chemicals
* radiation
* trauma
* pelvic congestion
52
Thick yellow vaginal discharge
gonococci or chlamydia
53
Frothy yellow-green, offensive vaginal discharge
Trichomonas vaginalis
54
Cheesy-white vaginal discharge
Vaginal mycosis
| • candida albicans
55
Grey-white vaginal discharge with fishy odour
gardnerella vaginalis
56
Foul smelling vaginal discharge
* gardnerella vaginalis
* trichomonad vaginalis
* bacterial vaginitis
* foreign body
57
Watery vaginal discharge
* endocervical orcervical stricture
* malignancy of upper genital tract
* reaction to radiation therapy
58
Bloody vaginal discharge
* endometrial or cervical polyps
* marked cervicitis
* endometriosis
* cervical or upper repro tract malignancy
* myoma of uterus
59
What is vulvovaginitis?
* inflammation of vaginal mucosa and vulva
* vaginal discharge and pruritis
FROM:
• STI
• yeast (candida)
• bacteria (chlamydia, gardnerella, gonorrhoea, E.coli)
60
What is cervicitis?
* inflammation of cervix
* FROM: STI, childbirth trauma, instrumentation
* red, swollen, ulceration on cervix
* vaginal discharge, no symptoms, infertility
61
What is pelvic inflammatory disease?
* 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
What is pelvic congestion syndrome?
* years of pelvic inflammatory disease
* pelvic pain, bloating
* pain before period
63
Is it possible to have vulvovaginitis, cervicitis or pelvic infection, without attaining it from a sexual partner?
* Yes
* if immunosuppressed
* backstreet abortion
* allergy to soap
64
What is the hallmark symptom of an STI?
burning on urination
65
What is the significance of tender costovertebral angles on examination?
indicates peritonitis
66
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?
means there is inflammation and the peritoneum is involved
67
What is the significance of mucopurulent discharge from the cervix os?
* bacterial (gonorea or chlamydia)
| * pelvic inflammatory disease
68
What is the significance of bilateral tenderness with cervical motion?
cervix inflammed, infected
69
What is an adnexal mass?
mass on the uterine tube
70
What are the possible causes of an adnexal mass?
* ectopic pregnancy
| * enlarged ovary
71
What is a uterine fibroma?
* 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
What is endometriosis?
* functional endometrial tissue outside of uterus
* infertility
* dysmenorrhoea, abnormal menstruation
* dyspareunia
* frequency, malaise
* haematuria
73
What is a functional ovarian cyst?
* follicular or corpus lutteur
* asymptomatic
* or menstrual irregularities
74
What is endometrial carcinoma?
* malignancy of endometrium
* most common in post menopausal women
* irregular bleeding
* discharge
* mild hypogastric pain
75
What is cervical dysplasia?
* bening growth of cervix cells
* asymptomatic
* can lead to malignancy
76
What is cervical carcinoma?
* invasive malignant growth from cervix
* early: asymptomatic
* later: general malignancy symptoms
77
What is ovarian carcinoma?
* menopausal or post-menopausal women
* symptoms only late
* abdominal discomfort, bloating, back pain
* dyspepsia
* frequency
* ankle swelling
* anorexia
78
Describe the pain in primary dysmenorrhoea? vs secondary dysmenorrhoea?
Primary: starts with period, max on days 1-2
Secondary: before period
79
What is a yeast infection?
* candida albicans
* white cheesy discharge
* pruritus, pain
80
What is congestive dysmenorrhoea?
* secondary dysmenorrhea caused by pelvic congestion (from + blood supply from disease of pelvis)
* abdominal distension
81
What is the difference between menorrhagia and metrorrhagia?
Menorrhagia: heavy menstrual bleeding
Metrorrhagia: abnormal bleeding not during menstruation
82
What is the DDx of a 48yr old female with 6/7 heavy vaginal bleeding with her last menstrual period 7 weeks earlier?
* perimenopause
* endometrial carcinoma
* pregnant
* miscarriage
* fibroids & stress
* adenomyoma & stress
83
What question would you ask a 48yr old female with 6/7 heavy vaginal bleeding with her last menstrual period 7 weeks earlier?
* 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
What do you think of when faced with a 33 year old female patient coming in with a reproductive problem?
* chance of pregnancy
* less chances of malignancies
* PCOS (starts at 12 usually)
85
dyspareunia
painful or difficult coitus
86
What is the DDx of a 33yr old female with 3/12 Hx of spotting between regular periods, post-coital bleeding?
* STI
* pelvic inflammatory disease
* PCOS
* HPV
* cervical carcinoma
* change in contraceptive method
87
What questions do you ask a 33yr old female with 3/12 Hx of spotting between regular periods, post-coital bleeding?
* Any fever, discharge, pruritus, dysuria?
* Diagnosed with PCOS? or signs of PCOS?
* Any unplanned weight loss, fever, fatigue?
88
What investigations would you do for a 33yr old female with 3/12 Hx of spotting between regular periods, post-coital bleeding?
```
• pap smear
• ultrasound of ovaries, uterus
• blood test for ESR
• urine culture
(can't rule out with just questions, DDx too broad)
```
89
What is the classic presentation of primary dysmenorrhoea?
* 30 fish year old
* chronic Hx of dysmenorrhoea
* max pain on day 1-2 of period bleeding
* no premenstrual pain
* heavy bleeding
* nulliparous
90
Nulliparous
woman who has never given birth either by choice or for any other reason
91
What are the consequences of being nulliparous?
Increases risk for:
• primary dysmenorrhoea
• endometriosis
92
What increases a patient's risk for developing a UTI?
* immune suppressed (HIV, stress, infectious mono, pregnancy, low nutrition)
* diabetes mellitus
* excess cortisol (stress, Cushing's, corticosteroids)
* oral contraceptive
93
What is the classic presentation of endometriosis?
* 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
How does endometriosis lead to decreased fertility?
* endometrium outside uterus
| * scarring of surrounding structures (tubes and ovaries)
95
What are risk factors for endometriosis?
* high socioeconomic status
| * nulliparous
96
What are the consequences of being pregnant with endometriosis?
```
Increased risk of:
• pre-eclampsia
• ectopic
• early birth
• miscarriage
• placenta previa
```
97
What is the DDx of a 17yr old female with irregular periods, with nothing else? What investigations?
* PCOS (#1)
* iron deficiency
* excess exercise with low fat
* contraceptive pill
* hyper-/hypo-thyroidism
* stress
Investigations:
• ultrasound
• blood
98
How many weeks is a term pregnancy?
40wks (38-42wks)
Post-mature > 40wks
Pre-mature: 36-37wks
99
What is the difference between gestational hypertension, mild pre-eclampsia and severe pre-eclampsia?
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
What could cause right iliac fossa pain?
* appendicitis
| * meckles diverticulum
101
What can cause left iliac fossa pain?
• diverticular disease (elderly)
102
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
* 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
Who is especially at risk of ectopic pregnancy?
Scarring from:
• pelvic inflammatory disease
• endometriosis
104
What are some symptoms of an ectopic pregnancy?
* unilateral iliac fossa pain
* vaginal bleeding
* symptoms and signs of pregnancy
* fever, tachycardia
* muscle spasm over iliac fossa
105
What is the DDx of a new breastfeeding mother with chills, headache, arthralgia, myalgia, fever and a very painful right breast?
* Acute mastitis (#1) -most likely from staph aureus (skin) through a cracked nipple
* breast cancer
106
Can a mother with acute mastitis still breastfeed?
yes if on antibiotics
107
What are the aetiologies of acute mastitis?
* breastfeeding (systemically ill)
| * chaffing clothing (would not be systemically ill)
108
Why do pregnant women get low back pain?
* centre of gravity displaced anteirorly
* increased weight
* increased joint laxity
* increased lordosis
* increased anterior pelvic tilt
109
What are the consequences of pre-eclampsia?
Mother:
• seizures -> brain damage)
• kidney damage
Baby:
• low nutrients -> dysmaturity
• early delivery
• placenta abrupture
110
What are the consequences of gestational diabetes?
* overweight baby
* baby at risk for hypoglycaemia, seizures
* mother at risk for diabetes later in her life
111
What is the hormone they check for in pregnancy test?
beta HCG
112
Should you worry if a 36wks pregnant women has vaginal bleeding?
yes. might be:
• placenta praevia
• placenta abrupture
• he show
-straight to hospital
113
Differentiate between placenta abrupture, placenta praaevia and show
Abrupture: detached from uterus wall
Praaevia: positioned over the cervix
Show: mucus plugging the cervix
114
What are Braxton-Hicks contractions?
normal contractions in late pregnancy
115
What is the DDx of a small lump in the breast?
* fibroadenoma
* fibroadenosis
* cyst
• breast carcinoma
116
Where are the most common sites for a breast cancer to be located?
upper outer quadrant
117
Why do people die from breast cancer, even when it is removed surgically?
* metastasis
| * recurrents
118
When is a breast lump suspicious (think its cancer)?
* rapid growth
* hard, irregular, fixed
* patient with high risk (smoking, gene, >40, early monarch, late menopause)
* peau d'orange
* en cuirasse
119
Where are the most common sites for breast cancer to spread?
* liver
* lung
* bone
* brain
* adrenals
120
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?
* fibroadenosis (hormonal causes)
* chronic mastitis
• mammograms + ultrasound + biopsy
121
What is the risk with a patient with fibroadenosis?
* 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)
