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ESA4 > Disorders of the Reproductive System > Flashcards

Disorders of the Reproductive System Flashcards

1
Q

What is Amenorrhoea?

A

Absence of Menses
Primary - Never Present, also secondary sexual characteristics are absent from age 14

Secondary - Where established Menstruation has ceased for 3 months/6 months

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2
Q

What is PMS?

A

Pre-Menstrual Syndrome.

Emotional and Physical Symptoms in the 2nd half of the menstrual cycle

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3
Q

What is Menorrhagia?
What is Dysmenorrhoea?
What is Oligomenorrhoea?

A

Abnormal heavy bleeding or length of a period.
Painful menstruation.
Irregular intervals between menses

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4
Q

What can cause Primary Amenorrhoea?

A

Outflow Tract Obstruction - Mullarian Agenesis
Imperforate Hymen
Atresic Vagina
Cryptomenorrhoea

Gonadal - Dysgenesis (Turners)
Androgen Insensitivity
Congeital Adrenal Hyperplasia
FSH/LH Receptor Abnormalities

Kallmann’s Syndrome
Hyper/Hypothyroidism

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5
Q

What can cause Secondary Amenorrhoea?

A

Outflow Tract Obstruction - Intrauterine Adhesions

Gonadal Disorders - Pregnancy
PCOS
Menopause

Hypothalamus - Exercise
Stress
Weight

Pituitary - Sheehan syndrome
Hyperprolactinaemia
Haemochromatosis

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6
Q

What is DUB?

A

Dysfunctional Uterine Bleeding

Abnormal Bleeding - heavy, prolonged, frequent

Causes 60% of menorrhagia

No obvious cause (pathology/pregnancy or other bleeding disorders), normally anovulatory

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7
Q

What can cause Menorrhagia?

A 
Fibroids
DUB
Coagulation Defects
Endometrial Carcinoma
Polyps
PID
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8
Q

What is Hyperprolactinaemia?

What does it cause?

A

Increase Prolactin Secretions

Secondary Amenorrhoea & Chronic Anovulation

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9
Q

What causes Hyperprolactinaemia?

Hint: There are three types

A

Physiological- Sleep, Stress, Pregnancy/Post-Partum

Pharmocological- Drug inhibits Dopamine

Pathological - Adenoma, 1. Hypothyroidism

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10
Q

What is PCOS?

A

Enlarged polycystic ovaries, leads to increase in GnRH pulses, LH and androgen secretions and lowered FSH

Androgens often changed to testosterone rather than Oestrogen which -> Symptoms

Associated with Type 2 Diabetes

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11
Q

What does PCOS cause?

A

Chronic Anovulation
Secondary Amenorrhoea
Physical signs of hyperandrogenism

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12
Q

How do we investigate PCOS?

A

Blood Test: Increased Testosterone, Increase LH, Decreased Sec Hormone Binding Globulin

Ultrasound: PC Ovaries and Thickened Capsule

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13
Q

What is PID?

A

Pelvic Inflammatory Disease

Infection ascends from the endocervix

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14
Q

What can PID cause?

A 
Endometriosis; 
Salpingitis; 
Oophritis; 
Parametritis; 
Tubo-ovarian Abcess 
Pelvic Peritonitis
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15
Q

What causes PID?

A

Infection of some kind ascending from the Endocervix
e.g. STIs - Chlamydia, Gonorrhea

e.g. Gardnerella vaginalis

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16
Q

How does PID cause damage?

A

Infection causes inflammation which can damage the epithelium
e.g. in the tubes, can cause Adhesions to form

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17
Q

What is a tubo-ovarian abcess?

A

Exudate fills the salpinx
Adhesions form in the tubes
Fibrin exudate blocks the tube

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18
Q

What are some Risk Factors for PID?

A

Intrauterine Contraceptive Devices

STIs

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19
Q

What are some symptoms of Pelvic Inflammatory Disease?

A

Pyrexia
Pelvic Pain
Abnormal Bleeding or Discharge

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20
Q

How do you manage PID?

A

IV antibiotics if severe/inpatient
Surgery if signs of TOA or Peritonitits
IM Ceftrioxone, Doxy or Metro
as an outpatient

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21
Q

What are some potential complications of PID?

A

Ectopic Pregnancy (tube damage)

Infertility (blockage of tube)

Chronic Pain

Fitz-Hugh-Curtis Syndrome

Reiters Syndrome

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22
Q

Describe Klinefelter Syndrome

A 
XXY
Most common chromosomal abnormality
1/1000 boys
Normal internal genitalia
Breast tissue (gynacomastia)
Get small testes and penis
Decreased testosterone and Fertility
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23
Q

Describe Turner’s Syndrome

A 
Aneuploidy XO
Get Cardiac and Renal Problems
Infertile
Shield Chest and Webbed Neck
Short Stature
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24
Q

Describe Pseudohermaphroditism

A 
Phenotype doesn't match genotype
Can be due to androgen insensitivity
if XY, testes don't descend, remain in lumbosacral region
Get no internal genitalia
External is female
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25
Q

Describe True Hermaphroditism

A

A true mosaic of XY XX XO
Ambiguous Genitalia
Get Teste and Ovarian Tissue Development

26
Q

Describe Congenital Adrenal Hyperplasia

A

Increased secretion of androgens
If XX, will have both internal genitalia, with female gonads
External will be male due to testosterone’s action
Can reange in severity

27
Q

Describe a Bicornate Uterus

A

Uterus has 2 horns

Appears due to the lack of fusion of the Mullerian /Paramesonephric Ducts

28
Q

Describe Hypospadia

A

When there is incomplete fusion of the tubercles
Opening of urethra is not on the head of the penis
Tends to be near glans, on dorsal surface

29
Q

Describe Ambiguous Genitalia

A

Large Clitoris
Small Penis
In some cases you can get characteristics of both sexes

30
Q

What is the normal blood loss in a period?

A

37-43ml per cycle (most in the first 48 hours)

some people lose up the 80ml per cycle, important to think of what is normal for them with a history (60-70% of them are anaemic)

31
Q

What defines menorrhagia?

A

Abnormally long ( over 7 days) or heavy (over 80ml)

but regular

32
Q

How can age affect a woman’s sexual excitation response?

A

Fewer rhythmic contractions of the uterus
Lose of muscular tone of vagina (lose of expansile ability)
Reduced desire
Reduced lubrication (due to reduced vasocongestion)
Resolution is more rapid
Vaginal tissue loses elasticity

33
Q

What are the 2 aspects affected by sexual dysfunction?

A

desire

arousal

34
Q

How can desire be affected?

A 
Most common dysfunction
hyperactive/nymphomaniac
hypoactive
CNS lesion - Kluver Bucci syndrome
Aversion- fear or revulsion of one or more aspects, usually due to assault
35
Q

How can arousal be affected in men?

A

Can be scared/psychological
Tears in corpora cavernosa
Vascular - atherosclerosis, diabetes
drugs- alcohol and anti-hypertensives

36
Q

How can arousal be affected in women?

A

Cannot retain lubrication-swelling response

37
Q

How do you treat arousal dysfunction?

A

Viagra

inhibits cGMP breakdown

38
Q

What are the methods of contraception?

A

Natural - Abstain, Rhythm Method, Coitus Interruptus

Barrier - Condom, Diaphragm/Cap

Vasectomy- prevent sperm

Prevent Ovulation - OCP

Sterilisation - occlude fallopian tubes

Inhibit sperm getting through the cervix - OCP, Progesterone Pill/Implant. Thick mucus, hostile!

Inhibit implantation - IUCD, post-coital contraceptive, hormonal contraceptive

39
Q

What are the signs of breast disease?

A

Pain
Nipple Discharge
Mammographic Changes
Masses

Skin Changes and Lumps

40
Q

When is pain more likely a sign of physiological/benign problems of the breast?

A

If it is cyclic and diffuse

41
Q

What are the types of nipple discharge?

What can each indicate?

A

Blood- benign (papilloma, adenoma) or malignant lesion
Milky - endocrine disorders, medication (OCP)

More worrying if occurs spontaneously and unilaterally

42
Q

What are the types of mass in the breast?

A

Normal nodularity
Worry- hard, craggy, non-motile
Fibroadenoma - “breast mice” motile lump

43
Q

What changes can you see in mammography?

Example that causes this…

A

Calcification - Ductal carcinoma (DCIS)

Densities - fibroadenoma, cysts, invasive carcinomas

44
Q

Describe breast screening

A

Women 47-73
Every 3 years
mammogram
looks for densities, calcification, parenchymal deformalities

45
Q

What are some physiological changes of the breast?

A

Post-ovulation- oedema, and lobules proliferate
Pregnancy - increase in size and number of lobules, adipose tissue, decrease in stroma
Post-lactation- atrophy but not to previous size
Menopause/Old age- involution of breast tissue, adipose replaces fibrous stroma, decrease in terminal ducts

46
Q

What are some benign changes in the breast?

A

Fibroademona - localised hyperplasia

Fibrocystic Changes - disappears after FNA

Milk Line remnants- accessory axillary tissue and polythelia

Gynacomastia

Epithelial hyperplasia (can become carcinoma)

Papilloma - small palpable mass, discharge

47
Q

What are some inflammatory conditions of the breast?

A

Acute Mastitis - S. aureus infection when lactating, nipple cracks

Fat Necrosis - trauma or surgery

48
Q

What are the benign stroma disorders?

Describe each

A

Fibroadenoma- common in younger women, mobile, elusive mass, well circumscribed, white, rubbery, compresses epithelia

Phyllodes Tumour - most benign, grow quickly, nodules of stroma covered in epithelia, stroma cellular and atypical, excise with wide margin

49
Q

What can cause gynacomastia?

A 
Liver cirrhosis
Klinefelters
Drug related
Puberty (transient)
Gonadotrophin excess

Due to increased oestrogen and decreased androgens

50
Q

What are some breast cancers?

A

In situ:
DCIS
Paget’s disease

Invasive carcinoma:
Can be ductal (70-80%), tubular (1-2%), lobular (5-15%) or mucinous (1-6%)

Tubular and Mucinous have best prognosis
Lobular - lines of cells infiltrate, lack cohesion

51
Q

What are the risk factors for breast malignancy?

A

OCP, Late menopause, early menarche, female, HRT
(Oestrogen Exposure)

Obesity- peripheral tissues produce oestrogen
Radiation
Breast Feeding
Reproductive History
Genetics
52
Q

Where do breast cancers metastasise to?

A 
Through the Blood:
Brain
Liver
Lung
Bone

Axillary Lymph Nodes

53
Q

Where can lobular carcinomas spread to?

A

Retroperitoneum, Peritoneum, Ovaries, GI tract, Uterus

54
Q

How do you manage breast cancer?
Localised?
Systemic?

A

Surgery - mastectomy or breast sparing
Axillary surgery (test with sentinel node sampling)
Post Op Radiotherapy

Neo-adjuvant Chemotherapy
Hormonal - tamoxifen
Herceptin

55
Q

What genes are involved in breast cancer?

A

Her2 expression
Oestrogen receptors
BRCA gene - associated with negative ^ have high grade and poor prognosis :(

56
Q

What is the triple approach?

breast cancer

A

Investigations to do

1) Clinical - history, family histort, examination
2) Imaging - mammogram or ultrasound
3) Pathology - core biopsy, fine needle aspiration (cytology)

57
Q

Examples of teratogenic agents and infectious agents that can cross the placenta

A

Alcohol
Lithium and Thalidomide
Smoking

Varicella Zoster
CMVirus
Rubella
Toxoplasma gondii

58
Q

What is Foetal Alcohol Syndrome?

Visible Features

A

Maternal drinking causing developmental defects in the foetus as it harms the CNS development and neural cell migration

Short Palpabral Fissure
Flat Maxilla
Lack of philtrum, thin upper lip

59
Q

Describe Pre-eclampsia

A

Hypertension and Proteinurea during pregnancy

Unknown circulating factor damages the endothelium, this causes systemic vasoconstriction which causes hypertension.

The mother is unable to make a low resistance vascular bed for the placenta which can lead to insufficiency and growth restriction of the foetus

60
Q

What is eclampsia?

A

Seizures during pregnancy

ESA4 (7 decks)

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