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female Flashcards

1
Q

what is the anatomy of the vulva?

A

external to the hymen - labia major/minora vestibule

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2
Q

what is a bartholin cyst and what is the clinical presentation

A
  • cystic dilation of bartholin gland
  • arises due to ifnalmmation and obstruction of gland, usually occurs in women of reproductive age
    presentation: unilateral, painful cystic lesion in the lower vestibule adjacent to thev aginal canal
    frequently super imposed infection –> abscess
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3
Q

a lady presents with a warty neoplasma of the vulvar skin - what is it likely to be and what is the pathgenesis?

A
  • condyloma
  • commonly due to HPV types 6 or 11
  • characterised by koilocytic change
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4
Q

a lady presents with a leukoplakia of the vulva - what are your differentials and how do they differ?

A

Lichen sclerosis –> thinning of epidermis and fibrosis of dermis - atrophy and immune change, most commonly post menopausal women, benign assocaited with slight increased risk of SCC

lichen simplex chronicus - hyperplasia of vulvar squamous epithelium - chronic irritation and scratching –> thickening of skin, thick leathery, benign no increased risk of SCC

vulvar carcinoma

  • arises from squmamous equithelium
  • relatively rare, accounts for small % of female genital cancers
  • eithology - HPV (high risk 16, 18, 31, 33 - VN - 40-50 years) OR non-HPV related (long standing lichen sclerosis chronic inflammation and irritation)

biopsy all leukoplakia

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5
Q

what is extramammary paget disease and how does it present

A
  • malignant epithelial cell in the epidermis of the vulva –> prsent in skin
  • presents as erythematous, pruritic, ulcerated skin
  • presents as carcinoma in situ, usually no underlying carcinoma
  • differential - carcinoma vs melanoma
    paget: PAS+, Keratin + and S100-
    melanoma: PAS-, Keratin - and S100+
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6
Q

what is the anatomy of the vagina

A
  • fibromuscular canal that leads to the cervix
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7
Q

what is amenorrhoea and what are the causes - primary and secondary ?

A

primary: have not reached menarche - developmental abnormality
secondary: cessation for >6/12 having previously menstruated

Aeitology

  • normal: pregnancy (increased progesterone and oestrogen), menopause (no E)
  • uterus: increased androgen exposure, congenital, endometrial destruction
  • ovary: gonadal dysgenesis (no DNA), decreased follicle number, PCOD
  • H-P: stress, exertion, decreased weight, PRL-secreting tumour (all decrease GnRH)
  • thyroid: hypo/hyper - change in sex hormone binding globulin, metabolism

Symptoms

  • headache
  • galactorrhea (milk production)
  • no vision (pit tumour)
  • change in weight
  • dry vagina
  • hisutism (increased hair)
  • change voice
  • change breast size
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8
Q

what is dysmenorrhoea

A

primary: unknown cause - no identifiable disease
- change/ increased PG production by endometrium –> myometrial contractions –> ischemia of SMC - stimulates pain fibres, anxiety/fear/stress increase pain
Tx: OCP, NSAIDs

secondary dysmenorrhoea: pelvic disease
- endometriosis, fibroids, andemoyosis, PID, cervical stenosis, cancer

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9
Q

what is menorrhagia

A

prolonged/heavy cyclic menstruation (>8/28 or >80ml)

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10
Q

what is metorrhagia

A

intermenstrual/acyclical bleeds (implanon, OCP)

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11
Q

what is hypomenorrhea?

A

decreased flow/short duration

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12
Q

what is oligomenorrhea?

A

irregular, infrequent cycles

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13
Q

what is epimenorrhea

A

normal volume, increased frequency

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14
Q

what is epimenorrhagia

A

excessive volume, increased frequency

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15
Q

what is withdrawal bleeds?

A

predictable bleed from P withdrawal

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16
Q

what is intermenstrual bleeding? how does it differ between early, middle and later

A

early: poor follicular development –> decreased oestrogen –> cant support endometrium
Middle: decreased oestrogen due to ovulation - mid cycle spotting
late: failure of CL –> decrease oestrogen and progesterone –> shedding, endometriosis also

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17
Q

what is the incidence of abnormal uterine bleeding

A

10-30% repro aged women, 50% perimenopausal women - else uncommon

  • age: #1 factor - increasing organic causes with age
  • organic in 25% - functional HPO axis in 75% (dysfunctional uterine bleeding, DUB)
18
Q

what are the causes of abnormal uterine bleeding?

A

vulval: trauma, infection, skin conditions, SCC
- vaginal: trauma (coital, scatch, prolapse), foreign body, infection, tumours, atrophy
- cervix: polyps (benign), carcinoma (+/- Sx), infection, trauma
- uterus: endoemtrial/placental polyps, fibroids, DUB, endometrial cancer, endometriosis, pregnancy complications
- Oviducts: PID, endometriosis, ectopic pregnancy
- ovary: endometriosis, oophoritis, PID, ovarian cancer

19
Q

what are some congenital conditions of the vagina

A

atresia/absence
septate/double vagina (+ double uterus)
genital hypoplasia
gernter duct cysts

20
Q

what are some neoplasms of the vagina?

A

benign: rhabdomyomas, stromal polyps, leiomyomas, hemangiomas

vaginal intra-epithelial Neoplasia and SCC: rare

  • 99% of HPV associated
  • RF: previous carcinoma of cervix/uterus
  • upper-posterior –> regional iliac LNs
  • PC: irregular spotting, leukorrhea

Adenocarcinoma

Rhabdomyosarcoma

21
Q

what are some non neoplastic conditions that affect the endomtrium

A

inflammation: normally protected by the cervix
- acute: rare - after delivery or miscarriage
- chronic: occurs in - chronic PID, post partal/post-abortal endometrial cavities, UIDs, TB
- PC: abnormal bleeding, pain, discharge, infertility
- Abx to prevent sequelae

Endometrial polyps: project into endometrial cavity

  • ASx or abnormal bleeding (ulcerated, necrosis)
  • hyperplastic endometrium - responsive to oestrogen

endoemtrial hyperplasia: (EIN) - increased gland: stroma ratio

  • prolonged E exposure (anovoluation) or increased E pdn
  • causes: menopause, PCOD, ovarian tumours, HRT/OCP
  • associated with endometrial carcinoma
  • Tx: high dose progestin, hysterectomy
22
Q

what are some neoplastic conditions of the endometrium

A

most invasive
- RFs: obesity, DM, HTN, infertility, anovulatory cycles, HTN, early menache, late menopause, tamoxifen (increased E)

features
- abnormal discharge, post menopausal bleeding, leukorrhea, uterine enlargement

23
Q

what is the name of the whorled bundles of SMC in normal myometrium

A

Leiomyoma - fibroids - 75% of reproductive aged females
circumscribed, round firm grey-white tumours
submucosal –> bleeding
bladder compression –> frequency
sudden pain
decreased fertility
pregnancy: increased miscarriage, foetal malpresentation, mpost partum haemorrhage

24
Q

list some conditions and symptoms of the oviduct

A

Salpingitis

  • suppruative: gonorrhea, chlamydia
  • tuberculus: rare

paratubal cysts: 1-20mm, translucent

tumours
- rare - benign mesotheliomas, adenocarcinoma

25
what is endometriosis and adenomyosis and how does it present?
Endometriosis: glands/stroma outside uterus Adenomyosis: glands in myometrium hormonally dependent - reproductive aged women theories: regurgitation, metaplasia, vascular/lymphatic dissemination sites: ovaries, uterine ligaments, retrovaginal septum, pelvic peritoneum, scars, others morphology: foci of endometrium - nodules, scarring --> fibrous adhesions, chocolate cysts clinical features: pelvic pain + dyspareunia, dysmenorrhea, infertility, rectal pain/blood pain starts 2-7/7 days before menses Dx: normal O/E, U/S or MRI of little use
26
how does an ectopic pregnancy present?
sites: all undergo usual development + decidual changes - oviduct, ovary, abdominal cavity predispositions: PID, chronic salpingitis, peritubal adhesions, leimyomas, previous surgery, IUD use pathology - poor adhesion to wall --> haemorrhage - placental invasion --> haemorrhage + tubal rupture course - severe abdominal pain - 6/52 after prev normal menstruation - pain may develop shock + acute abdomen SSx Dx - HCG assay, U/S, laparoscopy
27
what are some non-neoplastic conditions of the cervix?
cervicitis: physiological in all mliparious/many nulliparious women - infection: gonococci, chamydiae, mysoplasma, HSV --> acute/chronic cervicitis pathogenesis: menarche = increased oestrogen --> maturation of cervical/vaginal squ epithelia (glycogen uptake) - shedding cells --> increased glycogen for flora --> decrease pH --> metaplasia - crypt openings covered by epithelia --> mucous cysts + inflammatory infiltrate acute: acute cells + errosion + reactive/repairative epithelial change chronic: monocytes +/- necrosis/granulation tissue Endocervical polyps: relative innocuous - 2-5% - produce irregular spotting - Tx: curettage, excision
28
explain the types of cervical cancer? and how they progress
-
29
what is asherman syndrome?
- second amenorrhoea due to loss of basalis (regenerative layer of endometrium) and scarring - result of overaggressive dilation and curettage (D&C) (scrape away the uterine wall)
30
what is the difference between acute and chronic endometritis
- acute = bacterial infection of endometrium, usually due to retained products of conception, presents as fever, abdominal uterine bleeding and pelvic pain chronic - chronic inflammation of endoemtrium - neutrophils are normal --> characterised by plasma cells - products of conception, chronic PID, IUB, TB - presents as abnormal uterine bleeding, pelvic pain and infertility (common for endometrial biopsy to be done)
31
explain the female reproductive physiology
ovarian cycle - follicular phase - ovulation - luteal phase menstrual cycle - menstruation - proliferative phase - secretory phase
32
explain the pelvic diaphragm
- levator ani - pubococcygeus, puborectalis, iliococcygeus | - coccygeus
33
what is the definition of menopause
Menopause is the cessation of menstruation due to the demise of ovarian function. The average age is 51 years (range 47-55). Permanent cessation of menstrual periods, determined retrospectively after a women has experienced 12 months of amenorrhoea without any other obvious pathologicla or physiological cause Menopause is a reflection of complete or near complete ovarian follicular depletion with resulting hypoestrogenemia and high FSH concentration
34
what are symptoms experienced by women during menopause and the physiology behind them
- hot flushes - sleep disturbance - depression/psychological - vaginal dryness - sexual function - cognitive - joint pain
35
what is the causes of menopause?
Decreased follicles → decrease granulosa cells → decrease inhibin → decrease negative feedback to pituitary and hypothalamus → increase FSH → earlier follicle recruitment → shorter follicular phase of menstruation → shorter cycles AND decrease estradiol → increase LH → ovaral decrease in androgens but maintain relatively high concentration esp free testosterone → decrease ovulation → decrease corpus luteum → decrease progesterone → lighter bleeding AND lengthening of cycles
36
what are some complications of menopause and why
oesteoporosis urogenital tract skin dementia
37
list some of the disorders of cycle length
- polymenorrhea - cycles with intervals of 21 days or fewer - irregular menstruation - variation in menstrual cycle length of more than approx 8 days for a woman - oligomenorrhoea - infrequent often light menstrual periods (intervals exceeding 35 days) - amenorrhoea
38
some causes of menorrhagia
abnormal heavy and prolonged menstrual period that may be caused due to abnormal blood clotting, disruption of normal hormonal regulation of periods or disorders of the endometrial lining RF: obesity, anovulation, oestrogen adminstratoin Aetiology - disorders of coagulation - excessive build up of endometrial lining - consideration by nature of the menstrual cycle
39
explain the cycles of ovulatory and anovulatory disorders
-
40
what are some differential diagnosies for abnormal vaginal bleeding
anatomical: leiomyoma, endometrial polyp, ovarian masses, malignancy, adnomyosis hormonal: withdrawal progesterone, withdrawal oestrogen, increased progesterone, increased oestrogen infection: chronic endometritis, PID, cervicitis

reproductive medicine (4 decks)

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