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Reproductive Health > General > Flashcards

General Flashcards

1
Q

Features of Low Oestrogen

A

Vaginal dryness
Dyspareunia
Decline in bone mineral density - osteopenia/porosis

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2
Q

Sheehan’s Syndrome

A

Postpartum hypopituitarism

3 Fs Failure of lactation, fatigue, failure to resume menstruation

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3
Q

Asherman’s Syndrome

A

Intrauterine adhesions
1-2% of 2nd amenorrhoea.
Frequently after DandC.
Ix- hysteroscopy, hormone studies Normal

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4
Q

D and C

A

Dilation and Curettage
Opening the cervix and removing contents of the uterus
Done after miscarriage usually if over 10 weeks old.

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5
Q

Cervical Smear Testing

A

Routine every 3 or 5 years depending on age
Borderline change - repeat in 6-12 months
Mild Dyskaryosis (CIN1) - Colposcopy or repeat in 6 months
Mod Dyskaryosis (CIN2)- Refer for colposcopy
Severe Dyskaryosis (CIN3) - colposcopy
Suspected invasive CA - Urgent colposcopy
Inadequate - repeat, after 3x then colposcopy

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6
Q

Leiomyoma (Fibroids)

A

Benign Smooth muscle tumours of the uterus
20-50% of women over 30 yrs
Most are aymptomatic and only 10-20% need tx
Sx- abdo cramps, menorrhagia.
Tx - Meds or surgery

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7
Q

Pharmacological Tx of fibroids

A

NSAIDS - mefanamic acid reduce menstrual blood loss
Antifibrinolytic agents - tranexamic acid do the same
COCP
Danazol
GnRH agonists

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8
Q

Surgical Tx of fibroids

A

Myomectomy
Hysteroscopic endometrial ablation
Total hyseterectomy
Uterine artery embolisation

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9
Q

Adenomyosis

A

Ectopic endometrial tissue within the myometrium
Endometrial glands 1 high power field deeper than E-M junction
Sx- heavy freq periods, dysmenorrhoea, pelvic pain

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10
Q

Ruptured Ovarian Cyst

A

History of mild trauma after fall or intercourse.
Mild chronic lower abdo discomfort that suddenly worsen
USS- fluid in space between falopian tubes and ovaries

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11
Q

Red Degeneration of Fibroid

A

5-10& of pregnant women with myomas
Acute significant localised abdo pain.Vomiting and fever
USS- mixed echodense or echolucent appearance.

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12
Q

Hyperemesis Gravidarum

A 
Intractable vomiting in early pregnancy
Ix- raised haematocrit, low Na, low K, low urea, high creat
high AST. high free t4, low TSH
Urine - ketonuira
Tx- Promethazine, ginger
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13
Q

Acute fatty liver of pregnancy

A

Rare life threatening in 3rd trimester.
Disordered metabolism of fatty acids causing liver failure
Raised AST
Tx- prompt delivery of the baby.

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14
Q

Placental Abruption

A

Premature separation of the placenta from the uterus
Present with bleeding (some have concealed bleeding), tender tense uterus, foetal distress
Should be considered in bleeding 2nd half of pregnancy

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15
Q

Placenta Praevia

A

Implantation of the placenta over the internal cervical os

Painless vaginal bleeding,

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16
Q

Vasa Praevia

A

Foetal vessels crossing or close to inner cervical os

Antepartum haemorrhage immediately after artifical rupture.

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17
Q

Bleeding in 1st Trimester

A

Spontaneous abortion
Ectopic pregancy
Hydatidiform mole

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18
Q

Bleeding in 2nd Trimester

A

Spontaneous abortion
Hydatidiform mole
Placental abruption

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19
Q

Bleeding in 3rd Trimester

A

Placental abruption
Bloody show
Placenta praevia
Vasa praevia

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20
Q

Hydatidiform mole

A

Gestational trophoblastic disease

Non viable fertilised egg implants in the uterus

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21
Q

Antenatal USS times

A

11-14 weeks for dating and nuchal translucency

18 weeks is the anomaly scan.

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22
Q

Amniocentesis

A

Measure alpha fetoprotein at 16 weeks to detect neural tube defects (1% risk of foetal loss)

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23
Q

Combined Test

A

Between 10-13 weeks to screen for Downs.
Includes Nuchal translucency, free B-HCG, pregnancy associated plasma protein, women’s age
If high risk then offered CVS (if less than 13 weeks) or amniocentesis (if beyond 15 weeks)

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24
Q

Uterine Prolapse

A

1st degree - Cervix remains within vagina
2nd deg - Cervix protrudes through introitus
3rd deg - Uterus lies entirely outside introitus
Should be examined using Sims’s speculum.
Tx- pelvic floor exercises, ring pessary

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25
Q

Dysfunctional uterine bleeding

A

Abnormal uterine bleeding in the absence of organic dx
Heavy menstrual bleeding around menarche and perimenopause
Tx - Levonorgestrel-releaseing IU system, tranexamic acid, norethisterone.

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26
Q

Bartholin’s glands

A

Pair of peas sized glands whose secretions maintain moisture of the vestibular surface of the vagina
At 4 and 8 o’clock position
Cyst - rapid onset painful lump size of a walnut.

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27
Q

Pre-eclampsia

A

Pregnancy induced hypertension in the 2nd half (after 20 weeks) associated with proteinuria +/- oedema
RF- age >40, nulliparity, FH, BMI over 30, HTN, Renal disease.
Only cure is terminate pregnancy and deliver the placenta.

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28
Q

Eclampsia

A

Occurrence of one or convulsions during pre-eclampsia

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29
Q

HELLP syndrome

A

Haemolysis
Elevated liver enzymes
Low platelets
Occurs in severe pre-eclampsia

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30
Q

Ectopic Pregnancy

A

Triad 1. Pain 2. Amenorrhoea 3. Vaginal bleeding.
only 50% present like this.
IX- transvaginal USS. hCG levels.
Tx- Methotrexate

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31
Q

Endometrial Cancer

A

Post menopausal bleeding is endometrial cancer until proven otherwise. Peak incidence 60 years.
75% occur after menopause
RF - obesity, nulliparity, late menopause, fh, tamoxifen, HRT, DM, PCOS
Offensive discharge rare (unlike cervical carcinoma)
PAIN - late sx showing extensive disease
IX- USS and endometrial sampling.

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32
Q

Threatened Misscarriage

A

Minimal pain
Minimal bleeding
Cervix closed
Foetal heart visualised.

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33
Q

Inevitable Misscarriage

A

Pain +
More bleeding than regular period
Cervix open
Foetal heart may or may not be visualised

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34
Q

Complete Misscarriage

A

No pain
Less bleeding than period
Cervix - closing
Uss - empty

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35
Q

Incomplete Misscarriage

A

Pain +/-
A lot more bleeding than normal period
Cervix open
Retained products, no foetal heart

36
Q

Missed Misscarriage

A

No pain
Minimal bleeding
Cervix closed
No foetal heart

37
Q

Bacterial Vaginosis

A

Caused by mixture of bacteria
Fishy smelling discharge, commonly after sex
Microscopy - CLUE CELLS
Tx- Metronidazole

38
Q

Gonorrhoea

A

Gram -ve diplococcus Neisseria Gonorrhoeae
2nd most common STI after chlamydia in the UK
Tx - ceftriaxone and azithromycin

39
Q

Trichomonas Vaginalis

A

2nd most common cause of vag discharge after candida
18-35 yr old females, sexually acquired.
Discharge -yellow/green offensive, frothy
2% have strawberry cervix
Tx - Metronidazole

40
Q

Cervical Carcinoma

A

6th most common malignancy in females
45-55 yrs commonly.
1st sx- post coital bleeding. dysuria, malodorous discharge
ix- colposcopy, biopsy.

41
Q

Risk factors for Cervical Carcinoma

A 
HPV 16, 18, 33. 
Smoking 
HIV
Young age of first coitus
Young age of first pregnancy
Lots of sexual partners
High parity
Low Socioeconomic class.
42
Q

Round Ligament Pain

A

Brief sharp, stabbing pain or dull ache that pregnant women feel in the lower abdomen or groin in 2nd trimester
Due to uterus pulling on the round ligament

43
Q

Braxton Hicks Contraction

A

Tightening rather than pain after 20 weeks

44
Q

Rectus Muscle Haematoma

A

Rupture of inferior epigastric vessels

Sudden severe abdo pain after coughing or trauma

45
Q

Listeriosis

A

Gram +ve Listeria Monocytogenes
Ingestion of contaminated food - meat, dairy, seafood
Soft cheese and unpasteurised milk
Chorioamnionitis, premature labour, spon abortion, stillbirth
Tx - Amoxicillin and Gentamicin

46
Q

Syphillis

A

Treponema Pallidum
In pregnancy can cause stillbirth, abortion, prm delivery
Tx in pregnancy - Benzylpenicillin

47
Q

Congenital Toxoplasmosis

A

Infection can occur in utero or during vag delivery
Early infection - foetal death, or newborn with CNS issues
Tx- Spiramycin

48
Q

Depo-Provera

A

Long acting progestogen given IM
For pts who have CIs to oestrogen therapy
S/Es - Delayed return of fertility and irregular cycles, heavy bleeding

49
Q

POP

A

Mini pill with just progestogen
Common in breastfeeding, BMI>35, smokers, migraines
Causes plug of mucus in the cervix that blocks sperm, also thins lining of the uterus and stop ovulation.
Major complaint - Irregular periods

50
Q

Post Pill Amenorrhoea

A

Stopping oral contraceptive does not lead to resumption of normal menstrual cycle. Usually settles spontaneously in 6 months.

51
Q

PCOS

A 
Presence of 2 out of 3:
1. Polycystic ovaries 
2. Oligo or anovulation
3. Signs of hyperandrogenism 
Mx- clomiphene
COC
Dianette or cypoterone for hirsutism.
52
Q

Blood results in PCOS

A

High LH
High LH:FSH ration (FSH Normal)
High testosterone
Oestriol reduced

53
Q

Combined Pill

A

Contains oestrogen and progesterone
Prevents GnRH from hypothalamus
Therefore no FSH/LH released from pituitary
Prevents ovulation

54
Q

Mirena Coil

A

Inhibits endometrial proliferation

Causes cervical mucous thickening

55
Q

Morning after pill

A

Contain levonorgestrel
Inhibits ovulation
Should be within 12 hours and no later than 72 hours after

56
Q

Melasma

A

Generally between age 30-40 commoner in tanned pts
Affects forehead, cheeks and upper lips.
Triggers - pregnancy, contraceptives, sun

57
Q

First line Tx of Menorrhagia

A
  1. Mirena
  2. Tranexamic acid, mefanamic acid, COC
  3. Norethisterone
58
Q

HRT

A

Effective tx for menopause related sx
Replaces oestrogen in the post menopausal women
Types- no uterus - oestrogen only
Uterus - need progestogen to prevent endometrial thicken
Used for 3-5 years.
DOESN’T ACT AS A CONTRACEPTIVE

59
Q

Tibolone

A

Man made hormone as an alternative to HRT in those who cannot take oestrogen.

60
Q

Risks of HRT

A

VTE
Breast Cancer
Endometrial Cancer
May inc risk of stroke and heart disease

61
Q

Benefits of HRT

A

Stops hot flushes and night sweats
Reverses changes around vagina
Dec risk of osteoporosis

62
Q

Contraindications of HRT

A 
Previous endometrial, breast or ovarian cancer
Previous clots
Prevous IHD, Stroke
Uncontrolled high BP
Severe liver disease
63
Q

Missed COC Pill

A

Defined as >24 hours
1 missed pill - take pill now even if means 2 together. Resume normal pill taking no extra precautions
2 missed pills - take pill now even if 2 together. Resume normal pill taking and use extra precautions (condoms) for 7 days
if from first 7 tablets, need morning after pill
if from last 7 tablets, run packs back to back.

64
Q

Missed POP Pill

A

> 3 hours overdue

1 pill missed - take pill now and use extra precautions for next 48 hours

65
Q

Post Coital Bleeding

A

Cervical causes:
Ectropion (commonest cause)

Vaginal:
Vaginitis

66
Q

Secondary Amenorrhoea

A

Menstruation has previously occurred by now stopped for consecutive 6 months
FSH>20 in women 5 could be androgen secretion tumour

67
Q

Polyurethan condoms

A

For people with latex allergy.

68
Q

Physiological Change in Pregnancy

A

Hb Falls
Prolactin inc, WBC, platelets ESR all rise
BP falls in 2nd trim and then normal by term.

69
Q

Sexual Offences Act

A

Rape as non consensual penetration of the vagina mouth or anus by a penis.
Child under 13 cannot consent to sex

70
Q

Endometriosis

A

Presence of endometrial like tissue outside the uterine cavity. Peak age presentation 40-44.
Sx- Pelvic pain, infertility, dysmenorrhoea, dyspareunia
Ix- laparoscopy
Tx- COC, danazol, medroxyprogesterone acetate. IUS

71
Q

Nutrition in Pregnancy

A

Folic acid 400mcg before conception and 12weeks
Importance of Vit D
No iron supplementation
Risk of birth defects with too much Vitamin A

72
Q

Pregnancy Dates

A

Term 37 -42 weeks
Preterm before 37 weeks
Postterm after 42 weeks.

73
Q

COC pill harmful effects

A

VTE, MI, Stroke
Breast cancer
Cervical cancer

74
Q

Metorrhagia

A

Normal volume of menstrual flow at irregular intervals

75
Q

Menometrorrhagia

A

Frequent and excessive flow

76
Q

Polymenorrhoea

A

Bleeding at intervals less than 21 days

77
Q

Pregnancy Test

A

OTC testing will become +ve 9 days post conception until about 20 weeks

78
Q

Goserelin

A

GnRH agonist
Used to suppress production of sex hormones (oestrogen and testosterone)
Used to tx hormone sensitive cancers like breast and prostate.

79
Q

HB in Pregnancy

A

Anaemia defined as Hb

80
Q

Gravida

A

Total number of times a women has been pregnant including the present one.

Twins or triplets still counted as one.

81
Q

Para X+Y

A

X- Number of pregnancies beyond 24 weeks
(twins count as one, still birth over 24 weeks count as one)

Y- No. of losses before 24 weeks (terminations, abortions, ectopic).

82
Q

Breast Cancer Screening

A

Mammogram every 3 years for women 50-70

83
Q

Cervical Cancer Screening

A

Every 3 years between age 25-49

Every 5 years for age 50-64.

84
Q

Bowel Cancer Screening

A

Faecal occult blood every 2 years between 60-74

85
Q

UTI in pregnancy

A

Nitrofurantoin safe except at term
Penicillins and cephalosporins also safe
Trimethoprim has a teratogenic risk in 1st trimester
Sulphonamides - interfere with bile conjugating
Quinolones and tetracyclines - stain developing bone and teeth.

86
Q

Bishop Score

A 
Pre labour scoring to help decided if induction needed
Max score of 10. 9 labour most like to start itself
PEDSS
Position of cervix
Effacement or length of cervix
Dilation of cervix
Softness or consistency of cervix
Station of the foetus
87
Q

HCG Levels

A

Detectable at day 11
Peak at 10-12 weeks. rise again at 22weeks until term
Remain +ve 5 days after miscarriage
High in trophoblastic disease

Reproductive Health (1 decks)

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