Gynae 1 Flashcards
Describe the most common risk factor for uterine fibroids (leiomyomas)
Race, specifically Black race
What is the most common site for uterine fibroids (leiomyomas)?
Intramural
What is the most common symptom of uterine fibroids (leiomyomas)?
Bleeding
What complications are associated with the submucosal type of uterine fibroids (leiomyomas)?
Infertility and recurrent abortion
What complication is associated with the subserosal type of uterine fibroids (leiomyomas)?
Torsion
How is severe pain during pregnancy in uterine fibroids (leiomyomas) managed?
Ischemic necrosis is an important complication
Define the impact of estrogen levels on uterine fibroids (leiomyomas) prognosis
Mainly affected by estrogen levels, rare before puberty, and degenerates after menopause
What is the recommended treatment for young females with uterine fibroids (leiomyomas) who still want children?
Myomectomy
Describe the treatment approach for uterine fibroids (leiomyomas) in older patients who do not want children
Hysterectomy
What is the significance of red degeneration in fibroids?
Associated with timing during pregnancy, presenting with abdominal pain and fever
How is primary dysmenorrhea managed in young females?
First line treatment with NSAIDs, second line with OCPs
Describe the most common site of endometriosis
Ovary, often presenting as a chocolate cyst
What are the common symptoms of endometriosis in young patients?
Infertility, dysmenorrhea, dyspareunia, dyschezia
What is the investigation of choice for endometriosis?
Laparoscopy
How is endometriosis treated in young patients?
Not Encourage pregnancy bad racgp myth
Empirical treatments include simple analgesics, nonsteroidal anti-inflammatory drugs (NSAIDS), progesterones, and the combined oral contraceptive pill (COCP), as well as exercise, nutrition and multiple alternate therapies.
Endometriosis can occur in teenagers. In the presence of ongoing symptoms not responding to the OCP or continuous OCP (where several periods are missed by skipping the sugar pills), then careful pelvic ultrasound and consideration of laparoscopy may be appropriate. Care needs to be taken with making this diagnosis, as a negative outlook on pelvic pain and future fertility may be established. Other causes of pelvic pain, and factors that may contribute to pain such as stresses and past physical and sexual abuse need to be considered. racgp
What are the side effects of danazol in endometriosis treatment?
Menopausal symptoms like acne, hirsutism, and hot flushes
Describe the treatment for androgen insensitivity syndrome
Removal of testes after puberty due to defect in androgen receptors
What are the common characteristics of Turner syndrome?
Short stature, low IQ, webbed neck, wide-spaced nipples, and CHD
Describe the clinical presentation of congenital adrenal hyperplasia in infants.
Infants with congenital adrenal hyperplasia may present with weight loss, vomiting, dehydration, salt-losing features like hyponatremia, hyperkalemia, and hypoglycemia. Female infants may have masculinized external genitalia.
What is the most common cause of hirsutism in idiopathic hirsutism?
Idiopathic hirsutism is most commonly caused by spironolactone.
Define primary amenorrhea in the context of Kallman syndrome.
Primary amenorrhea in Kallman syndrome is characterized by low levels of GnRH, FSH, and LH, leading to absent menstruation and anosmia.
How is secondary amenorrhea defined, and what is the initial test recommended for diagnosis?
Secondary amenorrhea is the absence of menstruation for at least 3 months in women with previously normal menstrual cycles. The initial test recommended is a beta-hCG to rule out pregnancy.
Describe the clinical features of polycystic ovarian syndrome (PCOS).
PCOS is characterized by irregular bleeding, obesity, acne, hirsutism, infertility, and acanthosis nigricans due to insulin resistance.
What is the treatment approach for infertility in PCOS patients?
Infertility in PCOS patients can be treated with clomiphene or human menopausal gonadotropin as first-line options.
Explain the hormonal profile seen in PCOS.
In PCOS, androgen and testosterone levels are increased, LH levels are elevated, and the LH:FSH ratio is reversed (greater than 2).
Describe the management of hypothalamic pituitary failure.
Hypothalamic pituitary failure can be managed with pulsatile GnRH therapy.
The management of hypothalamic-pituitary failure (hypopituitarism) involves:
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Hormone Replacement:
- Corticosteroids (e.g., hydrocortisone) for adrenal insufficiency.
- Levothyroxine for thyroid hormone deficiency.
- Sex Hormones (testosterone for males, estrogen/progesterone for females).
- Growth Hormone if needed.
- Desmopressin for diabetes insipidus.
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Monitoring and Follow-up:
- Regular hormone level checks.
- Adjust doses during stress or illness.
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Address Underlying Cause:
- Treat tumors, infections, or inflammatory conditions if present.
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Patient Education:
- Teach about lifelong hormone therapy and emergency hydrocortisone use.
For more detailed guidelines, refer to the RACGP and the Australian Endocrine Society guidelines.
What is the most common malignancy associated with premature ovarian failure?
Endometrial cancer is the most common malignancy associated with premature ovarian failure.
Premature ovarian insufficiency (POI) can be associated with various malignancies, with ovarian cancer being a primary concern due to the common iatrogenic causes such as chemotherapy and radiotherapy. Additionally, the hormonal imbalances associated with POI can influence the risk of endometrial cancer.
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Ovarian Cancer:
- Risk Factors: Chemotherapy and radiotherapy for other cancers can increase the risk of ovarian cancer in women with POI.
- Management: Regular screening and follow-up are recommended for early detection.
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Endometrial Cancer:
- Hormonal Imbalance: Women with POI may have altered levels of estrogen and progesterone, which can affect the endometrial lining.
- Hormone Replacement Therapy (HRT): Proper use of HRT can help manage symptoms and reduce the risk of endometrial hyperplasia and cancer. It is crucial to tailor HRT to balance benefits and risks.
- Monitoring: Women on HRT should have regular follow-ups to monitor the health of the endometrium.
- Regular Screening: Women with POI, especially those on HRT, should undergo regular gynecological evaluations to monitor for signs of malignancy.
- Individualized HRT: HRT should be customized based on individual risk factors and needs, ensuring a combination of estrogen and progesterone if the uterus is intact.
- Lifestyle Modifications: Encouraging a healthy lifestyle, including a balanced diet and regular exercise, to support overall health and reduce cancer risks.
For more detailed guidelines, refer to the RACGP resources on managing premature ovarian insufficiency and associated malignancies:
- RACGP - Premature Ovarian Insufficiency and Infertility
- RACGP - Meeting the Needs of Women with Premature Ovarian Insufficiency
These resources provide comprehensive information on the diagnosis, management, and long-term care of women with POI.
How is congenital adrenal hyperplasia typically treated?
Congenital adrenal hyperplasia is usually treated with cortisone.
1. Glucocorticoid Replacement: Hydrocortisone is commonly used in children to replace cortisol, while prednisone or dexamethasone may be used in adults. The objective is to use the lowest effective dose to avoid long-term side effects while suppressing excess androgen production. 2. Mineralocorticoid Replacement: For salt-wasting forms of CAH, fludrocortisone is administered to replace aldosterone, which helps maintain sodium balance and prevent dehydration.
Congenital adrenal hyperplasia (CAH) is a group of genetic disorders that affect the adrenal glands, which are responsible for producing vital hormones like cortisol, aldosterone, and androgens. The most common form of CAH is due to a deficiency of the enzyme 21-hydroxylase, which is crucial for the synthesis of cortisol and aldosterone.
- Hormonal Imbalances: Due to the enzyme deficiency, there is a buildup of precursor molecules that are shunted into the androgen production pathway, leading to an excess of androgens (male hormones). This hormonal imbalance can cause various symptoms depending on the severity of the enzyme deficiency.
- Cortisol Deficiency: Cortisol is essential for stress response, blood sugar regulation, and immune function. A deficiency can lead to poor stress tolerance, hypoglycemia, and increased susceptibility to infections.
- Aldosterone Deficiency: Aldosterone helps regulate sodium and potassium levels and maintain blood pressure. Its deficiency can lead to salt-wasting, dehydration, low blood pressure, and hyperkalemia (high potassium levels).
- Androgen Excess: Increased androgen levels can cause virilization (development of male physical characteristics) in females, such as ambiguous genitalia at birth, and early puberty in both boys and girls. In females, this can lead to hirsutism (excessive hair growth) and menstrual irregularities later in life.
- Newborns: Ambiguous genitalia in females, poor feeding, vomiting, dehydration, and failure to thrive in both genders.
- Children: Rapid growth and early development of secondary sexual characteristics (precocious puberty).
- Adults: Fertility issues, irregular menstruation in females, and potential psychological impacts due to physical changes.
- Newborn Screening: Most cases of CAH are identified through routine newborn screening tests that measure 17-hydroxyprogesterone levels, a precursor that accumulates due to 21-hydroxylase deficiency.
- Hormonal Tests: Confirmatory tests include measuring levels of cortisol, aldosterone, and androgens.
- Genetic Testing: Genetic analysis can identify mutations in the genes responsible for CAH.
- Hormone Replacement Therapy: Lifelong glucocorticoid (e.g., hydrocortisone) and, if necessary, mineralocorticoid (e.g., fludrocortisone) replacement to manage cortisol and aldosterone deficiencies.
- Monitoring: Regular follow-ups to adjust medication dosages and monitor growth and development.
- Surgery: In some cases, reconstructive surgery may be necessary to correct ambiguous genitalia.
- Psychological Support: Counseling and support for patients and families to address the psychosocial aspects of the condition.
Explain the genetic inheritance pattern of congenital adrenal hyperplasia.
Congenital adrenal hyperplasia is typically inherited in an autosomal recessive pattern.
What are the causes of secondary amenorrhea other than pregnancy?
Causes of secondary amenorrhea include obesity leading to polycystic ovaries, excessive exercise, low body fat, emotional distress, hyperprolactinemia, brain tumors, chemotherapy drugs, antipsychotic medications, hyperthyroidism, and reduced ovarian function.
Describe the clinical features of congenital lymphedema.
Congenital lymphedema presents with swelling due to abnormal lymphatic drainage present at birth.
How is congenital lymphedema managed?
Congenital lymphedema is managed with compression garments and physical therapy.
Explain the hormonal changes seen in premature ovarian failure.
Premature ovarian failure is characterized by increased FSH levels.
What is the recommended treatment for premature ovarian failure?
Premature ovarian failure can be treated with estrogen and progesterone replacement therapy after puberty.
What is the treatment for bacterial vaginosis during pregnancy?
Metronidazole
