Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Obs and gynae > Gynae > Flashcards

Gynae Flashcards

1
Q

what are the 2 most common causes of menorrhagia and 2 rarer causes?

A

fibroids and polyps

thyroid disease and haemostasis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

what is the subtle abnormalities that cause menorrhagia in women with regular cycles?

A

endometrial fibrinolytic

uterine prostaglandins

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

what investigations would you do for heavy bleeding?

A

Hb-for blood loss
exclude systemic causes e.g. coagulation and thyroid causes
transvaginal US-assess uterine thickness for fibroids, intrauterine polyps
endometrial biopsy-exclude malignancy and pre malignancy
hysteroscopy-allows inspection of the uterine cavity-detects polyps and sub mucous fibroids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

treatment for menorrhagia?

A

1st line-IUS (copper coil) reduce by 90%
2nd line-anti-fibrinolytic (tranexamic acid), NSAIDs (mefanamic acid, inhibit prostaglandin synthesis), COCP (less effective if pathology)
3rd line-hysteroscopic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

list some of the hysteroscopic procedures to stop menorrhagia?

A

polyp removal
endometrial ablation
Transcervical Resection of fibroid
myomectomy (removal of fibroid from myometrium)
hysterectomy (last resort)
uterine artery embolisation (treats menorrhagia due to fibroids)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

list some causes of irregular and Intermenstrual bleeding

A 
fibroids 
uterine and cervical polyps 
adenomyosis 
ovarian cysts 
chronic pelvic cysts 
malignancy-particularly endometrial (but also cervical and ovarian)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

investigations for irregular and intermenstrual bleeding

A

assess blood loss
exclude malignancy-smears
USS-masses
endometrial biopsy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

what are the causes of physiological amenorrhoea?

A

pregnancy
menopause
lactation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

what is hypogonadism and what are the 2 types?

A

hypogonadism refers to the lack of sex hormones
hypogonadotropic hypogonadism: lack of production of LH, FSH
hypergonadotropic hypogonadism: lack of response to LH and FSH (therefore low levels of oestrogen have a negative feedback causing high levels of LH and FSH)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

what are some causes of primary amenorrhoea?

A 
hypogonadotropic hypogonadism 
hypergonadotropic hypogonadism
kallman syndrome 
congenital adrenal hyperplasia 
androgen insensitivity syndrome 
structural pathology
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

what are the causes of secondary amenorrhoea?

A 
pregnancy 
menopause 
hormonal contraception 
hypothalamic or pituitary pathology 
PCOS 
uterine pathology such as ashermans
thyroid pathology 
hyperprolactinaemia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

what is the definition of secondary amenorrhoea?

A

no menstruation for more than three months after previous regular menstrual periods
consider assessment and investigation after three to six months

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

what happens when there is a low body weight or psychological stress for example leading to amenorrhoea?

A

hypothalamus reduces the production of GnRH in response to significant physiological or psychological stress

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

what are the pituitary causes of secondary amenorrhoea?

A

pituitary tumours such as prolactin secreting prolactinoma

pituitary failure due to trauma, radiotherapy, surgery or sheenan syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

what hormone tests are done for secondary amenorrhoea?

A 
bHCG, 
LH, FSH 
prolactin 
TSH 
testosterone
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

what are the causes for post-coital bleeding?

A

cervical carcinoma
ectropion (when surface isn’t covered in healthy squamous epithelium)
benign polyps
atrophic vaginitis (bleeding from the vaginal wall)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

investigations and management for postcoital bleeding?

A

cervix is carefully inspected and smear taken
polyps avulsed and sent for histology
smear normal: cryotherapy
smear abnormal: colposcopy (rule out malignancy)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

what is the difference between primary and secondary dysmenorrhoea?

A

primary: no organic cause found, coincides with menstruation and responds to NSAIDs
secondary: when pain is due to pelvic pathology and often precedes or relived by menstruation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

what is dysmenorrhoea?

A

painful menstruation associated with high prostaglandin levels in the endometrium
due to high contraction and uterine ischaemia

20
Q

causes of secondary dysmenorrhoea?

A 
fibroids
adenomyosis 
endometriosis 
pelvic inflammatory disease 
ovarian tumours
21
Q

what is precocious puberty?

A

menstruation before the age of 10 years or secondary sexual characteristics before the age of 8 years

growth spurt occurs early but final height is reduced due to early fusion of the epiphyses

22
Q

what is the treatment for precocious puberty?

A

GnRH agonists used to inhibit sex hormones

causes regression of secondary sex characteristics and cessation of menstruation

23
Q

what is a pathological cause for early onset puberty?

A

increased oestrogen secretion-hormone predicting tumours of the ovary or adrenal glands can cause premature sexual maturation

24
Q

what are the causes of ambiguous development?

A

congenital adrenal hyperplasia

androgen insensitivity syndrome

25
Q

what is congenital adrenal hyperplasia?

A

increased androgen function in the genetic female
autosomal recessive
result of 21 hydroxylase deficiency
ACTH excess causes increased androgen production

(androgen secreting tumours, Cushing’s syndrome)

26
Q

what is androgen insensitivity syndrome?

A

reduced androgen function in genetic male
therefore converted peripherally to oestrogen
appear to be female but present with amenorrhoea

27
Q

what is premenstrual syndrome?

A

psychological, behavioural, physical symptoms that are experienced on a regular basis during the luteal phase of the menstrual cycle and resolve by the end menstruation

dependent on normal ovarian function and progesterone (therefore exogenous progesterones cause PMS symptoms)

28
Q

presentation of premenstrual syndrome?

A

cyclical natura

tension, irritability, aggression, depression, loss of control

29
Q

treatments for premenstrual syndrome

A

SSRIs
endometrial ablation-reduces hormones
continuous oral contraceptive (containing drospirenone)
HRT oestrogen
GnRH agonist and add on oestrogen therapy

30
Q

what are fibroids?

A

benign tumours of myometrium (leiomyomata)
oestrogen sensitive
more common approaching menopause, those with family history
less common in parous women or those on COCP or depo

31
Q

what are the different types of fibroids?

A 
intracavity
pedunculated 
submucosal (inner)
subserosal (outer)
intramural (inside wall)
32
Q

what is the presentation of fibroids?

A

menorrhagia, intermenstrual bleeding (submucosal)
pain (dysmenorrhoea)
bladder (large fibroids may cause frequency, urinary retention, hydronephrosis)
fertility-block tubes or prevent implantation

33
Q

what are the complications of fibroids?

A

enlargement-may calcify after menopause (HRT may restimulate)

degeneration-inadequate blood supply

malignancy-0.1% are leiomyosarcomata, may undergo malignant change

pregnancy-red generation is more common, severe pain. may cause preterm labour, malpresentation, transverse lie, obstructed labour, PPH

torsion-pedunculated fibroid

34
Q

investigations for fibroids

A

USS-large fibroids

MRI, laparoscopy-distinguish between ovarian mass or adenomyosis

hysteroscopy or HSG-assess distortion of uterine cavity, particularly in fertility issues

35
Q

treatment for fibroids

A

asymptomatic-no treatment required, risk of malignancy is so small

medical management-tranexamic acid, NSAIDs, progestogens

GnRH-halts menstruation temporary shrinkage and amenorrhoea (only used 6 months) may be given HRT along side

(<3cm)- Mirena, COCP

surgical-hysteroscopy (3-4mm), hysterectomy, myomectomy, embolisation uterine artery

36
Q

what is red degeneration of fibroids?

A

ischaemia, infarction and necrosis due to disrupted blood supply
large fibroids >5cm

treatment: supportive, rest, fluids, analgesia

37
Q

presentation of red generation of fibroids?

A

severe abdominal pain
low grade fever
tachycardia
vomiting

38
Q

what is adenomyosis?

A

presence of endometrium tissue in the storm of the myometrium
oestrogen dependent
associated with endometriosis and fibroids

39
Q

what increases the risk of adenomyosis?

A

later reproductive age

multiparous

40
Q

how is adenomyosis diagnosed?

A

TV USS - not as clear
MRI
gold standard histological examination after hysterectomy

41
Q

what is the treatment for adenomyosis in those that do and don’t want contraception?

A

no contraception

  1. tranexamic acid
  2. mefemic acid

contraception

  1. Mirena
  2. COCP
  3. cyclical progestogen
42
Q

symptoms of adenomyosis

A

dysmenorrhoea
menorrhagia
dyspareunia

43
Q

other treatments for adenomyosis that may be used?

A

GnRH analogues
endometrial ablation
uterine artery embolisation
hysterectomy

44
Q

what is endometritis?

A

inflammation of the endometrium
often secondary to STI, complication of surgery due to retained tissue

infection in post-menopausal uterus commonly due to malignancy

45
Q

what is pyometra?

A

pus accumulates and is unable to escape

46
Q

treatment of endometritis?

A 
antibiotics 
occasionally ERPC (evacuation of retained products of conception)
47
Q

Name some other benign conditions of the uterus

A

endometritis
intrauterine polyps
haematometroa
congenital uterine malformation

Obs and gynae (10 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions