Gynaecology Flashcards
(185 cards)
1
Q
What is primary amenorrhoea?
A
not starting menstruation
2
Q
When is primary amenorrhoea diagnosed?
A
by 13 years when there is no other evidence of pubertal development
by 15 years of age where there are other signs of puberty such as breast bud development
3
Q
What is hypogonadotropic hypogonadism?
A
deficiency of LH and FSH
4
Q
What is hypergonadotropic hypogonadism?
A
lack of response to LH and FSH by the gonads
5
Q
What can cause hypogonadotropic hypogonadism?
A
hypopituitarism
damage to the hypothalamus or pituitary (e.g. radiotherapy, surgery)
significant chronic conditions
excessive exercise or dieting
constitutional delay in growth and development
endocrine disorders
Kallman syndrome
6
Q
What can cause hypergonadotropic hypogonadism?
A
previous damage to the gonads
congenital absence of ovaries
Turner’s syndrome (XO)
7
Q
What is Kallman syndrome?
A
genetic condition causing hypogonadotrophic hypogonadism and anosmia
8
Q
What causes congenital adrenal hyperplasia?
A
deficiency of 21-hydroxylase or 11-beta-hydroxlase (rare) enzyme
9
Q
What are the hormone abnormalities in congenital adrenal hyperplasia?
A
underproduction of cortisol and aldosterone
overproduction of androgens
10
Q
How does congenital adrenal hyperplasia present in female patients?
A
tall for their age
facial hair
primary amenorrhoea
deep voice
early puberty
11
Q
What is the mode of inheritance of congenital adrenal hyperplasia?
A
autosomal recessive
12
Q
What structural pathology can cause primary amenorrhoea?
A
imperforate hymen
transverse vaginal septae
vaginal agenesis
absent uterus
female genital mutilation
13
Q
What is the management of primary amenorrhoea with an ovarian cause?
A
COCP
14
Q
What is the management of hypogonadotrophic hypogonadism?
A
fertility = pulsatile GnRH
pregnancy not wanted = COCP
15
Q
What is secondary amenorrhoea?
A
no menstruation for more than three months after previous regular menstrual periods
16
Q
What are the causes of secondary amenorrhoea?
A
pregnancy (most common)
menopause and premature ovarian failure
hormonal contraception
hypothalamic or pituitary pathology
ovarian causes (e.g. PCOS)
uterine pathology (e.g. Asherman’s syndrome)
thyroid pathology
hyperprolactinaemia
17
Q
What is the most common cause of hyperprolactinaemia?
A
pituitary adenoma
18
Q
What is the treatment for hyperprolactinaemia?
A
dopamine agonists (e.g. bromocriptine or cabergoline)
19
Q
What does a high FSH in secondary amenorrhoea suggest?
A
primary ovarian failure
20
Q
What does a high LH or LH:FSH ratio in secondary amenorrhoea suggest?
A
PCOS
21
Q
What can be done to reduce the risk of osteoporosis when amenorrhoea lasts more than 12 months?
A
ensure adequate vitamin D and calcium intake
HRT or COCP
22
Q
When are symptoms of premenstrual syndrome present?
A
resolve once menstruation begins
not present before menarche, during pregnancy or after menopause
23
Q
What are the symptoms of PMS?
A
low mood
anxiety
mood swings
irritability
bloating
fatigue
headaches
breast pain
reduced confidence
cognitive impairment
clumsiness
reduced libido
24
Q
What are the primary care management options for PMS?
A
general healthy lifestyle changes
COCP - drospirenone (i.e. Yasmin) first line
SSRIs
CBT
25
What are the causes of menorrhagia?
dysfunctional uterine bleeding (no identifiable cause)
extremes of reproductive age
fibroids
endometriosis and adenomyosis
PID
contraceptives
anticoagulant medications
bleeding disorders
endocrine disorders
connective tissue disorders
endometrial hyperplasia or cancer
PCOS
26
What are the key things to ask about in a gynae history?
age at menarche
cycle length, days menstruating and variation
intermenstrual bleeding and post coital bleeding
contraceptive history
sexual history
possible of pregnancy
plans for future pregnancies
cervical screening history
migraines +/- aura
27
When should outpatient hysteroscopy be arranged for menorrhagia?
suspected submucosal fibroids
suspected endometrial pathology
persistent intermenstrual bleeding
28
When should pelvic and transvaginal US be arranged for menorrhagia?
possible large fibroids (palpable pelvic mass)
possible adenomyosis (associated pelvic pain or tenderness on examination)
examination is difficult to interpret (e.g. obesity)
hysteroscopy is declined
29
What is the management of menorrhagia in patients who do not want contraception?
no associated pain = tranexamic acid
associated pain = mefenamic acid
30
What is the management of menorrhagia in patients that deem contraception acceptable?
first line = mirena coil
second line = COCP
third line = cyclical oral progesterones
31
What are the secondary care management options for menorrhagia?
endometrial ablation
hysterectomy
32
What are fibroids/uterine leiomyomas?
benign tumours of the smooth muscle of the uterus
33
What hormone are fibroids sensitive to?
oestrogen
34
What are the types of fibroids?
intramural (within the myometrium)
subserosal (just below the outer layer of the uterus)
submucosal (just below the endometrium)
pedunculated (on a stalk)
35
How can fibroids present?
often asymptomatic
menorrhagia
prolonged menstruation (>7 days)
abdominal pain, worse during menstruation
bloating or feeling full in the abdomen
urinary or bowel symptoms due to pelvic pressure or fullness
deep dyspareunia (pain during intercourse)
reduced fertility
36
What are the management options for fibroids <3cm?
medical = same as menorrhagia
surgical = endometrial ablation, resection of submucosal fibroids during hysteroscopy, hysterectomy
37
What are the management options for fibroids >3cm?
gynae referral
medical = same as menorrhagia
surgical = uterine artery embolisation, myomectomy, hysterectomy - GnRH agonists can be used to shrink the size of the fibroid before surgery
38
Give examples of GnRH agonists
goserelin (Zoladex)
leuprorelin (Prostap)
39
What are the potential complications of fibroids?
menorrhagia often with iron deficiency anaemia
reduce fertility
pregnancy complications
constipation
urinary outflow obstruction and UTIs
red degeneration of the fibroid
torsion of the fibroid
malignant change to a leiomyosarcoma
40
What is red degeneration of fibroids?
ischaemia, infarction and necrosis due to disrupted blood supply
41
When is red degeneration of fibroids most likely to occur?
pregnancy
42
What is the presentation of red degeneration of fibroids?
severe abdominal pain
low-grade fever
tachycardia
vomiting
43
What is the management of red degeneration of fibroids?
supportive - rest, fluids, analgesia
44
What is endometriosis?
condition where there is ectopic endometrial tissue outside the uterus
45
What is an endometrioma?
lump of endometrial tissue outside the uterus
46
What are chocolate cysts?
endometriomas in the ovaries
47
What is adenomyosis?
endometrial tissue within the myometrium of the uterus
48
How can endometriosis present?
asymptomatic
cyclical abnormal or pelvic pain, urinary or bowel symptoms or bleeding from other sites
deep dyspareunia (pain on deep sexual intercourse)
dysmenorrhoea (painful period)
infertility
49
What may be found on examination in endometriosis?
endometrial tissue visible in the vagina on speculum examination - particularly in the posterior fornix
fixed cervix on bimanual examination
tenderness in the vagina, cervix and adnexa
50
What investigations can be done in suspected endometriosis?
pelvic US
laparoscopic surgery with biopsy (gold standard for diagnosis)
51
What is the ASRM staging system for endometriosis?
stage 1 = small, superficial lesions
stage 2 = mild but deeper lesions than stage 1
stage 3 = deeper lesions, with lesions on the ovaries and mild adhesions
stage 4 = deep and large lesions affecting the ovaries with extensive adhesions
52
What are the management options for endometriosis?
initial management = establishing a diagnosis, providing a clear explanation, listening to the patient, analgesia prn
hormonal management
surgical options = laparoscopic surgery to excise or ablate the endometrial tissue and remove adhesions (adhesiolysis), hysterectomy
53
When can menopause be diagnosed?
woman has had no periods for 12 months
54
What is the average age of menopause?
51 years
55
What is menopause?
point at which menstruation stops
56
What is post menopause?
period from 12 months after the final menstrual period onwards
57
What is perimenopause?
time around menopause when the woman may be experiencing vasomotor symptoms and irregular periods
58
When does premature menopause occur?
<40 years
59
What are the sex hormone changes in menopause?
low oestrogen and progesterone
high LH and FSH (due to absence of negative feedback)
60
What are the perimenopausal symptoms?
hot flushes
emotional lability or low mood
premenstrual syndrome
irregular periods
joint pains
heavier or lighter periods
vaginal dryness and atrophy
reduced libido
61
What does a lack of oestrogen increase the risk of?
CVS disease and stroke
osteoporosis
pelvic organ prolapse
urinary incontinence
62
How are perimenopause and menopause diagnosed?
>45years with typical symptoms
FSH blood test to help with diagnosis in:
<40 years
40-45 with menopausal symptoms or change in the menstrual cycle
63
For how long should contraception be used after the last menstrual period?
<50 = 2 years
>50 = 1 year
64
What are the good contraceptive options (UKMEC1) for women approaching the menopause?
barrier methods
mirena or copper coil
progesterone only pill
progesterone implant
progesterone depot injection (<45 years)
sterilisation
65
How is premature ovarian insufficiency diagnosed?
<40 with typical menopausal symptoms plus elevated FSH on two consecutive samples separated by more than 4 weeks
66
What are the options for HRT in premature ovarian insufficiency?
HRT
COCP
67
What can unopposed oestrogen HRT lead to?
endometrial hyperplasia and endometrial cancer
68
What are the non-hormonal treatment options for menopausal symptoms?
lifestyle changes = improved diet, exercise, weight loss, smoking cessation, reducing alcohol, reducing caffeine, reducing stress
CBT
clonidine
SSRIs
venlafaxine (SNRI)
gabapentin
69
What is the MOA of clonidine?
agonist of alpha-2 adrenergic receptors and imidazoline receptors in the brain - lowers blood pressure and reduces HR
70
What is clonidine used for in the menopause?
reducing vasomotor symptoms and hot flushes
71
What are the common side effects of clonidine?
dry mouth
headaches
dizziness
fatigue
72
What are the symptoms of sudden withdrawal of clonidine?
rapid increases in blood pressure
agitation
73
What are the indications for HRT?
replacing hormones in premature ovarian insufficiency, even without symptoms
reducing vasomotor symptoms such as hot flushes and night sweats
improving symptoms such as low mood, decreased libido, poor sleep and joint pain
reducing the risk of osteoporosis in women under 60 years
74
Under what age do the benefits of HRT outweigh the risks?
60
75
What are the benefits of HRT?
improved vasomotor and other symptoms of menopause
improved quality of life
reduced the risk of osteoporosis and fractures
76
What are the risks of HRT?
increased risk of breast cancer (particularly combined HRT - oestrogen only has a lower risk)
increased risk of endometrial cancer
increased risk of VTE
increased risk of stroke and coronary artery disease
77
What patients do the risks of HRT not apply to?
risks are not increased in women <50 years compared with other women their age
no risk of endometrial cancer in women without a uterus
no increased risk of coronary artery disease with oestrogen only HRT
78
How can the risks associated with HRT be reduced?
risk of endometrial cancer is greatly reduced by adding progesterone in women with a uterus
risk of VTE is reduced by using patches rather than pills
79
What are the contraindications to HRT?
undiagnosed abnormal bleeding
endometrial hyperplasia or cancer
breast cancer
uncontrolled hypertension
VTE
liver disease
active angina or MI
pregnancy
80
What should be assessed before starting HRT?
full history to ensure no contraindications
FMHx to assess risk of oestrogen dependent cancers and VTE
check BMI and blood pressure
ensure cervical and breast screening is up to date
encourage lifestyle changes that are likely to improve symptoms and reduce risks
81
How do you chose the HRT formulation?
step 1 = do they have local or systemic symptoms?
local symptoms = topical treatments (e.g. oestrogen cream)
systemic symptoms = use systemic treatment - go to step 2
step 2 = does the women have a uterus?
no uterus = oestrogen only HRT
uterus = combined HRT - go to step 3
step 3 = have they had a period in the past 12 months?
perimenopausal = cyclical combined HRT
postmenopausal = continuous combined HRT
82
What are the options for delivery of oestrogen in HRT?
oral
transdermal
83
When are patches the most suitable method of oestrogen delivery in HRT?
poor control on oral treatment
higher risk of VTE, CVS disease and headaches
84
What are the options for delivery of progesterone in HRT?
oral (tablets)
transdermal (patches)
intrauterine system (e.g. Mirena coil)
85
What are the two significant progesterone classes used in HRT, what are they derived from and what are their uses?
C19 progestogens - derived from testosterone, helpful for women with reduced libido
C21 progestogens - derived from progesterone, helpful for depressed mood or acne
86
Give examples of C19 progestogens
norethisterone
levonorgestrel
desogestrel
87
Give examples of C21 progestogens
progesterone
dydrogesterone
medroxyprogesterone
88
What are the oestrogenic side effects of HRT?
nausea
bloating
breast swelling and tenderness
headaches
leg cramps
89
What are the progestogenic side effects of HRT?
mood swings
bloating
fluid retention
weight gain
acne and greasy skin
90
What is anovulation?
absence of ovulation
91
What is oligoovulation?
irregular, infrequent ovulation
92
What is oligomenorrhoea?
irregular, infrequent menstrual periods
93
What is the Rotterdam criteria for diagnosing PCOS?
at least two of three key features:
oligoovulation or anovulation - presenting with irregular or absent menstrual periods
hyperandrogenism - characterised by hirsutism and acne
polycystic ovaries or ovarian volume of more than 10cm3 on US
94
How can PCOS present?
oligomenorrhoea or amenorrhoea
infertility
obesity (in about 70% of patients)
hirsutism
acne
male pattern hair loss
95
What are the complications of PCOS?
insulin resistance and diabetes
acanthosis nigricans
CVS disease
hypercholesterolaemia
endometrial hyperplasia and cancer
obstructive sleep apnoea
depression and anxiety
sexual problems
96
What are the differential diagnosis of hirsutism?
medications
ovarian or adrenal tumours that secrete androgens
Cushing's syndrome
congenital adrenal hyperplasia
97
What medications can cause hirsutism?
phenytoin
ciclosporin
corticosteroids
testosterone
anabolic steroids
98
How can insulin resistance contribute to PCOS?
insulin resistance causes increased insulin secretion
insulin promotes the release of androgens from the ovaries and adrenal glands
higher levels of insulin results in higher levels of androgens
insulin also suppresses sex hormone-binding globulin (SHBG) production by the liver
SHBG normally binds to androgens and suppresses their function
high insulin levels contribute to halting the development of the follicles in the ovaries, leading to anovulation and multiple partially developed follicles (seen as polycystic ovaries on the scan)
99
What will hormonal blood tests typically show in PCOS?
raised LH:FSH ratio
normal or mildly elevated testosterone
low SHBG
100
What may be seen on a TVUS in PCOS?
string of pearls appearance
diagnostic criteria:
12 or more developing follicles in one ovary
ovarian volume of more than 10cm3
101
What symptoms can ovarian cysts occasionally cause?
pelvic pain
bloating
fullness in the abdomen
palpable pelvic mass
102
What is the management of a simple ovarian cyst in a premenopausal patient?
<5cm = will almost always resolve within three cycles
5-7cm = routine referral to gynae, yearly US monitoring
>7cm = MRI scan or surgical evaluation
103
What is the management of an ovarian cyst in a postmenopausal woman?
raised CA125 = two week suspected cancer referral
simple cysts <5cm = 4-6 monthly US s
104
What are the potential complications of an ovarian cyst?
torsion
haemorrhage into the cyst
rupture with bleeding into the peritoneum
105
What is Meig's syndrome?
triad of:
ovarian fibroma (type of benign ovarian tumour)
pleural effusion
ascites
106
What is the presentation of ovarian torsion?
sudden onset severe unilateral pelvic pain
pain is constant and gets progressively worse
nausea and vomiting
107
What imaging should be done in ovarian torsion?
pelvic US - ideally TVUS
108
What is seen on pelvic US in ovarian torsion?
whirlpool sign
free fluid in pelvis
oedema of the ovary
109
What is the management of ovarian torsion?
laparoscopic surgery to either:
un-twist the ovary and fix it in place (detorsion)
remove the affected ovary (oophorectomy)
110
How may cervical ectropion present?
increased vaginal discharge
vaginal bleeding
dyspareunia (pain during sex)
postcoital bleeding
111
What is the appearance of cervical ectropion on speculum examination?
well-demarcated border between the redder, velvety columnar epithelium extending from the os and the pale pink squamous epithelium of the ectocervix
112
What is the management of an ectropion?
typically self-resolve
problematic bleeding = cauterisation of the ectropion using silver nitrate or cold coagulation during colposcopy
113
What are Nabothian cysts?
benign fluid-filled cysts often seen on the surface of the cervix
114
What is the appearance of Nabothian cysts?
smooth, rounded bumps on the cervix usually near to the os
can range in size from 2mm to 30mm
have a whitish or yellow appearance
115
What is a uterine prolapse?
uterus descends into the vagina
116
What is a vault prolapse?
occurs in women that have had a hysterectomy and no longer have a uterus
top of the vagina (vault) descends into the vagina
117
What is a rectocele?
defect in the posterior vaginal wall that allows the rectum to prolapse forwards into the vagina
118
What can cause a rectocele?
constipation
119
What are the symptoms of a rectocele?
faecal loading resulting in constipation, urinary retention and a palpable lump in the vagina
120
What is a cystocele?
defect in the anterior vaginal wall, allowing the bladder to prolapse backwards into the vagina
121
What is a urethrocele?
defect in the anterior vaginal wall, allowing the urethra to prolapse backwards into the vagina
122
What is a cystourethrocele?
defect in the anterior vaginal wall, allowing the bladder and urethra to prolapse backwards into the vagina
123
What are the risk factors for pelvic organ prolapse?
multiple vaginal deliveries
instrumental, prolonged or traumatic delivery
advanced age and postmenopause status
obesity
chronic respiratory disease causing coughing
chronic constipation causing straining
124
What are the typical presenting symptoms of a pelvic organ prolapse?
feeling of something coming down in the vagina
dragging or heavy sensation in the pelvis
urinary symptoms (e.g. incontinence, urgency, frequency, weak stream and retention)
bowel symptoms (e.g. constipation, incontinence, urgency)
sexual dysfunction (e.g. pain, altered sensation, reduced enjoyment)
125
What type of speculum can be used to examine for a rectocele or a cystocele?
Sim's
126
What are the grades of uterine prolapse?
0 = normal
1 = lowest part is more than 1cm above the introitus
2 = lowest part is within 1cm of the introitus (above or below)
3 = lowest part is more than 1cm below the introitus but not fully descended
4 = full descent with eversion of the vagina
127
What is uterine procidentia?
prolapse extending beyond the introitus
128
What are the three management options for pelvic organ prolapse?
conservative management
vaginal pessary
surgery
129
What are the conservative management options for pelvic organ prolapse?
physiotherapy
weight loss
lifestyle changes for associated stress incontinence (e.g. reduced caffeine intake, incontinence pads)
treatment of related symptoms (e.g. stress incontinence with anticholinergic medications)
vaginal oestrogen cream
130
What are the type of vaginal pessaries?
ring pessaries (ring shape, sit around the cervix holding the uterus up)
shelf and gellhorn pessaries (flat disc with a stem, sits below the uterus with the stem pointing downwards)
cube pessaries
donut pessaries
hodge pessaries (rectangular, one side is hooked around the posterior aspect of the cervix and the other extends into the vagina)
131
What causes urge incontinence?
overactivity of the detrusor muscle of the bladder
132
What are the symptoms of urge incontinence?
suddenly feeling the urge to pass urine, having to rush to the bathroom and not arriving before urination occurs
133
What causes stress incontinence?
weakness of pelvic floor muscles
134
What are the symptoms of stress incontinence?
urinary leakage when laughing, coughing or surprised
135
What are the risk factors for urinary incontinence?
increased age
postmenopausal status
increased BMI
previous pregnancies and vaginal deliveries
pelvic organ prolapse
pelvic floor surgery
neurological conditions such as MS
cognitive impairment and dementia
136
How can the strength of pelvic muscle contractions be assessed?
ask woman to squeeze against fingers on bimanual examination
modified oxford system:
0 = no contraction
1= faint contraction
2 = weak contraction
3 = moderate contraction with some resistance
4 = good contraction with resistance
5 = strong contraction, a firm squeeze and drawing inwards
137
What is the management of stress incontinence?
1st line = avoiding caffeine, diuretics and overfilling of the bladder, avoid excessive or restricted fluid intake, weight loss, supervised pelvic floor exercises
2nd line = surgery or duloxetine
138
What are the surgical options for stress incontinence?
tension-free vaginal tape = mesh ling looped under the urethra and up behind the pubic symphysis to the abdominal wall
autologous sling procedures = similar to TVT but a strip of fascia from the patient's abdominal wall is used rather than tape
colposuspension = stitches connecting the anterior vaginal wall and pubic symphysis
intramural urethral bulking = injections around the urethra
139
What is the management of urge incontinence?
1st line = bladder retraining for at least six weeks
2nd line = anticholinergic medication
3rd line = mirabegron
4th line = invasive procedures
140
Give examples of anticholinergic medications
oxybutynin
tolterodine
solifenacin
141
What are the side effects of anticholinergic medications?
dry mouth
dry eyes
urinary retention
constipation
postural hypotension
cognitive decline, memory problems and worsening of demenita
142
What are the contraindications to mirabegron?
uncontrolled hypertension
143
What is required to be monitored regularly during mirabegron treatment?
BP
144
What are the invasive options for management of an overactive bladder?
botulinum toxin type A injection into the bladder wall
percutaneous sacral nerve stimulation
augmentation cystoplasty (using bowel tissue to enlarge the bladder)
urinary diversion (redirecting urinary flow to a urostomy on the abdomen)
145
What is atrophic vaginitis?
dryness and atrophy of the vaginal mucosa related to a lack of oestrogen
146
What is the presentation of atrophic vaginitis?
itching
dryness
dyspareunia (discomfort or pain during sex)
bleeding due to localised inflammation
147
What is seen on examination of the labia and vagina in atrophic vaginitis?
pale mucosa
thin skin
reduced skin folds
erythema and inflammation
dryness
sparse pubic hair
148
What is the management of atrophic vaginitis?
vaginal lubricants
topical oestrogen
149
Where are Bartholin's glands located?
either side of the posterior part of the vaginal introitus
150
What is the role of Bartholin's glands?
produce mucus to help with vaginal lubrication
151
What is the management of a Bartholin's cyst?
resolve with good hygiene, analgesia and warm compresses
152
What is the management of a Bartholin's abscess?
antibiotics
swab of pus or fluid
may require surgical intervention - word catheter, marsupialisation
153
What are the types of FGM?
type 1 = removal of part or all of the clitoris
type 2 = removal of part or all of the clitoris and labia minora, labia majora may also be removed
type 3 = narrowing or closing the vaginal orifice (infibulation)
type 4 = all other unnecessary procedures to female genitalia
154
What are the two key risk factors for FGM?
coming from a community that practice FGM
relatives affected by FGM
155
What are the immediate complications of FGM?
pain
bleeding
infection
swelling
urinary retention
urethral damage and incontinence
156
What are the long term complications of FGM?
vaginal infections (e.g. BV)
pelvic infections
UTIs
dysmenorrhoea
sexual dysfunction and dyspareunia
infertility and pregnancy related complications
significant psychological issues and depression
reduced engagement with healthcare and screening
157
Where do the upper vagina, cervix, uterus and fallopian tubes develop from in the embyro?
paramesonephric ducts (Mullerian ducts)
158
What is a bicornuate uterus?
two horns to the uterus giving it a heart shaped appearance
159
What are the potential pregnancy complications of a bicornuate uterus?
miscarriage
premature birth
malpresentation
(successful pregnancies are generally expected)
160
What is the presentation of an imperforate hymen?
cyclical pelvic pain and cramping without any PV bleeding
161
What can an imperforate hymen cause?
retrograde menstruation leading to endometriosis
162
What is the treatment of an imperforate hymen?
surgical incision to create an opening
163
What is vaginal hypoplasia?
abnormally small vagina
164
What is vaginal agenesis?
absent vagina
165
What is androgen insensitivity syndrome?
cells are unable to respond to androgen hormones due to a lack of androgen receptors
166
What is the mode of inheritance of androgen insensitivity syndrome?
X-linked recessive
167
What is the pathophysiology of androgen insensitivity syndrome?
extra androgens are converted into oestrogen resulting in female secondary sexual characteritistics
168
Are patients with androgen insensitivity syndrome male or female?
genetically male with XY sex chromosomes
female phenotype externally - normal female external genitalia and breast tissue
169
What reproductive organs do patients with androgen insensitivity syndrome have?
testes in the abdomen or inguinal canal
absence of a uterus, upper vagina, cervix, fallopian tubes and ovaries
170
When does androgen insensitivity syndrome typically present?
infancy with inguinal hernias containing testes
puberty with primary amenorrhoea
171
What are the results of hormone tests in androgen insensitivity syndrome?
raised LH
normal or raised FSH
normal or raised testosterone levels (for a male)
raised oestrogen levels (for a male)
172
What can be used as a short-term option to rapidly stop heavy menstrual bleeding?
norethisterone 5mg tds
173
What are the causes of premature menopause?
idiopathic (most common, may be a family history)
bilateral oophorectomy (hysterectomy with preservation of the ovaries has also been shown to advance the age of menopause)
radiotherapy
chemotherapy
infection (e.g. mumps)
autoimmune disorder
resistant ovary syndrome (due to FSH receptor abnormalities)
174
What can cause delayed puberty with short stature?
Turner's syndrome
Prader-Willi syndrome
Noonan's syndrome
175
What can cause delayed puberty with normal stature?
PCOS
androgen insensitivity
Kallman's syndrome
Klinefelter's syndrome
176
What are the types of physiological ovarian cysts?
follicular
corpus luteum
177
What is the commonest type of ovarian cyst?
follicular cyst
178
What causes a follicular cyst?
non-rupture of the dominant follicle or failure of atresia in a non-dominant follicle
179
What causes a corpus luteum cyst?
if the corpus luteum doesn't break down and disappear when pregnancy doesn't occur, it fills with blood or fluid
180
What lines a dermoid ovarian cyst?
epithelial tissue - may contain skin appendages, hair and teeth
181
What is the most common benign ovarian tumour in women under 30 years?
dermoid cyst
182
With which type of ovarian cyst, is torsion most likely?
dermoid
183
What are the benign epithelial ovarian tumours?
serous cystadenoma
mucinous cystadenoma
184
What may happen if a mucinous cystadenoma ruptures?
pseudomyxoma peritonei
185
What are the initial investigations for urinary incontinence?
bladder diary for a minimum of 3 days
vaginal examination to exclude pelvic organ prolapse and assess ability to initiate voluntary contraction of pelvic floor muscles (Kegel exercises)
urine dipstick and culture
urodynamic studies
