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Obs & Gynae 01.15 > Menorrhagia & Subfertility > Flashcards

Menorrhagia & Subfertility Flashcards

1
Q

Azospermia means

A

No sperm produced

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2
Q

Asthenospermia means

A

Abnormal sperm prod

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3
Q

Oligospermia means

A

Low sperm produced

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4
Q

2 metals taken as supplement to help sperm production (3 months minimum)

A

Zinc & Selenium

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5
Q

What promotes egg development at the start of the ovulatory cycle?(Hypothalamus - 1, pituitary - 2)

A

Hypothalamus prod- GnRH (gonadotrophin releasing hormone) stimulates:
Pituitary - prod LH (Luteinizing hormone) and FSH ( follicular stim horm)
Note - ONLY FSH has effect on ovary at this stage.

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6
Q

What is produced by the ovary EARLY in ovulatory cycle in LOW levels to INHIBIT further FSH / LH production from pituitary?

A

Oestrogen

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7
Q

What function does oestrogen serve EARLY within the menstrual cycle (2)

A
  1. NEGATIVE feedback - pituitary inhibit FSH and LH prod

2. Build endometrial lining

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8
Q

What do follicles develop receptors for later in development?

A

LH - promotes maturation of follicles, then ovulation.

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9
Q

After ovulation, LH causes development of corpus luteum from follicular tissue - what 2 hormones does this produce, and what is their effect?

A

Oestrogen and Progesterone
1. Continues to build endometrium
2. Neg feedback at pituitary - red. LH / FSH levels
Therefore red. stimul of corpus luteum - degenerates,
therefore red. prod of oestrogen / progesterone
therefore - lining endometrium shed.

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10
Q

Why are oestrogen and progesterone effective as a. Contraceptive b. Reduce menstrual bleeds

A

a. High levels of both will inhibit LH / FSH prod, so stops ovulation / follicular development
b. Both promote endometrial lining to build - prevents periods

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11
Q

Most common cause of menorrhagia

A

DUB - dysfunctional uterine bleeding

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12
Q

6 other causes of menorrhagia

A 
Fibroids
Endometriosis
Infections
Cancer
IUDs
Drugs - eg warfarin
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13
Q

Possible drug treatments for menorrhagia (3)

A

Tranexamic acid
Mefanamic acid
Mirena coil
others

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14
Q

Possible side effects of Tranexamic acid and Mefanamic acid

A

GI irrit - stomach ulcer

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15
Q

Implant option to treat menorrhagia

A

IUD

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16
Q

Surgical option for menorrhagia

A

Ablation

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17
Q

Radical surgical option for uncontrolled serious menorrhagia

A

Hysterectomy

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18
Q

What is dysmenorrhea?

A

Menstrual pain

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19
Q

What is dyspareunia

A

Pain during sex

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20
Q

These non cancerous tumours in uterus, composed of muscle and fibrous tissue, can cause menorrhagia

A

Fibroids

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21
Q

What other symptoms might fibroids cause depending on their size / location (4)

A

Abd/back pain
Oligouria
Constipation
Dyspareunia

22
Q

3 features other than mennorrhagia with long gaps between, of polycystic ovary syndrome (PCOS)

A

Ovary cysts
Poor ovulation
Incr. androgen levels (hirsuitism)

23
Q

6 key questions for any gynae history

A 
Age
Parity
LMP
Period length  / character
Contraception
Last smear & result
24
Q

What does SSPMT mean in relation to pelvic examination

A 
Size
Shape
Position
Mobility
Tenderness
25
Q

Which of these types of fibroids may cause inc menstrual bleed and why?

  1. Subserous
  2. Intramural
  3. Submucosal
A

Submucosal - project into endometrium, increase it’s SA therefore more area to bleed.

26
Q

What is endometriosis

A

Growth of endometrial tissue outside the uterus - will still bleed each month.

27
Q

Why does endometriosis cause pain in odd places when bleeding

A

Blood hits nerves

28
Q

4 factors reduce liklihood of fibroids

A

Smoking
Exercise
Menopause
Parity

29
Q

4 Risk factors incr liklihood of fibroids (there are more)

A

Tamoxifen
Nulliparous
HTN / CV disease
Race (afto carrib)

30
Q

Rare complication of fibroids can lead to what type of tumour

A

Sarcoma - leiomyosarcoma

31
Q

Detail the 3 ways in which Esmya (ulipristal acetate) treats fibroids:

  1. Fibroid
  2. Uterine
  3. Hormonal
A
  1. Blocks progesterone - apoptosis and shrinkage
  2. Direct effect on uterus - reduc bleed
  3. Blocks FSH & LH prod (through blocking progesterone) but keeps Oestrogen levels - prev. bleeds.
32
Q

This type of cyst is a “chocolate cyst”

A

Endometriosis

33
Q

This type of cyst might contain teeth and hair

A

teratoma

34
Q

This type of delivery involves a suction cap on the skull of thebaby

A

Ventouse

35
Q

The luteal phase of the cycle (up to ovulation) is what length?

A

14 days

36
Q

The primary oocyte once ferlized, goes on to form what?

A

Zygote

37
Q

The zygote goes on to form what

A

Embryo

38
Q

The embryo goes on to form what

A

Blastocyst

39
Q

What are the 5 main causes of failure to conceive, other than UNEXPLAINED

A 
1 Ovulation disorder 25%
2 Sperm dysfunction 30%
3 Tubal disease 20%
4 Endometriosis 10%
5 Coital failure, cervical mucus disorders, uterine
abnormalities 10%
40
Q

Eating disorders or excessive exercise are likely to cause ovulation disorder at what point in the hormonal axis

A

Hypothalamus

41
Q

Adenomas, prolactinomas and drugs are likely to cause ovulation disorder at what point in the hormonal axis

A

Pituitary

42
Q

Oligoasthenoteratozoospermia is what

A

Reduced sperm count - mainly dysfunctional sperm left

43
Q

Two infective causes of tubal disease and subfertility

A

Neisseria gonorrhea

Chlamydia trachomatis

44
Q

An inflammatory cause of tubal subfertility

A

Endometriosis

45
Q

5 common problems in early pregnancy

2 not so bad, 3 pretty bad

A 
Hyperemesis gravidarum (vomiting)
Vag. bleed and abd pain
Ectopic preg
Molar preg
Misscarriage
46
Q

Preg lady with bleeding shows “vesicles” in tissue in the uterus - what is this?

A

Molar pregnancy - unviable

47
Q

What can a molar pregnancy develop into

A

Choriocarcinoma

48
Q

This hormone produced by the placental cells can be detected from 11/12 days after conception and will double every 72 hours. The level will reach its peak in the first 8 – 11 weeks of pregnancy and then will decline and level off for the remainder of the pregnancy.

A

HCG - Human chorionic gonadotropin

49
Q

Risk factors for ectopic preg

A 
Mirena coil (physically stops implantation in uterus)
Pre. fallopian infection - Chlamydia
50
Q

In event of misscarriage - 2 drugs that can expel foetus

A
  1. Mifiprostone = anti progesterone

2. Misoprostol = prostaglandin analogue

51
Q

Anti inflamm drug will kill foetus (used intentionally)

A

Methotrexate - anti metabolite

52
Q

3 types of HRT

A
  1. Oestrogen only - post hysterectomy
  2. Sequential - Oestrogen & progesterone for 14 days, then have withdrawel bleed.
  3. Continuous combined - Oestr and prog daily. - ONLY if LMP was>1yr ago = NO BLEED HRT

Obs & Gynae 01.15 (4 decks)

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