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1 Obs & Gyn > Menstrual Cycle Abnormalities > Flashcards

Menstrual Cycle Abnormalities Flashcards

1
Q

List two examples of physiological amenorrhoea

A

childhood
pregnancy
post-menopausal
breast feeding

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2
Q

List three investigations for amenorrhoea

A

FSH/LH
Androgens
USS (PCOS)

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3
Q

What might you see on USS in patient with PCOS?

A

string of pearls

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4
Q

Name two complications of PCOS

A

subfertility
acne
hirsutism

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5
Q

List two investigations for menorrhagia

A

TFTs
FBC
USS (fibroid)

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6
Q

Which fibroid is associated with the most amount of bleeding?

A

submucosal (Dependent on location of fibroid rather than size and number)

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7
Q

Patient with post-menopausal bleeding. What are you worried about?

A

endometrial cancer- 10% risk
cervical cancer (lower risk)

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8
Q

List two investigations for post menopausal bleeding

A

USS
speculum

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9
Q

Post menopausal woman’s endometrium is 2mm thick on USS. Do you biopsy?

A

> 4 mm no HRT
5mm on HRT
(only biopsy if >3mm)

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10
Q

Name one protective factor for endometrial cancer?

A

marina coil (progestogen only)

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11
Q

List the two criteria for primary amenorrhoea

A

no periods by 16 + secondary sexual characteristics

no periods by 14 + no secondary sexual characteristics

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12
Q

How is secondary amenorrhoea defined?

A

no periods for 6 months with pervious normal menstruation

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13
Q

What is thelarche?

A

breast tissue development

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14
Q

What is adrenarche?

A

pubic hair development

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15
Q

Which is the first sexual characteristic to develop?

A

breast enlargement

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16
Q

List two primary hypothalamic causes of amenorrhoea

A

anorexia nervosa
excessive exercise
stress
kallmann’s syndrome
constitutional delay

17
Q

List two causes of secondary amenorrhea (hypothalamic)

A

anorexia nervosa
excessive exercise
stress
tumours
infections (TB)

18
Q

Name one cause of anterior pituitary cause of amenorrhoea

A

hyperprolactinaemia (prolactin has negative feedback effect on hypothalamus)
primary- prolactinoma, pituitary hyperplasia

secondary- Sheehan’s syndrome

19
Q

How does hypothyroidism cause amenorrhoea

A

Increased TSH promotes prolactin release, therefore negative feedback on GnRH

20
Q

What are the adrenal causes of amenorrhoea?

A

cushing’s syndrome
androgen secreting syndrome
congenital adrenal hyperplasia (21-hydroxylase deficiency)

21
Q

How does Cushing’s syndrome result in amenorrhoea?

A

raised cortisol has negative feedback on GNRH, decreasing oestrogen levels

22
Q

What is the most common cause of primary amenorrhoea?

A

Turner’s syndrome

23
Q

What is the most common cause of secondary amenorrhoea?

A

PCOS

24
Q

Which criteria is used to diagnosed PCOS?

A

Rotterdam criteria

25
Q

What does the rotterdam criteria consist of?

A

2/3
-PCO on US
-irregular periods
-hirsutism/excessive androgens/ biochemical findings

26
Q

What happens to the levels of LH and FSH in PCOS?

A

Higher LH relative to FSH

27
Q

Differentials/system for amenorrhoea?

A

ovarian
hypothalamus
thyroid
adrenal
ant pituitary
outflow obstruction

28
Q

Name three hormones you would test for in the hormone profile of amenorrhoea

A

estrogen
progesterone
FSH
LH
Prolactin
Testoterone
TFTs

29
Q

List three types of abnormal uterine bleeding

A

heavy menstrual bleeding
intermenstrual bleeding
postcoital bleeding
postmenopausal bleeding
amenorrhoea

30
Q

List three questions you should ask in the history of patient with heavy menstrual bleeding

A

how long?
how many pads?
clots?
intermenstrual bleeding?
post coital bleeding?

31
Q

List four differentials for heavy menstrual bleeding?

A

PALM COINE
Polyps
Adenomyosis
Leiomyoma
Malignancy and hyperplasia

Coagulopathy
Ovulatory dysfunction
Iatrogenic
Not yet classified
Endometrial

32
Q

Which is the most common coagulopathy?

A

von willebrand disease

33
Q

List three investigations for heavy menstrual bleeding

A

TFTs
FBC
Coag
Transvaginal US
Endometrial biopsy

34
Q

List three options for management of heavy menstrual bleeding

A

tranexamic acid
NSAIDs
OCP
Mirena
Myomectomy
Hysterectomy
Uterine artery embolisation

1 Obs & Gyn (31 decks)

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