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MD Finals > O+G > Flashcards

O+G Flashcards

1
Q

What is the cervix like pre-puberty?

A

Lined with squamous epithelium
Becomes columnar during pregnancy and puberty
SCJ migrates down
Normal change - ectopy
When SCJ is in low pH vagina region, becomes squamous - transformation zone

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2
Q

Transformation Zone vs SCJ

A

TZ wide area between highest and lowest point that SCJ was in lifetime - pre- and post-puberty
SCJ is the exact position of histological change

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3
Q

What is ectopy also known as?

A

An ectropion

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4
Q

What is the pathology in an ectropion?

A

Columnar epithelium present on vaginal surface - normal physiological state

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5
Q

Presentation of an ectropion

A

Excess mucous secretion
Post-coital bleeding
O/E Red looking area on os

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6
Q

RFx for an ectropion?

A

Oestrogen-containing contraceptives

Menstruating age - Raised oestrogen

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7
Q

Ix For ectropion?

A

Colposcopy +/- biopsy for sinister causes

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8
Q

Mx for Ectropion

A

Not usually needed
Can stop pill
Ablation

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9
Q

What are the high risk HPVs

A

16 and 18

16 = 50% Ca’s

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10
Q

What is CIN?

A

Cervical intraepithelial neoplasia AKA dyskaryosis
Abnormal growth, potentially pre-malignant
Almost always caused by HPV

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11
Q

How Dx and staging CIN made?

A

Picked up on cervical screening, which shows degree of dyskaryosis
Colposcopy and histology
Dx made by cytology

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12
Q

How many grades of CIN?

A

3
Stage 1: Mild dyskaryosis - basal 1/3 epithelium of TZ
Stage 2: Moderate - Basal 2/3 epithelium
Stage 3: Severe - >2/3 epithelium AKA carcinoma in situ

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13
Q

Prognosis of CIN

A

~15 years until cervical Ca

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14
Q

RFx for CIN

A 
Sexual promiscuity 
Birth  < 16y
Young age commencing  sexual  activity
Aged 25-35
Not vaccinated
Smoker
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15
Q

How to Ix CIN?

A

Colposcopy - 2 solutions: acetic acid (dysplastic cells), iodine (stains yellow/orange - should go dark in normal)
Biopsy usually done
Silver nitrite for cauterisation

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16
Q

Mx CIN

A

One stop clinic - ablation/excision
CIN 1 not treated
LLETZ (Large Loop excision of TZ) procedure - curative
Cold coagulation or laser ablation - efficacy 90-95%

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17
Q

What is common cell type of cervical Ca?

A

SCC

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18
Q

Epidemiology of cervical Ca?

A

Disease of young
Less common due to screening
Highly linked to smoking

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19
Q

Smear test screening

A

Negative - no further Mx
Inadequate - repeat - 3 inadequate - Colposcopy
Borderline - Endocervical - Colposcopy; Squamous cells - screen in 6m
Mild/Moderate/Severe - Colposcopy

3 years 25 - 49y; 5yearly after

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20
Q

Presentation of cervical Ca?

A

Often asymptomatic
Many present on smear testing
Non menstrual bleeding typical presentation

Advanced:
Post-coital
PMB

Very advanced:
Backache, leg pain, hydronephrosis

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21
Q

RFx cervical Ca?

A 
High  parity
STI Hx
Sexual promiscuity 
Birth  < 16y
Young age commencing  sexual  activity
Aged 25-35
Not vaccinated
Smoker
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22
Q

Mx of Cervical Ca?

A

Curative vs Palliative
Ia: Hysterectomy/Biopsy
Ib: Total Hysterectomy + RTx +/- CTx

II-IV: Chemo/RTx

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23
Q

Prognosis of Cervical Ca?

A

Average 5y survival 61%

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24
Q

What is the HPV vaccine?

A

Vaccination against 16 and 18
Given at 12-13y
3 doses over 6 months

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25
Q

What is Vulval Cancer?

A

Mostly SCC

Post menopausal females

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26
Q

Presentation of Vulval Cancer?

A 
Elderly
PM
Itching
Burning
Patches discolouration - red, black or white
Lumps or growths
Vulval bleeding
Dyspareunia 
Dysuria
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27
Q

RFx for Vulval Cancer?

A

HPV
Smoking
CIN/VIN

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28
Q

DDx of Vulval Cancer?

A

Vulval dermatoses - lichen sclerosis - steroid cream
VIN - Vulval intraepithelial neoplasia
Vaginal cancer - upper 1/3 post wall most common
Senile vaginitis - atrophic vaginitis

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29
Q

Mx for Vaginal Cancer?

A

RTx - preserve genitalia

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30
Q

What is the staging system for Vulval Cancer?

A

FIGO staging

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31
Q

Mx of Vulval Cancer?

A

Surgery and reconstruction AKA excision
RTx - shrink pre-op
Chemo
Palliative - symptom control

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32
Q

What is the most common genital tract Ca?

A

Endometrial Ca

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33
Q

What is the pathology of Endometrial Ca?

A

Adenocarcinoma

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34
Q

What is the presentation of Endometrial Ca?

A

Tumour related - abnormal vaginal bleeding (PMB - little and occasional: gets more frequent and heavy; Pre-menstrual - irregular, heavier or change)

Metastases related - Local, lymphogenic or haematogenic

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35
Q

RFx for Endometrial Ca?

A 
Long-term exposure to oestrogens:
Nulliparous
Early menarche and late menopause
PCOS
Obesity - aromatase 
Tamoxifen
DM
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36
Q

Ix for Endometrial Ca

A

Transvaginal USS - Ca > 5mm
Biosy via Hysteroscopy (done if >4mm on USS or multiple bleeds)
Pre-menopausal - Hysteroscopy regardless

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37
Q

DDx for PMB

A 
Endometrial Ca
Cervical Ca
Atrophic vaginitis 
Ectropion
Endometrial Polyp
Vaginal Ca
Endometrial Hyperplasia 
Tamoxifen
HRT
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38
Q

Mx of Endometrial Ca?

A

Surgical: TAH +/- Bilat salpingo-oophorectomy +/- RTx +/- High dose progesterones

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39
Q

What is Endometrial Hyperplasia?

A

Extensive stimulation –> Proliferation of endometrium
AKA HRT without progestin

Pre-cancerous - risk carcinoma in complex hyperplasia with atypia (30%)

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40
Q

How to classify Endometrial Hyperplasia?

A

Based on histology

Simple or complex

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41
Q

Presentation of Endometrial Hyperplasia?

A

Constant bleeding
Intramenstrual bleeding
Post-menopausal bleeding

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42
Q

Ix of Endometrial Hyperplasia?

A

USS or hysteroscopy

> 1cm in pre-menopausal
5cm in post-menopausal

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43
Q

Mx of Endometrial Hyperplasia?

A

Depends on presence atypia and age

No atypia - progesterone (mirena coil) and surveillance
Atypia - TAH +/- BSO

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44
Q

What is Amenorrhoea?

A

Absence menstruation in women of reproductive age

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45
Q

What are the two main reasons for physiological Amenorrhoea?

A

Pregnancy

Breast feeding

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46
Q

What is primary Amenorrhoea?

A

When patient never had period

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47
Q

When should primary Amenorrhoea be Ix?

A

14y and no breast development

15y with breast development

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48
Q

Most common causes of Amenorrhoea?

A 
Late puberty
GU malformation e.g. imperforate hymen
Turner's 
Hypothyroid
Congenital absence of organs e.g. uterus/ovaries
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49
Q

When to consider further Ix in primary Amenorrhoea?

A

Abnormal genitalia

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50
Q

Common causes secondary Amenorrhoea?

A 
Emotional distress
Weight loss
Excessive exercise 
Drug induced
PCOS
PRegnancy 
Contraception
Anorexia
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51
Q

Ix in secondary Amenorrhoea?

A

Urinary BHCG
Serum free androgen index - PCOS
FSH in premature menopause
T and LH in PCOS and adrenal hyperplasia

LH and FSH - High = premature ovarian failure; Low = Hypothalamic cause; Normal FSH, High LH = PCOS

Prolactin in prolactinoma/anything blocking DA e.g. antipsychotics

USS for PCOS and sexually inactive girls

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52
Q

Mx Amenorrhoea?

A

Treating cause

Determined whether want children

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53
Q

Dysmorphic features of Turner’s

A

Short stature
Wide neck
Pubertal delay
Low set ears

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54
Q

What is PCOS?

A

Excess androgens
Presence multiple immature follicles ovaries
Assoc. with excessive androgen secretion and insulin resistance

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55
Q

Pathology of PCOS?

A

High LH = High androgens

Insulin resistance = Low SHBG (sex hormone binding globulin) –> Higher androgens

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56
Q

Why is ovulation suppressed despite high levels LH in PCOS?

A

Androgens suppress surge

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57
Q

Presentation PCOS

A 
Amenorrhoea
Oligomenorrhoea (irregular)
Acne
Weight gain
Dark patches skin (acanthosis nigricans)
Hirsutism 
Infertility
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58
Q

Diagnostic criteria for PCOS?

A

Rotterdam Criteria - 2/3 of:

  • Oligomenorrhoea +/- anovulation
  • Clinical or biochemical signs hyperandrogenism
  • Poly cystic ovaries on imaging
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59
Q

What would be seen on bloods in PCOS?

A

Raised T
Low SHBG - high circulating levels of LH
Normal FSH
Low Progesterone

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60
Q

What would be seen on USS of PCOS?

A

String of pearls

> 5 follicles/ovary

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61
Q

Mx of PCOS

A

Treat DM/HTN/Hyperlipidaemia
Weight management
Oral contraceptive pill (effect oestrogen unopposed - give POP)
Anti-androgen for hirsutism aka spironolactone

Infertility:
Clomifine in conjunction with metformin
Ovarian drilling
COCP

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62
Q

Complications of PCOS

A

T2DM
Weight gain
Increased risk endometrial Ca

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63
Q

What is PID?

A

Inflam condition affecting any part of higher female reproductive system - salpingitis or endometritis

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64
Q

Causative organisms in PID?

A

Chlamydia Trachomitis and Neisseria Gonorrhoea

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65
Q

Presentation of PID

A 
Lower abdo pain
N&amp;V
Fever >38
Deep dyspareunia 
Cervical/Vaginal discharge 
Irregular bleeding
Dysuria 
Cervicitis

O/E: Cervical excitability, tenderness at fornices

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66
Q

RFx for PID

A 
STD
Young age
Multiple partners
Intercourse without protection
IUD insertion
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67
Q

Ix for PID

A

Swabs - endocervical (chlamydia and gonorrhoea) and high vaginal swab Bacterial vaginosis
Urine dip +/- MSSU
Pregnancy test

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68
Q

Mx PID

A

Abx - Doxycycline and Metronidazole
Paracetamol
Contact tracing
Avoid intercourse until patient and partner treated

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69
Q

When to admitt someone with PID

A

Pregnant
Septic
Peritonitic

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70
Q

Complications of PID

A 
Abscess
Infertility
Chronic pain
Chronic salpingitis - adhesions
Fitz-Hugh Curtis syndrome - Liver capsulitis secondary to PID
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71
Q

What is an Ovarian Cyst?

A

Fluid filled sack within ovary

Common - especially pre-menstrual patients

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72
Q

How to tell if Ovarian Cyst will be malignant?

A

RMI (Risk of Malignancy Index)

  • USS x Menopausal Status x Ca-125
  • > 250 should be referred to specialist
  • 1 point if pre-menopausal; 3 if post
  • USS features = 1 point; 3 points if 2 or more
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73
Q

Presentation of Ovarian Cyst?

A 
Incidental and asymptomatic
Chronic pain - secondary to pressure bladder/bowel
Dysparenueria/cyclical pain
ACute pain in rupture or haemorrhage
PV bleeding
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74
Q

Presentation of Ovarian Cyst Rupture?

A

Sudden onset, unilateral, lower abdo pain
Fluid and blood loss - Shock
Acute abdo
Occurring during exercise
Dx - Pelvic USS - free fluid Pouch of Douglas

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75
Q

Rx Ruptured Ovarian Cyst?

A

Stable: Supportive - Obs and analgesia
Unstable: Laparoscopy

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76
Q

Presentation of Ovarian Cyst Torsion?

A

Sudden onset, unilateral, lower abdo pain
N&V
Pain improves over 24h as ovary dies
Venous return impaired - disruption arterial supply
Occurs during exercise or ovarian enlargement

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77
Q

Mx Ovarian Torsion?

A

USS - Enlarged, oedematous ovary

Laparoscopy and flip - should turn pink

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78
Q

Mx Ovarian Cyst?

A

Post-menopausal - Low RMI, follow up for year if <5cm with Ca-125 and USS;
Moderate RMI - Bilateral oopherectomy w/ Ca-125
Severe RMO: Laparotomy and staging

Pre-menopausal
LDH, aFP, B-HCG
Re-scan 6wk after finding - still there --> USS and Ca-125
3-6m then RMI
>5cm --> Cystectomy
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79
Q

Cell Type Ovarian Cancer?

A

Mostly epithelial subtype

Serous > mucinous cystadenocarcinoma

80
Q

What do Granulosa cell tumours produce?

A

Oestrogen

81
Q

What do Sertoli-Leydig cell tumours produce?

A

Androgens

82
Q

What is Meigs Syndrome?

A

Triad of benign ovarian tumour, ascites, and pleural effusion (transudate)

83
Q

What on USS is included in RMI?

A 
Bilateral
Ascites 
Metastases
Solid areas
Multilocular cysts
84
Q

Presentation of Ovarian Cancer?

A

Vague symptoms delay Dx
Abdo/pelvic pain
Bloating
Change bowel habit

O/E: Mass, ascites, cervical excitation

85
Q

RFx for Ovarian Cancer?

A 
More ovulation = Increased risk
Nulliparity
Early menarche
Late menopause 
Oestrogen-only HRT
Smoking
86
Q

What are 2 genetic mutations predisposing to Ovarian Ca?

A

BrCa 1/2
Patients < 30y
HNPCC - Lynch syndrome

87
Q

3 Tumour markers in Ovarian Ca

A

Ca-125
CEA (Carcinoembryonic antigen)
Ca-19.9

88
Q

If < 40, what additional tests for Ovarian Ca?

A

LDH, AFP, B-HCG

89
Q

DDx for Ovarian Ca

A

IBS

Diverticular disease

90
Q

Ix for Ovarian Ca

A

USS
CT abdo/pelvis
CXR for pleural effusion/ lung mets
MRI - staging?

91
Q

How is Ovarian Ca Staged?

A

FIGO

92
Q

Mx Ovarian Ca?

A

Full staging laparotomy with midline incision
Hysterectomy, BSO, Omentectomy, LN sampling, Peritoneal washings

Platinum-based Chemotherapy (carboplatin)

Letrozole

93
Q

Role of screening in Ovarian Ca?

A

If gene mutation identified - yearly USS with Ca-125

BrCa +ve - BSO offered and warned of risk finding incidental disease

94
Q

What does sexual offences act of 2009 say?

A

Legal age consent is 16
Not intended to prosecute mutually consented sex between 13 and 16
< 13y is crime with no defence

95
Q

What is Gillick Competence?

A

< 16y and their capacity to consent to their own sexual activity

96
Q

What are the Fraser Guidelines?

A 
Only concerned of contraception 
UPSSI is criteria 
- Must have understanding
- Parental involvement unless cannot be persuaded
- Sex ongoing  regardless of advice 
- Suffering will ensue 
-  In best interest
97
Q

What is Endometriosis?

A

Relapse and remitting Condition where endometrial tissue located outside uterus
Ovaries, pouch of Douglas, Lung

98
Q

What does adenomyosis mean?

A

Presence Endometrial tissue in uterine muscle

99
Q

What are 3 proposed theories for Endometriosis?

A
  1. Retrograde menstruation
  2. Metaplasia of mesothelial cells
  3. Impaired immunity
100
Q

What hormone Endometriosis driven by?

A

Oestrogen - acts like would to cyclical hormones - growing and bleeding at times

101
Q

What happens when there is endometrial tissue in ovaries?

A

Bleeds and forms chocolate cysts

102
Q

What is the presentation of Endometriosis?

A 
Cyclical pelvic pain
Occurs at time of menstruation 
Can be chronic due to adhesions
Severe dysmenorrhoea
Deep dyspareneuria 
Dysuria
Dyschezia (pain on defecation)
Cyclical rectal bleeding
Subfertility

O/E:
Fixed, retroverted uterus
Palpable uterosacral ligament
Tenderness and adnexal masses

103
Q

What features on examination would suggest adenomyosis?

A

Enlarged, tender, boggy uterus

104
Q

RFx for Endometriosis?

A

FHx
Short menstrual cycles
Heavy menstrual bleeding
Early menarche

105
Q

DDx Endometriosis?

A

PID
Ectopic
Fibroids
IBS

106
Q

Ix for Endometriosis?

A

Bloods - anaemia, urine dip (haematuria), MRI if bowel, transvaginal USS (cancer), pelvic USS (Severity - pre-surgery)

Gold standard is laparoscopy - chocolate cysts, adhesions, peritoneal deposits

107
Q

Mx of Endometriosis?

A

Asymptomatic - nothing

Non-hormonal - pain management

Hormonal/Systemic:

  • Pseudo-preg: COCP or POP
  • Pseudo-menopause: GnRH analogues

Hormonal/Local:

  • Mirena Coil
  • Surgery: Diathermy or Hysterectomy
108
Q

RFx for STIs

A 
Unprotected sex
Young female
Multiple sexual partners 
MSM
Metropolitan
109
Q

What is most common Bacterial STI in UK?

A

Chlamydia trachomitis

110
Q

How should chlamydia be screened?

A

Opportunistic and all sexually active people <25

Repeat in 3-6m

111
Q

Causative organism of chlamydia

A

Chlamydia trachomatis which is obligate intracellular bacteria

112
Q

Symptoms of chlamydia

A 
Women:
Asymptomatic in 80%
Post-coital and intramenstrual bleeding
Purulent discharge
Lower abdo pain
PRoctitis 
Signs: Cervicitis, contact bleeding 
Men: 
Urethral discharge
Dysurea
Testicular/epididymal pain
Proctitis
113
Q

How to Ix Chlamydia?

A

PCR testing from vulvovaginal swab

Men: first void urine of day

114
Q

Rx Chlamydia

A

Stat azithromycin
Then doxycycline
Avoid all sexual contact until 1 wk after both partners treated

115
Q

Complications of Chlamydia

A

PID
Epididymitis
Fitz-Hugh Curtis Syndrome

116
Q

What can Chlamydia cause in neonates/preg?

A

Neonatal conjunctivitis
Low BW
Post-partum endometreitis in mother

117
Q

What is Gonorrhoea?

A

Neisseiria Gonorrhoea

118
Q

How is Gonorrhoea transmitted?

A

Always sexually in adults
Neonates - eye involvement
Older children - sexual abuse

119
Q

Symptoms of Gonorrhoea?

A 
Depends on location 
Often asymptomatic
Women:
Vaginal discharge
Lower abdo pain
Rectal infection in absence of anal intercourse - spread by fingering or rimming

Men:
Urethral infection with discharge and dysuria

120
Q

Ix of Gonorrhoea?

A

PCR testing via vulvovaginal swab or first void urine in men

121
Q

Mx of Gonorrhoea?

A

Ceftriaxone and Azithromycin

OR Azithromycin and Doxycycline

122
Q

Causative organism in HSV?

A

HSV-1/2

123
Q

Symptoms of HSV?

A

Variable
80% no clinical symptoms
PRimary infection - febrile illness 5-7d, dysuria and ulcers

124
Q

How is HSV Dx?

A

PCR

125
Q

Causative organism Syphilis?

A

Treponium pallidum

126
Q

Transmission of Syphilis?

A

Skin to skin

Mucosa to mucosa

127
Q

Rx of HSV?

A

Acyclovir

128
Q

Symptoms of Syphilis?

A

Ano-genital ulcers which may occur in mouth

Classically - painless ulcers, known as chancres

129
Q

How to Dx Syphilis?

A

Syphilis serology

Swab for PCR

130
Q

Rx for Syphilis?

A

Ben Pen IM

131
Q

Complications of Syphilis

A

Secondary: Gumata

Tertiary: Neurosyphilis (may happen early if immunocompromised); CV

132
Q

Causative organism of Anogenital warts?

A

HPV 6 and 11

133
Q

Transmission of anogenital warts?

A

Close skin to skin - 40% carry (1-2% develop warts)

134
Q

Symptoms of warts?

A

Appear round sites max trauma (introitous or penis)

May be itchy or bleed

135
Q

Mx warts

A

Home-based Rx with toxin cream solution

Can give cryotherapy

136
Q

4 common causes vaginal discharge?

A

Candida - thick and white; itch - Clotrimazole
BV - watery and fishy; pH >5 - Metronidazole
Trichamonis vaginalis - frothy, yellow and fishy; itch - Metronidazole
Physiological - clear white, no smell

137
Q

Ix for vaginal discharge

A

pH
High vaginal swab - Candida, BV, TV
Vulvovaginal swab - Chlamydia, Gonorrhoea

138
Q

What is female sterilisation?

A

Tubular ligation
Occlusion
Salpingectomy with rings or clips (99.5%)

139
Q

What is male sterilisation?

A

Vasectomy:

  • Ligation of vas deferens
  • Cauterisation of the ends
  • Insertion of a fascia between the two
140
Q

Complications of a vasectomy?

A 
Bleeding
Infection
Epididymitis
Pain
Granuloma
141
Q

3 Types of non-hormonal contraception?

A

Male condom
Intrauterine
Sterilisation

142
Q

Typical Failure rate of condom?

A

18%

143
Q

What is a non-hormonal IU contraceptive?

A

Copper coil - 0.8% failure

144
Q

MoA of combined hormonal contraceptives?

A

Inhibits ovulation
Alters mucous and endometrium
Can be given as pill, patch or ring
9% failure

145
Q

Risks associated with combined hormonal contraceptive?

A

VTE and PE
Breast Ca
Migraine with aura

146
Q

What is a POP?

A

Progestogen only
Thickens mucous
Thins myometrium
9% failure

147
Q

Benefits of POP over COCP?

A

Can be used by women who smoke, >35y and breastfeeders

148
Q

S/E of POP

A

Breakthrough bleeding

149
Q

What is the implant?

A 
Small, flexible rod
Under dermis of non-dominant arm
Contains progestogen
Inhibits ovulation
Thickens mucous 
Failure 0.05%
150
Q

How long implant in for?

A

3 years

151
Q

S/E of implants?

A

1/3 no periods
1/3 irregular periods
1/3 normal periods

152
Q

What is the contraceptive Depot

A 
Injection into gluteal or abdo fat
Contains progestogen
Stops ovulation
Mucous thickening
Myometrium thinning 
6% failure
Repeated 13 weeks - recall at 3 months
153
Q

S/E depot injection?

A

Weight gain
Reduced BMD
Can take one week for women to ovulate again

154
Q

What is IU hormonal contraception?

A 
Progestogen
Stops ovulation
Mucous thickening
Myometrium thickening
In for 3-5y (Mirena)
T-shaped device
Failure 0.2%
155
Q

S/E Hormonal IUD?

A

Irregular bleeding up to 6m

Periods then become lighter and less painful

156
Q

Emergency contraception

A

Best within 72h but can be up to 5d after (if ellaone)
Gold standard - copper coil
EllaOne/Levonorgestrel EHC

157
Q

Reasons to avoid combined hormonal contraceptives?

A

VTE
PEs
Cancer - endometrial and Breast
Hepatitis or Liver tumours

158
Q

What is Ovarian Hyperstimulation?

A

Complication of ovulation induction

Superovulation

159
Q

What is the pathology of Ovarian Hyperstimulation?

A

Ovarian enlargement

Fluid shift from intra to extravascular space - peritoneal fluid and haemoconcentration (hypercoagulable)

160
Q

Presentation of Ovarian Hyperstimulation?

A

Abdo discomfort

SoB

161
Q

Risk factors for Ovarian Hyperstimulation?

A

Young age
Low BMI
PCOS
Prev OHSS

162
Q

Mx of Ovarian Hyperstimulation?

A

Analgesia
Fluid balance
Anti-embolic measures

163
Q

Prevention of Ovarian Hyperstimulation?

A

Low dose Gonadotrophin

164
Q

What is the definition of infertility?

A

Inability of a couple to conceive despite 1y of unprotective sex

Primary: Those who never conceived

Secondary: Previously conceived

165
Q

Definition of recurrent pregnancy loss?

A

Inability of a woman to carry a live birth even if conception possible AKA fibroid or antiphospholipid syndrome

166
Q

What are the causes of infertility?

A

40% female
30% male
30% combination

167
Q

What are the female causes of infertility?

A

PCOS
Ovarian insufficiency
Tubal adhesions
Sexual dysfunctions

168
Q

How to Dx Male infertility?

A

Semen analysis after abstaining for 3-4d

169
Q

How to Dx Male infertility?

A

Semen analysis after abstaining for 3-4d

More than 30% sperm morphology should be normal

170
Q

Mx Male infertility

A

Surgical treatment anomalies
Reproductive technology AKA sperm donor
Testosterone or Clomiphine for medical therapy

171
Q

Ix of Female infertility?

A
  1. Ovulatory function - mid-luteal progesterone (Raised in infertility); FSH (elevated), Prolactin may be high
  2. Patency fallopian tubes and uterus using hysterosalpingography (dye test)
  3. Examine cervix
172
Q

Mx of Female infertility?

A

Inducing OVulation:

  • Weight loss/gain
  • Clomiphine (increases FSH)
  • Ovarian drilling in PCOS
  • Letrazole (aromatase inhibitor - lowers oestrogen, increase FSH)
  • ?Metformin (PCOS)

Egg Retrieval:
- HCG analogue given priorly

IUS - Intrauterine insemination
IVF - In vitro fertilisation
ICSI - Intra-cytoplasmic sperm injection

173
Q

Define Heavy menstrual bleeding

A

Bleeding that has any adverse impact on quality of life

174
Q

Causes of Heavy menstrual bleeding

A

Fibroids
Adenomyosis
Malignancy

175
Q

Ix for Heavy menstrual bleeding

A

FBC - anaemia
B-hCG - pregnancy
USS - fibroids etc.

176
Q

Mx of Heavy menstrual bleeding

A 
No treatment
Methanamic or tranexamic acid
Pseudopregnancy or pseudomenopause
- Contraception 
- GnRH analogues (pseudomenopause)

Surgical:
Hysteroscopy and resection (polyps)
Uterine artery ablation
Hysterectomy

177
Q

What is Oligomenorrhoea?

A

Cycle > 35d

178
Q

How to Examine for Amenorrhoea

A

Tanner staging

179
Q

What is Asherman Syndrome?

A

Most common form of anovulatory infertility

Caused by excessive curettage of endometrial cavity

180
Q

What is dysmenorrhoea?

A

Characteristically cramping lower abdo pain, radiates to back and legs

Primary: idiopathic with high level prostaglandins
Secondary: due to pelvic pathology (usually endometreisis)

181
Q

What is intermenstrual bleeding?

A

Bleeding incl brown discharge between periods

182
Q

Definition of PMV

A

Bleeding 12m after last menstrual period

183
Q

Causes of PMV

A 
Vulval Ca
Cervical Ca
Vaginal Ca
Cervical Polyps
Endometrial Ca
184
Q

What is the climateric?

A

Peri-menopause

First instance of symptoms AKA infrequent menstruation

185
Q

What is the menopause

A

Time when woman permanently stops menstruating

12m after amenorrhoea

186
Q

What is post-menopause

A

Time beginning 12m after last menstrual cycle

187
Q

Physiology of Menopause

A

Reduced ovarian function
Reduced -ve feedback
Increased GnRH
Anovulatory cycles

188
Q

Presentation of Menopaue

A

3 Categories:

  • Vasomotor - sweating, hot flushes, heat intolerance
  • Mental - impaired sleep, depressed mood, loss libido
  • Atrophic - Vulvovaginal atrophy, general weight gain and bloating
189
Q

Dx for Menopause

A

> 45y - clinical Dx

< 45y - ?POI (prem ovarian insufficiency) - FSH measurements

190
Q

Indications for Mx of menopause

A 
Impacts QoL
Premature or surgical 
Bleeding - coil
Atrophic vaginitis - Vaginal oestrogen creams 
HRT 
Paroxetine - hot flushes
191
Q

Types of HRT

A

Oestrogen-only if hysterectomy

Oestrogen and Progesterone if have uterus - protects from affect unopposed oestrogen

192
Q

C/I to HRT

A

Pregnancy
DVT/PE
Chronic liver disease
Endometrial/Breast Ca

193
Q

What is premature ovarian insufficiency

A

Cessation periods before 40

194
Q

Pathology of premature ovarian insufficiency

A

Decreased oestrogen
Loss feedback
FSH and LH high

195
Q

Causes of premature ovarian insufficiency

A

Idiopathic
Smoking
Post-oopherectomy
Induction multiple ovulations and infertility

196
Q

Dx of premature ovarian insufficiency

A

High FSH after 3m amenorrhoea

197
Q

Mx of premature ovarian insufficiency

A

HRT
IVF if want baby
Treat underlying disorders

MD Finals (7 decks)

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