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Phase 3A > Obstetrics & Gynaecology > Flashcards

Obstetrics & Gynaecology Flashcards

1
Q

What is Gynaecology?

A

Area of medicine that involves the treatment of women’s diseases, especially those of the reproductive organs

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2
Q

What is amenorrhoea?

A

A lack of menstrual periods.

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3
Q

What is primary amenorrhoea?

A

When a patient has never started menstruation.

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4
Q

What are the causes of primary amenorrhoea?

A

Abnormal functioning of the hypothalamus or pituitary gland (hypogonadotropic hypogonadism)
Abnormal functioning of the gonads (hypergonadotropic hypogonadism)
Imperforate hymen or other structural pathology

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5
Q

What is secondary amenorrhoea?

A

When the patient previously had periods that subsequently stopped

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6
Q

What are causes of secondary amenorrhoea?

A

-Gynaecological
Pregnancy (the most common cause)
Menopause
Premature ovarian insufficiency (menopause before 40 years)
Polycystic ovarian syndrome

-Stress
Physiological stress due to excessive exercise, low body weight, chronic disease or psychosocial factors

-Iatrogenic
Medications, such as hormonal contraceptives

-Hormonal
Thyroid hormone abnormalities (hyper or hypothyroid)
Excessive prolactin, from a prolactinoma
Cushing’s syndrome

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7
Q

What does abnormal uterine bleeding refer to?

A

Irregularities in the menstrual cycle affecting frequency, duration, regularity of the cycle length and the volume of menses.

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8
Q

What do irregular menstrual periods indicate?

A

Anovulation (lack of ovulation) or irregular ovulation.

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9
Q

What are the causes of irregular menstrual periods?

A

-Gynaecological
Extremes of reproductive age (early periods or perimenopause)
Polycystic ovarian syndrome

-Stress
Physiological stress (excessive exercise, low body weight, chronic disease and psychosocial factors)

-Iatrogenic
Medications, particularly progesterone only contraception, antidepressants and antipsychotics

-Hormonal
Hormonal imbalances, such as thyroid abnormalities, Cushing’s syndrome and high prolactin

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10
Q

What is intermenstrual bleeding?

A

Any bleeding that occurs between menstrual periods

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11
Q

Why is intermenstrual bleeding a red flag?

A

Could indicate cervical or endometrial cancer

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12
Q

What are the causes of intermenstrual bleeding?

A

-Iatrogenic
Hormonal contraception
Medications, such as SSRIs and anticoagulants

-Cervix Related
Cervical ectropion, polyps or cancer

-Gynaecological
Pregnancy
Ovulation can cause spotting in some women
Sexually transmitted infection
Endometrial polyps or cancer
Vaginal pathology, including cancers

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13
Q

What is dysmenorrhoea?

A

Painful periods

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14
Q

What are the causes of dysmenorrhoea?

A

-Primary dysmenorrhoea (no underlying pathology)
-Secondary dysmenorrhoea
Endometriosis or adenomyosis
Fibroids
Pelvic inflammatory disease
IUD-Copper coil
Abnormal pregnancy (ectopic, POUL)

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15
Q

What is menorrhagia?

A

Heavy menstrual bleeding.

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16
Q

What are the causes of menorrhagia?

A

Gynaecological
-Dysfunctional uterine bleeding(no identifiable cause)
-Extremes of reproductive age
-Fibroids
-Endometriosis and adenomyosis
-Endometrial hyperplasia or cancer
-Polycystic ovarian syndrome
-Pelvic inflammatory disease (infection)

Iatrogenic
-Contraceptives, particularly the copper coil
-Anticoagulant medications

Bleeding disorders (e.g.Von Willebrand disease)
Endocrine disorders (diabetes and hypothyroidism)
Connective tissue disorders

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17
Q

What is postcoital bleeding?

A

Bleeding after sexual intercourse

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18
Q

Why is postcoital bleeding a red flag?

A

Could indicate cervical cancer

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19
Q

What are the causes of postcoital bleeding?

A

Cervical cancer, ectropion or infection

Trauma

-Vagina Related
Vaginitis
Vaginal cancer
Vaginal dryness

Polyps or Fibroids (Both benign. Fibroids- smooth muscle tumour, polyps endometrial tissue ).
Endometrial cancer

STI
PID

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20
Q

What is primary amenorrhoea defined by?

A

As not starting menstruation by 13 years when there is no other evidence of pubertal development or by 15 years of age where there are other signs of puberty, such as breast bud development

21
Q

What is the ‘normal’ puberty for boys and girls?

A

Puberty starts age 8 – 14 in girls and 9 – 15 in boys.

22
Q

How long does puberty last ?

A

It takes about four years from start to finish.

23
Q

Do boys or girls have their pubertal growth spurt earlier?

A

Girls

24
Q

Explain the development of puberty in girls?

A

Puberty starts with the development of breast buds, then pubic hair, and finally menstrual periods about two years from the start of puberty.

25
Q

What is Hypogonadism?

A

A lack of the sex hormones, oestrogen and testosterone, that normally rise before and during puberty.

26
Q

What can hypogonadism result in?

A

Delay in puberty.

27
Q

What are the two possible causes of hypogonadism?

A

Hypogonadotropic hypogonadism: a deficiency of LH and FSH
Hypergonadotropic hypogonadism: a lack of response to LH and FSH by the gonads (the testes and ovaries)

28
Q

What hormones are deficient in Hypogonadotropic hypogonadism?

A

LH and FSH which leads to a deficiency of oestrogen.

29
Q

Where are LH and FSH released from?

A

They are gonadotrophins produced by the anterior pituitary gland in response to gonadotropin releasing hormone (GnRH) from the hypothalamus

30
Q

How does hypogonadotropic hypogonadism occur?

A

There are no gonadotrophins simulating the ovaries, so the gonads do not respond by producing sex hormones (oestrogen). Therefore, “hypogonadotropism” causes “hypogonadism”.

31
Q

What are possible causes of hypogonadotropic hypogonadism?

A

Abnormal functioning of the hypothalamus or pituitary gland. This could be due to:
Hypopituitarism (under production of pituitary hormones)
Damage to the hypothalamus or pituitary, for example, by radiotherapy or surgery for cancer
Significant chronic conditions can temporarily delay puberty (e.g. cystic fibrosis or inflammatory bowel disease)
Excessive exercise or dieting can delay the onset of menstruation in girls
Constitutional delay in growth and development is a temporary delay in growth and puberty without underlying physical pathology
Endocrine disorders such as growth hormone deficiency, hypothyroidism, Cushing’s or hyperprolactinaemia
Kallman syndrome

32
Q

What is Kallman’s Syndrome?

A

X-linked recessive trait causing hypogonadotrophic hypogonadism, due to hypothalamic failure i.e insufficient production of LH and FSH due to the failure of GnRH-secreting neurons to migrate to the hypothalamus.

33
Q

Typical presentation of Kallman’s syndrome?

A

Lack of smell (anosmia) in a boy with delayed puberty.

34
Q

What hormones are deficient in Hypergonadotropic hypogonadism?

A

Oestrogen and Testosterone as the gonads fail to respond to stimulation.

35
Q

How does hypergonadotropic hypogonadism occur?

A

As there is no negative feedback from the sex hormones (oestrogen/testosterone), the anterior pituitary produces increasing amounts of LH and FSH. Consequently, you get high gonadotrophins (“hypergonadotropic”) and low sex hormones (“hypogonadism”).

36
Q

What are possible causes of hypergonadotropic hypogonadism?

A

Abnormal functioning of the gonads. This could be due to:
Previous damage to the gonads (e.g. torsion, cancer or infections such as mumps)
Congenital absence of the ovaries
Turner’s syndrome (XO)

37
Q

What is Turner’s syndrome?

A

Turner’s syndrome is a chromosomal disorder affecting around 1 in 2,500 females. It is caused by either the presence of only one sex chromosome (X) or a deletion of the short arm of one of the X chromosomes. Turner’s syndrome is denoted as 45,XO or 45,X.

38
Q

What are the three classical features to remember and look out for Turner syndrome?

A

Short stature, webbed neck and widely spaced nipples.

39
Q

What is congenital adrenal hyperplasia?

A

Congenital deficiency of the 21-hydroxylase enzyme can also sometimes be 11-beta-hydroxylase.

40
Q

What happens in congenital adrenal hyperplasia?

A

21-hydroxylase plays a role in producing hormones called cortisol and aldosterone. The absence of the 21-hydroxylase enzyme decreases the release of cortisol and aldosterone but increases the level of androgens (male hormone) this causes male characteristics to appear early in boys or inappropriately in girls.

41
Q

What are the symptoms of severe congenital adrenal hyperplasia?

A

The symptoms that present and the age at which they become apparent depends on the degree of cortisol and/or aldosterone deficiency.

Boys with severe CAH show symptoms soon after birth, when a baby develops heart rhythm abnormalities, dehydration and vomiting. The levels of minerals (electrolytes) in the body are also affected, particularly showing low salt levels (hyponatraemia) and low blood sugar levels (hypoglycaemia).

Females with severe CAH are born with virilised (male looking) genitalia, so confusion as to the sex of the baby may occur. This is referred to as atypical or ambiguous genitalia. They too have low levels of minerals, especially salt, so show similar symptoms to boys.

42
Q

What are the symptoms of mild congenital adrenal hyperplasia?

A

Children with mild CAH may not have the same mineral imbalances as more severely affected children.

Symptoms present at a later age caused by an increase in androgens.

Girls:
Tall for their age
Facial hair
Absent periods (primary amenorrhoea)
Deep voice
Early puberty

Boys:
Enlarged penis
Small testicles
Early puberty
Acne
Deep voice.

43
Q

What is Androgen Insensitivity Syndrome?

A

X-linked recessive condition where tissues are unable to respond to androgen causing genetically male children (46XY) to have a female phenotype.

44
Q

What are the symptoms of Androgen Insensitivity Syndrome?

A

It results in a female phenotype, other than the internal pelvic organs. Patients have normal female external genitalia and breast tissue. Internally there are testes in the abdomen or inguinal canal, and an absent uterus, upper vagina, fallopian tubes and ovaries.

45
Q

What are the two types of Androgen Insensitivity Syndrome and what is the difference in their symptoms?

A

Complete androgen insensitivity syndrome (CAIS) – where testosterone has no effect on sex development, so the genitals are entirely female

Partial androgen insensitivity syndrome (PAIS) – where testosterone has some effect on sex development, so the genitals are often not as expected for boys or girls

46
Q

Explain Complete androgen insensitivity syndrome (CAIS)?

A

CAIS is not usually obvious from birth because affected babies have female genitals, including a vagina and labia

They’ll also have undescended testicles, but this will usually go unnoticed unless they cause a hernia.

The first signs usually begin at puberty, which starts at around the age of 11 or 12.

When a girl with CAIS reaches puberty, she will:
Develop breasts and have growth spurts as normal, although she may end up slightly taller than usual for a girl
Amenorrhoea
Develop little or no pubic and underarm hair
Girls with CAIS do not have a womb or ovaries, so are unable to get pregnant. Their vagina will also be shorter than normal, which may make some sexual acts difficult.

47
Q

Explain Partial androgen insensitivity syndrome (PAIS)?

A

In many cases, the genitalia at birth is the first sign and affected babies may have:
an enlarged clitoris (the sexual organ that allows women to have an orgasm)
partially undescended testicles
hypospadias – where the hole through which urine passes out of the body is on the underside of the penis, rather than at the end
Children with PAIS are often raised as boys, although they will continue to have a small penis and may develop some breast tissue at puberty.

48
Q

What tests can be performed to confirm a diagnosis of Androgen insensitivity syndrome?

A

Buccal smear or chromosomal analysis to reveal 46XY genotype
After puberty, testosterone concentrations are in the elevated reference range
Ultrasound to confirm absence of uterus and ovaries

49
Q

What is the treatment of Androgen insensitivity syndrome?

A

Counselling
Psychological support surrounding gender identity
Surgery- removal of undescended testes, vaginal surgery for short vagina

Phase 3A (2 decks)

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