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Sexual and reproductive health > Pathology of the uterus > Flashcards

Pathology of the uterus Flashcards

1
Q

prolonged and increased menstrual flow

A

menorrhagia

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2
Q

regular inter menstrual bleeding

A

metrorrhagia

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3
Q

menses occurring at <21 day interval

A

polymenorrhoea

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4
Q

increased bleeding and frequent cycle

A

polymenorrhagia

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5
Q

prolonged menses and intermenstrual bleeding

A

menometrotthagia

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6
Q

absence of menstruation >6 months

A

amenorrhea

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7
Q

menses at intervals of >35 days

A

oligomenorrhea

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8
Q

The menstrual cycle may be irregular in adolescents during the first few months/years after menarche. This is not pathological.

A

Anovulatory cycle

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9
Q

what endometrial thicknesss is indicated for biopsy in postmenopausal women?

A

> 4mm

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10
Q

what endometrial thickness is indicated for biopsy in premenopausal women?

A

16mm

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11
Q

hypothalamic amenorrhoea including stress, excessive exercise, anorexia, Kallman’s syndrome, isolated gonadotrophin deficiency falls under which Who definition of ovulatory disorders?

A

Group I

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12
Q

Hypothalamic pituitary dysfunction: normogonadotrophic, normoestrogenic, an ovulation - PCOS falls under which WHO definition of ovulatory disorders/

A

Group II

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13
Q

Ovarian failure - high gonadotrophin with low estrogen’s - all variants of ovarian failure and resistant ovary fall under which WHO definition of ovulatory disorders?

A

group III

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14
Q

what are other causes of ovulatory disorders according to The Who defitnition?

A

hyperprolactinaemia

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15
Q

what is the 1st line treatment of Group I and II to induce ovulation?

A

clomiphene citrate

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16
Q

what is 2nd line treatment of Group II and II to induce ovulation?

A

Lh and FSH injections

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17
Q

how would you treat hyperprolactinaemia?

A

bromocyptin

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18
Q

what happens to FSH and LH in hyperprolactinaemia?

A

reduces

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19
Q

how would you treat ovarian failure?

A

refer to donor egg group

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20
Q

lesion affecting the pituitary or hypothalamus or affecting gonadotropin production?

A

Group I

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21
Q

what is the commonest cause of an ovulation and is caused by PCOS?

A

group II

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22
Q

why can’t ovulation be induced in the third type of ovulatory disorders?

A

follicular depletion

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23
Q

what is the commonest cause of infertility and amenorrhoea?

A

PCOD

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24
Q

what type of drug is clomiphene citrate?

A

selective estrogen receptor modulator

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25
Q

Clomiphene citrate stimulate the release of gonadotropins, ——-, and ———–, which leads to the ———– and ———— of ovarian follicle, ovulation, and subsequent development and function of the coprus luteum, thus resulting in pregnancy

A

FSH, LH, Development and maturation

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26
Q

insufficent progesterone or poor response by the endometrium to progesterone. Abnormal follicular development (inadequate FSH/LH) – poor corpus luteum

A

luteal phase deficiency

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27
Q

what are the two forms of protection against infection in the endometrium?

A

cervical mucous plug

cyclical shedding of the endometrium

28
Q

what are the causes of endometritis? (6) (micro-organisms)

A 
Neisseria
Chlamydia
TB
CMV
Actinomyces
HSV
29
Q

what are the causes of endometritis without specific organisms? (7)

A 
Intra-uterine contraceptive device
Postpartum
Postabortal
Post curettage
Chronic endometritis NOS
Granulomatous (sarcoid, foreign body post ablation)
Associated with leiomyomata or polyps
30
Q

how do you treat chlamydia?

A

azithromycin 1gm stat, if allergic to macrolide - doxycycline 100mg bd ofr7 days

31
Q

do you treat the partner if chlamydia positive?

A

yes

32
Q

do you test for other STDs if chlamydia positive?

A

yes

33
Q

what are the risk factors who are at high risk of endometrial pathology?

A

women with persistent inter menstrual or persistent irregular bleeding and women with infrequent heavy bleeding who are obese or have PCOS
women taking tamoxifen
women for whom treatment for HMB has been unsuccessful

34
Q

who do you biopsy during hysteroscopy?

A

those who are at high risk of endometrial pathology

35
Q

which women do you offer ultrasound to?

A

uterus is palpable abdominally
history or examination suggests a pelvic mass
examination is inconclusive or difficult - eg. women who are obese

36
Q

who do you offer transvaginal ultrasound to?

A

women with suspected adenomyosis

37
Q

what suggests adenomyosis?

A

significant dysmenorrhoea or a bulky tender uterus

38
Q

what advice do you give women who require endometrial ablation/

A

avoid subsequent pregnancy and use effective contraception, if needed, after endometrial ablation

39
Q

treatment for patients with fibroids less than 3cm in diameter or suspected or diagnosed adenomyosis? (mild or not as severe)

A

lNG-IUS
tranexmic acid, NSAIDs, combined hormonal contraception
Cyclical oral progestogens

40
Q

If pharmacological treatment is declined or symptoms severe in patients with fibroids less than 3cm?

A

repeat investigations
surgical options - second generation endometrial ablation
hysterectomy

41
Q

for women with submucosal fibroids consider?

A

hysteroscopic removal

42
Q

what should you consider the using LNG-IUS?

A

there is no distortion of the uterine cavity or suspected or diagnosed adenomyosis

43
Q

how do you treat women with fibroids of 3cm or more? (9)

A 
NSAIDS, tranexamic acid 
uliprestaal acetate 
LNG-IUS 
Combined hormonal contraception 
cyclical oral progestogens 
uterine artery embolisation 
myomectomy 
hysterectomy
44
Q

what is the name of the condition where endometrial glands and stroma are outside of the uterine endometrial lining?

A

endometriosis

45
Q

why does endometriosis occur?

A

most likely due to retrograde menstruation with plantation at an ectopic site

46
Q

what is thee most common site of involvement in endometriosis?

A

ovary

47
Q

what is formed in the ovary in endometriosis?

A

chocolate cyst

48
Q

what is endometriosis that involves the uterine myometrium called?

A

Adenomyosis

49
Q

what are the signs of endometriosis?

A

chronic pelvic pain
period related dysmenorrhea that affects daily activities and quality of life
deep pain during or after sexual intercourse
period related cyclical GI symptoms and urinary symptoms
infertility in association with 1 or more of the above

50
Q

what is the initial treatment for endometriosis?

A

NSAID +/- COCP pr a progestogen

51
Q

how do you diagnose endometriosis?

A

transvaginal USS if not appropriate then trans abdominal USS

52
Q

consider laparoscopy to diagnose endometriosis

A

even if USS normal

53
Q

what is an abnormal form of pregnancy in which a non-viable fertilized egg implants in the uterus or tube?

A

molar pregnancy

54
Q

A form of gestational trophoblastic disease which grows as a mass characterised by swollen chorionic villi.

A

partial or complete moles

55
Q

caused by a single (incidence is about 90%) or two (incidence is about 10%) sperm combining with an egg which has lost its DNA (the sperm then reduplicates forming a “complete” 46 chromosome set. Only paternal DNA is present

A

complete mole

56
Q

Partial mole occurs when egg is fertilized by two sperm or by one sperm which reduplicates itself yielding the genotypes of 69,XXY (triploid). have both maternal and paternal DNA?

A

partial moles

57
Q

what has a higher risk of developing into choriocarcinoma (a malignant tumour of trophoblast) than partial moles.

A

complete hydatidiform moles

58
Q

what is a benign neoplastic proliferation or smooth muscle arising from myometrium?

A

leiomyoma

59
Q

what is the most common tumour in females?

A

leiomyoma

60
Q

the growth of leiomyomas are dependent on?

A

estrogen exposure

61
Q

what is the medical treatment of fibroids?

A

GnRH analogues, mirena or progestins

62
Q

what is the surgical treatment of leiomyomas?

A

laproscopic/laparotomy
myomectomy (hysteroscopic or abdominal)
subtotal/total hysterectomy

63
Q

anovulatory cycles are more common in?

A

obese women

64
Q

ovulatory causes of duB are more common in?

A

women aged 35-45

65
Q

what is the cause DUB (ovulatory)

A

inadequate progesterone production by corpus lute

Sexual and reproductive health (5 decks)

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