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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
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
FSH, LH, Development and maturation
26
insufficent progesterone or poor response by the endometrium to progesterone. Abnormal follicular development (inadequate FSH/LH) – poor corpus luteum
luteal phase deficiency
27
what are the two forms of protection against infection in the endometrium?
cervical mucous plug | cyclical shedding of the endometrium
28
what are the causes of endometritis? (6) (micro-organisms)
``` Neisseria Chlamydia TB CMV Actinomyces HSV ```
29
what are the causes of endometritis without specific organisms? (7)
``` Intra-uterine contraceptive device Postpartum Postabortal Post curettage Chronic endometritis NOS Granulomatous (sarcoid, foreign body post ablation) Associated with leiomyomata or polyps ```
30
how do you treat chlamydia?
azithromycin 1gm stat, if allergic to macrolide - doxycycline 100mg bd ofr7 days
31
do you treat the partner if chlamydia positive?
yes
32
do you test for other STDs if chlamydia positive?
yes
33
what are the risk factors who are at high risk of endometrial pathology?
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
who do you biopsy during hysteroscopy?
those who are at high risk of endometrial pathology
35
which women do you offer ultrasound to?
uterus is palpable abdominally history or examination suggests a pelvic mass examination is inconclusive or difficult - eg. women who are obese
36
who do you offer transvaginal ultrasound to?
women with suspected adenomyosis
37
what suggests adenomyosis?
significant dysmenorrhoea or a bulky tender uterus
38
what advice do you give women who require endometrial ablation/
avoid subsequent pregnancy and use effective contraception, if needed, after endometrial ablation
39
treatment for patients with fibroids less than 3cm in diameter or suspected or diagnosed adenomyosis? (mild or not as severe)
lNG-IUS tranexmic acid, NSAIDs, combined hormonal contraception Cyclical oral progestogens
40
If pharmacological treatment is declined or symptoms severe in patients with fibroids less than 3cm?
repeat investigations surgical options - second generation endometrial ablation hysterectomy
41
for women with submucosal fibroids consider?
hysteroscopic removal
42
what should you consider the using LNG-IUS?
there is no distortion of the uterine cavity or suspected or diagnosed adenomyosis
43
how do you treat women with fibroids of 3cm or more? (9)
``` NSAIDS, tranexamic acid uliprestaal acetate LNG-IUS Combined hormonal contraception cyclical oral progestogens uterine artery embolisation myomectomy hysterectomy ```
44
what is the name of the condition where endometrial glands and stroma are outside of the uterine endometrial lining?
endometriosis
45
why does endometriosis occur?
most likely due to retrograde menstruation with plantation at an ectopic site
46
what is thee most common site of involvement in endometriosis?
ovary
47
what is formed in the ovary in endometriosis?
chocolate cyst
48
what is endometriosis that involves the uterine myometrium called?
Adenomyosis
49
what are the signs of endometriosis?
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
what is the initial treatment for endometriosis?
NSAID +/- COCP pr a progestogen
51
how do you diagnose endometriosis?
transvaginal USS if not appropriate then trans abdominal USS
52
consider laparoscopy to diagnose endometriosis
even if USS normal
53
what is an abnormal form of pregnancy in which a non-viable fertilized egg implants in the uterus or tube?
molar pregnancy
54
A form of gestational trophoblastic disease which grows as a mass characterised by swollen chorionic villi.
partial or complete moles
55
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
complete mole
56
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?
partial moles
57
what has a higher risk of developing into choriocarcinoma (a malignant tumour of trophoblast) than partial moles.
complete hydatidiform moles
58
what is a benign neoplastic proliferation or smooth muscle arising from myometrium?
leiomyoma
59
what is the most common tumour in females?
leiomyoma
60
the growth of leiomyomas are dependent on?
estrogen exposure
61
what is the medical treatment of fibroids?
GnRH analogues, mirena or progestins
62
what is the surgical treatment of leiomyomas?
laproscopic/laparotomy myomectomy (hysteroscopic or abdominal) subtotal/total hysterectomy
63
anovulatory cycles are more common in?
obese women
64
ovulatory causes of duB are more common in?
women aged 35-45
65
what is the cause DUB (ovulatory)
inadequate progesterone production by corpus lute

Sexual and reproductive health (5 decks)

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