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Reproduction > Repro Revision Prt 2 > Flashcards

Repro Revision Prt 2 Flashcards

1
Q

Symptoms of endometrial cancer

A

Post menopausal bleeding ⭐️
Irregular heavy menstrual bleed ⭐️

Post-coital bleed 
Pelvic pain 
Loss of appetite/weight
Tiredness 
Constipation
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2
Q

Risk factors for endometrial cancer

A 
Overweight 
Nullparity 
Early menarche/late menopause 
(Tamoxifen/unopposed oestrogen therapy)
➡️➡️lots of oestrogen

PCOS
Family hx
HNPCC
DM, HT

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3
Q

What can protect you from endometrial cancer

A

Oral contraceptive pill
Aspirin
Increased physical activity

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4
Q

Treatment of endometrial cancer

A

Hysterectomy and remove tubes and ovaries
Pelvic lymph node dissection

Chemo, radio

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5
Q

Prognosis of ovarian cancer

A

Poor because most present at advanced stage

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6
Q

Symptoms of ovarian cancer

A 
VAGUE 
Indigestion
Early satiety
Poor appetite 
Altered bowel habit
Pain 
Pelvic mass --> no symptoms or asymptomatic
(1% of women with these symptoms will have ovarian cancer)
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7
Q

CA125

A

???

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8
Q

Which genes put you in high risk of ovarian cancer

A

HPCC
BRCA1
BRCA2

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9
Q

Presentation of cervical cancer

A 
Assymptomatic - picked up on cervical smear 
Intermenstrual bleeding 
Postcoital bleeding 
Pelvic pain 
Persistent offensive discharge
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10
Q

Treatment of cervical cancer

A

Chemo/radio therapy in early stage

Surgical - excision biopsy, radical hysterectomy, trachelectomy (to spare fertility)

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11
Q

Factors predisposing to cervical cancer

A

HPV - 16+18
Multiple partners
Early age of first intercourse
Smoking

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12
Q

Presentation of vulval cancer

A

Vulval lump or mass
Long standing pruritis
Postmenopausal bleed
Discharge or dysuria

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13
Q

Majority of vulval cancer are

A

Squamous cell carcinoma

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14
Q

Epidemiology of vulval cancer

A 
Rare 
80% >60yrs
Vulval skin conditions & vulval Intraepithelial neoplasia
HPV -- high risk 
Smoking
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15
Q

Factors that increase risk of urinary incontinence

A 
Age
Parity ⭐️
Menopause 
Increased intra-abdominal pressure - chronic coughing condition 
Connective tissue disease
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16
Q

Assessment of urinary incontinence

A

3 day urinary diary - fluid intake/output; frequency, nocturia…

Urine dipstick

Examination

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17
Q

Investigations for urinary incontinence

A

(Urinary diary, urine dipstick, exam)

MSSU and multistick
Bladder scanning
Urodynamics

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18
Q

Management of urinary incontinence (stress)

A

Lifestyle - stop smoking, lose weight, avoid constipation, avoid alcohol and caffeine

Pelvic floor muscle training

Duloxetine with muscle training

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19
Q

Symptoms of overactive bladder syndrome

A

Urgency
Urge UI
Frequency
Nocturia

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20
Q

What bowel problems may cause urinary incontinence

A

IBS
Constipation
Anal incontinence

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21
Q

Risk factors for overactive bladder syndrome

A

Increasing age
Diabetes
Recurrent UTI
Smoking

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22
Q

Pharmacological management of overactive bladder syndrome

A

Tri-cyclic antidepressants - imipramine

Anti-muscarinic - oxybutinin

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23
Q

Most common age of last period

A

51

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24
Q

When would menopause be considered premature

A
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25
Q

Symptoms of menopause

A

Vasomotor symptoms - “hot flushes”
Vaginal dryness/soreness
(Mood change, memory loss)

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26
Q

Benefits of HRT

A

Treat vasomotor symptoms, local genital symptoms

Helps osteoporosis (not first line),

Less colon cancer risk

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27
Q

Risks of HRT

A 
Breast cancer
Ovarian cancer
Endometrial cancer
Venous thrombosis
Myocardial infarct 
CVA
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28
Q

How does mortality in HRT compare to non-users

A

No overall increase in mortality in HRT

XS risk of cancers (etc.) as for never users after 5 yrs off of treatment

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29
Q

Causes of premature menopause

A 
Idiopathic - radio, chemo, surgery
Infection - TB, mumps
Chromosome abnormalities
Autoimmune endocrine disease
FSH receptor abnormalities
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30
Q

Complications of menopause

A

Lose the protective effect of oestrogen on bones so accelerates osteoporosis

Greater risk of ischaemic heart disease

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31
Q

Absolute contraindications for HRT

A 
Severe hepatic impairment 
Recurrent idiopathic thrombosis
History of recent breast cancer
Irregular vaginal bleeding of unknown origin 
Myocardial infarction and stroke
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32
Q

Choice of HRT preparation

A

Oestrogen only for those without uterus

Need progesterone for those with uterus to prevent endometrial proliferation

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33
Q

Treatment alternative to HRT for menopause

A

Tibolone - selective oestrogen receptor modulator

SSRI/SNRI for hot flushes

Natural methods such as exercise, red clover..

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34
Q

When is never having had a period a concern

A

> 14 with no secondary sexual characteristics

> 16 with secondary sexual characteristics

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35
Q

Define primary amenorrhoea

A

Never having had a period

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36
Q

Define secondary amenorrhoea

A

Has had periods in the past but none for 6 months

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37
Q

Causes of primary amenorrhoea

A

Constitutional delay
Illness affecting the hypothalamopituitary axis - thyroid, coeliac, anorexia, renal failure
Chromosomal - turner’s
Endocrine - congenital adrenal hyperplasia
Infection - TB, mumps
Anatomical

38
Q

Illnesses which can affect the hypothalamopituitary axis

A 
Renal failure 
Coeliac 
Anorexia 
Thyroid 
Cushing's 
Galactosaemia
39
Q

Chromosomal causes of primary amenorrhoea

A

Turners XO
XY androgen insensitivity
Fragile X
Noonans

40
Q

Endocrine causes of primary amenorrhoea

A

Congenital adrenal hyperplasia

Pregnancy

41
Q

What causes hypogonadotropic hypogonadism

A

Low levels of LH and FSH

Constitutional delay (short for the family but appropriate for the stage of puberty and bone age
Chronic medical condition (hypothyroid or malabsorption)
Anorexia nervosa

42
Q

Causes of secondary amenorrhoea

A

Pregnancy or lactation
Polycystic ovaries
Stress/weight change
BMI >30 or

43
Q

Causes of increased prolactin

A

Phenothiazine

Prolactinoma/pituitary adenoma

44
Q

Treatment of premature menopause

A

Offer HRT until aged 50

45
Q

Tests for secondary amenorrhoea

A

PREGNANCY TEST
Dipstick for glucose
Blood - LH, FSH, oestradiol, prolactin, thyroid function, testosterone
Pelvic ultrasound

46
Q

What triggers menstruation

A

A decrease in progesterone 2 weeks after ovulation if not pregnant

47
Q

Term for heavy periods

A

Menorrhagia

48
Q

Term for painful periods

A

Dysmenorrhoea

49
Q

Term for infrequent periods

A

Oligomenorrhoea

50
Q

Term for lack of period

A

Amenorrhoea

51
Q

Causes of menstrual problems in early teens

A

Anovulatory cycles ⭐️
Congenital abnormalities
Coagulation problems

52
Q

Treatment of dysfunctional uterine bleeding

A

Non-hormonal or hormonal tablets or IUD to preserve fertility

If family complete consider endometrial ablation or hysterectomy

53
Q

Likely cause of menstrual problems in the 40-menopausal age group

A

Perimenopausal anovulation
Endometrial cancer
Warfarin
Thyroid dysfunction

54
Q

Presentation of polycystic ovarian syndrome

A

Oligo/amenorrhoea
Androgenic sx - hair/acne
Anovulatory infertility

Diabetes, cardiovascular disease

55
Q

Management of PCOS

A

Encourage weight loss
Antiandrogens - combined OCP
Spironolactione

Endometrial protection - progestogens, mirena IUD, CHC

Fertility treatment with clomiphene or metformin (have underlying insulin resistance)

56
Q

What is endometriosis characterised by

A

Endometrial type tissue outside the uterine cavity

–> pouch of douglas, ovary, pelvic peritoneum

57
Q

Symptoms of endometriosis

A

Perimenstrual pain
Dysmenorrhoea
Deep dyspareunia
Sub fertility

58
Q

Medical treatment of endometriosus

A

PSEUDOPREGNANCY

Progesterone - oral, injection, mirena
Combined oral contraceptive pill for 3 months at a time
GnRH analogues

59
Q

Surgical management of endometriosus

A

Excision of deposits from peritoneum/ovary
Diathermy/laser ablation of deposits
Hysterectomy AND oophorectomy

60
Q

In someone with amenorrhoea what do low LH and FSH levels imply; what do high levels imply

A

Low: no stimulation from hypothalamus

High: PCOS or ovarian failure (if very high)

61
Q

Describe the progesterone challenge test

A

Test for amenorrhoea

Administer a progestogen for 5 days and within 3 days of stopping there will be a withdrawal bleed. This implies that the endometrium has been primed with oestrogen, the uterus is present and there is no outflow tract obstruction

62
Q

How does prolactin affect menstruation

A

High prolactin levels inhibit pulsatile release of GnRH from the hypothalamus

63
Q

Diagnosis of endometriosis

A

Diagnostic laparoscopy show powder burns and chocolate cysts

MRI

USS of endometrioma

64
Q

Which race has the highest incidence of fibroids

A

Afro-caribbean women

65
Q

Name the types of fibroids

A

Submucus (protrude into uterine cavity)
Intramural (within uterine wall)
Subserous (project out of uterus into peritoneal cavity

66
Q

Symptoms of fibroids

A

Pressure sx if large
If enlarge uterine cavity surface area may cause menorrhagia
If submucous or polyp may cause intermenstrual bleeding
May grow fast in pregnancy –> pain, malpresentation, obstruction

67
Q

Treatment of fibroids

A

Nothing!
Standard menorrhagia treatment if cavity not too distorted
GnRH analogues to shrink
Antiprogestogen (ella1) over 3 months at low dose
Transcervical resection
Uterine artery embolisation

68
Q

Investigation of fibroids

A

Pelvic exam to be confirmed on ultrasound

69
Q

How does the menopause affect fibroids

A

They shrink!

Due to oestrogen being removed

70
Q

Dyskariosis

A

Low or high grade dyskaryosis reflects cervical intraepithelial neoplasia

71
Q

Treatment of CIN

A

LLETZ
Cold coagulation
Laser ablation

72
Q

What is the cervical transformation zone

A

The area where endocervical epithelium is pushed out and transformed into squamous cells - occurs during puberty and pregnancy

73
Q

Most common form of endometrial cancer

A

Adenocarcinoma

74
Q

Risk factors for pelvic organ prolapse

A 
Obesity 
Advancing age
Pregnancy and vaginal birth
Previous pelvic surgery 
Large baby
Forceps delivery/prolonged second stage
75
Q

Vaginal symptoms of a pelvic organ prolapse

A 
Sensation of bulge or protrusion 
Seeing or feeling bulge or protrusion 
Heaviness 
Pressure 
Difficulty inserting tampons
76
Q

Urinary symptoms of pelvic organ prolapse

A 
Incontinence 
Frequency/urgency 
Hesitancy 
Prolonged or weakened stream 
Feeling of incomplete emptying
77
Q

Bowel symptoms of pelvic organ prolapse

A

Incontinence of flatus or liquid or solid stool
Feeling of incomplete emptying/straining
Urgency

78
Q

Assessment of pelvic organ prolapse

A

POPQ (quantification) score

Exam to exclude pelvic mass

79
Q

Prevention of pelvic organ prolapse

A

Avoid constipation
Manage respiratory problems
Smaller family size

80
Q

Management of pelvic organ prolapse

A

Pelvic floor muscle training
Pessaries
Surgery

81
Q

What are women offered as a routine screening for down’s syndrome

A

CUB - combined ultrasound and biochemical screening

82
Q

Is an oblique lie a contraindiction to induction of labour

A

Yes!

83
Q

Which women are recommended to recieve Anti-D in their pregnancy

A

Rhesus negative women with a rhesus positive partner

84
Q

Best investigation to confirm endometriosis

A

Diagnostic laparoscopy

85
Q

31 year old woman presenting with severe right sided upper abdominal pain at 34 weeks gestation, who has reported normal fetal movements until now; has no vaginal bleeding; a tense and tender abdomen; high blood pressure and a clean urine dipstick is likely to be

A

Placental abruption!

86
Q

Best clinical signs to assess if someone is in active labour

A

Abdominal examination to assess the strength of contractions

Vaginal examination to see if membranes are intact

87
Q

Best method of pain relief for someone in established labour with no previous analgesia

A

Morphine

88
Q

Primary prevention of cervical cancer in the UK is performed by

A

HPV 16 and 18 immunisation

89
Q

Why should a pregnant woman always be examined in a left lateral position

A

In the supine position the pressure of the gravid uterus on the inferior vena cava causes a reduction in venous return to the heart with a possible 25% reduction in cardiac output

90
Q

Which infections are pregnant women routinely screened for

A

Hep B
HIV
Rubella
Syphilis

Reproduction (6 decks)

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