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Conditions + definitions > Repro wk 4 > Flashcards

Repro wk 4 Flashcards

1
Q

What is the important gynae history of an adolescent?

A

Age of menarche
Cycle
Pain

Sexual (absence of parents) - activity/contraception
Abuse

Weight loss/gain
Exercise

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2
Q

When do you investigate primary ammenorrhoea?

A

If normal secondary secondary characteristics for age - 16

If absent secondary sexual characteristics - age 14

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3
Q

What investigations should be done before gynae referral?

A

FSH, LH, PRL, TSH, testosterone/oestrogen
Pelvic USG
Progesterone withdrawal bleed - pregnancy vs not enough oestrogen

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4
Q

How do you induce puverty?

A

Gradual build up with oestrogen
Check its effect on breast development

Add progesterone once maximum height potenital is reached
Once on at least 20mg of oestrogen

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5
Q

What can cause secondary amenorrhoea?

A

Weight
PCOS
Pregnancy
Fluctuating LH/oestrogens

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6
Q

What can cause bleeding disorders in the young?

A

Anovulation (najority - normal up to 2-4 years post menarche)
Sexual abuse/trauma
Pregnancy complications
PLatlet defects/other blood disorders

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7
Q

How do you treat menorrhagia?

A 
Reassure + talk to girl directly
Progesterone only pill/combined
Mefenamic acid
Tranexamic acid
Mirena
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8
Q

What are the possible adverse outcomes with ovarian cysts?

A

They can turn gangrenous
Tort
Or rupture

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9
Q

What are the symptoms of ovarian cysts?

A

Subacute history
Usually tender on one side of pelvis or behind uterus
May feel mass

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10
Q

What is prolapse?

A

50% of parous

Only 10-20% seek medical help

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11
Q

How many women have prolapse?

A

A protrusion of an organ/structure beyond its normal anatomical confines

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12
Q

What are the three layers of the pelvic floor?

A

Endopelvic fascia
Pelvic diaphragm
Urogenital diaphragm

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13
Q

What is the endopelvic fascia?

A

Network of fibro-muscular connective tissue

Fibromuscular allows it to stretch

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14
Q

What is pelvic diaphragm?

A

Layer of striated muscle with fascial coverings

Consists of levator ani + coccygeus

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15
Q

What is the urogenital diaphragm?

A

Superficial + deep transverse perinela muscles with fascial coverings
Normally weakest part

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16
Q

What are the parts of the endopelvic fascia?

A

Uterosacral/cardinal complex
Pubocervical fascia
Rectovaginal fascia

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17
Q

Where does the uterosacral c/cardinal complex extend to/from?

A

Medially from uterus, cervix
Laternal vaginal fornices
Pubocervical/rectovaginal fascia

Laterally to sacrum + fascial overlying piriformis muscle

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18
Q

How do you palapate the uterosacral complex?

A

Down traction on cervix

See if there is any side-side movement of cervix

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19
Q

Where does the uterosacral complex tend to break?

A

Medially

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20
Q

What is the pubocervical fascia?

A

A trapezoid fibromuscular tissue
Which provides the main support of the anterior vaginal wall
Often leads to bladder prolapse

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21
Q

What structures are found on the central surface of the pubocervical fascia?

A

Base of cardinal ligmanets (where it merges)

Cervix

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22
Q

What are found at the lateral boundaries of the pubocervical fascia?

A

Arcus tendineis fascia pelvis (a white line)

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23
Q

What is found at the distal boundary of the pubocervical fascia?

A

Urogenital diaphragm

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24
Q

Where does the pubocervical fascia tend to break?

A

At lateral attachments

Or immediately in front of cervix

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25
Q

What is the rectovaginal fascia?

A

Fibro-muscular elastic tissue

Holds rectum in place and leads to rectal prolapse

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26
Q

What does the rectovaginal fascia fuse with centrally?

A

Mereges with base of cardinal/uterosacral ligaments and perineum

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27
Q

What does the rectovaginal fascia fuse with laterally?

A

Fuses with fascia over levator ani

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28
Q

What is the attachment of the rectovaginal fascia distally?

A

Perineal body

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29
Q

Where does the rectovaginal fascia tend to brreak?

A

Centrally

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30
Q

How many levels of endopelvi support are there?

A

3 levels

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31
Q

What are the risk factors for pelvic organ prolapse?

A 
Forceps delivery
Large baby
Prolonged second stage of labour
Child birth in general
Advancing age
Obesity
Previous pelvic floor surgery
Other - syndromes, hormonal, constipation, heavy lifting
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32
Q

What is a safe answer for all pelvic floor disorders?

A

Forceps delivery

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33
Q

What types of exercise can cause pelvic prolapse?

A

High impact aerobics

Weight lifting

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34
Q

What are the typical vaginal pelvic organ prolpase symptoms?

A 
Sensation of buldge/protrusion "heaviness"
Seeing or feeling buldge/protrusion
Pressure
Difficulty inserting tampons
Splinting
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35
Q

What investigations are there for prolapse?

A

No investigations to diagnose

MRI/USS - levator ani thickness, fascial defects

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36
Q

How do you prevent vaginal prolapse?

A

Avoid constipation
Effective management of chronic chest pathology
Smaller family size
Pelvic floor exercises
Improvements in antenatal/intrapartum care

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37
Q

What are management options of vaginal prolapse?

A

Pessaries

Surgery

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38
Q

What are the aims of pelvic floor surgery?

A

Relieve symptoms
Restore/maintain bowel/bladder function
Maintain capacity for vaginal sexual function

Tailorto individual needs

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39
Q

What is the benefit of giving methadone via mouth?

A

Do not get any of the IV side effects

40
Q

Is methadone safe in pregnancy?

A

No direct harm, like most opiates
However, if mother stops taking care of self - not eating etc or abuse (as common in opiate drug users) then foetus may be harmed

41
Q

Why is cocain dangerous in pregnancy?

A

High chance of miscarriage
Causes vasoconstriction of vessels
Sometimes in heart

42
Q

How should you care for a neonate with a mother on methadrone?

A

Monitor and house in neonate unit for 5 days

Risk of epileptic fits or death from withdrawl

43
Q

How does the umbilical cord look in uterine death?

A

Dark red

44
Q

What can cause excess coils in the cord? What is the normal amount?

A

Exzcessive movement

Normal is 1 coild every 5-6 cm

45
Q

What can cause placenta abruption?

A

Hypertension
Trauma
Cocaine

46
Q

What is the mecahnism behind pre-eclampsia?

A

Trophoblast problem
Either too many or too active

Tropohoblasts break down smooth muscle around placenta implantation site to prevent vasoconstriction

47
Q

What is the 5yr (average) survival rate of ovarian cancer after 5yrs?

A

30%

48
Q

Who is likely to get ovarian cancer?

A

Mostly over 30 years
Some genetic cases (5-10%)
Incessant ovulation (no contraception, no pregnancy)
Breast feeding/OCP protective

49
Q

What are the symptoms of ovarian cancer?

A 
Often vague
Indegestion/poor appetiite
Altered bowel habit
Bloating/discomfort
Weight gain
Pelvic mass - often asymptomatic and large at presentation
50
Q

How do you diagnose ovarian cancer?

A

USS abdo + pelvis
CT to stage
Ca 125 biochem test

51
Q

What is the Ca 125 test?

A

A glycoprotein antigen
Caused by inflamation as well as
Malignancy (ovarian, colon/pancreas, breast)
Also in benign conditions - menstration, endometriosis
Liver disease

52
Q

What are the normal levels of Ca 125?

A

0-30/35

53
Q

How do you calculate risk of ovarian cancer?

A

U x M x Ca125
U being US features, 1 = 1 multiple = 3
M = menopausal, pre = 1, post = 3

54
Q

What are the US features that contribute to the risk score?

A 
Multi-locular lesion
Solida reas
Bilateral
Ascites
Intra-abdominal
55
Q

How do you treat ovarian cancer?

A

Surgery (gold standard)

Chemo after has best survival, although sometimes before to reduce

56
Q

What are the cure rates of the sages of ovarian cancer?

A

1: 85%
2: 47%
3: 15%
4: 10%

57
Q

What is the chemo regime for ovarian cacner?

A

First line being platinum + taxane within 8 wks of surgery
Cure unlikely
Average response being 2 yrs

58
Q

How do you manage recurrance of ovarian cancer?

A

Chemo, possibly surgery

If unable to tolerate - tamoxifen or palliation

59
Q

How thick should the endometrium be in a post menopausal woman?

A

Less than 4mm

60
Q

How do you investigate post menopausal bleeding?

A

Trans-vaginal USS

Endometrial biopsy

61
Q

How is a hysteroscopy carried out?

A

Either as out-patient with local anaesthesia

In-patient with general anaesthesia

62
Q

How do you stage endometiral cancer?

A

Surgical/pathological

MRI

63
Q

What is type 1 endometrial cancer?

A

Endometrioid adenocarcinoma
Caused by unopposed oestrogen
Characterised by hyperplasia with atypia precurosr

By far most common

64
Q

What is type 2 endometrial cancer?

A

Uterine serous + clear cell carcinoma
Has higher grade + more aggressive so worse prognosis
Generally in older women
Has serous intraepithelial carcinoma precurose

65
Q

How do you treat endometrial cancer?

A

Early stages - surgery
High risk - chemo
Advanced - radio

Surgery preferred if possible
With progesterone for palliation

66
Q

What is the difference between a total ans subtotal hysteroectomy?

A

Total includes uterus and cervix

Subtotal only uterus

67
Q

What are the risk factors for endometrial cancer?

A 
Post menopausal
High circulating oestrogen
>obesity
>unopposed oestrogen therapy
>PCOS
>early menarch/late menopause
Atypical endometrail hyperplasia
68
Q

What are the symptoms of endometrial cancer?

A

Abnomrla vaginal bleeding

Post menopausal bleesing

69
Q

What can cause post-menopausal bleeding?

A 
HRT
Atrophic chance (vaginitis)
Polyps cervical/endometrial
Endometrial cancer
Other cancer
70
Q

What is the 5yr survival for endometrial cancer?

A

78% for all stages
95% stage 1
14 stage 4

71
Q

What is the average age for menopause?

A

51

72
Q

When is premature menopause?

A

40 years or less

73
Q

Why does menopause happen?

A

Due to ovarian insufficnency - not enough viable eggs left
Means that follicle no longer develops to form oestrogen
As a result, oestradiol falls
FSH rises

Results in oestridol from peripheral conversion of androgens in fat

74
Q

What are the symptoms of menopause?

A 
Vasomotor symptoms "flush"
Vaginal dryness/soreness
Low libido
Muscle/joint aches
Mood changes
silent - Osteoporosis
75
Q

What are the modes of treatment for menopause?

A

HRT either:
local
systemic

76
Q

What are the local treatments for menopause?

A

Vaginal oestrogen pessary

Vaginal cream

77
Q

What are the systemic treatment options for menopause?

A

Transdermal - reduced risk of VTE as avoids first pass
Oral

Either oestrogen only if no uterus
Progesterone if still has uterus - can be oral

78
Q

What are the contraindications to HRT?

A

Current hormone dependant cancer (breast/ endometrium)
Current active liver disease
Uninvestigated abnormal bleeding

Seek advice if previous VTE/blood disorders
Seek advice if previous breast cancer or BRCA carrier

79
Q

When do you give cyclical vs non-cyclical HRT?

A

Cyclical (14 days just oestrogen, 14 days with progesterone) - if still ovarian function (perimenopausal)
Still bleeds

Continuous if no ovarian function
Bleed free after 3 months

80
Q

What are the risks of HRT?

A 
Breast cancer on combined (dependant on BMI)
>Returns to normal after 5 yrs off HRT
Ovarian cancer
VTE (if oral)
CVA (oral) (if after 60)
81
Q

What are the benefits of HRT?

A

Vasomotor flushes get better
Treats local genital symptoms
Helps prevent osteoporosis

82
Q

What is secondary amenorrhoea?

A

Has had periods, none for last 6 months

83
Q

What are the causes of secondary amenorrhoea?

A 
Pregnancy/breast feeding
Contraception
Polycystic ovaries
Early menopause
Thyroid disease/cushings
Significant illness
Raised prolactin
Hypotholamic (stress/weight change (only need 10% weight change)
Andorgen secreting tumour
84
Q

How do you investigate secondary amenorrhoea?

A

Check androgen features (hirsutism etc) /virilisation
Check pregnancy
Bloods - FSH, LH, oestrogdiol/testosterone
Thyroid function

Pelvic ultrasound

85
Q

How do you treat secondary amenorrhoea?

A

Treat specific cause
Assume fertile and give contraception unless after 2yrs post menopause
Check for Fragile X syndrome

86
Q

How does PCO present?

A

Oligo/amenorrhoea
Androgenic symptoms
Anovulatory infertility

Does not cause weight gain or pain

87
Q

How do you manage PCO?

A

Weight loss/exercise
Anti-androgen
Endometrial protection (progestogens)

88
Q

How do you manage an ovarian cyst?

A

Do not touch as may kill eggs

Reassure + USS

89
Q

What is vulvovaginitis?

A

Inflammation of the vulva and vagina

Most common condition in young girls (yrs 2-7 most common)

90
Q

What causes vulvovaginitis?

A

Most commonly bacteria

91
Q

What is labial agglutination?

A

Adhesion of labia minor in midline
Encourages urine retention + vaginal secretions
Can lead to vulvovaginitis

92
Q

How do you manage labial aggluation?

A

If symptomatic - improved hygiene may be all that is needed
Treat only if chronic vulvoaginitis or difficulty urinating
Topical oestrogen
Lubrication of labial with bland ointment

93
Q

Who is likely to get vaginal discharge?

A

Mucoid discharge common in infants 2 weeks after birth due to maternal oestrogen
Prepubertal girls experiencing increased oestrogen

94
Q

What can cause pathological vaginal discharge?

A

Infections by organisms
Haemolytic streptococcal vaginitis
Monial vaginitis
Foreign body

95
Q

How do you manage vaginal discharge?

A 
Conservatively:
Culture to identify organism
Urinalysis to rule out cystitis
Review hygiene
Check for pin worms
If persistent, review under anesthesia for foreign body

Conditions + definitions (68 decks)

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