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Conditions + definitions > Repro wk3 > Flashcards

Repro wk3 Flashcards

1
Q

What is infertility?

A

Infertility is the inability to conceive with active intercourse (with no contraception) for a period of at least 12 months

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2
Q

What is primary infertility?

A

Being infertile without having had a previous pregnancy

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3
Q

What are irregular periods?

A

Where the time between the first day of each period changes between cycles

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4
Q

How do you diagnose PCOS?

A 
2 of the following 3:
Androgen access (Clinical vs biochemical)
Infrequent periods (anovulation)
Polycystic ovaries

When no other cause can be identified!

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5
Q

How do polycystic ovaries (PCO) and polycystic ovary syndrome (PCOS) differ?

A

PCOS is a diagnosis of exclusion over set criteria.
There are 3 criteria with PCO being one, 2 are needed for a diagnosis of PCOS

PCO is a common occurance in many women

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6
Q

What are the biochemical investigations into androgen access?

A

Testosterone
DHEAS (If over 700 CT adrenal to check for ovarian vs adrenal cause)
17-OH progesterone

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7
Q

What is pre-eclampsia?

A

New hypertension developed at or over 20 weeks with significant proteinuria

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8
Q

What is significant proteinuria?

A

Regent strip urinalysis 1+
Spot Urinary Protein: Creatinine Ratio > 30 mg/mmol
24 hours urine protein collection > 300mg/ day

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9
Q

What are the different types of fibroids?

A

Submucosal
Subserosal
Intermural

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10
Q

What are you looking for in a pelvic exam for infertility?

A 
Masses
Pelvic distortition
Tenderness
Vaginal septum
Cervical abnormalities
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11
Q

What are teh baseline investigations into infertility?

A 
Rubella immunity
Chlamydia
TSH
Biochemical tests
Male semen analysis
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12
Q

What biochemical tests are used to investigate regular periods?

A

Mid-luteal progesterone

Taken 7 days before expected periods

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13
Q

What biochemical tests are used to investigate irregular periods?

A 
Day 1-5:
FSH
LH
PRL
TSH
Testosterone
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14
Q

How do you investigate suspected tubual and uterine abnormalities?

A

Hysterosalpinogram (falling out of favour)
HyCoSy (becoming more prevelant

Laparoscopy if indicated by test above

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15
Q

What are the important questions for fertility in a male history?

A

Development -
Testicular descent
Change in shaving frequency? (change in T levels)
Loss of body hair

Infections - Mumps/STIs
Surgical - variocele repair? Vasectomy
Drugs (smoking.alcohol etc)
Sexual history (libido, fertility)

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16
Q

What side is a variocele more common on?

A

Left side, due to drainage into renal vein

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17
Q

What is klinefelter syndrome?

A 
Primary hypergonadism (small testis) caused by XXY
Impaired spermiogensis (azoospermia)
Testosterone deficiency
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18
Q

What is congenital bilateral absence of vas deferens associated with?

A

Cystic fibrosis

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19
Q

What are the types of ovulatory disorders?

A

3 types

1: Hypothalamic pituitary failure
2: Hypothalamic pituitary ovarian failure
3: ovarian failure

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20
Q

How do you manage type 1 ovulatory disorders?

A 
Encourage to have BMI of 19-29
Treat underlying cause
Potentially HRT to modulate ovulation:
>Clomifene
>Gonadotrophins
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21
Q

What is clomifene?

A

Selective oestrogen receptor modulator
Taken as lowest dose first, and graudally increase if ineffective
Usuable for 6 cycles

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22
Q

What are the side-effects of clomifene?

A

Vaso-motor
Visual disturbances
Multiple pregnancies

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23
Q

When do you use gonadotrophins?

A

No ovulation with clomifene
Ovulation but no pregnancy
FSH used

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24
Q

How do you treat hydrosalpinges?

A

Surgery - salpingectomy

BEFORE IVF

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25
Q

What are the causes of azzospermia?

A 
Testicular (hormones levels off)
Post testicular (congeinital, ineffective)
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26
Q

How do you investigate azoospermia?

A

History/examination
FSH/LH/Testosterone
Karyotype
CF screen

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27
Q

What are the classifications of azzospermia?

A

Transportation problem

Production problem

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28
Q

How do you manage transportation problems of azoospermia?

A

Surgical sperm retreival

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29
Q

How do you manage unexplained fertility?

A

No ovarian stimulation agents

2 years of unprotected sex before IVF

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30
Q

What is the difference between IVF and intracytoplasmic sperm injection?

A

IVF sperm is placed with eggs to fertilise

ICSI injection of eggs with sperm - individual

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31
Q

What is gestational hypertension?

A

New hypertension develped at or over 20 weeks

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32
Q

What is pre-eclampsia?

A

New hypertension developed at or over 20 weeks with significant proteinuria

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33
Q

What is significant proteinuria?

A

Regent strip urinalysis 1+
Spot Urinary Protein: Creatinine Ratio > 30 mg/mmol
24 hours urine protein collection > 300mg/ day

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34
Q

What can cause spontaneous miscarriages?

A 
Abnormal conception (genetic, structural, chromosomal)
Uterine abnormality (fibroids/genetic)
Cervical incompetence
Maternal (age/diabetes)
Unkown factors
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35
Q

How do you manage an inevitable miscarriage?

A

If bleeding is very heavy consider evacuation

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36
Q

How do yu manage a threatened miscarriage?

A

Conservatively

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37
Q

How do you manage a missed miscarriage?

A

Conservatively
Medically - prostaglandins
Surgical management of miscarriage

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38
Q

How do you manage a septic miscarriage?

A

Antibiotics and evacuate uterus

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39
Q

How common are ectopic pregnancies?

A

1 in 90

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40
Q

What are the risk factors of an ectopic pregnancy?

A

Pelvic inflammatory disease
Previous tubual surgery
Previous ectopic
Assisted conception

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41
Q

How does an ectopic pregnancy present?

A 
Period of ammenorhea with positive pregnancy test
\+/- the following
Vaginal bleeding
Abdominal pain
GI/urinary symptoms
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42
Q

How do you investigate an ectopic pregnnacy?

A

US (no intrauterine signs
Serum beta HCG levels (do not rise as steeply as normal)
Serum progesterone levels

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43
Q

How do you manage an ectopic pregnancy?

A

Medially - methotrexate
Surgical - laparosciopical

Conservatively (sit and wait to see if it solves itself)

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44
Q

What is an antepartum haemorrhage?

A

Haemorrhage from genital tract after 24th week of pregnancy but before birth of baby

Obstetric emergency - high mortality and morbidity for mother and child

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45
Q

What can cause atepartum haemotrrhage?

A 
Placenta praevia
Placental abruption
Unkown origin
Local lesions of genital tract
Vasa praevia (rare)
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46
Q

What is placenta praevia?

A

Where placenta is attached to lower segment of uterus (all or part)

47
Q

What is placenta abruption?

A

Where placenta has started to separate from uterine wall before birth of baby

48
Q

Who is likely to get placenta praevia?

A

Multiparous women
Multiple pregnancies
Previous C section

49
Q

What is the incidence of placenta praevia?

A

1/200

50
Q

What are the classifications of placenta praevia?

A

1: placenta encroaching on lower segment, but not in internal cervical os
2: placenta reaches internal os
3: placenta eccentrically covers internal os
4: central placenta praevia

51
Q

How does placentae praveia present?

A

Painless PV bleeding
Soft, non tender uterus +/- Malpresentation of foetus
Incidental

52
Q

How do you diagnose placenta praevia?

A

Ultra sound
MRI if inconclusive

DO NOT do a vaginal exam

53
Q

How do you manage placenta praevia?

A

Depends on gestation + severity

Although C section most common - post partum haemorrhage common

54
Q

How do you manage a post partum haemorrhage?

A

Medically - ocytocin, egometrine, carbaprost, tranexemic acid
Balloon tamponade
Surgical - B lynch cutre, ligation of uterine/illiac vessels
Hysterectomy

(in increaseing order)

55
Q

What factors are assocated with placental abruption?

A 
Pre-eclampsia/chronic hypertension
Multiple pregnancies
Polyhydramnios
Smoking
Increasing age
Parity
Previous abortion
Cocaine use
56
Q

What are teh types of placental abruption?

A

Revealed (apparent externally as escapes through cervical os)
Concealed (between uterine wal and placenta)
>Increased uterine contents + larger fundal height than would otherwise be expected for gestation
>Uterus may appear bruised
Mixed (both of above)

57
Q

What is the presentation of placental abruption?

A

Pain (abdominal)
Vaginal pleeding
Increased uteruine activity (tone + contractions)

58
Q

How do you manage APH?

A

Depends on:
Amount of bleeding
General condition of mother/baby
Gestation

Expectant treatment
Vaginal delivery
Immediate C section

59
Q

What are the complications of placental abruption?

A

Maternal shock/collapse
Foetal death
Maternal DIC, renal failure
Postpartum haemorrhage

60
Q

What is preterm labour?

A

Onset of labour before 37 weeks of gestation
Can be spontaneous of induced
Varies in severity - from 24 weeks being extremely to mild at 32 weeks

61
Q

How common is preterm labour?

A

5-7% of singletons

30-40 in multipl pregnancnies

62
Q

What are the predisposing factors of preterm labour?

A 
Multiple pregnancues
Polyhydramnios
APH
Pre-eclampsia
Infection
Prelabour premature rupture of membranes
63
Q

How do you manage a preterm delivery?

A

All cases variable
In 24-26 weeks prognosis poor and discuss with parents/neonatologists

Consider toclyosis to allow steroids/transfer
Steroids unless contraindicated
Transfer to unit with neonate intensive care
Aim for vaginal delivery

64
Q

What are the risks of a severe preterm labour?

A

Poor mortality rates

High chance of disability in newborn, increasing the earlier preterm they are

65
Q

What are the morbiditys resulting from being preterm??

A 
Respiratory distress syndrome
Intraventicular haemorrhage
Cerebral palsy
Nutrition
Temperature control
Jaundice
Infections
Visual impairment
Hearing loss
66
Q

In patients with chronic hypertension, what is the ideal pre-pregnancy care?

A

Change ACEI/ARBs to beta blockers (labetolol), CCB (nifedipine) or metyldopa
Lower dietary sodium
Aim to keep BP below 150/100
Monitor during pregnancy + foetal growth

67
Q

How do you diagnose pre-eclampsia?

A

Mild hypertension on 2 occasions (more than 4 hrs apart)
Or one instance of moderate - severe hypertension

PLUS significant proteinuria

68
Q

What is the pathophysiology preeclampsia?

A

Immunological
Genetic predisposition

Due to either secondary invasion of maternal spiral arterioles being impaired leading to poor perfusion

Or inbalance of vasodilators/constrictors in pregnancy

69
Q

What are the risk factors of pre-eclampsia?

A 
First pregnancy
Extremes of maternal age
Pre-eclampsia in previous pregnancy
BMI
Family history of PET
Multiple pregnancy
Underlying medical disorders (HT, renal, diabetes, autoimmune)
Long interval between last pregnancy
70
Q

What are the complications of PET?

A

Eclampsia (seizures)
Severe hypertension - leads to haemorrhage (cerebral)/stroke
HELLP (haemolysis, elevated liver enzymes, low platlets)
Disseminated intravascular coagulation
Renal failure
Pulmonary oedem/cardiac failure

Can also impair foetal placental perfusion leading to distress or prematurity

71
Q

What are the clinical features of severe PET?

A 
Headache/visual disturbances
Epigastric pain/ pain below ribs
Vomitting
Sudden swelling of hands/face
Severe hypertension
Clonus/brisk reflexes
Reduced urine output
Convulsions (eclampsia)
72
Q

What are the biochemical abnormalities in preeclampsia?

A

Raised liver enzymes
Raised billirubin if HELLP present
Raised urea + creatinine + urate

73
Q

What are the haemtological abnormalities of PET?

A

Low platlets
Low haemoglobin
Signs of haemolysis
Features of disseminated intravascular coagulation

74
Q

How do you manage PET?

A

Only “cure” is delivery
Manage conservatively - diet etc to bring blood pressure down
Then drugs

Monitor closely with BP + urine protein + symptoms
Check with blood tests + check for distress in baby

Consider induction if starting to get severe
Continue to monitor post delivery

75
Q

How do you treat PET seizures /impending seizures?

A

Magnesium suphate bolus + IV infusion
Control blood pressure
Avoid fluid overload (perihperal oedema often already present)

76
Q

What is the prophylaxis for PET?

A

Aspirin low dose from 12 weeks until delivery

77
Q

What is gestational diabetes?

A

Carboydrate intolerance with onset in pregnancy
Abnormal glucose tolerance returns to normal after delivery
More at risk of type 2 later in life

78
Q

What happens in pre-existing diabetes and pregnancy?

A

Insulin requirements of mother increases (hormones from diabetes have anti-insulin action)

Foetal hyper-insulinaemia occurs (maternal glucose crosses placenta and increases insulin production.
Causes macrosomina, polhydramnios

79
Q

What are the potential risks with children born to mothers with preexisting diabetes?

A 
Higher risk of neonatal hypoglycaemia
Increased risk of respiratory distress
Foetal congeital abnormalities (cardiac abnormalities, sacral agenesis)
Impaired lung matuiry
Jaundice
80
Q

What are the risks to the mother in preexisting diabetes?

A 
Increased risk of preeclamsia
Worsening of maternal neprhopathy, retinopathy + hypoglycaemia
Decreasesd awareness of hypoglycaemia
Infections
Can result in miscarriage/still birth
81
Q

How do you manage diabetes pre-conception?

A

Try to encourage better glycaemic control
Give folic acid
Dietary advice
Retinal + renal assessment

82
Q

How do you manage preexisting diabetes during pregnancy?

A

Optimise glucose control as insulin requirements increase
Continue most dugs, but stop sulfonureas
Give glucose solution/glucagon injections and school on risk of hypos

Watch for infection
Watch foetal growth
Retinal assessments
Observe for PET

83
Q

How do you manage labour in those with preexisting diabetes?

A

Usually induce it at 38-40, although maybe earlier depending on concerns
C section if significant macrosmnia
Give mother insulin/dextrose infusion during labour
Foetal monitoring in labour CTG continous
Feed baby early to reduce hypoglycaemia

84
Q

What are the risk factors of gestational diabetes?

A

BMI > 30
Previous macromic baby
Previous gestation diabetes
FH of dibates
Women at high risk of diabetes
Polyhydramnios or macrosmnia in current pregnancy
Recurrent glycosuria in current pregnancy

85
Q

How do you screen for gestational diabetes?

A

Offer HbA1C if risk factors present
>6% then do an oral glucose tolerance test
Repeat at 24-48 (OGTT)

86
Q

How do you manage gestational diabetes?

A

Control blood sugars - det often enough, metformin if remain high
Gect oral glucose test post term
Yearly check as higher risk of diabeties

87
Q

Why are pregnant women at greater risk of thromboembolism?

A 
Hypercoaguable state
>Increased fibrinogen + clotting factors + platlets
>Increase in fibrinolysis
>Decrease in natural anticoagulants
Increased stasis
88
Q

Who is at increased risk of thromboembolism in pregnancy?

A 
Older mothers/high parity
Increased BMI
Smoking/IV drugs/alcohol
PET
Dehydration
Decreased mobility
Infections
Operative delay or prolonged labour
Haemorrhage
Sickle cell disease
89
Q

What are the signs of VTE /symptoms?

A

Calf pain
Increased girth in one leg
Calf muscle tenderness

Breathlessness/pain on breathing
Cough
Tachycardia
Hypoxic
Pleural rub
90
Q

What is Duchenne muscular dystrophy?

A

X linked disease
Fatal in early adult life
Characterised by way boys get up onto their feet

91
Q

What are the symptoms of sickle cell disorders?

A 
Pain (lots)
Cold
Dehydration
Infections
Jaundice
Stroke
Leg ulcers
Anaethestia issues
92
Q

What is tay-sachs disease?

A

Progressive lyosomal storage disease
Deficency in an enzyme leads to build up of lipids in cells, especially nerve cells of brain
Neurological deteriation

Usually fatal by 3-5 years

93
Q

What is pehynlketonuria?

A

Recessive condition unable to break down phenylalanine
Untreated babies develp serious mental disability
Early treatment with dtrict diet prevents disability

94
Q

What is congenital hypothyroidism?

A

Not enough thyroixine produced
Untreated babies develop serious physical + mental disability
Treatment by 21 days with thyroxine tablets prevents disability

95
Q

What is mediam change Acytl-COA dehydogenase deficency

A

Recessive condition
Cannot break down fat to make energy fr baby
Life threatening
Mean age of presentation 14 months
Treatment - avoid fasting + monitor frequency of meals to prevent metabolic crisis
In imergency give IV dextrose

96
Q

What are the common sexually transmitted organisms in the UK?

A

Bacteria
Chlamydia trachomatis
Klebsiella granulomatis
Mycoplasma genitalium

Viruses
HSV
HIV
HPV
Molluscum contagiosum virus

parasites
Pthrius pubis
Sarcoptes scabei
Trichomonas vaginalis

97
Q

What conditions only need genital contact?

A

Pubic lice (pthirus pubis)
Scabies (sarcoptes scabeii)
Warts (HPV 6 + 11)
Herpes (HSV 1/2)

98
Q

What are the systemic symptoms from STIs?

A 
Fever
Rash
Lymphadenopathy
Malaise
Infertility
99
Q

What are the important questions in STI management?

A 
When did you last have sexual contact?
Was it casual or with a regular partner (how long with regular?)
Male/female?
Nature of sex?
Condoms?
Contraception?
Nationality
100
Q

What are the questions for risk assessment for a man?

A 
Ever had sex with a man?
Ever injected drugs?
Ever had sexual contact with someone from outside of UK/injected drugs
Medical treatment outside of UK?
Involvement with sex industry?
101
Q

What is the process of STI testing?

A

History/consultation
Test + offer further testing - always think HIV
Partner notification
Promote health - condoms

102
Q

What STIs are condoms good at preventing + bad?

A

Good - HIV, chlamydia, gonorrhoea

Bad - herpes/warts

103
Q

What are the presenting complaints of genital symptoms?

A 
Discharge from orifice
Pain
Rashes
Lumps/swellings
Cuts, sores, ulcers
Itching
Change in appearance
Vague sense of something not being right
104
Q

What microbial conditions are not regarded as STDs?

A 
Vulvovaginal candidosis
Bacterial vaginosis
Balanopothitis
Tinea cruris
Erythrasma
Infected sebacous gland
Impetigo
Cellulitis
105
Q

What is vulvovaginal candiosis?

A 
Very common and usually trivial
Usually acquired from bowel
Often asymptomatic
"Thrush" is symptomatic
Itchy with discharge
106
Q

What bacteria causes thrush/vulvovaginal candidosis?

A

90% candida albicans

107
Q

Who is at risk of vulvovaginal candidosis?

A

Diabetes/oral steroids
Immune suprresion
Pregnancy
Reproductive age group (oestrogen leading to glycogen)

108
Q

How do you diagnose vulvovaginal candidosis?

A 
Characteristic history
Examination:
>Fissuring
>Erythema with satellite lesions
>Characteristic discharge
Investigations - not very sensitive
>gram stain - low sensitivity
>Culture - low specificity
109
Q

How do you treat thrush?

A 
Azole antifungals
>clotrimazole 500mg
>Fluconazole 150mg
If recurrent - reinfection or reistance?
Other management - maintain skin + aoid irritants
110
Q

What is bacterial vaginosis?

A

Most common cause of abnormal vaginal discharge
Symptoms:
>Most asymptomatic
>Watery grey/yellow “fishy” discharge (worse after sex)
>Sometimes sore/itch from dampness

Due to imbalance of bacteria rather than infection with biofilm

111
Q

What are the problems associated with bacterial vaginosis?

A

Endometritis if uterine instrumentation/delivery
Premature labour
Increased HIV acquistion

112
Q

How do you diagnose bacterial vaginosis?

A 
Characteristic history
Examination findings (not normally done)
Would find thin, homogenous discharge

Gram stained smear of vaginal discharge

113
Q

How do you treat bacterial vaginosis?

A

Metronidazole (oral - avoid alcohol)
>Vaginal gel

Clindamycin

114
Q

What is zoons balanitis?

A

Chronic inflammation secondary to overgrowth of commensal organisms
+ foreskin malfunctiojn

Not pathogenic

Conditions + definitions (68 decks)

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