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Clinical scenarios by CBL > Reproductive > Flashcards

Reproductive Flashcards

1
Q

What 6 common drugs are contraindicated throughout pregnancy?
(remember mneumonic)

A

I May Want An Annoying Toddler
1.Isotretinoin (Accutane-used for severe acne/cysts)
2.Methotrexate
3.Warfarin (Coumadin)
4.ACE inhibitors (e.g., Enalapril)
5.Angiotensin II receptor blockers (e.g., Losartan)
6.Tetracycline antibiotics(e.g Doxycycline i.e - cycline)

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2
Q

What are the differential diagnoses for a female patient presenting with pelvic pain?

A

-Endometriosis
-Fibroids (Uterine Leiomyomas)
-Ovarian Cysts
-Ectopic Pregnancy
-Cervical Infections (e.g Cervicitis)
-Adenomyosis

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3
Q

What are the differential diagnosis for lower abdominal pain?

A

-Pelvic Inflammatory Disease
-UTI
-Ovarian Torsion
-Ovarian Cysts
-Ectopic Pregnancy

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4
Q

What is the typical presentation of Pelvic Inflammatory disease?

A
  • Lower abdominal pain
  • -Typically associated with a recent history of unprotected sexual activity or gynecological infection.
    -Pyrexia
    -Vaginal discharge
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5
Q

What is the typical presentation of Endometriosis?

A

-Pelvic pain (Cyclic pattern)
-Dyspareunia (pain during sex)
-Infertility
-Symptoms often worsen during menstruation
-May be associated with heavy menstrual bleeding
-May have a history of endometriosis or family history.

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6
Q

What is the presentation of Fibroids (Uterine Leiomyomas)?

A

-Pelvic pain
-heavy menstrual bleeding,
-URINARY FREQUENCY
-May have abdominal enlargement or uterine enlargement
-Typically associated with a history of fibroids.

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7
Q

What is the presentation of Ovarian Cysts?

A

-Pelvic pain
–>INCREASED PRESSURE:
=Bloating
-Irregular menstrual bleeding
-Usually associated with recent onset or change in symptoms
- May have a history of previous cysts.

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8
Q

What is the presentation of a Ectopic pregnancy?

A
  • Pain: Pelvis, Lower Abdomen, Can radiate to Shoulder and Neck (if build up of bleeding as it can cause nerves to get irritated)
  • Vaginal bleeding
  • -nausea
  • missed period
    • Positive pregnancy test
      – May have risk factors such as a history of ectopic pregnancy or tubal surgery.
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9
Q

What is presentation of Cervical Infections?

A
  • Pelvic pain, abnormal vaginal discharge, and painful urination or intercourse - Often associated with a recent history of sexual activity or new sexual partner.
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10
Q

What is the presentation of Vulvar disorders?

A
  • Vulvar pain (burning, stinging, soreness), often unprovoked - No visible abnormalities on examination - Typically associated with chronic, unexplained vulvar pain.
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11
Q

What is the presentation of Adenomyosis?

A
  • Pelvic pain, typically worse during menstruation
    – Heavy menstrual bleeding
  • May have an enlarged uterus
  • Commonly seen in women with prior uterine surgery or childbirth.
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12
Q

What is the presentation of Ovarian Torsion?

A

-SUDDEN AND SEVERE PAIN-
=lower abdominal pain, often one-sided
- Pelvic tenderness
- Nausea, vomiting,
- May have a history of ovarian cysts.

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13
Q

Who is most likely to get Pelvic Inflammatory Disease?

A
  • Recent or multiple sexual partners
  • History of previous PelvicInflammatory Disease
  • Young age (adolescents and young adults)
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14
Q

Who is most likely to get Endometriosis?

A

-Family history of endometriosis
-Early menarche (starting menstruation at a young age)
-Infertility
-Uterine abnormalities
-High caffeine or alcohol consumption

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15
Q

Who is most likely to get Fibroids (Uterine Leiomyomas)?

A

-African Carribean ethnicity
-Family history of fibroids
-Hormonal factors (Oestrogen- e.g due to Oral Contraceptive Pill, Increased Body fat, and stress)
-Obesity
-Early menarche

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16
Q

Who is most likely to have have Ovarian Cysts?

A
  • Polycystic ovary syndrome (PCOS) - Hormonal therapies (e.g., fertility treatments) - Previous history of ovarian cysts
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17
Q

Who is at a higher risk of Ectopic Pregnancy?

A

-Previous Pelvic Inflammatory Disease
-Use of reproductive technologies (e.g IVF)

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18
Q

Who is most at risk of developing Vulvar Disorders?

A
  • History of sexual abuse or trauma - Chronic stress - Previous vulvar infections or inflammation - Early menopause
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19
Q

What is the pathophysiology of Pelvic Inflammatory Disease?

A

Infection of the upper female reproductive organs, often due to sexually transmitted infections.

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20
Q

What is the pathophysiology of Endometriosis ?

A

Ectopic Growth of endometrial tissue outside the uterus, leading to inflammation and scarring.

Note: Growth will be around the structure not IN (that would be Adenomyosis)

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21
Q

What is the pathophysiology of Fibroids (Uterine Leiomyomas)?

A

Benign tumors made of smooth muscle and connective tissue growing in the uterine wall.

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22
Q

What is the pathophysiology of Ovarian Cysts?

A

Fluid-filled sacs forming on or inside the ovaries. They can be functional or pathological.

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23
Q

What is the pathophysiology of Vulvar disorders?

A

Chronic, unexplained vulvar pain or discomfort, potentially involving nerve hypersensitivity.

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24
Q

What investigations are required for a suspect Pelvic Inflammatory Disease and would the results be?

A
  • Clinical examination - Blood tests (elevated white blood cell count, CRP) - Pelvic ultrasound
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25
Q

What is the treatment for Pelvic Inflammatory Disease?

A

Antibiotics:
Clindamycin or Metronidazole

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26
Q

What investigations are to be done for a suspect Endometriosis?

A

Imaging (ultrasound, MRI) - Laparoscopy for definitive diagnosis

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27
Q

What is the management for Endometriosis?

A

Pain management (e.g., NSAIDs), hormonal therapy (e.g., birth control), and surgical options (e.g., laparoscopic excision).

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28
Q

What investigations should be done for a suspect Fibroids (Uterine Leiomyomas)?

A
  • Pelvic ultrasound - MRI for better visualization - Hysteroscopy or laparoscopy (if needed)
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29
Q

What is the management for Fibroids (Uterine Leiomyomas)?

A

1.Observation for asymptomatic cases

2.Medications for symptom management:
-NSAIDs (Pain)
-Hormonal Contraception (Heavy menstruation)
-Tranexamic acid (Excessive bleeding : antifibrinolytic agent)
-Cyclical Progesterones (Regulation of menstrual cycle)

  1. Severe cases:
    myomectomy, or hysterectomy
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30
Q

What investigations are done for a suspect Polycystic Ovary Syndrome?

A

-MRI/CT
-Blood tests
(rule out ovarian cancer)

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31
Q

When accessing for Ovarian cancer, what gene are they looking for?

A

CA-125

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32
Q

What is the management for Polycystic Ovary Syndrome.

A

Observation for small, asymptomatic cysts. Surgical removal for large, painful, or complex cysts.

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33
Q

What medication is given to an early stable case of Ectopic Pregnancy?

A

Methotrexate

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34
Q

What investigations are done for a suspect Ectopic Pregnancy?

A
  • Transvaginal ultrasound - Serial beta-hCG blood tests - Laparoscopy for definitive diagnosis
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35
Q

What investigations are done for suspect Cervical Infections?

A
  • Pelvic examination - Swab cultures for infectious agents - Polymerase chain reaction (PCR) testing for STIs
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36
Q

What are the signs and symptoms of Placenta Previa?

A
  • Painless vaginal bleeding, often in the third trimester - Abdominal pain may occur in severe cases
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37
Q

What are risk factors for Placenta Previa?

A
  • Previous placenta previa - Multiple pregnancies (multiparity) - Maternal age (older women) - Smoking - Prior uterine surgery
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38
Q

When is the typical onset of Placenta Previa?

A

Third trimester

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39
Q

What is the pathophysiology of Placenta Previa

A

Abnormal implantation of the placenta over or near the cervical os, leading to bleeding as the cervix dilates.

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40
Q

What investigations are done for a suspect Placenta Previa?

A

(pelvic ultrasound) - Monitoring for signs of shock - Blood type and Rh status

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41
Q

What is the treatment for Placenta Previa?

A

Bed rest, observation, and often caesarean section if bleeding is severe or persistent.

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42
Q

What are the signs and symptoms of Placental Abruption?

A
  • Sudden, severe abdominal pain - Vaginal bleeding - Uterine tenderness - Uterine contractions - Foetal distress
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43
Q

What are the risk factors for Placental Abruption?

A

-Previous abruption - High blood pressure (hypertension) - Substance abuse (e.g., cocaine) - Trauma - Multiple pregnancies (multiparity)

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44
Q

When is the typical onset of Placental Abruption

A

Any stage of pregnancy

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45
Q

What is the pathophysiology of Placental Abruption?

A

Premature separation of the placenta from the uterine wall, leading to bleeding and potential foetal distress.

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46
Q

What investigations are required for a suspect Placental Abruption?

A

Ultrasound - Foetal monitoring - Blood tests (coagulation profile)

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47
Q

What is the management of Placental Abruption?

A

Immediate delivery in severe cases, blood transfusion, monitoring, and supportive care.

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48
Q

What are the signs and symptoms of Uterine Rupture?

A

-Sudden, severe abdominal pain - Vaginal bleeding - Loss of uterine tone - Fetal distress

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49
Q

What are the risk factors for Uterine Rupture?

A
  • Previous uterine surgery (e.g., C-section) - Trauma - Induction of labour with prostaglandins - High parity (many pregnancies)
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50
Q

When is the typical onset of Uterine Rupture?

A

During labour or delivery

51
Q

What is the pathophysiology Uterine Rupture?

A

The uterine wall tears, potentially causing bleeding and compromising the foetus’s oxygen supply.

52
Q

What investigations are required for suspect Uterine Rupture?

A

Ultrasound - Monitoring of foetal heart rate - Blood tests (haemoglobin, coagulation profile)

53
Q

What is the management for Uterine Rupture?

A

Emergency caesarean section, blood transfusion, and repair of the uterine rupture.

54
Q

What are the signs and symptoms of Placental Infarction or Insufficiency?

A
  • Decreased foetal movement - Uterine growth restriction - Abnormal Doppler flow studies
55
Q

What are the risk factors of Placental Infarction or Insufficiency?

A
  • Chronic conditions (e.g., hypertension, diabetes) - Smoking - Multiple pregnancies (multiparity) - History of placental problems
56
Q

What are the typical risk factors of Placental Infarction or Insufficiency?

A

Typically in the second or third trimester

57
Q

What are the investigations to be done for a suspect Placental Infarction or Insufficiency?

A

Ultrasound (Doppler studies) - Foetal monitoring (non-stress test) - Blood tests (if indicated)

58
Q

What is the pathophysiology Placental Infarction or Insufficiency?

A

Reduced blood flow to the placenta, leading to insufficient oxygen and nutrient supply to the foetus.

59
Q

What is the management for Placental Infarction or Insufficiency?

A

Management depends on the severity: close monitoring, induction of labour, or caesarean section.

60
Q

What are the signs and symptoms of Dysfunctional Uterine Bleeding (DUB)?

A
  • Irregular, heavy, or prolonged bleeding - Common in perimenopausal women - No other identifiable pathology
61
Q

What are the risk factors for Dysfunctional Uterine Bleeding (DUB)?

A
  • Perimenopausal or menopausal age - Obesity - Polycystic ovary syndrome (PCOS)
62
Q

What is the pathophysiology of Dysfunctional Uterine Bleeding (DUB)

A

Hormonal imbalances, leading to irregular or heavy uterine bleeding.

63
Q

What investigations are required for suspected Dysfunctional Uterine Bleeding (DUB)?

A

Pelvic examination - Hormone levels (e.g., FSH, LH, thyroid function)

64
Q

What is the management Dysfunctional Uterine Bleeding (DUB)?

A

Hormonal therapy (e.g., birth control), non-hormonal options, or endometrial ablation.

65
Q

What are the signs and symptoms of Endometrial Polyps?

A
  • Abnormal uterine bleeding - Postmenopausal bleeding - May have pelvic pain or pressure
66
Q

What are the risk factors of Endometrial Polyps?

A
  • Age (more common in perimenopausal and postmenopausal women) - Obesity - Hormone replacement therapy
67
Q

What is the pathophysiology of Endometrial Polyps?

A

Benign growths of endometrial tissue in the uterine cavity.

68
Q

What investivations are required for suspect Endometrial Polyps?

A
  • Transvaginal ultrasound - Hysteroscopy (definitive diagnosis)
69
Q

What is the management for Endometrial Polyps?

A

Hysteroscopic removal of polyps, especially if symptomatic or causing bleeding.

70
Q

What are the signs and symptoms of Cervical Polyps?

A
  • Vaginal bleeding, often post-coital - May have pelvic pain or discomfort
71
Q

What are the risk factors of Cervical Polyps?

A
  • Age (more common in perimenopausal and postmenopausal women) - High parity - Chronic inflammation - Hormone replacement therapy
72
Q

What is the pathophysiology of Cervical Polyps?

A

Benign growths on the cervix’s surface, often originating from cervical glands.

73
Q

What is the main diagnostic for Cervical Polyps?

A

Colonoscopy

74
Q

What is the management for Cervical Polyps?

A

Polypectomy to remove the polyps if symptomatic or causing bleeding.

75
Q

What are the signs and symptoms of Endometrial Hyperplasia?

A
  • Abnormal uterine bleeding, especially postmenopausal bleeding - May have pelvic pain or pressure
76
Q

What are the risk factors of Endometrial Hyperplasia?

A
  • Hormone therapy (oestrogen without progesterone) - Obesity - Polycystic ovary syndrome (PCOS)
77
Q

What is the pathophysiology Endometrial Hyperplasia?

A

Abnormal thickening of the endometrial lining, often due to unopposed estrogen exposure.

78
Q

What investigations are required for a suspected Endometrial Hyperplasia?

A
  • Endometrial biopsy (definitive diagnosis) - Ultrasound to assess endometrial thickness
79
Q

What is the treatment for Endometrial Hyperplasia?

A

Treatment depends on the degree of hyperplasia: hormonal therapy, hysteroscopy with D&C, or hysterectomy.

80
Q

What are the signs and symptoms of Endometrial Cancer?

A

Postmenopausal bleeding - Abnormal uterine bleeding - May have pelvic pain - Typically occurs in older women

81
Q

What are the risk factors Endometrial Cancer?

A
  • Age (most common after menopause) - Obesity - Hormone therapy without progesterone
82
Q

What is the pathophysiology of Endometrial Cancer?

A

Malignant growth of cells in the endometrial lining.

83
Q

What investigations are required for a suspected Endometrial Cancer?

A
  • Endometrial biopsy (definitive diagnosis) - Imaging (MRI or CT for staging)
84
Q

What is the management of Endometrial Cancer?

A

Surgery (hysterectomy), radiation, chemotherapy, or hormonal therapy, depending on the stage and patient’s health.

85
Q

What are the signs and symptoms of Cervical Cancer?

A
  • Abnormal vaginal bleeding, especially post-coital - Watery or bloody vaginal discharge - Pelvic pain (in advanced stages)
86
Q

What are the risk factors of Cervical Cancer?

A
  • HPV infection (high-risk strains) - Smoking - Immunocompromised status - Early sexual activity
87
Q

What is the pathophysiology of Cervical Cancer?

A

Malignant growth of cells in the cervix, often associated with high-risk HPV infection.

88
Q

What investigations are to be done for a suspected Cervical Cancer?

A
  • Pap smear and HPV testing - Colposcopy with biopsy (definitive diagnosis) - Imaging (MRI or CT for staging)
89
Q

What is the treatment for Cervical Cancer?

A

Treatment depends on the stage: surgery, radiation, chemotherapy, or a combination of these modalities.

90
Q

What are the signs and symptoms of Vaginal Cancer?

A
  • Vaginal bleeding (often postmenopausal) - Pelvic pain or discomfort - Vaginal discharge (in advanced stages)
91
Q

What are the risk factors for Vaginal Cancer?

A
  • Age (more common in older women) - History of cervical cancer - Smoking - HPV infection
92
Q

What is the pathophysiology of Vaginal Cancer?

A

Malignant growth of cells in the vaginal lining, often associated with risk factors.

93
Q

What investigations are to be done for suspected Vaginal Cancer?

A
  • Colposcopy with biopsy (definitive diagnosis) - Imaging (MRI or CT for staging)
94
Q

What is the management for Vaginal Cancer?

A

Treatment depends on the stage: surgery, radiation, chemotherapy

95
Q

List the causes in the female genital tract that cause abdominal distension.

A

-Ovarian Cysts
-Ovarian Tumours
-Uterine Fibroids
-Adenomyosis
-Pelvic mass

96
Q

What are the risk factors of Adenomyosis?

A
  • Most common in 40s-50s
    -Previous uterine surgery (such as C-section or Fibroid Removal)
    -Complicated childbirth
97
Q

What is the pathophysiology of Adenomyosis?

A

Endometrial tissue (the tissue that lines the uterus) grows into the muscular wall of the uterus. Adenomyosis of the fallopian tube is not a typical presentation, as adenomyosis primarily affects the uterus, leading to uterine enlargement and abdominal distension.

Note: Different from Endometriosis as the endometrial tissue as it has not invaded.

98
Q

When is the typical onset for Adenomyosis?

A

Women in their 40s-50s

99
Q

What is one disadvantage of breast milk?

A

Provides insufficient vitamin K

100
Q

A women’s autopsy (after she died after child birth) shows Foetal Squamous Cells in the pulmonary blood vessels. What was the most likely case?

A

Amniotic Fluid Embolism

101
Q

What is Amniotic Fluid Embolism?

A

This is when foetal cells/ amniotic fluid enters the mothers bloodstream and stimulates a reaction

102
Q

What is a typical presentation of Amniotic Fluid Embolism?

A

The majority of cases occur in labour , though they can also occur during caesarean section and after delivery in the immediate postpartum.
Symptoms include: chills, shivering, sweating, anxiety and coughing.

103
Q

What clinical signs would be seen from a patient with Amniotic Fluid Embolism?

A

Cyanosis, hypotension, bronchospasms, tachycardia. arrhythmia and myocardial infarction.

104
Q

A pregnant patient presents with persistent pelvic pain and discomfort with radiation to her lower back, hips and groin. There are no bladder or bowel abnormalities. What is the most common cause?

A

Pubic symphysis dysfunction
=due to ligaments become lax due to hormonal changes experienced during pregnancy

105
Q

What does Primigravida mean?

A

Pregnant for the first time

106
Q

A woman has an abnormal ovarian cyst. What type of ovarian cancer would cause raised Alpha-Fetoprotein (AFP)?

A

Yolk-sac tumour

107
Q

What is a precipitant labour?

A

Short and quick labour (<3hrs)

108
Q

List the causes for Perineal tears during Labour.

A

-Primigravida (first pregnancy)
-Precipitant labour (fast labour)
-Larger babies
-Forceps delivery
-Shoulder Dystocia (shoulder gets stuck behind mother’s pubic symphysis)

109
Q

What is the general management for a perineal tear?

A

If no muscle involvement:
NO TREATMENT REQUIRED

Muscle involvement:
Suturing on the ward

Muscle +Anal sphincter involvement:
Surgery

110
Q

What is Choriocarcinoma?

A

Type of persistent trophoblastic disease where a cancerous mole (developed from a ‘Molar Pregnancy’) produces HCG:
Cancer affecting women after pregnancy. Tumour secretes Human Chorionic Gonadotrophin

Note: It is highly metastatic (especially to the lungs) and therefore can cause respiratory symptoms

111
Q

What type of symptoms can extremely excessive HCG cause and why?

A

HYPERTHYROIDISM SYMPTOMS
=HCG is structurally similar to TSH and therefore increase thyroid activity would be seen

112
Q

What is the management for Choricarcinoma?

A

-Urgent referral
-Oral Contraception for the next 12 months

113
Q

What is the biggest complication of a molar pregnancy?

A

Cancer of the mole secreting HCG

114
Q

What are the signs of a molar pregnancy?

A
115
Q

What are the signs and symptoms of Polycystic Ovarian Syndrome?

A
116
Q

What hormones levels are altered in Polycystic Kidney Disease and what does this cause?

A

High levels of testosterone and insulin as well as Infertility

117
Q

What is the most likely cause of inflammation of the fallopian tube and what is it called?

A

Pelvic Inflammatory Disease
Bacterial infections: from STIs
-Chlamydia
-Gonnohorea

118
Q

What is another name for Uterine Fibroids?

A

Leiomyoma

119
Q

What are the key complications of Pelvic Inflammatory Disease?

A

-Infertility
-Scarring can cause ECTOPIC PREGNANCY

120
Q

What is the difference in pathophysiology of Choriocarcinoma VS a Hydatidiform mole / Molar Pregnancy

A

Both are a form of Gestational Trophoblastic Disease: Hydatidiform mole is a non-cancerous genetic abnormality while Choriocarcinoma is cancerous and can be due to a Hydatidiform mole

Hydatidiform mole:
=Abnormal embryonic development
1.Abnormal Fertilisation
2.Abnormal formation of placental tissue
3.The foetus is usually not viable and is made up of either fully the mole or part mole / foetus.

Choriocarcinoma:
=Malignant highly metastatic tumour (from transformation from the trophoblastic cells) which can arise from a Hydatidiform mole that loses all regulatory mechanisms and secretes A LOT of HCG (a lot more than in a Hydatidiform (Mole) to the point that it is a diagnostic marker.

121
Q

What is the presentation of Adenomyosis?

A

Menstruation:
-Severe debilitating pelvic pain before and during menstruation
-Menorrhagia (heavy menstrual bleeding)
-Irregular menstrual cycles

-Pelvic and abdominal discomfort (“heaviness” feeling)

-Dyspareunia (pain during intercourse)

-Enlarged and tender Uterus

-Fatigue and stress (due to pain)

122
Q

What are the causes of Choriocarcinoma?

A

-Hydatidiform mole / Molar pregnancy
-Ectopic pregnancy
-Spontaneous abortion

123
Q

What is meant by Spontaneous Abortion?

A

Loss of pregnancy naturally before 20 weeks of gestation

Clinical scenarios by CBL (8 decks)

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