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SBO5 > Reproductive pathologies > Flashcards

Reproductive pathologies Flashcards

1
Q

What is menopause?

A

cessation of menses for 12 consecutive months

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2
Q

What is the physiology of menopause?

A
  • •As ovarian follicles diminish with age, so too does the amount of oestrogen produced by granulosa cells
  • •BecauseLH secretion isdependent on oestrogen levels, menopause is preceded by ~5 years of increasingly anovulatory cycles (referred to as the climacteric)
  • •Eventually, menstruation ceases due to reduced number of follicles & reduced responsiveness to FSH
  • •Average age for cessation of menses: 51 years
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3
Q

What are the clinical features of menopause?

A

Non-specific - hot flushes, hight sweat, fatigue, lethargy

reproductive: reduction fo breast size, vaginal dyspareunia, UTI

Neurological: changes mood and memory, headache, dizziness

Musculoskeletal: osteoporosis, arthralgia, myalgia

cardiovascular: HBP, AMI

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4
Q

what is the climacteric period?

A

period with irregular menses before complete cessation of menstruation

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5
Q

What are the advantages and disadvantages of hormone therapy?

A

ADVANTAGES

  • •Relieves symptoms of menopause
  • •Prevents early menopausal bone loss – reductionin #risk

DISADVANTAGES

  • •‘Premenstrual-like’ symptoms e.g. bloating & fluid retention, breast tenderness, irritability
  • •Increased risk for:
    • •Thromboembolic disease
    • •Cardiovascular disease: stroke
    • •Cancer: breast, endometrial (oestrogen-only HT)
    • •Gall bladder disease
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6
Q

What is Polycystic ovarian syndrome?

A

Inappropriate secretion of gonadotrophins

Diagnostic criteria

  • menstrual irregularity
  • clinical hyperandrogenism
  • polycystic ovaries
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7
Q

What is the correlation between PCOS and Chronic disease?

A

Hyperinsulanemia

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8
Q

What is the pathophys behind PCOS?

A
  1. •Follicular growth is continuously stimulated, but not to full maturation
  2. •Hyperinsulinaemia suppresses normal follicular apoptosis – this permits the survival of follicles that would normally disintegrate
  3. •The net result is anovulation and enlargement of the ovaries with cyst formation
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9
Q

What are the clinical features of PCOS?

A
  • •Menstrual disturbance: oligomenorrhoea, amenorrhoea
  • •Infertility
  • •Hyperandrogenism: acne, hirsutism, male pattern baldness
  • •Obesity (38% of cases)
  • •Asymptomatic (20% of cases)
  • •Increased risk for: Type 2 diabetes, cardiovascular disease, endometrial cancer
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10
Q

Management of PCOS?

A

combined oral contraceptive

anti-androgen agents

Insulin sensitisers

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11
Q

What is Pelvic inflammatory disease (PID)?

A

ANy infection in the genitourinary tract which was not treated.

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12
Q

WHat are the risk factors for PID?

A

Sexually active women

Inadequately treated chlamydia or gonorrhea

surgical procedure: IUD, Abortion, C-section

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13
Q

What are the clinical features for PID?

A

Low abdominal pain

irregular bleeding

mucopurulent discharge

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14
Q

What are the complications fro PID?

A
  • infertility
  • •Pelvic adhesions
  • •Abscess formation
  • •Ectopic pregnancy
  • •Chronic pain
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15
Q

What is the management for PID?

A

antibiotics

Surgery

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16
Q

what is endometriosis?

A

deposits of endometrial tissue found anywhere except the uterine mucosa.

related to vicarious bleeding

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17
Q

Where are the posible sites for vicarious bleeding related to endometriosis?

A

Common:

  • uterine tube
  • uterus
  • bowel
  • bladder
  • ureters

Post surgery: vagina, perineum

Rare: umbilicus, inguinal canal

very rare; pleura, diaphragm, nose

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18
Q

What are the 3 possible pathophys mechanisms for endometriosis?

A

Retrograde menstruation

embryonic cells

endometrial emboli

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19
Q

Clinical features related to endometriosis

A

•Pain: pelvic pain, dysmenorrhea, dyspareunia

•Bleeding: menorrhagia, irregular periods, spotting

•Bowel or bladder symptoms: dysuria, dyschezia, ‘cyclical’ IBS symptoms

•Reduced fertility

•Systemic: fatigue, lethargy, depression

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20
Q

what is the management of endometriosis?

A
  • Analgesia
  • Suppression of ovulation e.g. COCP
  • Laparoscopic ablation of ectopic tissue, adhesions

looks to restore fertility and reduce spread of tissue

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21
Q

What is a uterine fibroid (leiomyoma)?

A

A common, benign tumour arising from the smooth muscle cells of myometrium

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22
Q

What is the pathophys behind uterine fibroids?

A
  • Myomas are usually spherical
  • Some extend out on stalks (pedunculated)
  • There may be multiple (in some cases up to 200!)
  • The fibroid develops in the myometrium and can remain there
  • Alternatively, it can protrude into the uterine cavity (submucosal fibroid) or out of the perimetrium (subserosal fibroid)
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23
Q

What are the clinical features of fibroids?

A
  • •Bloating,
  • palpable mass,
  • protruding belly,
  • sensation of abdominal heaviness
  • •Dysmenorrhea or menorrhagia (can lead to iron deficiency anaemia)
  • Pressure on surrounding organs
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24
Q

What are the complications of fibroids?

A
  • Torsion: twisting on their stalks (pedicles)
  • Ulceration & bleeding
  • Small risk of malignant change (to uterine sarcoma)
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25
Q

What is the most common type of uterine cancer?

A

adenocarcinoma: •Develops from the secretory epithelium of the endometrium

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26
Q

What are the risk factors for uterine cancer?

A

Exposure to oestrogen

Obesity

family Hx

previous pelvic radiation for cancer

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27
Q

What are the clinical features for uterine cancer?

A

irregular vaginal bleeding

vaginal discharge: watery brown

lower abdominal pain

spread of tumour

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28
Q

What are the types of ovarian cancer?

A

epithelial type: arise from a germ cell type.

rarely primary tumour mostly arise from breast cancer.

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29
Q

What are the risk factors for ovarian cancer?

A

Age

family Hx

Oestrogen

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30
Q

What are the clinical features of ovarian cancer?

A

Pain or pressure on the back, abdomen and pelvis

abdominal bloating

indigestion/ nausea

urinary frequency and urgency

hormone-secreting tumour

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31
Q

What are the types of cervix cancer?

A

squamous cell carcinoma

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32
Q

What are the clinical features fro vaginal cancer?

A

Asymptomatic

vaginal discharge with a foul odour

abnormal bleeding

pelvic pain

symptoms of compression of bladder discomfort.

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33
Q

What are the possible spread sites if vaginal cancer is not detected?

A
  • Direct spread: Through the uterine/vaginal walls to adjoining organs
  • Lymphatic spread: To pelvic, inguinal, iliac and aortic nodes
  • Blood spread: to the liver, lungs and bone
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34
Q

What is the management of vaginal cancer?

A

Early vaccination

HPV test - if positive do Pap smear

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35
Q

What is the two-tiered classification system of the squamous intraepithelial lesion (vaginal cancer)r?

A
  • CIN 1 was renamed Low-grade Squamous Intraepithelial Lesion (LSIL)
  • CIN 2 & CIN 3 were renamed High-grade SILs (HSIL) – Surgery
36
Q

What is a venerial disease

A

STI

37
Q

What are the female defences against infections

A
  1. •Normal defences of the female GUT include:
  2. •Oestrogen & lactobacilli
  3. •Thick vaginal epithelium
  4. •Cervical mucus plug
  5. •Regular shedding of endometrium
38
Q

WHat are the defenses of the male reproductive tract?

A
  1. •Normal defences of the male GUT include:
  2. •Prostatic secretions
  3. •Confer a degree antimicrobial activity
  4. •Increasedlength of the male urethra
  5. •A drier peri-meatalenvironmentcompared to women
39
Q

What are the complications of STI?

A
  • •Malignancy,
  • Infertility,
  • Ectopic pregnancy,
  • PID,
  • Neonatal morbidity
  • mortality
40
Q

What are the contributing factors for increased incidence of STI?

A
  • Sexual freedom
  • change in perceived sexual risk
  • increased travel
  • use of recreational drugs
  • less barriers for contraception
41
Q

What is Chlamydia?

A

Bacterial STI caused by Chlamydia trachomatis bacteria.

lives and multiply within cell

incubation for 14 days

42
Q

What is the pathophys of clamydia?

A

WOMEN:

  • •Cervix affected more than vagina
  • •Chronic cervicitis, even salpingitis can develop
  • •Complications: ectopic pregnancy, infertility

MEN:

  • •Typically develop urethritis
  • •Women & MSM who engage in receptive anal intercourse may develop an infection in the rectum
  • •It is possible for the conjunctivae* and oropharynx to be infected through direct inoculation
  • •*Leading cause of infectious blindness in the world
43
Q

What are the clinical features of clamydia?

A

WOMEN:

  • •Vaginal discharge,
  • bleeding,
  • abdominal pain,
  • bloating,
  • dyspareunia

MEN:

  • •Dysuria is more common,
  • there may be a penile discharge

OTHER SITES OF INFECTION:

  • •Proctitis,
  • pharyngitis,
  • conjunctivitis

8% of patients develop a reactivearthritis

44
Q

What is gonorrhoea?

A

STI bacteria caused by Neisseria gonorrhoeae

3-7 incubation day

45
Q

What are the clinical features of gonorrhea?

A

•Rectal infection

  • •Proctitis:rectal pain
  • tenesmus,
  • anal discharge
  • •Asymptomatic

•Pharyngealgonorrhoea

  • •Most commonly asymptomatic
  • •+/- cervical lymphadenopathy

•Conjunctivitis:

  • •Copious amounts of exudate, bright red or “beefy” conjunctivae
  • •Serious complications: cornealulceration and visual deterioration
  • Mother-to-child transmission during vaginal delivery can occur
46
Q

What is reactive arthritis?

A

a complication of chlamydial & gonorrhoeal infection related too

oligoarthritis on •knees, SIJs, interphalangeal joints, LBP

may affect Aquiles tendon

47
Q

What are the clinical features for the 3 types acquired syphilis?

A

Primary syphilis:

  • Symtoms 2-4 weeks
  • chancre in: penis, cervix, vagina, anus, oropharynx
  • chancrea may heal without treatment

Secondary syphilis

  • 6-8 weeks
  • rash
  • wart like lessions
  • silvery gray lesions
  • systemic symptoms
  • lymphadenopathy

Tertiary syphilis

  • 10 to 25yr
  • Gummas: skin, mucous membranes, bone
  • neurosyphilis:
    • •Mild symptoms: Headaches, photophobia, dizziness, blurred vision, poor concentration •Severe symptoms: Meningitis, seizures, paraplegia, psychosis, cognitive decline
  • cardiovascular features: Gummas in the myocardium
48
Q

WHat is the causitive agent of genital herpes?

A

Herpes simplex type 2

transmitted through genital or oral contact

becomes active 2-3 times a year

49
Q

clinical features of herpes simplex?

A
  • Group tender vesicles at •penis, labia, perianal skin, buttocks
  • •Intense burning
  • stinging
  • •Fever, lethargy
  • HVS nerve root

progression

  • •First attack:lasts 2-4/52 before lesions crust and disappear
  • •There may be recurrences, which typically last for 7-10 days
50
Q

What is vaginal Thrush?

A

overgrowth of the fungus Candidaalbicans

Arises from disordered local ecology that allows the overgrowth of the yeast

•Factors that can change vaginal microbiome:

  • •Pregnancy,
  • diabetes,
  • antibiotic therapy,
  • some types of OCP
51
Q

What is toxic shock syndrome?

A

a form of septic shock (circulatory failure), secondary to bacterial infection and toxin release

Causative agent: •Staphylococcal aureus +, Streptococcus pyogenes

Cause: tampons + low menstrual flow while using tampons may cause vaginal lesions

52
Q

What are the clinical features and complications of septic shock?

A

Clinical features

  • •Abrupt onset: high fever, vomiting, diarrhoea
  • •Also common: sore throat, myalgia, headaches, skin rash

Complications

  • septic shock
53
Q

What is acute prostatitis and its classifications?

A

acute inflammation of the prostate

Non-bacterial prostaitis: trauma, infection

Bacteria prostaitis: E coli, clamydia, gonorrhea

54
Q

what is the clinical presentation of prostatitis?

A

Pain

dysuria

obstructive voiding

irritative voiding

***Infective prostatitis: fever, chills

55
Q

What is benign prostate hyperplasia BPH?

A

hyperplasia of stroma

affects transition zone

affects old men

56
Q

what is the enzyme related to BPH?

A

5a reductase (an enzyme that converts testosterone to DHT)

responsible Dihydrotestosterone DHT

57
Q

What area of the prostate does BPH affect?

A

transitional zone

58
Q

what are the clinical features of BPH?

A

Obstructive symptom (affect urine flow and stream)

Irritative symptoms (affect urine urgency, frequency, night pee)

59
Q

3 B’s

what are the complications fo BPH?

A

Bacterial infection

bladder stones

bladder diverticuli

60
Q

What are the managements for BPH?

A

Meds: 5-alpha-reductase inhibitor

surgery

61
Q

What is the pathogen responsible for Prostate cancer?

A

adenocarcinoma

62
Q

what is the aetiology of prostate cancer?

A

Old, obese, male smoker with diabetes

loves BBQ

works with chemicals

genetics

Hormonal factors

63
Q

Where is the first spread zone for prostate cancer and how?

A

spine via blood and lymphs

64
Q

how do prostate cancer tumours affect bones different to other cancers

A

(tumours in bones)

cause secondary osteoblastic that are dense and easy to detect in x-ray

This is the only detectable site of metastasis

65
Q

What are the clinical features for prostate cancer?

A

asymptomatic

Obstructive and irritative symptoms

Others

  • hematuria
  • pain
  • systemic
  • DRE
  • Bone #
66
Q

What is TURP?

A

removal of the prostate via rectum

transurethral resection of prostate

67
Q

Management for prostate cancer?

A

Surgery (TURP or Open)

Radiation (needle vs seed brachytherapy)

68
Q

what is an inguinal hernia and how is it classified?

A

protrusion fo abdominal content into inguinal canal

indirect - inside canal via deep inguinal ring

direct - posterior wall of canal (weakness in transversalis fascia

69
Q

what is the risk of getting an inguinal hernia?

A

male 27%

female 3%

Profile

  • old man, tradie/ athlete, smoker with high BMI
70
Q

what are the clinical features

A

lump in groin and discomfort in abdomen

71
Q
A
72
Q

Define Hydrocele?

A

accumulation of fluid in Tunica vaginal

73
Q

how are hydrocele classified?

A

Primary hydrocele: fluid not reabsorved

Secondary: excess fluid from infection

congenital: conection between vaginalis and abdomen not closed

74
Q

What is Cryptorchidism?

A

failure of testicles to descend from abdo to scrotum.

75
Q

Where is the most common arrest site of testes in cryptorchidism?

A

inguinal canal

76
Q

what are the complications in cryptorchidism?

A

inguinal hernia

infertility

testicular cancer

77
Q

What is the management for cryptorchidsm?

A

surgery - orchiopexy

78
Q

What is the venous drainage for the testes and epididimis?

A

pampinfon plexus

drains into testicular vein in abdo

79
Q

What is varicocele and how are they classified?

A

varicosity of the testicular and pampiniform plexus

primary: incompetent valves

Secondary: pathological condition

80
Q

What is testicular torsion?

A

twisting of sperm cord

***its a medical emergency*** may lead to infarction, must be fixed 6 hours after onset to avoid ischaemic necrosis

81
Q

what is the most common cause of testicular torsion?

A

congenital malformation of tunica vaginalis

“bell-clapper abnormality”

82
Q

Who is the most affected population with testicular torsion?

A

Adolescents

83
Q

What are the 2 main varieties of testicular cancer ?

A

seminomas: cancer in seminiferous tube - common

non semionmas: mixed germ cell - aggressive

84
Q

What is the incidence and risk factors of testicular cancer ?

A

seminomas: adult 25+

non-seminoma: young adult 20’s

Risks

  • family Hx
  • cryptorhidism
85
Q

what are the clinical features for testicular cancer?

A

large testicles

sensation of “heavy” scrotum”

asymptomatic

metastatic disease

secondary hydrocele

gynaecomastia (large man bobs’)

86
Q

what is the management for testicular cancer

A

surgery - radial orchiectomy

87
Q
A

SBO5 (16 decks)

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