SDL - gynae Flashcards
INFERTILITY 1
i) what is primary and secondary? what is the most common cause? name three other causes?
ii) what four tests should be done in femal assessment? name three things tested for ovarian reserve? which cells produce AMH?
iii) name four things are tested in semen analysis? name three causes of abnormal semen analysis? name three caues of azoospermia
iv) what is the most common cause of tubal damage? name three ways that tubal patency can be tested? what is done if low risk of tubal disease? what screening should be done before testing?
i) primary - never had a pregnancy
secondary - pregnant before
most common cause is anovulation then male factors, tubal factors, endometriosis, unexplained
ii) female assess - screen for chlamidya and rubella, ovarian reserve, ovulation test, tubal test
ovarian reserve - early follicular phase hromones FSH, LH, E2, AMH, antral follicle count
AMH produced by granulosa cells
iii) semen analysis - count > 15, motility > 40%, morphology > 4%, volume 1.5-6
abnormal anal - no reason in 50%, primary testicular failure, obstructive, Y chromo microdeletion CF if count is low
azoospermia - congenital absence of vas def, previous surgery of testes and vas def, inflam due to gon or chlam
iv) PID second to chlamidya is most common cause of tubal damage
patency tested by HSG, HyCOSy, laparoscopy and dye
if low risk do HSG or HyCOsy
chalmid screen before testing
INFERILITY 2
i) when is HSG done in relation to menstruation? what should be given before its done? what is the risk of infection?
ii) what ix is sensitive and specfic? what are the risks to the patient? which is ideal screening test for most patients
iii) name two adv of HSG and one disadv? which investigation is good to look at abnorms eg adhesions, polyps, submuc fibroids
i) 2-5 days before menstruation
give abx to prevent flare up if hx of PID - overall risk is 1%
ii) lap and dye is sens and spec but risk of injury to visceral organs
ideal screening for most patients is HSG
iii) adv HSG - safe, no anaes, look at ut cavity and fallopian tube
disadv - inability to asses pelvic periteoneum
hysteroscopy is good for fibroids etc
INFERTILITY 3
i) who is ovulation induction good for? what can be given? what are the risks of this?
ii) are testos tx good in male factor tx? name a surgical option that may be done? what else can be done?
iii) who should IUI not be offered to? who is it for? (2) what is sucess rate per cycle?
iv) name four indications for IVF? what is the national average success <35yrs old
i) good for women with PCO - give clomifene or FS injections for resistant PCO
risks are multiple preg
monitor with US
ii) testos not good
if obstructive azoo - surgical correction of epidid blockage
IVF
iii) dont offer IUI to couples who have unexplained infert
for single women, same sex couple, unable to have intercourse
10% success
iv) IVF - tubal damage, low sperm quality, unexplained fertility and low ovarian reserve
success 30-35%
PROLAPSE 1
i) what is cystocele? what is rectocele? what is uterine prolapse? what is third degree prolapse?
ii) what is urethrocele? what is enterocele? what type of prolapse can occur after hysterectomy?
iii) name five things that can weaken pelvic floor and cause prolapse? which of the pelvic floor muscles is most implicated?
iv) name four symptoms? name four lifestyle changes that should be adopted?
v) name two pessaries that can be used? how often do they need to be changed?
i) cystocele - anterior wall prolapse where bladder bulges into the front wall of the vagina
rectocele - post wall prolapse where rectum bulges into post vaginal wall
third degree - uterus protrudes outside the body
uterine - uterus > vagina
ii) urethrocele = prolapse of urethra
enterocele - weak upper 1/3 of vaginal wall and may contain small bowel/omentum
hysterectomy > vaginal vault prolapse
iii) weaken pelvic floor - preg/birth, lack of oes after meno, constipation, obesity, coughing, hysterectomy
implicates levator ani
iv) may be asymp, lump coming down, bowel (incomplete empty, constipation, push prolapse back up), bladder (freq, difficulty passing urine, stress incont), sexual activity discomfort
stop smoking, avoid constipation, weight loss, pelvic floor exercise, avoid heavy lifting
v) ring pessary and shelf pessary
change every 4-6 months
PROLAPSE 2
i) what needs to be checked for when a pessary is used? name two things that may be seen one exam
ii) what can correction of a large cystocele cause? what can predict this?
i) change every 4-6 months and check vaginal mucosa for erosion
may see offensive dc and bleeding
ii) anterior repair can unmask stress incontinence
use reduction testing to predict post op stress incont
INCONTINENCE 1
i) what triggers stress incont? what is urge incont? what is mixed? what is overactive bladder?
ii) what causes stress? what causes urge? name three factors pre dis to stress? name four things that can cause urge?
iii) what first line approach can be taken in incont? what is medical mx for? what is surgical mx for? how should mixed be tx?
iv) name two lifestyle changes that can be employed? when may pelvic floor training be done? for how long?
v) what is first line for urge and mixed?when may urodynamic testing be done? (3)
i) stress triggered by sneeze or cough
urge is invol leakage with urgency
mixed is invol leakage with urgency and sneeze/cough etc
OAB is urgency that occ with or without urine incont and not usually assoc with frequency
ii) stress due to weak.danage of muscles that prevent urination - pelvic floor and urethral sphinct
urge is result of overactive detrusor muscles
stress - preg/vag birth, obesity, FH, inc age,
urge - too much ETOH/caffiene, poor fluid intake (conc urine > irritating), UTI, constipation, bladder tumour
iii) bladder diary if urge or OAB for min 3 days
medical for urge
sx for stress
mixed - tx dominant symptom
iv) less caffiene if OAB, change fluid intake, lose weight if BMI >30
pelvic floor training is 1st linef or SI or mixed for at least 3m do at least 8 contractions 3x per day
v) urge and mixed = bladder training is first line, min 6 weeks (drugs for OAB)
UDT before surgery if symp of OAB, voiding dysfunc and cystocele, prev sx for stress incont
INCONTINENCE 2
i) what type of drugs are given for OAB or mixed? what should be avoided in old frail women? name two meds that can be used
ii) after how long should med mx be reviewed? when may invasive therapy be needed?
iii) what invasive therapy can be given first line for OAB? what may the patient need to do for themself?
iv) what tx is given second line for OAB? name two others?
v) what surgery can be done for stress?
i) anti muscarinics
give oxybutinin, tolterodine but avoid oxy in frail women
ii) review after 4 weeks and may need invasive if detrusor overactive
iii) botox for OAB - may need self catheter
iv) fail botox perc sacral nerve stim, augmentation cystoplasty or urine diversion
v) stress - synthetic mid urtheral tape, colposuspecuinm rectus facial sling, artificial sphincter
