Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

PHA223 > sex hormones 5-6 > Flashcards

sex hormones 5-6 Flashcards

1
Q

What is gynaecology?

A

the study of diseases unique to women especially those of the genital tract and breasts

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is obstetrics?

A

branch of health science dealing with pregnancy, labour and puerperium (3rd stage of labour until anovulation of uterus 3-6 weeks)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

importance of the fornix and contraception

A

where the contraceptive diaphragm rests inside the vagina, covers the cervix

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What can excessive body hair be due to?

A

polycysitc ovary syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

reasons for absent periods

A

pregnancy
menopause
PCOS
congenital abnormality

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

reasons for heavy periods

A

dysfunctional uterine bleeding
fibroids
endometrial polyps

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

reasons for vaginal bleeding in pregnancy

A

haemorrhage from the

  • placenta
  • placental bed (miscarriage)
  • decidua (ectopic pregnancy)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

reason for vaginal bleeding in postmenopause

A

haemorrhage from uterine lesion

- poly/carcinoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

types of infections with abnormal vaginal discharge

A

bacterial vaginosis
candida sp
trichomonas vaginalis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

causes of abnormal vaginal discharge

A

infections
chemical/physical irritants
allergy/contact dermatitis
carvical polyp/neoplasms (rare)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is bacterial vaginosis?

A

caused by loss of normal vaginal flora

lactobacillus replaced by an overgrowth of mixed flora, including gardnerrella species and anaerobes

thin discharge with fishy odour

complication in pregnancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is volvo-vaginal candida (thrush) caused by?

A

usually candida albicans

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

symptoms of candida

A

vulvovaginal itching and burning
dysparenuia (painful intercourse)
dysuria
thick, white discharge

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

risk factors for candida

A

pregnancy
diabetes
steroid therapy
antibiotic therapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is trichomonas vaginalis?

A

STD of flagellated protozoan acquired from sexual contact

causes epithelial damage leading to vaginal and vulvar inflammation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

symptoms of trichomonas vaginalis

A

vulvular itching

discharge if profuse (a lot), frothy, yellow/green in colour with unplesant odour

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

only condition that can be treated OTC

A

thrush

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Why is thrush rare in under 16 or over 60?

A

lack of vaginal oestrogen

-> refer to GP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

treatment for trichomonas and bacterial vaginosis

A

metronidazole

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

pH of trichomonas discharge

A

> 5

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

pH of bactreial vaginosos discharge

A

> 4.5

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

treatment of candida

A

topical/systemic azoles

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

How do azoles work to treat vaginal thrush?

A

synthetic antimycotic agents that inhibit replication of yeast cells by interfering with the synthesis of ergosterol (main sterol in yeast cell membrane)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

examples of azoles

A

fluconazole

clotrimazole

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

fluconazole

A

single dose 150mg capsule for vaginal thrush

symptoms improve 12-24hrs after administration

side effects - abdominal pain, diarrhoes, vomiting, nausea, flatulence

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

clotrimazole

A

topically for vaginal thrush

available as a single 500mg pessary/5g prefilled single application of 10% cream/2% cream applied 2/3 times daily to external genitalia

symptoms improve more quickly than with oral fluconazole

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

bases used in some preparations of clotrimazole

A

the bases of some preparations might damage latex condoms and diaphragms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

When should intra-vaginal preparations of clotrimazole be used?

A

night time

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

advice for vaginal thrush treatment

A
  • complete course of treatment
  • topical treatment can damage latex (condoms)
  • avoid perfumed tolietries/baths/douched/deodrants, they can strip away the protective liing of the vagina
  • candida can be transferred to the bowel, wipe anus from front to back to prevent transfer
  • wear cotton underwear, avoid tights, cool, loose fitting clothes
  • dry vagina after washing, infection thrives in warm/moist environment
  • avoid sexual intercourse until treatment is over
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

metronidazole dose for treatment for bacterial trichomonas and bacterial vaginosis

A

400mg BD for 5-7 days
OR
2g as a single dose

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

MOA of metronidazole

A

anaerobic, protozoal parasites have electron transport component (such as ferrodoxins), small Fe-S proteins that have sufficiently negative redox potential to donate e- to metronidazole

this single transfer froms a highly reactive nitro radical-mediated mechanism that target the DNA and other biomolecules

-> results in cell death

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

PCOS

A

polycystic ovarian syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

What is PCOS associated with?dyslipidaemia

A

insulin resistance
obesity
hirsutisn
dysfunctional bleeding

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

hormones in PCOS

A
  • high LH (low FSH:LH ratio)
  • elevated orstrogen and androgen
  • low progesterone
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

diagnosis of PCOS

A

at least 2 of:
- ovulatory failure -> oligomenorrhoea/amenorrhoea

  • androgen excess -> elevated circulating androgens in the blood or clinical manifestations of excess andeogen (hirsutism/acne)
  • polycyctic ovary seen on ultrasound
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

What is increased in PCOS?

A

inc free oestradiol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

What does incresed free oestradiol lead to?

A
  • dysfunctional uterine bleeding (heavy bleeding)
  • dec FSH
  • inc LH (no LH surge, no ovuation, theca call hyperplasia)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

What does theca call hyperplasia in PCOS lead to?

A

increased androgens

  • > inc DHT (dihydrotestosterone)
  • > hirsutism and virilisation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

treatment of amenorrhoea/oligomenorrhoea in PCOS

A

progesterone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

treatment to induce ovulation and fertility in PCOS

A 
clomifene
OR
gonadotropin preparations
OR
pulsatile GnRH analogues
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

How does clomifene work?

A

antagonises the normal negative feedback of endogenous oestrogen on the hypothalamus and the pituitary

resulting in increased FSH release which induces folicular growth

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

side effects of clomifene

A

ovarian enlargement
palpitations
flushing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

How is clomifene used in breast cancer?

A

anti-oestrogen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

What is danazol and MOA?

A

weak androgen

inhibits gonadotropin secretion resulting in reduction in oestrogen levels
minics feedback of endogenous androgens and reduces gonadotropin secretion

45
Q

examples of gonadotropin receptor agonists used in PCOS

A

leuprolide

nafarelin

46
Q

How do gonadotropin receptor agonists work?

A

stimulate GnRH receptors

after brief stimulation they cause desensitisation of the GnRH receptor

this results in reduced concentrations of LH and FSH

47
Q

How are gonadotropin receptor agonists administered?

A

parenteral

48
Q

side effects with gonadotropin receptor agonists

A

bone loss
vasomotor symptoms
genitourinary atrophy

49
Q

examples of steroidal anti-androgens used in PCOS

A

spironolactone

cyproterone

50
Q

MOA of spironolactone

A

inhibits cytochrome P450 mono-oxygenases and alters steroidogenesis

reduces testosterone synthesis and increases its metabolism

causes K retention
-> need to monitor K

51
Q

monitoring for spironolactone

A

potassium

-> can cause potassium retention

52
Q

cyproterone for PCOS

A

progesteronic actions

requires periodic interruption of therapy to allow breakthrough menstrual bleeding

can be given with EE to give contraceptive cover

53
Q

What is used for PCOS androgen excess when infertility is not an issue?

A

COC

54
Q

What is endometriosis?

A

presence of endometrial glands and stroma outside the uterus, anywhere in the pelvis

55
Q

What does endometroisis cause?

A

dysmenorrhoea
pelvic pain
subfertility

56
Q

What causes subfertility with endometriosis?

A

distortion of pevlic anatomy by adhesions/cysts or disturbance of reproductive processes

57
Q

age where endometroisis is more commonly diagnosedq

A

between 30-40yrs

uncommon under 20

58
Q

pathogenesis of endometroisis (3)

A
  1. retrograde/implantation theory - menstrual blood containing fragments of endometrium forced upwards through the fallopian tubes into the peritoneal cavity
  2. metaplasia/metastatic theory - dormant immature cellular elements spread over wide area during embryonic development persist into adult life and differentiate into endometrial tissue
  3. vascular/lymphatic theory - endometrial tissue may metastasise through the lymphatics or vascular system
59
Q

diagnosis of endometriosois

A

needs 2/3 findings:
endometrial glands
endometrial strome
hemosiderin

60
Q

signs/symptoms of endometriosis

A

secondary dysmenorrhoea (before/during menstruation)
deep dyspareunia
chronic pelvic pain
ovulation related pain
cyclical or peri-menstrual bowel or bladder symptoms
subfertility
pain on defecation/micturition

61
Q

mamanement of endometriosis

A

COC (continuous)
progesterones (medroxyprogesterone/norethisterone)
POP
IUS
implant
androgens and GnRH analogues
surgery (excision/albation) - can improve symptoms and sub fertility

62
Q

What are fibroids?

A

benign smooth muscle tumours of the uterus

leiomyomas

63
Q

Who do fibroids affect?

A

women of reproductive age

after puberty prevalence of fibroids increases progressively until menopause

64
Q

How do fibroids develop?

A

promoted and maintained by exposure to oestrogen and progestogen

65
Q

What increases the risk of fibroids?

A

early puberty
obesity
increasing age

66
Q

What reduces the risk of fibroids?

A

pregnancy

dec with an increasing number of pregnancies

67
Q

How are fibroids found?

A

during examniation or investigation for gynaecological problems or during pregnancy assessment

they’re usually asymptomatic

67
Q

How are fibroids found?

A

during examniation or investigation for gynaecological problems or during pregnancy assessment

they’re usually asymptomatic

68
Q

symptoms of fibroids

A

menorrhagia in 30s/40s (heavy bleeding)

abdominal swelling
pevlic pain/discomfort
dyspareunia
constipation
urinary symptoms due to compression of adjacent structures
69
Q

What can distortion of the endometrial cavity cause in fibroids?

A

increase the SA and impair haemostasis
-> results in menorrhagia and dysmenorrhoea

abnormality in pregnancy
obstructed labour
impaired haemostasis after separation of the placenta

70
Q

treatment options for fibroids where fertility is desired

A

primary (medical) - leuprorelin, mifepristone, LNG-IUS

secondary - naproxen

primary (surgical) - myomectomy

71
Q

What does treatment for fibroids dependon?

A

if fertility is desired or not

72
Q

leuprorelin for fibroids

A

3.75mg IM once a month for up to 3 months
OR
11.25mg IM as a single dose

73
Q

mifepristone for fibroids

A

5-50mg orally OD for 3-6mths

74
Q

LNG-IUS for fibroids

A

insert52mg device into uterine cavity

remove and replace after 5yrs

75
Q

naproxen for fibroids

A

500mg orally BD PRN

76
Q

myomectomy for fibroids

A

surgical removal of uterine fibroids

or: laparotomy/laparoscopy/hysteroscopy

77
Q

treatment options for fibroids where fertility is NOT desired AND uterine preservation is DESIRED

A

primary - uterine artery embolisation (UAE)
or
myomectomy

adjunct preoperative therapy - same as primary for desired fertility

78
Q

What does fibroids treatment for when fertility is not desired depend on?

A

if uterine preservation is desired

79
Q

fibroid treatment when fertility NOT desired AND uterine preservation NOT desired

A

surgical candidate:

  • primary - hysterectomy (vaginal/laparoscopic/abdominal)
  • preoperative therapy

non surgical candidate:

  • surgery if willing
  • preoperative therapy
80
Q

Why would a woman not be a surgical candidate?

A 
significant obesity
diabetes
hypertension
serious cardiac/pulmonary dysfunction
-> high risk for major surgery
81
Q

How does heavy menstrual bleeding (HMB) affect QoL?

A

physical
emotionsl
social
material

82
Q

risk factors for HMB

A

gynaecological conditions:

  • uterine fibroids
  • adenomyosis/endometriosis
  • endometrial cancer
  • unopposed oestrogen use

increased age

ethnic group

sociocultural factors

83
Q

investigations for HMB (3)

A
  1. if Hx suggests structural abnormalities and uterus is palpable - ULTRASOUND to ID structural abnormalities
  2. HYSTEROSCOPY WITH BIOPSY - ultrasound outcomes are inconclusive to determine location of fibroid/nature of abnormality
  3. ENDOMETRIAL BIOPSY if - intermittent bleeding presists, med treatment fails/not effective over age of 45
84
Q

phaemaceutical treatment for HMB (hormonal and non-hormonal treatment acceptable)

A

LNG-IUS - for LT use (>12mths), 1st line

tranexamic acid/NSAIDs/COC

norethisterone 15mg daily from days 5-26 of cycle/injected long acting progestogens

85
Q

What to do if symptoms of HMB don’t improve within 3mths?

A

NSAIDs

tranexamic acid

86
Q

What NOT to use for HMB?

A

danazol

etamsylate

87
Q

surgical options for HMB

A
  1. endometrial ablation methods - HMB alone with uterus no bigger than 10 week pregnancy
  2. hysterectomy - not 1st line, route: vaginal first then abdominal
88
Q

What is pelvic inflammatory disease?

A

polymicrobial infection of upper reproductive tract

associated with sexually transmitted organisms - Chlamydiatrachomatis, Neisseria gonorrhoeae, Gardnerella vaginalis, anaerobes, other vaginal organisms

89
Q

How does pelvic inflammatory disease occur?

A

organisms ascent through cervical canal to endometrial cavity and then to tubes and ovaries

bacteria then multiply in the favourable environment and ascend to the fallopian tube

90
Q

risk factors for pevlic inflammatory disease

A 
age 16-24
nulliparity (never given birth)
Hx of multiple sexual partners
insertion of IUD
PMH of the disease
91
Q

symptoms of pevlic inflammatory disease

A 
abdominal pain (bilateral)
dyspareunia
back pain
purulent cervical discharge
presence of adnexal tenderness
painful cervix on bimanual examination
abnormal vaginal bleeding (including post-cotial, inter-menstrual, menorrhagia)
92
Q

clinical features of pevlvic inflammatory disease

A

fever
raised WBC
increased ESR
increased CRP

93
Q

minimum criteria fordiagnosis of pelvic inflammatory disease

A
  • presence of lower back pain
  • adnexal tenderness
  • cervical motion tenderness on bimanual examination with no apparent cause
94
Q

differential diagnosis of pelvic inflammatory disease

A
  • ectopic pregnancy
  • acute appendicitis
  • endometriosos
  • ovarian cyst torsion or rupture
  • UTI
  • functional pain
95
Q

investigations for pelvic inflammatory disease

A
  • test for gonorrhoea and chlamydia -> positive supports diagnosos, negative doesn’t exclude PID
  • elevated CRP/ESR -> support diagnosis, not specific
  • absence of endocervical/vaginal pus cell -> PID unlikely but non-specific
96
Q

What can delating PID treatment lead to?

A

increase risk of LT problems

  • ectopic pregnancy
  • infertility
  • pelvic pain
97
Q

treatment for PID

A

rest

analgesia

98
Q

What should be offered after PID diagnosis?

A

full STI screen including HIV

99
Q

signs of severe PID (admit for IV treatment)

A
  • temp > 38
  • signs of tubo-ovarian abcess
  • pelvic peritonitis
  • no response to oral treatment
  • pregnancy
100
Q

What needs to be taken into account before treatment for PID?

A
  • age
  • contraindications
  • cautions
  • possible adverse effects
  • local antimicrobial sensitivity patterns
101
Q

first line treatment for PID (3)

A
  1. ceftriaxone 500mg single IM dose
    followed by oral doxycycline 100mg BD
    and metronidazole 400mg BD for 14 days
  2. oral ofloxacin 400mg BD
    and metronidazole 400mg BD for 14 days
    (levofloxacin 500mg OD 14 days alternative to ofloxacin)
  3. oral moxifloxacin 400mg OD for 14 days
102
Q

What treatment if positive for Mycoplasma genitalium in initial test?

A

treatment with moxifloxacin recommended

-> good microbiological activity against M. genitalium

103
Q

alternative treatments if 1st line not suitable

A

ceftriaxone 500mg singe IM dose

followed by oral azithromycin 1g per week for 2 weeks

104
Q

What is there a high risk for in PID and when if infection risk high?

A

risk of gonococcal infection high

  • partner has gonorrhoea
  • symptoms are severe
  • sexual contact when abroad
105
Q

treatment if risk of gonococcal infection is high

A

ceftriaxone 500mg single IM dose
followed by oral doxycycline 100mg BD
and oral metronidazole 400mg BD for 14 days

106
Q

after care for PID

A
  • offered to all sexual contacts within 6mths
  • chlamydia/gonorrhoea diagnosed partner treated
  • both partners avoid SI until completed full treatment course
  • reassess at 72hrs to encure responding to treatment
  • consider review at 2-4 weeks to ensure completion of antibiotits, pregnancy test if needed and further education
107
Q

common clinical breast problems

A 
breast lump
breast lumpiness
breast pain
nipple discharge
bone pain

PHA223 (43 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions