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Reproduction & Sexual Health > Week 1 > Flashcards

Week 1 Flashcards

1
Q

Indications for endometrial sampling

A
  • abnormal uterine bleeding
  • investigation for infertility
  • spontaneous and therapeutic abortion
  • assessment of response to hormonal therapy
  • endometrial ablation
  • work up prior to hysterectomy for benign indications
  • incidental finding of thickened endometrium on scan
  • endometrial cancer screening in high risk patients
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2
Q

menorrhagia

A

prolonged and increased menstrual flow

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3
Q

metrorrhagia

A

regular intermenstrual bleeding

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4
Q

polymenorrhoea

A

menses occurring at < 21 day interval

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5
Q

polymenorrhagia

A

increased bleeding and frequent cycle

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6
Q

menometrorrhagia

A

prolonged menses and intermenstrual bleeding

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7
Q

amenorrhoea

A

absence of menstruation > 6 months

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8
Q

Oligomenorrhoea

A

Menses at intervals of > 35 days

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9
Q

microorganisms that can cause endometritis

A

Neisseria
Chlamydia
TB
CMV
Actinomyces
HSV

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10
Q

endometrial polyps presentation

A

usually asymptomatic but may present with bleeding or discharge

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11
Q

when do endometrial polyps often occur

A

around and after menopause

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12
Q

are endometrial polyps benign

A

almost always yes, but endometrial carcinoma can present as a polyp

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13
Q

what is molar pregnancy?

A

A form of gestational trophoblastic disease which grows as a mass.

characterised by swollen chorionic villi.

Categorized as partial moles or complete moles

It happens when the fertilisation of the egg by the sperm goes wrong.

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14
Q

complete mole

A

a single or two sperm combining with an egg which has lost its DNA (the sperm then reduplicates forming a “complete” 46 chromosome set.

Only paternal DNA is present in a complete mole.

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15
Q

is maternal or paternal DNA present in a complete mole

A

paternal

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16
Q

Partial mole

A

egg is fertilized by two sperm or by one sperm which reduplicates itself yielding the genotypes of 69,XXY (triploid).

Partial moles have both maternal and paternal DNA

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17
Q

which has higher risk of developing into choriocarcinoma - complete or partial mole?

A

complete

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18
Q

Adenomyosis

A

occurs when the tissue that normally lines the uterus (endometrial tissue) grows into the muscular wall of the uterus

Endometrial glands and stroma within the myometrium

Causes menorrhagia/dysmenorrhoea

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19
Q

Leiomyoma

A

Benign tumour of smooth muscle, may be found in locations other than the uterus

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20
Q

what scan is most clinically useful for assessing the endometrium and ovaries?

A

transvaginal ultrasound

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21
Q

is follicular cyst a neoplasm?

A

no it’s a physiological cyst

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22
Q

complications of endometriosis

A
  • pain
  • cyst formation (usually in ovary)
  • adhesions
  • infertility
  • ectopic pregnancy
  • malignancy (endometrioid carcinoma)
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23
Q

why is infertility a complication of endometriosis?

A

inflammation and scarring you get in the tube due to the endometriosis

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24
Q

what are chocolate cysts a sign of

A

endometriosis

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25
Q

where are chocolate cysts most commonly found?

A

ovary

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26
Q

is cystic tumour usually malignant or benign?

A

benign

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27
Q

is a very solid tumour usually malignant or benign?

A

benign

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28
Q

classification of ovarian tumours

A
  • Epithelial
  • Germ cell
  • Sex‐cord/stromal
  • Metastatic
  • Miscellaneous
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29
Q

which of the ovarian tumours is most likely to be malignant?

A

epithelial

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30
Q

epithelial ovarian tumours

A
  • Serous
  • Mucinous
  • Endometrioid
  • Clear cell
  • Brenner
  • Undifferentiated carcinoma
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31
Q

borderline epithelial ovarian tumours

A
  • cytological abnormalities, proliferative
  • no stroma invasion
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32
Q

commonest epithelial malignancy of the ovary

A

serous carcinoma

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33
Q

precursor lesion of high grade serous carcinoma

A

serous tubal intraepithelial carcinoma (STIC)

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34
Q

are 95% of serous carcinomas high grade or low grade?

A

high grade

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35
Q

what distinguishes malignant from benign or borderline epithelial ovarian tumour?

A

stromal invasion

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36
Q

Endometrioid and Clear Cell carcinoma of the ovary are associated with _______ syndrome

A

lynch

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37
Q

which epithelial ovarian cancers are associated with lynch syndrome?

A

endometrioid and clear cell carcinoma

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38
Q

prognosis of endometrioid carcinoma of the ovary

A

most are low grade and early stage so good

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39
Q

what is primary diagnosis of serous carcinoma often made on

A

ascitic fluid - e.g. epithelium which shouldn’t be there

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40
Q

benign serous neoplasia

A

thin walled cysts filled with straw coloured fluid

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41
Q

brenner tumour is a tumour of what type of epithelium?

A

transitional

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42
Q

Are brenner tumours usually malignant or benign

A

benign

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43
Q

most common germ cell tumour of ovary

A

mature cystic teratoma

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44
Q

if fat is seen on scan in ovary, what might be there?

A

teratoma

45
Q

granulosa cell tumour may produce oestrogen, true or false

A

true

46
Q

commonest cancers that metastasise to ovary

A

Stomach
Colon
Breast
Pancreas

47
Q

what is salpingitis

A

inflammation of the fallopian tubes, caused by bacterial infection

48
Q

ectopic pregnancy commonest site

A

fallopian tube

49
Q

when should you consider ectopic pregnancy?

A

any female of reproductive age with amenorrhoea and acute hypotension or an acute abdomen

50
Q

main pathological groups of ovary

A

Cysts
Endometriosis
Tumours

51
Q

how long do follicular cysts usually take to resolve?

A

a few months

52
Q

what is endometriosis?

A

Endometrial glands and stroma outside the uterine body

53
Q

endometriosis sites

A

– Ovary (‘chocolate’ cyst)
– Pouch of Douglas
– Peritoneal surfaces, including uterus
– Cervix, vulva, vagina
– Bladder, bowel etc

54
Q

how can cervicitis lead to infertility?

A

simultaneous silent fallopian tube damage

55
Q

neoplastic pathology of cervix

A
  • Cervical Intraepithelial Neoplasia (CIN)
  • Cervical cancer (squamous carcinoma, adenocarcinoma, other rare tumours)
56
Q

risk factors for CIN/cervical cancer

A
  • persistence of high risk HPV viruses, mostly type 16 and 18. Many sexual partners
  • vulnerability of SC Junction in early reproductive life
    age at first intercourse
    long term use of oral contraception
    non-use of barrier contraception
  • smoking 3x risk
  • immunosuppression
57
Q

genital warts - what types of HPV

A

6 and 11

58
Q

Can Cervical Intraepithelial Neoplasia (CIN) be detected by cervical screening?

A

yes

59
Q

what is the most common cervical cancer?

A

invasive squamous carcinoma

60
Q

cervical invasive squamous carcinoma develops from pre-existing ___

A

CIN

61
Q

what is figo staging used for?

A

gynae cancers, including cervical

62
Q

symptoms of cervical invasive carcinoma

A

usually none at microinvasive and early invasive stages

abnormal bleeding
pelvic pain
haematuria/urinary infections
ureteric obstruction/renal failure

63
Q

What is Cervical Glandular Intraepithelial Neoplasia (CGIN) a preinvasive of/precursor to?

A

endocervical adenocarcinoma

64
Q

causes of miscarriage

A
  • embryonic abnormality: chromosomal
  • immune cause e.g. antiphospholipid syndrome
  • infections
  • stress
  • iatrogenic
  • “associations” - smoking, cocaine, alcohol misuse
  • uncontrolled diabetes
  • cervical incompetence and shortened cervix
65
Q

NICE guidelines for threatened miscarriage

A

vaginal micronised Progesterone 400 mg b.d. till 16 weeks if viable intrauterine pregnancy is noted on scan and they have vaginal bleeding and have previously had a miscarriage

66
Q

ectopic pregnancy presentation

A

pain>bleeding
dizziness/collapse
shoulder tip pain
SOB
diarrhoea rarely

67
Q

miscarriage presentation

A

bleeding>pain
cramping

68
Q

what is molar pregnancy?

A

gestational trophoblastic disease
outcome of a non-viable fertilised egg

69
Q

pathology of molar pregnancy

A

overgrowth of placental tissue with chorionic villi swollen with fluid rich in hCG; giving picture of “grape like clusters”.

70
Q

types of molar pregnancy

A

Complete and Partial

71
Q

molar pregnancy USS

A

“ snow storm appearance” +/- fetus, theca lutein cysts.

72
Q

molar pregnancy presentation

A
  • Hyperemesis, hyperthyroidism, early onset pre-ecclampsia
  • Varied bleeding and occasional history of passage of “grapelike tissue”
  • Fundus > dates on abdominal palpation.
  • Rare cases: shortness of breath (due to embolisation to lungs) or seizures (metastasis to brain)
73
Q

mainstay treatment for molar pregnancy

A

surgery (uterine evacuation)

74
Q

timing of implantation bleeding

A

about 10 days post ovulation

75
Q

does pregnancy usually continue if implantation bleeding

A

yes

76
Q

chorionic haematoma

A

a collection of blood between the chorion (the outer membrane surrounding the embryo) and the uterine wall

77
Q

cervical causes of bleeding in early pregnancy

A

Ectopy/ectropion.

Infections: Chlamydia, Gonococcus or bacterial.

Polyp.

Malignancy

78
Q

treatment for bacterial vaginosis in pregnancy

A

Metronidazole 400mg twice daily for 7 days
Avoid alcohol during medication
Option of vaginal gel

79
Q

treatment of chlamydia in pregnancy

A

Erythromycin, Amoxicillin
Test of Cure 3 week later
Liaise with Sexual health, include partner tracing
Confidentiality issue

80
Q

predominant symptom in ectopic pregnancy

A

pain

81
Q

Hyperemesis Gravidarum (HG)

A

a more severe form of morning sickness

82
Q

Hyperemesis Gravidarum (HG) consequences

A

Dehydration, ketosis, electrolyte and nutritional disbalance
Weight loss, altered liver function ( up to 50%)
Signs of malnutrition
Emotional instability, anxiety. Severe cases can cause mental health issues e.g. depression.

83
Q

PUQE score - what is it used for

A

vomiting in pregnancy

84
Q

which women are given anti-D in pregnancy?

A

rhesus negative women

85
Q

manual vacuum aspiration

A

used to perform an abortion or to remove products of conception from the uterus

<10 weeks

86
Q

medical management of pregnancy of unknown location

A

methotrexate

87
Q

what size of cyst makes ovarian torsion more likely?

A

> 5cm

88
Q

what percentage of adnexal torsions occur in children?

A

25%

89
Q

management of ovarian torsion

A

surgical emergency
- resuscitation
- laparoscopy
- laparotomy
- detorsion
- cystectomy
- oophorectomy

90
Q

cyst rupture management

A
  • conservative if small amount of fluid
  • resuscitation
  • laparoscopy
  • lavage
  • stop bleeding
  • if bleeding is very bad remove ovary (very rare)
91
Q

pelvic inflammatory disease causative organisms

A

chlamydia
gonorrhoea
gardenella
anaerobes

92
Q

pelvic inflammatory disease management

A

14 days metronidazole and doxycycline

93
Q

acute bleeding - menstrual

A

anovulatory
fibroids
anticoagulant
von willebrand’s disease

94
Q

acute bleeding - non menstrual

A

miscarriage
cervical cancer
endometrial cancer
vaginal trauma

95
Q

what type of drug is tranexamic acid?

A

anti-fibrinolytic
(controls bleeding, e.g. heavy periods)

96
Q

acute bleeding management

A
  • resuscitation
  • tranexamic acid
  • mefenamic acid
  • norethisterone
  • IUS
  • COCP
  • GnRH analogues (don’t release LH and FSH so go into temporary menopause)
97
Q

Bartholin’s abscess management

A
  • conservative if not too bad and not causing bad pain
  • antibiotics
  • incision and drainage
  • word catheter
  • marsupialization (larger incision for recurrent and stuff)
98
Q

procidentia

A

a severe form of pelvic organ prolapse (POP) that includes herniation of the anterior, posterior, and apical vaginal compartments through the vaginal introitus

99
Q

endometrial polyps

A

overgrowths of endometrial glands

protrude into the uterine cavity

100
Q

what age endometrial polyps

A

reproductive age and postmenopausal

101
Q

types of endometrial polyps

A

pedunculated
sessile

102
Q

risk factors for endometrial polyps

A

tamoxifen use (tamoxifen used in breast cancer)

excess endogenous oestrogen - raised BMI

103
Q

where do fibroids (uterine leiomyoma) develop?

A

myometrium

104
Q

types of fibroid (uterine leiomyoma)

A

sub mucosal
intramural
subserosal
broad ligament
cervical
pedunculated fibroid

105
Q

fibroid medical treatment

A

non hormonal methods, hormonal

106
Q

fibroid interventional radiology treatment

A

uterine artery embolisation

107
Q

when is anti-D given in abortion?

A

if woman is rhesus negative and abortion is after 10 weeks
(but if surgical abortion give before 10 weeks too)

108
Q

how does copper coil work

A

The copper alters the cervical mucus, which makes it more difficult for sperm to reach an egg and survive.

IUD prevents implantation

109
Q
A

Reproduction & Sexual Health (36 decks)

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