Week 1 part 2 Flashcards
What cells produce oestrogen?
Granulosa cells
In the follicular phase what does the increase in oestrogen cause?
Inhibition of FSH production causing atresia but not of dominant follicle
What occurs before ovulation?
Prior LH surge and dominant follicle ruptures to release oocyte
What happens 14 days post-ovulation?
Luteolysis
What uterine phase occurs over days 5 - 14?
Proliferative phase
What urterine phase occurs over days 14-28?
Secretory phase
What happens in uterine proliferative phase?
Oestrogen induced growth of endometrial glands and stroma
What phase of uterine cycle is this: Progesterone-induced glandular secretory activity
Decidualisation in late secretory phase
Endometrial apoptosis and subsequent menstruation
Luteal phase
In menstruation phase- what inhibits scar tissue formation?
Fibrinolysis
How much is lost in menstruation?
Less than 80 mls
No clots
How long is menstrual cycle
average 28 days
between 21 - 35 days cycle
Menorrhagia
Prolonged and increased menstrual flow
Metrorrhagia
Regular intermenstrual bleeding
Polymenorrhoea
Menses occuring at less than 21 day interval
Polymenorrhagia
Increased bleeding and frequent cycle
Menometrorrhagia
Prolonged menses and intermenstrual bleeding
Amenorrhoea
Absence of menstruation greater than 6 months
Oligomenorrhoea
Menses at intervals osf greater than 35 days
What is non-organic causes of menorrhagia (prolonged and increased menstrual flow) also known as?
Dysfunctional Uterine Bleeding
Name some local disorders causing organic menorrhagia?
- Fibroids
- Adenomyosis
- Endocervical or endometrial polyp
- Cervical eversion
- Endometrial hyperplasia
- Intrauterine contraceptive device
- PID
- Endometriosis
- Malignancy of cervix/uterus
- AV malformations
a benign tumour of muscular and fibrous tissues, typically developing in the wall of the womb.
Fibroids
a condition of the uterus (womb) where the cells that normally form a lining on the inside of the uterus, also grow in the muscle wall of the uterus.
Adenomyosis
the uterine lining grows outside the uterus –in the fallopian tubes, the ovaries or the tissue lining the pelvis (the peritoneum).
Endometriosis
a mass in the inner lining of the uterus. They may have a large flat base (sessile) or be attached to the uterus by an elongated pedicle (pedunculated). Pedunculatedpolypsare more common than sessile ones. They range in size from a few millimeters to several centimeters.
Endometrial polyp
In many women, cells from inside the cervical canal, known as glandular cells, are present on the outside surface of thecervix[1]. This used to be called cervical erosion and is now more commonly known as
Cervical eversion
s athickeningof the lining of the womb, caused by overgrowth of the cells that line the womb. It is not cancer. But in some women it can develop into womb cancer
Endometrial hyperplasia
Name four causes of organic menorrhagia in relation to endocrine?
- Hypo/hyperthyroidism
- Diabetes Mellitus
- Adrenal disease
- Prolactin disorders
3 Disorders of haemostasis causing organic menorrhagia?
- Von Willebrands disease
- ITP
- Factor II, V, VII and XII deficiency
Name four organic menorrhagia problems related to pregnancy?
Miscarriage
Ectopic pregnancy
Gestational trophoblastic disease - hydatidiform mole
post partum haemorrhage
What class are 85% of all dysfunctional uterine bleeding?
Anovulatory
What type of dysfunctional uterine bleeding is more common in obese women?
Anovulatory
What class of dysfunctional uterine bleeding is related to women aged 35-45, regular heavy periods, due to inadequate progesterone production by corpus luteum?
Ovulatory
How is DUB investigated?
FBC Cervical smear TSH Coagulation screen Renal/liver tests
What imaging is done for investigating DUB?
Transvaginal ultrasound - endometrial thickness, presence of fibroids
Name another test used for investigating DUB?
Endometrial sampling - pipelle biopsies, hysteroscopic directed, dilatation and curettage
How is DUB managed non surgically?
Progestogens Combined oral contraceptive pill Danazol GnRH analogues NSSAIDS Anti-fibrinolytics Capillary wall stabiliers Progestogen relasing IUCD
What is the management of DUB sugically?
Endometrail resection/ablation (rollerball, thermal balloon)
Hysterectomy
What si the main concern between surgical management of DUB and medical?
Fertility lost in surgical
Name some differences between endometrial ablation and hysterectomy for DUB?
EA - daycase procedure, shorter, requries smear, combined HRT needed
H - major operation, longer, no smear required, oestrogen only HRT
What bacteria predominate in the healthy vagina and produce lacti acid and hydrogen peroxide?
Lactobacillus spp.
Name three other organisms found in the vagina healthy?
Strep viridans
Group B strep
Candida
Name 4 predisposing facotrs for candida infection?
- Recent antibiotic therapy
- High oestrogen levels (pregnancy)
- Poorly controlled diabetes
- Immunocomporomised patients
Intensly itchy white vaginal discharge?
Thrush
How is thrush diagnosed?
Clinical diagnosis
High vaginal swab for culture
Name a bacteria in the vagina that buds?
C. albicans
Typical spotty rash on penis?
Candida balantis
What organism plays a role in bacterial vaginosis?
Gardnerella vaginalis/mobiluncus sp.
Thin, watery, fish smelling vaginal discharge?
Bacterial vaginosis
How is BV diagnosed?
Clinical diagnosis
Raised vaginal pH > 4.5
What cells are looked for from HVS in lab testing in BV?
Presence of clue cells
What does Hay-Ison scoring system estimate in BV?
Proportions of clue cells to epithelial cells and lactobacilii
How is BV treated?
Metronidazole orally
Symptoms of UTI but may have lower abdo pain/back/perineal/penile and tender prostate?
Acute bacterial prostatitis
Name a rare complication of UTI in men?
Acute bacyterial prostatitis
How is acute bacterial prostatitis diagnosed?
Clinical signs + MSSU for C&S (+/- first pass urine for chlamydia/gonorrhoea)
How is acute bacterial prostatitis treatd?
Ciprofloxacin for 28 days
Trimethoprim if high C .diff risk
Commonest bacterial STI in UK?
cHLAMYDIA TRACHOMATIS
Describe the chalmydia trachomatis bacteria?
Obligate intracellular bacteria wit hbiphasic life cycle - energy parasite
Does chlamydia reproduce outside host cell?
No
What test should not be done for chlamydia trachomatis?
Culture or gram stain - does not stain because no peptidoglycan in cel wall
What serological group causes chlamydia trachoma (eye infeciton)?
Serovars A - C
What serological group causes genital infection in chlamydia?
Serovars D-K
What does serological group L1-L3 cause in chlamydia?
Lymphogranuloma venereum
Treatment for chlamydia?
Azithromycin 1g oral dose
STI that is gram negative dipplococcus?
Neisseria gonorrhoeae
What does gonorrhoea look like on gram stain?
2 kidney beans facing each other - easily phagocytosed by polymorphs so often appear intracellularly
Purulent discharge, a dripping tap?
Gonnorhoea
How do you test for both chlamydia and gonorrhoea in one test?
Combined nucleic acid amplification tests (NAATS) or PCR - highly sensitive and specific tests
Howis chalmydia nad gonnorhoea tested on male patients? for PCR/NAAT
First pass urine sample
What swab is not used for culture of gonorrhoea?
High vaginal swab
Will pcr and NAAT be positive even if organism have fied?
Yes - test takes hours not days
What also has to be done other than PCR/NAAT for gonorrhoea?
5 weeks wait to do test of cure
Treatment for gonorrhoea?
Ceftriaxone IM + oral azithromyicin
What type of organism is treponema pallidum?
Spirochaete
Does symphilis stain?
No
Describe the primary stage of symphiis?
Chancre (painless ulcer) at site of infection - heals without treatment
What occurs in secondary stage of symphilis?
Snail track mouth ulcers, generalised rahs and flue like symptoms
When diagnosing symphilis what is done to look for spirochaetes in exudate from primary and secondary lesions?
Dark ground microscopy
In sepcific test serology for syphilis can antibodys remain positive for life?
Yes
What is non specific serology used for in syphilis?
To monitor response to treatment and test how active disease is
Name two non specific serological tests for syphilis?
VDRL - Venereal Diseases Reserach Lab
RPR (rapid plasma reagin)
Name 3 specific serological tests for syphilis?
TPPA (particle agglutination assay)
TPHA (haemagglutination assay)
IgM and IgG ELISA
What is used as screenign test for syphilis?
IgG and IgM ELISA
What two tests are specific for syphilis but remain positive for life, not useful in monitoring response to therapy?
TPPA
TPHA
tREATMENT for Syphilis?
Injectable long actining penicillin
Commonest viral STI?
Genital Warts
What virus causes genital warts?
HPV
Describe the genital wart causing virusl HPV?
Non-enveloped icosohedral virus containing double stranded DNA
wHAT type of HPV cause genital warts?
6 and 11
What type of HPV cause increased risk of cervical cancer?
16 and 18
How are genital warts diagnosed?
Clinical
Treatment of genital warts?
Cryotherapy, podophyllotoxin cream
What vaccine is there for genital warts?
Quadrivalent vaccine given to 11-13 yo girls. Protects against 6,11, 16 and 18
Lumps on vagina, whiter than surrounding skin with rough surface#?
Genital warts
Describe herpes simplex virus?
Enveloped virus containing double stranded DNA
Exquisitely painful multiple small vesicles, which are easily deroofed?
Genital herpes HSV
wHERE does genital herpes virus migrate to and hide from the immune system at?
Sacral root ganglion
How is genital herpes diagnosed?
Swab in virus transport medium of deroofed blister for PCR - highly sensitive and specific
Treatment of HSV genital?
Aciclovir and pain relief
Decribe the organism that infects in trchomonas vaginalis?
Single celled protozoal parasite
How is trichomonas vaginalis transmitted?
Sexual contact
Vaginal discharfe and irritation in females, urethritis in males?
Trichomonas vaginalis
How is trichomonas vaginalis diagnosed?
High vaginal swab for microscopy
How is trichomonas vaginalis treated?
Oral metronidazole
How long do male pubic lice and female pubic lice liver for?
Males - 22 days
Females - 17 days
