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Semester 6 > Womans Health > Flashcards

Womans Health Flashcards

0
Q

Menorrhagia

A

Heavy cyclical bleeding

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1
Q

Polymenorrhoea

A

Normal duration and flow but shortened cycle with intervals less than 25 days

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2
Q

Metorrhagia

A

Uterine bleeding independent of menstrual pattern

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3
Q

Menometorrhagia

A

Increased flow during menstruation and between periods

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4
Q

Chronic AUB

A

More than 6 months

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5
Q

Acute AUB

A

Severe enough to require immediate intervention

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6
Q

HMB

A

Heavy menstrual bleeding that affects quality of life

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7
Q

Objective Menorrhagia (HMB)

A
  • blood loss > 80ml per cycle

- 60% have iron deficiency anaemia

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8
Q

Subjective Menorrhagia

A

50% have bold loss in normal limits

Still considered abnormal

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9
Q

Normal blood loss

A

10-55 ml

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10
Q

Causes of AUB

A
  • polyps
  • adenomyosis
  • leiomyomas
  • malignancy
  • coagulopathy
  • ovulation dysfunction
  • endometrial disorders
  • iatrogenic
  • not classified
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11
Q

Types of leiomyomas

A
  • sub mucosal
  • other (intramural and sub serosal)
  • hybrid
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12
Q

Feature of coagulopathy

A 
One of:
- postpartum haemorrhage
- surgical related bleeding
- dental bleeding
Two or more of:
- bruising 
- epistaxis
- frequent gum bleeding
- fam history of bleeding symptoms
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13
Q

What are LOOP events?

A
  • luteal out of phase events

Premature development of estradiol-producing follicles in the luteal phase

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14
Q

Things causing endometrial disorders

A
  • deficiencies in the local production of vasoconstrictors (endothelin1)
  • increased prod of vasodilatory prostaglandins (prostacyclin)
  • accelerated lysis of endometrial clot (plasminogen activator)
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15
Q

Things causing iatrogenic AUB

A
  • break through bleed

- mirena

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16
Q

What is used for endometrial sampling?

A

Pipelle

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17
Q

Who do you take an endometrial sample from?

A
  • over 40’with irreg bleeding
  • risk factors for endometrial Ca
    Prolonged chronic anovulatin
    Obese
    Fam Hx of Ca
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18
Q

Who do you refer for hysteroscopy?

A
  • chronic irreg bleeding
  • peri-menopause with abnormal bleeding
  • US suggests fibroid or polyp
  • post- menopause ET >5mm or ongoing bleeding with ET <5 mm
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19
Q

How to hormonally manage an acute bleeding episode

A
  • high dose oestrogen for atrophic endometrium
  • high dose OCP if bleeding not too severe
  • progesterone for anovulatory bleeding
  • cyclokapron (antifibrinolytic)
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20
Q

Medical management of AUB

A
  • antifibrinolytic drugs (tranexamic acid)
  • NSAIDS (mefenamic acid)
  • low dose Monophasic oral contraceptives
  • progesterone
  • mirena
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21
Q

Mechanism of tranexamic acid

A

Prevents action so plasminogen

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22
Q

Mechanism of mefenamic acid

A

Altered ratio of prostaglandin E2 to F2

- increased ratio of prostacyclin to thromboxane

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23
Q

Mirena method of action

A
  • reduction in endometrial prostaglandin synthesis
  • reduction in endometrial fibrinolytic activity
  • production of an inactive endometrium
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24
Q

When is endometrial ablation done

A
  • HMB with uterus <3 cm and no desired fertility
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25
Q

Types of endometrial ablation

A 
First gen
- electrocautery
Second gen
- microwave endometrial ablation 
- hydrothermablation
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26
Q

What does UAE stand for?

A

Uterine artery embolisation

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27
Q

When is UAE, myomectomy or hysterectomy done?

A

HMB with fibroids >3 cm

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28
Q

When is hysterectomy done?

A
  • completed family
  • over 45
  • fAiled medical treatment
  • failed endometrial ablation
  • failed myomectomy
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29
Q

What is a haematinic?

A

Stimulates the production of red blood cells

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30
Q

AUB-O

A

Abnormal menstrual bleeding with a disorder of ovulation (endometrial sampling NB- assoc with endometrial hyperplasia)

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31
Q

When is normal vag discharge least acidic?

A

Days prior to and during menstruation

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32
Q

Physiological causes of changes in discharge

A
  • menstrual cycle
  • emotional stressors
  • nutritional status
  • pregnancy
  • medications
  • sexual arousal
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33
Q

Trichomoniasis discharge

A

Yellow/green, offensive, frothy

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34
Q

What constitutes the adnexa?

A

Fallopian tubes, ovaries, round ligaments

35
Q

Most common pelviabdominal mass in reproductive age

A
  • functional or physiological cysts
36
Q

Things to describe about a mass

A
  • size (weeks)
  • surface
  • consistency
  • tender
  • mobile or fixed
  • ascites
  • cannot get below the mass
37
Q

Starting point in mass differential

A
  • gynae (pregnant or non-pregnant)

- non gynae (urinary tract or bowel)

38
Q

Types of physiological cysts

A
  • follicular
  • corpus lutuem
  • theca-lutein
39
Q

Why do follicular cysts occur?

A
  • failure of the mature follicle to ovulate or
  • failure of the immature follicle to reabsorb or undergo atresia
    (Asymptomatic)
40
Q

Why corpus lutuem cysts occur

A
  • haemorrhage into the corpus lutuem 2 days after ovulation
  • can rupture and mimic tubal pregnancies
  • occur late in cycle
  • assoc with acute pain
41
Q

Why do theca lutein cysts occur?

A
  • overstimulation of ovaries by hCG
42
Q

Features suggestive of ovarian malignancy

A
  • bilateral
  • cysts >8cm
  • multiloculated
  • thick walled
  • papillary projections
  • ascites
43
Q

Types of ovarian neoplasia

A
  • celomic epithelium
  • germ cell
  • specialized gonadal stroma
  • non-specific mesenchyme
  • metastatic to ovary
44
Q

Possible tubal masses

A
  • ectopic pregnancy
  • pyosalpinx
  • hydrosalpinx
  • tubo-ovarian abscess
  • para tubal cyst
45
Q

Where do leiomyomas originate?

A

Müllerian duct

46
Q

Appearance of a fibroid

A
  • round, firm, white
  • pseudo capsule
  • whorled.
  • grow gradually
  • relatively avascular
  • undergo degeneration (hyaline, red, sarcomatous)
47
Q

What is a didelphic uterus?

A
  • double uterus with 2 cervices and 2 vaginas
48
Q

Factors associated with cervical cancer

A
  • early sexual debut
  • multiple partners
  • other STIs
  • smoking
  • OCP
49
Q

Symptoms of cervical cancer

A
  • abnormal vag bleeding (postcoital)
  • malodorous discharge (infection)
  • pelvic pain, weight loss, renal failure, fistula
50
Q

Patterns of spread of cervical cancer

A
  • direct
  • haematogenous
  • lymphatic (obturator nodes)
51
Q

Treatment of micro-invasive cervical Ca

A
  • cone biopsy

- simple hysterectomy

52
Q

What is removed in a radical hysterectomy?

A

Uterus, parametria, cuff of vagina, pelvic lymph nodes

53
Q

Vaccines for cervical Ca

A
  • bivalent (cervarix)

- quadrivalent (gardasil)

54
Q

What does VIA stand for

A

Visual inspection with acetic acid

55
Q

Features of ideal contraception

A
  • forgettable
  • reversible
  • usable
  • buy able
  • acceptable
  • invisible
  • infallible
56
Q

What does UPSI stand for?

A

Unprotected sexual intercourse

57
Q

Types of emergency contraception

A
  • progesterone only (Norlevo up to 72 hrs)
  • combined regimen (2 tablets 12 hrly)
  • CuT (up to 120 hrs)
58
Q

At what concentration can a pregnancy test work?

A

20mU (7-10 days after conception)

59
Q

Riffs of acute pregnancy related pain

A
  • rupture of ectopic
  • miscarriage
  • pre term labour
  • fibroid degeneration
60
Q

Adnexal disorders that cause pelvic pain

A
  • haemorrhagic functional ovarian cysts
  • torsion of adnexa
  • twisted para-ovarian cyst
  • rupture of functional cyst
61
Q

Causes of recurrent pelvic pain

A
  • mittelshmerz (ovulation pain)

- primary or secondary dysmenorrhea

62
Q

Where can pain refer in ectopic?

A

Right shoulder

63
Q

How to diagnose ectopic pregnancy

A
  • bhcg more than 2000
  • empty uterus on US
  • adnexae mass
64
Q

Medical management of ectopic

A

Methotrexate (anti-folate)

65
Q

Difference between gonococcal and chlamydial PID

A

Gonococcal is acute, chlamydial is insidious

66
Q

Dyschezia

A

Painful defeacation

67
Q

Causes of chronic pelvic pain

A
  • endometriosis
  • adenomyosis (endometrium in myometrium)
  • adhesions
  • pelvic congestion
  • salpingo-oopheritis
  • ovarian remnant syndrome
  • fibroids
  • IBS
68
Q

Type of pain with adhesions

A
  • non-cyclical

- increases with coitus

69
Q

Features of pelvic congestion

A

Pain starts with ovulation to end if menses

- bulky uterus with enlarged tender ovaries

70
Q

What does TAH BSO stand for?

A

Total abdominal hysterectomy bilateral salpingo-oophorectomy

71
Q

Where is pain felt with ovarian remnant syndrome

A

Lateral pelvic pain

72
Q

Definition of rape

A

Any person who unlawfully and intentionally commits an act of sexual penetration with another person without such persons consent

73
Q

Clip used to do tubal ligation

A

Filshee clip

74
Q

What is fitz- Hugh- Curtis syndrome?

A

A thinning of cervical mucus to allow bacteria from the vagina into the uterus and oviducts, causing infection and inflammation

75
Q

Another name for vaginal reconstruction

A

Colporhapphy

76
Q

What is colpocleisis?

A

Closure of the vagina

77
Q

Methods of TOP

A
  • vacuum curettage
  • medical
  • dilatation and evacuation
  • induction of labour
  • hysterotomy
  • hysterectomy
78
Q

Definition of TOP

A

The separation and expulsion by surigcal or medical means of the contents of the uterus of a pregnant woman

79
Q

When can medical TOP be performed

A

Up to 9 weeks

80
Q

Drugs used in medical TOP

A

Mifepristone
- progesterone antagonist
Misoprostol
- prostaglandin analogue (stim myometrium contraction)

81
Q

ERPOC

A

Evacuation of retained products of conception

82
Q

Amsel’s diagnostic criteria for bacterial vaginosis

A

3out of 4

  • homogenous vaginal discharge
  • fishy odour when mixed with pat assign hydroxide
  • clue cells present
  • raised vaginal PH
83
Q

Definition of menopause

A

Permanent cessation of menstraution due to loss of ovarian follicular activity
- 12 consecutive months of amenorrhea without other cause

84
Q

Definition of premature ovarian failure

A

Menopause before 40

Semester 6 (12 decks)

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