Women's health - Pathology and symptoms Flashcards

Question

Hyatidiform mole/molar pregnancy Rf Pathology Sx

Answer 1

Chromosomal abnormal pregnancies that have the potential to become malignant RF - Asian women, first trimester of pregnancy Gestational trophoblastic disease - Trophoblastic tissue part of the blastocyst that invades the endometrium proliferates more aggressively than normal. 1) Hyatidiform mole - where proliferation is localised and non invasive. --- PREMALIGNANT 2) Invasive mole - molar tissue invade the myometrium (locally invasive) Malignant (gestational trophoblastic neoplasm) If metastases occurs = Choriocarcinoma (chemosensitive) Sx - Vaginal bleeding (from light spotting to heavy bleeding) - Uterine size is greater than expected for gestational age (Possible: Pre eclampsia, hyperthyroidism, nausea and vomiting)

Answer 2

Rf - MEN 1, oestrogen therapy, females aged 20-50 Pathology - Benign lactotroph adenomas - Represent 50% of all pituitary adenomas Sx - Amenorrhea - Infertility - Galactorrhoea - Osteoporosis Dx - Serum prolactin - Pituitary MRI Tx - Dopamine agonists (cabergoline, bromocriptine) GS - Trans-sphenoidal resection of the pituitary

Answer 3

Rf - 60 years, mutation of BRCA1/BRCA2, early menarche, late menopause, nulliparity ( the last 3 relates to the number of ovulations --> the higher the number of ovulations, the higher the risk) Pathology - 90% are epithelial in origin (epithelium covers the ovarian capsule and distal fallopian tube). (with 70-80% being serous adenocarcinomas - serous epithelial layer) - The disease is widely metastatic as they usually present late. Sx (Vague) - Abdominal distention (/mass) and bloating - Abdominal and pelvic pain - Urinary symptoms - urgency/frequency - Early satiety - Diarrhoea

Answer 4

Rf - early menarche, PCOS, pre-menopausal group, first trimester of pregnancy Benign ovarian cysts - very common Complex (e.g. multi-loculated) ovarian cysts should be biopsied to exclude malignancy. Pathology Follicular cyst - Most common type of ovarian cyst - Due to non-rupture of the dominant follicle Corpus luteum cyst - If corpus luteum doesn't break down (when pregnancy does not occur) - Can present with intraperitoneal bleeding (Benign germ cell tumour - Dermoid cyst/teratoma --> most common in women <30 years (may contain, skin, hair, teeth)) Vague symptoms - Palpable adnexal mass (near the fallopian tube and ovaries) - Abdominal distension/bloating - Early satiety - Pelvic pain

Answer 5

Torsion of the ovary on its supporting ligaments that may compromise the blood supply. (if fallopian tube also involved - adnexal torsion) Rf - Ovarian mass, reproductive age, pregnancy, ovarian hyperstimulation syndrome Sx - Sudden onset (usually unilateral) colicky abdominal pain with a history of recent vigorous activity/sudden increase in abdominal pressure - Vomiting - Fever in a minority Dx - Ultrasound - whirlpool sign GS (diagnostic and therapeutic) - Laparoscopy/surgical detorsion/salpingo-oopherectomy

Answer 6

(Sexually transmitted) Infection and inflammation of the female pelvic organs (uterus, fallopian tubes, ovaries and surrounding peritoneum) Rf: Young age sexual activity, unprotected sex, history of PID, multiple sex partners Pathology - Usually the result of ascending infection from the endocervix Common causes - Chlamydia trachomatis - Most common cause - N.gonorrhoea - Mycoplasma Sx - Bilateral lower abdominal pain - Dyspareunia - Fever, vomiting - Dysuria - Menstrual irregularities and vaginal discharge - Cervical excitation (pain on moving cervix)

Answer 7

A condition of ovarian dysfunction affecting 5-20% of women of reproductive age. Pathology - Highly associated with hyperinsulinaemia and high levels of luteinising hormone Sx - Subfertility and infertility - Menstrual disturbances; oligomenorrhoea and amenorrhoea - Hirsutism, acne (due to hyperandrogenism) - Obesity

Answer 8

A short term dip in mood after delivering a baby. (Seen in 6-70% of women) It usually starts 2-7 days after giving birth and goes away 1-2 weeks after. (Could be due to changes in hormone levels - oestrogen dropping by more than 100 times. or due to parental stress) Sx - Mood swings - Irritable, anxious, restless - Feeling guilty that you're not happy - Fatigue - Changes to appetite (Usually emotional support, counselling and patience can help a new mum get through this period)

Answer 9

RF: history of depression, recent stressful life events, poor social support Affects about 10% of women. Depression starts within a month and peaks at 3 months Sx - Depression - Anhedonia (loss of interest and pleasure) - Decreased energy - Suicidal - Unreasonable self-blaming/guilt Investigations Depression identification questions - During the last month, have you often been bothered by feeling down, depressed or hopeless? - During the last months, have you often been bothered by having little interest of pleasure in doing things? 1) Edinburgh postnatal depression scale (score >13 = suggestive of moderate depression) 2) Patient health questionnaire 9 (PHQ 9) score (score <16 = less severe depression) Tx - Reassurance and support 1st line - Cognitive behavioural therapy 2nd line - In breast feeding women/severe symptoms --> SSRIs (Sertraline/paroxetine)

Answer 10

A mental health emergency affecting a person's sense of reality. (Affects 0.2% of women) Rf: first child, history of PP, sleep deprivation Pathology - Onset within the first 2-3 weeks following birth (up to 6 weeks after) Sx - Severe mood swings - Hallucinations - Delusions (false beliefs) - Higher risk of harming themselves or their child - Irritable Dx - Blood and urine tests - CT/MRI (All to exclude other causes) Tx - Admission to hospital Antipsychotics, mood stabilisers, antiepileptics

Answer 11

Persistent low mood, loss of interest and enjoyment and reduced energy leading to social and occupational dysfunction. Rf - Postnatal status, family history, history of anxiety disorder, adverse childhood experiences. Sx - Depressed mood/loss of interest for most of the day, nearly every day for a period of 2 weeks. - Diminished interest of pleasure in almost all/all activities most of the day, nearly every day for a period of 2 weeks - Weight loss - Sleep disturbance - Low energy - Excessive guilt - Poor concentration - Suicidal ideation

Answer 12

Implantation of a fertilised ovum outside the uterus Rf: (Anything that can slow the ovum's passage to the uterus) - Pelvic inflammatory disease (damages the tubes), endometriosis, progesterone only pill, IVF, IUD use, smoking, STI Pathology - Most common site - ampulla of fallopian tube - Most dangerous in the isthmus as it increases the risk of rupture - Should the ectopic pregnancy rupture, the women may present in shock from blood loss (and referred pain from intraperitoneal blood) Sx - history of 6-8 weeks amenorrhoea who presents with lower abdominal pain and later develops dark vaginal bleeding. - Constant lower abdominal pain (due to tubal spasm - mostly unilateral) - Dizziness or syncope - Peritoneal bleeding can cause shoulder pain. (Pregnancy related symptoms like breast tenderness)

Answer 13

Rf - Advanced maternal age (>35), history of miscarriage, smoking, alcohol, obesity, diabetes, thyroid problems, previous cervical cone biopsy. Pathology - Highest incidence in the first trimester (first 12 weeks) - Chromosomal abnormalities account for 50% of early miscarriages Sx - Vaginal bleeding with/without clots - Suprapubic pain (cramping may signify the process of expulsion of the fetus) (post coital bleeding)

Answer 14

1) Threatened miscarriage - Painless vaginal bleeding (usually within the first 12 weeks) 2) Missed/delayed miscarriage - A gestational sac containing a dead fetus before 20 weeks without the symptoms of expulsion (light vaginal bleeding/discharge -Symptoms of pregnancy disappear) 3) Inevitable miscarriage - Heavy bleeding with clots and pain - Cervical os is open 4) Incomplete miscarriage - Not all products of conception have been expelled - Pain and vaginal bleeding - Cervical os is open

Answer 15

3 or more consecutive spontaneous abortions. Causes - Antiphospholipid syndrome - Poorly controlled diabetes/thyroid disorders - PCOS - Parental chromosomal abnormalities - Smoking

Answer 16

(Abortion) - 2 registered medical practitioners must sign a legal document. Abortion can only be performed within 24 weeks of gestation. Anti-D prophylaxis should be given to women are rhesus D negative and are having an abortion after 10 weeks gestation --> to prevent the mother's own body from producing it's own natural anti-D prophylaxis (which can affect future pregnancies) Medical abortion - Mifepristone (anti-progestogen) followed by misoprostol 48 hours later - to stimulate uterine contractions (this mimicks a miscarriage) Multi-level pregnancy test (detecting hCG level) - A pregnancy test is required after 2 weeks to confirm the pregnancy has ended. Surgical - Transcervical proecdures e.g. vaccum aspiration, dilatation and evacuation --> Following this, an intrauterine contraceptive can be inserted immediately after evacuation.

Answer 17

Twins occur 1 in 100 pregnancies, triplets 1 in 10000 pregnancies. Rf of dizygotic twins: Previous twins, IVF, induced ovulation, multigravida, increasing maternal age, Afro-carribean. Types of multiple pregnancies 1) Dizygotic twins (most common twin type - 80%) - Non identical - Fertilisation of 2 different oocytes by 2 different sperm (Triplets same cause) 2) Monozygotic twins - Identical - A single ovum that (mitotically) divided into 2 embryos --> Monoamniotic monozygotic twins share the same placenta and amniotic sac. They are associated with: increased spontaneous miscarriage, perinatal mortality rate, increased malformations, prematurity (Most diagnosed only at ultrasound. (Uterus may be larger and palpable before 12 weeks)

Answer 18

Maternal complications - Gestational diabetes - Pre-eclampsia - Anaemia (due to increased blood volume - dilutional effect + increased demand for folic acid and iron) Antenatal complications (for twins. Triplets will be worse odds) - Greater mortality (6x) - Long term handicap (5x) (Rf: pre term delivery, intrauterine growth restriction, monochorionicity) Monochorionicity 1) Monochorionic, diamniotic - shared placenta but separate amnions --> Leads to twin-twin transfusion syndrome (TTTS) - unequal blood distribution due to abnormal vascular anastomoses with the shared placenta --> One twin (the donor) develops anaemia, IUGR and oligohydramnios whilst the other may develop polycythaemia, polyhydramnios. (TX: laser ablation) - poor prognosis

Answer 19

Defined as BMI >30. Maternal risks - Miscarriage - Venous thromboembolism - Gestational diabetes - Pre-eclampsia - Postpartum haemorrhage - Wound infections (Higher C-section rate) Fetal risks - Prematurity - Macrosomia - Stillbirth - Increased risk of developing obesity and metabolic disorders in childhood - Neonatal death (within the first 28 days of birth)

Answer 20

Rf - Obese, previous gestational diabetes, previous macrosomic baby, first degree relative with diabetes, unexplained still birth in previous pregnancy, south asian (usually asymptomatic) Pathology - Glucose tolerance decreases in pregnancy Fetal complications - Macrosomia - Raised fetal blood glucose levels induce fetal hyperinsulinemia --> increased fetal fat deposition and excessive growth - POLYHYDRAMNIOS - Raised blood glucose --> increased glucose excretion into the urine --> water follows glucose --> thus producing more urine than usual - Congenital abnormalities - neural tube or cardiac defects Maternal complications - Hypoglycemia may result from treatment - UTI infection - Pre-eclampsia - Pre-existing ischaemic heart disease can worsen

Answer 21

(Blood pressure falls in the first 24 weeks of pregnancy) Rf of gestational hypertension: nulliparous, maternal age >35, black, obesity. 3 types of hypertension 1) Pre-existing hypertension - A history of hypertension before pregnancy/before 20 weeks gestation - No proteinuria/oedema - If a pregnant woman is taking ACE inhibitor or ARB for hypertension, stop this immediately and start labetolol 2) Gestational hypertension - Blood pressure > 140/90 occurring after 20 weeks gestation in a previously normotensive patient without the presence of proteinuria. - No proteinuria, no oedema - Resolves following birth (after 1 month) - increased risk of pre-eclampsia or hypertension later in life (also an increase in systolic >30 or diastolic >15) MANAGEMENT - Regular monitoring of BP and urinalysis during the pregnancy to exclude pre-eclampsia 1st line - Oral labetalol 2nd line/asthmatic - oral nifedipine (hydralazine) 3) Pre-eclampsia - Pregnancy induced hypertension associated with proteinuria - Possible oedema

Answer 22

New onset BP >14/90 after 20 weeks of pregnancy AND proteinuria/other organ involvement e.g. renal insufficiency (creatinine > 90), liver, neurological, uteroplacental dysfunction. Triad of: new-onset hypertension, proteinuria, oedema Pre-eclampsia is thought to be caused by abnormal trophoblast invasion and failure of spiral artery remodelling --> and so remains narrow and high resistance --> hypoxic placenta --> oxidatively stressed placenta over secretes proteins --> resulting in manifestations of the disease RF: hypertension in previous pregnancy, CKD, autoimmune diseases, diabetes, maternal age >40, obesity, family history, nulliparity Sx - Hypertension (usually >160/110) - Proteinuria - Headache - Visual disturbance - Papilloedema - Oedema - Abdominal pain (RUQ/epigastric) - Hyperreflexia - Low platelets, abnormal liver enzymes or HELLP syndrome

Answer 23

A subtype of severe pre-eclampsia characterised by: Haemolysis - Dark urine, raised lactic dehydrogenase, anaemia Elevated Liver enzymes - epigastric pain, liver failure, abnormal clotting Low platelets - normally self limiting

Answer 24

The development of seizures in association with pre-eclampsia - Pregnancy induced hypertension after 20 weeks gestation with proteinuria Tx First line - magnesium sulphate (for prevention and treatment of seizures) - should be continued for 24 hours after delivery/last seizure Important things to monitor during treatment: - Oxygen saturations - Urine output - Reflexes - Respiratory rate (if respiratory depression occurs due to magnesium sulphate, GIVE CALCIUM GLUCONATE)

Women's health - Pathology and symptoms Flashcards

(49 cards)