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womens health > Womens health > Flashcards

Womens health Flashcards

1
Q

Which organs are found in the pelvic cavity?

A

Ovaries
Uterine tubes
Uterus
Superior aspect of vagina

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2
Q

Which organs are found in the perineum?

A 
Inferior aspect of vagina
Perineal muscles
Bartholins glands
Clitoris
Labia
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3
Q

What separates the pelvic cavity from the perineum?

A

Pelvic floor muscles - levator ani

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4
Q

What forms the floor of the peritoneal cavity & roof of the pelvic cavity?

A

Inferior parietal peritoneum

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5
Q

What are the 2 clinically relevent pouches in the women?

A

Vesicouterine pouch

Rectouterine pouch

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6
Q

What is the broad ligament & what does it contain?

A

Double layer of peritoneum that keeps the uterus in midline position

Contains the uterine tubes & proximal aspect of the round ligament

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7
Q

What are the 3 layers of the uterus?

A

Perimetrium
Myometrium
Endometrium

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8
Q

What is the most common position of the uterus?

A

Antiverted - cervix tipped anterior to vagina

Antiflexed - uterus tipped anterior to cervix

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9
Q

Where does fertilisation occur

A

Ampulla

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10
Q

What is the connection between the pelvic cavity & peritoneal cavity

A

Fimbrae open into the peritoneal cavity

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11
Q

Which organ is the primary female reproductive organ

A

Ovaries

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12
Q

What is the role of the ovaries?

A

Secrete oestrogen & progesterone

Release ovum

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13
Q

What is the role of the levator ani muscle?

A

Tonic contraction - supports organs

Reflexively contracts further if intra-abdo pressure increases

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14
Q

What is the innervation of levator ani

A

S2,3,4 & S3,4,5

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15
Q

Which nerve innervates the peroneum

A

Pudendal nerve

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16
Q

What is the perineal body

A

A centre of collagen & elastin where the muscles of the perineum attach

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17
Q

What is the fornix?

A

The point at which the cervix holds the walls of the vagina apart

Anterior
Posterior
2 Lateral

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18
Q

What is the histological organisation of the ovaries?

A

Cortex - Tunica albuginea & germinal epithelium (cuboidal)

Medulla - helocrine arteries

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19
Q

What condition would be seen with low testosterone & high GnRH

A

Primary gonadal failure

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20
Q

What is the role of GnRH

A

It is secreted from the hypothalamus & stimulates the anterior pituitary to release LH & FSH

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21
Q

What is the role of FSH individually?

A

Stimulates follicular growth

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22
Q

What is the role of LH individually?

A

Stimulates further follicle development (production of the corpus luteum_

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23
Q

What is the role of LH & FSH together?

A

Stimulate the ovarian follicles to secrete oestrogen

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24
Q

What is the role of progesterone & oestrogen?

A

Prepare and maintain the endometrium for implantation

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25
Q

How is heavy menstrual bleeding (with no pathological cause) treated medically?

A

Mirena coil

Tranexamic acid

COC

Norethisterone

DMPA

Surgery

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26
Q

What are the causes of heavy menstrual bleeding?

A 
Fibroids
Polyps
Adenomyosis
Coagulopathy
Malignancy
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27
Q

What are premenstrual disorders?

A

premenstrual symptoms that have an impact on daily life

Physical, emotional & behavioural symptoms

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28
Q

How is premenstrual disorder diagnosed?

A

Symptom diary over a minimum of 2 cycles

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29
Q

What are the medical treatments of premenstrual disorder?

A

Ovulation suppression

  • Combined oral contraception
  • GnRH agonist - 6 month max
  • Surgery
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30
Q

What are the main indications for an endometrial biopsy?

A 
Abnormal uterine bleeding
Infertility
Miscarriage
Assess response to hormone therapy
Endometrial ablation
Cancer screening
Pre-hysterectomy work up
Incidental thickening seen on scan
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31
Q

What are the main forms of combined hormonal contraception?

A

Pill
Vaginal Ring
Patch

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32
Q

How does CHC work?

A

Stops ovulation via release of oestrogen & progesterone

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33
Q

What are the main risks associated with CHC?

A

VTE
Arterial disease
Breast & cervical cancer

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34
Q

How does Desogestrel work?

A

POP - inhibits ovulation via progesterone release

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35
Q

When is the progesterone only pill contraindicated?

A

In patients with breast cancer

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36
Q

Why is the progesterone only pill used in epileptics

A

anti-epileptic drugs are usually enzyme inducers which effect the efficacy of CHC

POP is not affected by enzyme inducers

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37
Q

What is the definition of menopause

A

The absence of period for 1 year

38
Q

What are the core symptoms of menopause

A

Mood swings
Night sweats
Hot flush

  • Affects all systems
39
Q

How is menopause diagnosed in perimenopausal women?

A

Treat the patient regardless of FSH levels

  • Measure FSH in women >50 on hormonal contraception that do not want to continue until 55
40
Q

When is FSH measured in perimenopausal women?

A

Measure FSH 6 weeks apart in women aged >45 in women with atypical symptoms OR in women 40-35 with menopausal symptoms and iatrogenic amenorrhoea

41
Q

What else should be checked in younger-perimenopausal women?

A 
FSH
E2
TFT
Glucose
Prolactin
FAI
  • <40

Check chromosomes & AI disease in women under 35

42
Q

What lifestyle changes should be considered for women with menopausal symptoms?

A 
Healthy diet
Phytoestrogens
Health weight
Exercise
Sleep
No smoking/alcohol/caffeine
Reduce stress
CBT
43
Q

What are the benefits of HRT

A 
Reduce vasomotor symptoms
Improve low mood
Reduce osteoporosis & fragility fractures
Improve sexual funsion
Prevent vulvovaginal atrophy
44
Q

What are the contraindications to HRT?

A 
History of breast cancer
Coronary heart disease
TIA/ stroke
Unexplained vaginal bleeding
Active liver disease
45
Q

General principles of HRT

A

If the patient has had a hysterectemy or mirena in situ - oestrogen only

If not - oestrogen and progesterone

46
Q

What are the main indications for transdermal HRT?

A 
Individual preference
Poor control with oral
GI disorder - absorption
Increased VTE risk
BP
Migraine
Use of enzyme inducers
Gall bladder disease
47
Q

How to treat vulvovaginal atrophy?

A

use vaginal oestrogens long term

48
Q

What are the main symptoms associated with ectopic pregnancy?

A

Abdo pain (iliac fossa)
Vaginal bleeding
Positive pregnancy test

49
Q

What investigations should be done with women experiencing ectopic pregnancy?

A

bHCG - to assess change

Serum progesterone

Transvaginal ultrasound

50
Q

How is ectopic pregnancy managed

A

Stable - wait

Pharmacology - methotrexate

Laprascopic salpingectomy

51
Q

What are the main symptoms associated with menopause?

A 
Hot flush
Night sweat
Irregular bleeding
Mood changes
MSK symptoms 
Vaginal dryness
Loss of libido
Sleep disturbance
52
Q

How is menopause treated medically

A

In women with uterus - Oestrogen & progesterone

In women without a uterus - Oestrogen only

53
Q

What age is premature ovarian insufficiency diagnosed?

A

Menopause before age 40

54
Q

What age is early menopause diagnosed?

A

40-44

55
Q

When are FSH levels tested in query menopause?

A

Women aged >45 with atypical symptoms

Women 40-45 with menopause symptoms & iatrogenic amenorrhoea

56
Q

How are FSH levels tested in menopausal women?

A

2 tests - 6 weeks apart

57
Q

What should be done in women with menopausal symptoms?

A

Trial HRT - Dependant on contraindications

58
Q

How are STI swabs taken in symptomatic females

A

NAAT test - vulvovaginal swab (pre speculum)

59
Q

How are STI tests taken in symptomatic males?

A

First void urine - holding for at least 2 hours

NAAT test

60
Q

How is chlamydia treated?

A

Doxycycline 100mg BD - 1 week

Azythromycin 1g stat + 500mg for 2 days

61
Q

How is Pelvic inflammatory disease treated?

A

Ceftriaxione - 1g IM
Doxycycline 100mg BD x 2 weeks
Metronidazole 400mg BD x 2 weeks

62
Q

How does chlyamidia present?

A 
Urethral discharge
Irregular bleeding
Abdo pain
Dysuria
Urethritis
Cervicitis
Epididymo-orchitis
Proctitis
63
Q

What are the main complications associated with chlyamidia?

A 
PID
Tubal damage
Reactive arthritis
Fitz-hugh-curtis (Liver)
Vertical transmission - pneumonia & conjunctivits
64
Q

What are the risk factors associated with endometrial cancer?

A

HPV -

65
Q

What are the classifications of ovarian cyst

A 
Follicular
Luteal
Endometriotic
Epithelial
Mesothelial
66
Q

What are “chocolate cysts”

A

Cysts on the endometrial lining- brown coloured due to haemorrhage

Endometriosis on the ovary

67
Q

What is endometriosis?

A

Endometrial glands & stroma outside of the uterine body

68
Q

What are the symptoms associated with endometriosis?

A

Pelvic inflammation, Pain, Infertility

69
Q

What are the classifications of ovarian tumour?

A

Epithelial
Germ cell
Sex-cord
Metastatic

70
Q

What are the different classes of epithelial origin ovarian tumours

A 
Serous
Mucoid
Endometriod
Clear cell
Brenner
Undifferentiated
71
Q

What are the different types of serous carcinoma (ovarian)

A

High grade - STIC

Low grade - serous borderline

72
Q

What are the main risk factors associated with cervical cancer?

A

Smoking
Long term oral contraception
HPV - 16 & 18
Immunosuppression

73
Q

What are the 2 major types of cervical cancer?

A

Squamous cell carcinoma

Adenocarcinoma

74
Q

What is the main symptom of cervical cancer?

A

Abnormal bleeding - post-coital or post-menopausal

75
Q

How is cervical cancer tested for?

A

Smear test to detect abnormal cells (koilocytosis)

If abnormal smear results - biopsy

76
Q

What is CIN?

A

Cervical intraepithelial neoplasia
- preinvasive stage of cervical cancer?
Seen in the tranformation zone

77
Q

What is CIN Histologically?

A

Squamous cell dysplasia
Delay in cell maturation
nuclear abnormalities

78
Q

How is invasive squamous carcinoma graded?

A

Figo staging

79
Q

What are the major symptoms of invasive squamous carcinoma

A 
Abnormal bleeding
Discharge
Pelvic pain
Haematuria
UTI
Ureteric obstruction
Renal Failure
80
Q

How does cervical SCC spread locally?

A 
uterus
Vagina
Bladder
Ureters
Rectum
81
Q

How does cervical SCC spread through lymph & haem

A

Early - lymph - pelvic & para-aortic nodes

Late - Haem - liver, lung, bone

82
Q

What other diseases are caused by HPV

A

Vulvar intraepithelial neoplasia
Vaginal intraepithelial neoplasia
Anal intraepithelial neoplasia

83
Q

What are the precursors to endometrial carcinoma?

A

Atypical hyperplasia - endometrial

Serous intraepithelial carcinoma - serous

84
Q

What are the main risk factors associated with endometrial cancer?

A 
nulligravida
Obesity
PCOS
Hypertension
Diabetes
85
Q

What is the main cause of endometrial cancer

A

Unopposed oestrogen - especially due to obesity

86
Q

What is seen O/E in endometrial cancer?

A

Speculum - nothing

Endometrial thickening in TVUS - biopsy necessary

87
Q

What are the 2 main types of endometrial cancer?

A

Type 1 - endometriod - unopposed oestrogen

Type 2 - serous & clear cell - TP53 mutation

88
Q

What is the precursor of type 1 endometrial cancer?

A

Atypical hyperplasia

Hyperplasia = increased cell number

89
Q

What us the precursor to type 2 endometrial tumours?

A

serous endometrial intraepithelial carcinoma

90
Q

How are type 2 endometrial tumours graded?

A

They arent graded - always assumed to be high grade

91
Q

What are the main types of ovarian tumour?

A

surface epithelium stroma
Germ cell
Sex cord stroma

92
Q

What are the main tumour markers associated wiht ovarian cancer?

A

Ca-125

Produced by mesothelium

womens health (1 decks)

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