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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
How is heavy menstrual bleeding (with no pathological cause) treated medically?
Mirena coil Tranexamic acid COC Norethisterone DMPA Surgery
26
What are the causes of heavy menstrual bleeding?
``` Fibroids Polyps Adenomyosis Coagulopathy Malignancy ```
27
What are premenstrual disorders?
premenstrual symptoms that have an impact on daily life Physical, emotional & behavioural symptoms
28
How is premenstrual disorder diagnosed?
Symptom diary over a minimum of 2 cycles
29
What are the medical treatments of premenstrual disorder?
Ovulation suppression - Combined oral contraception - GnRH agonist - 6 month max - Surgery
30
What are the main indications for an endometrial biopsy?
``` Abnormal uterine bleeding Infertility Miscarriage Assess response to hormone therapy Endometrial ablation Cancer screening Pre-hysterectomy work up Incidental thickening seen on scan ```
31
What are the main forms of combined hormonal contraception?
Pill Vaginal Ring Patch
32
How does CHC work?
Stops ovulation via release of oestrogen & progesterone
33
What are the main risks associated with CHC?
VTE Arterial disease Breast & cervical cancer
34
How does Desogestrel work?
POP - inhibits ovulation via progesterone release
35
When is the progesterone only pill contraindicated?
In patients with breast cancer
36
Why is the progesterone only pill used in epileptics
anti-epileptic drugs are usually enzyme inducers which effect the efficacy of CHC POP is not affected by enzyme inducers
37
What is the definition of menopause
The absence of period for 1 year
38
What are the core symptoms of menopause
Mood swings Night sweats Hot flush - Affects all systems
39
How is menopause diagnosed in perimenopausal women?
Treat the patient regardless of FSH levels - Measure FSH in women >50 on hormonal contraception that do not want to continue until 55
40
When is FSH measured in perimenopausal women?
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
What else should be checked in younger-perimenopausal women?
``` FSH E2 TFT Glucose Prolactin FAI ``` - <40 Check chromosomes & AI disease in women under 35
42
What lifestyle changes should be considered for women with menopausal symptoms?
``` Healthy diet Phytoestrogens Health weight Exercise Sleep No smoking/alcohol/caffeine Reduce stress CBT ```
43
What are the benefits of HRT
``` Reduce vasomotor symptoms Improve low mood Reduce osteoporosis & fragility fractures Improve sexual funsion Prevent vulvovaginal atrophy ```
44
What are the contraindications to HRT?
``` History of breast cancer Coronary heart disease TIA/ stroke Unexplained vaginal bleeding Active liver disease ```
45
General principles of HRT
If the patient has had a hysterectemy or mirena in situ - oestrogen only If not - oestrogen and progesterone
46
What are the main indications for transdermal HRT?
``` Individual preference Poor control with oral GI disorder - absorption Increased VTE risk BP Migraine Use of enzyme inducers Gall bladder disease ```
47
How to treat vulvovaginal atrophy?
use vaginal oestrogens long term
48
What are the main symptoms associated with ectopic pregnancy?
Abdo pain (iliac fossa) Vaginal bleeding Positive pregnancy test
49
What investigations should be done with women experiencing ectopic pregnancy?
bHCG - to assess change Serum progesterone Transvaginal ultrasound
50
How is ectopic pregnancy managed
Stable - wait Pharmacology - methotrexate Laprascopic salpingectomy
51
What are the main symptoms associated with menopause?
``` Hot flush Night sweat Irregular bleeding Mood changes MSK symptoms Vaginal dryness Loss of libido Sleep disturbance ```
52
How is menopause treated medically
In women with uterus - Oestrogen & progesterone In women without a uterus - Oestrogen only
53
What age is premature ovarian insufficiency diagnosed?
Menopause before age 40
54
What age is early menopause diagnosed?
40-44
55
When are FSH levels tested in query menopause?
Women aged >45 with atypical symptoms Women 40-45 with menopause symptoms & iatrogenic amenorrhoea
56
How are FSH levels tested in menopausal women?
2 tests - 6 weeks apart
57
What should be done in women with menopausal symptoms?
Trial HRT - Dependant on contraindications
58
How are STI swabs taken in symptomatic females
NAAT test - vulvovaginal swab (pre speculum)
59
How are STI tests taken in symptomatic males?
First void urine - holding for at least 2 hours | NAAT test
60
How is chlamydia treated?
Doxycycline 100mg BD - 1 week Azythromycin 1g stat + 500mg for 2 days
61
How is Pelvic inflammatory disease treated?
Ceftriaxione - 1g IM Doxycycline 100mg BD x 2 weeks Metronidazole 400mg BD x 2 weeks
62
How does chlyamidia present?
``` Urethral discharge Irregular bleeding Abdo pain Dysuria Urethritis Cervicitis Epididymo-orchitis Proctitis ```
63
What are the main complications associated with chlyamidia?
``` PID Tubal damage Reactive arthritis Fitz-hugh-curtis (Liver) Vertical transmission - pneumonia & conjunctivits ```
64
What are the risk factors associated with endometrial cancer?
HPV -
65
What are the classifications of ovarian cyst
``` Follicular Luteal Endometriotic Epithelial Mesothelial ```
66
What are "chocolate cysts"
Cysts on the endometrial lining- brown coloured due to haemorrhage Endometriosis on the ovary
67
What is endometriosis?
Endometrial glands & stroma outside of the uterine body
68
What are the symptoms associated with endometriosis?
Pelvic inflammation, Pain, Infertility
69
What are the classifications of ovarian tumour?
Epithelial Germ cell Sex-cord Metastatic
70
What are the different classes of epithelial origin ovarian tumours
``` Serous Mucoid Endometriod Clear cell Brenner Undifferentiated ```
71
What are the different types of serous carcinoma (ovarian)
High grade - STIC Low grade - serous borderline
72
What are the main risk factors associated with cervical cancer?
Smoking Long term oral contraception HPV - 16 & 18 Immunosuppression
73
What are the 2 major types of cervical cancer?
Squamous cell carcinoma | Adenocarcinoma
74
What is the main symptom of cervical cancer?
Abnormal bleeding - post-coital or post-menopausal
75
How is cervical cancer tested for?
Smear test to detect abnormal cells (koilocytosis) If abnormal smear results - biopsy
76
What is CIN?
Cervical intraepithelial neoplasia - preinvasive stage of cervical cancer? Seen in the tranformation zone
77
What is CIN Histologically?
Squamous cell dysplasia Delay in cell maturation nuclear abnormalities
78
How is invasive squamous carcinoma graded?
Figo staging
79
What are the major symptoms of invasive squamous carcinoma
``` Abnormal bleeding Discharge Pelvic pain Haematuria UTI Ureteric obstruction Renal Failure ```
80
How does cervical SCC spread locally?
``` uterus Vagina Bladder Ureters Rectum ```
81
How does cervical SCC spread through lymph & haem
Early - lymph - pelvic & para-aortic nodes Late - Haem - liver, lung, bone
82
What other diseases are caused by HPV
Vulvar intraepithelial neoplasia Vaginal intraepithelial neoplasia Anal intraepithelial neoplasia
83
What are the precursors to endometrial carcinoma?
Atypical hyperplasia - endometrial Serous intraepithelial carcinoma - serous
84
What are the main risk factors associated with endometrial cancer?
``` nulligravida Obesity PCOS Hypertension Diabetes ```
85
What is the main cause of endometrial cancer
Unopposed oestrogen - especially due to obesity
86
What is seen O/E in endometrial cancer?
Speculum - nothing Endometrial thickening in TVUS - biopsy necessary
87
What are the 2 main types of endometrial cancer?
Type 1 - endometriod - unopposed oestrogen Type 2 - serous & clear cell - TP53 mutation
88
What is the precursor of type 1 endometrial cancer?
Atypical hyperplasia Hyperplasia = increased cell number
89
What us the precursor to type 2 endometrial tumours?
serous endometrial intraepithelial carcinoma
90
How are type 2 endometrial tumours graded?
They arent graded - always assumed to be high grade
91
What are the main types of ovarian tumour?
surface epithelium stroma Germ cell Sex cord stroma
92
What are the main tumour markers associated wiht ovarian cancer?
Ca-125 Produced by mesothelium

womens health (1 decks)

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