13. Reproductive INCOMPLETE got to 6.5 LUSUMA notes

Question 1

What is amenorrhoea?

Answer 1

Absence of periods for at least 6 months.

Question 2

What is the difference between primary and secondary amenorrhoea?

Answer 2

Primary is never having a period by age 14 with absence of secondary sexual characteristics or by 16 with SSC, secondary is when established menstruation has ceased for three month in a woman with history of regular cyclic bleeding or nine months with irregular cyclic bleeding.

Question 3

What is oligomenorrhoea?

Answer 3

Infrequent period occurring at intervals of 35 days to 6 months.

Question 4

What is dysmenorrhoea?

Answer 4

Painful periods.

Question 5

What is menorrhagia?

Answer 5

Heavy periods: excessive (>80ml) or prolonged (>7 days).

Question 6

What is cryptomenorrhoea?

Answer 6

Periods occur but not visible due to obstruction in outflow tract.

Question 7

What is dysfunctional uterine bleeding?

Answer 7

Abnormal bleeding, no obvious organic cause.

Question 8

What are anovulatory cycles?

Answer 8

No ovulation/luteal phase, oligo/amenorrhoea +/- menorrhagia.

Question 9

What are ovulatory cycles?

Answer 9

Normal menstrual cycles + dysmenorrhoea/mastalgia (sore breasts).

Question 10

What is the pathophysiology behind hypothalamic/pituitary amenorrhoea?

Answer 10

Inadequate levels of FSH lead to inadequately stimulated ovaries, which then fail to produce enough oestrogen to stimulate endometrium of uterus.

Question 11

What is a primary hypothalamic cause of amenorrhoea?

Answer 11

Kallmann syndrome - inability to produce GnRH.

Question 12

What are some secondary hypothalamic causes of amenorrhoea?

Answer 12

Exercise amenorrhoea from physical exercise, stress amenorrhoea, eating disorders (weight drops below critical weight 47kg).

Question 13

What are some secondary pituitary causes of amenorrhoea?

Answer 13

Sheehan syndrome (hypopituitarism), hyperprolactinaemia, haeocrhomastosis.

Question 14

What is the pathophysiology behind gonadal/end-organ amenorrhoea?

Answer 14

Ovary does not respond to pituitary stimulation so oestrogen levels are low, lack of negative feedback from oestrogen causes elevated FSH levels.

Question 15

What are some causes of primary gonadal/end-organ amenorrhoea?

Answer 15

Gonadal dysgenesis (e.g. Turner syndrome), androgen insensitivity syndrome, receptor abnormalities for FSH and LH, congenital adrenal hyperplasia.

Question 16

What are some causes of secondary gonadal/end-organ amenorrhoea?

Answer 16

Pregnancy, anovulation, menopause, polycystic ovarian syndrome, drug-induced.

Question 17

What are some primary outflow tract obstruction causes of amenorrhoea?

Answer 17

Uterine - Mullerian agenesis.

Vaginal - vaginal atresia, cryptomenorrhoea, imperforate hymen.

Question 18

What is a secondary outflow tract obstruction cause of amenorrhoea?

Answer 18

Intrauterine adhesion (Asherman’s syndrome).

Question 19

How can amenorrhoea be managed?

Answer 19

Depends on cause, if insufficient in a hormone - hormone replacement, if due to lifestyle - modify factors.

Question 20

What is the pathophysiology behind dysfunctional uterine bleeding?

Answer 20

90% cases from no ovulation as corpus luteum doesn’t form to produce progesterone so oestrogen is made continuously -> overgrowth of uterine bleeding and subsequent bleeding.
10% from prolonged progesterone secretion with ovulation, low levels of oestrogen means irregular shedding of uterine lining and erratic bleeding.

Question 21

How is menorrhagia managed?

Answer 21

With progesterone.

Question 22

What are some of the common clinical problems of the ovary?

Answer 22

Ovarian cysts and tumours of the ovary.

Question 23

What is polycystic ovaries?

Answer 23

More than 10 cysts in ovary, associated with infertility.

Question 24

What cells of the ovaries have tumours most commonly?

Answer 24

Epithelial components or from germ cells.

Question 25

What is salpingitis?

Answer 25

Inflammation of the uterus tube caused by microorganisms causing fusions or adhesions of the mucosa and blocked lumen.

Question 26

How can salpingitis lead to trouble conceiving?

Answer 26

Fusions of adhesions of the mucosa of the uterine tube can block the lumen -> infertility. This could lead to ectopic pregnancy or implantation outside the uterus.

Question 27

What is endometriosis?

Answer 27

Ectopic endometrial tissue is dispersed to various sites along the peritoneal cavity and beyond.

Question 28

What are some of the complications of endometriosis?

Answer 28

Severe period pain (dysmenorrhoea), infertility.

Question 29

Where do most neoplasms form in endometrial carcinomas?

Answer 29

In the transformation zone - junction between columnar cells of endocervix and squamous cells of exocervix.

Question 30

What is the major symptoms of endometrial carcinoma?

Answer 30

Abnormal uterine bleeding.

Question 31

What are some of the clinical conditions affecting the greater vestibular glands (Bartholin glands)?

Answer 31

Bartholinitis (infection/inflammation), bartholin gland cyst (duct of gland is blocked -> cyst).

Question 32

What is vaginitis?

Answer 32

Inflammation of the vagina.

Question 33

What is vaginismus?

Answer 33

Condition making any vaginal penetration painful (e.g. tampon insertion, sexual intercourse) due to reflex of pubococcygeus muscle.

Question 34

What is ectopic implantation?

Answer 34

Implantation anywhere but the body of the uterus.

Question 35

What is the peritoneal cavity a risk of infection spread in females?

Answer 35

If is open via the ostium of the uterine tube.

Question 36

What is an episiotomy?

Answer 36

Cutting medio-lateral in labour to avoid perineal body rupture.

Question 37

How can the pelvic floor be damaged by stretching of nerves, muscles, and ligaments?

Answer 37

Stretch pudendal nerve -> neuropraxia and muscle weakness. Stretch and damage of pelvic floor and perineal muscle -> muscle weakness. Stretch/rupture of ligament supports of muscles -> ineffective muscle action.

Question 38

What are some risk factors for pelvic floor dysfunction?

Answer 38

Age, menopause (atrophy of tissue without oestrogen), obesity, chronic cough, intrinsic connective tissue laxity.

Question 39

Outline how pelvic floor dysfunction can be managed.

Answer 39

Pelvic floor muscle exercises, continence surgeries (tension-free vaginal tape), prolapse procedures.

Question 40

What are the pathogens causing the following sexually transmitted infections? HPV, herpes, chlamydia, gonorrhoea, syphilis, trichomoniasis.

Answer 40

``` HPV - human papillomavirus Herpes - herpes simplex virus type I (oral) or II (genital) Chlamydia - Chlamydia trachomatis Gonorrhoea - Neisseria gonorrhoeae Syphilis - Treponema pallidum Trichomoniasis - trichomonas vaginalis ```

Question 41

What are the differential diagnoses for genital skin and mucous membrane lesions?

Answer 41

Genital ulcers, vesicles or bullae, genital papules, anogenital warts.

Question 42

What are the differential diagnoses for urethritis (discharge, dysuria, frequency)?

Answer 42

Gonococcal urethritis, chlamydial urethritis, non-specific urethritis, post-gonococcal urethritis, non-infectious urethritis.

Question 43

What are the differential diagnoses for vulvo-vaginitis and cervicitis?

Answer 43

Vulvo-vaginitis, cervicitis, bacterial vaginosis, Bartholinitis.

Question 44

What are the differential diagnoses for infection of the female pelvis?

Answer 44

Pregnancy-related, pelvic inflammatory disease.