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repro and sexual health > diseases > Flashcards

diseases Flashcards

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1
Q

why does ovarian torsions occur

A

due to hypermobility of the ovary or
adnexal mass, most commonly a dermoid cyst

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2
Q

investigation for ovarian torsion

A

bloods- raised white cells
US- initial imaging of choice (whirlpool sign)
CT

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3
Q

management of ovarian torsion

A

urgent surgery

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4
Q

where is HCG secreted from

A

syncytiotrophoblast
it acts to maintain the production of progesterone by the corpus luteum in early pregnancy

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5
Q

what type of origin is ovarian cancer

A

epithelial

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6
Q

risk factors for ovarian cancer

A

family history: BRAC
many ovulations: early menarche, late menopause, nullipartity

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7
Q

70 year old with dragging sensation down below and incontinence

A

uterine prolapse

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8
Q

management of prolapse

A

lifestyle- wt loss, stop smoking, avoid heavy lifting
oestrogens- only is symptomatic atrophic vaginitis
pelvic floor exercises
pessaries- if unfit for surg
surgical

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9
Q

treatment of urge incontinence

A

mainly lifestyle and bladder retraining
medications- antimuscarinics (oxybutynin and tolterodine), B3 agonists
posterial tibial nerve stimulation

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10
Q

investigations for disrupted uterine bleeding

A

if regular cycle do a midluteal progesterone
if an irregular cycle doe a progesterone challenge test

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11
Q

hypothalamic causes for DUB

A

genetic causes
idiopathic hypogondaotrophic hypogondsim
kallmas syndrome- lack of smell
other factors- anorexia, bulimia

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12
Q

results in hypothalamic cause of DUB

A

low everything- GnRH, low FSH, low LH, low oestrogen and progesterone

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13
Q

results in pituitary caused DUB

A

high GnRH, low FSH, low LH, low oestrogen and progesterone

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14
Q

causes of pituitary DUB

A

drugs- dopamine antagonists
sheehan’s syndrome
prolactinoma
pituitary adenoma

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15
Q

ovarian causes of DUB

A

PCOS
premature ovarian failure
congenital
tubal disease

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16
Q

criteria for diagnosing PCOS

A

rotterdam criteria
1. oligo/amenorrhoea
2. hyperandrogenism- hirsutism (increased free testosterone)
3. evidence of Polycystic ovaries on USS

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17
Q

clinical features of PCOS

A

obesity
hirsutism
acne
cycle abnormalities
infertility
insulin resistance

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18
Q

treatment of PCOS

A

lifestyle- wt loss
NOT wanting a family: OCP (dianette if hirsutism), metformin
wanting a family: clomifene citrate +/- metformin, (2nd line gonadotrophin therapy, 3rd line IVF/laparoscopic drilling)

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19
Q

what is premature ovarian failure

A

menopause <40 years old
decrease in oestrogen
increase in FSH >30

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20
Q

causes of premature ovarian failure

A

idiopathic
chemo/radiotherapy
genetic: turners syndrome, fragile X

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21
Q

treatment of premature ovarian failure

A

HRT

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22
Q

infective causes of tubal disease

A

PID
transperitoneal spread
post-procedure

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23
Q

non-infective causes of tubal disease

A

endometriosis
surgical (sterilisation/ectopic)
fibroids/polyps
congenital

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24
Q

presentation of PID

A

fever, pain, discharge, cervical excitation, deep dyspareunia

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25
complications of PID
infertility hydrosalpinx ectopic pregnancy chronic pain abscess
26
management of PID
High risk of GC or <18 years – IM ceftriaxone 500mg IM single dose then doxycycline 100mg bd + metronidazole 400mg bd (14 days) Low risk of GC - Ofloxacin 400mg bd + metronidazole 400mg bd (14days)
27
endometriosis presentation
dysmennorrhoea, menorrhagia, dyspareunia, painful defecation, pelvic pain is cyclical (tissue under hormonal influence), bloating and distension
28
investigations for endometriosis
USS- chocolate cysts on ovary, diagnostic laparoscopy- definitive investigation
29
treatment of endometriosis
1. COCP/mirena IUD + NSAIDs 2. GnRH agonist eg goserelin- not if they want to get pregnant 3. laparoscopic ablation
30
what is adenomyosis
endometrial glands and stroma within the myometrium also presents with menorrhagia and dysmenorrhoea (boggy uterus)
31
what is leiomyoma
benign smooth muscle growth is oestrogen dependent presents with pain, menorrhagia, infertility
32
what is endometritis
plasma cells in endometrial stroma infective until proven otherwise
33
primary treatment of dysmenorrhoea
NSAIDs COCP is pretty definitive treatment
34
first line of menorrhagia
mirena IUS 2nd line: tranexamic acid 3rd line: IM progestogens
35
what is cervical extropion
physiological condition get squamous metaplasia of the endocervical columnar epithelium caused by vaginal acidity exacerbated by increase in oestrogen (pregnancy of COCP)
36
what do infected cells in HPV show
koilocytosis- paler cells with oddly shaped nuclei
37
what strains does the HPV vaccine protect against
HPV types 6, 11, 16, 18
38
plan if HPV screen is negative
repeat screen in 5 years
39
plan if HPV screen is positive
do cytology > if positive then do coloposcopy > if negative recall for screening in 1 year
40
precursor for Squamous cervical cancer
CIN
41
adenocarcinoma of cervix
rarer higher SE, smoking HPV 18 later onset sexual activity
42
symptoms of cervical cancer
abnormal bleeding particularly post coital blood stained discharge contact bleeding pelvic pain haemeaturia ureteric obstruction
43
how is spread of cervical cancer determined
FIGO staging system - first locally, then liver, lungs and bone
44
vulvar paget's disease
crusting rash sharp demarcation- intraepithelial adenocarcinoma
45
'Beads-on-a-string' sign on USS
chronic salpingitis- mural nodules appearing as beads and the relatively thin wall appearing as string
46
fibroids on USS
hypoechoic masses
47
snow storm on imaging
hydatidiform mole
48
what is a bartholins cyst/abscess
build up of mucus secretion can cause the duct of the gland to become become blocked
49
where are bartholin's cysts found
4 and 8 o'clock positions
50
presentations of bartholin's cyst
typically soft, fluctuant and non-tender
51
presentation of bartholin's abscess
typically tense and hard with surrounding cellulitis
52
management if the bartholins cyst of abscess keep coming back
surgical procedure- marsupialisation
53
risk factors for uterine cancer
unopposed oestrogen (obestity, nulliparity, early menarche/late menopause, tamoxifen, PCOS) and lynch sundrome
54
what is protective against uterine cancer
COCP
55
peak incidence of entometrial cancer
50-60 years if in young women, consider underlying predisposition- PCOS or lynch
56
types of endometrial cancer
endometrioid and mucinous carcinoma serous and clear cell carcinoma
57
most common presentation of endometrial cancer
postmenopausal bleeding
58
general presentations for endometrial cancer
postcoital bleeding intermenstrual bleeding unusually heavy menstrual bleeding abnormal vaginal discharge haematuria anaemia raised platelet count
59
what is a endometrioid carcinoma
oestrogen driven cancer with a good prognosis
60
what is a serious carcinoma
NOT oestrogen driven but TP53 mutation, more aggressive cancer and worse prognosis
61
what is a fibroid
benign smooth muscle tumour in the uterus
62
presenting complaint with fibroids
menorrhagia, uterine mass (bulky), infertility, pain (torsion or red degeneration)
63
what is red degeneration
occurs at pregnancy and menopause due to thrombosis of venous blood supply- bed rest and analgesia
64
risk factors for ovarian cancer
think more cycles more risk older age young first pregnancy nulliparity obesity
65
types of ovarian cancers
epithelial cell tumours dermoid/germ cell tumours sex cord-stromal tumours metastasis
66
epithelial cell ovarian tumours
arise from epithelial cells most common - serous tumours- most common subtype - also endometrioid, clear cell, mucinous, undifferentiated
67
dermoid cysts/ germ cell ovarian tumours
benign ovarian tumours teratomas- come from germ cells associated with ovarian torsion
68
blood tests in germ cell ovarian tumours
may cause raised alpha fetoprotein and HCG
69
krukenberg tumour
metastasis in ovary usually from GI tract cancer signet-ring cells on histology
70
type of ovarian cancer arising from stroma
granulose cell (oestrogen), theca/leydig cell (androgen), fibroma (meig's syndrome)
71
yellow benign ovarian cancer
benign
72
most common ovarian cancer
serous
73
most common ovarian cancer under 25 years old
teratoma
74
meigs syndrome
triad of benign ovarian tumour, ascites, pleural effusion
75
RMI for ovarian cancer
risk of malignancy index menopausal status, USS, CA125
76
normal flora of the vagina
lactobacilus group B strep small number of candida strep viridans groups
77
risk factors for candida
antibiotics poorly controlled diabetes high oestrogen levels immunocompromised
78
presentation of candida
itchy and white discharge
79
treatment of candida
Reassure Clotrimazole 500mg pessary OR Fluconazole 150mg stat Clotrimazole 1% cream for external symptoms Worsening/recurring advice
80
what is BV
gardnarella vaginitis/anaerobes- get an imbalance of flora
81
presentation of BV
thin watery discharge and stinks of fish
82
management of BV
Reassure Metronidazole 400mg bd 5/7 Worsening/recurring advice

repro and sexual health (21 decks)

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