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Disorders of the Reproductive System Flashcards

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1
Q

What is Amenorrhoea?

A

Absence of Menses
Primary - Never Present, also secondary sexual characteristics are absent from age 14

Secondary - Where established Menstruation has ceased for 3 months/6 months

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2
Q

What is PMS?

A

Pre-Menstrual Syndrome.

Emotional and Physical Symptoms in the 2nd half of the menstrual cycle

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3
Q

What is Menorrhagia?
What is Dysmenorrhoea?
What is Oligomenorrhoea?

A

Abnormal heavy bleeding or length of a period.
Painful menstruation.
Irregular intervals between menses

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4
Q

What can cause Primary Amenorrhoea?

A

Outflow Tract Obstruction - Mullarian Agenesis
Imperforate Hymen
Atresic Vagina
Cryptomenorrhoea

Gonadal - Dysgenesis (Turners)
Androgen Insensitivity
Congeital Adrenal Hyperplasia
FSH/LH Receptor Abnormalities

Kallmann’s Syndrome
Hyper/Hypothyroidism

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5
Q

What can cause Secondary Amenorrhoea?

A

Outflow Tract Obstruction - Intrauterine Adhesions

Gonadal Disorders - Pregnancy
PCOS
Menopause

Hypothalamus - Exercise
Stress
Weight

Pituitary - Sheehan syndrome
Hyperprolactinaemia
Haemochromatosis

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6
Q

What is DUB?

A

Dysfunctional Uterine Bleeding

Abnormal Bleeding - heavy, prolonged, frequent

Causes 60% of menorrhagia

No obvious cause (pathology/pregnancy or other bleeding disorders), normally anovulatory

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7
Q

What can cause Menorrhagia?

A 
Fibroids
DUB
Coagulation Defects
Endometrial Carcinoma
Polyps
PID
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8
Q

What is Hyperprolactinaemia?

What does it cause?

A

Increase Prolactin Secretions

Secondary Amenorrhoea & Chronic Anovulation

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9
Q

What causes Hyperprolactinaemia?

Hint: There are three types

A

Physiological- Sleep, Stress, Pregnancy/Post-Partum

Pharmocological- Drug inhibits Dopamine

Pathological - Adenoma, 1. Hypothyroidism

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10
Q

What is PCOS?

A

Enlarged polycystic ovaries, leads to increase in GnRH pulses, LH and androgen secretions and lowered FSH

Androgens often changed to testosterone rather than Oestrogen which -> Symptoms

Associated with Type 2 Diabetes

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11
Q

What does PCOS cause?

A

Chronic Anovulation
Secondary Amenorrhoea
Physical signs of hyperandrogenism

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12
Q

How do we investigate PCOS?

A

Blood Test: Increased Testosterone, Increase LH, Decreased Sec Hormone Binding Globulin

Ultrasound: PC Ovaries and Thickened Capsule

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13
Q

What is PID?

A

Pelvic Inflammatory Disease

Infection ascends from the endocervix

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14
Q

What can PID cause?

A 
Endometriosis; 
Salpingitis; 
Oophritis; 
Parametritis; 
Tubo-ovarian Abcess 
Pelvic Peritonitis
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15
Q

What causes PID?

A

Infection of some kind ascending from the Endocervix
e.g. STIs - Chlamydia, Gonorrhea

e.g. Gardnerella vaginalis

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16
Q

How does PID cause damage?

A

Infection causes inflammation which can damage the epithelium
e.g. in the tubes, can cause Adhesions to form

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17
Q

What is a tubo-ovarian abcess?

A

Exudate fills the salpinx
Adhesions form in the tubes
Fibrin exudate blocks the tube

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18
Q

What are some Risk Factors for PID?

A

Intrauterine Contraceptive Devices

STIs

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19
Q

What are some symptoms of Pelvic Inflammatory Disease?

A

Pyrexia
Pelvic Pain
Abnormal Bleeding or Discharge

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20
Q

How do you manage PID?

A

IV antibiotics if severe/inpatient
Surgery if signs of TOA or Peritonitits
IM Ceftrioxone, Doxy or Metro
as an outpatient

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21
Q

What are some potential complications of PID?

A

Ectopic Pregnancy (tube damage)

Infertility (blockage of tube)

Chronic Pain

Fitz-Hugh-Curtis Syndrome

Reiters Syndrome

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22
Q

Describe Klinefelter Syndrome

A 
XXY
Most common chromosomal abnormality
1/1000 boys
Normal internal genitalia
Breast tissue (gynacomastia)
Get small testes and penis
Decreased testosterone and Fertility
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23
Q

Describe Turner’s Syndrome

A 
Aneuploidy XO
Get Cardiac and Renal Problems
Infertile
Shield Chest and Webbed Neck
Short Stature
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24
Q

Describe Pseudohermaphroditism

A 
Phenotype doesn't match genotype
Can be due to androgen insensitivity
if XY, testes don't descend, remain in lumbosacral region
Get no internal genitalia
External is female
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25
Describe True Hermaphroditism
A true mosaic of XY XX XO Ambiguous Genitalia Get Teste and Ovarian Tissue Development
26
Describe Congenital Adrenal Hyperplasia
Increased secretion of androgens If XX, will have both internal genitalia, with female gonads External will be male due to testosterone's action Can reange in severity
27
Describe a Bicornate Uterus
Uterus has 2 horns | Appears due to the lack of fusion of the Mullerian /Paramesonephric Ducts
28
Describe Hypospadia
When there is incomplete fusion of the tubercles Opening of urethra is not on the head of the penis Tends to be near glans, on dorsal surface
29
Describe Ambiguous Genitalia
Large Clitoris Small Penis In some cases you can get characteristics of both sexes
30
What is the normal blood loss in a period?
37-43ml per cycle (most in the first 48 hours) some people lose up the 80ml per cycle, important to think of what is normal for them with a history (60-70% of them are anaemic)
31
What defines menorrhagia?
Abnormally long ( over 7 days) or heavy (over 80ml) but regular
32
How can age affect a woman's sexual excitation response?
Fewer rhythmic contractions of the uterus Lose of muscular tone of vagina (lose of expansile ability) Reduced desire Reduced lubrication (due to reduced vasocongestion) Resolution is more rapid Vaginal tissue loses elasticity
33
What are the 2 aspects affected by sexual dysfunction?
desire | arousal
34
How can desire be affected?
``` Most common dysfunction hyperactive/nymphomaniac hypoactive CNS lesion - Kluver Bucci syndrome Aversion- fear or revulsion of one or more aspects, usually due to assault ```
35
How can arousal be affected in men?
Can be scared/psychological Tears in corpora cavernosa Vascular - atherosclerosis, diabetes drugs- alcohol and anti-hypertensives
36
How can arousal be affected in women?
Cannot retain lubrication-swelling response
37
How do you treat arousal dysfunction?
Viagra | inhibits cGMP breakdown
38
What are the methods of contraception?
Natural - Abstain, Rhythm Method, Coitus Interruptus Barrier - Condom, Diaphragm/Cap Vasectomy- prevent sperm Prevent Ovulation - OCP Sterilisation - occlude fallopian tubes Inhibit sperm getting through the cervix - OCP, Progesterone Pill/Implant. Thick mucus, hostile! Inhibit implantation - IUCD, post-coital contraceptive, hormonal contraceptive
39
What are the signs of breast disease?
Pain Nipple Discharge Mammographic Changes Masses Skin Changes and Lumps
40
When is pain more likely a sign of physiological/benign problems of the breast?
If it is cyclic and diffuse
41
What are the types of nipple discharge? | What can each indicate?
Blood- benign (papilloma, adenoma) or malignant lesion Milky - endocrine disorders, medication (OCP) More worrying if occurs spontaneously and unilaterally
42
What are the types of mass in the breast?
Normal nodularity Worry- hard, craggy, non-motile Fibroadenoma - "breast mice" motile lump
43
What changes can you see in mammography? | Example that causes this...
Calcification - Ductal carcinoma (DCIS) | Densities - fibroadenoma, cysts, invasive carcinomas
44
Describe breast screening
Women 47-73 Every 3 years mammogram looks for densities, calcification, parenchymal deformalities
45
What are some physiological changes of the breast?
Post-ovulation- oedema, and lobules proliferate Pregnancy - increase in size and number of lobules, adipose tissue, decrease in stroma Post-lactation- atrophy but not to previous size Menopause/Old age- involution of breast tissue, adipose replaces fibrous stroma, decrease in terminal ducts
46
What are some benign changes in the breast?
Fibroademona - localised hyperplasia Fibrocystic Changes - disappears after FNA Milk Line remnants- accessory axillary tissue and polythelia Gynacomastia Epithelial hyperplasia (can become carcinoma) Papilloma - small palpable mass, discharge
47
What are some inflammatory conditions of the breast?
Acute Mastitis - S. aureus infection when lactating, nipple cracks Fat Necrosis - trauma or surgery
48
What are the benign stroma disorders? | Describe each
Fibroadenoma- common in younger women, mobile, elusive mass, well circumscribed, white, rubbery, compresses epithelia Phyllodes Tumour - most benign, grow quickly, nodules of stroma covered in epithelia, stroma cellular and atypical, excise with wide margin
49
What can cause gynacomastia?
``` Liver cirrhosis Klinefelters Drug related Puberty (transient) Gonadotrophin excess ``` Due to increased oestrogen and decreased androgens
50
What are some breast cancers?
In situ: DCIS Paget's disease Invasive carcinoma: Can be ductal (70-80%), tubular (1-2%), lobular (5-15%) or mucinous (1-6%) Tubular and Mucinous have best prognosis Lobular - lines of cells infiltrate, lack cohesion
51
What are the risk factors for breast malignancy?
OCP, Late menopause, early menarche, female, HRT (Oestrogen Exposure) ``` Obesity- peripheral tissues produce oestrogen Radiation Breast Feeding Reproductive History Genetics ```
52
Where do breast cancers metastasise to?
``` Through the Blood: Brain Liver Lung Bone ``` Axillary Lymph Nodes
53
Where can lobular carcinomas spread to?
Retroperitoneum, Peritoneum, Ovaries, GI tract, Uterus
54
How do you manage breast cancer? Localised? Systemic?
Surgery - mastectomy or breast sparing Axillary surgery (test with sentinel node sampling) Post Op Radiotherapy Neo-adjuvant Chemotherapy Hormonal - tamoxifen Herceptin
55
What genes are involved in breast cancer?
Her2 expression Oestrogen receptors BRCA gene - associated with negative ^ have high grade and poor prognosis :(
56
What is the triple approach? | breast cancer
Investigations to do 1) Clinical - history, family histort, examination 2) Imaging - mammogram or ultrasound 3) Pathology - core biopsy, fine needle aspiration (cytology)
57
Examples of teratogenic agents and infectious agents that can cross the placenta
Alcohol Lithium and Thalidomide Smoking Varicella Zoster CMVirus Rubella Toxoplasma gondii
58
What is Foetal Alcohol Syndrome? | Visible Features
Maternal drinking causing developmental defects in the foetus as it harms the CNS development and neural cell migration Short Palpabral Fissure Flat Maxilla Lack of philtrum, thin upper lip
59
Describe Pre-eclampsia
Hypertension and Proteinurea during pregnancy Unknown circulating factor damages the endothelium, this causes systemic vasoconstriction which causes hypertension. The mother is unable to make a low resistance vascular bed for the placenta which can lead to insufficiency and growth restriction of the foetus
60
What is eclampsia?
Seizures during pregnancy

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