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Phase 3a > Gynae 1 - Reproduction > Flashcards

Gynae 1 - Reproduction Flashcards

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1
Q

What induces ovulation?

A

Biphasic LH surge

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2
Q

What are the four phases of the endometrial cycle?

A

Menstrual, repair, proliferative, luteal/secretory

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3
Q

What kind of feedback does oestrogen have on FSH?

A

Negative

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4
Q

What is the function of FSH?

A

Maturation of follicle

Stimulates ovaries to release oestrogen

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5
Q

A mutation in which gene causes androgen insensitivity syndrome (AIS)?

A

Androgen receptor gene

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6
Q

What are the two types of AIS?

A

Complete or partial

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7
Q

What is the presentation of CAIS individuals?

A

Female external genitalia
Short blind-ended vagina
Absent uterus and tubes

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8
Q

What is the spectrum of disease in PAIS?

A

Almost normal female phenotype with clitoral enlargement

To morphologically normal male with hypospadias

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9
Q

What occurs in the embryo in AIS?

A

Testis develop normally
Testosterone-dependent Wolffian structures do not develop normally
Regression of Mullerian structures occurs

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10
Q

Where are testes likely to be found in AIS?

A

Inguinal hernias
Labial swellings
Somewhere in the pelvis

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11
Q

What are the other symptoms of AIS?

A

Breast development
Scanty pubic/axillary hair
Amenorrhoea

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12
Q

How is AIS diagnosed?

A

Karyotyping - XY

Pelvic ultrasound to locate testis

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13
Q

What is the condition of enzyme defects in the adrenal steroidogenesis pathways?

A

Congenital adrenal hyperplasia

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14
Q

What mutation occurs with CAH?

A

Cyp21 on C6

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15
Q

What enzyme is deficient in CAH?

A

21-hydroxylase

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16
Q

What is the pathophysiology of CAH?

A

Cortisol deficiency, increased ACTH secretion, increased androgen production

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17
Q

What are the presentations of CAH?

A

Females - ambiguous genitalia and virilization
Males - precocious puberty
Both - Salt losing crisis at 1-3 weeks of age, with hypoglycaemia. Reduced fertility, with less natural fertility in salt losers

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18
Q

How is CAH diagnosed?

A

Increased plasma 17-hydroxyprogesterone levels
24h urinary steroid analysis
Polycystic ovaries

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19
Q

What is the treatment of CAH?

A

Hydrocortisone
Fludrocortisone if salt-losing type
Sodium chloride in first 6-12m of life
Adult women may need female hormones via the COCP or flutamide

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20
Q

How is CAH prevented in subsequent pregnancies?

A

Dexamethasone with a positive pregnancy test.

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21
Q

Define precocious puberty?

A

Onset and signs of puberty before age 8

Menarche before age 10

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22
Q

What is the consequence of precocious puberty?

A

Early accelerated linear growth with premature epiphyseal closure, resulting in decreased final height

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23
Q

What are some causes of precocious puberty?

A 
Idiopathic
Ovarian cysts
Primary hypothyroidism
McCune-Albright syndrome
Congenital adrenal hyperplasia
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24
Q

What is the average age for menarche?

A

12.7 years

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25
What staging is used for puberty?
Tanner's staging
26
What investigations are required in precocious/delayed puberty?
``` Bone age from hand radiograph FSH/LH/Oestradiol/17-hydroxyprogesterone/testosterone TFTs Pelvic USS/Cranial MRI Karyotyping ```
27
What is the treatment of idiopathic precocious puberty?
GnRH analogue injections e.g. leuprorelin
28
Define delayed puberty
Absence of menstruation and secondary sexual characteristics by age 14 Absence of menstruation by age 16
29
Give three causes of delayed puberty
Constitutional delay Low BMI/high levels of physical exertion Chronic systemic disease Ovarian failure - Turner's
30
How can puberty be induced?
Boys: PO/IM testosterone Girls: Oestrogen, gradually increasing doses with cyclical progesterone
31
Define primary and secondary amenorrhoea
Primary - lack of menstruation by 16y | Secondary - absence of menstruation for 6m
32
Give some causes of primary amenorrhoea
Constitutional delay GU malformation e.g. imperforate hymen AIS Ovarian failure
33
Give some causes of secondary amenorrhoea
PCOS Cushing's Premature ovarian failure Post-pill
34
What laboratory findings indicate premature ovarian failure?
Increased FSH and LH | Endometrial atrophy
35
What laboratory findings indicate pituitary failure?
Decreased T4 and TSH | Increased prolactin
36
Fusion of the two Mullerian ducts produces...
Uterus, upper 2/3 vagina, cervix, uterine body
37
FSH and LH are released by which gland?
Anterior pituitary
38
A cycle longer than 32 days is known as...
Oligomenorrhoea
39
Give three causes of oligomenorrhoea
PCOS Borderline low BMI Incipient POF - ovarian resistance leading to anovulation
40
What is a consequence of unopposed oestrogen in PCOS?
Endometrial hyperplasia
41
How are regular cycles attained in oligomenorrhoea?
COCP
42
What is the condition where excessive facial and body hair grows in women?
Hirsuitism
43
What is virilization?
Presence of cliteromegaly, balding, deep voice, male body habitus, in a woman
44
What is a common ovarian cause for hirsuitism?
PCOS
45
Give three other causes for hirsuitism
CAH Acromegaly Cushing's syndrome
46
What kind of hair is seen in women with hirsuitism, and where is it found?
Terminal | Face, chest, abdomen, back, thighs
47
What does virilization usually indicate?
Androgen-secreting tumour
48
What score is used to grade hirsuitism?
Ferriman-Gallwey score >8
49
What investigations are required in hirsuitism?
Testosterone DHEAS OGTT 17-OHP
50
What is the treatment of hirsuitism (other than treating the cause)?
Weight loss and cosmetic approaches COCP e.g. co-cyprindiol (Dianette) or Yasmin Anti androgens: Flutamide, finasteride, topical eflornithine
51
Give three causes of pelvic pain in adolescents
Ovarian or fallopian tube torsion Primary dysmenorrhoea Endometriosis Rare Mullerian abnormalities
52
What is the aetiology of endometriosis?
Retrograde menstruation with adherence Systemic/lymphatic spread Family history
53
What are the common sites for ectopic endometrial tissue?
Pouch of Douglas Uterosacral ligaments Ovarian fossae
54
What are endometriomas?
Ovarian endometrial cysts filled with old blood
55
What is the presentation of endometriosis?
``` Infertility Cyclical/constant pelvic pain Dysmenorrhoea Dyspareunia Bowel symptoms e.g. constipation, dyschezia Fatigue ```
56
How is endometriosis diagnosed?
Bimanual pelvic examination for adnexal tenderness and masses TVUSS for endometriomas Laparoscopy gold standard
57
What are the treatments of endometriosis?
Mefenamic acid or NSAIDs COCP - conventional, then tricycling Mirena IUS Refer if no improvement in 3-6 months/trying to conceive: GnRH agonists Surgery Endometrial ablation
58
What is PCOS a disorder concerning?
Hyperandrogenism
59
What are the features of PCOS?
Oligomenorrhoea Hirsuitism/acne Obesity Infertility
60
What is required for the Rotterdam criteria diagnosis of PCOS?
Need 2/3 of: Oligomenorrhoea/amenorrhoea Polycystic ovaries on TVUSS (>12 antral follicles on 1 ovary) Clinical or biochemical signs of hyperandrogenism
61
What hormone is increased in PCOS?
Testosterone | Maybe LH
62
How is PCOS managed (woman not wanting to get pregnant)?
Weight loss, low GI diet Improve menstrual regularity with COCP Metformin Co-cyprindiol or eflornithine: hirsuitism
63
What is the treatment of subfertility secondary to PCOS?
Weight loss Metformin, clomifene, or a combination Ovarian drilling
64
What are women with PCOS at higher risk of?
Diabetes and endometrial hyperplasia
65
What are three causes of secondary dysmenorrhoea?
Endometriosis/adenomyosis PID/STI Pelvic adhesions Congenital abnormalities causing genital tract obstruction
66
What are the management options in dysmenorrhoea?
Mefenamic acid 500mg TDS each period | COCP or Depot/Mirena IUS
67
What are the management option of refractory dysmenorrhoea?
Tricycle COCP Refer to a gynaecologist- GnRH analogues
68
Define dysfunctional uterine bleeding
Any abnormal uterine bleeding in the absence of pregnancy, genital tract pathology, or systemic disease
69
What are the symptoms of DUB?
Heavy/prolonged bleeding including clots and flooding Dysmenorrhoea Anaemia and disruption to life
70
What are the red flags for cervical or endometrial pathology?
Totally erratic bleeding IMB Post-coital bleeding
71
What may be seen on TVUSS in DUB?
Fibroids Polyps Endometrial thickening
72
What is the treatment for regular DUB?
Tranexamic acid COCP Mirena IUS
73
What is the treatment of irregular DUB?
Tranexamic acid and mefenamic acid COCP Mirena IUS
74
What is adenomyosis and what are the risk factors?
Presence of ectopic endometrial tissue in the myometrium | CS, surgical TOP, pregnancy
75
What medication is used in PCOS?
Co-cyprindiol (Dianette) | Anti-androgen, regulates cycle
76
What does metformin do in PCOS treatment?
Reduces insulin resistance which decreases androgens
77
How does tranexamic acid work?
Anti-fibrinolytic, decreases blood loss by 50%
78
What are the three main indications for mirena IUS?
Contraception Primary menorrhagia Endometrial protection during HRT
79
What is the medical management of menorrhagia?
1) Mirena IUS 2) Tranexamic acid. Combine tranexamic acid with mefanemic acid if pain is also a problem 3) COCP/POP
80
What is the surgical management of menorrhagia?
Myomectomy and uterine artery embolization are fertility sparing Non fertility sparing - endometrial ablation/hysterectomy
81
What are the gradings of utero-vaginal prolapse?
1- half way down to introitus 2- as far as introitus 3- procidentia - beyond introitus
82
When should you refer or arrange investigations for a patient with menorrhagia?
If the history or examination suggests that there may be fibroids, other pelvic masses, ascites, or anaemia
83
What are three red flag gynaecological symptoms?
Intermenstrual bleeding Post-coital bleeding Post-menopausal bleeding
84
What are the causes of intermenstrual bleeding?
Under 45 - chlamydia Over 45 - exclude endometrial cancer All - exclude a cervical cause
85
What does postcoital bleeding suggest?
A cervical cause
86
What are the causes of post-menopausal bleeding?
Endometrial cancer Atrophic vaginitis Fibroids or polyps
87
Which lymph nodes drain the ovary?
Para-aortic lymph nodes
88
What is a trachelectomy?
Removal of cervix and pelvic lymph nodes with preservation of body and uterus for fertility in cervical cancer
89
Define premature ovarian failure
The onset of menopausal symptoms and elevation of gonadotrophins before the age of 40 years
90
When is methotrexate appropriate management for ectopic pregnancy?
No symptoms bHCG<1500IU Small (<35mm) unruptured ectopic with no visible heartbeat
91
When is laparoscopy and salpingectomy appropriate management for ectopic pregnancy?
Symptomatic bHCG>1500IU Large >35mm or ruptured ectopic, visible heart beat
92
What is the test used to find out if a woman is ovulating?
Day 21 mid-luteal progesterone | Day 5 FSH
93
How is tubal patency checked?
Hysterosalpingo contrast sonography (HyCoSo) | Hysterosalpingogram, laparoscopy and dye test
94
What tests should be done in a woman failing to get pregnant?
``` FSH/TSH, LH Prolactin Testosterone OGTT STI screen ```
95
What is the mode of action of the COCP, and the implant?
Inhibit ovulation - primary MoA | Thicken cervical mucus and prevent proliferation of the endometrium (on the side)
96
What is the main mode of action of the POP?
Thickens cervical mucus
97
What is the main mode of action of the IUS?
Prevents endometrial proliferation | On the side - thickens cervical mucus

Phase 3a (18 decks)

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