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Gynaecology Flashcards

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1
Q

How long is the average menstrual cycle and what is the error?

A

28 days

+/- 7days

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2
Q

What event denotes the first day of the cycle?

A

first day of bleeding

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3
Q

What releases FSH?

A

Anterior pituitary gland

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4
Q

What does FSH act upon and what does this cause?

A

Ovary - growth of the primordial follicle

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5
Q

At what point in the menstrual cycle do levels of FSH peak?

A

Day 14

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6
Q

Which hormone surges mid cycle and what does this cause?

A

LH

Ovulation

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7
Q

What 3 phases does the ovary go through?

A

The Follicular phase
The Ovulatory phase
Luteal phase

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8
Q

What is the Luteal phase?

A

the corpus luteum is formed from the ruptured follicle which releases Progesterone

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9
Q

What is the Ovulatory phase?

A

where there is a surge of LH leading to the release of the oocyte or the ovum from the ovary

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10
Q

What is the Follicular phase?

A

the follicle grows into the dominant preovulatory follicle, due to the stimulation of FSH which causes an increase in the Oestrogen levels

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11
Q

When is the cervical mucus scanty and thick?

A

Pre and post menstruation

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12
Q

When in the cycle does cervical mucous become profuse, watery, clear and more alkaline under the influence of oestrogen?

A

Midcycle

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13
Q

Why does the cervical mucous become watery?

A

To facilitate the passage of sperm

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14
Q

What are the 2 layers that make up the endometrium?

A

Functionalis 2/3

Basalis 1/3

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15
Q

What is the purpose of the functionalis layer?

A

prepare for the implantation of the implantation of the fertilised egg.

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16
Q

What happens to the functionalis during the menstrual phase?

A

Desquamation

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17
Q

What happens to the functionalis layer outside of the menstrual phase and what is this known as?

A

Proliferation

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18
Q

Under the influence of Oestrogen the endometrium proliferates and there is an increase in capillary formation in the endometrium describes what phase of the menstrual cycle?

A

Proliferative

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19
Q

What happens to the endometrium during the secretory phase?

A

The endometrium glands become more tortuous and the spiral vessels become more prominent.

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20
Q

During what phase is the endometrium also influence by oestrogen?

A

secretory phase

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21
Q

implantation does not happen, due to negative feedback there is withdrawal of Oestrogen and Progesterone support to the endometrium causing break down of the endometrium leading to menstruation best describes which phase?

A

Pre- menstrual phase-

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22
Q

What are the 4 phases of the menstrual cycle?

A

Menstrual
Proliferative
secretory phase
Pre- menstrual phase-

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23
Q

Which phase of the cycle of not fixed and between what ranges can it last?

A

proliferative phase of the cycle may be as short as 7 days and as long as 21 days or more

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24
Q

What timing is said to be fixed during the menstrual cycle and how long is this?

A

Time between ovulation and and desquamation of endometrium - secretory phase
14 days

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25
6 causes of Menorrhagia
``` Dysfunctiona Uternine Bleeding DUB Fibroids Adenomyosis Copper IUCD Bleeding disorders Thyroid Disorders ```
26
What investigations could you perform to help diagnose a cause of menorrhagia?
FBC Pelvic Ultrasound Hysteroscopy and biopsy (>45yrs
27
Conservative treatment options for dysfunctional uterine bleeding?
Do nothing | Ferrous sulphate
28
Medical treatment options for DUB?
Tranexamic acid COCP POP, Depo injections, Implanon Mirena IUS
29
Surgical treatment options for DUB?
Endometrial Ablation | Hysterectomy
30
4 causes of Inter-menstrual bleeding?
Anovulation Endometrial polyps Progesterone only contraceptives Endometrial cancer
31
2 investigations for intermenstrual bleeding?
TV U/S | Hysteroscopy + biopsy
32
4 causes of post coital bleeding?
Cervical polyps Ectropion Infection (Chlamydia) Cervical cancer
33
3 investigations for post coital bleeding?
Speculum examination Cx swabs Colposcopy +/- biopsy
34
What is primary amenorrhoea and what are the age thresholds?
failure of menstruation by the age of 16 years in the presence of normal secondary sexual characteristics, or 14 years in the absence of other evidence of puberty.
35
What is secondary amenorrhoea?
absent periods for at least six months in a woman who has previously had regular periods, or 12 months if she has previously had oligomenorrhoea (bleeds less frequently than six-weekly).
36
4 causes of Amenorrhoea?
Hypothalamic Pituitary Ovarian Anatomical- mullerian abnormalities
37
What would you check on examination for someone with amenorrhoea?
``` Height, weight, BMI Blood pressure Clinical thyroid status Hisrsutism/ acne Tanner staging (breast/axillary) – Primary Abdominal /pelvic mass Perineal inspection (Imperforate hymen)- Primary Virilisation signs/male pattern baldness ```
38
What would be the appropriate investigations for someone with amenorrhoea?
``` Pregnancy test FSH/LH Prolactin TFT’s Testosterone/SHBG US MRI Karyotyping ```
39
8 potential Hypothalamic/pituitary/CNS causes of amenorrhoea?
``` Weight loss Exercise Genetic e.g Kallmans syndrome Stress Idiopathic Chronic illness Hyperprolactinemia/prolactinoma CNS tumours ```
40
3 potential ovarian causes of amenorrhoea?
Premature ovarian failure Gonadal dysgenesis- Turners PCOS
41
4 Anatomic causes of amenorrhoea
Mullerian Androgen insensitivity Radiation Asherman’s syndrome
42
3 types of mullerian cause of amenorrhoea?
Transverse septum Imperforate hymen Rokitansky syndrome
43
4 treatment option for anatomical causes of amenorrhoea
Surgical in outflow tract abnormalities Psychological support/vaginal dilators (MRKH) Removal of gonads in AIS Adhesiolysis for Asherman’s
44
3 most common cause of amenorrhoea?
PCOS Premature ovarian failure/menopause Secondary to hypothalamic causes due to extreme weight loss
45
Primary symptoms of menopause?
``` menstrual cycle changes oligomenorrhea, amenorrhea vasomotor symptoms hot flushes, night sweats vaginal dryness ```
46
Secondary Symptoms of Menopause
``` urinary stress/urge incontinence cystitis-like symptoms depression/irritability changes musculoskeletal pains (joint aches, osteoporosis) dry skin, hair thinning, nail changes decreased concentration decreased libido ```
47
In HRT what do oestrogen and progesterone help treat?
Oestrogen required for symptoms Progestagens required to prevent endometrial cancer
48
What alternative for HRT to treat anxiety/depression?
SSRI
49
What alternative for HRT to reduce vasomotor symptoms?
Progesterone (but not available orally) Progestagens (may work but androgenic S/E) Beta-blockers ?? Clonidine ??
50
Why is menopause associated with osteoporosis?
There are oestrogen receptors on bone, breast and uterus
51
What are the choice of route for HRT?
There are oestrogen receptors on bone, breast and uterus
52
What are the choices of oestrogens in HRT?
Oestradiol valerate commonest Oestriol Oestrone Equine oestrogens in Premarin
53
5 absolute contraindications for HRT?
``` Pregnancy Active venous thromboembolism Severe active liver disease Endometrial carcinoma with recurrence Breast carcinoma with recurrence ```
54
What are the 3 types of HRT regimen and what is the most common?
Oestrogen only Sequential or cyclical combined - most common Continuous
55
What is the typical cycle for Sequential or cyclical combined HRT?
Continuous oestrogen but only 12-14 days of a progestagen | Withdraw bleeds monthly or 3 monthly
56
What happens with continuous HRT regimen and who is this suitable for?
continuous daily oestrogen and progestagen no periods Suitable for women 2+ years post menopause
57
Who can have oestrogen only HRT?
Hysterectomy
58
6 Relative contraindications to HRT
``` Abnormal bleeding Breast lump (prior to investigation) Previous endometrial cancer Previous breast cancer Strong family history breast cancer Family history of thromboembolism ```
59
5 side effects of HRT
``` Tender or painful breasts Fluid retention causing bloating and weight gain Nausea Headaches Leg cramps Indigestion Mood swings/Low mood Acne Backache Lower abdominal pain Bleeding ```
60
2 short term benefits of HRT
Reduces vasomotor symptoms (eg hot flushes) | Improves psychological symptoms (eg mood swings)
61
7 long term benefits of HRT?
Maintains bone mass and reduces the risk of fracture Reduces urogenital problems (eg dry vagina) Improves skin (cosmetic) Reduces the risk of bowel cancer May improve balance and reduce falls – less fractures May reduce tooth loss May protect against arthritis
62
Risks of HRT
``` Endometrial Cancer (if unopposed oestrogen used) Breast Cancer Ovarian cancer Cardiovascular disease (stroke and MI) Venous thrombo-embolic disease (VTE) ```

Obstetrics & Gynaecology (2 decks)

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