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Flashcards in Maternal Health COPIED Deck (147):
1

Causes of acute abdominal pain 

2

Diagnosis - Cerebral Palsy

Clinically based:

  • abnormalities of tone
  • delays in motor development
  • abnormal movement patterns
  • persistent primitive reflexes

NB> diagnosis may be suspected in neonates, but can only be made months later.

3

Who gets neoplasms of the vagina and vulva?

mainly post menopausal and older women

4

Suspected ovarian cancer - when would you definitely refer?

If physical examination identifies ascites and/ or abdominal mass 

(when it is clearly not a fibroid)

5

Gravida

 Total number of confirmed pregnancies, regardless of the outcome.

6

What is triple assessment? (ref breast cancer)

Breast examination

Breast imaging (mammogram/ ultrasound)

Tissue sampling (core biopsy or FNA)

- for a definite diagnosis

7

What is an unusual protective factor for endometrial cancer in postmenopausal women?

smoking

8

A woman's hormone balance plays a part in the development of most endometrial cancers.

What is the biggest risk factor?

Hormones - a shift towards oestrogens. (Including HRT)

Obesity

Oestrogen from fat tissue has a bigger impact after menopause than it does before menopause.

"endometrial cancer is twice as common in overweight women,

and more than three times as common in obese women."

9

What is Paget's disease of the breast?

Paget's disease of the breast is a rare type of cancer of the nipple area of the breast.

It presents as eczema affecting the nipple.

10

weight faltering implies...

conditon is transient, not serious

11

Persistent fever - causes

12

Kawasaki disease

also known as mucocutaneous lymph node syndrome, is a disease in which blood vessels throughout the body become inflamed.

  • Coronary artery aneurysms occur as a sequela of the vasculitis in 20–25% of untreated children

 

13

When is endometrial cancer most common?

After menopause

 

- Immediate referral (NICE guidelines)

14

What is cervical excitation?

(chandelier sign)

Positive for PID (pelvic inflammatory disease) or ectopic pregnancy and it is useful to differentiate from appendicitis.

Put a finger each side of the cervix and push the cervix from side to side – this in turn stretches the tubes

 

15

Where does lymph from the breast drain?

Majority axillary

also

Behind sternum

NB Montgomery's glands is the name of the modified sweat glands found on the areola.

16

What is the most common (but still rare) inborn error of metabolism that is routinely screened for in all neonates?

Phenylketonuria (PKU)

 - newborn blood spot screening

People with PKU can't break down the amino acid phenylalanine, which then builds up in the blood and brain. This can lead to brain damage.

 

 

17

What does the corpus luteum secrete?

progesterone 

 

If pregnancy occurs then embryo takes over from corpus luteum by producing human chorionic gonadotropin (hCG).

Then 7-9 wks the placenta produces progesterone.

18

When would you take a breast cancer history from a patient? (4)

  • A person has concerns about their family history of breast cancer.
  • A person has breast symptoms.
  •  
  • It is clinically relevant:
    • In women over 35 years of age using an oral contraceptive pill.
    • In women being considered for long-term HRT.

19

What does LH do?

  • Rise in LH releases the ovum
  • stimulates the formation of the luteal body

20

Management of advanced breast cancer

endocrine therapy - for ER positive breast cancer

Chemotherapy

Bisphosphonates

21

Children and type I diabetes;

any specific symptoms?

 

usual symptoms + secondary enuresis (bedwetting)

 

22

How does type I diabetes initially present?

  • polyuria
  • polydipsia
  • weight loss

- over a few weeks.

Dx: random blood sugar >11.1 mmol/L

or fasting blood glucose > 7mmol/L

PLUS classic symptoms

23

tetanus

Anaerobic organism Clostridium tetani.

In soil, enters wounds. 

Neurotoxin causes progressive painful muscle spasms.

24

Cystocele 

"dropped bladder" or an anterior prolapse. Anterior wall of vagina has collapsed and bladder bulges downward into the vagina.

Causes; pregnancy, pelvic surgery, obesity, aging

Do pelvic floot (Kegel) exercises

Symptoms: stress incontinence, feeling of not emptied bladder, frequent bladder infections possible

25

Rectocele 

Rectal Symptoms

Difficulty having a complete bowel movement

Stool getting stuck in the bulge of the rectum

The need to press against the vagina and/or space between the rectum and the vagina to have a bowel movement

Straining with bowel movements

The urge to have multiple bowel movements throughout the day

Constipation

Rectal pain

Vaginal Symptoms

Pain with sexual intercourse (dyspareunia)

Vaginal bleeding

A sense of fullness in the vagina

26

What initiates the menstrual cycle?

 

neuronal stimuli from the cerebral cortex -  hypothalamus - GnRH

 

GnRH 

releases FSH and LH from anterior pituitary

27

What in the family history could suggest maturational delay?

Late maternal menarche

28

What is a leiomyoma?

A leiomyoma,[fibroid] is a benign smooth muscle tumor that very rarely becomes cancer (0.1%). They can occur in any organ, but the most common forms occur in the uterus, small bowel, and the esophagus

Polycythemia may occur due to increased erythropoietin production as part of a paraneoplastic syndrome.

29

The transformation zone

The transformation zone can be identified by visual inspection as there is a change in colour and texture from the pale, pink, shiny, smooth surface of the ectocervix to a reddish, granular appearance of the columnar cells that line the endocervical canal.

30

Breast cancer risk factors (5)

 Female sex (75 male deaths from breast cancer in 2004)

 Increasing age (80% of breast cancers in post menopausal women)

 Family history of breast cancer-BRCA1 and BRCA2

 Obesity (post menopausal women only)

 High alcohol consumption

31

Pertussis (whooping cough)

- high morbidity and mortality in children <2 years age.

Bacterium Bordetella pertussis

Lasts 6-8 weeks and has three stages:

catarrhal

paroxysmal

convalescent

whoop - caused by sudden inspiratory effort against a narrowed glottis.

32

New back ache ? Any red flag?

could be cervical cancer 

or prostate cancer in men

33

What does gonadotropin releasing hormone (GnRH) release?

follicle-stimulating hormone (FSH)

and 

luteinizing hormone (LH)

from the 

anterior pituitary.

34

Acute otitis media

pic: bulging tympanic membrane

organisms: Streptococcus pneumoniae, Haemophilus influenzae and viruses

Common with Eustachian tube dysfunction

Symptoms: fever, deafness, pain in ear. Otoscope examination.

Tx: paracetamol

Complications: mastoiditis, conductive deafness, secretory otitis media (glue ear). 

35

What's the incidence of diabetes in children?

1:500

36

Why aren't mammagraphs very useful for women under 35 years old?

dense breast tissue, poor x-ray penetration.

Ultrasound shows breast cysts well.

Aspiration for solid lesions.

37

Presents as sore throat and fever

Pharyngitis - inflammation of back of the throat

Mostly viral.

Strep throat is cause in 25% of children and 10% of adults.

: tonsillar fauces and palate are inflammed, cervical lymph nodes enlarged, tympanic membrane inflammed.

Tx: paracetamol, no antibiotics for viral.

38

What are the three main infections of the vulva?

  • genital warts -   HPV infection, most common viral STI, cryotherapy
  • genital herpes (vesicles, ulcers, burning pain and local pruritis)

- Herpes Simplex (HSV) Type II most common (85%). aciclovir

  • bartholin gland abscess (tender, red mass, occurs at 5or 70 clock. fever, unilateral vulvar pain)

39

Role of LH in males?

Stimulates the Leydig cells of the testis to produce testosterone.

40

suspected ovarian cancer; what physical examination signs may you find?

Persistent abdominal distension (bloating)

Feeling full (early satiety)/ anorexia

pelvic/ abdominal pain

increased urinary urgency/ frequency

(Nice guidelines)

41

Refer or don't refer?

Vaginal bleeding post menpausal

RED FLAG

42

Common cause of poor weight gain:

Malabsorption (diarrhoea and colic often present)

  • Coeliac disease
  • cystic fibrosis

43

Fever in infants less that 8 weeks... what's the story?

Could be sepsis; at this age other signs of sepsis may not be evident.

44

Steroids and growth.. what's the story

Cushing's disease is rare.

exogenous steroids (eg. asthma) is a big No No

If steroids required, give on alternate days to minimise damage.

45

Bleeding in between periods is called?

Metrorrhagia

46

What is the biggest risk factor for developing breast cancer?

The risk of breast cancer increases with the number of affected relatives, and increases as the age of those affected decreases.

Only a minority of this increase in risk is due to the presence of gene mutations such as BRCA1, BRCA2 or TP53.

The presence of malignancies such as ovarian, prostate, pancreatic cancer, or male breast cancer in a family in addition to female breast cancer increases the likelihood of having a BRCA1/2 mutation.​

Views are conflicting on; protective effects of CHC against ovarian cancer outweighing the increased risk of breast cancer.

The progestogen-only pill is the safest option.

47

Tonsillitis DDs

viral/ bacterial tonsillitis

hypertrophied but non-inflammed tonsils (common in preschool children)

infectious mononucleosis (glandular fever)

48

Most common type of breast cancer is

Invasive ductal carcinoma (IDC)

(infiltrating ductal carcinoma)

49

What is the biggest modifiable risk factor for endometrial cancer?

Obesity - well documented.

Fat cells - oestrogen levels

50

Why is obesity in post menopausal woman a risk factor in breast cancer?

due to oestrogen exposure

51

cyst develops from occlusion of the excretory duct.

52

Investigations for bedwetting?

  • urine microscopy and culture (UTIs)
  • urine dipstick (glycosuria)
  • renal ultrasound (if ectopic ureter is suspected)

53

conception rate graph

Two types of infertility:

 Primary infertility – never had a child

 Secondary infertility – previous pregnancy, struggling with fertility later. 

 

54

55

FIGO staging system

Need to know that >>> platelets (called thrombocytosis) is closely linked to endometrial cancer.

56

short stature versus fall-off growth

Fall-off growth is the concern because is suggests a pathological cause.

Are the parents short?

57

Post menopausal bleeding, red flag for?

Endometrial cancer

58

What's this?

Cervical ectropion (ectrophy)

(or cervical eversion)

Internal columnar cells present on the ectocervix.

These cells are more fragile causing vaginal discharge or bleeding, especially when having sex.

It is related to oestrogen. More common in young women, pregnant women and those taking combined oral contraceptive pills.

Ectropion treatment : Silver nitrate to cauterise the friable cells

This treatment is under local anaesthetic

It is not associated with cervical cancer. 

59

What is the danger if type I diabetes is not identified in children?

DKA 

presenting with ABDOMINAL PAIN and VOMITING and COMA.

NB. The mechanism of abdominal pain in DKA is poorly understood but gastric distension, hypovolaemia and electrolyte disturbance may contribute.

60

Menstrual hypothalamus pituitary axis

 

GnRH - hypothalamus

releases from anterior pituitary 

FSH and LH

61

Concerns about growth when:

  • weight below second centile
  • height is below second centile
  • OR when height or weight crosses down two centiles.

62

What's this?

Purpura :

red or purple non-blanching spots.

Bleeding underneath the skin usually secondary to vasculitis or dietary deficiency of vitamin C 

meningococcus (Neisseria meningitidis), a Gram-negative diplococcus organism, releases endotoxin when it lyses. Endotoxin activates the Hageman factor (clotting factor XII), which causes disseminated intravascular coagulation (DIC). 

63

What are leiomyoma?

"benign smooth muscle tumor that very rarely becomes cancer"

 

Uterine fibroids are leiomyomata of the uterine smooth muscle.

Benign, but may lead to excessive menstrual bleeding (menorrhagia),

often cause anemia and may lead to infertility.

 

 

64

Failure to thrive (FTT) implies...

growth failure combined with

failure of emotional and developmental progress.

often use to neglect. Non-organic cause.

65

Type II Diabetes, children. What's the story?

WAS RARE in children.

On the increase with << exercise and increase in carb intake.

66

What investigations might you consider for a child with fever?

FBC; leucocytosis with neutrophilia suggestions bacterial infection

Throat swab

Blood culture

Lumbar puncture (if meningitis suspected)

Urine analysis ; protein, RBCs, leucocytes, nitrates, protein

CXR

67

symptoms include sore throat, dysphagia, fever

Tonsillitis; a type of pharyngitis.

Usually viral (esp. under 2 years age), if bacterial then usually group A beta-haemolytic streptoccus (strep throat).

Other bacterium:

 Neisseria gonorrhoeae, Corynebacterium diphtheriae, or Haemophilus influenzae

* can get abdominal pain due to associated adenitis in the mesenteric nodes.

 

68

Cervical screening frequency

Age 24.5  - First invitation to ensure screening before age 25

Age 25-49 - every 3 years

Age 50-64 - every 5 years

Age 65 + : only if abnormal results, or not had screen since age 50.

Can't screen if: menstruating, infection, 12 week after pregnancy/ miscarriage/ less 12 weeks post natal, pregnancy.

 

69

What's the most common type of breast cancer?

Invasive ductal carcinoma (IDC)

70

Always consider ultrasound scan for woman > 55 years if 

- unexplained vaginal discharge

  or visible haematuria

 

combined with... 

thrombocytosis 

(or >> glucose levels - new NICE guideline)

71

Sometimes it can cause a sensation of needing to empty the bowels during intercourse

They may need to put a finger into the vagina to help the bowels to empty 

Common (10% of women)

72

Function of FSH?

  • Stimulates growth of follicles 
  • Indirectly causes an increase in oestradiol because as the follicle matures it starts to secrete oestradiol.

73

Symptoms?

and Treatment

Pelvic floor muscle exercises (Kegel)

vaginal pessaries

symptoms: pain/ urinary leakage during sexual intercourse

Incomplete bladder emptying

worse for ; standing long periods/ straining

74

What's the medical management of epilepsy with children?

  • monotherapy of most effective medication.
  • Second drug added if tx ineffective, and first drug is gradually discontinued.
  • drugs should be given no longer than one half-life, and peak level should be timed to coincide with seizures.

common drugs: sodium valproate, carbamazepine

Absence seizures: ethosuximide

75

Prolonged or heavy menstrual bleeding is called?

Menorrhagia

76

What hormone connected to the reproductive system does the hypothalamus make?

Gonadotropin-releasing hormone (GnRH)

77

Parity

Number of births that a woman has had after 20 weeks gestation.

78

What concerns might you have for a child who wets the bed?

  • Has the child ever been dry? (if so, what age)
  • Was there a trigger for bedwetting?
  • Any stress or sexual abuse?
  • Any symptoms suggesting a UTI?
  • History of constipation?
  • Any symptoms of diabetes mellitus?
  • What methods have the parents tried to stop bedwetting? Punishments? Fluid restrictions? Rewards?
  • What is the pattern? Diurnal or Nocturnal?

79

What must you rule out if a joint is acutely swollen?

Septic arthritis

Common organism: Staphylococcus (this lives on the skin)

80

What are some of the DISadvantages of breast screening?

(done 3 yearly, from 50-70 years age)

  • false positives; unnecessary further examinations, and unnecessary anxiety.
  • over-diagnosis; some breast cancers would not be life-threatening.
  • Missed cancers
  • pain & discomfort of the procedure
  • >> radiation exposure
  • << follow up mammograms if women has anxiety of false positive.

81

FSH stimulates follicle develop. As Follicle grows it starts to secrete oestradiol. What does this increase in oestradiol cause?

Causes the hypothalamic-pituitary axis to secrete LH

82

what's this?

cervix incompetence

May be caused by a previous injury to this area, usually after a surgical procedure. The muscle weakness can cause the cervix to open too early during pregnancy, leading to a miscarriage.

tx. big stitch

83

What can cause weight faltering?

eating difficulties, difficulties in home environment

limited parenting skills, illness

SERIOUS: neglect, mental disorders (child/ parent)

 

84

What is the common cause of cervical dysplasia?

Cervical dysplasia generally develops after infection of the cervix with the human papillomavirus (HPV).

85

Differential diagnoses of iliac fossa pain

86

Recurrent abdo pain with children is likely to be...

functional rather than organic.

mebeverine: helps smooth spasms.

ASK:

  • history of colic as a baby?
  • keep diary of episodes
  • history of stress/ overachievement at school?

87

APGAR score

a measure of the physical condition of a newborn infant.

 

88

What's the difference between primary and secondary bedwetting?

 

NB. 15% of 5-year olds wet the bed. There is rarely an organic cause. 

Secondary bedwetting refers to wetting in a child who had previously been dry; often psychological stress underpining. 

89

Clinical manifestations of PCOS

  • menstrual irregularies/ anovulation (80%)
  • hirsutism (70%) ; upper lip, chin, chest, back
  • Obesity (50%) 
  • Infertility
  • Acanthosis nigricans ; dermatologic marker of insulin resistance and hyperinsulinaema (at neck, groin, axillae)

90

Infectious mononucleosis

EBV - Epstein Barr Virus

  • low grade fever
  • malaise
  • pharyngitis
  • cervical lymphadenopathy

 

occasionally; hepatosplenomegaly, jaundice

NB. Amoxicillin causes maculopapular rash

91

What's this?

Cervicitis can be caused by any of a number of infections, of which the most common are chlamydia and gonorrhea, with chlamydia accounting for approximately 40% of cases.

Can be mucopurulent with exudate.

92

Recurrent abdo pain, could be a parasite. Which is most common?

 

Giardia lamblia (intestinalis)

 flagellated parasite that colonizes and reproduces in the small intestine, causing giardiasis

93

Mesenteric adenitis

Inflammation of intra-abdominal lymph nodes following an upper respiratory tract infection or gastroenteritis.

Enlarged nodes can cause pain which can mimic appendicitis, but there is no peritonism or guarding.

Maybe evidence of throat/ chest infection.

94

periovulatory unilateral pelvic pain that some women consistently experience.

What's it called?

 

 

Mittelschmerz

95

remember: important symptoms of DKA

 

Triggers: poor compliance/ infections

thirst, polyuria

VOMITING and ABDOMINAL PAIN

KUSSMAUL acidotic breathing

Acetone on breath

Hypovolaemic shock

Monitoring; HbA1c test (% of glycosylated haemoglobin)

 

96

What could cause recurrent abdominal pain?

Idiopathic

constipation

inflammatory bowel disease

urine infections

sickle cell disease

97

What common endocrine disorder can cause fall-off growth across centiles?

 acquired hypothyroidism

(aka Hashimoto's autoimmune thyroiditis) - more common in girls

Dx: low T4, high TSH, + antithyroid antibodies.

Possible goitre.

 

 

98

Name the five gynae cancers

Ovarian,

endometrial/ uterine

cervical, vaginal,

vulval

99

What are the characteristics of non-organic abdominal pain?

  • periodic pain with intervening good health
  • periumbilical
  • may be related to school hours

100

What does CIN stand for (with cervical screening)

cervical intraepithelial neoplasia

101

Stages of cervical cancer (4) 

 

FIGO staging of Cervical carcinomas

  • Stage I ; strictly confined to the cervix.
  • Stage II ; extends beyond the cervix, but does not extend into the pelvic wall. The carcinoma involves the vagina, (but not lower 1/3)
  • Stage IIIextended into the pelvic sidewall. On rectal examination, there is no cancer-free space between the tumour and the pelvic sidewall. The tumour involves the lower third of the vagina.
  • Stage IV ; extended beyond the true pelvis or has clinically involved the mucosa of the bladder and/or rectum.

102

If peptic ulcer suspected with children then...

  • trial a PPI - omeprazole
  • investigate H. Pylori (stool examination, hydrogen breath test, endoscopy)

 

Tx if positive: triple therapy: omeprazole, amoxicillin, metronidazole.

103

Acute fever - causes

104

Red flags concerns with fever and children

  • serious infections; meningitis, urinary tract infection, pneumonia.
  • fever in babies < 8 weeks old
  • NB. commonest causes; otitis media and tonsillitis

 

105

Definition of cerebral palsy

An umbrella term used to describe disorder of movement and posture caused by permanent and non-progressive cerebral lesion early in brain development.

106

What is Traztusamab (Herceptin) used to treat?

(monoclona antibody therapy)

HER2 positive breast cancer

 

107

What genetic condition is an important cause of short stature and delayed puberty in girls?

Turner's syndrome - absence of one X chromosome

Turner babies often have webbing of the neck and lymphoedematous hands and feet.

Tx: GH and Oestrogen in childhood.

 

108

Rotterdam 2003 PCOS criteria

Two out of three of the following criteria:

  1. oligo-ovulation and/or anovulation
  2. excess androgen activity
  3. polycystic ovaries by sonogram, other endocrine disorders excluded.

109

Breast tissue begins to form in the fourth week of fetal life. In the fetus, breast tissue develops along two "milk lines" that start at the armpit and extend to the groin.

110

Ovarian cancer

- most deaths (gynae cancers)

Risk factors?

Protective factors?

 

Risk factors

Low parity

family history of breast cancer or ovarian cancer

Protective factors:

Multiparity! Breast feeding, chronic anovulation.

Also oral contraception. Remember

111

80% of breast cancers are oestrogen receptor positive ( ER+ )

what pharmacological treatment is used post op?

 

NB. progesterone sensitive is  PR+ (not common)

pre menopausal - tamoxifen (selective oestrogen receptor modulator)

post menopausal - anastrazole (aromatase inhibitor)

(aromatase enzyme is used in body fat to produce oestrogen)

112

That is the transformation zone on the cervix?

The site where the columnar epithelium is undergoing metaplasia due to the columnar epithelium being exposed to the low pH of the vagina.

113

notes needed for the nationals

114

What is a cervical ectropion?

The columnar epiethelium is present on the vaginal surface of the cervix (the ectocervix)

Normal physiological state for some women after puberty

There may be a red looking area around the os;

don't confuse with cervicitis.

It can result in an excess section of mucous, as the columnar epithelium contains mucous secreting glands (normal)

It may also cause post-coital bleeding, due to the presence of delicate blood vessels in the columnar epithelium

115

What factors increase the risk of cervical ectropion?

those that increse levels of oestrogen.

eg. COC, menstruating age.

ablation if troublesome.

116

where is cervical cancer likely to start?

(squamous cell carcinoma)

In the transformation zone.

 

 

117

What is dyskaryosis?

Abnormal cytologic changes of squamous epithelial cells. 

May be followed by the development of a malignant neoplasm.

Used synonymously with dysplasia.

118

What is CIN?

Cervical intraepithelial neoplasia (cervical dysplasia).

The abnormal growth of cells on the surface of the  cervix that could potentially lead to cervical cancer.

CIN refers to the potentially premalignant transformation of cells of the cervix.

119

How long does it typically take for CIN to progress to cervical cancer?

15 years

although could be 3-40 years.

There is usually a linear progression from CIN stages 1,2, and 3.

120

Risk factors for CIN

 

NB.  women with previous CIN have a higher risk of cervical disease in future

Smoking

 

young age commencing sexual activity

giving birth under 16

multiple sexual partners

immunosuppresant drugs

121

What's this?

Acetic acid added during colposcopy; turns areas of dysplasia white.

122

What is the Schiller's test?

Sensitive test, but not specific because abnormalities can occur with simple inflammation.

Schiller's iodine solution is applied to the cervix.

Normal cervical mucosa contains glycogen (this is used as an energy source to fight off infection) and stains brown, whereas abnormal areas do not take up the stain.

 The composition of Schiller's iodine is the same as Lugol's iodine, the latter being more concentrated. 

123

What's this?

under green light, red blood vessels show up black.

124

What is large loop excision of the transformation zone (LLETZ)

procedure involves a loop of wire (with current) that cuts a dome shaped piece of the cervix away.

The excision should be 4-5mm deeper than the affected area – which usually means about an 8mm deep incision

local anaesthetic

125

Rare but significant side effect of LLETZ?

Rare but significant – as it can affect subsequent pregnancy – e.g. may require c-section,

and also

increases the risk of premature rupture of membranes, and preterm delivery.

126

What type of cancer is cervical cancer?

85% squamous cell

the rest are adrenocarcinoma

127

How does cervical cancer present?

Often symptomatic

Non-menstrual bleeding - typical presentation.

Later: post coital bleeding, intermenstrual bleeding, post menopausal bleeding, offensive blood stained discharge.

128

Uterine Fibroids

Risk factors, presentation, management

50% asymptomatic, 30% menorrhagia

Oestrogen and progesterone dependent growth

Risk factors; increasing age, increase BMI, Afro Caribbean

Investigations; bimanual examination, ultrasound scan

Medical tx: tranexamic/ mefenamic acid

otherwise surgery.

129

intrauterine/ endometrial polyps

They often cause no symptoms, otherwise bleeding related symptoms.

Appear to be affected by hormone levels and grow in response to circulating estrogen.

Polyps can increase the risk of miscarriage in women undergoing IVF treatment.

 

130

Some more facts about endometrial cancer

10% of post-menopausal bleeding is due to endometrial cancer.

Cause of intermenstrual bleeding in pre-menopausal women.

85% of cases in post-menopausal women

Risk factors; oestrogen! (therefore obesity, nulliparity, tamoxifen use, PCOS, late menopause

131

menstrual cycle

Cigarette smoking was found to be significantly associated with a reduced risk of endometrial cancer, especially among postmenopausal women.

132

What is the most common type of painful periods?

Primary dysmenorrhoea

(but only diagnosis once secondary dysmenorrhoea has been discounted)

Most common in teenagers and women in their 20s.

133

What is adenomyosis?

How does it present?

(risk group 40-50s)

endometriosis is a common co-morbidity.

 

endometrial tissue within the myometrium.

Symptoms vary from asymptomatic (33%) to severe pain.

  • chronic pelvic pain (77%)
  • heavy menstrual bleeding (40-60%)
  • uterine enlargement (30%)
  • abnormal uterine bleeding, painful cramping menstruation, dyspareunia (7%)

Responsive to hormones, thus can improve post-menopausal, otherwise surgery.

134

What are some causes of secondary dysmenorrhoea?

fibroids, adenomyosis, endometriosis, PID, ovarian caner

135

Endometriosis - possible sites

136

What could cause primary dysmenorrhoea?

stress/ weight loss/ excessive exercise, body dysmorphia, chronic systemic illness: HPA axis

pregnancy!!! 

consitutional delay (as about menarche with mother/ sisters)

Genetics (e.g. Turner's, congenital adrenal hyperplasia)

Drugs; cocaine, chemo, anti-psychotics

137

What is Asherman's Syndrome?

(1-2% cases of 2nd amenorrhoea)

Can follow D & C, infections, endometriosis

Also referred to as intrauterine adhesions, is an acquired uterine condition that occurs when  adhesions form inside the uterus and/or the cervix.

AS can be the cause of menstrual disturbances, infertility, and placental abnormalities

tx: hysteroscopy. 

138

What are some possible causes of cervical stenosis?

Surgical procedures performed on the cervix such as colposcopy, cone biopsy, or a cryosurgery procedure

Trauma to the cervix

Repeated vaginal infections

Atrophy of the cervix after menopause

Cervical cancer, Radiation

Cervical nabothian cysts

139

Treatment and definition of primary ovarian failure

loss of ovarian function before the age of 45 years.

>> FSH (taken on day 2-4) and low oestradiol levels. Repeat in four weeks to confirm diagnosis.

>> risk of CV disease

>> risk of OA

Tx: HRT for bone and CV protection

140

Oligomenorrhoea - defined

 

Def: infrequent menstruation defined by a cycle length between 6 weeks and 6 months.

 

141

PCOS - Rotterdam criteria

 

(also remember that insulin resistance is a pathophysiological feaure of PCOS, and along with this can come obesity and diabetes)

NB acanthosis nigricans is thought to be a sign of insulin resistance.

Requires 2/3 of the following:

Oligo/ anovulation

hyperandrogenism (hirsutism/ male pattern balding,  upper lip, chin, around the nipples and in a line beneath the umbilicus)

polycystic ovaries on ultrasound

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what are theca cells , and their function?

Endocrine cells in the ovary surrounding the follicle that synthesis androgens.

 

hyperactivity of theca cells causes hyperandrogenism

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What is CA-125?

Cancer Antigen 125

a protein that may be found in high amounts in the blood of patients with ovarian cancer.

Only 50% sensitive with early-stage cancer.

 

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Is there a screening programme for ovarian cancer?

NO because there is no test that reliably picks up ovarian cancer at an early stage. 

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What risk groups and factors for breast cancer?

no history of breast-feeding, having no children, having children at late ages (especially over the age of 30 years), l

long-term hormone replacement therapy (HRT) use,

obesity (for postmenopausal women only)

and high consumption of alcohol 

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Target population for breast mammography screening

All women between the ages of 50 and 70 years are invited to attend for screening every three years. It is a rolling programme, which means that not all women will be invited when they reach 50 years, but all will be invited before their 53rd birthday

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