Maternal Health COPIED Flashcards
(147 cards)
1
Q
Causes of acute abdominal pain
A
2
Q
Diagnosis - Cerebral Palsy
A
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
Q
Who gets neoplasms of the vagina and vulva?
A
mainly post menopausal and older women
4
Q
Suspected ovarian cancer - when would you definitely refer?
A
If physical examination identifies ascites and/ or abdominal mass
(when it is clearly not a fibroid)
5
Q
Gravida
A
Total number of confirmed pregnancies, regardless of the outcome.
6
Q
What is triple assessment? (ref breast cancer)
A
Breast examination
Breast imaging (mammogram/ ultrasound)
Tissue sampling (core biopsy or FNA)
- for a definite diagnosis
7
Q
What is an unusual protective factor for endometrial cancer in postmenopausal women?
A
smoking
8
Q
A woman’s hormone balance plays a part in the development of most endometrial cancers.
What is the biggest risk factor?
A
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
Q
What is Paget’s disease of the breast?
A
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
Q
weight faltering implies…
A
conditon is transient, not serious
11
Q
Persistent fever - causes
A
12
Q
Kawasaki disease
A
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
Q
When is endometrial cancer most common?
A
After menopause
- Immediate referral (NICE guidelines)
14
Q
What is cervical excitation?
(chandelier sign)
A
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
Q
Where does lymph from the breast drain?
A
Majority axillary
also
Behind sternum
NB Montgomery’s glands is the name of the modified sweat glands found on the areola.
16
Q
What is the most common (but still rare) inborn error of metabolism that is routinely screened for in all neonates?
A
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
Q
What does the corpus luteum secrete?
A
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
Q
When would you take a breast cancer history from a patient? (4)
A
- 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.
- It is clinically relevant:
19
Q
What does LH do?
A
- Rise in LH releases the ovum
- stimulates the formation of the luteal body
20
Q
Management of advanced breast cancer
A
endocrine therapy - for ER positive breast cancer
Chemotherapy
Bisphosphonates
21
Q
Children and type I diabetes;
any specific symptoms?
A
usual symptoms + secondary enuresis (bedwetting)
22
Q
How does type I diabetes initially present?
A
- 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
Q
tetanus
A
Anaerobic organism Clostridium tetani.
In soil, enters wounds.
Neurotoxin causes progressive painful muscle spasms.
24
Q
A
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 alcoho**l 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 5o or 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 i**ncreases 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 i**ncreases 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 wome**n 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** **_c_****_ombined 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 c**hlamydia 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 III** ; **extended 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**
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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.
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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
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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**
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Oligomenorrhoea - defined
Def: infrequent menstruation defined by a cycle length between 6 weeks and 6 months.
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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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