Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Phase 3a Medicine - Riona > Obstetrics > Flashcards

Obstetrics Flashcards

(109 cards)

Start Studying
1
Q

What is the cervix and upper 1/3rd of the vagina supported by? (2)

A

Carinal and uterosacral ligaments

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is the middle 1/3rd of the vagina supported by?

A

Endofascial condensation (endopelvic fascia)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is the lower 1/3rd of the vagina supported by? (2)

A

Levator ani muscles and perineal body

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Define urethrocoele

A

Prolapse of the lower anterior vaginal wall involving the urethra only

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Define cystocoele

A

Prolapse of the upper anterior vaginal wall involving the bladder (if urethra involved - cystourethrocoele)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Define enterocoele

A

Prolapse of the upper posterior vaginal wall (usually contains loops of small bowel)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Define apical prolapse

A

Prolapse of uterus, cervix, upper vagina

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Define rectocoele

A

Prolapse of the lower posterior wall of vagina, involving anterior wall of rectum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are the 5 stages of pelvic organ prolapse?

A

0 - no descent of pelvic organs during straining
1 - leading surface of prolapse <1cm above hymenal ring
2 - leading surface of prolapse from 1cm above to 1cm below hymenal ring
3 - leading surface ≥1cm below hymenal ring, not complete
4 - vagina completely everted

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Give 3 causes of prolapse

A
  • vaginal delivery and pregnancy
  • congenital factors
  • menopause
  • chronic predisposing factors
  • iatrogenic
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Give 2 chronic predisposing factors to prolapse

A

Increased intra-abdominal pressure

  • obesity
  • chronic cough
  • constipation
  • heavy lifting
  • pelvic mass
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Give 3 symptoms of prolapse

A
  • dragging sensation
  • lump sensation
  • worse at end of day/standing
  • bleeding
  • discharge
  • interference with sex
  • urinary symptoms
  • bowel symptoms
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Give 3 examinations for prolapse

A
  • abdominal exam
  • bimanual exam
  • Sims speculum
  • PR
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Give 2 investigations for prolapse

A
  • pelvic USS
  • urodynamic testing
  • assessments for fitness for surgery
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

How is prolapse prevented?

A

Recognition of obstructed labour and avoidance of a prolonged second stage
Pelvic floor exercises after birth

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are the 3 aspects of management for prolapses?

A

General, pessaries, surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is the general management for prolapses? (3)

A

Lose weight
Physiotherapy
Smoking cessation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What does pessary management for prolapse involve?

A

Ring or shelf, change 6-9 monthly

HRT/topical oestrogen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Give 3 different surgical managements for prolapses

A

Uterine - hysteropexy, hysterectomy
Vaginal vault - sacropopexy, sacrospinous fixation
Vaginal wall - anterior and posterior repairs, mesh
Stress incontinence - tape, colposuspension

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is urodynamic stress incontinence?

A

Involuntary leakage of urine on effort, exertion, sneezing or coughing. Often due to urethral sphincter weakness.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Give 3 causes of urodynamic stress incontinence

A

Vaginal delivery and pregnancy
Obesity
Age
Previous hysterectomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What is the mechanism for urodynamic stress incontinence?

A

1) Increased intra-abdominal pressure (e.g. cough) causes the bladder to be compressed and bladder pressure to increase.
2) Normally, the bladder neck is also compressed and pressure also increases.
3) If pelvic supports are weak the bladder neck can slip below the pelvic floor, and therefore isn’t compressed - no pressure increase.
4) Bladder pressure > urethral pressure = incontinence

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Give 2 symptoms of urodynamic stress incontinence

A

Stress incontinence
Urgency
Frequency
Urge incontinence

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

How is urodynamic stress incontinence examined?

A

Sims’ speculum
Abdominal exam
Cough

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
What are the investigations for urodynamic stress incontinence?
Urine dipstick | Cystometry
26
What are the 4 domains of management for urodynamic stress incontinence?
General, conservative, drugs, surgery
27
What is the general management for urodynamic stress incontinence?
Lose weight Treat chronic coughs Decrease excessive fluid intake
28
What is the conservative management for urodynamic stress incontinence?
Pelvic floor muscle training | Vaginal cones/sponges
29
What is the drug management for urodynamic stress incontinence?
Duloxetine
30
What type of drug is duloxetine
Serotonin and noradrenaline reuptake inhibitor
31
What is the surgical treatment for urodynamic stress incontinence?
TVT TOT Burch colposuspension Injectable periuretheral bulking agents
32
Define overactive bladder
Urgency with/without urge incontinence, usually with frequency or nocturia, in absence of proven infection
33
Define detrusor overactivity
Urodynamic diagnosis characterised by involuntary detrusor contractions during filling phase which may be spontaneous/provoked
34
Give 2 causes for overactive bladder
Idiopathic Iatrogenic Detrusor overactivity
35
What is the mechanism for overactive bladder?
1) Detrusor contractions large enough to make bladder pressure > urethral pressure 2) Leakage, urge incontinence 3) Can be spontaneous, due to a rise in intra-abdominal pressure, or due to a trigger (tap, key in door)
36
Give 3 symptoms of an overactive bladder
``` Urgency Urge incontinence Frequency Nocturia Stress incontinence Leakage at night/orgasm Childhood enuresis Faecal urgency ```
37
What are the investigations for overactive bladder?
Urinary diary | Cystometry
38
What are the 3 main treatment options for overactive bladder?
Conservative Drugs Surgery
39
What does conservative management of overactive bladder involve? (2)
``` Advice (decreased fluid intake, avoiding caffeine) Bladder training (delay voiding) ```
40
What does drug management of overactive bladder involve? (3)
Anticholinergics Oestrogens Botulinum toxin A
41
How do anticholinergics work in overactive bladder?
Block muscarinic receptors that mediate detrusor smooth muscle contractions
42
How does botulinum toxin A work in overactive bladder?
Blocks neuromuscular transmission, injected into detrusor
43
What does surgical management of overactive bladder involve?
Neuromodulation and sacral nerve stimulation (S3 nerve route) Clam augmentation oleocystoplasty
44
Give 3 investigations for urinary symptoms
``` Frequency volume chart/bladder diary Urinanalysis/dip stick Residual urine measurement Questionnaire Urodynamics ```
45
What is the detrusor muscle innervated by?
Sacral roots, parasympathetic
46
What is endometriosis?
The presence and growth of endometrial tissue outside of the uterine cavity
47
What is endometriosis dependent on?
Oestrogen
48
When does is endometriosis repressed? (2)
After menopause | During pregnancy
49
Where does endometriosis most often occur?
Uterosacral ligaments Ovaries Pouch of Douglas
50
What is an endometrioma?
Chocolate cyst/accumulated blood in ovaries
51
Give 2 causes of endometriosis
Retrograde menstruation | Mechanical, lymphatic, blood bourne, metaplastic
52
Give 3 symptoms of endometriosis
``` Chronic cyclical pelvic pain Dysmenorrhoea before menstruation Deep dyspareunia Subfertilty Dyschezia during menses Menstrual problems ```
53
Give a finding on examination in endometriosis
Tenderness and/or thickening behind uterus/in adnexa | Immobile uterus
54
Give 2 investigations for endometriosis
Laparoscopy +/- biopsy Transvaginal USS MRI CA125 levels
55
Give 3 medical treatments for endometriosis
``` Analgesia COCP Progestogen GnRH analogues Danazol (androgenic) IUD ```
56
Give 2 surgical treatments for endometriosis
Laparoscopic laser ablation/diathermy Adhesiolysis Hysterectomy +/- BSO
57
Give 2 ways in which endometriosis can cause infertility
``` Immune factors Oocyte toxicity Adhesions Tubal dysfunction Ovarian dysfunction ```
58
What are fibroids?
Benign tumours of the myometrium
59
What factors make fibroids more common?
Near the menopause Afro-Caribbean Family history
60
What factors make fibroids less common?
Parous COCP Progestogen injections
61
When do fibroids regress?
Menopause (not necessarily in pregnancy)
62
Give 2 symptoms of fibroids
Menstrual problems (menorrhagia, intermenstrual loss) Dysmenorrhoea Bladder symptoms Subfertility
63
Give 2 complications of fibroids
Torsion Degenerations (red, cystic, hyaline) Malignancy Pregnancy problems
64
What are the investigations for fibroids?
USS, MRI, laparoscopy | Hysteroscopy
65
What are the medical treatments for fibroids?
GnRH agonists | Transexamic acid, NSAIDs, progestogens
66
How long can one take GnRH agonists for, why, and what can be done to extend this?
~6 months Bone density decreases, side effects Take HRT too
67
What are the surgical treatments for fibroids?
Hysteroscopic resection Myomectomy Hysterectomy
68
Give a less common management of fibroids
Uterine artery embolisation | Ablation
69
What is adenomyosis?
The presence of endometrium and underlying storm in myometrium
70
How does adenomyosis occur?
Endometrium grows into myometrium
71
What are the symptoms of adenomyosis?
Painful, regular, heavy periods
72
What are the treatments for adenomyosis?
IUD or COCP +/- NSAIDs | Hysterectomy
73
What are endometrial polyps?
Small usually benign tumours
74
What are the symptoms of endometrial polyps
Menorrhagia Intermenstrual bleeding Prolapse through cervix
75
What is the management for endometrial polyps?
Resection
76
What is the pathology of most endometrial carcinomas?
Adenocarcinoma of columnar endometrial gland cells
77
Give 3 risk factors for endometrial carcinoma
``` High ratio of oestrogen:progestogen Obesity PCOS Nulliparity and late menopause Oestrogen secreting tumours Tamoxifen ```
78
Give 1 protective factor for endometrial carcinoma
COCP | Pregnancy
79
What is the premalignant stage to endometrial carcinoma?
Endometrial hyperplasia with atypia
80
Give 2 symptoms of endometrial carcinoma
Post-menopausal bleeding Inter-menstrual bleeding Abnormal cervical smear
81
What are the stages for endometrial carcinoma? (4)
1 - lesions confined to uterus 2 - also in cervix 3- invades through uterus 4 - further spread
82
Give an investigation for endometrial carcinoma
USS +/- endometrial biopsy
83
Give 3 managements for endometrial carcinoma
Hysterectomy and BSO Lymphadenectomy Radiotherapy
84
What is the 5 year prognosis endometrial carcinoma?
85% at stage 1
85
Explain the 3 stages of the menstrual cycle
Days 1-4: menstruation - endometrium shed as hormonal support withdrawn - myometrial contractions 😡 Days 5-13: proliferative phase - pulses of GnRH from hypothalamus stimulate LH and FSH release, which stimulate follicular growth - follicles produce oestradiol and inhibin, which suppress FSH secretion in a negative feedback loop - as oestradiol levels rise, a positive feedback effect causes sharp rise in LH - 36 hours after LH surge, ovulation - oestradiol causes endometrium to become proliferative Days 14-29: luteal/secretory phase - follicle becomes CL, which produces oestradiol and progesterone - progesterone induces secretory changes in endometrium - if no fertilisation occurs, CL fails, causing oestrogen and progesterone to fall
86
Give 2 features of a proliferative endometrium
Stromal cells proliferate | Glands elongate
87
Give 3 features of a secretory endometrium
Stromal cells enlarge Glands swell Blood supply increases
88
Define menorrhagia
Heavy menstrual bleeding in an otherwise normal cycle
89
Define intermenstrual bleeding
Bleeding between periods
90
Define irregular periods
Periods outside range of 23-35 days with range of >7 days
91
Define postcoital bleeding
Bleeding after intercourse
92
Define primary amenorrhoea
Periods never start
93
Define secondary amenorrhoea
Periods stop for 6 months or more
94
Define oligomenorrhoea
Infrequent periods (> every 35 days)
95
Define post-menopausal bleeding
Bleeding 1 year after menopause
96
Define dysmenorrhoea
Painful periods
97
What is the clinical definition of menorrhagia?
Excessive menstrual blood loss that interferes with physical, emotional, social and material QOL
98
What is the objective definition of menorrhagia?
>80mL blood loss
99
Give 2 causes of menorrhagia
``` Subtle abnormalities of endometrial haemostasis or uterine PG levels Fibroids Polyps Coagulation disorders Adenomyosis ```
100
Give 2 symptoms of menorrhagia
Flooding | Large clots
101
Give 2 investigations for menorrhagia
``` Haemoglobin Coagulation and thyroid function Transvaginal USS Endometrial biopsy Hysteroscopy ```
102
What is the first line medical treatment for menorrhagia?
IUS
103
What is the second line medical treatment for menorrhagia? (3)
Antifibrolytics NSAIDs COCP
104
What is the third line medical treatment for menorrhagia?
Progestogens | GnRH agonists
105
What are the surgical treatments for menorrhagia? (5)
``` Polyp removal Fibroid removal/myomectomy Endometrial ablation Hysterectomy Uterine artery embolisation ```
106
What are the two causes of irregular menstruation and IMB?
Anovulatory cycles | Pelvic pathology
107
Who are more likely to have anovulatory cycles in irregular menstruation and IMB?
Just started menarche | Almost at menopause
108
Give 2 investigations for irregular menstruation and IMB
Haemoglobin levels Cervical smear USS Endometrial biopsy
109
Give 2 drug treatments for irregular menstruation and IMB
IUS COCP Progestogens HRT

Phase 3a Medicine - Riona (3 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions