repro LO Flashcards Preview

repro > repro LO > Flashcards

Flashcards in repro LO Deck (327)
Loading flashcards...
1

describe the production of sperm

Germ cells known as spermatogonia undergo mitosis, some continue mitosis others undergo meiosis and become primary spermatocytes. This divides into two secondary spermatocytes and undergoes further division into two spermatids each with 23 chromosomes.

2

Leydig cell produce

Leydig cells in the testis produce testosterone and androgens that also stimulate sustencular cells in the seminiferous tubules

3

Sertoli cells role

support sperm producing cells and produce inhibin

4

LH and FSH and produced in the

anterior pituitary

5

which hormone stimulate the production of LH and FSH in the anterior pituitary and where from?

GnRH produced in the hypothalamus

6

LH targets

endocrine cells to produce steroid and peptide hormones which then can target the anterior pituitary and hypothalamus in a long loop positive/negative feedback. it also stimulates Leydig cells.

7

FSH targets

gamete production in the testes

8

role of inhibins

inhibits FSH secretion

9

activtins role

stimulate FSH secretion as well as spermatogenesis

10

factors affecting spermatogenesis

environmental factors
puberty
problems with hormonal control (genetics, tumours, medications, functional)
problems at the site of production (genetics, cancer, surgery, trauma, infection)

11

testosterone targets

skin for hair growth, balding, sebum production, liver for synthesis of serum proteins, male sexual organs for penile growth, spermatogenesis, prostate growth and function, brain for libido, mood, muscle for increase in strength and volume, kidney for stimulation of erythropoietin production, bone marrow for stimulation of stem cells, bone for accelerated linear growth and closure of epiphyses.

12

GnRH action in female

stimulate LH and FSH secretions from anterior pituitary

13

FSH action in female

stimulate follicular recruitment and development

14

LH action in female

maintain dominant follicle, induce follicular maturation and ovulation, stimulate CL function

15

oestradiol is produced from

granulosa cells

16

oestradiol role in females

support secondary sexual characteristics and reproductive organs
negative feedback control of LH, GnRH and oestrogen for most of the cycle
except for late follicular phase – positive control of LH surge during day 12-14
stimulates proliferative endometrium

17

progesterone from corpus Luteum role

maintenance of secretory endometrium
negative feedback control of HPO

18

targets of oestrogen

targets of oestrogens are central nervous system, anterior pituitary, hypothalamus, fat distribution, ovary, mammary gland, bone maturation and turnover, cervix, vagina, fallopian tube, uterus. Its systemic effects include protein metabolism, carbohydrates, lipids, water and electrolyte balance, blood clotting.

19

production of eggs description

Oogonia the ovary germ cell complete mitosis and meosis by the firth month of female development resulting in primary oocytes resulting in ovaries containing half a million primary oocytes. Upon puberty meiosis resumes, with the primary diving into two sells a large egg (secondary oocyte) and a tiny first polar body which disintegrates. If the secondary is chosen for ovulation it undergoes meosis as the sister chromatids separate, and the final step occurs with fertilisation

20

ovaries hormone produce

. The ovaries also produce inhibins that inhibit FSH secretion and activins that stimulate FSH secretion as well as oogenesis.

21

the ovarian cycle

follicular phase
ovulation
luteal phase

22

luteal phase description

ruptured follicle forms the corpus luteum, secretes hormones in preparation for pregnancy. If not it will cease function and the ovarian cycle continues.

23

follicular growth lasts for

10-21 days

24

endometrial cycle stages

menses
proliferative phase
post ovulation

25

endometrial cycle post ovulation description

after ovulation corpus luteum hormones convert the thick endometrium into a secretory phase, if not pregnancy occurs the superficial layer is lost during menstruation.

26

early follicular phase hormonal control

GNRH stimulates FSH and LF which stimulate the follicle to produce androgens and AMH, androgens stimulate further production of oestrogens as stimulated by FSH, this generates a positive feedback as it also inhibits FSH, LH, and GnRH.

27

late follicular phase and ovulation hormonal control

GnRH stimulate FSH and LH. FSH stimulates the follicle to produce inhibin which inhibits FSH, but also lots of oestrogen which now stimulates the hypothalamus to produce GnRH. LH stimulates the production of androgens which stimulate more follicular production of oestrogen as well as a small amount of progesterone which stimulates LH and GnRH production.

28

early luteal phase hormonal control

GnRH, FSH and LH levels decrease in response to increased oestrogen, progesterone and inhibin from the corpus luteum

29

late luteal phase hormonal control

tonic secretion of GnRH stimulates increased FSH to develop a new follicle and LH. The corpus luteum disintegrates reducing levels of oestrogen and progesterone.

30

factors affecting oogenesis

stress, nutritional status
changes in the day and night cycle
hormonal contraception
problems with hormonal control (genetics, tumours, medications, functional) problems at the site of production (genetics, cancer, surgery, trauma, infection)

31

morning sickness affects what percentage of women?

80-85%

32

morning sickness can develop into

hyperemesis gravidarum

33

pregnancy Cardiac output increases to

30-50%

34

blood pressure drops in which trimester?

2nd

35

during pregnancy renal plasma flow increases by

20-50%

36

during pregnancy GFR increases by

50%

37

pyelonephritis is associated with what in pregnancy?

preterm labour

38

plasma volume increases by what during pregnancy?

50%

39

RBC mass increases by what during pregnancy?

25%

40

iron requirements increase by how many grams?

1g

41

progesterone effect on respiratory system?

reducing C02 consumption and oxygen consumption increases by 20% with hyperaemia of respiratory mucous membranes.

42

GI affects during pregnancy

peristalsis is reduced, gastric emptying slows, the cardiac sphincter relaxes and overall GI motility reduced due to increased progesterone and reduced motilin. Acid reflux

43

focus of pre-pregnancy counselling?

It should focus on general health measures such as improving diet, optimising BMI, reducing alcohol consumption, smoking cessation and folic acid. A risk assessment should be conducted considering socioeconomic factors, parity (Pre-eclampsia), occupation, substance misuse.

44

goal of pre-pregnancy counselling?

ensure optimum maternal and psychiatric health, stopping unsuitable drugs and advice complications and sometimes against pregnancy. With attempts made to reduce any fetal or maternal risks.

45

what should an antenatal exam focus on?

(wellness, foetal movement), blood pressure, urinalysis, abdominal palpation (estimated size, liquor volume, and symphyseal fundal height). Determine foetal position and foetal heart.

46

what infection screens are offered to a pregnant women?

hepatitis
syphilis
HIV
MSSU

47

what blood/immunological screens are available for pregnant women ?

anaemia and (rhesus disease, anti C, anti Kell)

48

when does the first scan occur?

10-14 weeks

49

what does the first scan look at?

(viability, multiple pregnancy, abnormalities, down syndrome screening

50

what maternal risk factors during pregnancy can be examined?

Beta CG, PAPP-A and fetal nuchal translucency

51

second trimester US for

neural tube defects, if no Nuchal translucency possible alpha fetoprotein screen.

52

amniocentesis miscarriage percentage risk?

1%

53

down syndrome screening issues

cut off high risk is 1/150, overall is 1/700 but isn’t an exact yes or no answer)

54

mechanical changes during pregnancy

spine curvature increases

55

metabolic changes during pregnancy

the body enters a starvation like mode with increased ketone production

56

thyroid issues during pregnancy

TSH reduces but binding globulins increase but there is then iodine deficiency often with temporary hyperthyroidism in the first semester,

57

issue with a supine position If pregnant

25% reduction in CO

58

intrapartum CV changes

pain results in increased catecholamines and CO increases 10% in labour and 80% in 1st post-delivery. However there is also an effective ½L of blood added.

59

how long post partum before CV returns to normal

3 months

60

what increase in folate during pregnancy

10-20 fold folate requirements

61

how might human placenta lactogen affect insulin resistance?

increased insulin resistance

62

Hg during pregnancy

reduced

63

WCC during pregnancy

increased

64

platelets during pregnancy

same/reduced

65

CRP during pregnancy

same

66

ESR during pregnancy

increased

67

urea during pregnancy

reduced

68

creatinine during pregnancy

reduced

69

urate during pregnancy

reduced but increases during gestation - uric acid marker for renal dysfunction and marker for pre-eclampsia

70

24hr protein during pregnancy

increased

71

total protein during pregnancy

reduced

72

albumin during pregnancy

reduced

73

AST/ALT/GGT during pregnancy

reduced/same

74

Alk Phos during pregnancy

greatly increased

75

bile acids during pregnancy

same

76

D dimer during pregnancy

increased

77

HBA1c during pregnancy

reduced

78

Combined hormonal contraception method

ethinyl oestradiol and synthetic progesterone. Stop ovulation and affects cervical mucus and endometrium (21 days and a hormone free week)

79

Combined hormonal contraception options

pill taken daily

patch EVRA (changed weekly)

Ring Nuvaring - changed every 3 weeks

80

progestogen method

take same time every day without free trial can be desogestrel pill or traditional LNG NET pill

81

injectable progestogen method

injection every 13 weeks that prevents ovulation, alters cervical mucous making it hostile to sperm, makes endometrium unsuitable for implantation

82

subdermal progestogen implant method

inhibition of ovulation and effects cervical mucous, can last 3 years.

83

intrauterine contraception options

copper or levonorgestrel

84

intrauterine contraception copper method

toxic to sperm, stop sperm reaching egg, may sometimes prevent implantation of fertilised egg. Can last 5-10 years.

85

intrauterine contraception levonorgestrel method

affect cervical mucus and endometrium but still ovulate it stops fertilisation and implantation, slow release progestogen.

86

combined hormonal contraception general side effects

breast tenderness, nausea, headache, irregular bleeding first 3 months, mood changes, weight gain. Serious include venous thrombosis, increased arterial thrombosis (MI/stroke), avoid if active gall bladder or previous liver tumour, increased risk of cercial cancer or breast cancer.

87

EVRA patch side effect

<5% skin reaction

88

progestogen pill side effects

appetite increase, hair loss, mood change, bloating, headache, acne, still avoid if current breast cancer or liver tumour.

89

injectable progestogen side effects

delay in return to fertility, reversible reduction in bone density, problematic bleeding, weight gain.

90

subdermal progestogen implant side effects

30% have prolonged frequent bleeding, may cause mood changes

91

intrauterine contraception general risk

1:100 perforation risk, 5:100 expulsion risk, <1:1000 small infection risk.

92

copper intrauterine contraception risk

may make periods heavier

93

female sterilisation procedure

laparoscopic sterilisation – Filshie clips applied across tube to block tube lumen
may do a salpingectomy at planned caesarean section if discussed in advance

94

laparoscopic sterilisation failure risk

1/200 lifetime

95

male sterilisation procedure

vans deferens divided and ends cauterised small incision midline scrotum.

96

failure risk for vasectomy

is 1 in 2000 lifetime.

97

issues with reversing with a vasectomy

anti-sperm antibodies

98

describe the abortion act

2 drs must sign and under
Under 24 weeks and continuation of pregnancy involves risk greater than if the pregnancy were terminated of injury to the physical or mental health of the pregnant woman or of the existing child (ren) of the pregnant. risk that if the child were born it would suffer physical or mental abnormalities as to be seriously handicapped

99

surgical abortion method

cervical priming misoprostol 3 hrs preop. Transcervical suction catheter. (5-12 weeks) 1

100

medical abortion method

mifepristone oral antiprogestogen tablet, 36-48hrs later misoprostol expels pregnancy (5-24 weeks).
can be done at home.

101

physiology of the initiation of labour description

the cervix softens, myometrial tone changes to allow for coordinated contractions, progesterone decreases whilst oxytocin and prostaglandins increase to allow for labour to initiate.

102

stage 1 of labour description

dilation of 0.5cm-1.0cm per hour and is completed once the cervix is fully dilated.

103

stage 2 part 1 of labour description

passive stage, important to position for gravity to assist

104

stage 2 part 2 labour description

active second stage expulsive contractions prima expect crowning within two hours, multi within an hour.

105

stage 3 of labour

from the birth of the baby to the expulsion of the placenta and membranes

106

mechanisms part of labour

A) before engagement
B) engagement, flexion and descent
C) descent, rotation
D) complete rotation, early extension
E) complete extension
F) restitution
G) anterior shoulder delivery
H) posterior shoulder delivery

107

methods of assessing labour

maternal observations
abdominal palpation (assessing orientation, engagement and position)
vaginal examination (for cervix dilation but important for high risk)
monitoring of liquor (colour, smell, consistency)
auscultation of the foetal heart (stage 1 HR every 15 minutes, stage 2 every 5 minutes)
palpation of uterine muscle contractions
external signs (rhomboid of michaelis and anal cleft line)
CTG monitoring

108

methods of analgesia

breathing, message, TENs, paracetamol, dihydrocodeine
water
Entonox
opioids
remifentanil patient controlled analgesia (might overdo it making pushing harder)
epidural
positioning

109

pharmacokinetics in pregnancy refers to

the process of Administration, Distribution, Metabolism and Excretion.

110

pharmacodynamics of pregnancy refers to

affect of site of action and receptor response to drugs. Altering the efficacy.

111

issue with absorption in pregnancy

morning sickness, increased gastric emptying and gut motility, increased blood flow and for inhalation there is increased cardiac output and decreased tidal volume may increase absorption of drugs. In general, there is increased absorption.

112

issue with distribution in pregnancy

: increased plasma volume and fat will alter distribution and greater dilution of plasma will decrease relative amount of plasma proteins resulting in more free drugs

113

issues with metabolism in pregnancy

oestrogen and progestogens can induce or inhibit P450 enzymes, increasing or reducing metabolism.

114

issues with excretion in pregnancy

GFR is increased by 50%, reduced plasma concentration

115

pharmacodynamic issues with pregnancy

changes in blood flow
changes in receptor
placental exchange
teratogenicity
fetotoxicity

116

issues with medication in breast feeding

most drugs will be present at lower doses. Avoid immunosuppressants, anti-convulsant, drugs of abuse, amiodarone, lithium, radio-iodine, cytotoxic.

117

guidelines for medication and breast feeding

Avoid unnecessary drug use, check on up to date information. If licensed and safe in paediatrics use likely to be safe in pregnancy. Choose drugs with pharmacokinetic properties that reduce infant exposure (high protein bound).

118

principles for prescribing in pregnancy

safe to assume all drugs will cross the placenta
try non-pharma logical treatment first
avoid new drugs unless proven safe
use lowest effective dose
use the drug for shortest time, intermittent if possible
consider stopping or reducing dose before delivery
don’t under treat disease harmful to the foetus

119

common reasons for abnormal labour

failure to start labour, inadequate progress, malposition, foetal distress

120

failure to start labour treatment

induction and amniotomy with I.V oxytocin to achieve adequate contractions.

121

cephalopelvic disproportion refers to

(foetal head in correct position but too big to negotiate pelvis)

122

in pregnancy malposition refers to

(foetal head being in an incorrect position)

123

foetal distress may arise from

excessive contractions reducing placental blood flow

124

the 4 T's of post partum haemorrhage

tone, Trauma, Tissue, Thrombin

125

primary post partum haemorrhage is

<24hrs

126

secondary post partum haemorrhage refers to

post partum to 6 weeks

127

venous thromboembolism in pregnancy investigation and treatment

hypercoagulability treat with thromboprophylaxis. D-Dimer unreliable in pregnancy treat with heparin.

128

1 maternal death occurs how many minutes along?

2

129

maternal mortality refers to

death of a woman while pregnancy or within 42 days of termination of pregnancy. Any cause related to the pregnancy/management.

130

maternal mortality ratio refers to

No. of death during given time per 100,00 livebirths during the same period. Risk each pregnancy.

131

maternal mortality rate refers to

No. of death in given time period per 100,000 women of reproductive age or woman-years of risk exposure in same time period. Frequency of exposure to the risk

132

proportionate mortality ratio : (maternal)

: maternal deaths as proportion of all female deaths of those of reproductive age in a given time period. Measure of women’s risk of becoming pregnant and well as the risk of dying pregnant

133

still birth is defined as

birth of a death baby after 20/24/28 weeks

134

early neonatal death is defined as

first week of life

135

late neonatal death is defined as

death within 28 days of life

136

perinatal refer to

still birth and neonatal

137

infant mortality refers to

death of an infant within the first year

138

child mortality refers to

death of a child within 5 years

139

measuring global maternal and neonatal mortality facility

health information systems, registries, confidential enquiries, maternal death review, audit

140

measuring global maternal and neonatal mortality facility population

law, vital registration, census, surveys or surveillance (sisterhood or verbal autopsy).

141

what are the three areas responsible for perinatal and maternal death

addressing the delay in decisions to seek care
addressing the delays in reaching care
addressing the delays in receiving care

142

methods for reducing global maternal and perinatal death

better antenatal care (monitoring weight, B.P. proteinuria, folic acid, malaria prophylaxis), skilled attendant at birth, emergency obstetric care.

ensure the baby is breathing, exclusive breastfeeding right away, warmth and handwashing before baby contact.

143

vulvovaginal candidosis symptoms

itch, discharge, thick ‘cottage cheese’ but usually asymptomatic carriage

144

bacterial vaginosis symptoms

watery/yellow fishy discharge, sore itch from dampness, asymptomatic, worse after sex

145

vulvovaginal candidosis signs

fissuring, erythema with satellite lesions, characteristic discharge

146

bacterial vaginosis signs

thin homogenous discharge

147

list the types of miscarriage

• List the types of miscarriages
Spontaneous miscarriage
Threatened miscarriage
inevitable miscarriage
missed miscarriage
incomplete miscarriage
complete miscarriage
septic miscarriage

148

initial management of a threatened miscarriage

conservative

149

initial management of a inevitable miscarriage

– if heavy bleeding then may need evacuation

150

initial management of a missed miscarriage

either conservative, medical (prostaglandins (misoprostol)) or surgical

151

initial managment of a septic miscarriage

antibiotics and evacuate uterus

152

definition of a antepartum Haemorrhage

Haemorrhage from the genital tract after the 24th week of pregnancy but before the delivery of the baby.

153

antepartum haemorrhage can be caused by

Placenta Praevia, placental abruption, unknown, local lesions or vasa praevia.

154

initial managment of APH

vary from expectant treatment to attempt a vaginal delivery to caesarean depending on amount of bleeding, general condition of mother and gestation.

155

list common STI's

Gonorrhoea

chlamydia
Herpes
anogenital warts
syphilis
trichomoniasis

156

gonorrhoea Male presentation

asymptomatic, thick profuse yellow discharge, dysuria.

157

Gonorrhoea Female presentation

vaginal discharge, dysuria, post-coital bleeding

158

Chlamydia male presentation

asymptomatic, slight watery discharge, dysuria

159

chlamydia female presentation

vaginal discharge, dysuria, post-coital bleeding

160

chlamydia presentation for both sexes

conjunctivitis

161

herpes presentation

80% have no symptoms. The rest have recurring symptoms – monthly, annually. Burning/itching then blistering then tender ulceration. Tender inguinal lymphadenopathy. Flu-like symptoms. Dysuria, Neuralgic pain in back, pelvis and legs,

162

Trichomoniasis presentation males

asymptomatic

163

trichomoniasis female presentation

profuse, thin vaginal discharge, greenish, frothy and foul smelling, vulvitis

164

anogenital warts presentation

Lumps with a surface texture of a small cauliflower. Occasionally itching or bleeding especially if perianal or intraurethral.

165

syphilis primary presentation

chancre

166

syphilis secondary presentation

Rash, mucosal ulceration, neuro symptoms, patchy alopecia, other symptoms
asymptomatic phase

167

syphilis tertiary presentation

Neurological, cardiovascular or gummatous – skin lesions, (all v rare).

168

Gonorrhoea diagnosis

Nucleic Acid Amplification Test (NAAT) on urine or swab from an exposed site, Gram stained smear from urethra/cervix/rectum in symptomatic people. Culture of swab-obtained specimen from an exposed site using highly selective lysed blood agar in a 5% CO2 environment.

169

chlamydia diagnosis

First void urine in men. Self-taken or clinician-taken swab from cervix, urethra, rectum as appropriate. All specimens tested using a NAAT

170

herpes diagnosis

– clinical impression, swab from lesion tested using PCR.

171

urogenital warts diagnosis

appearance

172

trichomoniasis diagnosis

PCR on a vaginal swab

173

syphilis diagnosis

Clinical signs Serology for TP IgGEIA, TPPA and RPR PCR on sample from an ulcer

174

gonorrhoea treatment and follow up

Blind treatment with ceftriaxone 1g im. Test of cure at 2 weeks and test of reinfection at 3 months.

175

chlamydia treatment and follow up

Doxycycline 100mg bd 1 week. Test for reinfection at 3-12 months. Earlier test of cure not needed unless symptoms persist.

176

herpes primary treatment

Aciclovir: various regimens – eg 400mg tds for 5 days, Lidocaine ointment

177

herpes infrequent recurrences treatment

Lidocaine ointment. Aciclovir 1.2g once daily until symptoms gone (1-3 days)

178

herpes frequent recurrences

Aciclovir 400bd long-term as suppression

179

trichomoniasis

Metronidazole 400mg po bd for 5 days or 2g single dose.

180

anogenital warts at home treatment

Podophyllotoxin (brands warticon and condyline), imiquimod (brand Aldara). Both home treatments.

181

anogenital warts other treatments

Others – cryotherapy Bulky warts – diathermy, scissor removal.

182

syphilis early stage Tx

- Benzathine penicillin 2.4 MU im once Or Doxycycline 100mg bd po 2 weeks

183

syphilis late stage Tx

Benzathine penicillin 2.4MU im weekly for 3 doses Doxycycline 100mg bd po 28 days

184

male complications for gonorrhoea

epididymitis

185

female complications for gonorrhoea

pelvic inflammatory disease, Bartholin's abscess

186

complications for gonorrhoea both

Acute monoarthritis usually elbow or shoulder. Disseminated Gonococcal Infection: skin lesions - pustular with halo

187

chlamydia male complications

epididymitis

188

chlamydia female complications

PID and hence ectopic pregnancy, pelvic pain and infertility. Probably only ~1% of women who get chlamydia will develop a problem with their fertility

189

complications for both sexes chlamydia

Reactive arthritis/ Reiter’s syndrome – urethritis/cervicitis + conjunctivitis + arthritis

190

herpes complications

Autonomic neuropathy (urinary retention), neonatal infection, secondary infection.

191

trichomoniasis complication s

miscarriage and preterm labour

192

syphilis complications

cranial nerve palsies are commonest, cardiac or aortal involvement.

193

blood test assessment of ovulation

blood test to measure serum progesterone in the mid luteal phase of their cycle day 21 of a 28 cycle to confirm ovulation

194

when to refer to a fertility clinic?

Refer after 1 year of trying or if period irregularity, past medical issues, testicular issues, abnormal tests, HIV/Hep B, anxiety

195

female history fertility points

duration of infertility, previous contraception, fertility in past relationships, previous pregnancies and complications, menstrual history, medical and surgical history, sexual history, previous investigations, psychological assessments.

196

female fertility examination

weight, height, BMI, fat and hair distribution, galactorrhoea, abdominal examination, pelvic examination.

197

investigations for female fertility

Testing for ovulation, pelvic ultrasound, ovulation assessment, if irregular menstrual cycles then measure serum gonadotrophins

198

baseline assessment of what for female fertility

rubella immunity, chlamydia, TSH, mid luteal progesterone, PRL, TSH, testosterone

199

screening for female fertility

hysterosalpingography (HSG), HyCoSy (combined contrast and US) for tubal patency
tubal patency: laparoscopy

200

male history fertility

developmental (testicular descent, change in shaving frequency, loss of body hair), infections (STD, mumps), surgical (varicocele repair, vasectomy), previous fertility. Drugs/environment (alcohol, smoking, anabolic steroids, chemo, radiation, drugs), sexual history (libido, frequency and prior fertility assessments, chronic illness

201

male fertility examination

weight, height, BMI, fat and hair distribution, abdominal and inguinal examination, genital examination (epididymis, testes, vas deferens, varicoele), testicular size

202

male baseline assessments for fertility

semen analysis (volume, concentration, number, progressive motility, total motility, morphologically normal)

203

female group 1 ovulation disorders (anovulatory infertility) treatment

increase body weight, moderate exercise, offer pulsatile administration of gonadotrophin releasing hormone or gonadotrophins with LH to induce ovulation.

204

PCOS treatment of infertility

treat underlying cause, weight loss/gain, BMI >18 and <35, ovulation induction clomifene, gonadotrophins

205

tubal factors and endometriosis treatment for infertility

surgery for hydro salpinges before IVF, ideally offered a salpingectomy via laparoscopy

206

male infertility treatment options

IVF, sperm retrieval, urology, donor insemination

207

explanation of IVF

eggs harvested, then fertilised in lab with sperm, undergo divisions before being transferred to womb. Via intracytoplasmic sperm injection, ideally, we wait for 5 days if possible but if necessary 2 or 3 days. Spare embryos are kept in cryopreservation.

208

Gillick competence refers too

child under the age of 16 can consent if they fully understand and can communicated what is involved in the treatment, purpose, effects, risks, chances of success and availability of other options. If they do not pass, then the consent of a guardian is required.

209

gynae history for an adolescent

gynaecological
age of menarche
cycle
pain
sexual activity
contraception
weight gain/loss
exercise
sexual abuse

210

examination in an adolescent gynae examination

(never in a first visit and should only be conducted on consenting adolescents who are sexually active and when necessary)

211

Primary amenorrhoea refers too

failure of menstruation by the age of 16 In presence of normal secondary sexual characteristics, or 14 years in the absence of other evidence of puberty.

212

secondary amenorrhoea refers too

absent periods for at least 6 months in a women who previously had regular periods or 12 months if she previously had oligomenorrhoea

213

puberty induction in young women may be achieved through

oestrogen induction, once maximum height reached add progesterone

214

investigations in amenorrhoea

FSH, LH, PRL, TSH, testosterone, oestrogen. Pelvic USS, progesterone withdrawal bleed (pregnancy test).

215

secondary further investigations in amenorrhoea

weight, PCOS, pregnancy, fluctuating LH/oestrogens

216

polycystic ovaries investigations

USS-TAS, FSH, LH, oligo/anovulation, hyperandrogenism, US/direct inspection findings.

217

Fraser guideline -

– a doctor can proceed to give contraceptive advice and treatment to a girl under 16 if; they understand, doesn’t force her to tell her parents, is sexually active, her health is at risk, and it is in her best interests

218

vulvovaginitis presentation

persistent vulval irritation/discharge. yellow-green offensive discharge, vaginal soreness, itching.

219

vulvovaginitis signs

red flush around vulva and anus

220

vulvovaginitis aetiology

: Poor perineal hygiene, lack of oestrogen, chemical irritation.

221

foreign body presentation and examination

vaginal bleeding or foul-smelling refractory discharge. Examination under anaesthetic is required.

222

labial adhesions presentation

Clearly visible thin membranous line in the mid-line where the tissues fuse, the urethra may just be a pinhole. Most children are asymptomatic.

223

labial adhesions management

Surgical separation is rarely needed unless urinary symptoms are persistent and oestrogen therapy has failed

224

Menorrhagia presentation

: frequent troublesome, irregular and heavy periods.

225

Menorrhagia managment

Diary may be helpful and irregular periods are common, and somewhat normal for the first 2 years. Haematological conditions must be ruled out, main treatment is POP or combined oral pill. If severe bleeding than tranexamic acid.

226

Dysmenorrhoea refers too

pain during menstruation

227

managment of dysmenorrhoea

Attributed to higher levels of prostaglandins, so anti-prostaglandin drugs such as mefenamic acid can be helpful as well as suppression of ovulation with the combined oral contraceptive pill.

228

endometriosis management

if refractory then NSAIDS and oral contraceptive, a diagnostic laparoscopy.

229

risk with uterine cysts

can tort, become gangrenous and rupture threatening ovaries. Usually tender and mass present.

230

the anatomical support of the pelvic floor

endo-pelvic fascia
pelvic diaphragm
urogenital diaphragm

231

endo-pelvic fascia refers too

: network of fibro-muscular connective tissue/ surrounds the various visceral structures. Fibromuscular components stretch but connective tissue breaks.

232

pelvic diaphragm refers too

layer of striated muscles with its fascial coverings

233

urogenital diaphragm refers too

superficial and deep transverse perineal muscles with their fascial coverings.

234

level 1 of the female pelvic floor consists of

utero-sacral ligaments
cardinal ligaments

235

level 2 of the female pelvic floor consists of

para-vagina to arcus tendinous fascia: pubocervical/rectovaginal fascia

236

level 3 of the female pelvic floor consists of

urogenital diaphragm
perineal body

237

predisposing factors for uterovaginal prolapse

forceps delivery, large baby, prolonged second stage, advancing age, obesity, continence procedures ,hysterectomy

238

different types of prolapse

urethrocele
cystocele
uterovaginal
enterocele
rectocele

239

urethrocele refers too

prolapse of lower anterior vaginal wall involving urethra

240

cystocele refers too

prolapse of upper anterior vaginal wall involving the bladder

241

uterovaginal prolapse refers too

prolapse of uterus, cervix and upper vagina

242

enterocele refers too

prolapse of upper posterior wall of the vagina containing loops of small bowel

243

rectocele refers too

prolapse of the lower posterior wall of the vagina involving the rectum

244

examinations for pelvic organ prolapse

exclude pelvic mass, record position of examination, QoL. Objective Baden-Walker-Halfawy grading, POPQ score (gold standard).

245

investigations for pelvic organ prolapse

investigations: USS/MRI, urodynamics, renal USS/IVU

246

effects of pelvic organ prolapse on women's quality of life

sensation of bulge, pressure, protrusion, heaviness, difficulty inserting tampons. Urinary incontinence, frequency, weak stream, incomplete emptying, hesitancy, manual reduction of prolapse to start complete voiding. Urgency with bowel, splinting around bowel to aid defecation.

247

prevention of pelvic organ prolapse

avoid constipation, management of chronic chest pathology, small family size, improving antenatal and intrapartum care.

248

Physiotherapy for Pelvic organ prolapse

pelvic floor muscle training, increase pelvic floor strength and bulk to relieve the tension of the ligaments. Supplemented with perineometer, biofeedback, vaginal cones and electrical stimulation

249

surgery for pelvic organ prolapse

relieve symptoms, restore function both sexually and continence. Remember prophylactic antibiotics, thrombo-embolic prophylaxis, post-operative urinary Vs. SPC.

250

chronic hypertension during pregnancy is only evident earlier than how many weeks?

<20 weeks

251

gestational hypertension is evident after how many weeks?

>20 weeks

252

severe hypertension in pregnancy

>110/160

253

mild hypertension in pregnancy

90-99/140-149

254

moderate hypertension in pregnancy

100-109/150-159

255

Pre-Eclampsia refers too

>20 weeks in association with significant proteinuria

256

symptoms of Pre-Eclampsia

headaches, blurring vision, epigastric pain, pain below ribs, vomiting, sudden swelling of hands and face, clonus, papilloedema, epigastric tenderness, reduced urine output, convulsion.

257

biochemical signs of Pre-Eclampsia

raised liver enzymes, bilirubin, raised urea, creatinine and urate, low platelets, low haemoglobin, signs of haemolysis, features of DIC.

258

management for Pre-eclampsia

check protein, BP., FBC, renal function, LFT’s, scan for growth, CTG. Only ‘cure’ is delivery of baby and placenta. Conservatively looking as anti-hypertensive (labetolol, methyldopa, nifedipine) and steroids for foetal lung maturity if <36weeks.

259

post delivery care for pre-eclampsia

Continue monitoring post-delivery. In case of seizure than Mg + sulphate bolus IV infusion, I.V. labetolol and hydralazine whilst avoiding fluid overload. Prophylaxis for PET in subsequent pregnancy is low dose aspiring from 12 weeks till delivery.

260

chronic management for pre-eclampsia

Drug review, pre-pregnancy care and control (<150/100), use of labetolol, nifedipine, methyldopa and continue monitoring of mother and foetus.

261

complications of hypertensive disorders

risk of placental abruption
PET
multisystem multi-organ disorder
seizures, cerebral haemorrhage, stroke, HELLP (Haemolysis, elevated liver enzymes, low platelets), DIC (disseminated intravascular coagulation), renal failure, pulmonary oedema, cardiac failure.
foetal impaired placental perfusion leading to foetal distress, prematurity and increased PN mortality and intrauterine growth restriction.

262

HELLP refers too

(Haemolysis, elevated liver enzymes, low platelets)

263

DIC refers too

disseminated intravascular coagulation),

264

complications associated with diabetes in pregnancy

insulin requirements of mother increase
foetal hyper-insulinemia occurs causing macrosomia and more risk of neonatal hypoglycaemia and respiratory distress, jaundice

265

increased risks of diabetes in pregnancy

increased risk of foetal congenital abnormalities, miscarriage, polyhydramnios, shoulder dystocia, still birth and increase perinatal mortality, pre-eclampsia, worsening of maternal nephropathy, retinopathy, hypoglycaemia’s, infections.

266

signs/symptoms of VTE

pain in calf, unilateral increased girth of calf, muscle tenderness, breathlessness, pain on breathing, cough, tachycardia, hypoxia, pleural rub.

267

risks for developing a VTE

; older mothers, increase parity, smokers, BMI, IV drug users, PET, dehydration, reduced mobility, infection, operative delivery, prolonger labour, haemorrhage, prior VTE, thrombophilia, sickle cell disease

268

symptoms of a pelvic mass related to the ovaries

vague, IBS like symptoms, poor appetite, bloating, weight gain, pelvic mass, pressure

269

diagnosis of ovarian cancer

surgical/pathological, US scan abdomen and pelvis, CT scan, CA125, surgery

270

CA125 refers too

glycol protein antigen, however is not specific as produced in various malignant and benign conditions not all related to ovarian cancer

271

treatment for ovarian cancer

surgical, chemotherapy adjuvant or neo-adjuvant, CA 125 used in detecting and monitoring epithelial ovarian tumours.

272

surgical treatment in ovarian cancer is

laparotomy – obtain tissue diagnosis, stage disease, disease clearance and debulk disease.

273

chemotherapy treatment in ovarian cancer is

first line platinum and taxane, complete/partial response, cure unlikely, average response 2 years

274

prophylaxis for ovarian cancer is

oophorectomy

275

investigation of pest menopausal bleeding

pelvic and speculum examination
transvaginal ultrasound scan to measure her endometrial thickness, contour.
if >4mm or irregular then biopsy (pipelle)

276

presentation of endometrial cancer

include abnormal vaginal bleeding and post-menopausal bleeding, post menopausal women, high circulating oestrogen, atypical endometrial hyperplasia, HNPCC/Lynch type 2 familial cancer syndrome.

277

causes for high circulating oestrogen

(obesity, unopposed E2 therapy/tamoxifen, polycystic ovarian syndrome, early menarche/late menopause

278

treatment for endometrial cancer

often Total laparoscopic hysterectomy and bilateral salpingoophorectomy plus peritoneal washings.

279

high risk histology of endometrial cancer calls for

chemotherapy

280

advanced stages of endometrial cancer calls for

RT

281

palliation of endometrial cancer calls for

progesterone

282

type 1 of histological endometrial cancer

endometrioid adenocarcinoma, common. Hyperplasia with atypia precursor

283

type 2 histological endometrial cancer

uterine serous and clear cell carcinoma, aggressive and worse. Serous intraepithelial carcinoma precursor.

284

upper urinary tract mechanical description

low pressure, distensible conduit with intrinsic peristalsis

285

lower urinary tract mechanical description

low pressure storage of urine

286

vesico-ureteric mechanism refers too

protects the nephrons from any damage secondary to retrograde transmission of back pressure or infection from the bladder

287

cortical influence for bladder control

pontine micturition centre) activation and parasympathetic and inhibition of sympathetic pathways. (sympathetic hypogastric for storage), (parasympathetic for voiding and pudendal for voluntary control.)

288

both stress and urge incontinence arise from the same anatomical defect which is

defect in the anterior vaginal wall and pubo-urethral ligament

289

suburethral hammock laxity may result In

stimulation of bladder neck stretch receptors provoking a premature micturition reflex and urge incontinence

290

stress urinary incontinence refers too

involuntary leakage on effort or exertion, on sneezing/ coughing

291

urge urinary incontinence refers too

involuntary leakage accompanied by or immediately preceded by urgency

292

mixed urinary incontinence

involuntary leakage accompanied by or immediately preceded by urgency and on effort or exertion.

293

history for female incontinence

age, parity, delivery, baby weight, smoking, HRT. Medical conditions (DM, glaucoma, liver/kidney, cognitive, anti-depressants), prior PFMT, surgical treatment.

294

presentation for female incontinence

urgency, increased daytime frequency (>7), nocturia, dysuria, haematuria, coital, severity

295

assessments for female incontinence

urinary diary, urine dipstick

296

examination for female incontinence

general, abdominal, neuro if indicated, gynaecological, pelvic floor assessment

297

investigations for female incontinence

urinalysis, post voiding residual volume assessment, urodynamics

298

lifestyle changes for female incontinence

stop smoking, eat healthily, stop drinking alcohol and caffeine, low weight), medical treatments, physiotherapy, surgery

299

pharmacological treatment for female incontinence

Yentreve (Duloxetine) – in combination with pelvic floor muscle training

300

surgery for female incontinence

colosuspension, mid-urethral slings retropubic TVT

301

overactive bladder conservative management

fluid intake, reduce caffeine, fizzy drinks, chocolate, stop smoking, weight loss, bladder training, continence nurse

302

pharmacological treatment for overactive bladder

antimuscarinic, tricyclic antidepressants

303

recent advances in treatment for overactive bladder

botox, neuromodulation

304

natural process of menopause

Ovarian insufficiency, oestradiol falls, FSH rises, still some oestriol from peripheral, conversion of adrenal androgens in fat.

305

symptoms of menopause

hot flushes’, vaginal dryness, low libido, muscle and joint aches, mood changes/poor memory. Osteoporosis (fractures).

306

management of menopause

DEXA scan, prevention of fractures with exercise, calcium and Vit D, HRT, bisphosphonates, denosumab, teriparatide

307

general symptomatic treatment of menopause

General symptoms treated with HRT (systemic, oestrogen if no uterus, oestrogen and progesterone if uterus present) local vaginal oestrogen only. Selectiv oestrogen modulators, SSRI SNRI antidepressants (Venlafaxine), natural (phytoestrogen, hypnotherapy, CBT), lubricants.

308

causes of secondary amenorrhoea

pregnancy, breast feeding, contraceptive, polycystic ovaries, early menopause, thyroid disease, chronic disease, cushings, prolactinoma, edication, hypothalamic stress, androgen secreting tumour, sheehan’s syndrome, Asherman’s syndrome

309

examinations for secondary amenorrhoea

BMI, androgen signs, abdominal, bimanual vaginal, urine pregnancy test, bloods (FSH, oestradiol, thyroid function, prolactin, testosterone), pelvic US

310

management for secondary amenorrhoea

treat cause, assume fertile (unless 2 years post menopause) then contraception, if premature ovarian insufficneyc offer HRT till 50.

311

PCOS management

weight loss, increase SHBG, antiandrogens (combined hormonal contraception, spironolactone, eflornithine). Endometrial protection (CHC, progestogens, mirena IUS), fertility clomiphene/metformin.

312

normal blood loss during a period is

normal loss less then 80ml over 7 days

313

average duration of menstruation

2-7 days

314

average menarche

10-16 years

315

average age of menopause

50-55 years

316

PALMCOEIN causes of heavy menstrual bleeding

Polyp
Adenomyosis
Leiomyoma
Malignancy
Ovulation dysfunction
Endometrium
Iatrogenic
Not yet classified

317

Polyps diagnosis is by

diagnosis by US or hysteroscopy, management is polypectomy

318

adenomyosis treatment is

partially responds to hormone but definitively surgery

319

small Leiomyoma treatment is

POP, mirena, COCP

320

large Leiomyoma treatment is

fertility preservation, embolization, and myomectomy

321

submucosal Leiomyoma treatment

then hysteroscopic fibroid resection, if failed then hysterectomy

322

investigations for endometriosis

pelvic examination, US, diagnostic laparoscopy

323

managment for endometriosis

analgesia, medical COCP, POP, mirena IUS, depot provera, GnRH analogues, surgical ablation, hysterectomy, endometrioma excision, pelvic clearance, hysterectomy

324

hormonal options in general for heavy menstrual bleeding

mirena IUS, COCP, POP, depot provera

325

medical non hormonal options for heavy menstrual bleeding

mefenamic acid, tranexamic acid, GnRh analogues

326

surgical options for heavy menstrual bleeding

endometrial ablation, fibroid embolization, hysterectomy.

327

dysfunctional uterine bleeding treatment

GnRh analogues for nearly menopausal women not responding to medical treatment and surgical not desirable alongside HRT