Reproductive Health Flashcards

Question

Ix for vaginal discharge

Answer 1

vaginal swabs - vulvovaginal and high vaginal and potentially endocervical swabs blood tests for hiv, hep b/c, syphilis serology pregnancy tests culture, microscopy, gram staining, sensitivity testing

Answer 2

a permanent method of sterilisation prevents the egg from travelling along the Fallopian tubes to the sperm

Answer 3

Failure rate of 0.5% LARC is much more reliable

Answer 4

+permanent +no hormones +no side effects -difficult to reverse -potential to regret -periods can become heavier -more likely to have an ectopic if pregnancy does occur -not as easy or as effective as male sterilisation -surgery risks -no protection against STIs

Answer 5

permanent method of contraception vasectomy small operation to cut the end of the vas deferens tube - the tube that takes sperm from the testicles to the penis sperm can no longer get into the semen

Answer 6

Very reliable, but not 100% 1 in 2500 men will become fertile again at some point in the future

Answer 7

+permanent +easier to do than female sterilisation +more effective than female sterilisation -may take a few months before the semen is free from sperm -it's permanent, potential for regret -no protection against STIs

Answer 8

Menstrual cycle: Follicular phase Luteal phase Uterine cycle: Proliferative phase Secretory phase Menstrual phase

Answer 9

FSH rises, stimulates ovarian follicles Ovarian follicle that fully matures will produce large amounts of oestrogen Large amounts of oestrogen will result in endometrial thickening, thinning of cervical mucus to allow sperm to enter, inhibition of LH by the pituitary gland Eventually, when oestrogen gets to the threshold level, stimulates LH production (around 12 days) The follicle ruptures and releases an oocyte, matures into an ovum, is released into the peritoneal space and taken to the fallopian tube

Answer 10

Once ovulation has occurred, LH and FSH stimulate the Graafian follicle to develop into a corpus luteum - this produces progesterone These increased levels of progesterone causes the endometrium to become receptive to implantation of the blastocyst, negative feedback causes decreased LH and FSH, an increase in the woman's basal body temp. Levels of FSH LH fall, the corpus luteum degenerates. As this happens, the progesterone is stopped being produced. Falling levels of progesterone triggers menstruation and the whole cycle begins again

Answer 11

the endometrium is exposed to increasing levels of oestrogen as a result of FSH and LH oestrogen stimulates repair and growth of the functional endometrial layer - allowing recovery from the recent menstruation

Answer 12

begins once ovulation has occurred driven by progesterone, results in secretion of various substances by the endometrial glands ensures the uterus is a welcoming environment for the embryo to implant

Answer 13

at the ned of the luteal phase, the corpus luteum degenerates and this results in decreased progesterone production decreasing levels of progesterone causes the spiral arteries in the functional endometrium to contract loss of blood supply causes the functional endometrium to become ischaemic and necrotic - the functional endometrium is shed and exits through the vagina as menstruation

Answer 14

excess androgen production - usually due to excess LH production or hyperinsulinaemia and insulin resistance "cysts" found in women with PCOS are immature follicles which have had their ovulation phase arrested due to elevated baseline of LH and lack of LH surge causing ovulation

Answer 15

obesity diabetes mellitus family history of PCOS premature adrenarche - early onset of pubic hair

Answer 16

hirsutism, infertility, acne, menstrual cycle disturbance, obesity and weight gain, alopecia, depression and other psychological disorders htn, acanthosis nigricans

Answer 17

bedside: urine hcg, capillary blood glucose bloods: fbc, u&e, crp, testosterone, sex hormone-binding globulin, lh and fsh, oral glucose tolerance test, lipid screen, tfts, prolactin imaging: pelvic ultrasound scan (shows "cysts" on the ovaries and/or increased ovarian volume), but it can exist without polycystic ovaries

Answer 18

Two of three criteria must be met to make a diagnosis of PCOS *imaging: polycystic ovaries on ultrasound *oligo- or anovulation, or oligo- or amenorrhoea *hyperandrogenism: clinical and/or biochemical changes

Answer 19

goals are to restoration of regular menses to reduce the risk of endometrial hyperplasia; weight loss and preventing insulin resistance/diabetes; restoring fertility; treatment of hirsutism/acne lifestyle: weight loss, regular exercise, diet pharmological: COCP, "anti-androgens", metformin, orlistat, eflornithine hydrochloride

Answer 20

infertility higher incidence of pregnancy complications higher risk of endometrial hyperplasia and endometrial cancer higher cardiovascular risk profile higher risk of psychological complications

Answer 21

benign tumours arising from the myometrium most common type fo pelvic tumour, usually arising in women of child-bearing age hormone driven growths, maintained by high levels of oestrogen and progesterone

Answer 22

risk is decreased by pregnancy, progesterone only contraceptives appear to do the same increased by early age of puberty, increasing age, obesity, ethnicity (black females)

Answer 23

menorrhagia, abdominal swelling, pelvic pain, dyspareunia, dysmenorrhoea, urinary/bowel symptoms

Answer 24

transvaginal ultrasound is the initial diagnostic modality of choice may require an FBC and a pelvic MRI +/- hysteroscopy

Answer 25

depends on the presenting symptoms of the patient menorrhagia is the most common problem so mx focuses on treating heavy periods - IUS, NSAIDs, tranexamic acid and/or the COCP surgical intervention with myomectomy or hysterectomy can be considered

Answer 26

divided into pregnancy and non-pregnancy pregnancy: infertility, malpresentation, placental abruption, intrauterine growth restriction, preterm labour non-pregnancy: prolapsed fibroid, anaemia, endocrine effects (polycythaemia, hypercalcaemia, hyperprolactinaemia)

Answer 27

extrauterine implantation and growth of endometrial tissue chronic and debilitating condition deposits are most frequently on pelvic structures, ovaries are most affected adenomyosis - specifically refers to deposits of endometrial tissue in the myometrium endometriomas - cystic structures developing on the ovaries, often referred to as chocolate cysts due to the appearance of contained, old, altered blood causes are unknown

Answer 28

cause is unknown although there are some theories *metaplastic conversion of other tissues has been suggested and could explain why deposits are seen in seemingly anatomically distinct positions *lymphatic or haematogenous spread has been suggested as endometriosis may develop in remote regions of the body

Answer 29

early menarche late menopause nulliparity delayed childbearing short menstrual cycle family history white ethnicity

Answer 30

chronic pelvic pain dysmenorrhoea irregular periods dyspareunia dyschezia (difficulty pooping) blaoting, nausea LUTS infertility/sub-fertility

Answer 31

laparoscopy is considered the gold-standard in the diagnosis of endometriosis USS, MRI, laparoscopy may be used in ix and diagnosis of endo Additional investigation to exclude urinary and STIs

Answer 32

pain management - paracetamol +/- NSAIDs hormonal therapies can reduce pain experienced (COCP, POP, LNG-IUS, implant) psychological support

Answer 33

surgery may be indicated diagnostic laparoscopy will be used for therapeutic intervention too peritoneal endometriosis and uncomplicated endometriomas may be treated excision or ablation can be used hormonal treatment may be advised to sustain benefit of surgery hysterectomy may be an option

Answer 34

growths attached to the inner wall of the uterus that expand into the uterus also known as endometrial polyps

Answer 35

vaginal bleeding after menopause bleeding between periods frequent, unpredictable periods whose lengths and heaviness vary very heavy periods infertility some may even have no symptoms

Answer 36

transvaginal ultrasound hysteroscopy endometrial biopsy

Answer 37

watchful waiting - may resolve on their own hormonal medications surgical removal

Answer 38

precancerous condition in which there is an irregular thickening of the uterine lining

Answer 39

heavy periods longer periods intermenstrual bleeding short menstrual cycles post menopausal bleeding anaemia - due to heavy menstrual bleeding

Answer 40

early menarche nulliparity diagnosed with infertility late menopause obese tamoxifen prescription oestrogen without progesterone diabetes PCOS thyroid disease gallbladder disease lynch syndrome cowden syndrome oestrogen secreting tumour family history of cancer

Answer 41

pelvic examination transvaginal ultrasound biopsy hysteroscopy

Answer 42

hormonal contraception LNG-IUS hysterectomy may be considered

Answer 43

Condition similar to PMS that also happens in the week or two before your period starts as hormone levels begin to fall after ovulation

Answer 44

lasting irritability or anger that may affect other people feelings of sadness or despair, even thoughts of suicide feelings of tension or anxiety panic attacks mood swings, crying often lack of interest in daily activities and relationships trouble thinking and focusing tiredness or low energy food cravings or binge eating trouble sleeping feeling out of control physical symptoms - cramps, bloating, breast tenderness, headaches, joint/muscle pain

Answer 45

Must have 5 or more PMDD symptoms, including one mood-related symptom

Answer 46

SSRIs contraceptives paracetamol +/- NSAIDs stress management, relaxation techniques healthy changes - diet and exercise safety netting - feel unsafe, thinking of harming yourself or others, seek further help

Answer 47

natural cessation of menstruation due to loss of ovarian follicular activity occurs between the ages of 45-55, mean age 51

Answer 48

when menopause occurs prior to the age of 40

Answer 49

occurs prior to menopause and is characterised by an irregular menstrual cycle and vasomotor symptoms

Answer 50

The time after periods have ceased for 12m

Answer 51

number of follicles falls with each menstrual cycle as the oocytes fall, there's a fall in follicular activity - causing a marked reduction in oestrogen and inhibin. Negative feedback on the pituitary is alleviated, results in higher amounts of LH and FSH decrease in oestrogen results in vasomotor symptoms (flushing, sweats) estradiol production falls, results in amenorrhoea changes result in a permanently lowered level of oestrogen and high levels of FSH and LH

Answer 52

menstrual irregularity vasomotor symptoms - common, first symptoms noticed, last for a median duration of 7 years, hot flushes and night sweats in particular urogenital symptoms - vaginal dryness, dyspareunia, UTIs other - anxiety/depression, difficulty concentrating, sleep disturbance, reduced libido, musculoskeletal pains

Answer 53

over the age of 45, diagnosis can be made in women with: *perimenopause based on vasomotor symptoms and irregular periods *menopause in women who have not had a period for at least 12m and are not using hormonal contraception *menopause based on symptoms in women without a uterus

Answer 54

can help with symptoms of menopause women with a uterus are given combined oestrogen and progesterone HRT women without a uterus are given oestrogen only HRT topical HRT is also available; typically used to help with vaginal dryness

Answer 55

breast cancer - combined HRT is associated with an increased risk ovarian cancer - small increased risk VTE - increased risk with oral HRT stroke - increased risk with oral oestrogen

Answer 56

lifestyle modifications - exercise can help, weight loss can be advised, good sleep hygiene contraception - HRT will not act as contraception, may be fertile for one/two years after their last period, should use contraception to cover this period

Answer 57

atrophic vaginitis endometrial atrophy cervical or womb polyps endometrial hyperplasia less commonly - it can be caused by cancer (e.g. ovarian and womb)

Answer 58

transvaginal ultrasound speculum examination hysteroscopy with biopsy bimanual examination bloods

Answer 59

Depends on the cause cervical polyps- surgical removal vaginal or endometrial atrophy- may not need treatment; oestrogen creams/pessaries endometrial hyperplasia- may be offered no treatment, hormonal treatment or total hysterectomy HRT side effect - changing medications womb cancer - total hysterectomy recommended with radio/chemotherapy, hormone therapy, often a combination of treatments

Answer 60

involuntary leakage of urine o/e - leakage with "stress test", pelvic organ prolapse, pelvic floor contraction, other pelvic pathology

Answer 61

UTIs overactive bladder genuine stress incontinence retention with overflow

Answer 62

Stress incontinence Urgency incontinence Mixed incontinence Overflow incontinence

Answer 63

Incontinence occurs secondary to a rise in intra-abdominal pressure - triggered by coughing, sneezing, exertion RFs: age; pregnancy and vaginal delivery, constipation, obesity, family history

Answer 64

identify the underlying type of UI hx and examination bedside: urine dip +/- MSU, bladder scan patient-based assessments: bladder diaries, quality of life assessments urodynamic testing

Answer 65

lifestyle - consistent fluid, not excess or insufficient; pelvic floor muscle training; specialist care surgical: colposuspension, autologous rectus fascial sling duloxetine may be offered second line

Answer 66

characterised by the urge to pass urine associated with involuntary leakage occurs secondary to an overactive bladder occurs due to detrusor muscle overactivity that leads to involuntary contractions of the bladder usually idiopathic; but can be secondary to some neurological disorders

Answer 67

lifestyle - consistent fluid intake, reduce caffeine, weight loss bladder training - 6wks; trains the bladder to tolerate larger volumes of urine; attempt to hold the urine for gradually increasing lengths of time pharmacological - anticholinergic therapy can be used - oxybutynin 1st line

Answer 68

happens when someone is unable to empty their bladder; incontinence occurs when the bladder is too full can be secondary to physical obstruction (prolapse, fibroids, following pelvic surgery) or underactivity of the detrusor muscle (peripheral neuropathy, MS, antimuscarinics)

Answer 69

all patients should be managed under a urogynaecologist/uro/gynaecologist obstruction may require surgical treatment catheterisation may be considered when pathology cannot be corrected

Answer 70

40mg BD, then assessed for benefit and tolerability after 2-4wks Serotonin and noradrenaline re-uptake inhibitor allergic reaction, glaucoma, kidney/liver impairment, taking other medications for depression dry mouth, headache, dizziness, nausea, sexual dysfunction, reported increased risk of suicide

Answer 71

5mg TDS Antimuscarinic glaucoma, GI obstruction, MA, ileus, pyloric stenosis diarrhoea, dry mouth, dizziness, headache, constipation, vision disorders, urinary retention, confusion

Answer 72

ligaments involved - round, ovarian, broad ligaments; uterosacral ligament most important in preventing prolapse

Answer 73

trauma during childbirth multiple vaginal births obesity chronic coughing or straining chronic constipation

Answer 74

incomplete prolapse - uterus drops part way down into the vagina, creates a bulge complete prolapse - uterus slips down and protrudes out of the vagina

Answer 75

symp- heaviness or pressure in pelvis; pelvic pain; abdominal or lower back pain; dyspareunia; recurrent UTIs; urinary incontinence; symptoms worsened by prolonged standing or walking (added pressure on muscles by gravity) o/e - protrusion of tissue at opening of vagina (in complete prolapse); excessive vaginal discharge

Answer 76

supportive tissues around the bladder and vaginal wall weaken and stretch, allowing bladder and vaginal wall to fall into the vaginal canal anterior vaginal prolapse s/s - difficulty starting urine stream, incomplete emptying of the bladder, frequency/urgency or urination, may have stress incontinence

Answer 77

prolapse where supportive wall of tissue between rectum and vaginal wall weakens; the front wall of the rectum sags and bulges into the vagina posterior vaginal prolapse s/s- difficulty with bowel movements, sensation of rectal pressure, tenesmus

Answer 78

Pelvic examination

Answer 79

kegel exercises to strengthen pelvic floor muscles vaginal pessary to hold the uterus in place hysterectomy sacrohysteropexy - resuspension of the prolapsed uterus using a mesh sling

Answer 80

infection of the upper female genital tract; polymicrobial endometritis, salpingitis, tubo-ovarian abscess, pelvic peritonitis

Answer 81

<25 years of age risky sexual behaviour earlier age at first intercourse increasing number of sexual partners previous STI uterine instrumentation - surgical TOP for example post partum endometriosis

Answer 82

symp- lower abdominal or pelvic pain, chills, deep dyspareunia, dysuria, nausea or vomiting, IMB/PCB o/e- fever, abnormal cervical discharge or bleeding, cervical friability, abnormal vaginal odour, ecchymosis (erythema) and swelling, diffuse tenderness, RUQ tenderness (perihepatic space may be involved) cervical motion tenderness, adnexal tenderness, uterine tenderness

Answer 83

uss - transvaginal if tubo-ovarian abscess is suspected swabs for STIs screen for other STIs FBC, CRP

Answer 84

Ceftriazone 1g stat dose Doxycycline 400mg Metronidazole 400mg for 14 days

Answer 85

infertility ectopic pregnancy Fitz-Hugh Curtis syndrome - infection of liver with multiple peritoneal adhesions

Answer 86

fluid-filled sac/s within an ovary

Answer 87

unilateral lower abdominal/pelvic pain sudden onsent, usually after physical activity may have signs of 'acute abdomen/shock'

Answer 88

endometrioma dermoid cyst bleeding diathesis - increased susceptibility to bleeding/bruising anticoagulation

Answer 89

pelvic ultrasound - will find free fluid usually in the rectouterine pouch

Answer 90

haemodynamically stable - conservative symptom management haemodynamically unstable - laparoscopy for haemorrhage control

Answer 91

unilateral lower abdominal/pelvic pain sudden onset nausea/vomiting

Answer 92

pelvic ultrasound with Doppler - enlarged ovary with decreased blood

Answer 93

detorsion if ovary is viable

Answer 94

APP in a woman of reproductive age with a +ve pregnancy test is an ectopic pregnancy until proven otherwise miscarriage PID ovarian cyst - torsion, haemorrhage, rupture torsion of fallopian tube, salpingo-ovarian abscess endometriosis 1` dysmenorrhoea non-gynaecological cause (appendicitis, IBS/IBD, mesenteric adenitis, diverticulitis, UTI, MSK)

Answer 95

Pain - SQITARS LMP contraception recent UPSI risk factors for an EP - PID, ART vaginal discharge, bleeding bowel symptoms urinary symptoms precipitating factors

Answer 96

o/e - haemodynamically stable? acute abdomen? pelvic (discharge, cervical excitation, adnexal tenderness, masses?) hCG MSU triple swabs (high vaginal, cervical and endocervical) FBC, G&S, CRP,pelvic USS - TV or abdo abdominal X-ray, CT, MRI as appropriate diagnostic laparoscopy

Answer 97

resuscitate if necessary analgesia specific treatment will depend on the cause avoid unnecessary laparoscopy

Answer 98

Intermittent or constant pelvic pain in the lower abdomen or pelvis of at least 6m duration, not occurring with menstruation or intercourse, not associated with pregnancy severe enough to cause functional disability or require treatment

Answer 99

endometriosis adenomyosis adhesions chronic PID fibroids IBS, constipation, hernia, interstitial cystitis, calculi, fibromyalgia, nerve entrapment, neuropathic pain

Answer 100

as for acute pelvic pain

Answer 101

analgesia hormonal treatments surgical option of hysterectomy, limited role but can be helpful

Answer 102

pregnancy-related pelvic girdle pain

Answer 103

pain in the pubic region, lower back, hips, groin, thighs or knees clicking or grinding in the pelvic area pain made worse by movement

Answer 104

stay active rest well good posture physiotherapy warm baths hydrotherapy support belt or crutches simple analgesia

Answer 105

miscarriage molar pregnancy ectopic pregnancy pregnancy of unknown location hyperemesis gravidarum

Answer 106

a hydatidiform mole is type of tumour that grows like a pregnancy inside the uterus two types: complete mole and partial mole

Answer 107

occurs when two sperm cells fertilise an ovum that contains no genetic material the sperm combine genetic material and the cells divide and grow in to a tumour no fetal material will form

Answer 108

occurs when two sperm cells fertilise a normal ovum containing its own genetic material new cell has three sets of chromosomes cell dividies and multiplies into a partial mole tumour some fetal material may form

Answer 109

cessation of periods more severe morning sickness vaginal bleeding increased enlargement of the uterus abnormally high hCG thyrotoxicosis uss- snowstorm appearance of the pregnancy

Answer 110

examination bhCG bloods: TFTs imaging: ultrasound diagnosis is confirmed with histology of the mole after evacuation

Answer 111

evacuation of the uterus, contents sent for histological examination to confirm molar pregnancy referred to a gestational trophoblastic disease centre for mx and f-up hCG levels are monitored until they return to normal mole can metastasise and may require systemic chemotherapy

Answer 112

implantation of a conceptus outside the uterine cavity 93-95% tubal; the remainder are in CS scars, interstitial, abdominal, ovarian, cervical

Answer 113

often asymptomatic amenorrhoea (6-8wks) pain (lower abdominal, often mild/vague, classically unilateral) vaginal bleeding (usually small amount, often brown) diarrhoea and vomiting dizziness, light headedness shoulder tip pain - diaphragmatic irritation - haemoperitoneum collapse, if ruptured signs- often no signs normal size uterus; cervical excitation and adnexal tenderness occasionally; adnexal mass rarely; peritonism due to intra-abdominal blood if ruptured

Answer 114

history of infertility or assisted conception history of PID endometriosis pelvic or tubal surgery previous ectopic iucd, ius, progesterone based contraception smoking

Answer 115

tvs/uss - establish location serum progesterone - establish whether a pregnancy is failing serum hCG and repeat after 48hrs laparoscopy - gold standard but only used when is necessary

Answer 116

unruptured, small and stable - conservative mx, go away on its own unruptured, large and stable - surgical or medical mx preferred all ruptured require surgery

Answer 117

if bHCG is <1500 and falling; patient is asymptomatic; <1.5cm will dissolve itself

Answer 118

1.5-3.5cm; 1500-5000bHCG; no cardiac activity will require methotrexate 15mg per m^2 will require reliable contraception for 3m after as methotrexate is teratogenic

Answer 119

laparoscopy to take out the ectopic and stabilise the patient if there is cardiac activity; large >3.5cm; bHCG >5000; ruptured

Answer 120

pt will need bloods: FBC, LFTs - they need to be stable

Answer 121

follow up bHCG; more than 50% decline in a week follow up until it is less than 15

Answer 122

excessive vomiting rare (1:1000)

Answer 123

multiple pregnancies molar pregnancy - due top higher amount of hCG

Answer 124

1st trimester - intractable vomiting (inability to keep food or fluid down) with a triad of 1. >5% weight loss 2. dehydration 3. electrolyte imbalance muscle wasting ptyalism (inability to swallow saliva) hypovolaemia behaviour disorders haematemesis (MWTs)

Answer 125

urinalysis MSU FBC U&Es LFTs USS for reassurance and to exclude multiple and molar pregnancies

Answer 126

admission if not tolerating oral fluid for IV fluids (NaCl or Hartmann's) - avoid gluocse as it can precipitate Wernicke's encephalopathy Daily U&es, replace K+ when necessary Keep nil by mouth for 24hr the nintroduce light diet as tolerated Antiemetics - cyclizine 50mg/8hr or promethazine

Answer 127

Maternal risks: *liver and renal failure *hyponatraemia and rapid reversal of hyponatraemia -> central pontine myelinolysis *thiamine deficiency may lead to Wernicke's encephalopathy Fetal risks: *FGR theoretically possible though most fetal outcome is normal *fetal death may ensue in cases with Wernicke's encephalopathy

Answer 128

spontaneous loss of pregnancy before 24wks of gestation around 10-24% of clinically recognised pregnancies end in miscarriage

Answer 129

fetal chromosomal abnormalities maternal and paternal age infection appendicitis with surgical mx and anaesthesia poorly controlled diabetes and thyroid disease PCOS hx of miscarriage smoking obesity stress

Answer 130

PV bleeding abdominal pain

Answer 131

Missed Threatened Inevitable Incomplete Complete

Answer 132

closed non-viable pregnancy no abdominal pain or bleeding diagnosed on a scan

Answer 133

closed viable pregnancy vaginal bleeding

Answer 134

open non-viable pregnancy bleeding and/or abdominal pain

Answer 135

open some remaining products of conception partial expulsion of products of conception lining of uterus >15mm

Answer 136

closed no products of conception all products of conception passed and bleeding ceased lining of uterus <15mm

Answer 137

expectant, medical or surgical

Answer 138

in a viable pregnancy where the patient wishes to continue, symptoms should be monitored if stable, pt advised to return if symptoms worsen or do not settle after 14d. analgesia, written information, contact details and safety netting advice should be given vaginal micronised progesterone 400mg BD if had a previous miscarriage

Answer 139

offered 1st line and trialled for 7-14d for missed or incomplete miscarriage most women need no further medical intervention if symptoms settle at 7-14 days, should take a pregnancy test at 3wks - if positive return to obstetric care

Answer 140

mx of missed or incomplete miscarriage is vaginal or oral misoprostol - synthetic prostaglandin; stimulates uterine contraction analgesia and anti-emetics PRN pregnancy test advised at three weeks - positive requires specialist review

Answer 141

mx of incomplete or missed miscarriage is typically indicated where expectant or medical management fails two options: *manual vacuum aspiration (LA) *surgical management (GA) Anti-D should be offered to women who are rhesus negative undergoing surgical management

Answer 142

Common area impacted following the loss of a pregnancy grief, mourning, depression and anxiety are common following miscarriage counselling and additional support should be offered where necessary

Answer 143

there are numerous information leaflets and support groups to provide additional avenues for information sex- can resume once symptoms have settled completely wish to conceive- menstruation tends to resume at 4-8wks, give routine pre-conception advice do not wish to conceive- discuss and offer suitable contraceptive options

Answer 144

three or more consecutive, spontaneous miscarriages occurring in the 1st trimester with the same biological father, which may or may not follow a successful birth

Answer 145

advanced maternal age increasing number of miscarriages

Answer 146

antiphospholipid syndrome (APS) genetic fetal chromosomal abnormalities anatomical abnormalities fibroids thrombophilic disorders infection endocrine disorders cervical weakness immune dysfunction

Answer 147

parental blood for karyotyping cytogenetic analysis of products of conception at the time of miscarriage pelvic uss thrombophilia screening lupus anticoagulant anticardiolipin antibodies

Answer 148

sometimes no treatment is offered; 75% chance of a succesful pregnancy next time if miscarriage was unexplained should be seen in a dedicated clinic surgical intervention for intrauterine abnormalities or fibroids may be helpful antiphospholipid syndrome - combination of aspirin and heparin when viability of fetus is confirmed cervical cerclage may be offered

Answer 149

It behaves like a normal pregnancy so periods will stop and the hormonal changes will occur a few things can indicated a molar pregnancy vs a normal pregnancy: *more severe morning sickness *vaginal bleeding *increased enlargement of the uterus *abnormally high hCG *thyrotoxicosis (because hCG can mimic TSH and stimulate the thyroid to produce more t3 and 4)

Answer 150

Ultrasound (of the pelvis) - will show a characteristic 'snowstorm appearance' of the pregnancy histology of the mole after evacuation provides definitive diagnosis

Answer 151

evacuation of the uterus to remove the mole products of conception will be sent for histological examination referral to a gestational trophoblastic disease centre for mx and follow-up hCG monitoring until they return to monitoring occasionally the mole can metastasise and the patient may require systemic chemotherapy

Answer 152

the situation when the pregnancy test is positive but there are no signs of intrauterine pregnancy or an extrauterine pregnancy via transvaginal ultrasound can be: 1. too small to be seen on scan because it is earlier than 6wks 2. has passed and will be a miscarriage 3. is outside of the womb but cannot see it on a scan, this is an ectopic pregnancy

Answer 153

may be asymptomatic abdo pain vaginal bleeding

Answer 154

Transvaginal ultrasound bhCG monitoring, serial monitoring to assess pregnancy repeat ultrasound

Answer 155

Depends on the underlying cause 1. small intrauterine embryo - continue with regular antenatal care 2. miscarriage - depending on type of miscarriage mx will change, expectant vs medical vs surgical mx 3. ectopic - expectant vs medical vs surgical - depends on size, rupture, bhCG etc

Answer 156

1967 Abortion Act and 1990 Human Fertilisation and Embryology Act

Answer 157

An abortion can be performed before 24 weeks if continuing the pregnancy involves greater risk to the physical or mental wellbeing of a) the woman and/or b) existing children of the family the threshold for when the risk of continuing the pregnancy outweighs the risk of termination is a matter of clinical judgement and opinion of the medical practitioners

Answer 158

* continuing the pregnancy is likely to risk the life of the woman * terminating the pregnancy will prevent "grave permanent injury" to the physical or mental health of the woman * there is "substantial risk" that the child would suffer physical or mental abnormalities making it seriously handicapped

Answer 159

* two registered medical practitioners must sign to agree abortion is indicated * it must be carried out by a registered medical practitioner in an NHS hospital or approved premise

Answer 160

-many services are accessed by self-referral pathways women should be offered counselling and information to help decision making from a trained practitioner informed consent is essential

Answer 161

it is the most appropriate earlier in pregnancy, but can be used at any gestation involves two drugs: mifepristone (anti-progestogen) and misoprostol (prostaglandin analogue) 1-2 days later

Answer 162

anti-progestogen medication that blocks the action of progesterone, halting the pregnancy and relaxing the cervix

Answer 163

prostaglandin analogue, meaning it binds to prostaglandin receptors and activates them prostaglandins soften the cervix and stimulate uterine contractions from 10wks gestation, additional misoprostol doses are required until expulsion

Answer 164

rhesus negative women with a gestational age of 10wk+ having a medical TOP should have anti-D prophylaxis

Answer 165

surgical abortion can be performed, depending on preference and gestational age, under LA, LA+sedation, and GA

Answer 166

medications are used for cervical priming - this softens and dilates the cervix misoprostol, mifepristone or osmotic dilators are used

Answer 167

Device inserted into the cervix that gradually expands as it absorbs fluid, therefore opening the cervical canal

Answer 168

1. cervical dilatation and suction of the contents of the uterus (usually up to 14wks) 2. cervical dilatation and evacuation using forceps (14-24wks)

Answer 169

rhesus negative women having a surgical TOP should have anti-D prophylaxis NICE suggests it should be considered in women less than 10wks gestation

Answer 170

vaginal bleeding and intermittent abdominal crmaping for up to two weeks after the procedure urine pregnancy test completed 3wks after the abortion to confirm it is complete contraception is discussed and started where appropriate support and counselling is offered

Answer 171

bleeding pain infection failure of the abortion damage to the cervix, uterus, other structures

Answer 172

-different options available -suitability (including assessing contraindications and risks) -effectiveness -mechanism of action -instruction on use worth mentioning that all forms of contraception are available free in the UK on the NHS

Answer 173

-natural family planning [rhythm method] -barrier methods [condoms] -combined contraceptive pills -progesterone-only pills -coils [mirena or copper] -progestogen injection -progestogen implant -surgery [sterilisation or vasaectomy] emergency contracpetion is available after unprotected intercourse, however it should not be relied upon as a regular method of contraception

Answer 174

FSRH has UKMEC guidelines from 2016 to categorise the risks of starting different methods of contraception in different individuals UKMEC 1 - no restriction in use, minimal risk UKMEC 2 - benefits generally outweigh the risks UKMEC 3 - risks generally outweigh the benefits UKMEC 4 - unacceptable risk, typically this means the method is contraindicated

Answer 175

Effectiveness is expressed as a percentage 99% effective means that is an average person used this method correctly with a regular partner for a single year they would only have a 1% chance of pregnancy

Answer 176

this is especially important with methods such as natural family planning, condoms, and the pill, effectiveness is very user-dependent

Answer 177

*breast cancer - avoid all hormonal contraception and opt for a copper coil or barrier methods *cervical or endometrial cancer - avoid the Mirena coil *Wilson's disease - avoid the copper coil

Answer 178

uncontrolled hypertension (particularly >=160/>=100) migraine with aura history of VTE aged over 35 smoking more than 15 cigarettes a day major surgery with prolonged immobility vascular disease or stroke ischaemic heart disease, cardiomyopathy, or atrial fibrillation liver cirrhosis and liver tumours systemic lupus erythematosus and antiphospholipid syndrome

Answer 179

after their last period, contraception is required for 2 years in women under 50 and 1 year in women over 50 HRT doesn't prevent pregnancy and extra contraception the COCP can be used up to age 50, can treat perimenopausal symptoms Depo-Provera should be stopped before 50 due to risk of osteoporosis

Answer 180

combined and progestogen only pills are unaffected by age progestogen only implant us a good choice of LARC progestogen injection is UKMEC2 due to reduced bone mineral density Coils are UKMEC2 as they have a higher rate of expulsion

Answer 181

fertility is not considered to return until 21 days after giving birth, but after 21 days contraception is needed the progestogen-only pill/implant can be used any time after birth and during breastfeeding COCP avoided in breastfeeding IUD/IUS inserted within 48hr or after 4wks

Answer 182

allows people to attain their desired number of children, if any, and to determine the spacing of their pregnancies it is achieved through use of contraceptive methods and the treatment of infertility +lowers maternal ill health and number of pregnancy related deaths +reduces the need for unsafe abortion and reduces HIV transmissions from mothers to newborns

Answer 183

Explore conception history - open questions about how they've been trying to get pregnant, how long, previous contraception Address ICE Pregnancy history - previous pregnancies? outcome of pregnancies? assisted reproductive techniques? mode of delivery? baby's health outcome? Menstrual history - regular cycles? LMP? pain? Sexual history - how often having UPSI? any pain/bleeding? ask about previous STIs and treatment? Systemic enquiry - screen for other symptoms in other systems PMHx - specifically ask about smears, vaccinations, allergies DHx - prescribed and OTC? folic acid in particular FHx - genetic problems? haemoglobinopathies? early menopause? SHx - smoking, alcohol, recreational drug use, diet, exercise, occupation Partner history - a full history from the partner is required

Answer 184

Primary - female pt has never conceived before Secondary - pt has conceived previously, irrespective of how the pregnancy developed, but is now struggling to conceive again

Answer 185

1. egg must be produced: failure to release an egg is known as 'anovulation' 2. adequate sperm must be released: a sperm sample may be required as part of further investigations 3. the sperm and egg must form an embryo: sexual, cervical and/or problems with the fallopian tube may prevent the sperm from reaching the egg 4. the embryo must implant: the incidence of defective implantation is unknown

Answer 186

substance use (smoking tobacco, other tobacco products, marijuana use, heavy drinking, illegal drugs) reduces fertility hypertension changes the shape of sperm and reduces fertility being underweight and having very little amounts of body fat are associated with ovarian dysfunction and infertility in women sedentary or excessive exercising can impact fertility anxiety and depression nutrition high scrotal temperature (tight clothing, hot baths) caffeine consumption

Answer 187

Disorders of ovulation Tubal causes Uterine/peritoneal causes

Answer 188

Group I (hypothalamic-pituitary failure) - hypogonadotropic hypogonadism; a failure to produce the required amount of LH and FSH, results in anovulation Group II (hypothalamic-pituitary-ovulation dysfunction) - occurs as a result of polycystic ovary syndrome, the most common cause of female infertility Group III (ovarian failure) - hypergonadotropic hypogonadism; normal hypothalamic and pituitary function but insufficient numbers of follicles within the ovary; less oestrogen produced and follicles do not develop fully; results in anovulatory cycles Sheehan's syndrome - ischaemic necrosis of the pituitary causes hypopituitarism; occurs as a result of severe hypotension or haemorrhagic shock secondary to massive PPH Hyperprolactinaemia - inhibits both FSH and LH secretion, leads to menstrual dysfunction and galactorrhoea Pituitary tumours - tumour displaces/destroys normal tissue and can affect production of FSH and LH

Answer 189

fallopian tubes are delicate and are more susceptible to damage most common cause of tubal damage is PID others include: previous sterilisation, endometriosis, previous pelvic surgery

Answer 190

Most prevalent is endometriosis, causes inflammation and adhesions in the pelvis, can distort pelvic anatomy others include: cervical mucus dysfunction/defect, previous pelvic or cervical surgery, uterine fibroids, Asherman's syndrome, previous abdominal infections which have resulted in adhesions, congenital abnormalities

Answer 191

unexplained genetic factors immune factors and systemic illnesses medications: chemotherapy and cytotoxic agents lifestyle factors: smoking, excessive alcohol, obesity

Answer 192

should be commenced after 1y in couples who have not conceived despite regular UPSI -mid-luteal phase progesterone to assess ovulation -chlamydia screening -testing for susceptibility to rubella (protects the baby, prevents harm to the baby and having to terminate the pregnancy) -serum progesterone -gonadotrophins -thyroid function tests -prolactin

Answer 193

Referral should be considered in hx, ex, ix are normal in both partners and the couple have not conceived after 1 year

Answer 194

-age 36+ (after 6m) -amenorrhoea or oligomenorrhoea -previous abdominal or pelvic surgery -previous PID -previous STI -abnormal pelvic examination -known reason for infertility (e.g. previous cancer treatment)

Answer 195

Tubal patency tests: hysterosalpingography (screens for tubal occlusion) HSG or diagnostic laparoscopy and dye - tubal and other pelvic abnormalities can be assessed simultaneously

Answer 196

weight management - aim for 19-25kg/m2 BMI psychological stress management

Answer 197

clomiphene 50mg OD for 5 days (anti-oestrogen drug) for induction of ovulation (e.g. anovulation in PCOS); gonadotrophins can be considered if no response to clomiphene (as an injection. risk of multiple pregnancies, ovarian hyperstimulation syndrome) pulsatile gonadotrophin-releasing hormone can induce ovulation dopamine agonists may be used for ovulatory disorders that are 2` to raised prolactin IVF is next option. Artificial insemination.

Answer 198

tubal microsurgery (tubal catheterisation or cannulation) in women with mild tubal disease laparoscopy for excision or ablation of endometriosis lap ovarian drilling may be considered if no response to clomiphene lap ovarian cystectomy if endometriomas lap salpingectomy in presence of hydrosalpinx

Answer 199

1. primary spermatogenic failure 2. genetics 3. obstructive azoospermia 4. varicocele 5. hypogonadism 6. other

Answer 200

Defined by NICE as 'any spermatogenic abnormality caused by a condition other than hypothalamic pituitary disease'

Answer 201

absence of testes cryptorchidism - absence of at least one testicle from the scrotum/undescended testicle genetic abnormalities

Answer 202

testicular trauma/torsion mumps orchitis testicular tumour systemic disease (e.g. liver cirrhosis) varicocele cytotoxic agents

Answer 203

idiopathic

Answer 204

Klinefelter's syndrome: 47 XXY karyotype Kallmann syndrome leading to a hypogonadotropic hypogonadism Androgen insensitivity syndrome (karyotype of XY, but phenotypically female)

Answer 205

bilateral obstruction of the seminal ducts leading to a total absence of sperm in semen

Answer 206

absent vas deferens post-infection post-surgery congenital abnormalities cystic fibrosis

Answer 207

found in 25% of men with abnormal semen analysis pathophysiology linking varicocele with infertility is unclear, potentially due to increased scrotal temperature

Answer 208

hypergonadotropic hypogonadism due to testicular failure

Answer 209

hypogonadotropic hypogonadism due to reduced gonadotrophin-releasing hormone and/or FSH/LH scretion

Answer 210

end organ resistance to gonadotrophins

Answer 211

Medications - chemotherapy and cytotoxic agents, sulfasalazine, anabolic steroids Psychological factors - ejaculation disorders or erectile dysfunction Lifestyle factors - smoking, obesity, excessive alcohol, illicit drug use

Answer 212

full medical, sexual and social history, with particular interest in: -length of time trying to conceive -frequency and type of sexual intercourse -children born to the man -ejaculatory or erectile dysfunction -medications (sulfasalazine, chemotherapy, anabolic steroids) -PMHx (mumps, STIs, testicular trauma, undescended testes, systemic disease [e.g. liver cirrhosis, diabetes], prior surgery [e.g. orchidopexy]) FHx (i.e. cystic fibrosis) SHx (smoking, alcohol intake, exercise, diet, occupation)

Answer 213

-BMI calculation -genital exam (position of urethral meatus, structural abnormalities of the penis; testicular volume and consistency, varicocele, hernia, undescended testes) -check for signs of hypogonadism: gynaecomastia, lack of body hair growth, reduction in muscle mass -look for signs of anabolic steroid use

Answer 214

Semen analysis results should be compared to WHO reference values -if results of 1st are abnormal, repeat testing is offered 3m after 1st test -if results are normal, no further tests required Chlamydia testing

Answer 215

Referral is required after two abnormal semen analysis results

Answer 216

If the following are present: -previous genital pathology -previous urogenital surgery -previous STI -varicocele -significant systemic illness -abnormal genital examination -known reason for infertility (e.g. previous cancer treatment)

Answer 217

genetic testing sperm culture endocrine tests - FSH and testosterone imaging of the urogenital tract testicular biopsy

Answer 218

weight management psychological stress management lifestyle advice - smoking and alcohol cessation

Answer 219

hypogonadotropic hypogonadism - gonadotrophin drugs should be offered

Answer 220

If obstructive azoospermia then surgical correction can be offered

Answer 221

Breast screening - mammogram for women aged 50-71 Cervical screening - cervical smears for women aged 25-64

Answer 222

During the appt, a small sample of cells are taken from the cervix The sample is checked for specific types of HPV that can cause changes to the cells of the cervix; these are called 'high risk' types of HPV If it is found, the sample is sent to histology to check for any cellular changes - this can be treated before it progresses to cervical cancer

Answer 223

A breast X-ray to look for any lumps/signs of early breast cancer that are too small to feel or see A patient will have 4 mammograms taken, 2 for each breast during the appt Each breast will be squeezed between two pieces of plastic to keep it still while the xrays are being taken

Answer 224

invited for screening in another year and a year later, if HPV still positive then will be asked for a colposcopy

Answer 225

Get a colposcopy

Answer 226

A test to take a closer look at your cervix; a microscope is used to look at the cervix in greater detail; a small sample of cells may be taken from the cervix [a biopsy]

Answer 227

*early age of first intercourse *higher number of sexual partners *HPV infection *lower socioeconomic group *smoking *partner with prostatic or penile cancer

Answer 228

squamous cell carcinoma of the cervix exist in a pre-malignant state CIN describes any changes to cervical epithelial cells pre-malignancy Can be low grade or high grade

Answer 229

Deeper third of cells show abnormal cytoplasmic and nuclear maturation ++nuclear to cytoplasmic ratio Loss of polarity ++mitotic figures Hyperchromatic nuclei

Answer 230

Up to 2/3 of epithelium shows abnormalities

Answer 231

More than 2/3 of epithelium shows abnormalities

Answer 232

*intense acetowhite, pale on iodine staining *mosaicism and punctuation due to atypical vessel formation *raised or ulcerated surface

Answer 233

It is a pre-malignant condition which can lead to cancer if left untreated Most often caused by unopposed oestrogen

Answer 234

Having irregular periods Having an ovulation periods Obesity PCOS tamoxifen Nulliparity Early menarche, late menopause Post-menopausal women

Answer 235

Heavy periods Long periods Intermenstrual bleeding Post menopausal women Anaemia - due to heavy bleeding

Answer 236

Transvaginal ultrasound Hysteroscopy with biopsy and histology is gold standard for diagnosis

Answer 237

Medical - progesterone either oral continuous or local IUS Atypical hyperplasia is typically managed with a total hysterectomy due to likelihood of it progressing to cancer

Answer 238

There aren’t always signs/symptoms associated with CIN that’s why it’s important to get screened for cervical cancer regularly

Answer 239

Biopsy will have been taken and sent for histology in order to get a diagnosis of CIN

Answer 240

If abnormal cells are seen during colposcopy then they may be removed during the procedure LLETZ may be a procedure undertaken to remove CIN

Answer 241

Large Loop Excision of the Transformation Zone (LLETZ) Diathermy is used to remove the abnormal cells from the cervix

Answer 242

chronic inflammatory skin disease cause is unknown

Answer 243

itchy and painful patches of thin, white, wrinkled-looking skin - in women, typically on the vulva and/or the skin around the anus painful intercourse and difficulty on urinating

Reproductive Health Flashcards

(269 cards)