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WH Flashcards

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1
Q

Define primary amenorrhoea

A

Primary amenorrhoea = when menstruation has not started by 16 years old

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2
Q

Define secondary amenorrhoea

A

Secondary amenorrhoea = when menstruation stops for >6 months

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3
Q

Define oligomenorrhoea

A

Oligomenorrhoea = irregular periods - a cycle of 35d to 6m

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4
Q

A 17 year old presents to you complaining that her periods haven’t started when all of her friends have. What causes are you going to investigate?

A 
Non path - constitutional delay? Drugs?
Head to toe 
- anorexia nervosa/athletism/hyperprolactinaemia
- Hyper/hypothyroidism 
- adrenal tumours/ hyperplasia 
-PCOS/POF
-Turners syndrome
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5
Q

A 35yr old female complains of not having a period for 7 months. What could be the cause of this?

A

Non-path = pregnancy/lactation/early menopause/drugs
Head to toe
-Anorexia nervosa/athletism/hyperprolactinaemia
-Hyper/hypothyroidism
-Adrenal tumours
-PCOS/POF
-Ashermans syndrome

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6
Q

What is dysmenorrhoea?

A

Dysmenorrhoea is painful menstruation. It is associated with prostaglandin levels in the endometrium and is due to contraction and uterine ishaemia

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7
Q

A 18 year old f comes to you complaining of painful periods. She has a regular cycle of 28 days but the pain can be so bad that she has to miss college every month for 2 days. What advice would you give her and what treatment options would you suggest?

A

Dysmenorrhoea is very common and occurs in 50% of women especially adolescents. Most of the time there is no cause.
She could use NSAIDs for pain suppression or she could use the COCP to suppress her ovaries.

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8
Q

A 33 year old f comes to you complaining of very heavy periods. What investigations would you request?

A

FBC
Coag screen and thyroid function
Transvaginal USS (Polyps/fibroids/endometrial thickening)
Endometrial biopsy - >45 do they have endometrial hyperplasia?
Hysteroscopy

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9
Q

What are some of the causes of menorrhagia?

A

Uterine fibroids
Polyps
silent changes in endometrial haemostasis/uterine prostaglandin levels
Rare: thyroid disease, von-willebrand’s disease + anti coag therapy

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10
Q

A 26 yr old complains of very heavy periods. However she wants to conceive. What is the first line treatment?

A

Menorrhagia and wanting to get pregnant
Antifibrinolytics = tranexamic acid
NSAID = Mefenamic acid

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11
Q

A 38 yr old f comes wanting treatment for her menorrhagia. She has 5 children already and doesn’t want any more. What is the first line treatment for her?

A

Intra-uterine device - mirena coil

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12
Q

What treatment options can a hysteoscopy offer for a lady wishing to treat her heavy periods?

A

Polyp removal
Transcervical resection of fibroid
Endometrial ablation - reduces fertility

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13
Q

What are the treatment options for menorrhagia?

A 
IUD 
Traexamic acid (anti fibrinolytic) 
Mefenamic acid (NSAID) 
Progestagens 
Histeroscopy (polyp/fibroid removal if small or endometrial ablation) 
Myomectomy 
Hysterectomy
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14
Q

What pelvic pathology can cause IMB?

A

Non-malignant = fibroids, uterine + cervical polyps, ovarian cysts and chronic pelvic infection

Malignant (older w/ recent change) = ovarian, cervical + endometrial

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15
Q

What are the treatment options for IMB?

A

IUD or COCP

HRT if perimenopausal

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16
Q

What are the 3 pregnancy hormones?

A

hCG
Progesterone
Oestrogen

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17
Q

What is the role of hCG in pregnancy?

A

It maintains the corpus luteum which secretes progesterone and oestrogen to maintain the pregnancy initially

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18
Q

What are the roles of progesterone during pregnancy?

A

1) Vascularization and proliferation of endometrial storma
2) Myometrium quiescence (SM of myometrium relaxation)
3) Increased maternal ventilation
4) Increased glucose stores in fat
5) Suppression of maternal immune system to foetal antigens

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19
Q

What are the roles of oestrogen during pregnancy?

A

Increased BF to uterus due to vasodilation
Changes in sensitivity to CO2
Breast ductal development for lactation
Cervical softening, myometrial excitation + initiating uterine activity + maintaining labour
Relaxation of pelvic ligaments in mother

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20
Q

At what week range would you offer fetal anomaly scan?

A

18+0 –> 20+6

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21
Q

What is the combined test in relation to fetal screening?

A

Its the screening test for Down’s syndrome that occurs at 10-14 weeks.
Contains:
1) USS - nuchal translucency
2) Bld serum levels - PAPP-A + hCG

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22
Q

What is the quadruple test in the relation to fetal screening?

A

Quadruple test is the screening for down syndrome done in the 2nd trimester
Looks at 4 specific proteins;
1) Alpha-fetoprotien (AFP)
2) hCG
3) Oestriol (form of oestrogen produced in placenta)
4) Inhibin A

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23
Q

Define the 1st and second stages of labour

Study These Flashcards
A

1st = start of contractions –> 10cm/fully dilated

2nd = 10cm/fully dilated –> delivery

24
Q

What does the 1st stage of labour contain?

Study These Flashcards
A

Latent phase + active phase

Latent phase = dilation –> 4cm
Cervical effacement, mucus show + strom

Active phase = 3/4cm –> 10cm
Stronger contractions 2-5 mins apart, intense peaks, pressure in the back of the rectum

25
What does the 2nd stage of delivery contain?
Passive stage + active stage + delivery Passive stage = flexion of the head + internal rotation @ level of ischial spines Active stage = Crowning + expulsive contractions (prinip 40m, multi 20m) Delivery = extension (stretching of the perineum) + external rotation (restitution)
26
Describe the descent of the baby's head before delivery (order of the words)
``` Engagement (OT) Descent Flexion Internal rotation (ROT --> ROA) Extension External rotation (restitution) (back to OT) Expulsion ```
27
What is effacement of the cervix?
Effacement is the thinning of the cervix as it is drawn up into the lower segment of the uterus. Throughout pregnancy the cervix is tightly closed and is protected by a mucus plug (mucus show in 1st stage of labour)
28
What is cervical ripening?
The softening of the cervix + it becoming more distensible in preparation for labour and delivery Due to the effects of prostaglandins, estrogen + pregesterone
29
Define a fibroid
A benign tumour of muscle and fibrous tissue
30
What are the RF for fibroids?
Oestrogen!!! - Long menarche (early periods/late menopause) - Age - Obesity - Nuliparous Black> Caucasian FHx
31
How can fibroids present?
Menstural problems = menorrhagia/IMB Pain = dysmenorrhia/dyspareunia Compression = urinary symptoms/consipation Sub fertility
32
A 55 year old complains of very painful periods. After questioning she reveals that she has been experiencing pain during intercourse. She has no other symptoms. O/E you feel a pelvic mass. You order a USS and a she has a uterine fibroid. What treatment would you give her?
Menorrhagia Rx: Levonorgestel intra uterine system LNG-IUS But if she was wanting to conceive - would give Tranexamic acid
33
What are the treatment options for fibroids?
Levonorgestel intra uterine system LNG-IUS (X wanting to conceive) Tranexamic acid (If wanting to conceive) Ibuprofen COCP Progesterone Pill GnHR analogues +/- HRT (this shrinks the fibroids) Surgical options: Hysteroscopy Myomectomy Hysterectomy
34
What is adenomyosis?
Adenomyosis = endometrial tissue that grows in the myometrium and causes enlargement. It can cause heavy/long menstrual bleeding, severe cramping and pain during inter course
35
What is the definition of polycystic ovaries?
PCO: 1) PCO on USS (proven that they have cysts) 2) Irregular periods >35 days apart (cysts interfering with regular ovulatory function - symptoms 3) Hirtuism = acne/increased body hair due to increased testosterone and increased unopposed oestrogen
36
Explain the pathophysiology of PCOS and how it leads to its symptoms
Genetics + Obesity + sedentary life style 1) Increased GnRH, Increased LH:FSH 2) Insulin resistance, hyperinsulinemia 1 + 2 = androgen excess Androgen (testosteron) excess -->Hirsutism + acne + alopecia And... androgen causes an arrest in follicle development causing cysts (...PCO) Corpus luteum produces progesterone - less progesterone and more unopposed oestrogen causes anovulatory bleeds and irregular periods. Unopposed oestrogen also increases risk of endometrial Ca
37
What would you need to see on TVUSS to diagnose PCOS?
>/= 12 small follicles of <5mm Poly - cystic... lots of small cysts (mosts cysts are from the follicle)
38
A 33 year old presents to you as her and her partner have been trying unsuccessfully to conceive for the past 3 years. They have regular intercourse. She has a BMI of 31. After further questioning she reveals she has acne and irregular periods. What investigations are you going to request?
? PCOS LH:FSH - is the ratio high? 3:1 Testosterone levels BM Prolactin (to exclude prolactinoma)
39
What medications can you give to treat hirsutism symptoms?
Cyrproate acetate + ethinylestrdiol Anti androgen + synthetic oestrogen Anti androgen reduces sebum production in sebaceous glands and reduces amount of androgens produces OCP + Spirinolactone (also anti-androgen)
40
Give an example of a medication used to treat an ovulation experienced by a lady with PCOS
Clomiphene Citrate | A selective oestrogen receptor blocker that stimulates ovulation
41
When is breast screening done in the uk?
47 and 73 years | was 50-70 but in the process of extending it
42
What is included in the triple assessment?
1. Clinical assessment = Hx + Ex 2. Imaging = USS, mammogram >35 3. Histology = core biopsy or punch biopsy
43
DD for lump in a 35 yr old a) fibroadenoma b) fibrocystic change c) breast cyst
``` 15-30 = fibroadenoma 30-45 = fibrocystic change 45-55 = breast cyst ```
44
DD for lump in a 15 yr old a) fibroadenoma b) fibrocystic change c) breast cyst
``` 15-30 = fibroadenoma 30-45 = fibrocystic change 45-55 = breast cyst ```
45
DD for lump in a 85 yr old a) fibroadenoma b) fibrocystic change c) breast cyst
``` 15-30 = fibroadenoma 30-45 = fibrocystic change 45-55 = breast cyst ```
46
What type of drug is tamoxifen? | And what are its SE?
Selective estrogen receptor blocker | SE: hot flush, mood swings and sexual dysfunction
47
What type of drug is Herceptin?
Monoclonal AB that targets HER2 receptors
48
How long does a woman need to be period free for before no longer needing contraception?
``` <50 = 24 months >50 = 12 months ```
49
Give female and male factors as to why you would refer someone before 1years with fertility issues.
Female >35, menstrual disorder, previous abdo/pelvic surgery, previous STI, PID or abnormal abdo exam Male previous genital pathology, surgery pr STD, systemic illness or abnormal genital exam
50
What are the 3 main areas you investigate for infertility?
1) ovulation/ovarian issues 2) Male factors and sperm quality 3) Tubual patency
51
What hormones do you test for ovulation and ovarian function?
Mid-luteal progesterone FSH Antral follicle count AFC Antimullerian hormone AMH
52
What medication can you give for ovulation induction?
Clomifene
53
Give some causes of infertility
Amenorrhoea - PCOS, Sheemans syndrome, kallmans syndrome Tubual disease - adhesions, PID, STI Male factor - variocele, low sperm count, hypogonadism, Uterine abnormality - polyps, fibroids, septum defect
54
Describe sheemans syndrome
Occurs due to ishaemic damage to the pituitary A post partum haemorrhage can cause ischaemic necrosis in the pituitary gland due to hypovolaemic shock Pres: amenorrhoea or reduced lactation or later hypopituitary symptoms
55
What is included in the combined and the quadruple test and when do you do them?
Combined test at 11-13+6 weeks: NAT GONNA PAPP Nuchal translucency, hCG and PAPPA (pregnancy associated plasma protein A) Quadruple test if later 15-20 weeks: BAAE bhCG, alpha fetoprotein, Estriol, Inhibin A

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