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Flashcards in Womans Health Deck (85):
0

Polymenorrhoea

Normal duration and flow but shortened cycle with intervals less than 25 days

1

Menorrhagia

Heavy cyclical bleeding

2

Metorrhagia

Uterine bleeding independent of menstrual pattern

3

Menometorrhagia

Increased flow during menstruation and between periods

4

Chronic AUB

More than 6 months

5

Acute AUB

Severe enough to require immediate intervention

6

HMB

Heavy menstrual bleeding that affects quality of life

7

Objective Menorrhagia (HMB)

- blood loss > 80ml per cycle
- 60% have iron deficiency anaemia

8

Subjective Menorrhagia

50% have bold loss in normal limits
Still considered abnormal

9

Normal blood loss

10-55 ml

10

Causes of AUB

- polyps
- adenomyosis
- leiomyomas
- malignancy
- coagulopathy
- ovulation dysfunction
- endometrial disorders
- iatrogenic
- not classified

11

Types of leiomyomas

- sub mucosal
- other (intramural and sub serosal)
- hybrid

12

Feature of coagulopathy

One of:
- postpartum haemorrhage
- surgical related bleeding
- dental bleeding
Two or more of:
- bruising
- epistaxis
- frequent gum bleeding
- fam history of bleeding symptoms

13

What are LOOP events?

- luteal out of phase events
Premature development of estradiol-producing follicles in the luteal phase

14

Things causing endometrial disorders

- deficiencies in the local production of vasoconstrictors (endothelin1)
- increased prod of vasodilatory prostaglandins (prostacyclin)
- accelerated lysis of endometrial clot (plasminogen activator)

15

Things causing iatrogenic AUB

- break through bleed
- mirena

16

What is used for endometrial sampling?

Pipelle

17

Who do you take an endometrial sample from?

- over 40'with irreg bleeding
- risk factors for endometrial Ca
Prolonged chronic anovulatin
Obese
Fam Hx of Ca

18

Who do you refer for hysteroscopy?

- chronic irreg bleeding
- peri-menopause with abnormal bleeding
- US suggests fibroid or polyp
- post- menopause ET >5mm or ongoing bleeding with ET <5 mm

19

How to hormonally manage an acute bleeding episode

- high dose oestrogen for atrophic endometrium
- high dose OCP if bleeding not too severe
- progesterone for anovulatory bleeding
- cyclokapron (antifibrinolytic)

20

Medical management of AUB

-antifibrinolytic drugs (tranexamic acid)
- NSAIDS (mefenamic acid)
- low dose Monophasic oral contraceptives
- progesterone
- mirena

21

Mechanism of tranexamic acid

Prevents action so plasminogen

22

Mechanism of mefenamic acid

Altered ratio of prostaglandin E2 to F2
- increased ratio of prostacyclin to thromboxane

23

Mirena method of action

- reduction in endometrial prostaglandin synthesis
- reduction in endometrial fibrinolytic activity
- production of an inactive endometrium

24

When is endometrial ablation done

- HMB with uterus <3 cm and no desired fertility

25

Types of endometrial ablation

First gen
- electrocautery
Second gen
- microwave endometrial ablation
- hydrothermablation

26

What does UAE stand for?

Uterine artery embolisation

27

When is UAE, myomectomy or hysterectomy done?

HMB with fibroids >3 cm

28

When is hysterectomy done?

- completed family
- over 45
- fAiled medical treatment
- failed endometrial ablation
- failed myomectomy

29

What is a haematinic?

Stimulates the production of red blood cells

30

AUB-O

Abnormal menstrual bleeding with a disorder of ovulation (endometrial sampling NB- assoc with endometrial hyperplasia)

31

When is normal vag discharge least acidic?

Days prior to and during menstruation

32

Physiological causes of changes in discharge

- menstrual cycle
- emotional stressors
- nutritional status
- pregnancy
- medications
- sexual arousal

33

Trichomoniasis discharge

Yellow/green, offensive, frothy

34

What constitutes the adnexa?

Fallopian tubes, ovaries, round ligaments

35

Most common pelviabdominal mass in reproductive age

- functional or physiological cysts

36

Things to describe about a mass

- size (weeks)
- surface
- consistency
- tender
- mobile or fixed
- ascites
- cannot get below the mass

37

Starting point in mass differential

- gynae (pregnant or non-pregnant)
- non gynae (urinary tract or bowel)

38

Types of physiological cysts

- follicular
- corpus lutuem
- theca-lutein

39

Why do follicular cysts occur?

- failure of the mature follicle to ovulate or
- failure of the immature follicle to reabsorb or undergo atresia
(Asymptomatic)

40

Why corpus lutuem cysts occur

- haemorrhage into the corpus lutuem 2 days after ovulation
- can rupture and mimic tubal pregnancies
- occur late in cycle
- assoc with acute pain

41

Why do theca lutein cysts occur?

- overstimulation of ovaries by hCG

42

Features suggestive of ovarian malignancy

- bilateral
- cysts >8cm
- multiloculated
- thick walled
- papillary projections
- ascites

43

Types of ovarian neoplasia

- celomic epithelium
- germ cell
- specialized gonadal stroma
- non-specific mesenchyme
- metastatic to ovary

44

Possible tubal masses

- ectopic pregnancy
- pyosalpinx
- hydrosalpinx
- tubo-ovarian abscess
- para tubal cyst

45

Where do leiomyomas originate?

Müllerian duct

46

Appearance of a fibroid

- round, firm, white
- pseudo capsule
- whorled.
- grow gradually
- relatively avascular
- undergo degeneration (hyaline, red, sarcomatous)

47

What is a didelphic uterus?

- double uterus with 2 cervices and 2 vaginas

48

Factors associated with cervical cancer

- early sexual debut
- multiple partners
- other STIs
- smoking
- OCP

49

Symptoms of cervical cancer

- abnormal vag bleeding (postcoital)
- malodorous discharge (infection)
- pelvic pain, weight loss, renal failure, fistula

50

Patterns of spread of cervical cancer

- direct
- haematogenous
- lymphatic (obturator nodes)

51

Treatment of micro-invasive cervical Ca

- cone biopsy
- simple hysterectomy

52

What is removed in a radical hysterectomy?

Uterus, parametria, cuff of vagina, pelvic lymph nodes

53

Vaccines for cervical Ca

- bivalent (cervarix)
- quadrivalent (gardasil)

54

What does VIA stand for

Visual inspection with acetic acid

55

Features of ideal contraception

- forgettable
- reversible
- usable
- buy able
- acceptable
- invisible
- infallible

56

What does UPSI stand for?

Unprotected sexual intercourse

57

Types of emergency contraception

- progesterone only (Norlevo up to 72 hrs)
- combined regimen (2 tablets 12 hrly)
- CuT (up to 120 hrs)

58

At what concentration can a pregnancy test work?

20mU (7-10 days after conception)

59

Riffs of acute pregnancy related pain

- rupture of ectopic
- miscarriage
- pre term labour
- fibroid degeneration

60

Adnexal disorders that cause pelvic pain

- haemorrhagic functional ovarian cysts
- torsion of adnexa
- twisted para-ovarian cyst
- rupture of functional cyst

61

Causes of recurrent pelvic pain

- mittelshmerz (ovulation pain)
- primary or secondary dysmenorrhea

62

Where can pain refer in ectopic?

Right shoulder

63

How to diagnose ectopic pregnancy

- bhcg more than 2000
- empty uterus on US
- adnexae mass

64

Medical management of ectopic

Methotrexate (anti-folate)

65

Difference between gonococcal and chlamydial PID

Gonococcal is acute, chlamydial is insidious

66

Dyschezia

Painful defeacation

67

Causes of chronic pelvic pain

- endometriosis
- adenomyosis (endometrium in myometrium)
- adhesions
- pelvic congestion
- salpingo-oopheritis
- ovarian remnant syndrome
- fibroids
- IBS

68

Type of pain with adhesions

- non-cyclical
- increases with coitus

69

Features of pelvic congestion

Pain starts with ovulation to end if menses
- bulky uterus with enlarged tender ovaries

70

What does TAH BSO stand for?

Total abdominal hysterectomy bilateral salpingo-oophorectomy

71

Where is pain felt with ovarian remnant syndrome

Lateral pelvic pain

72

Definition of rape

Any person who unlawfully and intentionally commits an act of sexual penetration with another person without such persons consent

73

Clip used to do tubal ligation

Filshee clip

74

What is fitz- Hugh- Curtis syndrome?

A thinning of cervical mucus to allow bacteria from the vagina into the uterus and oviducts, causing infection and inflammation

75

Another name for vaginal reconstruction

Colporhapphy

76

What is colpocleisis?

Closure of the vagina

77

Methods of TOP

- vacuum curettage
- medical
- dilatation and evacuation
- induction of labour
- hysterotomy
- hysterectomy

78

Definition of TOP

The separation and expulsion by surigcal or medical means of the contents of the uterus of a pregnant woman

79

When can medical TOP be performed

Up to 9 weeks

80

Drugs used in medical TOP

Mifepristone
- progesterone antagonist
Misoprostol
- prostaglandin analogue (stim myometrium contraction)

81

ERPOC

Evacuation of retained products of conception

82

Amsel's diagnostic criteria for bacterial vaginosis

3out of 4
- homogenous vaginal discharge
- fishy odour when mixed with pat assign hydroxide
- clue cells present
- raised vaginal PH

83

Definition of menopause

Permanent cessation of menstraution due to loss of ovarian follicular activity
- 12 consecutive months of amenorrhea without other cause

84

Definition of premature ovarian failure

Menopause before 40