Quiz
L13 Endometriosis + Polycystic ovary syndrome
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Perguntas do quiz (15)
1Endometriosis is defined as the presence of endometrial [blank_start]glands and stroma[blank_end] outside the uterus.
Pathogenesis: Several theories have been proposed for the development and progression of endometriosis, yet no single one holds true for every patient or manifestation.
• [blank_start]Implant[blank_end] theory: tissue travels via retrograde menstruation or surgery/deliveries
• [blank_start]Lymphatic/vascular[blank_end] theory: explains distant location
• [blank_start]Metaplasia[blank_end] theory: undifferentiated cells transform into endometrial tissue- Aglands and stroma
- BImplant
- CLymphatic/vascular
- DMetaplasia
2Signs and symptoms of endometriosis:
Common -
• Dysmenorrhea – painful [blank_start]menstrual cramps[blank_end]
• Pelvic pain
• Dyspareunia – pain during [blank_start]sexual intercourse[blank_end]
• Sub-fertility/[blank_start]Infertility[blank_end]
• Pelvic mass
Uncommon -
• Dyschezia - painful [blank_start]bowel movements[blank_end], particularly during menstruation
• Dysuria – painful [blank_start]urination[blank_end]- Amenstrual cramps
- Bsexual intercourse
- CInfertility
- Dbowel movements
- Eurination
3Which of these is not an endometriosis complication?
- AAdhesions causing pain and structural changes
- BOvarian failure post surgery
- CPelvic inversion
4Investigative options for endo include:
• Ultrasound – usually [blank_start]transvaginal[blank_end]
• Laparoscopy – definitive diagnosis – direct [blank_start]visualisation[blank_end] with biopsyconfirmed endometrial glands or stroma outside of uterine cavity- Atransvaginal
- Bvisualisation
5Classification of Endometriosis:
Stages I through IV, based on visual inspection during [blank_start]laparoscopy[blank_end]:
• The appearance, [blank_start]size[blank_end], and depth of peritoneal and ovarian [blank_start]implants[blank_end]
• The presence, extent, and type of [blank_start]lesions[blank_end] (red, red-pink and clear, white, peritoneal defects and black)
• Presence, extent, and type of pelvic [blank_start]adhesions[blank_end] (ovaries and tubes) and the degree of [blank_start]cul-de-sac[blank_end] obliteration.- Alaparoscopy
- Bsize
- Cimplants
- Dlesions
- Eadhesions
- Fcul-de-sac
6Laparoscopy is not required prior to medical management. Overall risk of any complication with laparoscopy, minor or major, is ~[blank_start]9[blank_end]%.
• Injury to bowel, bladder, major blood vessel
• Risk of [blank_start]bleeding[blank_end] or infection
• Risk of anaesthetic
Treatment options depend on whether [blank_start]fertility[blank_end] is desired. Medical management is based on [blank_start]hormonal[blank_end] suppression of
endometriotic lesions. Oral contraceptives are considered [blank_start]first[blank_end] line treatment and patients get significant relief of dysmenorrhea within [blank_start]4[blank_end] months. Progestins in any form can be used, cons are loss of bone [blank_start]mineral[blank_end] density, • prolonged delay in resumption of [blank_start]menses/ovulation[blank_end], and breakthrough bleeding. Mirena, a progesterone IUD results in amenorrhea in [blank_start]60[blank_end]% of patients(good).
Other options:
- Danazol. Weak [blank_start]androgen[blank_end] capable of suppressing gonadotropin secretion, leading to [blank_start]amenorrhea[blank_end]. Bad side effects: weight [blank_start]gain[blank_end], acne, hirsutism, breast [blank_start]atrophy[blank_end], virilization, impact on lipids.
- Gonadotrophin-releasing hormone (GnRH) agonists. 2 subsidized in NZ, [blank_start]goserelin acetate[blank_end] (implant) and [blank_start]leuprorelin[blank_end] (injection). For women who do not respond to oral contraceptives or progestins. Induces [blank_start]hypoestrogenism[blank_end] which causes menopausal symptoms. Cannot be used [blank_start]long[blank_end]-term (> 6 months) without hormone add-back therapy .- A9
- Bbleeding
- Cfertility
- Dhormonal
- Efirst
- F4
- Gmineral
- Hmenses/ovulation
- I60
- Jandrogen
- Kamenorrhea
- Lgain
- Matrophy
- Ngoserelin acetate
- Oleuprorelin
- Phypoestrogenism
- Qlong
7Surgical management:
1. Conservative
• Laparoscopy to excise or ablate all [blank_start]visible[blank_end] lesions
• Preserves fertility
2. Definitive
• Total abdominal [blank_start]hysterectomy[blank_end] + bilateral salpingo-[blank_start]oophorectomy[blank_end]
• Lose fertility
• Early menopause- Avisible
- Bhysterectomy
- Coophorectomy
8Polycystic Ovarian Syndrome (PCOS)
• Collection of signs and symptoms
• May be [blank_start]difficult[blank_end] to diagnose
• Often [blank_start]undiagnosed[blank_end]
• Heterogeneous presentation
• Features [blank_start]change[blank_end] with age
• PCOS is a syndrome so NO single test or feature is diagnostic- Adifficult
- Bundiagnosed
- Cchange
9PCOS is the most common endocrine disorder among reproductive aged women and is largely genetic.
- AVerdadeiro
- BFalso
10PCOS: Aetiology
• Neuroendocrine derangement: Increased [blank_start]LH[blank_end] relative to [blank_start]FSH[blank_end]
• Hyperinsulinemia: defect in [blank_start]insulin[blank_end] action or secretion
• [blank_start]Androgen[blank_end] excess: ovarian and adrenal- ALH
- BFSH
- Cinsulin
- DAndrogen
11Clinical presentation – signs and symptoms of PCOS
1. Infertility - [blank_start]70[blank_end]% affected
2. Menstrual [blank_start]disturbance[blank_end] - 60-70% affected
3. Hyper[blank_start]androgenism[blank_end] (hirsutism 70%, acne 30%, alopecia 10%)
4. Obesity, particularly [blank_start]truncal[blank_end] - 35-50% affected
5. Asymptomatic - [blank_start]22-33[blank_end]%- A70
- Bdisturbance
- Candrogenism
- Dtruncal
- E22-33
12PCOS diagnosis, [blank_start]2[blank_end] of 3 criteria need to be met:
1. Hyperandrogenism
- Clinical (hirsutism, acne, frontal balding)
- Biochemical (high serum [blank_start]androgen[blank_end] concentrations)
2. Menstrual [blank_start]irregularity[blank_end] – absent or infrequent periods
3. Polycystic ovaries
AND [blank_start]exclusion[blank_end] of other aetiologies (congenital adrenal hyperplasia, androgen-secreting tumours, Cushings syndrome)- A2
- Bandrogen
- Cirregularity
- Dexclusion
13Which of these conditions is NOT a possible explanation for polycystic ovaries without PCOS?
- AHypothalamic amenorrhea
- BHyperprolactinemia
- CDysmenorrhea
14Which of these is NOT a PCOS comorbidity?
- AInsulin resistance
- BT2DM
- CGestational diabetes
- DEndometrial hyperplasia/cancer
- EMetabolic syndrome
- FDepression
- GSexual dysfunction
- HInsomnia
15Clomiphene citrate is considered first line treatment for infertility in PCOS.
- AVerdadeiro
- BFalso
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- O usuário eliminou as informações de disciplina Quiz sobre L13 Endometriosis + Polycystic ovary syndrome, criado por Usuário eliminado em 02-10-2019.
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- Criado em 2 out 2019 · atualizado em 2 out 2019
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