Mer Scott
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PHCY320 (Reproductive and Sexual Health) Quiz on L13 Endometriosis + Polycystic ovary syndrome, created by Mer Scott on 27/09/2019.

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Mer Scott
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L13 Endometriosis + Polycystic ovary syndrome

Question 1 of 15

1

Endometriosis is defined as the presence of endometrial 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.
theory: tissue travels via retrograde menstruation or surgery/deliveries
theory: explains distant location
theory: undifferentiated cells transform into endometrial tissue

Drag and drop to complete the text.

    glands and stroma
    Implant
    Lymphatic/vascular
    Metaplasia

Explanation

Question 2 of 15

1

Signs and symptoms of endometriosis:
Common -
• Dysmenorrhea – painful
• Pelvic pain
• Dyspareunia – pain during
• Sub-fertility/
• Pelvic mass
Uncommon -
• Dyschezia - painful , particularly during menstruation
• Dysuria – painful

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    menstrual cramps
    sexual intercourse
    Infertility
    bowel movements
    urination

Explanation

Question 3 of 15

1

Which of these is not an endometriosis complication?

Select one of the following:

  • Adhesions causing pain and structural changes

  • Ovarian failure post surgery

  • Pelvic inversion

Explanation

Question 4 of 15

1

Investigative options for endo include:
• Ultrasound – usually
• Laparoscopy – definitive diagnosis – direct with biopsyconfirmed endometrial glands or stroma outside of uterine cavity

Drag and drop to complete the text.

    transvaginal
    visualisation

Explanation

Question 5 of 15

1

Classification of Endometriosis:
Stages I through IV, based on visual inspection during :
• The appearance, , and depth of peritoneal and ovarian
• The presence, extent, and type of (red, red-pink and clear, white, peritoneal defects and black)
• Presence, extent, and type of pelvic (ovaries and tubes) and the degree of obliteration.

Drag and drop to complete the text.

    laparoscopy
    size
    implants
    lesions
    adhesions
    cul-de-sac

Explanation

Question 6 of 15

1

Laparoscopy is not required prior to medical management. Overall risk of any complication with laparoscopy, minor or major, is ~%.
• Injury to bowel, bladder, major blood vessel
• Risk of or infection
• Risk of anaesthetic
Treatment options depend on whether is desired. Medical management is based on suppression of
endometriotic lesions. Oral contraceptives are considered line treatment and patients get significant relief of dysmenorrhea within months. Progestins in any form can be used, cons are loss of bone density, • prolonged delay in resumption of , and breakthrough bleeding. Mirena, a progesterone IUD results in amenorrhea in % of patients(good).
Other options:
- Danazol. Weak capable of suppressing gonadotropin secretion, leading to . Bad side effects: weight , acne, hirsutism, breast , virilization, impact on lipids.
- Gonadotrophin-releasing hormone (GnRH) agonists. 2 subsidized in NZ, (implant) and (injection). For women who do not respond to oral contraceptives or progestins. Induces which causes menopausal symptoms. Cannot be used -term (> 6 months) without hormone add-back therapy .

Drag and drop to complete the text.

    9
    bleeding
    fertility
    hormonal
    first
    4
    mineral
    menses/ovulation
    60
    androgen
    amenorrhea
    gain
    atrophy
    goserelin acetate
    leuprorelin
    hypoestrogenism
    long

Explanation

Question 7 of 15

1

Surgical management:
1. Conservative
• Laparoscopy to excise or ablate all lesions
• Preserves fertility
2. Definitive
• Total abdominal + bilateral salpingo-
• Lose fertility
• Early menopause

Drag and drop to complete the text.

    visible
    hysterectomy
    oophorectomy

Explanation

Question 8 of 15

1

Polycystic Ovarian Syndrome (PCOS)
• Collection of signs and symptoms
• May be to diagnose
• Often
• Heterogeneous presentation
• Features with age
• PCOS is a syndrome so NO single test or feature is diagnostic

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    difficult
    undiagnosed
    change

Explanation

Question 9 of 15

1

PCOS is the most common endocrine disorder among reproductive aged women and is largely genetic.

Select one of the following:

  • True
  • False

Explanation

Question 10 of 15

1

PCOS: Aetiology
• Neuroendocrine derangement: Increased relative to
• Hyperinsulinemia: defect in action or secretion
excess: ovarian and adrenal

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    LH
    FSH
    insulin
    Androgen

Explanation

Question 11 of 15

1

Clinical presentation – signs and symptoms of PCOS
1. Infertility - % affected
2. Menstrual - 60-70% affected
3. Hyper (hirsutism 70%, acne 30%, alopecia 10%)
4. Obesity, particularly - 35-50% affected
5. Asymptomatic - %

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    70
    disturbance
    androgenism
    truncal
    22-33

Explanation

Question 12 of 15

1

PCOS diagnosis, of 3 criteria need to be met:
1. Hyperandrogenism
- Clinical (hirsutism, acne, frontal balding)
- Biochemical (high serum concentrations)
2. Menstrual – absent or infrequent periods
3. Polycystic ovaries
AND of other aetiologies (congenital adrenal hyperplasia, androgen-secreting tumours, Cushings syndrome)

Drag and drop to complete the text.

    2
    androgen
    irregularity
    exclusion

Explanation

Question 13 of 15

1

Which of these conditions is NOT a possible explanation for polycystic ovaries without PCOS?

Select one of the following:

  • Hypothalamic amenorrhea

  • Hyperprolactinemia

  • Dysmenorrhea

Explanation

Question 14 of 15

1

Which of these is NOT a PCOS comorbidity?

Select one of the following:

  • Insulin resistance

  • T2DM

  • Gestational diabetes

  • Endometrial hyperplasia/cancer

  • Metabolic syndrome

  • Depression

  • Sexual dysfunction

  • Insomnia

Explanation

Question 15 of 15

1

Clomiphene citrate is considered first line treatment for infertility in PCOS.

Select one of the following:

  • True
  • False

Explanation