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repro > Blood supply anatomy, imaging, HRT, premature ovarian failure > Flashcards

Blood supply anatomy, imaging, HRT, premature ovarian failure Flashcards

1
Q

obturator foramen covered in?

A

obturator memrane

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2
Q

in the male, which artery supplies the majority of the male perineum?

A

internal pudendal

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3
Q

dorsal artery of the penis, is it on the front or the back?

A

front

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4
Q

most arteries supplying the penis come from the ?

A

internal pudendal

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5
Q

ovarian artery has 2 branches…name them?

A

tubal branch supplies fallopian tube and ovarian branch supplies ovary

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6
Q

in the pelvis, the veins form a number of plexus, , where do they mainly drain?

A

internal iliac

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7
Q

disease can penetrate through the peritoneal layer, and disseminate into the peritoneal cavity. which cancer does this, and can end up depositing in liver, under diaphragm and forming a malignant effusion in the lungs?

A

ovarian

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8
Q

is ultrasound in gynae safe?

A

yes, no ionising radiation

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9
Q

what are the two types of ultrasound used

A

transabdominal and transvaginal

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10
Q

frequency comparison?

A

transvaginal is high frequency

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11
Q

in transabdominal, why do you need a full bladder/

A

it acts as an acoustic window, displaces gas filled bowel loops out of the pelvis

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12
Q

transabdominal, is there any ionising radiation?

A

no

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13
Q

transvaginal, gives better spatial resolution, why does the transducer have to be close to the target organ?

A

higher frequencies are more likely t be scattered in the body

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14
Q

bladder in transvaginal?

A

empty, is uncomfortable if bladder is full

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15
Q

who is unsuitable for trans v us?

A

those who have not been sexually active

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16
Q

what is often used 2nd line in patients with abdominal pain?

A

CT

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17
Q

Ct scan is used to stage gynae malignancies

A

also assess response to chemo/radiotherapy

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18
Q

whats the downside of CT? where in particular is a significant dose delivered to?

A

high radiation dose (equivalent to 160 cxrs)

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19
Q

what does MRI use instead of radiation?

A

radio frequency (window)

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20
Q

how can different tissue compositions be defined in different parts of the body

A

can be weighted

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21
Q

benefit of MRI?

A

no ionising radation

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22
Q

what can it give an idea of?

A

composition of soft tissue masses (chopping board)

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23
Q

MRI is suitable for women of repro age and children

A

gives poor definition of lung parenchyma

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24
Q

some uses of MRI in gynae? (scroll)

A

cancer staging, further investigation of masses (after us), evaluation of fertility and imaging of the pituitary gland in suspected prolactinoma

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25
Q

endometriosis - why is it able to be picked up on MRI?

A

it has altered blood due to haemoglobin breakdown products, this causes characteristic MR changes

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26
Q

it returns a high signal on t1 (white) and a low signal on t2 (grey)

A

y

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27
Q

where can you get endometriosis?

A

bowel/bladder, uterine tunes, ovaries

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28
Q

dermoid cysts - how is it diagnosed?

A

predictable changes on MR but can also be diagnosed on CT

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29
Q

what is HSG used for and what is it?

A

close off the cervix and fill uterus with fluid, used to assess tube potency. real time image on x ray

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30
Q

ascites, peritoneal and omental nodules, liver and sub diaphragmatic deposits seen in?

A

ovarian cancer

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31
Q

malgnant pleural effusions can result from?

A

pleural peritoneal communications

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32
Q

what is the parametrium?

A

connective tissue and fat around the uterus and cervix

33
Q

***what imaging is better for looking at local disease?

A

MRI

34
Q

mets?

A

CT

35
Q

what is the best imaging technique to establish a thickened endometrium in a post menopausal woman with PMB?

A

transvaginal us (hock st)

36
Q

MRI used to look for local myometrial spread but CT used to look for distant nodal and pulmonary mets

A

y

37
Q

what is the most common age to get endometrial cancer.uncommon below what age?

A

60 uncommon under 40

38
Q

e1 name? e2?

A

oestrogen one 1, estradiol e2 di

39
Q

e1 seen more in ?

A

post menopausal women (oneoone)

40
Q

which is less biologically active? e1 or e2?

A

e1

41
Q

what happens in menopause?

A

ovaries contain a finite number of eggs. ovaries start to become less sensitive to lh and fsh. when the serum fsh is above 30 on two separate occasions = menopause

42
Q

loss of ovarian function leads to _______depletion?

A

oestradiol

43
Q

average age of menopause?

A

52

44
Q

adipocytes convert androgens into?

A

e1

45
Q

why do you get dyspareunia?

A

vaginal dryness

46
Q

long term effects of menopause?

A

COC - cardiovascular disease, cerebrovascular disease and osteoperosis

47
Q

oestrogen effects on LDL, hdl, cholesterol and fat distribution?

A

decreases LDL, increases HDL, reduces cholesterol and fat distribution. also protective in terms of bone density.

48
Q

who are the only patients suitable for an oestrogen only hormone replacement therapy?

A

TOTAL hystorectomy

49
Q

if they’ve had a subtotal hysterectomy, they may also need progesterones

A

y

50
Q

who is sequential combined given to?

A

perimenopausal

51
Q

who is continuous combined given to?

A

post menopausal bleed free

52
Q

what contains more synthetic oestrogen at higher dose? HRT or OCP?

A

HRT

53
Q

what does progesterone reduce?

A

the risk of endometrial cancer

54
Q

progesterone protects the uterus and leads to regular bleed in sequential

A

progesterone ogven for 10-14 days

55
Q

which one mimics the normal cycle?

A

sequential

56
Q

what hormones are given in continuous combined?

A

oestrogen and prog for 28 days

57
Q

no monthly bleed after first 6 months

A

y

58
Q

when should sequential treatment be started?

A

when required, women may still be having periods

59
Q

why do you want them to switch to continuous asap?

A

prolonged use can increase risk of endometrial cancer

60
Q

continuous should not be started until __________after LMP or after 2 year __________

A

1 year 2 years taking sequential if under 54

61
Q

continuous shouldn’t be taken under the age of 54, unless?

A

been on sequential for 2 years

62
Q

tibolone - weak oestrogenic, progestrogenic and androgenic properties. licensed for ? (3)

A

vasomotor, psychological and libido problems

63
Q

increased risk of what in over 60s

A

stroke

64
Q

what does the oestrogen have a protective effect on?

A

bone mass

65
Q

increased risk of?

A

endometrial cancer

66
Q

broadly what does testosterone do?

A

helps general feeling of wellbeing and improves libido

67
Q

HRT patient assessment at 3, 6 and 12 months

A

in most cases less than 5 years is sufficient

68
Q

what sort of thing do women get checked/check themselves?

A

annual BP, self examination breast, cervical smears every 3 years, mammography every 3 years,

69
Q

what cancer does HRT reduce the risk of?

A

colorectal. also reduces osteoporotic fractures

70
Q

combined HRT, risk of breast cancer, returns to normal within how long stopping?

A

5 years

71
Q

increased risk of VTE. which HRT and when?

A

combined, in the first year

72
Q

stroke?

A

increased risk of stroke

73
Q

**risk of endometrial cancer in oestrgen only, seq and con?

A

increased in oestrogen only, lower in seq and eliminated in continuous

74
Q

small increased risk of ovarian cancer, but eliminated once it is stopped

A

y

75
Q

pof - cessation of ovarian activity before the age of

A

45

76
Q

long term effects if untreated?

A

cerebrovascular and cardiovascular disease, osteoporosis, infertility, reduced life ex, dementia and cognitive decline

77
Q

causes?

A

chromosome and enzyme deficiency

78
Q

treatment ?

A

COCP or HRT

repro (30 decks)

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