book 1 Flashcards
where can you palpate the ischial spines?
4 and 8 oclock
where can you palpate the ischial spines?
4 and 8 oclock
2 ligaments of the pelvis?
sacrospinous and sacrotuberous
if you get life threatening haemorrhage after pelvic fracture, which vessels are likely affected?
common iliac artery/vein
do you want the station to be positive or negative
positive
describe medulla of ovary?
highly vascularised, connective tissue, nerves, lymphatics
what is the name of the group of arteries that enter hilum from broad ligament and supply blood to the ovary?
helicine
dense connective tissue in the penis?
tunica albuginea
name for the development of oocytes?
oogenesis
growth of follicle term?
folliculogenesis
loss of oogonia and oocytes by apoptosis?
atresia
what happens to folic if it fails to associate with pregranulosa cells?
die
what are pregranulosa cells like? what happens to them if the follicle enters growth phase?
squamous, become cuboidal
what do you call cuboidal granulosa cells?
zona granulosa
layer of specialised extracellular matrix between oocyte and granolas cells?
zona pellucida
what cells associate with the outside of the folic?
stroma cells
what do they go on to become?
theca (interna and externa)
which layer of the theca secrete oestrogen precursors?
inner
which cells convert the precursors to esrogen?
granulosa cells
name of strucure, filled with follicular fluid which starts to form?
antrum
after ovulation, follicle transforms into?
CL
which cells of the corpus lute secrete oestrogen and progesterone?
theca and granulosa
if no implantation, CL becomes?
corpus albicans
what colour is the corpus albicans?
white
if implantation occurs, placenta secretes HCG. what is the effect of this?
prevents CL degeneration
the corpus lute maintains progesterone levels, and so maintains the pregnancy
ie corpus lute needs HCG
name sites of uterine tubes (fun to as it is)
infundibulum, ampulla, isthmus, interstital part
where does fertilisation usually occur?
ampulla
how many layers of smooth muscle are in the ampulla? isthmus?
2 in the ampulla, 3 in the isthmus
which layer of the endometrium contains 3 layers of smooth muscle, with collagen and elastic tissue?
myometrium
which layer shed during menstruation?
endometrium
2 layers of endometrium?
striatum basalis and stratum functionalis
which part is grown and shed?
f
during secretory phase, describe the appearance of the glands? what do they secrete?
coiled with corkscrew appearance. glycogen
what is glycogen converted into in the vagina? by what?
lactic acid by commensal bacteria
describe mucus in proliferative phase and following ovulation?
thin and watery in proliferative phase, thick and viscous following ovulation
4 layers of the vagina?
NLFA - i hop - non keratinised stratified squamous epithelium, lamina propria, fibromuscular layer, adventitia
vagina lubricated by cervical mucous and ?
fluid from thin walled vessels in lamina propria
contains 2 tubes of erectile vascular tissue?
clitoris
minora, which has only sebacsous glands, wad which has both sebaceous and apocrine
minora only s, majora has s and a
what does FSH stimulate?
follicle development and granolas cells to produce oestrogen
dominant follicles release what substance which inhibits FSH?
inhibin
decline in FSH causes?
atresia of all but dominant follicle
term for degeneration of corpus luteum?
luteolysis
estrogen induced growth of endometrial glands, which phase?
proliferative phase
what happens in L phase?
secretory activity
which process inhibits scar formation in menstruation?
fibrinolysis (breakdown of clots)
how many days does bleeding usually last ?
4-6
should there be clots?
no
variation of days in normal cycle?
21-35 days
menorrhagia?
prolonged and increased menstrual flow
RAGE PI
y
metrorrhagia
regular intermenstrual bleeding
increased bleeding and frequent cycle?
polymenorrhagia
polymenorrhoea - menses occurring at?
menometrorrhagia?
prolonged menses and intermenstrual bleeding
oligomenorrhoea?
menses at intervals of more than 35 days
how long do you need absence of periods to be amennorheic?
6 months
DUBs are all to do with?
corpus luteum
what percentage of women with abnormal uterine bleeding have DUB?
50
both anovulatory and ovulatory have a deficiency of?
prog
85% are an/ov?
anovulatory
which one more common in obesity?
anovulatory
what ages do you expect to get anovulatry?
extremes of fertility, 20 and 40
management of DUB? (pro foo, dan, pillh, NSAID, GnRH analogues, capillary wall stabilisers)
PROGESTERONE
2 alternatives that release progesterone?
IUCD or IUS
which hormone converts endometrium to secretory stage to prepare for implantation?
pro
can also do resection or ablation for DUB
y
infertility - female should take 0.4mg folic acid for how long before conception?
12 weeks
mild or moderate endometriosis, what fertility treatment can be offered? also for unexplained fertility?
IUI
Indications for IVF?
unexplained 2 year duration, pelvic disease, anovulatory, male factor infertility
which drug used to down regulate GnRH?
buretin
side effects?
hot flushes, mood swings, nasal irritation, headaches
what should endometrium look like following this?
thin
how is ovary stimulated?
gnrh
side effects of ovarian stimulation?
mild allergic reactions and ovarian hyperstimulation syndrome (OHSS)
what is injected to mimic LH surge 36 hours before egg collection?
HCG
no more than 2 embryos to be transferred in women less than 40. however, 3 can be transferred in special circumstances
y
after the transfter, what hormone is given?
prog
what complications can arise from sperm aspiration?
abdominal pain/bloating/nausea, diarrhoea, breathless
what is the chance of success in a woman under 35?
37%
over 41
0.5%
pathway of IVF?
down regulation using bretin (menopausal symptoms) - ovarian stimulation - scan - oocyte retrieval - embryo transfer - luteal support (progesterone)
complications of IVF?
ectopic pregnancy, OHSS, multiple pregnancies
in breast, i larger ducts, epithelial lining is?
columnar
in smaller i.e. acini, its?
columnar or cuboidal
keratinised stratified squamous epithelium with a curve of dense irregular connective tissue mixed with bundles of smooth muscle?
nipple
in absence of pregnancy, what happens to lumina of ducts and epithelial cells in luteal phase?
lamina increases, epithelial cells increase in height
if pregnancy occurs, you get elongation and branching of the smaller ducts
y
also proliferation of the epithelial cells of the glands and the myoepithelial cells
y
in pregnancy, 2nd trimester, which cells infiltrate the connective tissue?
plasma and lymphocytes
during pregnancy, E and P stimulate proliferation of secretory tissue. what happens to fibrofatty tissue
becomes sparse
composition of breast milk?
88% water, 7% carb, 3.5% fat, 1.5% protein
also contains?
vitamins, ions, IgA
what sort of secretion for lipids?
apocrine, takes a bit of cytoplasm with it
proteins in milk made by ?
rER
packaged in ?
the golgi
which type of secretion for proteins?
merocrine, secretion, merge with the apical membrane
following menopause, the secretory cells of TDLU degenerate leaving only ducts. in connective tissue there is reduced ______ and _______? fewer of which cell type
collagen and elastic fibres, fibroblasts
histopathology - tissue
cytology cells
B1-b5
c1 - c5
what would you do to establish hormone receptor status?
biopsy
causes of gynaecomastia?
hormones, cannabis, prescription drugs, liver disease, hyperthyroid, renal disease, puberty, idiopathic
describe the growth?
ductal growth with no lobular growth?
lumpy rope like change?
fibrocystic change
pain, tenderness, lumpiness in pre menopausal woman. sudden pain, both breasts, cyclical pain, smooth discrete lumps?
FCC
describe cysts?
1mm blue domed with pale fluid, sisal multiple. cysts are thin walled but may have fibrotic wall. lined by apocrine epithelium
management?
exclude malignancy, reassure, excise if necessary (aspirate)
what percentage of cysts are associated with malignancy?
1-2 percent
circumscribed lesion composed of cell types normal to the breast but present in an abnormal proportion or distribtion/
hamartoma
black woman in 20s, solitary painless firm discrete mobile mass?
fibroadeoma. circumscribed, rubbery, grey white colour.
management of fibroadenoma?
diagnose, reassure, excise
when do you excise it?
if it is abnormal shape, enlarging or don’t know what it is
type of sclerosis. benign disorderly proliferation of acini and stroma. pain, tenderness, lumpiness, may cause calcification?
sclerosing adenosis
radial scar - buzzwords?
stellate architecture, central puckering, fibroelastic core, radiating, epithelial proliferation, distorted ductules, fibrocystic change
what may develop within these lesions?
cancer
are these types of sclerosis pre malignant?
no
fat necrosis - path?
trauma, damage to adipcytes, foamy macrophage infiltration - scarring and fibrosis
duct ectasia - which ducts does it affect?
sub areolar
pain?
yes
most common cause of?
green discharge
acute episodic inflammatory changes
y
associated with? what can happen to the nipple?
smoking, retraction and distortion
what happens to the sub areolar ducts?
dilation, also become inflamed and fobrosed
management?
treat infections, exclude maignancy, stop smoking. can excise if necessary
2 main aetiologies of abcess/mastitis
duct ectasia and breast feeding
management
CONTINUE BREAST FEEDING, antibiotics (flucloxacillin/co amoxixillin) drainage or incision and drainage
management
CONTINUE BREAST FEEDING, antibiotics (flucloxacillin/amoxixillin) drainage or incision and drainage
what is storm of breast?
connective tissue and fat, not glandular tissue
unilateral breast mass, doesn’t metastasis, benign, prime to local recurrence, leaf shaped?
phyllodes tumour
papillary lesions, can they cause blood nipple discharge?
yes
painful?
usually no, asymptomatic at screening
nodules may be calcified
core is fibrovascular, may show proliferative activity, myoepithelium and epithelium
pathway of intraduct papilloma?
none, usual type hyperplasia, atypical hyperplasia, dcis
breast carcinoma arises from which epithelium?
glandular
metastatic tumours to breast come from?
kidneys, lungs, ovaries
in situ carcinomas can be lobular or ductal
arise in the glandular epithelium of the terminal duct lobular unit
2 types of lobular neoplasia?
atypical lobular hyperplasia, lobular carc in sit (>50%)
describle neoplasia
er positive, e cad negative, intracytoplasmic lumens/vaculoes, small/intermediate sized nuclei. MULTIFOCAL AND BILATERAL.
DCIS tends to be unicentric
involvement of the nipple in DCIS is known as pagets
what nipple symptoms do you get in pagets?
redness, scaling and flaking of nipple
lobular neoplasia, palpable? calcium?
not palpable, but visible grossly. may calcify
why is lobular neoplasia significant?
8 x rr of invasive carcinoma, 15-20 percent when you investigate them they have higher grade lesion than diagnostic biopsy
high grade DCIS can extend along the ducts to reach the epidermis of nipple
pagets
most common invasive breast cancer?
ductal 80 percent, lobular 10 percent
risk factors for breast cancer/
age, age at first menarche, age at first birth, age at menopause, hrt, cocp, alcohol , obesity, smoking, BRACA 1 and 2
BRACA 1 and 2 - lifetime risk of breast cancer?
45 - 64 percent lifetime risk
DCIS management?
excise and radiotherapy
what staging system is used in breast cancer?
TNM t = local invasion
pathological assessment breast cancer?
TGSPP (prognostic and predictive)
well differentiated - good prognosis - cells similar
poorly differentiated - cells different - bad prognosis
3 grading parts?
tubular differentiation 1-3 nuclear polymorphism 1-3 mitotic activiy 1-3
drug that blocks oestrogen receptor in breast?
tamoxifen
how can you reduce amount of oestrogen?
gnRH antagonists, aromitast inhibitors (TAG OOPH) also oophrectomy
name an aromatase inhibitor?
letrozole (aroma to let)
