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Clinical- Week 6 Flashcards

1
Q

compare the characteristics of the glands in simple, complex and atypical endometrial hyperplasia?

A

simple- dilated glands
complex- crowded glands
atypical- crowded glands

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2
Q

what type of carcinomas are most endometrial carcinomas?

A

well differentiated adenocarcinomas

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3
Q

why do folliular cysts occur?

A

due to ovulation not occuring

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4
Q

what are the types of cervical intraepithelial neoplasia?

A

CIN 1, 2, 3

3 being the worst

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5
Q

what are the disadvantages of cyst aspiration for ovarian cysts?

A
  • will recur

- if it turns out to be malignant, you are spilling it out into the peritoneal cavity

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6
Q

compare the distribution of simple, complex and atypical endometrial hyperplasia?

A

simple- general
complex- focal
atypical- focal

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7
Q

which area of the cervix is most vulnerable to HPV infection and therefore cervical cancer?

A

transformation zone (squamocolumnar junction)

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8
Q

when is fibroid degeneration seen?

A

pregnancy, peri-menopause

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9
Q

are uterine fibroids more common in pre or post menopausal women?

A

premenopausal

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10
Q

where do endometrial stromal sarcomas originate from?

A

endometrial stroma

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11
Q

what are the 7 main risk factors for endometrial cancer?

A

-age
-obesity/diabetes
-high -oestrogen/endometral hyperplasia
-PCOS
-nulliparity
lynch syndrome/HNPCC
-tamoxifen

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12
Q

why might you not be able to use oestrogens for atrophic vaginitis?

A

pre-existing/previous breast cancer

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13
Q

what is the treatment for vulval lichen sclerosus?

A
  1. steroid ointment

2. tacrolimus

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14
Q

what is the treatment for choriocarcinoma?

A

chemotherapy- often 100% cure

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15
Q

what are the 4 tumours which tend to metastasise to the ovaries?

A

breast, stomach, pancreas, colon

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16
Q

which type of mole (complete or partial) is more likely to develop into a choriocarcinoma?

A

complete

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17
Q

for pelvic masses, which is preferred- CT/US guided tissue biopsy or aspiration for cytolody?

A

CT/US guided tissue biopsy

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18
Q

what is the average age for a dysgerminoma?

A

22

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19
Q

how do endometrial hyperplasias present?

A

abnormal bleeding

DUB or PMB

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20
Q

what happens to the levels of sex hormone binding globulin and insulin binding globulin in obese women?

A

reduces level of binding globulins (increased active hormone)

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21
Q

what are the 6 main physical symptoms of menopause?

A 
hot flushes
night sweats
insomnia
palpitations
joint aches
headaches
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22
Q

what mutation is found commonly in type 2 endometrial carcinomas (serous)?

A

TP53 mutation and overexpression

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23
Q

which endometrial carcinoma is related to unopposed oestrogen?

A

type 1 endometrioid tumours

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24
Q

if a primary ovarian tumour contains granulosa cells, what hormones may be secreted?
what may this cause?

A

oestrogens

-precocious puberty, PMB

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25
Q

what are the 2 groups of functional ovarian cysts?

A

follicular cysts

luteal cysts

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26
Q

what does aromatase (found in adipocytes) do to ovarian androgens? how does this link obesity to endometrial cancer

A

converts them to oestrogens which induce endometrial proliferation

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27
Q

what cells are follicular cells lined with?

A

granulosa cells

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28
Q

what cancer risk is increased in endometriosis?

A

endometrial carcinoma

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29
Q

how are epithelial ovarian tumours classified?

A

benign
borderline
malignant
[except serous carcinoma- high grade or low grade]

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30
Q

what are the 3 layers of the uterus?

A

endometrium
myometrium
peritoneum

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31
Q

what are the 5 main psychologial symptoms of menopause?

A 
mood swings
irritability
anxiety
difficulty concentrating
forgetfulness
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32
Q

when do endometrial polyps most commonly occur?

A

around/after menopause

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33
Q

how do ovarian tumours tend to present?

A

non-specific

bloating, abdominal distension

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34
Q

what is the very top area of the uterus called?

A

fundus

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35
Q

what are the treatment options for ovarian cysts?

A
  • conservative
  • cyst aspiration
  • cystectomy
  • oophrectomy
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36
Q

what is salpingitis?

A

inflammation of the fallopian tube (usually due to infection)

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37
Q

what are the 2 main grous of endometrial carcinoma?

A

type 1- endometrioid carcinoma

type 2- serous carcinoma

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38
Q

what 3 cancers do people with lynch syndrome have an increased risk of?

A

colorectal cancer
endometrial cancer
ovarian cancer

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39
Q

what is the treatment of atrophic vaginitis?

A

topical oestrogen therapy

lubricants

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40
Q

what is the treatment of a functional ovarian cyst?

A

usually resolve spontaneously

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41
Q

what classifies as late menopause?

A

menopause after 54 years old

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42
Q

what is the area of the uterus where the fallopian tubes insert?

A

the cornu

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43
Q

what is a paratubal cyst?

A

a small, close fluid filled sac near the fallopian tube/ovary (embryological remnants)

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44
Q

what is the main function of CEA tumour marker?

A

used to exclude the cause of ovarian cancer to be secondary mets from GI primary

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45
Q

where do most ovarian tumours arise from?

A

epithelium

ie serous- looks like fallopian tube epithelium, endometrioid- endometrium, mucinous- cervical epithelium

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46
Q

what is brachytherapy?

A

cancer treatment- place radioactive source beside tumour (reduces exposure to surrounding tissues)

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47
Q

why should large ovarian cysts be operated on?

A

because of the complications:
rupture or torsion
-needing emergency surgery

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48
Q

what tumour markers are often present in ovarian cancer?

A 
CA 125
carcino-embryonic antigen (CEA)
[HCG
AFP
if below 40]
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49
Q

compare the cytology of simple, complex and atypical endometrial hyperplasia?

A

simple- normal
complex- normal
atypical- atypical

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50
Q

how long does a hot flush period usually last?

A

3-5 minutes

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51
Q

why does the OCP decrease risk of ovarian cancer?

A

due to prevention of ovulation (which causes trauma(

52
Q

compare the components involved in simple, complex and atypical endometrial hyperplasia?

A

simple- glands and stroma
complex- glands
atypical- glands

53
Q

what type of benign ovarian tumour has a whole variety of different materials in them? (ie teeth, bones etc)

A

teratoma

54
Q

how do patients with complete or partial moles present?

A

pregnancy with large for dates

55
Q

how do uterine tumours (or fibroids) tend to present?

A 
abnormal bleeding
infertility
menhorragia
pelvic mass
pain/tenderness
56
Q

in addition to US what investigation may you also do for suspected ovarian cancer?

A

CT

57
Q

what infiltrate of immune cells are present in endometriosis due to the need to phagocyte haemosiderin?

A

macrophages

58
Q

what is the precursor for serous sendometrial carcinoma?

A

serous intraepithelial carcinoma

59
Q

what is the treatment for asymptomatic fibroids?

A

no treatment

60
Q

what type of cancers are automatically screened for the BRCA gene? (in terms of type of cancer, not location)

A

serous epithelial cancers

61
Q

what is the triad of meig’s syndrome?

A

ascites
pleural effusion
primary benign ovarian tumour (eg fibroma)

62
Q

what drugs can be used in the chemotherapy treatment of cervical cancer?

A

cisplatin

carboplatin/paclitaxel

63
Q

women with BRCA1 or 2 genes should be offered what surgical treatment prophylactially?

A

salpingo-oophrectomy

64
Q

what is the precursor to cervical squamous carcinoma?

A

cervical intraepithelial neoplasia

65
Q

describe the HCG levels of a patient with a molar pregnancy compared to a viable pregnancy?

A

HCG levels in molar pregnancy are much higher

66
Q

what type of inheritance is lynch syndrome?

A

autosomal dominant

67
Q

what are ‘chocolate cysts’ on the ovaries caused by?

A

endometriosis (endometriomas)

68
Q

how do you calculate the risk of malignancy index for ovarian cancer?

A

menopausal status x serum Ca125 x US score

69
Q

what is the average age of menopause?

A

51 years old

70
Q

in PCOS, what type of cysts are formed in the ovaries?

A

follicular cysts

71
Q

deep dyspareunia in a patient with endometriosis indicates what?

A

endometriosis within pouch of douglas

72
Q

what are the 3 types of endometrial hyperplasia?

A

simple
complex
atypical (precursor of carcinoma)

73
Q

what is an ovarian dermoid cyst?

A

a benign cystic teratoma of the ovary (arises from germ cells)

74
Q

describe complete, optimal and suboptimal debulking of a tumour?

A

complete- no tumour left
optimal- less than 1cm left
suboptimal- more than 1cm left

75
Q

what is the gold standard investigation for ovarian cancer?

A

CT guided biopsy

76
Q

why can ovarian cancer cause shortness of breath?

A

due to pleural effusion

77
Q

what are the 7 main risk factors for ovarian cancer?

A
  • nulliparity
  • higher social class
  • early menarche and late menopause
  • BRCA (esp type 1) gene
  • endometriosis
  • obesity
  • IUD
78
Q

what is the diagnostic investigation for suspected fibroids?

A

US

MRI if you need precise location

79
Q

what is cachexia?

A

wasting of the body due to serious chronic illness

80
Q

what defines a malignant epithelial ovarian tumour?

A

stromal invasion

81
Q

where is the most common metastatic spread from endometrial stromal sarcoma?

A

ovary and lung

82
Q

what is atrophic vaginitis?

A

thinning of the tissues and decreased lubrication due to lack of oestrogen

83
Q

has BRCA 1 or 2 got a higher risk of ovarian cancer?

A

BRCA 1

84
Q

what pigment tends to be present in endometriosis?

A

haemosiderin

85
Q

what is the commonest uterine mass?

A

uterine fibroids

86
Q

in addition to US what investigation may you also do for suspected uterine mass?

A

MRI

87
Q

what is the treatment for menorrhagia due to a fibroid smaller than 3cm?

A
  1. IUS
  2. hormonal treatment (eg COCP)
  3. ullipristal acetate
88
Q

what is the treatment of red degeneration of a uterine fibroid?

A

strong painkillers

-should settle on itsown

89
Q

what are the 2 types of uterine muscle wall tumours?

A

leiomyoma (uterine fibroids)

leiomyosarcoma

90
Q

what does an ovarian cancer look like on ultrasound? (3 points)

A
  • complex cyst (some cystic and solid areas)
  • increased vascularity
  • papillary projections
91
Q

what is the treatment for menorrhagia due to a fibroid greater than 3cm?

A
  1. myomecomy

2. uterine artey embolisation

92
Q

stopping which two forms of hormonal contraception can cause a period of time with raised FSH and LH?

A

combined OCP

depot

93
Q

what is the histology of most cervical carcinomas?

A

squamous carcinoma

94
Q

what is the name of ovarian cancer staging?

A

FIGO staging

95
Q

what is the surface of the ovaries covered with?

A

germinal epithelium (single layer of cuboidal cells)

96
Q

what is pyosalpinx?

A

a fallopian tube filled with pus

97
Q

if a primary ovarian tumour contains theca/leydig cells, what hormones may be secreted?

A

androgens

-hirsuitism, virilisation

98
Q

what is the chance that PMB is caused by endometrial cancer?

A

10%

99
Q

on average, how long do menopausal women get hot flushes for?

A

2 years

100
Q

is a fetus more likely to develop in a partial or complete mole?

A

partial

no maternal DNA in complete

101
Q

which is more common- endometriod carcinoma or serous carcinoma?

A

endometriod carcinoma

102
Q

how do endometrial carcinomas generally present?

A

abnormal bleeding (PMB or irregular bleeding)

103
Q

what is the treatment for endometrial carcinomas?

A

hysterectomy with bilateral salpingoophrectomy

chemo/radiotherapy

104
Q

what happens to the tunica aluginea as age increases?

A

density decreases

105
Q

what is the most common malignant primitive germ cell tumour of the ovaries?

A

dysgerminoma

106
Q

what classifies as early menopause?

A

menopause before 45 years old

107
Q

what is the other term for Lynch syndrome?

A

Hereditary non-polyposis colorectal cancer (HNPCC)

108
Q

what are the 4 highest risk HPV type?

A

16, 18, 31, 33

109
Q

what ligament attaches the ovary laterally?

A

suspensory ligament

110
Q

compare neoadjuvant treatment to adjuvant treatment?

A

neoadjuvant treatment given before the main treatment

111
Q

what is the precursor for endometrioid carcinoma?

A

atypical endometrial hyperplasia

112
Q

what is the upper part of the uterus called?

A

the corpus

113
Q

do women with endometrial cancer tend to present premenopausally or postmenopausally?

A

post- menopause

114
Q

what ligament attaches to the ovary to the uterus?

A

ovarian ligament

115
Q

what is the most common site of an ectopic pregnancy?

A

fallopian tube

116
Q

what is endometriosis?

A

endometrial glands and stroma outside the uterine body

117
Q

what cells in the ovaries secrete oestrogens?

A

granulosa cells

118
Q

what is the main advantage of cyst aspiration for ovarian cyst?

A

doesnt need general anaesthetic

119
Q

what is a hydrosalpinx?

A

a distally blocked fallopian tube with serous or clear fluid

120
Q

what is tamoxifen?

A

a selective oestrogen receptor modulator used in breast cancer (blocks oestrogen reeptors)

121
Q

what is the presentation of red degeneration of a uterine fibroid?

A

severe lower abdominal pain

122
Q

what is the treatment of uterine fibroids?

A

myomectomy
uterine artery embolisation
hysteroscopic resection
hysterectomy

123
Q

what is red degeneration of a uterine fibroid?

A

a rare complication during pregnancy- haemorrhage in the centre of the fibroid due to fibroid outgrowing its blood supply

124
Q

what is the threshold risk or malignancy index for ovarian cancer?

A

greater than 200

125
Q

how do patients with endometriosis present?

A

pelvic pain
infertility
dysmenorrhoea
dyspareunia

126
Q

what investigation should all women who present with PMB have?

A

transvaginal US

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