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Obstetrics And Gynaecology > General Gynaecology > Flashcards

General Gynaecology Flashcards

1
Q

Which cells release FSH?

A

Granulosa cells

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2
Q

Which cells release LH?

A

Theca cells

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3
Q

What is the action of FSH?

A

Binds to granulosa cells to stimulate follicle growth, permit conversion of androgens to oestrogen and stimulate inhibin secretion

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4
Q

What is the role of LH?

A

The production and secretion of androgens

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5
Q

What are the two phases the ovarian cycle called?

A

Follicular

Luteal

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6
Q

What changes occur during the follicular phase?

A

Follicles begin to mature and prepared to release oocyte
Low steroid and inhibin levels means less negative feedback therefore increased FSH and LH
These stimulate the follicular growth and oestrogen production
One dominant follicle selected
LH surge causes ovulation

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7
Q

For how long is an egg viable?

A

24 hours

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8
Q

Describe the changes in the luteal phase

A

Corpus luteum is formed at the sight of the ruptured follicle
Produces oestrogen, progesterone and inhibin to maintain conditions for fertilisation and implantation
Spontaneously regresses after 14 days if no fertilisation

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9
Q

What are the phases of the uterine cycle?

A

Proliferative
Secretory
Menses

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10
Q

Describe the proliferative phase

A

This occurs alongside the follicular phase of the ovaries
Preparation for implantation
Oestrogen initiates fallopian tube formation, thickening of the endometrium, increased growth and motility of myometrium and production of thin, alkaline cervical mucus

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11
Q

Describe the secretory phase

A

This occurs alongside the luteal phase
Progesterone stimulate further thickening of endometrium into glandular secretory form, increased thickening of the myometrium, decreased nativity of myometrium, thick, acidic cervical mucus production and changes in mammary tissue

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12
Q

What occurs during menses?

A

Corpeus luteum breaks down

Internal lining of uterus shed

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13
Q

Define menorrhagia

A

Periods with such heavy bleeding that it causes a significant impact on the women’s life
>80ml per cycle

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14
Q

Name some causes of menorrhagia

A

Abnormal clotting: vW disease, thrombocytopenia, leukaemia, platelet disorders
Pathology: fibroids, adenomyosis, endometriosis, IUD, PID, polyps
Medical disorders: hypothyroidism, liver disease, SLE, cancer, progesterone contraception

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15
Q

What is the management of menorrhagia?

A

Tranexamic acid
NSAIDs
IUS
Management of the cause

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16
Q

What is the basic MoA of tranexamic acid?

A

Anti fibrinolytic

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17
Q

How do NSAIDs work in menorrhagia?

A

Reduce the production of prostaglandins and therefore decrease the bleeding

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18
Q

Define endometriosis

A

Function endometrial glands and storms outside of the uterine cavity

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19
Q

What percentage of reproductive age women have endometriosis?

A

5-10%

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20
Q

What are the symptoms of endometriosis?

A

Pelvic pain - cyclic, deep dyspareunia
Pain with defaecation
Infertility

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21
Q

What are the commonest findings in a patient with endometriosis?

A

Fixed, retroverted uterus
Nodularity of uretosacral ligaments
Enlarged, tender adnexa

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22
Q

What is the management of endometriosis?

A

NSAIDs - pain and menstrual flow
Oral contraceptives
GnRH agonist
Surgical = Laser/excise endometriosis and hysterectomy

23
Q

What is adenomyosis?

A

Endometrial glands and storms within the myometrium

24
Q

What are the symptoms of adenomyosis?

A

Dysmenorrhea
Menorrhagia
Dyspareunia

25
Q

What is the examination finding for adenomyosis?

A

Smoothly enlarged, boggy uterus

26
Q

How do we diagnose adenomyosis?

A

Suggested by pelvic US/MRI

histological diagnosis

27
Q

What is the management of adenomyosis?

A

Continuous oral contraceptives
IUS/injections
Hysterectomy

28
Q

What are the causes of pelvic prolapse?

A 
Vaginal births/pregnancy
Race - more common in white women
Oestrogen deficiency 
Chronic conditions - obesity, COPD, constipation
Connective tissue disease
29
Q

What are the symptoms of prolapse?

A

Feeling of something coming down
Bulge at vaginal introitus
Incomplete bladder/bowel emptying

30
Q

What is the management of prolapse?

A

Pessaries
Pelvic floor training
Hysterectomy
Fixations

31
Q

What ix are appropriate for suspected PCOS?

A

Testosterone, LH, FSH

US

32
Q

What would FSH and LH levels show in PCOS?

A

Raised LH

Decreased FSH

33
Q

What are the symptoms of PCOS?

A

Amenorrhoea/oligo menorrhoea
Hirsutism
Obesity
Infertility

34
Q

What is the management of PCOS?

A

Oral contraceptives
Metformin
Clomiphene citrate or ovarian drilling for fertility

35
Q

What do we call the 2 holes in the pelvic floor?

A

Urogenital hiatus

Rectal hiatus

36
Q

What are the functions of the pelvic floor?

A

Support the viscera
Resistance to increased pressure
Urinary and faecal continence

37
Q

The levator ani consists of which 3 muscles?

A

Pubococcygeus
Iliococcygeus
Puborectalis

38
Q

What is the nerve supply to levator ani?

A

Pudendal nerve

S2-4

39
Q

Define the stages of uterine prolapse

A

I - uterus in upper half of vagina
II - uterus has descended almost to intoroitus
III - uterus protrudes out of vagina
IV - uterus completely out of vagina

40
Q

What are the complications specific to hysterectomy?

A

Damage to bladder, ureter or bowel

Pelvic abscess or infection

41
Q

High vaginal swab is used to detect …

A

Bacterial vaginosis
Trichomonas vaginalis
Candida
Group B strep

42
Q

Endocervical swabs can detect …

A

Gonorrhoea

Chlamydia

43
Q

What is the treatment for atrophic vaginitis?

A

Topical or oral oestrogen

44
Q

What is lichen sclerosus?

A

Atrophic change/thinning of the epidermis of the vulva

45
Q

What is the main sx of lichen sclerosus (if any)?

A

Itching

46
Q

What is the management of lichen sclerosus?

A

Topical testosterone

Or topical corticosteroid

47
Q

What is lichen planus?

A

Chronic inflammatory dermatitis of unknown aetiology causing multiple, small, shiny, purple papules

48
Q

What can cause a rapid increase in size of fibroids?

A

Progestins
Clomiphene
Pregnancy

49
Q

How do we classify fibroids?

A

Based on location:
Subserosal
Intramural
Submucosal

50
Q

Define threatened miscarriage

A

Uterine bleeding before 20 weeks with a closed cervical os and confined viable intrauterine pregnancy

51
Q

Define cervical ectropion

A

Eversion of the endocervix exposing the columnar epithelium

52
Q

What cells line the endo and ectocervix?

A

Endo - simple columnar

Ecto - stratified squamous non-keratinised

53
Q

What are the risk factors for cervical ectropion?

A

Use of COCP
pregnancy
Adolescence
Menstruating age

54
Q

What is the management of cervical ectropion?

A

Normal variant, does not require mx unless symptomatic
Stop oestrogen containing medications
Ablation

Obstetrics And Gynaecology (6 decks)

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