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Y1&2 Medicine Zoe Veary > GUM 204 & 220 Gynae & Gynae Cancer > Flashcards

GUM 204 & 220 Gynae & Gynae Cancer Flashcards

1
Q

What happen in the late luteal/early follicular phase of the menstrual cycle? (Days 25-5)

A

The corpus luteum is regressing and dying
Decreased steroids esp. progesterone = -ve feedback to increase LH/FSH
intercyle rise in FSH = follicular selection

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2
Q

What does LH stimulate? (Menstrual Cycle)

A

Theca cells in the developing follicles to stimulate testosterone production

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3
Q

What converts testosterone to oestrogen and where from? (Menstrual cycle)

A

Aromatase enzyme from follicular granulosa cells

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4
Q

What happens in the mid follicular phase? (days 5-10)

A

Oestrogen is increasing
-ve feedback = less FSH and there is inhibin production = no more follicular development
Dominant follicle has to have LH receptors to survive

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5
Q

What happens in the mid cycle phase? (days 10-20)

A

2 days of high oestrogen switches the negative feedback to positive
= LH (and smaller FSH) surge
= follicle rupture from ovum and atresia of other follicles

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6
Q

What happens to theca cells after the follicle has ruptured?

A

Undergo atrophy

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7
Q

What happens to the granulosa cells after the follicle has ruptured?

A

Undergo hypertrophy

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8
Q

Describe the mid luteal phase? (days 20-25)

A

Corpus luteum is formed by ruptured follicle
Oestrogen levels dropped so feedback is -ve again
Progesterone levels increase to maintain CL and endometrium

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9
Q

What has happened if there is menstruation?

A

No fertilisation so corpus luteum regresses

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10
Q

When does the primary oocyte finish the 1st meiotic division?

A

Ovulation - LH surge

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11
Q

What feature of seminal fluid protects against the vaginas acidity?

A

It is slightly alkaline

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12
Q

What two changes to sperm undergo once in the vagina/fertilisation?

A

Capacitation and the acrosome reaction

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13
Q

Describe capacitation?

A

Biochemical removal of the surface glycoprotein on spermatozoa initiating whiplash movement of tail = hyperactive sperm

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14
Q

What is the acrosome reaction?

A

Allows sperm to make a slit in the zona pellucida and stimulates the cortical reaction - prevents polyspermy

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15
Q

What hormone maintains the corpus luteum after implantation and is responsible for maternal recognition?

A

Beta-HCG

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16
Q

What do testes mostly consist of?

A

Seminiferous tubules

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17
Q

What are the walls of the seminiferous tubules made up of?

A

Sertoli cells

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18
Q

What lie on the basement membrane of the seminiferous tubules? What are they capable of?

A

Spermatogonia - germ cells

Can divide by mitosis or meiosis

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19
Q

What happens to spermatogonia next on the pathway to becoming mature sperm?

A

They undergo mitosis to produce diploid cells committed to differentiative pathway - 46XY
Primary spermatocytes

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20
Q

What happens to primary spermatocytes next?

A

Undergo 1st meiotic division to become 23X and 23Y = secondary spermatocytes

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21
Q

What happens to secondary spermatocytes?

A

They undergo second round of meiosis to give 4 mature spermatozoa

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22
Q

As sperm mature where do they travel from and to?

A

Away from basement membrane –> lumen where they then travel into rete/epidiymus and along route they undergo spermiogenesis - final maturation for motility and acrosomal cap

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23
Q

Once the sperm fuses with the oocyte what happens to the oocyte?

A

It undergoes its second meiotic division

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24
Q

What is mennorhagia?

A

Excessive blood loss during menstruation

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25
Q

What is primary dysmenorrhoea?

A

Painful menstrual bleeding usually starts 1-2 years after menarche and has no underlying pathology

26
Q

What is secondary dysmenorrhoea?

A

Painful menstrual bleeding, occurs 3-4 days before menstruation and later in life - indicates pathology

27
Q

What is DUB - dysfunctional uterine bleeding?

A

Menorrhagia not associated with any disease - diagnosis of exclusion

28
Q

What are other causes of menorrhagia?

A

Fibroids
Endometriosis
PCOS

29
Q

What is a uterine fibroid? What are the risk factors?

A

Benign tumour of the myometrium

Risk factors tamoxifen, null-parity, obesity and family hx

30
Q

What are the 3 classifications of fibroids?

A

Intramural - within uterine wall, most common
Sub-serosal - under serosal surface, can become pedunculated
Sub mucosal - most likely to produce mennorhagia

31
Q

What are some general treatments for menorrhagia?

A 
Mirena Coil/OCP
Tranexamic acid
Mefenamic Acid
Progestogens
GnRH analogues
Surgical - endometrial ablation/hysterectomy
32
Q

What is endometriosis?

A

When endometrial tissue is found outside of the uterus

33
Q

What are chocolate cysts?

A

Ovarian cysts caused by bleeding of endometrial tissue into cysts at menstruation

34
Q

What is fecundity?

A

The ability to reproduce

35
Q

What is subfertility?

A

An involuntary failure to conceive

36
Q

What are the major reasons of subfertility?

A

Sperm dysfunction
Ovulation disorder
Tubal disease
Endometriosis

37
Q

What is azospermia? What can it be due to?

A

No sperm in ejaculate
Primary - failure of production e.g. congenital or iatrogenic
Secondary - failure of sperm to reach urethra e.g. infection, absent vas deferens

38
Q

What are some ovulatory disorders responsible for subfertility?

A

Hypothalamic - anorexia/low BMI
Pituitary - adenoma, prolactinomas or drugs
Ovarian - PCOS

39
Q

What is PCOS?

A

Several tiny cysts on ovaries associated with increased androgens and anovulation
Symptoms: hair growth, acne, weight gain

40
Q

What can cause tubal disease? How does it affect fertility?

A

Infections: mainly gonorrhoea and chlamydia
Endometriosis

Prevent a patent lumen or scars may prevent tube from moving ovary

41
Q

Who does vulval cancer normally present in? Is it common?

A

70 year olds - rare

42
Q

How may vulval cancer present?

A

Itching, irritation, pain, lumps, discharge and bleeding

43
Q

What are some risk factors for vulval cancer?

A

age, smoking, HPV and lichen sclerosis

44
Q

What is the most common type of vulval cancer?

A

Squamous cell carcinoma

45
Q

How do you treat vulval cancer?

A

Surgically - if > 1mm invasion then wide local incision with 15mm margin
Total vulvectomy if wider - may use radiotherapy to reduce size or in inguinal lymph node involvement

46
Q

What is the most common gynae cancer worldwide?

A

Cervical cancer

47
Q

What is the 3 rd most common gynae cancer in the UK?

A

cervical cancer

48
Q

What is the next step if dyskariosis is found on a cervical smear?

A

Colposcopy

49
Q

What is the most common type of cervical cancer?

A

Squamous cell

50
Q

Name risk factors for cervical cancer

A

Sexual behaviours - Increased risk of HOV

smoking, OCP and immunosuppressants

51
Q

What is stage 1 of cervical cancer and how is it treated?

A

confined to cervix and treated with local excision

52
Q

What is stage 2 of cervical cancer and how is it treated?

A

confined to uterus - total abdominal hysterectomy

53
Q

What is stage 3 of cervical cancer and how is it treated?

A

involves pelvic side wall/lower vagina

treat with radical radio/chemo

54
Q

What is stage 4 of cervical cancer and how is it treated?

A

beyond pelvis, bladder and rectal mucosa

radical radio/chemo

55
Q

What is endometrial cancer?

A

A malignant adenocarcinoma

56
Q

What is the second most common gynae malignancy?

A

Endometrial cancer

57
Q

What are the risk factors for endometrial cancer?

A

Obesity, unopposed oestrogen, long fertile period, null parity, family history, PCOS

58
Q

How does endometrial cancer often present?

A

Older women with PMB

59
Q

What is the most common gynae malignancy?

A

Ovarian cancer

60
Q

What type of cancer is ovarian cancer usually?

A

epithelial cancer - serous ovarian cancer

61
Q

How does ovarian cancer often present?

A

Late but can also have non-specific symptoms, bloating and abdominal pain

62
Q

What are risk factors for ovarian cancer?

A

nullparity, BRCA1 gene mutation, long fertile period

Y1&2 Medicine Zoe Veary (60 decks)

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