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Gynaecology Flashcards

1
Q

HORMONES

What is the main function of oestrogen

A

steroid sex hormone

Promotes secondary sexual characteristics

  • Breast tissue development
  • Growth of vulva/vagina/uterus
  • Development of endometrium
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2
Q

HORMONES

What is the function of progesterone

A

Acts on tissues previously stimulated by oestrogen to:

  • Thicken and maintain endometrium
  • Thickens cervical mucus
  • Increases body temp
  • Spiral artery formation
  • Decreases myometrial excitability
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3
Q

HORMONES

What structures produce progesterone

A

Not pregnant
- Corpus luteum after ovulation

pregnancy
Placenta - from 10 weeks

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4
Q

INCOTINENCE

Describe stress incontinence

A

Increase in abdominal pressure leads to urine leakage

due to urethral sphincter weakness

  • post childbirth
  • post prostatectomy
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5
Q

INCOTINENCE

Name 4 risk factors for stress incontinence

A 
age 
obesity 
prolonged vaginal childbirth 
Hysterectomy 
pelvic trauma 
post-menopausal (oestrogen)
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6
Q

INCOTINENCE

What investigations are required for Stress incontinence

A

Pelvic exam - determine if there is loss of tone

Urinalysis - Exclude UTI

  • MSU
  • MC&S

Bladder diary
shows frequent voiding of small volumes

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7
Q

INCOTINENCE

What is the management of stress incontinence

A

1st line

  • weight loss
  • smoking cessation
  • caffeine reduction
  • 3m Keegle exercises

2nd line -
Pharmacological
- Duloxetine

3rd line
- Burch colposuspension

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8
Q

INCOTINENCE

What is urge incontinence

A

sudden urge to void due to detrusor instability

leads to frequent urination and nocturia

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9
Q

INCOTINENCE

Name 3 risk factors for urge incontinence

A

recurrent UTIs
High BMI
Age
Smoking

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10
Q

INCOTINENCE

What investigations are required for a suspected urge incontinence

A

1st line
- MSU / Urinalysis

2nd line

  • Urodynamics
  • Bladder diary
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11
Q

INCOTINENCE

What is the management of urge incontinence

A

1st line - lifestyle

  • Bladder retraining
  • weight loss
  • caffeine reduction
  • smoking cessation

2nd line - Pharmacological

  • Oxybutynin
  • Mirabegron

3rd line
- Botox

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12
Q

INCOTINENCE

What is Mirabegron

A

Beta 3 agonist used if concerned about Anti-Ach effects of incontinence management in frail elderly patients

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13
Q

INCOTINENCE

Name 4 neurological causes on inconteincen

A

DM

Autonomic neuropathy - decreases detrusor excitability

Parkinson’s

Dementia

MS

Prostatectomy

Hysterectomy

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14
Q

PROLAPSE

Name 4 preventative methods of reducing the risk of a prolapse

A

recognising obstructed labour

avoid long 2nd stage labour

pelvic floor exercises post birth

weight reduction

Tx of chronic cough

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15
Q

PROLAPSE

Name 4 risk factors for a prolapse

A 
Multiple vaginal deliveries 
Instrumental deliveries 
prolonged deliveries 
advanced age 
post menopausal 
chronic constipation
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16
Q

PROLAPSE

Name 2 anterior wall prolapses

A

Cystocele - bladder

Urethrocele

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17
Q

PROLAPSE

What is a vaginal vault prolapse and what increases its risk

A

Prolapse of uterus / cervix / upper vagina

Hx of hysterectomy

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18
Q

PROLAPSE

Name 2 posterior wall prolapses

A

Rectocele

Enterocele - Pouch of Douglas

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19
Q

PROLAPSE

What is a cystocele

A

prolapse of anterior vaginal wall including bladder

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20
Q

PROLAPSE

What is a rectocele

A

Prolapse of lower posterior vagina involving anterior wall of rectum

associated with constipation and urinary retention

palpable lump in vagina

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21
Q

PROLAPSE

Name 4 causes of a prolapse

A

vaginal delivery

congenital factors
- Ehlers Danlos syndrome

Menopause
- Deterioration of collagenous connective tissue occurring following oestrogen withdrawal

Iatrogenic
- Hysterectomy

Cough

obesity

constipation

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22
Q

PROLAPSE

How does a prolapse present

A

Dragging sensation - worse at end of day or after prolonged standing
sensation of a lump
Stress incontinence
dyspareunia

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23
Q

PROLAPSE

What investigations are required for a suspected prolapse

A

Abdominal examination

bimanual pelvic exam

Sims speculum
- ask patient to cough

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24
Q

PROLAPSE

How is a prolapse managed

A

conservative

  • weight reduction
  • pelvic floor exercises

Medical
- Pessaries

surgical
- surgery

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25
Q

PROLAPSE

Describe a pessary

A

acts as artificial pelvic floor

changed every 6m

topical oestrogen provided

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26
Q

PROLAPSE

What are the adverse effects of a pessary

A

pain
urinary retention
infection
fall out

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27
Q

PUBERTY

What are the age ranges of puberty in males and females

A

F: 8 - 14

M: 9 - 15

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28
Q

PUBERTY

What is aromatase

A

enzyme found in adipose tissue that converts androgens into oestrogens

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29
Q

PUBERTY

What does FSH do during the early stages of puberty

A

Increase in oestrogen synthesis

oogenesis initiation in females

onset of sperm production in males

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30
Q

PUBERTY

What does LH do during the early stages of puberty

A

Increase in production of progesterone

increase in testosterone production

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31
Q

PUBERTY

How are the stages of puberty assessed

A

Tanner scale - based on secondary sexual characteristics

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32
Q

PUBERTY

Describe the 1st stage of puberty

A

Thelarche - breast bud development

occurs at around 9 - 10

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33
Q

PUBERTY

Describe the 2nd stage of puberty

A

Pubarche - pubic hair growth

hair becomes coarse and dark

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34
Q

PUBERTY

Describe the 3rd stage of puberty

A

Menarche

occurs 3yrs following thelarche
average age - 13

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35
Q

PUBERTY

What is precocious puberty

A

Appearance of secondary sexual characteristics before age of 8 or age of 9 in boys

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36
Q

PUBERTY

Name 4 causes of precocious puberty

A

Iatrogenic - exposure to oestrogens
- creams

Pathologies increasing GnRH secretion

  • Meningitis
  • CNS tumour
  • Hydrocephaly
  • Ovarian tumour
  • Adrenal tumour
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37
Q

PUBERTY

How is precocious puberty managed

A

GnRH agonists

- Arrest sexual development

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38
Q

PUBERTY

Name 4 genetic conditions leading to delayed puberty

A

Turners syndrome - 45X0

Klinefelter syndrome - 47XXY

Androgen insensitivity syndrome

Kallaman syndrome

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39
Q

PUBERTY

In males what do Leydig and Sertoli cells do

A

Leydig
- Testosterone synthesis

Sertoli
- Sperm production

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40
Q

OVARIAN TORSION

Name 2 causes of ovarian torsion

A

Ovarian mass > 5cm

Long infundibulopelvic ligaments - common in young girls before menarche

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41
Q

OVARIAN TORSION

How does ovarian torsion present

A

sudden onset unilateral pelvic pain

Pain radiates to loin, groin and back

Pain waxes and wains

N+V

Pain may improve after 24hrs - ovary dead

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42
Q

OVARIAN TORSION

How does ovarian torsion present on pelvic and vaginal examination

A

vaginal - adnexal tenderness

pelvic - palpable mass

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43
Q

OVARIAN TORSION

What investigations are required for suspected ovarian torsion

A

1st line - TVUS

  • shows free fluid
  • Whirlpool sign
  • potential volvulus

2nd line - Doppler studies
- shows lack of blood flow

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44
Q

OVARIAN TORSION

What is the diagnostic investigation for ovarian torsion

A

Laparoscopic surgery

diagnostic and therapeutic

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45
Q

OVARIAN TORSION

How is ovarian torsion managed

A

Laparoscopic surgery

  • Detorsion
  • Oophorectomy
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46
Q

OVARIAN TORSION

Name 3 risk factors for ovarian torsion

A

ovarian mass

reproductive age

pregnancy

ovarian hyperstimulation syndrome

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47
Q

MITTELSCHMERZ

What is mittelschmerz

A

Periovulatory unilateral pain experienced by women

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48
Q

MITTELSCHMERZ

Name 4 features consistent with mittelschmerz

A

Mid cycle pain

  • associated with ovulation
  • occurs 14 days prior to ovulation

sharp onset pain

recurrent epsioes

settles over 24-48hrs

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49
Q

MITTELSCHMERZ

What investigations are required for mittelschmerz

A

USS - Shows free fluid

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50
Q

MITTELSCHMERZ

What is the management of mittelschmerz

A

conservative - Analgesia

  • Paracetamol
  • NSAIDs
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51
Q

CHRONIC PELVIC PAIN

Give a definition of chronic pelvic pain

A

Intermittent or constant pain in lower abdomen/pelvis for minimum 6m not occurring excessively with menstruation or intercourse

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52
Q

CHRONIC PELVIC PAIN

Name 4 gynaecological causes of chronic pelvic pain

A

dysmenorrhoea

endometriosis

adenomyosis

PID

Ovarian cyst

pelvic organ prolapse

pelvic congestion syndrome

fibroids

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53
Q

OVARIAN TUMOURS

What are the 4 main types of ovarian tumours

A

Surface derived - epithelial
(Most common)

germ cell

sex cord stromal

Metastases

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54
Q

OVARIAN CYSTS

What is a simple ovarian cyst

A

contains fluid only

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55
Q

OVARIAN CYSTS

Name 2 functional cysts

A

follicular cyst

corpus luteum cyst

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56
Q

OVARIAN CYSTS

What is a follicular cyst

A

functional cyst < 3cm

represents developing follicle in first 1/2 of of cycle

cyst fails to rupture and release egg

disappears after a few menstrual cycles

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57
Q

OVARIAN CYST

What is the appearance of a functional cyst on US

A

Thin wall appearance

no internal structures

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58
Q

OVARIAN CYST

What is protective against functional cysts

A

COCP - Prevent ovulation

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59
Q

OVARIAN TUMOURS

What is a corpus luteum cysts

A

functional cyst < 5 cm

occurs in luteal phase after corpus luteum fails to breakdown

seen in early pregnancy

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60
Q

OVARIAN TUMOURS

Name 3 pathological cysts

A

Endometrioma

PCO

Theca lutein cyst

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61
Q

OVARIAN TUMOURS

What is a theca lutein cyst

A

increased ovarian cysts due to increased hCG

Eg: Molar pregnancy

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62
Q

OVARIAN TUMOURS

What ovarian masses are common in premenopausal women

A

follicular / letein cysts
dermoid cysts
endometriomas
benign epithelial tumours

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63
Q

OVARIAN TUMOURS

Which ovarian masses are common in postmenopausal women

A

benign epithelial tumours

malignancies

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64
Q

OVARIAN TUMOURS

Name 5 benign ovarian tumours

A

serous cystadenoma

Mucinous cystadenoma

Brenner

dermoid cyst

fibroma

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65
Q

OVARIAN TUMOURS

What is a serous cystadenoma

A

Epithelial benign tumour

  • Bilateral
  • Have septations
  • Cysts lined by ciliated cells
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66
Q

OVARIAN TUMOURS

Describe a mucinous cystadenoma

A

Epithelial benign tumour

  • can grow to be very large
  • Unilateral
  • Lined by mucous secreting epithelium
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67
Q

OVARIAN TUMOURS

Describe a brenner tumour

A

epithelial beingn tumour

  • unilateral
  • solid grey / yellow appearance
  • Coffee bean nuclei
  • Contain Walthard cell rests
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68
Q

OVARIAN TUMOURS

Describe a dermoid cyst

A

Benign germ cell tumour

  • Associated with premenopausal women
  • Bilateral
  • Large
  • Asymptomatic
  • Common in pregnancy
  • Associated with torsion
  • Contain complex cystic structures (teeth / hair)
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69
Q

OVARIAN TUMOURS

What does the histopathological analysis of a dermoid cyst show

A

Rokitansky’s protuberance

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70
Q

OVARIAN TUMOURS

What can rupture of a mucinous cystadenoma lead to

A

Pseudomyxoma peritonei

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71
Q

OVARIAN TUMOURS

Describe a fibroma tumour

A

Sex cord stromal tumour

  • Presents with Meig’s syndrome
  • pulling sensation in pelvis
  • Typically occurs around menopause
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72
Q

OVARIAN TUMOURS

What is Meig’s syndrome

A

Triad:

  • Ascites
  • Ovarian mass
  • R sided pleural effusion
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73
Q

OVARIAN TUMOURS

What are the indicators for malignancy in a cyst

A

Irregular boarders
ascites
septations

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74
Q

OVARIAN TUMOURS

What does the histopathological analysis of a serous cystadenoma show

A

Psammoma bodies - collection of calcium

75
Q

OVARIAN CYST

Name 3 risk factors for ovarian cysts

A 
obesity 
tamoxifen therapy 
early menarche 
Infertility 
Family hx - dermoid
76
Q

OVARIAN CYST

How does an ovarian cyst present

A 
Pain 
- dull ache 
- Lower back pain 
- Lower abdomen pain 
Dysparerunia 
Irregualr vaginal bleeding 
Pressure sx
- urinary frequency 
- bowel disturbance
77
Q

OVARIAN CYST

What are the effects of ovarian cysts on pregnancy

A

urinary retention

increased risk of miscarriage

increased risk of pre term delivery

Torsion - 1st trimester

Cyst haemorrhage

78
Q

OVARIAN CYST

What investigations are required for ovarian cysts

A

pregnancy test

FBC - Infection / haemorrhage

Ca125

  • Important for post meopausal women with complex cysts
  • calculate RMI
  • Other tumour markers in women < 40 (LDH/AFP/HcG)

TVUS

Laparoscopy - Diagnostic

79
Q

OVARIAN CYST

How do you calculate RMI

A

USS x Ca125 x Menopausal status

80
Q

OVARIAN CYST

What is the management of a simple ovarian cysts in a premeopausal woman

A

< 5 cm –> Resolves in 3 cycles

5 - 7cm –> Yearly USS follow up

> 7cm –> MRI / Surgery

81
Q

OVARIAN CYST

What do all post menopausal women with suspected ovarian cysts require

A

Ca125 levels

82
Q

OVARIAN CYST

What indicates a 2ww referral

A

complex cyst or raised Ca125

83
Q

OVARIAN CYST

Name 3 causes of raised Ca125

A 
ovarian cancer 
endometriosis 
fibroids 
adenomyosis 
pelvic infection 
liver disease 
pregnancy
84
Q

ENDOMETREOSIS

What is endometriosis

A

extrauterine implantation and growth of endometrial tissue

85
Q

ENDOMETREOSIS

What is a chocolate cyst

A

endometrioma in ovary - common in women aged 30 - 45

endometrioma - lump of endometrial tissue outside uterus

86
Q

ENDOMETREOSIS

When does the endometrium regress

A

pregnancy

menopause

87
Q

ENDOMETREOSIS

What are the common sites for endometriosis

A 
uterosacral ligaments 
on or behind ovaries 
pouch of Douglas 
bladder 
peritoneum 
vagina
rectum 
lung 
brain 
muscle
88
Q

ENDOMETREOSIS

State the 3 theories associated with endometreosis

A

Sampson

Halban’s

Meyers

89
Q

ENDOMETREOSIS

What is Sampson’s theory

A

retrograde menstruation with adherence invasion and growth

90
Q

ENDOMETREOSIS

What is Halban’s theory

A

Lymphatic / haematogenous system spread

91
Q

ENDOMETREOSIS

What is meyers theory

A

cell metaplasia

92
Q

ENDOMETREOSIS

What is protective for endometriosis

93
Q

ENDOMETREOSIS

Name 4 risk factors for endometriosis

A 
early menarche 
late menopause 
nulliparity 
short menstrual cycle 
family hx 
previous surgery to uterus
94
Q

ENDOMETREOSIS

What is infertility in endometriosis liked to

A 
adhesions 
inflammation 
tubal dysfunction 
ovarian dysfunction 
oocyte toxicity
95
Q

ENDOMETREOSIS

How does endometriosis present

A

chronic cyclical pelvic pain

dysmenorrhoea

deep dyspareunia
- indicates uterosacral ligament involvement

Infertility

pain on passing stools

dysuria and urgency

96
Q

ENDOMETREOSIS

What are the presentation findings in endometriosis

A

Bimanual pelvic exam

  • tenderness
  • adnexal mass
  • nodules and tenderness in uterosacral ligaments and posterior vaginal fornix
  • fixed retroverted uterus
97
Q

ENDOMETREOSIS

What investigations are required in endometriosis

A

Examination

Transvaginal USS
- trial medication prior to diagnostic

Laparoscopy and biopsy =- DIAGNOSTIC

98
Q

ENDOMETREOSIS

What is the medical management of endometriosis

A

1st line

  • NSAIDs / Tranexamic acid
  • Paracetamol

2nd line - ovulation suppression

  • COCP
  • Depot

3rd line - medical menopause
- GnRH analogues

4th line - surgery

  • Laparoscopic laser ablation
  • Hysterectomy
99
Q

ENDOMETREOSIS

How long are GnRH analogues taken for and what are the adverse effects

A

Goserlin
Zoladex

6m - bone demineralisation

hot flushes
night sweats
osteoporosis

100
Q

ENDOMETREOSIS

Why is suppressing ovulation beneficial

A

reduces endometrial associated pain as endometrium does not thicken however pain associated with adhesions persists

101
Q

FIBROIDS

What is a fibroid

A

Benign smooth muscle tumour of the uterus

Leiomyoma

102
Q

FIBROIDS

What is the histological appearance of a fibroid

A

Whorled smooth muscle cells

103
Q

FIBROIDS

name 3 protective factors for fibroids

A

Oestrogen and progesterone sensitive

pregnancy
POCP
Late puberty

104
Q

FIBROIDS

Name 4 risk factors for fibroids

A 
obesity 
peri-menopausal 
early menarche 
increasing age 
family hx 
COCP 
Afro-Caribbean
105
Q

FIBROIDS

Which is the most common classification of fibroid

A

Intramural - growth changes shape of and distorts the uterus

106
Q

FIBROIDS

Describe the presentation of fibroids

A

dysmenorrhoea

menorrhagia

subfertility - submucosal prevents implantation

deep dyspareunia

pressure sx

  • frequency / urgency
  • incontinence
107
Q

FIBROIDS

How do fibroids present on examination

A

Bimanual

  • irregular shape
  • enlarged firm non tender uterus
  • mass can be moved
108
Q

FIBROIDS

What investigations are required for fibroids

A

FBC - Anaemia

Imaging
1st line - USS + TVUS

2nd line - Hysteroscopy

3rd line - Laparoscopy
DIANGOSTIC

109
Q

FIBROIDS

Describe the management of fibroids

A

Asymptomatic
- Observation

Manage menorrhagia

  • Mirena coil
  • COCP / POP

shrink fibroids

  • GnRH analogues
  • Ulipristal acetate

Surgery

  • Endometrial ablation
  • Hysterectomy

Fertility

  • NSAIDs / Tranexamic acid
  • Uterine artery embolization
  • Myomectomy
110
Q

FIBROIDS

What is the MOA of upilistral acetate

A

Selective progesterone receptor modulator used to shrink fibroids

111
Q

FIBROIDS

Name 4 indications for myomectomy

A

excessive enlarged uterine size

pressure sx present

medical management not controlling sx

subfertility

112
Q

FIBROIDS

What is red degeneration

A

uterine fibroids increase in size during pregnancy and it outgrows its blood supply leading to necrosis and pain

113
Q

FIBROIDS

when does red degeneration typically occur

A

between 12th and 22nd week

114
Q

FIBROIDS

Describe the presentation of red degeneration

A

constant abdominal pain

low grade pyrexia

tachycardia

vomiting

115
Q

FIBROIDS

How is red degeneration managed

A

Analgesia - self limiting condition

116
Q

ADENOMYOSIS

What is adenomyosis

A

presence of endometrial tissue in the myometrium

117
Q

ADENOMYOSIS

Who is adenomyosis common in

A

Women - 40y/o who have had children

118
Q

ADENOMYOSIS

How does adenomyosis present

A

cyclical dysmenorrhoea
dyspareunia
infertility

119
Q

ADENOMYOSIS

What are the pregnancy related complications of adenomyosis

A

miscarriage
pre-term birth
small for gestational age
PPH

120
Q

ADENOMYOSIS

What does examination in adenomyosis show

A

Bimanual

  • Enlarged
  • Boggy
  • Tender uterus
121
Q

ADENOMYOSIS

What investigations are required in adenomyosis

A

1st line- TVUS

2nd line - DIAGNOSTIC
Hysterectomy and biopsy

122
Q

ADENOMYOSIS

What is the management of adenomyosis

A

Dependent on fertility wishes

conservative
- NSAIDs

Medical

  • IUS
  • COCP

Surgical
- Hysterectomy

123
Q

PELVIC INFLAMMATORY DISEASE

Name 4 causes for PID

A

Chlamydia - most common

Gonorrhoea

Gardnerella vaginalis - B.V association

E.Coli - Associated with UTI

124
Q

PELVIC INFLAMMATORY DISEASE

Name 4 risk factors for PID

A

Previous PID

No barrier protection during intercourse

Multiple sexual partners

younger age

existing STIs

IUD - Copper coil

125
Q

PELVIC INFLAMMATORY DISEASE

How does PID present

A

Bilateral lower abdo pain

abnormal vaginal discharge
- purulent

abnormal vaginal bleeding

  • IMB
  • PCB

Dysuria

Deep dyspareunia

126
Q

PELVIC INFLAMMATORY DISEASE

How does PID present on examination

A

Cervical excitation - motion tenderness

Adnexal tenderness - bilateral

Fever

127
Q

PELVIC INFLAMMATORY DISEASE

What investigations are required for PID

A

1st line - Pregnancy test
- rule out ectopic

2nd line - HVS

3rd line - Endocervical swabs –> NAAT and MC&S

  • Chlamydia
  • Gonorrhoea

4th line - Laparoscopy with fimbria biopsy
GOLD STANDARD

128
Q

PELVIC INFLAMMATORY DISEASE

How is PID managed

A

contact tracing - referral to GUM

Antibiotics

  • IM ceftriaxone
  • Doxycycline
  • Metronidazole
129
Q

MALIGNANCY

How do cells limit the number of divisions possible

A

Shortening of telomeres at end of each chromosome

malignant cells lengthen the telomeres

130
Q

MALIGNANCY

What is the action of TSG

A

Control cell growth - Cancers cause TSG to stop functioning

131
Q

MALIGNANCY

How do oncogenes work

A

AD - only 1 copy of the gene needs to be mutated to elevate cancer risk

stimulate the development of cancer

132
Q

MALIGNANCY

What is the mechanism of HPV causing cancer

A

HPV inhibits TSG

P53 and pRb are TSG

HPV produces oncogenes which inhibit TSH
HPV 16 –> E6 –> p53
HPV 18 –> E7 –> pRb

133
Q

MALIGNANCY

what strains does the HPV vaccine protect against

A

6 / 11 / 16 / 18

3 doses required

134
Q

MALIGNANCY

What does HPV 6 and 11 cause

A

genital warts

135
Q

MALIGNANCY

What does HPV 16 and 18 cause

A

cervical cancer

136
Q

MALIGNANCY

What other cancers does HPV cause

A 
Penile 
vulval 
cervical 
anal 
vaginal 
mouth 
throat
137
Q

MALIGNANCY

What age group is cervical cancer common in

A

70 - 80 years old

138
Q

MALIGNANCY

what is the most common histological subtype of ovarian cancer

A

Epithelial tumours

- Serous adenocarcinoma

139
Q

MALIGNANCY

Describe Germ cell tumours in ovarian cancer

A

Common in younger women < 35

  • associated with torsion and rupture
  • Raised AFP
  • Raised Beta-HcG
140
Q

MALIGNANCY

Describe a Krukenverg tumour in ovarian cancer

A

Mets from GI tract cancer

characteristic signet ring on histology

141
Q

MALIGNANCY

Name 4 risk factors for ovarian cancer

A

Increased ovulations = increased risk

Old age - > 60 
Family hx - BRAC1/2 and HNPCC 
Nulliparity 
Clomiphene 
Early menarche 
Late menopause 
HRT 
Obesity 
Smoking
142
Q

MALIGNANCY

Name 4 protective factors for ovarian cancer

A 
Parity 
Breastfeeding 
Lactation 
early menopause 
COCP
143
Q

MALIGNANCY

What investigations are required for ovarian cancer

A

1st line

  • Ca125
  • > 35IU/ml raised
  • USS and urgent referral

2nd line
- USS abdomen and pelvis

3rd line
- Laparotomy
DIAGNOSTIC

144
Q

MALIGNANCY

what is the most common gynaecological cancer in the UK

A

Endometrial cancer

145
Q

MALIGNANCY

Which age group is endometrial cancer most common in

146
Q

MALIGNANCY

what is the most common histological subtype of endometrial cancer

A

1st - Adenocarcinoma

2nd - Adenosquamous carcinoma

147
Q

MALIGNANCY

Name 4 risk factors for endometrial cancer

A

exposure to oestrogens

obesity 
early menarche 
late onset menopause 
Nulliparity 
PCOS 
Lynch syndrome

Unopposed oestrogen HRT
Tamoxifen
T2DM

148
Q

MALIGNANCY

How does having T2DM increase the risk of endometrial cancer

A

increased insulin stimulates endometrial cells

149
Q

MALIGNANCY

Name 3 protective factors for endometrial cancer

A

COCP
Pregnancy
Smoking

150
Q

MALIGNANCY

Describe the presentation of endometrial cancer

A

PMB

Premenopausal
- Irregular or intermenstrual bleeding

weight loss

fatigue

night sweats

151
Q

MALIGNANCY

What is the criteria for a 2ww referral for endometrial cancer

A

> 55 years old and PMB

152
Q

MALIGNANCY

what investigations are required for suspected endometrial cancer

A

1st line - TVUS

  • Assess endometrial thickness
  • > 4mm requires endometrial sampling

2nd line - Biopsy
DIAGNOSTIC
- Endometrial pipelle biopsy
- Hysteroscopy and biopsy

153
Q

MALIGNANCY

What is the eligibility criteria for cervical cancer screening

A

3 yearly for women aged 25 - 49

5 yearly for women aged 50 - 64

154
Q

MALIGNANCY

How long should individuals receiving treatment for CIN wait for their next smear

155
Q

MALIGNANCY

What does cell cytology during cervical cancer screening check for

A

Dyskaryosis - Precancerous cells

squamous epithelial cell cytologic changes characterised by hyperchromatic nuclei

156
Q

MALIGNANCY

Describe what occurs during colposcopy

A

Acetic acid applied to cervix

  • coagulates and clears mucus
  • triggers precipitation of nuclear proteins
  • abnormal cells have more nuclear proteins and appear ACETOWHITE

Schiller’s iodine test
Healthy cells stain Brown
Abnormal cells do not stain

Allows for see and treat - LEETZ

157
Q

MALIGNANCY

What age group is cervical cancer most common in

A

reproductive years - < 35

158
Q

MALIGNANCY

What histology is most common in cervical cancer

A

Squamous cell carcinoma

159
Q

MALIGNANCY

Name 2 causes of cervical cancer

A

CIN

Persistent infection with hrHPV

160
Q

MALIGNANCY

Name 4 risk factors for cervical cancer

A

Multiple sexual partners

not engaging with screening

smoking

immunosuppression

COCP - > 5 years

Increased number of full term pregnancy

Family hx

161
Q

MALIGNANCY

Describe the presentation of cervical cancer

A

Abnormal vaginal bleeding

  • IMB
  • PMB
  • PCB

Offensive vaginal discharge

dyspareunia

162
Q

MALIGNANCY

What investigations are required for cervical cancer

A

1st line -

Colposcopy +/- Punch biopsy

163
Q

MALIGNANCY

Name 4 risk factors for vaginal cancer

A

Age > 75
Pelvic radiotherapy
HPV
Immunosuppression

164
Q

MALIGNANCY

Name 3 causes of vulval cancer

A

High grade VIN

Lichen sclerosis

High risk HPV

165
Q

MENSTRUAL CYCLE DISORDERS

What is primary amenorrhoea

A

Failure to establish menstruation by:
15 - secondary sexual characteristics

13 - No secondary sexual characteristics

166
Q

MENSTRUAL CYCLE DISORDERS

What is secondary amenorrhoea

A

Previously normal menstruation stops for > 6m

167
Q

MENSTRUAL CYCLE DISORDERS

Describe the effects of hypo / hyperthyroidism on the menstrual cycle

A

Hypo

  • decreased T3/4 causes upregulation of TSH
  • Stimulates prolactin secretion
  • LH/FSH inhibited

Hyper

  • Increased sex hormone binding globulin secretion due to high T3/4
  • reduced amount of free bound oestrogen to trigger LH spike
168
Q

MENSTRUAL CYCLE DISORDERS

Name 5 causes of primary amenorrhoea

A

secondary sexual characteristics present

Genito-urinary malformations
- Imperforate hymen

Endocrine

  • Hypo/Hyperthyroidism
  • Hyperprolactinaemia
  • Cushing’s
  • CAH

secondary sexual characteristics not present

constitutional delay
Turners syndrome - 25X0
Kallaman syndrome
Androgen insensitivity

169
Q

MENSTRUAL CYCLE DISORDERS

What is Kallaman syndrome and what is it associated with

A

Primary GnRH defciency due to X linked recessive disorder

failure of GnRH cells to migrate

Associations - Anosmia

170
Q

MENSTRUAL CYCLE DISORDERS

What investigations are required for primary amenorrhoea

A

1st line - Pregnancy test

2nd line - Bloods

  • FSH / LH
  • Prolactin
  • TFTs
  • Testosterone levels

Others

  • USS (PCOS/ Structural abnormality)
  • Karyotyping
171
Q

MENSTRUAL CYCLE DISORDERS

What is Androgen insensitivity syndrome

A

X linked recessive condition causing mutation leading to end organ resistance to testosterone

Genotypically male children have female phenotype

46XY

172
Q

MENSTRUAL CYCLE DISORDERS

Describe the pathophysiology of Androgen insensitivity syndrome

A

mutation leads to resistance in target tissues

testis develop normally but testosterone dependent wolfiann ducts do not

AMH secreted by foetal testis causes regression of mullerian ducts

conversion of additional testosterone to oestrogen allows for secondary sexual charecteristics

173
Q

MENSTRUAL CYCLE DISORDERS

What structures do the wolfiann ducts form

A

epididymis
vas deferens
seminal vesicles

174
Q

MENSTRUAL CYCLE DISORDERS

What structures do the Mullerian ducts form

A 
ovaries 
fallopian tubes 
uterus 
upper part of vagina 
cervix
175
Q

MENSTRUAL CYCLE DISORDERS

Describe the presentation of androgen insensitivity syndrome

A

Infancy
- inguinal hernias containing testis

Puberty

  • Primary amenorrhoea
  • Breast development
  • Lack of pubic hair / facial hair / male type muscle development (testosterone)
176
Q

MENSTRUAL CYCLE DISORDERS

Describe the clinical features of androgen insensitivity syndrome

A

female external genitalia

short blind ending vagina

absent uterus and fallopian tubes

normal breast development

lack of pubic and axillary hair

177
Q

MENSTRUAL CYCLE DISORDERS

What investigations are required for suspected androgen insensitivity syndrome

A

Bloods

  • Raised LH
  • Normal or raised FSH
  • Normal or raised testosterone levels
  • Raised oestrogen levels for male

Chromosomal analysis

Pelvic USS

178
Q

MENSTRUAL CYCLE DISORDERS

How is androgen insensitivity syndrome managed

A

Bilateral oridectomy

Oestrogen therapy

counselling

179
Q

MENSTRUAL CYCLE DISORDERS

Where are prolactinomas commonly seen in

A

Pregnant women

180
Q

MENSTRUAL CYCLE DISORDERS

What are the features of prolactinoma

A

Amenorrhoea
- interferes with pulsatile GnRH secretion

Oligomenorrhoea

Galactorrhoea

Headache

Bitemporal hemianopia

Diabetes insipidus

181
Q

MENSTRUAL CYCLE DISORDERS

What investigations are required for suspected prolactinoma

A

Bloods - prolactin levels

MRI scan

182
Q

MENSTRUAL CYCLE DISORDERS

How is a prolactinoma managed in a woman that is NOT pregnant

A

Dopamine agonists

  • Cabergoline
  • Bromocriptine
183
Q

MENSTRUAL CYCLE DISORDERS

How is a prolactinoma managed in a pregnant woman

A

visual field testing

Bromocriptine may be started if concerns of tumour growth

Phase 3A (12 decks)

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