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Misc. Notes Year 3 > Gynaecology document > Flashcards

Gynaecology document Flashcards

1
Q

Which stage of the cell cycle does the primary oocyte stop at to become the primary follicle

A

Prophase 1

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2
Q

The fall in which hormone initially triggers the menstrual cycle

A

Fall in oestrogen and progesterone

followed by steady increase in FSH, LH and oestrogen

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3
Q

What does the increase in FSH and LH trigger

A

Completion of first meiotic division to form the secondary follicle.
Production of oestrogen

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4
Q

What does oestrogen act to do

A

Stimulate thickening of the endometrium

Stimulate thinning of the cervical mucus

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5
Q

As the follicular stage reaches completion, what happens to the levels of FSH and LH

A

Control of FSH/LH by oestrogen switches to positive feedback and there is a surge in the levels of both of these hormones

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6
Q

What does the LH surge at the end of the follicular stage stimulate

A

Ovulation

Occurs 12-36 hours after LH surge

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7
Q

Which phase of the menstrual cycle is usually static

A 
Luteal phase (after ovulation) 
14 days
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8
Q

What happens to the levels of FSH, LH, Oestrogen and Progesterone in the luteal phase

A

FSH, LH and oestrogen fall

Progesterone increases

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9
Q

How does progesterone act on the uterus

A

Acts to maintain the endometrium by increasing glandular secretions and vascularity

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10
Q

Where does the increase in progesterone during the luteal phase come from

A

produced by the corpus luteum, which develops from the leftover follicle cells

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11
Q

Why might the level of progesterone begin to decrease in the luteal phase

A

If fertilisation doesn’t occur, the corpus luteum will begin to degenerate and amount of progesterone produced will decrease

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12
Q

What will reduction in the level of progesterone at the end of the luteal phase result in

A

Menstruation

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13
Q

If fertilisation occurs, which hormones keep the endometrium viable for implantation

A

Embryo produces BhCG which stimulates the corpus luteum to continue making progesterone, which maintains the endometrium

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14
Q

In a cycle of 21-35 days, how long should menstruation last

A

4-6 days

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15
Q

What age is anovulatory Dysfunctional Uterine Bleeding seen in

A

Seen at extremes of fertility

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16
Q

What happens in anovulatory Dysfunctional Uterine Bleeding

A

Due to the irregularity of the cycles, the endometrium is not regularly shed and thus when bleeds to happen, they tend to be heavy

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17
Q

What happens in ovulatory Dysfunctional Uterine Bleeding

A

Caused by a poor quality egg and follicle, which fails to produce adequate amounts of progesterone.
This results in failure to fully shed the endometrium

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18
Q

Which type of Dysfunctional Uterine Bleeding is more common

A

Anovulatory

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19
Q

Define primary and secondary amenorrhoea

A

Primary - failure to start periods by 16

Secondary - loss of menstruation for 6 months after periods were previously established

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20
Q

If a girl has normal secondary sexual characteristics but has not had a period by 16, what should you suspect

A

Imperforate hymen

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21
Q

If a girl has a short stature, webbed neck and a shield shaped chest, what should you suspect

A

Turner’s syndrome

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22
Q

Post-menopausal bleeding is what until proven otherwise

A

Endometrial cancer

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23
Q

What is the most common cause of post-menopausal bleeding

A

Atrophic vaginitis

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24
Q

What does the Pearl index number actually mean

A

Number of contraceptive failures per 100 women per year

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25
Q

Which connective tissue disease is a complete contr-indication to using the combined oral pill

A

Anti-phospholipid syndrome

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26
Q

Post partum, what is the earliest date of ovulation in a non-breastfeeding woman

A

28 days

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27
Q

Emergency contraception is not required before how many days post partum

A

21 days

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28
Q

Why is emergency contraception not required before day 21 post partum if ovulation takes place day 28

A

Because sperm can survive up to 7 days

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29
Q

Why does menopause actually occur

A

The ovaries become less responsive to LH/FSH, which results in reduced ovarian production of oestrogen and progesterone and increased levels of FSH / LH, with the increase in FSH being more pronounced.

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30
Q

What are the psychological symptoms of menopause

A

low mood, anxiety, irritability, reduced concentration

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31
Q

What clinical investigation can you carry out to diagnose Menopause

A

serum FSH > 430, x2 6 weeks apart

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32
Q

When can oestrogen only HRT be used

A

In patients who have had a total hysterectomy

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33
Q

Who should be given Sequential and Continuous HRT

A

Sequential - peri-menopausal women

Continuous - post-menopausal women

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34
Q

How is post menopausal status defined

A

LMP >1 year ago

>54 years old

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35
Q

What is the maximum length of time that sequential HRT can be used for and why

A

Maximum of 2 years due to risk of endometrial cancer

36
Q

Why might some menopausal women be given an SSRI

A

To treat vasomotor symptoms

37
Q

Define premature ovarian failure

A

Loss of ovarian function and onset of the menopause < the age of 45

38
Q

Which chromosomal abnormalities could lead to primary premature ovarian failure

A

Turner’s syndrome

Down syndrome

39
Q

Define a miscarriage

A

Spontaneous loss of pregnancy before 24 weeks

40
Q

Define recurrent miscarriage

A

3 or more miscarriages before 24 weeks gestation

41
Q

How is Pelvic Inflammatory Disease investigated

A

Endocervical swab

Explorative laparotomy

42
Q

What is the pharmacological treatment for Pelvic Inflammatory Disease

A

Azithromycin and analgesia

43
Q

What is an ectropion

A

when the columnar epithelium is present at the ecto cervix as a circular area around the external os

44
Q

How is ectropion managed

A

cautery with silver nitrate or ablation with cold coagulation

45
Q

What is the precursor lesion of invasive squamous carcinoma of the cervix

A

Cervical Intra-epithelial Neoplasia (CIN)

46
Q

Define CIN I,II,III

A

CIN 1: Dyskaryosis found in basal 1/3rd
CIN2: Dyskariosis extends to 2/3rd of epithelium
CIN3: full thickness dyskaryosis

47
Q

What is the precursor lesion of invasive adenocarcinoma of the cervix

A

Cervical Glandular Intra-epithelial Neoplasia (CGIN)

48
Q

Describe the cervical screening programme

A

Age range: 25 – 64
o Every 3 years: 25 – 49
o Every 5 years: 50 – 64

49
Q

How often is cervical screening carried out in HIV and Transplant patients

A

Yearly

50
Q

What are the two possible interventions possible for CIN 2 and 3

A

Cold coagulation.
LLETZ: large loop excision biopsy (do if family complete – risk of cervical incompetence and preterm labour/miscarriage). Consider doing LLETZ if more concerned re cancer

51
Q

Which HPV types are high risk for cervical cancer and which one is particularly associated with adenocarcinoma

A

Type 16

Type 18 - association with adenocarcinoma

52
Q

Which strains of HPV are covered by the HPV vaccine

A

6, 11, 16, 18

53
Q

What is the outer layer of the uterine wall called

A

Perimetrium

54
Q

What does a bulky feeling uterus suggest

A

Fibroids

55
Q

What is the curative treatment of fibroids

A

myomectomy - preserves uterus but may result in haemorrhage and need for hysterectomy

56
Q

When might red degeneration of fibroids occur

A

Usually occurs in third trimester of pregnancy or puerperium

57
Q

What is the pathophysiology behind red degeneration of fibroids

A

Thrombosis of the vessels that supply the fibroid

58
Q

What is the difference between endometriosis and adenomyosis

A

Endometriosis - endometrial tissue outside the uterus

Adenomyosis - endometrial tissue in myometrium

59
Q

What are the two types of endometrial cancer and what is the difference

A

Type 1: 80% of tumours, arise from hyperplasia  endometriod

Type 2: 20%, don’t arise from hyperplasia  serous and clear cell

60
Q

What is the pathophysiology behind an ovarian follicular cyst

A

A functional cyst that develops due to failure of a follicle to rupture during menstruation

61
Q

What is a Krukenburg tumour and which cells will it have

A

Metastatic disease of the ovary that is gastric in origin and has signet ring cells

62
Q

What are the three types of epithelial ovarian tumours

A

Serous
Endometriod
Clear cell

63
Q

What are the three types of germ cell ovarian tumours

A

Dysgerminoma
Yolk sac
Choriocarcinoma

64
Q

Which marker will a yolk sac tumour secrete

A

AFP

65
Q

Which marker will a choriocarcinoma secrete

A

HCG

66
Q

What are the 2 sex cord ovarian tumour types and what do they secrete

A

Granulosa cell- oestrogen

Sertoli-Leydig cell - testosterone

67
Q

What is the first line imaging for suspected ovarian cancer

A

TV/TA ultrasound

68
Q

Which marker is tested for suspected ovarian cancer

A

CA 125

69
Q

Why might you check for carcino-embryonic antigen (CEA) in suspected ovarian cancer

A

To exclude mets from GI primary

70
Q

Name 2 indications for IVF

A

Anovultory infertility.

Unexplained infertility > 2 years

71
Q

Name 2 indications for ICSI

A

Previous failed IVF.

Severe male factor infertility

72
Q

What is the first stage of IVF

A

Downregulation of FSH and LH by use of GNRH analogues (buserelin)

73
Q

How is ovarian stimulation achieved in IVF

A

Daily injections of FSH and LH for 8-9days

74
Q

Why is an HCG injection given in IVF

A

Mimics the LH surge to stimulate ovulation

75
Q

Which type of endometrial cancer involves an atrophic endometrium and is not related to estrogen exposure

A

Serous

76
Q

Name 2 associations with serous endometrial carcinoma

A

Post-menopausal status

increasing age

77
Q

Which type of endometrial sarcoma is also known as malignant mixed Mullerian tumour?

A

Carcinosarcoma

78
Q

Which chemotherapy drug is most associated with the side effects of; tinnitus and pins and needles

A

Cisplatin

79
Q

Which breast cancer treatments cause hot flushes and how can this be treated

A

Aromatase inhibitors
Tamoxifen

Give clonidine

80
Q

Which breast cancer is always ER-positive

A

Lobular carcinoma in situ

81
Q

Breast cancers with which combination of receptors have the best prognosis?

A

ER +’ve
PgR +’ve
HER2 -‘ve

82
Q

Lipids in breast milk are secreted by apocrine or merocrine

A

Apocrine

83
Q

What is secreted in breast milk via mesocrine secretion

A

Protein

84
Q

Why are aromatase inhibitors more effective in postmenopausal women

A

Because most oestrogen in post-menopausal women is produced from aromatase activity (conversion of androgens to oestrogen by the aromatase enzyme)

85
Q

Which types of epithelium surround the lactiferous ducts?

A

Cuboidal and squamous

86
Q

Which types of epithelium are found within breast lobules?

A

Cuboidal and columnar

Misc. Notes Year 3 (25 decks)

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