Gynaecology document Flashcards
Which stage of the cell cycle does the primary oocyte stop at to become the primary follicle
Prophase 1
The fall in which hormone initially triggers the menstrual cycle
Fall in oestrogen and progesterone
followed by steady increase in FSH, LH and oestrogen
What does the increase in FSH and LH trigger
Completion of first meiotic division to form the secondary follicle.
Production of oestrogen
What does oestrogen act to do
Stimulate thickening of the endometrium
Stimulate thinning of the cervical mucus
As the follicular stage reaches completion, what happens to the levels of FSH and LH
Control of FSH/LH by oestrogen switches to positive feedback and there is a surge in the levels of both of these hormones
What does the LH surge at the end of the follicular stage stimulate
Ovulation
Occurs 12-36 hours after LH surge
Which phase of the menstrual cycle is usually static
Luteal phase (after ovulation) 14 days
What happens to the levels of FSH, LH, Oestrogen and Progesterone in the luteal phase
FSH, LH and oestrogen fall
Progesterone increases
How does progesterone act on the uterus
Acts to maintain the endometrium by increasing glandular secretions and vascularity
Where does the increase in progesterone during the luteal phase come from
produced by the corpus luteum, which develops from the leftover follicle cells
Why might the level of progesterone begin to decrease in the luteal phase
If fertilisation doesn’t occur, the corpus luteum will begin to degenerate and amount of progesterone produced will decrease
What will reduction in the level of progesterone at the end of the luteal phase result in
Menstruation
If fertilisation occurs, which hormones keep the endometrium viable for implantation
Embryo produces BhCG which stimulates the corpus luteum to continue making progesterone, which maintains the endometrium
In a cycle of 21-35 days, how long should menstruation last
4-6 days
What age is anovulatory Dysfunctional Uterine Bleeding seen in
Seen at extremes of fertility
What happens in anovulatory Dysfunctional Uterine Bleeding
Due to the irregularity of the cycles, the endometrium is not regularly shed and thus when bleeds to happen, they tend to be heavy
What happens in ovulatory Dysfunctional Uterine Bleeding
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
Which type of Dysfunctional Uterine Bleeding is more common
Anovulatory
Define primary and secondary amenorrhoea
Primary - failure to start periods by 16
Secondary - loss of menstruation for 6 months after periods were previously established
If a girl has normal secondary sexual characteristics but has not had a period by 16, what should you suspect
Imperforate hymen
If a girl has a short stature, webbed neck and a shield shaped chest, what should you suspect
Turner’s syndrome
Post-menopausal bleeding is what until proven otherwise
Endometrial cancer
What is the most common cause of post-menopausal bleeding
Atrophic vaginitis
What does the Pearl index number actually mean
Number of contraceptive failures per 100 women per year
Which connective tissue disease is a complete contr-indication to using the combined oral pill
Anti-phospholipid syndrome
Post partum, what is the earliest date of ovulation in a non-breastfeeding woman
28 days
Emergency contraception is not required before how many days post partum
21 days
Why is emergency contraception not required before day 21 post partum if ovulation takes place day 28
Because sperm can survive up to 7 days
Why does menopause actually occur
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.
What are the psychological symptoms of menopause
low mood, anxiety, irritability, reduced concentration
What clinical investigation can you carry out to diagnose Menopause
serum FSH > 430, x2 6 weeks apart
When can oestrogen only HRT be used
In patients who have had a total hysterectomy
Who should be given Sequential and Continuous HRT
Sequential - peri-menopausal women
Continuous - post-menopausal women
How is post menopausal status defined
LMP >1 year ago
>54 years old
What is the maximum length of time that sequential HRT can be used for and why
Maximum of 2 years due to risk of endometrial cancer
Why might some menopausal women be given an SSRI
To treat vasomotor symptoms
Define premature ovarian failure
Loss of ovarian function and onset of the menopause < the age of 45
Which chromosomal abnormalities could lead to primary premature ovarian failure
Turner’s syndrome
Down syndrome
Define a miscarriage
Spontaneous loss of pregnancy before 24 weeks
Define recurrent miscarriage
3 or more miscarriages before 24 weeks gestation
How is Pelvic Inflammatory Disease investigated
Endocervical swab
Explorative laparotomy
What is the pharmacological treatment for Pelvic Inflammatory Disease
Azithromycin and analgesia
What is an ectropion
when the columnar epithelium is present at the ecto cervix as a circular area around the external os
How is ectropion managed
cautery with silver nitrate or ablation with cold coagulation
What is the precursor lesion of invasive squamous carcinoma of the cervix
Cervical Intra-epithelial Neoplasia (CIN)
Define CIN I,II,III
CIN 1: Dyskaryosis found in basal 1/3rd
CIN2: Dyskariosis extends to 2/3rd of epithelium
CIN3: full thickness dyskaryosis
What is the precursor lesion of invasive adenocarcinoma of the cervix
Cervical Glandular Intra-epithelial Neoplasia (CGIN)
Describe the cervical screening programme
Age range: 25 – 64
o Every 3 years: 25 – 49
o Every 5 years: 50 – 64
How often is cervical screening carried out in HIV and Transplant patients
Yearly
What are the two possible interventions possible for CIN 2 and 3
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
Which HPV types are high risk for cervical cancer and which one is particularly associated with adenocarcinoma
Type 16
Type 18 - association with adenocarcinoma
Which strains of HPV are covered by the HPV vaccine
6, 11, 16, 18
What is the outer layer of the uterine wall called
Perimetrium
What does a bulky feeling uterus suggest
Fibroids
What is the curative treatment of fibroids
myomectomy - preserves uterus but may result in haemorrhage and need for hysterectomy
When might red degeneration of fibroids occur
Usually occurs in third trimester of pregnancy or puerperium
What is the pathophysiology behind red degeneration of fibroids
Thrombosis of the vessels that supply the fibroid
What is the difference between endometriosis and adenomyosis
Endometriosis - endometrial tissue outside the uterus
Adenomyosis - endometrial tissue in myometrium
What are the two types of endometrial cancer and what is the difference
Type 1: 80% of tumours, arise from hyperplasia endometriod
Type 2: 20%, don’t arise from hyperplasia serous and clear cell
What is the pathophysiology behind an ovarian follicular cyst
A functional cyst that develops due to failure of a follicle to rupture during menstruation
What is a Krukenburg tumour and which cells will it have
Metastatic disease of the ovary that is gastric in origin and has signet ring cells
What are the three types of epithelial ovarian tumours
Serous
Endometriod
Clear cell
What are the three types of germ cell ovarian tumours
Dysgerminoma
Yolk sac
Choriocarcinoma
Which marker will a yolk sac tumour secrete
AFP
Which marker will a choriocarcinoma secrete
HCG
What are the 2 sex cord ovarian tumour types and what do they secrete
Granulosa cell- oestrogen
Sertoli-Leydig cell - testosterone
What is the first line imaging for suspected ovarian cancer
TV/TA ultrasound
Which marker is tested for suspected ovarian cancer
CA 125
Why might you check for carcino-embryonic antigen (CEA) in suspected ovarian cancer
To exclude mets from GI primary
Name 2 indications for IVF
Anovultory infertility.
Unexplained infertility > 2 years
Name 2 indications for ICSI
Previous failed IVF.
Severe male factor infertility
What is the first stage of IVF
Downregulation of FSH and LH by use of GNRH analogues (buserelin)
How is ovarian stimulation achieved in IVF
Daily injections of FSH and LH for 8-9days
Why is an HCG injection given in IVF
Mimics the LH surge to stimulate ovulation
Which type of endometrial cancer involves an atrophic endometrium and is not related to estrogen exposure
Serous
Name 2 associations with serous endometrial carcinoma
Post-menopausal status
increasing age
Which type of endometrial sarcoma is also known as malignant mixed Mullerian tumour?
Carcinosarcoma
Which chemotherapy drug is most associated with the side effects of; tinnitus and pins and needles
Cisplatin
Which breast cancer treatments cause hot flushes and how can this be treated
Aromatase inhibitors
Tamoxifen
Give clonidine
Which breast cancer is always ER-positive
Lobular carcinoma in situ
Breast cancers with which combination of receptors have the best prognosis?
ER +’ve
PgR +’ve
HER2 -‘ve
Lipids in breast milk are secreted by apocrine or merocrine
Apocrine
What is secreted in breast milk via mesocrine secretion
Protein
Why are aromatase inhibitors more effective in postmenopausal women
Because most oestrogen in post-menopausal women is produced from aromatase activity (conversion of androgens to oestrogen by the aromatase enzyme)
Which types of epithelium surround the lactiferous ducts?
Cuboidal and squamous
Which types of epithelium are found within breast lobules?
Cuboidal and columnar
