Gyne Doc unknown bits Flashcards
what stage of meiosis does the primary oocyte halt at to form the primary follicle
prophase 1
how long after the LH surge does ovulation occur
12-36hrs
what does the embryo secrete which acts to maintain the corpus luteum
hCG
what does the oestrogen peak in the follicular phase trigger
the switch from -ive to +ive feedback and the LH surge
describe the pathogenesis of anovulatory DUB
due to the irregularity of the cycles, the endometrium isnt shed properly so when bleeds happen, they tend to be heavy
describe the pathogenesis of ovulatory DUB
poor quality egg and follicle fails to produce enough progesterone so endometrium isnt retained
describe the biochemistry seen in ovarian failure
HIGH LH and FSH
Low oestrogen
name the 2 diagnostic investigations for PCOS
- raised free testosterone
2. >12 ovarian follicles or ovarian volume >10cm
what is the medical management for PCOS
- COCP - controls periods and treats hirsutism
2. metformin - improves insulin resistance and ovulatory function
what can be used in POCS to stimulate ovulation
clomifene citrate
name 4 associations with PCOS
- obesity
- hypertension
- hyperlipidemia
- insulin resistance
what investigations are done for PMB
PV and speculum exam
hysteroscopy
TVUS +/- biopsy
name 5 contraindications to the copper coil
- peptic ulcer disease
- PID
- abnormal uterine anatomy
- history or current endometrial or cervical cancer
- pregnancy- has an increased risk of ectopic pregnancy and 2nd trimester miscarriage
mechanism of action of the IUS
prevention of implantation
main side effect of the implant
irregular bleeding
what specific side effects come with the transdermal patch
breast pain, nausea and painful periods
when should the COCP be restarted after emergency contraception
immediately after levonelle
5 days after EllaOne
what is the mechanism of action of the POP
thickens cervical mucous and supresses ovulation
in which 2 cases is the POP preferred over the COCP
- breast feeding mother
2. >35 and smoking >15/day woman
when is POP contraindicated
active breast cancer
before giving the IUD as emergency contraception, what must you screen for
chlamydia
what is the underlying physiology of the menopause
woman becomes less responsive to LH and FSH
less oestrogen and progesterone released
a higher circulating LH and FSH
clinical investigation to diagnose menopause
a high FSH, >430, x2, 6 weeks apart
why can oestrogen only HRT not be used in women without a hysterectomy
the unopposed oestrogen is a risk factor for endometrial cancer
which HRT has an increased risk of breast cancer
combined HRT
which 2 types of miscarriages present with a closed OS
threatened
complete
which disorder presents with acute abdomen with radiation of pain to the shoulder
ectopic pregnancy
what is the diagnostic test for an ectopic pregnancy
explorative laparoscopy
in normal pregancies, how should hCG levels change
they should double every 48hrs
in ectopic pregnancy, they don’t
what is associated with rapid mets to lungs or liver
choriocarcinoma
what is the serum hCG level in molar pregnancy and what is seen on US
HIGH - >10,000
no fetal heartbeat, snowstorm appearance
which infection usually causes PID
chlamydia
what 2 investigations are done for PID
- endocervical swab
2. explorative laparotomy
what is the treatment for PID
IM ceftriexone
Oral doxycycline and metronidazole
what is a polyp
a benign growth of the endocervix
what is the histology of most cervical cancer s
squamous cell carcinoma
what is the precursor to a squamous cell carcinoma
cervical intraepithelial neoplasia
what is the 2nd most likely histology of cervical cancer
invasive adenocarcinoma
what is the precursor to an invasive adenocarcinoma
GCIN
what makes GCIN different from CIN
GIN involves the columnar epithelium of the endocervix
where does stage 2 cervical cancer invade to
the upper 2/3 of vagina
invades to parametrium but not pelvic side wall
where does stage 3 cervical cancer invade to
the lower 1/3 of vagina
the pelvic side wall
where does stage 4 cervical cancer invade to
extends to bladder/rectum or extends beyond pelvis
how is 1a1 (microscopic) cervical cancer managed
cone biopsy- preserves fertility
how is 1a2 - 2a cervical cancer managed
radical hysterectomy with bilateral pelvic node dissection
how is stage 2b-4 cervical cancer managed
radiotherapy +/- chemotherapy
what’s the 1st and 2nd line curative treatment of fibroids
1st = myomectomy 2nd = hysterectomy
what histological type are most endometrial cancers
adenocarcinoma
what are type 1 endometrial cancers
arise from endometriod hyperplasia, account for 80%
what is the inheritance of Lynch syndrome/NPCC
autosomal dominant
which stage of endometrial cancer has local and regional spread
stage 3
in stage 2 endometrial cancer, where is the cancer confined to
the uterus
how are stage 1 and 2 endometrial cancer managed
surgical +/- radiotherapy
what is the triad in meigs syndrome
ovarian fibroma
ascites
pleural effusion
what does a yolk sac germ cell tumour secrete
AFP
what test is done to confirm ovulation is occurring
day 21 progesterone
