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Ned's PassMed notes 2019/20 > Gyne Doc unknown bits > Flashcards

Gyne Doc unknown bits Flashcards

1
Q

what stage of meiosis does the primary oocyte halt at to form the primary follicle

A

prophase 1

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2
Q

how long after the LH surge does ovulation occur

A

12-36hrs

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3
Q

what does the embryo secrete which acts to maintain the corpus luteum

A

hCG

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4
Q

what does the oestrogen peak in the follicular phase trigger

A

the switch from -ive to +ive feedback and the LH surge

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5
Q

describe the pathogenesis of anovulatory DUB

A

due to the irregularity of the cycles, the endometrium isnt shed properly so when bleeds happen, they tend to be heavy

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6
Q

describe the pathogenesis of ovulatory DUB

A

poor quality egg and follicle fails to produce enough progesterone so endometrium isnt retained

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7
Q

describe the biochemistry seen in ovarian failure

A

HIGH LH and FSH

Low oestrogen

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8
Q

name the 2 diagnostic investigations for PCOS

A
  1. raised free testosterone

2. >12 ovarian follicles or ovarian volume >10cm

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9
Q

what is the medical management for PCOS

A
  1. COCP - controls periods and treats hirsutism

2. metformin - improves insulin resistance and ovulatory function

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10
Q

what can be used in POCS to stimulate ovulation

A

clomifene citrate

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11
Q

name 4 associations with PCOS

A
  1. obesity
  2. hypertension
  3. hyperlipidemia
  4. insulin resistance
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12
Q

what investigations are done for PMB

A

PV and speculum exam
hysteroscopy
TVUS +/- biopsy

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13
Q

name 5 contraindications to the copper coil

A
  1. peptic ulcer disease
  2. PID
  3. abnormal uterine anatomy
  4. history or current endometrial or cervical cancer
  5. pregnancy- has an increased risk of ectopic pregnancy and 2nd trimester miscarriage
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14
Q

mechanism of action of the IUS

A

prevention of implantation

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15
Q

main side effect of the implant

A

irregular bleeding

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16
Q

what specific side effects come with the transdermal patch

A

breast pain, nausea and painful periods

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17
Q

when should the COCP be restarted after emergency contraception

A

immediately after levonelle

5 days after EllaOne

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18
Q

what is the mechanism of action of the POP

A

thickens cervical mucous and supresses ovulation

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19
Q

in which 2 cases is the POP preferred over the COCP

A
  1. breast feeding mother

2. >35 and smoking >15/day woman

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20
Q

when is POP contraindicated

A

active breast cancer

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21
Q

before giving the IUD as emergency contraception, what must you screen for

A

chlamydia

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22
Q

what is the underlying physiology of the menopause

A

woman becomes less responsive to LH and FSH

less oestrogen and progesterone released

a higher circulating LH and FSH

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23
Q

clinical investigation to diagnose menopause

A

a high FSH, >430, x2, 6 weeks apart

24
Q

why can oestrogen only HRT not be used in women without a hysterectomy

A

the unopposed oestrogen is a risk factor for endometrial cancer

25
Q

which HRT has an increased risk of breast cancer

A

combined HRT

26
Q

which 2 types of miscarriages present with a closed OS

A

threatened

complete

27
Q

which disorder presents with acute abdomen with radiation of pain to the shoulder

A

ectopic pregnancy

28
Q

what is the diagnostic test for an ectopic pregnancy

A

explorative laparoscopy

29
Q

in normal pregancies, how should hCG levels change

A

they should double every 48hrs

in ectopic pregnancy, they don’t

30
Q

what is associated with rapid mets to lungs or liver

A

choriocarcinoma

31
Q

what is the serum hCG level in molar pregnancy and what is seen on US

A

HIGH - >10,000

no fetal heartbeat, snowstorm appearance

32
Q

which infection usually causes PID

A

chlamydia

33
Q

what 2 investigations are done for PID

A
  1. endocervical swab

2. explorative laparotomy

34
Q

what is the treatment for PID

A

IM ceftriexone

Oral doxycycline and metronidazole

35
Q

what is a polyp

A

a benign growth of the endocervix

36
Q

what is the histology of most cervical cancer s

A

squamous cell carcinoma

37
Q

what is the precursor to a squamous cell carcinoma

A

cervical intraepithelial neoplasia

38
Q

what is the 2nd most likely histology of cervical cancer

A

invasive adenocarcinoma

39
Q

what is the precursor to an invasive adenocarcinoma

A

GCIN

40
Q

what makes GCIN different from CIN

A

GIN involves the columnar epithelium of the endocervix

41
Q

where does stage 2 cervical cancer invade to

A

the upper 2/3 of vagina

invades to parametrium but not pelvic side wall

42
Q

where does stage 3 cervical cancer invade to

A

the lower 1/3 of vagina

the pelvic side wall

43
Q

where does stage 4 cervical cancer invade to

A

extends to bladder/rectum or extends beyond pelvis

44
Q

how is 1a1 (microscopic) cervical cancer managed

A

cone biopsy- preserves fertility

45
Q

how is 1a2 - 2a cervical cancer managed

A

radical hysterectomy with bilateral pelvic node dissection

46
Q

how is stage 2b-4 cervical cancer managed

A

radiotherapy +/- chemotherapy

47
Q

what’s the 1st and 2nd line curative treatment of fibroids

A 
1st = myomectomy
2nd = hysterectomy
48
Q

what histological type are most endometrial cancers

A

adenocarcinoma

49
Q

what are type 1 endometrial cancers

A

arise from endometriod hyperplasia, account for 80%

50
Q

what is the inheritance of Lynch syndrome/NPCC

A

autosomal dominant

51
Q

which stage of endometrial cancer has local and regional spread

A

stage 3

52
Q

in stage 2 endometrial cancer, where is the cancer confined to

A

the uterus

53
Q

how are stage 1 and 2 endometrial cancer managed

A

surgical +/- radiotherapy

54
Q

what is the triad in meigs syndrome

A

ovarian fibroma
ascites
pleural effusion

55
Q

what does a yolk sac germ cell tumour secrete

A

AFP

56
Q

what test is done to confirm ovulation is occurring

A

day 21 progesterone

Ned's PassMed notes 2019/20 (17 decks)

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