Gyne Doc unknown bits

Question 1

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

Answer 1

prophase 1

Question 2

how long after the LH surge does ovulation occur

Answer 2

12-36hrs

Question 3

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

Answer 3

hCG

Question 4

what does the oestrogen peak in the follicular phase trigger

Answer 4

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

Question 5

describe the pathogenesis of anovulatory DUB

Answer 5

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

Question 6

describe the pathogenesis of ovulatory DUB

Answer 6

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

Question 7

describe the biochemistry seen in ovarian failure

Answer 7

HIGH LH and FSH

Low oestrogen

Question 8

name the 2 diagnostic investigations for PCOS

Answer 8

1. raised free testosterone

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

Question 9

what is the medical management for PCOS

Answer 9

1. COCP - controls periods and treats hirsutism

2. metformin - improves insulin resistance and ovulatory function

Question 10

what can be used in POCS to stimulate ovulation

Answer 10

clomifene citrate

Question 11

name 4 associations with PCOS

Answer 11

1. obesity
2. hypertension
3. hyperlipidemia
4. insulin resistance

Question 12

what investigations are done for PMB

Answer 12

PV and speculum exam
hysteroscopy
TVUS +/- biopsy

Question 13

name 5 contraindications to the copper coil

Answer 13

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

Question 14

mechanism of action of the IUS

Answer 14

prevention of implantation

Question 15

main side effect of the implant

Answer 15

irregular bleeding

Question 16

what specific side effects come with the transdermal patch

Answer 16

breast pain, nausea and painful periods

Question 17

when should the COCP be restarted after emergency contraception

Answer 17

immediately after levonelle

5 days after EllaOne

Question 18

what is the mechanism of action of the POP

Answer 18

thickens cervical mucous and supresses ovulation

Question 19

in which 2 cases is the POP preferred over the COCP

Answer 19

1. breast feeding mother

2. >35 and smoking >15/day woman

Question 20

when is POP contraindicated

Answer 20

active breast cancer

Question 21

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

Answer 21

chlamydia

Question 22

what is the underlying physiology of the menopause

Answer 22

woman becomes less responsive to LH and FSH

less oestrogen and progesterone released

a higher circulating LH and FSH

Question 23

clinical investigation to diagnose menopause

Answer 23

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

Question 24

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

Answer 24

the unopposed oestrogen is a risk factor for endometrial cancer

Question 25

which HRT has an increased risk of breast cancer

Answer 25

combined HRT

Question 26

which 2 types of miscarriages present with a closed OS

Answer 26

threatened | complete

Question 27

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

Answer 27

ectopic pregnancy

Question 28

what is the diagnostic test for an ectopic pregnancy

Answer 28

explorative laparoscopy

Question 29

in normal pregancies, how should hCG levels change

Answer 29

they should double every 48hrs in ectopic pregnancy, they don't

Question 30

what is associated with rapid mets to lungs or liver

Answer 30

choriocarcinoma

Question 31

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

Answer 31

HIGH - >10,000 no fetal heartbeat, snowstorm appearance

Question 32

which infection usually causes PID

Answer 32

chlamydia

Question 33

what 2 investigations are done for PID

Answer 33

1. endocervical swab | 2. explorative laparotomy

Question 34

what is the treatment for PID

Answer 34

IM ceftriexone | Oral doxycycline and metronidazole

Question 35

what is a polyp

Answer 35

a benign growth of the endocervix

Question 36

what is the histology of most cervical cancer s

Answer 36

squamous cell carcinoma

Question 37

what is the precursor to a squamous cell carcinoma

Answer 37

cervical intraepithelial neoplasia

Question 38

what is the 2nd most likely histology of cervical cancer

Answer 38

invasive adenocarcinoma

Question 39

what is the precursor to an invasive adenocarcinoma

Answer 39

GCIN

Question 40

what makes GCIN different from CIN

Answer 40

GIN involves the columnar epithelium of the endocervix

Question 41

where does stage 2 cervical cancer invade to

Answer 41

the upper 2/3 of vagina | invades to parametrium but not pelvic side wall

Question 42

where does stage 3 cervical cancer invade to

Answer 42

the lower 1/3 of vagina | the pelvic side wall

Question 43

where does stage 4 cervical cancer invade to

Answer 43

extends to bladder/rectum or extends beyond pelvis

Question 44

how is 1a1 (microscopic) cervical cancer managed

Answer 44

cone biopsy- preserves fertility

Question 45

how is 1a2 - 2a cervical cancer managed

Answer 45

radical hysterectomy with bilateral pelvic node dissection

Question 46

how is stage 2b-4 cervical cancer managed

Answer 46

radiotherapy +/- chemotherapy

Question 47

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

Answer 47

``` 1st = myomectomy 2nd = hysterectomy ```

Question 48

what histological type are most endometrial cancers

Answer 48

adenocarcinoma

Question 49

what are type 1 endometrial cancers

Answer 49

arise from endometriod hyperplasia, account for 80%

Question 50

what is the inheritance of Lynch syndrome/NPCC

Answer 50

autosomal dominant

Question 51

which stage of endometrial cancer has local and regional spread

Answer 51

stage 3

Question 52

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

Answer 52

the uterus

Question 53

how are stage 1 and 2 endometrial cancer managed

Answer 53

surgical +/- radiotherapy

Question 54

what is the triad in meigs syndrome

Answer 54

ovarian fibroma ascites pleural effusion

Question 55

what does a yolk sac germ cell tumour secrete

Answer 55

AFP

Question 56

what test is done to confirm ovulation is occurring

Answer 56

day 21 progesterone