miscellaneous pathology

Question 1

how do we define infertility

Answer 1

inability to conceive after 12 months of regular intercourse without contraception

Question 2

what is primary infertility

Answer 2

couple has never conceived

Question 3

what is secondary infertility

Answer 3

couple have previously conceived, although the pregnancy may not have been successful

Question 4

name some hypothalamic conditions which cause anovulatory infertility

Answer 4

anorexia/bulimia, excessive exercise, stress, kallmans syndrome

Question 5

inheritance in kallmans syndrome

Answer 5

x-linked recessive

Question 6

pathophysiology of kallmans syndrome

Answer 6

failure of the GnRH releasing neurons to migrate into the hypothalamus during development

Question 7

name some pituitary conditions which cause anovulatory infertility

Answer 7

hyperprolactinaemia, tumours, sheehan syndrome

Question 8

what is sheehan syndrome

Answer 8

ischaemic necrosis of the pituitary gland resulting in hypopituitarism

Question 9

what causes sheehan syndrome

Answer 9

severe post partum haemorrhage or hypovolaemic shock after childbirth

Question 10

name some ovarian causes of anovulatory infertility

Answer 10

PCOS, premature ovarian failure

Question 11

name some common causes of secondary infertility

Answer 11

tubal disease, endometriosis, fibroids

Question 12

name some non-obstructive causes of male infertility

Answer 12

47XXY, chemoradiotherapy, undescended testes, idiopathic

Question 13

clinical features of non-obstructive male infertility

Answer 13

low testicular volume, reduced secondary sexual characteristics, vas deferens is present

Question 14

endocrine features of non-obstructive male infertility

Answer 14

high LH and FSH, low testosterone

Question 15

name some obstructive causes of male infertility

Answer 15

congenital absence, infection, vasectomy

Question 16

give a condition which can cause congenital absence of the vas deferens

Answer 16

cystic fibrosis

Question 17

primary investigations for female infertility

Answer 17

assess ovulation
bloods for rubella immunity
thyroid
chlamydia swab
smear if due

Question 18

how do we assess ovulation in a patient with regular cycles

Answer 18

midluteal serum progesterone

Question 19

what is azoospermia

Answer 19

no sperm in ejaculate

Question 20

what is asthenozoospermia

Answer 20

% progressive motile sperm below reference limit
basically reduced sperm mobility/motility

Question 21

what is oligozoospermia

Answer 21

total number or concentration of sperm below the reference limit

Question 22

what is teratozoospermia

Answer 22

% morphologically normal sperm below the reference limit

Question 23

what are 2 supplements recommended to women who are wanting to get pregnant

Answer 23

folic acid and vitamin D

Question 24

first line management for inducing ovulation

Answer 24

clomifene citrate or letrozole

Question 25

what medication may be added on while inducing ovulation if the patient is clomefene resistant

Answer 25

metformin

Question 26

what is the biggest risk for patients having treatment for ovulation induction

Answer 26

ovarian hyperstimulation

Question 27

when would a patient be diagnosed with premature ovarian insufficiency

Answer 27

menopause < 40 yrs

Question 28

when is defined as early menopause

Answer 28

40-44

Question 29

what are some indications for investigating menopause and what do we do

Answer 29

2x FSH levels 6 weeks apart - women >45 with atypical symptoms - women 40-45 with menopausal symptoms - premature ovarian insufficiency

Question 30

what is a complication of menopause and reduced oestrogen

Answer 30

urogenital atrophy

Question 31

menopause management in a patient with a uterus

Answer 31

combined HRT (oestrogen and progestrogen)

Question 32

menopause management in a patient without a uterus

Answer 32

oestrogen-only HRT

Question 33

what is the most common pelvic mass in young women

Answer 33

pregnancy

Question 34

what is the most common pelvic mass in non-pregnant women

Answer 34

fibroids

Question 35

what are the 3 main types of benign ovarian masses

Answer 35

functional, endometriotic, dermoid

Question 36

what are functional cysts related to

Answer 36

ovulation

Question 37

how would you describe the cells in a dermoid cyst

Answer 37

totipotent - can differentiate into anything

Question 38

what is cervical excitation a sign of

Answer 38

an acute abdomen

Question 39

baseline screening for a pelvic mass

Answer 39

ultrasound

Question 40

what is used for characterisation of a pelvic mass

Answer 40

MRI

Question 41

cancer marker for ovarian mass

Answer 41

CA125

Question 42

tumour markers you test for in premenopausal women with pelvic mass

Answer 42

CA15, AFP, HCG, LDH

Question 43

what may cause a raised AFP

Answer 43

embryonal cell carcinoma

Question 44

what may cause an elevated HCG

Answer 44

choriocarcinoma

Question 45

what may cause an elevated LDH

Answer 45

dysgerminoma

Question 46

what are the 3 main components of the risk of malignancy index and how many points for each

Answer 46

menopausal status - pre = 1, post = 3 ultrasonic features - one feature = 1, > one feature = 3 serum CA125 - absolute value

Question 47

how do you calculate RMI

Answer 47

a x b x c

Question 48

what is classed as a high RMI

Answer 48

200

Question 49

what is classed as a low RMI

Answer 49

< 30

Question 50

what are the ultrasonic features used in the RMI

Answer 50

multifocal, solid areas, bilaterality, ascites, metastasis