O&G Flashcards
first line Rx PCOS
weight loss - improves androgen symptoms and returns regular menses
metformin (if diabetic/prediabetic)
COCP - reduces endometrial hyperplasia, reduce hirsuitism & acne, prevent pregnancy (unwanted)
what CA?
granulosa cell tumour of ovary
- cuboidal cells in sheets with coffee-bean nuclei arranged in microfollicular structure around pink, eosinophilic centre*
- yellow theca cells with lipid*
Gestational Choriocarcinoma
- benign/malignant
- trophoblast
- villi
- foetal/embryonic tissue
- malignant
- diffusely anaplastic, necrotic with vascular invasion
- absent
- present or absent
in postpartum haemorrhage, failure of haemostasis with uterotonic agents suggests what?
retained placenta/placenta accreta
Rx HSV-2 gential herpes
acyclovir, famciclovir, valacyclovir
diagnosis?
immature teratoma
three aetiologies of congenital toricollis
- foetal malposition & oligohydramnios
- traumatic delvery (e.g. breech presentation)
- [rarely] Cervical spine abnormality
2 major risk factors for cervical CA/CIN
lack of barrier contraception
++ lifetime sexual partners
both HPV-16/18 mediated
Rx bacterial vaginosis
what bug?
metronidazole and clindamycin
Gardnerella vaginalis
diagnosis?
mature teratoma
oral contraception, multiparity, breastfeeding all reduce risk of what cancer?
what is the common mechanism?
epithelial ovarian CA
reduction in the frequency of ovulation, reduction in ovarian surface trauma, reduction in ovarian surface repair, reduction in malignant transformation potential
Invasive mole
- benign/malignant
- trophoblasts
- villi
- foetal/embryonic tissue
- malignant
- diffusely hypertrophic with myometrial invasion
- diffusely enlarged, hydropic
- absent
Partial mole
- benign/malignant
- trophoblasts
- villi
- foetal/embryonic tissue
- benign
- focally hyperplastic
- focally enlarge, hydropic
- present, triploid
define mature and immature teratoma
mature = benign, contain cell types from >1 germ layer
immature = malignant, mature cell type from all 3 germ layers and immature (embryonic, not foetal) tissue from at least one germ layer (usually neuroectoderm)
if a woman wants to get pregnant, Rx PCOS
weight loss
metformin (if diabetic/pre-diabetic)
estrogen receptor modulator (clomiphine/letrozole) - reduces estrogen/ER negative feedback in hypothalamus resulting in increased gonadotroph stimulation of ovaries –> ovulation
3 associated abnormalities with congenital torticollis
- hip dysplasia
- club foot (tapies equinovarus)
- metatarsus adductus (foot adduction)
define congenital torticollis
pathologic contracture of SCM muscle in infant resulting in fixed flexion deformity from muscular injury and fibrosis
Complete mole
- benign/malignant
- trophoblast
- villi
- foetal/embryonic tissue
- benign
- diffusely hyperplastic
- diffusely enlarged, hydropic
- absent
gynae CA precocious puberty, endometrial hyperplasia large unilateral adnexal mass elevated serum Inhibin-alpha
granulosa cell tumour of the ovary
elevated maternal AFP suggests what (3)?
- neural tube defect
- ventral wall defect
- mutliple gestation
decreased maternal AFP suggests what (2)?
- aneuploidy (21, 18, 13)
- incorrect dating
decreased maternal uE3 suggests what?
placental abnormalities and IUGR
infundibulopelvic ligament/suspensory ligament of the ovary
what does it connect and what does it contain?
surgical importance
ovaries to the pelvic wall
ovarian vessels
ligate suspensory ligament during oophorectomy - ureters run close by so at risk of damage during ligation
cardinal ligament
connects what structures and contains what structures
surgical consideration
cervix to the pelvic wall
uterine vessels
ligation during hysterectomy, risk of damage to ureter during ligation
round ligament
connects what structures, contains what structures
surgical considerations
fundus of uterus, through the inguinal canal, to labia majora
contains nothing
travels above the artery of Sampson (insignificant, just know that it’s going to bleed)
broad ligament
connects what structures, contains what structures
fallopian tubes, ovaries and uterus to pelvic wall
fallopian tubes, ovaries and round ligament
comprised of mesosalpinx, mesovarium, mesometrium
ovarian ligament
connects what structures, contains what structures
medial pole of the ovary to the lateral wall of the uterus
contains nothing
what are the two ligamentous derivatives of the gubernaculum
round ligament of uterus
ovarian ligament
rank the potency of the different estrogens
where are they mainly produced?
estradiol > estrone > estriol
E1 - adipose tissue (via aromatization)
E2 - ovary
E3 - placenta
effect of oestrogen on circulating lipids
increase HDL
decrease LDL
(severe increase in CV risk for women post menopause)
physiological sources of progesterone
- corpus luteum (early pregnancy)
- placenta (late pregnancy)
- adrenal cortex
- testes
how does progesterone prevent pregnancy? (2)
- inhibition of gonadotrophins (LH and FSH)
- cervical mucus thickening preventing sperm entry to uterus
what is Mittelschmerz?
mechanism?
mid-cycle ovulatory pain
swelling and rupture of the follicle irritates the peritoneum. contraction of the fallopian tube can cause colicky pain.
can mimic appedicitis
which menstrual phase is always constant?
luteal phase.
once the follicle has ruptured/ovulation occured, it is always 14 days until menstruation
what uterine phase occurs during the luteal phase of the menstrual cycle?
secretory
what uterine phase(s) occur(s) during the follicular phase of the menstual cycle?
menses & proliferative phase
define low birth weight
birth < 2500g
what are the parts of the fallopian tube?
fimbrae, infundibulum, ampulla, isthimus, (uterotubal junction), intramural segment, ostium
when can you use a home pregnancy test?
at least 2 weeks following conception
when urine beta-HCG levels are high enough for detection.
betaHCG can be detected on blood by 1 week after conception
what are the placental hormones? (5)
which placental hormone decreases before the end of pregnancy?
progesterone, prolactin, betaHCG, estriol, human placental lactogen
betahCG - peak 8 - 10 weeks, minimal by 20 weeks
elevated hCG suggests what?
falling hCG suggests what?
multiple gestation, GTD, Down’s syndrome
Trisomy 13/18, ectopic pregnancy, failing pregnancy
how does pregnancy cause hyperthyroidism?
alpha subunit of hCG is identical to TSH. (also FSH and LH)
cross-activation of TSH receptor leads to increased T4
what must be supplemented with exclusively breast fed infants?
vitamin D
definition of premature ovarian failure?
premature atresia of ovarian follicles after puberty but before 40 years old
leads to early menopause, - oestrogen, + LH, ++FSH
what is the cellular mechanism by which HPV causes CIN?
HPV genes incorporated into host genome, production of proteins E6 and E7
inhibition of p53 and RB (respectively) cell cycle regulators
serum betaHCG is detectable on what day following fertilisation?
day 8
what are the four aetiologies for polyhydramnios?
- impaired swallowing: GI obstruction, anencephaly
- high foetal cardiac output: alloimmunisation (twin-to-twin transfusion syndrome), PVB19 infection, foetomaternal haermorrhage
- maternal diabetes (milder)
- multiple pregnancy (milder)
most common intrauterine configuration for dizygotic twins?
DCDA always
most common configuration for monozygotic twins
MCDA
failure of separation of monozygotic twins until day 8-12 results in what?
MCMA twins
high foetal fatality because of umbilical cord entanglement
failure of separation of monozygotic twins until day 13 likely results in what?
MCMA conjoined twins
another name for the Mullerian ducts?
describe the embryology in women, with 3 defects
paramesonephric ducts
- gives rise to fallopian tubes, uterus, cervix and upper vagina
- dependent on lateral and vertical fusion and involution of PMN ducts
- incomplete lateral fusion = bicornuate uterus
- total lack of fusion = didelphys uterus (double uterus & cervix)
- failure of involution = longitudinal intrauterine septum
HSG reveals uterine central filling defect
how do you tell the difference between septate and bicornuate?
MRI assessing the fundal outer uterine contour
what is Mayer-Rokitansky-Kuster-Hauser syndrome?
complete agenesis of Mullerian ducts
lower vagina generated from urogenital sinus but ends in blind pouch, total infertility
failure of vertical fusion of the Mullerian ducts leads to what?
transverse septum between the upper and lower vagina, where the Mullerian duct and urogenital sinus meet
Leads to primary amenorrhoea, haematometria and cyclic menstrual pain
what is the first line management for stres urinary incontinence
lifestyle modifications
- dietary fibre to reduce straining
- Kegel exercises to strengthen levator ani
fever and localised pelvic pain one week after delivery
what is the non-infective differential diagnosis here?
ovarian vien thrombosis
usually admitted to hospital with presumed infection, treated with Abx empirically but then no growth on cultures.. CT/MRI reveals thrombus in ovarian vein which may extend to IVC
what is the pathogenesis of peau d’orange?
malignant cell invasion of cutaneous lymphatic drainage, lymphoedema
what is this cell called and what does it indicate?
koilocyte
HPV infection found on cervical smear
immature squamous cell, dense irregularly staining cytoplasm. Perinuclear clearing. Pyknosis/’raisin appearance’
in fertility therapy, what is the role of menotropin?
Menotropin = human menopausal gonadotrophin (FSH)
mimic FSH during the follicular phase, establish a dominant ovarian follicle
Followed by single shot of hCG (mimic LH surge) which causes follicle rupture and ovum release
what are the signs/clinical features of ovulation?
- loss of dominant follicle on TA USS
- surge urine LH
- increased serum progesterone
- rise in basal body temperature
what are the steps in oestrogen and progesterone synthesis in the ovary?
theca interna - cholesterol to progesterone and androgens, stimulated by LH
granulosa cells - conversion of androgens to oestrogen by aromatase, stimulated by FSH
what are the effects of anovulatory cycles (usually in teenage girls)?
anovulation = no corpus luteum
no progesterone, constantly high oestrogen levels
chronic proliferative endometrium - disorganised and fragile
intermenstrual bleeding, disorganise and heavy menstrual bleeds
in teenagers -> HPA axis will mature and anovulation will remit naturally. Returns at the beginning of menopause due to ovarian exhaustion
what is the main action of progesterone on the endometrium during a regular cycle (pre-implantation)
to differentiate the proliferative (estrogen) endometrium into the secretory endometrium which is more hospitable for implantation
PCOS sequellae?
type II DM
endometrial hyperplasia and adenocarcinoma (unopposed action of oestrogen)
17alpha-hydroxylase, 17,20 lyase and 3beta-hydroxysteroid dehydrogenase are all increased in what disease?
What are the hormonal consequences?
PCOS
overexpression leads to increased androgen levels (testosterone, DHEA, androstenedione)
hirsuitism and acne; prevention of dominant follicle so no progesterone
what is the main factor contributing to gestational diabetes?
human placental lactogen (hPL)
what are the main physiologic roles of hPL?
- increase insulin resistance - increase circulating glucose for foetal fule, stimulate lipolysis to provide ketones as fuel in lieu for mother
- increase maternal pancreatic insulin secretion - as mother becomes insulin resistant she needs to increase circulating insulin to overcome this
effects are more prominent as the gestation progresses, reflecting the increasing nutritional demand of the foetus
at what week gestation does the alimentary canal finish canalization?
9th week
