OB-GYN Flashcards
Noonan syndrome
an autosomal dominant genetic disorder of congenital malformations.
The characteristic phenotypic features of Noonan syndrome are:
characteristic facial dysmorphic features: hypertelorism, downward slanting eyelid slits, ptosis, low-set ears with a thickened rim, wide short neck, sometimes with fluff features
organ abnormalities: defects of the cardiovascular system (especially pulmonary valve stenosis), kidney defects, cryptorchidism in boys,
abnormalities of the skeletal system: short stature, deformities of the sternum (shoemaker’s or chicken’s chest), valgus of the elbows, scoliosis, vertebral defects (semi-circles), rib defects,
usually a light blue color of the irises
disorders of the lymphatic system
tendency to ecchymosis, blood clotting disorders
hearing loss, deafness.
Prader-Willi syndrome (PWS)
is a birth defect syndrome caused by a deletion in the long arm of the father’s chromosome 15.
The disease occurs with a frequency of 1: 10 thousand. up to 1: 50,000 live births. In older sources, the acronym -HHHO was used, derived from the words: hypotonia-hypomentia-hypogonadism-obesity, that is: muscle hypotonia, mental retardation, underdevelopment of the genital organs, obesity
. The characteristic morphological features include: bulging forehead, amygdala eyes, narrow face, small lower jaw, small hands and feet.
Angelman syndrome
is a neurogenetic disorder that is caused by the inactivation of the UBE3A gene (E3 ubiquitin ligase), the product of which combines ubiquitin with a protein product to be degraded. As a result of the mutation, pathologically large amounts of protein accumulate, which disrupts the development and function of the CNS.
The syndrome is manifested by intellectual disability, seizures that are difficult to control, impaired speech development, uncontrolled bouts of laughter and movement stereotypes (the so-called happy puppet syndrome).
Klinefelter’s syndrome
is a genetically determined genetic disease that belongs to numerical aberrations with at least one additional copy of the X chromosome (47 XXY).
Klinefelter’s syndrome is the most common cause of male hypogonadism, with a frequency of 1: 500-1: 1,000 live-born male newborns.
The most typical features of these patients are tall stature, feminine silhouette, long limbs and small testicles.
Alport syndrome
genetically conditioned disease (type IV collagen defect)
revealed in childhood
Clinical picture of the disease:
progressive nephropathy
micro/macrohematuria
later, increasing proteinuria appears
may be accompanied by hypertension
the disease leads to end-stage renal disease
bilateral sensorineural hearing loss
eye changes:
- lenticonus
- pigmented retinal changes
- corneal ulcers
leiomiomatosis
aneurysms
Magnesium Sulfate MOA
decreases uterine tone and contractions by acting as a calcium antagonist and a membrane stabilizer.
Terbutaline MOA
acts by increasing conversion of ATP to cAMP, which decreases free calcium ions through sequestration in the sarcoplasmic reticulum.
Calcium channel blockers
decrease intracellular calcium, which reduces uterine contractility
Indomethacin MOA
blocks the enzyme cyclooxygenase and decreases the level of prostaglandins, which decreases intracellular levels of calcium and therefore decreases myometrial contractions.
Flushing, diplopia, and headache are common side effects of
magnesium sulfate
Women taking terbutaline often note
headache, tachycardia, and anxiety.
Calcium channel blockers such as nifedipine can cause
headache, flushing, and dizziness.
indomethacin has been associated with
the premature closure of the ductus arteriosus in the neonate.
The most effective test to monitor patients for magnesium toxicity is through
serial DTR examination. DTRs are diminished and then lost with magnesium serum levels between 6 and 10 mg/dL.
Toxic levels of magnesium (>10 mg/dL) result in respiratory depression, hypoxia, and cardiac arrest.
Serial DTR examination is therefore a cost-effective screening test for magnesium toxicity.
Serum levels are not necessary unless there is concern for absent DTRs or patients show symptoms of respiratory depression.
Rubin maneuver.
This maneuver involves pressure on either fetal shoulder to diminish the biacromial diameter in an effort to free the anterior shoulder and allow delivery of the fetus.
McRoberts maneuver is described first and involves
flexing the maternal hips, which results in ventral rotation of the maternal pelvis and an increase in the size of the pelvic outlet.
It is the least invasive of maneuvers.
Next, suprapubic pressure is applied by directing force just above the pubic symphysis in an oblique direction.
The goal of this maneuver is to disimpact the anterior shoulder.
It is very important that pressure be applied obliquely to free the shoulder, because downward pressure will not change the biacromial diameter.
Wood cork maneuver involves
placing a hand behind either the anterior or posterior fetal shoulder and rotating the fetus 180 degrees to lead to descent and delivery of the shoulders.
Papillary cancer -
accounts for about 80% of thyroid cancers (the most common malignant thyroid cancer). Metastasis mainly through lymphathic system.
Its only symptom can be an enlarged lymph node nearby the trachea or lateral neck (this is the metastasis of occult papillary cancer).
Follicular cancer -
represents about 20% of thyroid cancers, grows slowly as a single tumor.
Unlike papillary carcinoma, it rarely spreads via the lymphatic pathway (much more frequently through the bloodstream to the lungs and bones).
Anaplastic cancer
- i.e. undifferentiated - accounts for about 5% of thyroid cancers and is usually present in elderly people (over 60 years of age).
It occurs on the basis of differentiated, papillary or follicular cancer, usually infiltrates surrounding tissues.
Medullary cancer
- it accounts for about 5% of thyroid cancers and may be genetically conditioned (tumors usually occur bilaterally, may co-occur with parathyroid adenoma and phaeochromocytoma of the adrenal medulla).
It is metastasized by both the lymphathic and blood pathways. It grows slowly, produces and secretes CEA and calcitonin.
The second most common thyroid cancer is:
Follicular cancer
Some facts about thyroid cancer:
6 pts
A characteristic symptom of medullary cancer is diarrhea .
Frequent in medullary cancer is family occurrence ( RET mutation ).
Rapid progression is characteristic of anaplastic cancer.
In anaplastic cancer, the characteristic symptom is dyspnea .
Differentiated cancers can be treated with radioactive iodine .
Thyroid cancer is 4 times more common in women .
general symptoms:
in the case of an advanced stage of the cancer, symptoms associated with infiltration of other organs or the presence of distant metastases may occur
fever
lack of appetite
weight loss
iron deficiency anemia
presence of blood in / on the stool
right colon cancer (including caecum)
Symptoms depend on the location of the cancer
dull ache in the area of the abdomen on the right side, near the navel or abdomen
stool dark, brown or mixed with blood, anemia
tumor perceptible in the middle/ lower abdomen on the right side
cancer of the left half of the colon (including the sigmoid colon):
Symptoms depend on the location of the cancer
flatulence
often painful colic
fresh admixture of blood in the stool
change of the defecation rhythm
obstruction (bloating, pain, nausea, vomiting, constipation)
rectal cancer
Symptoms depend on the location of the cancer
admixture of bright red blood
feeling of incomplete defecation, diarrhea impossible to suspend
an intestinal colic causing the need to defecate
abdominal pain, crotch
Blood group A increases the risk of
stomach cancer
Antiphospholipid Syndrome (APS) is an autoimmune disorder associated with the presence of antiphospholipid antibodies, which include:
- anti-cardiolipin antibodies*
- antibodies against β2-glycoprotein I*
- lupus anticoagulant*
Recurrent miscarriages always require careful diagnostic evaluation.
Causes of recurrent miscarriages include:
Anatomical factors (uterine fibroids, intrauterine adhesions, birth defects)
Corpus luteum dysfunction
Antiphospholipid syndrome
Thyroid dysfunction
Diabetes mellitus
Most miscarriages in women with APS occur in the _______ of pregnancy.
Treatment:
The recommended therapy for pregnant women with APS consists of ?
Most miscarriages in women with APS occur in the first trimester of pregnancy.
Treatment:
The recommended therapy for pregnant women with APS consists of acetylsalicylic acid and heparin, which increases the chance of giving birth to a healthy child.
Which of the following changes in blood morphology occurs in the second trimester of normal pregnancy?
physiological hemodilution in pregnancy.
Thus we can observe during morphological analysis:
- a decrease in hematocrit value*
- a decrease in hemoglobin*
- a decrease in platelets*
- leukocytes may be normal or slightly elevated*
During pregnancy, there is also an increase in the production of the coagulation factors:
Name
- and*
- we observe a decrease in the concentation of* endogenous anticoagulants such as
___ ___ and ___
This is important in prevention of excessive bleeding throughout pregnancy, but it increases also the risk of_____
I, II, V, VII, VIII, X, XII
and
we may observe a decrease in the concentration of endogenous anticoagulants such as protein C and S.
This is important in prevention of excessive bleeding throughout pregnancy, but it increases also the risk of thromboembolism.
Symptoms depend on the location of the cancer:
right half of the colon -
left half of the colon -
rectum -
right half of the colon - increasing anemia and abdominal pain.
left half of the colon - change in bowel habits, diarrhea with lots of mucus or constipation, blood in the stool.
rectum - a tumor palpable during per rectum examination.
The most important examination in the diagnosis of colorectal cancer is ______, which allows to visualize the tumor growing in the intestine and enables the collection of biopsies for histopathological examination.
Based on the hist-pat examination, the TNM classification is assessed.
the “T” characteristic means:
colonoscopy
Based on the hist-pat examination, the TNM classification is assessed.
Tis - infiltration of the mucosa,
T1 - infiltration of the submucosa,
T2 - muscle membrane infiltration,
T3 - infiltration of periocecal / perianal tissues,
T4 - infiltration of adjacent organs / structures or visceral peritoneum.
Colorectal cancer - most of the procedures are performed using the classic method, but laparoscopic operations are becoming more common
depending on the location of the tumor, there are:
- segmental resections:* transverse colon tumors, sigmoid tumors
- right hemicolectomy:* caecum tumors, ascending colon tumors
- left hemicolectomy:* descending colon tumors, sigmoid tumors
- dilated hemicolectomy*
- Hartman’s operation:* tumors of the left half of the large intestine (including sigmoid colon).
fetal lie-
the ratio of the long axis of the fetus to the long axis of the uterus and birth canal
Possible position types:
longitudinal
transverse
oblique
position-
the ratio of individual parts of the fetus to the uterus
for the longitudinal position, the ratio of the fetal back to the uterus is determined
in the case of transverse and oblique position - the ratio of the head of the fetus to the uterus
setting I- fetal back / head on the left side
setting II - fetal spine / head on the right side
attitude-
the ratio of parts of the fetus to each other
Depending on the ratio of the head to the torso while passing through the birth canal, the following arrangement can be distinguished:
well-flexed
deflexed
engagement -
ratio of the leading part to the plane of the pelvic brim (measured in centimeters)
Tay-Sachs disease (GM2 gangliosidosis)
- a genetically determined disease from the group of storage diseases consisting in the accumulation of fatty substance - GM2 ganglioside in nerve cells of the brain.
- a rare genetic disorder passed from parents to child. It’s caused by the absence of an enzyme that helps break down fatty substances.
These fatty substances, called gangliosides, build up to toxic levels in the brain and spinal cord and affect the function of the nerve cells
Phakomatoses
group of developmental disorders of tissues from three germ layers, which are manifested by changes in
the skin, nervous and vascular systems and co-occurring defects of internal organs.
Asherman’s syndrome is
adhesions in the uterine cavity that completely or partially close its lumen.
This is manifested by either little or no bleeding.
The most common causes of Asherman’s syndrome are: curettage of the uterine cavity, endometrial biopsy, hysteroscopy, IUD insertion and brachytherapy.
The Mayer-Rokitansky-Küster-Hauser syndrome
congenital syndrome characterized by aplasia of structures originating in the Muller’s ducts, i.e. the uterus and vagina.
Primary amenorrhea is the most common cause of medical reports.
Couvelaire syndrome (uteroplacental stroke)
is a rare, life-threatening complication of pregnancy in which the detachment of the placenta is accompanied by an infiltration of the uterine muscle with blood that almost reaches the serosa.
dehiscence
the splitting or bursting open of a pod or wound.
Conditions in which the occipital softening may occur :
Name 2
What leads to Rickets?
rickets
excessive supply of phosphates in the diet
→ phosphates bind with ionized calcium and accumulate in soft tissues → low level of calcium in the serum stimulates the secretion of PTH (secondary hyperparathyroidism) → bone calcium release → rickets
The Ehlers-Danlos syndrome
the following occur in the course of the disease:
related to, among others, abnormalities in morphology of collagen
- excessive mobility in the joints (subluxation, dislocations, joint deformities, exudates)
- excessive skin stretching (formation of hernia)
- fragility of blood vessels (easy bruising)
- problems associated with sight (myopia, retinal detachment)
- no softening of the bones is found
Craniotabes
Define:
(softening and thinning of occipital and parietal bones)
A dizygotic pregnancy
is one in which two separate eggs were fertilized (for this to occur, polyovulation must happen) at one time. As a result, two genetically different fetuses develop.
They differ in the same way as siblings from two separate pregnancies.
This pregnancy will always be dichorionic and diamniotic
A monozygotic pregnancy
is a more complicated process. It is a pregnancy in which as a result of fertilization of one egg cell by one sperm, 2 identical embryos are formed.
This is done by splitting of the initially single zygote.
A very important element of this division is the time from fertilization in which this division takes place:
A very important element of this division is the time from fertilization in which this division takes place:
- if within 4 days of fertilization:*
- if between 4 and 7 days after fertilization:*
- if after day 7:*
- if after 13 days:*
- if within 4 days of fertilization* - it will be a dichorionic, diamniotic pregnancy
- if between 4 and 7 days after fertilization* - it will be a monochorionic, diamniotic pregnancy
- if after day 7* - it will be a monochorionic monoamniotic pregnancy
- if after 13 days* - there is a very high risk that the fetuses will be somehow connected to each other (conjoined twins)
chorion
- is one of the membranes that is involved in the creation of the placenta -
- it is quite significant and is related to serious consequences (which were explained in discussion under the question about TTTS)
amnion
is also one of the fetal membranes that, when filled with fluid, creates a safe environment for the development of the embryo.
- diaphragmatic hernia (define)*
- Name two types:*
. This disease happens when the abdominal organs are displaced into the chest cavity through a hole in the diaphragm.
2 types of diaphragmatic hernias:
anterior - Morgagni - usually on the right side
postero-lateral - Bochdalek - 90% of cases, usually on the left side
Anemia is common in pregnant women.
It is diagnosed at the level of
hemoglobin <11g / dl
non-pregnant women who have anemia diagnosed at
Hb <12 g / dl
In the course of pregnancy,
the volume of blood is?
This uneven growth leads to a ?
In the course of pregnancy, the volume of blood is increased by as much as 40-45%, and the mass of erythrocytes by 18-25%.
This uneven growth leads to a decrease in hematocrit and the occurrence of anemia.
Prader-Willi syndrome
is a multisystemic congenital disease, associated with genetic imprinting.
The cause of the syndrome is the deletion of a Chromosome 15 fragment from the father. In the clinical picture during the neonatal period, hypotonia, lack of sucking reflex (hence feeding problems) dominate, while starting at the age of 2 years the phenotype is dominated by increased appetite, which results in the rapid development of obesity.
There is also hypogonadism and intellectual disability.
Prader-Willi syndrome.
Characteristic features of the syndrome
short stature, small hands and feet, facial dysmorphia (amygdala eyelids, narrow upper lip, small lips, hypopigmentation of the skin and hair) and behavioral disorders (in this patient it may be skin picking).
All these features speak for Prader-Willi syndrome.
Klinefelter syndrome characterized by
delayed puberty - the most common cause of hypergonadotrophic hypogonadism.
Other symptoms include tall stature, female physique, gynecomastia, no voice mutation, and erection problems.
Alström syndrome
is a rare genetic disease.
The disease is caused by an autosomal recessive inherited mutation in the ALMS1 gene located on Chromosome 2.
The main disorder is congenital retinal dystrophy which causes blindness, deafness and obesity.
Photophobia and nystagmus are most commonly seen as the first symptoms of the syndrome. There is no reduced muscle tone or feeding problems.
Carpenter syndrome
is one of the forms of APS-2,
i.e. polyglandular (hypofunction) autoimmune syndrome type 2.
It consists of: primary hypoadrenocorticism, autoimmune thyroid disease and type 1 diabetes. It manifests most often at the age of 20-40.
The first node to drain the lymph from the tumor is called?
the sentinel node
Invasive breast cancer can also spread through the so-called?
Rotter route,
i.e. the intermuscular route, then it metastases directly to the second and third degree axillary nodes
The most common type of malignant breast cancer?
common location?
is adenocarcinoma,
its most common location is the superior external quadrant.
The two main types of adenocarcinomas are:
Ductal cancer - which occurs in the cells lining the milk ducts of the breast (as in the case of the patient in the question)
lobular carcinoma - arising in the cells of the mammary glands.
Malignant Primary
Germ Cell Tumors
name 6
Dysgerminoma
Yolk sac tumor
Embryonal carcinoma
Polyembryoma
Nongestational choriocarcinoma
Mixed germ cells
Biphasic or Triphasic
Teratomas
name 2
Immature teratoma
Mature teratoma
Monodermal Teratomas and
somatic-type Tumors
associated with Dermoid Cysts
Name 6
Thyroid tumor
Struma ovarii
Carcinoid
Neuroectodermal-type tumors
Glioblastoma
Melanoma
treatment of stress urinary incontinence (SUI) is
duloxetine.
Duloxetine (similar to venlafaxine) belongs to the drug group of ___and ___-
MOA?
Duloxetine (similar to venlafaxine) belongs to the drug group of serotonin and noradrenaline reuptake inhibitors (SNRIs).
The proposed mechanism for its action is probably the increase in bladder capacity and contractility of the urinary sphincter (via the noradrenergic mechanism -> α1-adrenergic and serotonin stimulation -> stimulation of 5HT2 receptors in the pudendal nerve).
Clinical studies have shown it is highly effective compared to placebo groups. The recommended dose is 40 mg/day.
However, application in depression and anxiety disorders, as well as neuropathic pain in the course of diabetes, remain the main indications for duloxetine.
Other groups of drugs used in the treatment of stress urinary incontinence include:
estrogens, α2-adrenergic agonists, cholinolytics (e.g. oxybutynin).
test interpretation
down syndrome
low AFP, low estriol, increased hCG
test interpretation
Edwards syndrome
low AFP, low estriol, low hCG
Test interpretation
neural tube defects
high concentration of AFP
malignant non-epithelial tumors of the ovary
Germinal tumors:
name 7
dysgerminoma
yolk sac tumor
embryonic tumors
polyembryoma
choriocarcinoma
teratomas: immature & mature
mixed germinal tumors
malignant non-epithelial tumors of the ovary
Gonadal tumors:
name 5
- folliculoma*
- thecoma*
- fibroma*
- Sertoli and Leydig cell tumors*
- mixed tumors*
Hormonal changes in polycystic ovary syndrome (PCOS):
↑ LH secretion ->
↑ LH secretion → stimulation of theecal cells → ↑ androgen production
Hormonal changes in polycystic ovary syndrome (PCOS):
↑ androgen levels →
↑ androgen levels → dysfunction of the hypothalamic-pituitary-ovarian axis → ↑ pulsatile GnRH secretion → ↑ LH levels → premature follicular maturation → premature estradiol peak → FSH inhibition → ↓ FSH levels
Hormonal changes in polycystic ovary syndrome (PCOS):
LH: FSH ratio?
ratio> 2
Hormonal changes in polycystic ovary syndrome (PCOS):
increased aromatization of androgens →
increased aromatization of androgens → relative hyperestrogenism
Mitochondrial diseases include:
Name 9
A syndrome of chronic progressive external ophthalmoplegia,
Kearns-Sayre syndrome
Mitochondrial encephalomyopathy syndrome involving the nervous system, stomach and intestines,
Pearson’s marrow-pancreas syndrome
Myoclonic epilepsy with ragged red fibers in the muscles (MERRF syndrome)
MELAS syndrome (mitochondrial myopathy, encephalopathy, lactic acidosis, occurrence of stroke-like incidents)
Leber’s hereditary neuropathy of optic nerve,
Neurogenic myopathy with ataxia and retinal pigment degeneration,
Aplastic anemia caused by chloramphenicol
Kearns-Sayre syndrome
Kearns–Sayre syndrome (KSS), oculocraniosomatic disorder or oculocranionsomatic neuromuscular disorder with ragged red fibers is a mitochondrial myopathy with a typical onset before 20 years of age.
KSS is a more severe syndromic variant of chronic progressive external ophthalmoplegia (abbreviated CPEO), a syndrome that is characterized by isolated involvement of the muscles controlling movement of the eyelid (levator palpebrae, orbicularis oculi) and eye (extra-ocular muscles). This results in ptosis and ophthalmoplegia respectively.
KSS involves a combination of the already described CPEO as well as pigmentary retinopathy in both eyes and cardiac conduction abnormalities. Other symptoms may include cerebellar ataxia, proximal muscle weakness, deafness, diabetes mellitus, growth hormone deficiency, hypoparathyroidism, and other endocrinopathies. In both of these diseases, muscle involvement may begin unilaterally but always develops into a bilateral deficit, and the course is progressive. .
The Lust sign
is one of the symptoms characteristic of tetany.
In order to observe it, you should hit a neurological hammer in the region of the common peroneal nerve.
We can consider it as positive if there is sagittal muscle contraction and abduction of the foot.
Landau reflex
appears at around 5 months of age and disappears up to 3 years old.
It is examined as follows - the child should be held in the air facing the ground - the reflex can be considered present if the child lifts his head up, then bends his back and straightens the lower limbs in the hip joints.
Levine’s sign means
showing the clenched fist on the sternum depicting the feeling of tightening while the patient describes the symptoms of angina pectoris.
Laseque sign
is the inability to raise the lower limb in a lying position. Its presence indicates the compression of the sciatic nerve.
The test is performed in a lying position on the back, the person examining lifts the lower limb of the patient by bending it in the hip joint.
The occurrence of non-physiological pain (should be distinguished with pain associated with muscle contraction!) Indicates a positive sign
Leigh syndrome
(also called Leigh disease and subacute necrotizing encephalomyelopathy) is an inherited neurometabolic disorder that affects the central nervous system.
Normal levels of thiamine, thiamine monophosphate, and thiamine diphosphate are commonly found but there is a reduced or absent level of thiamine triphosphate. This is thought to be caused by a blockage in the enzyme thiamine-diphosphate kinase, and therefore treatment in some patients would be to take thiamine triphosphate daily.
With Leigh’s name you should associate Leigh disease, or necrotic subacute encephalopathy caused by mutations in mitochondrial DNA
pancreatic neuroendocrine tumor - VIP-oma
→ severe diarrhea is typical, leading to electrolyte disturbances in the patient, such as hypochloridia, hypokalemia with arrhythmias and asthenia, non-respiratory acidosis.
pancreatic neuroendocrine tumor - glucagonoma
→ it is a tumor originating from pancreatic alpha cells and secreting glucagon. Symptoms are related to the hormone secreted and include diabetes mellitus, weight loss, mucositis, diarrhea, anemia, necrolytic migratory erythema.
. pancreatic neuroendocrine tumor - insulinoma
→ it is a neoplasm originating from β cells of the pancreatic islets. It secretes insulin, and therefore in the course of this cancer, we can expect hypoglycemic episodes in the patient and the associated disturbances of consciousness and behavior.
pancreatic neuroendocrine tumor - gastrinoma
→ a tumor that secretes gastrin, which stimulates the production of gastric juice. The symptoms cause Zollinger-Ellison syndrome.
normospermia include:
ejaculate volume: 1.5-6ml
sperm concentration: 15-250mln / ml
motility: Type A and B (progressive, rapid and slow motion)> 32%
morphology: > 4% sperm with normal structure
viability: > 58% live sperm.
Aspermia -
decreased volume of ejaculate: 0-0.5ml
Oligospermia -
reduced sperm count <15ml / ml
Asthenozoospemia -
decreased sperm motility <32% shows progressive movement
Teratozoospermia -
abnormal sperm morphology: <4% sperm with normal structure.
Cancer of the vulva:
Accounts for what %
accounts for 3-8% of all malignant neoplasms of female genital organs
more than 50% of cases are diagnosed after the age of 70.
Cancer of the Vulva:
There are 2 precancerous states
hyperplastic lichen sclerosus (precedes keratotic cancer)
VIN (vulvar intraepithelial neoplasia) (precedes squamous cell carcinoma associated with HIV infection)
Cancer of the Vulva:
histological types
squamous cell carcinoma (90%)
Bartholin gland cancer
basal cell carcinoma
adenocarcinoma
melanoma
sarcomas
metastatic tumors
Cancer of the Vulva:
risk factors
lichen sclerosus of the vulva
intraepithelial neoplasia (VIN)
a large number of sexual partners
early age of sexual intercourse
HIV and HPV infection
nicotinism
low socioeconomic status
Cancer of the Vulva:
treatment
surgery
radiotherapy
chemotherapy
the most common method is radical vulvectomy with inguinal lymph nodes removal
in the case of inoperable neoplasms, systemic treatment and/or radiotherapy are used
Cancer of the Vulva:
prognosis
tumor recurrences occur in up to 30% of patients
five-year survival of patients with stage FIGO I vulvar cancer is 98%, FIGO II- 85%, FIGO III- 74%, FIGO IV- 31%
Mechanism of action of the estrogen component:
- FSH suppression*
- inhibiting the selection and growth of the dominant follicle*
- prevention of bleeding*
- intensification of progestational activity*
Mechanism of action of the gestagen component:
LH suppression
effect on the endometrium
thickening of cervical mucus
effect on the fallopian tubes
menometrorrhagia
- abundant, irregular, prolonged bleedings, linked to an increase estrogens blood concentration, particularly in the perimenopausal period
hypermenorrhoea
- blood loss >100 ml
hypomenorrhoea
- blood loss <30 ml
dysmenorrhoea
- severe pain in perimenstrual period and during bleeding itself
algomenorrhoea
- menstrual pains are accompanied by vegetative symptoms
metrorrhagiea
- abundant, prolonged bleedings not on the time of expected menstruation
- juvenilis - acyclic bleeding in young women >10 days
- -climacteria* - bleeding in a woman 6-12 months after menopause
menorrhagia
- regular, cyclic, abundant, prolonged bleeding in menstruation time
amenorrhoea intermittens
- rare bleedings in intervals lasting from 43 days to 6 months, most often, but not always, are anovulatory cycles and typically occur in women with polycystic ovary syndrome.
Definition
Endometriosis
- the occurrence of the endometrium (glandular cells and stroma) outside the uterine cavity.
Endometriosis
Surgical Treatment options:
- removal of isolated foci
- removal of endometrial cysts
- removal of the entire ovary
- removal of the entire uterus with adnexa
Endometriosis
Pharmacological Tx options:
-
hormonal therapy:
- gonadoliberin analogs (goserelin) and their antagonists, e.g. danazole
- progesterone preparations (dienogest , progesterone)
- estrogen-progesterone preparations
- intrauterine device with levonorgestrol
- aromatase inhibitors
- selective progesterone receptor modulators (SPRMs)
- painkillers:
- NSAIDs
Symptoms
Endometriosis Symptoms
- restriction of fertility.
- lower pelvic pain syndrome, painful examination, and nodular lesions palpable in the projection of the uterosacral ligaments.
- painful menstruation (dysmenorrhoea), pains start a few days before the onset of menstruation
- dyspareunia.
- enlarged, tender, poorly mobile appendages.
Name 3 drugs
Dopamine D2 receptor agonists
(bromocriptine, quinagolide, cabergoline)
Dopamine D2 receptor agonists (bromocriptine, quinagolide, cabergoline) are used for:
Treatment of Pituitary tumors producing Prolactin
Dopamine is a neurotransmitter responsible for:
- motor drive
- emotional processes
- hormone secretion
The hormonal effect of dopamine is
antagonistic to prolactin → hence the other name for dopamine (prolactostatin). Dopamine agonists cause an increase in dopamine secretion, thereby enhancing its prolactin antagonism.
- Administering D receptor agonists (e.g. bromocriptine, quinegolide, cabergoline) → ↑ increased dopamine secretion → ↓ decreased prolactin secretion → prevention of symptoms of excessive prolactinemia.
Administering D receptor agonists (e.g. bromocriptine, quinegolide, cabergoline) →
↑ increased dopamine secretion → ↓ decreased prolactin secretion → prevention of symptoms of excessive prolactinemia
in the diagnosis of hyperprolactinemia-what is used as a functional test →
- metoclopradmide is used as the functional test.
Metoclopramide acts as a dopamine receptor?
MOA
Metoclopramide acts as a dopamine receptor antagonist→ action, ↑ stimulates prolactin secretion
Physiological changes in the circulatory system during pregnancy?
- ↑ cardiac output and increase in sodium and water retention → ↑ blood volume → ↓ peripheral vascular resistance → ↓ blood pressure (most prominent in the 2nd trimester)
- displacement of the apex of the heart upwards and to the left (lifting the diaphragm by the enlarging uterus)
- increase in heart size by about 12%
- ↑ blood volume
- I trimester: ↑ volume by approx. 10-15%
- maximum volume is reached at 28-34. week of pregnancy (increase by 40-45% compared to the state before pregnancy)
- ↑ red blood cell mass: by 20% (Bręborowicz 2010), by 30% (Bręborowicz 2015)
- mean value of hemoglobin in women at delivery - 12.5 g/dl
- pathological anemia is diagnosed at hemoglobin concentration <11 g/dl
- increased erythropoiesis → ↑ reticulocyte count
- ↑ stroke volume
- I trimester: ↑ by 30-40%
- the maximum value is reached about 20 tc
- ↑ cardiac output (cardiac output) by 30-50%
Define
Acute pyelonephritis
is a bacterial infection causing inflammation of the kidneys and is one of the most common diseases of the kidney. Pyelonephritis occurs as a complication of an ascending urinary tract infection (UTI) which spreads from the bladder to the kidneys and their collecting systems
Define
Acute pyelonephritis
is a bacterial infection causing inflammation of the kidneys and is one of the most common diseases of the kidney.
Pyelonephritis occurs as a complication of an ascending urinary tract infection (UTI) which spreads from the bladder to the kidneys and their collecting systems
Define
- also known as 46, XY complete (pure) gonadal dysgenesis (CGD), is a rare congenital disorder of sex development. It is characterized by the failed development of the sex glands (i.e. testicles or ovaries)
- have an XY genetic makeup, or genotype, but develop a vagina, uterus, and Fallopian tubes instead of a penis and scrotum.
- because dysgenetic gonads do not secrete testosterone (hypogonadism) nor anti-Müllerian hormone, Müllerian ducts’ derived organs develop (female)
- is characterized by a female phenotype , female internal sexual organs , normal or high growth, sexual infantilism and primary amenorrhea
Granulosa cell tumor
ex?
Belongs to?
Folliculoma:
- belongs to the gonadal tumors of the ovary
- it can occur in women of any age (only 5% are diagnosed before puberty)
- most often it occurs unilaterally (only 2% of tumors are bilateral)
granulomas secrete?
estrogens and inhibin
Folliculoma symptoms
- premature puberty in girls
- change in the nature of menstruation (irregular, heavy)
- coexistence of hyperplasia (25-50%) or endometrial cancer (5%)
- ascites (10%)
- symptoms of “acute abdomen” due to tumor rupture
- premature puberty, change in the nature of menstruation and coexisting endometrial hyperplasia result from increased estrogen levels (granulomas secrete estrogens and inhibin)
- determination of inhibin concentration is useful in monitoring treatment and detecting relapses
malignant non-epithelial tumors of the ovary
Gonadal tumors
Name 5
- folliculoma
- thecoma
- fibroma
- Sertoli and Leydig cell tumors
- mixed tumors
malignant non-epithelial tumors of the ovary
Germinal tumors
Name 7
- dysgerminoma
- yolk sac tumor
- embryonic tumors
- polyembryoma
- choriocarcinoma
- teratomas
- immature
- mature
- mixed germinal tumors
Explain CTG-Fetal
CTG:
Acceleration- explain
-
short-term, transient FHR acceleration by at least 15 beats per minute, lasting 15 seconds or longer
- periodic
- episodic
Explain CTG-Fetal
CTG
Deceleration - explain
short-term slowdown of the basic FHR by at least 15 beats per minute, lasting 10 seconds or longer
- early - the effect of central stimulation of the X nerve by compression of the head in the birth canal (Gaussian reflex)
- late
- variable
- complex
Define
Hypothalamic-pituitary insufficiency:
(classification, takes form of, causes)
- in the classification of menstrual disorders according to WHO, it is classified as group I
- takes the form of hypogonadotrophic hypogonadism
- There are pituitary and hypothalamic causes
causes of hypothalamic-pituitary insufficiency
Hypothalamic:
Congenital-name 3
- Kallmann’s syndrome
- isolated hypogonadotrophic hypogonadism
- GnRH receptor mutation
causes of hypothalamic-pituitary insufficiency
Hypothalamic:
Acquired- name 3
- functional hypothalamic amenorrhoea - FHA
- hypothalamic psychiatric amenorrhea
- organic hypothalamic amenorrhea (post-traumatic or inflammatory tumors, damage to the hypothalamic-pituitary area)
causes of hypothalamic-pituitary insufficiency
Pituitary:
Name 4
- post-traumatic or post-inflammatory tumors, damage to the hypothalamic-pituitary area
- Sheehan’s syndrome
- empty saddle syndrome
- lymphocytic pituitary inflammation
diagnostics of hypogonadotrophic hypogonadism
Symptoms
- congenital and pre-pubertal disorders: primary amenorrhea, failure to develop secondary sex characteristics
- disorders acquired after puberty: secondary amenorrhea, presence of secondary sex characteristics
diagnostics of hypogonadotrophic hypogonadism
Hormone concentration
↓ levels of FSH, LH and estradiol
diagnostics of hypogonadotrophic hypogonadism
progesterone test ?
estrogen-progesterone test ?
negative
Positive
diagnostics of hypogonadotrophic hypogonadism
gonadoliberin test ?
- positive for hypothalamic disorders
- negative in the case of pituitary disorders
The disulfiram-like reaction?
- symptoms induced by alcohol consumption resulting from the aldehyde dehydrogenase block, which results in the accumulation of toxic acetaldehyde.
- The name comes from ‘disulfiram’, a drug used to treat alcoholism.
- It blocks the aldehyde dehydrogenase
In the disulfiram-like reaction -
In the disulfiram-like reaction -
Symptoms:
- vasodilation (facial redness)
- hypotension
- increased heart rate
- excessive sweating
- breathing disorders
- dyspnea
- nausea
- vomiting
- anxiety
In the disulfiram-like reaction -
Description:
Long list of drugs with a disulfiram-like effect includes?
which we use to treat?
metronidazole
-which we use to treat genital infections
e.g. T. vaginalis infection and bacterial vaginosis.
Drug TX
Drug treatment of urinary tract infections in pregnant or lactating women:
“NAAC” most common
- nitrofurantoin
- furazidine - do not use in the first trimester of pregnancy
- co-trimoxazole
- trimethoprim
- fosfomycin (cat. B)
- amoxicillin (cat. B)
- amoxicillin with clavulanate (cat. B)
- cephalexin (cat. B)
- ampicillin
- cefuroxime (cat. B)
Drug TX
Pregnant women should not use:
name 5
“My TTSF”
- Tetracyclines (damage fetal teeth and bones)
- Trimethoprim (used in the first trimester of pregnancy may cause facial and heart malformations in the fetus)
- Sulfamethoxazole (when used in the third trimester of pregnancy, increases the risk of neonatal jaundice)
- Fluoroquinolones (completely contraindicated - they can cause spina bifida with meningeal hernia, hydrocephalus, hypidity, testicular failure, inguinal hernia, bilateral hip hypoplasia and atrial septal defect)
- Macrolides (should not be used as first-line drugs).
define
The triple marker?
test is a non-invasive test that assesses AFP, hCG and estriol in mother’s blood serum between weeks 14 and 20 of pregnancy
Due to the low sensitivity (65%) and the late diagnostic period, it is used less frequently than the double test.
The double test?
- is a non-invasive test carried out between 11 and 14 weeks of pregnancy
- It evaluates 2 biochemical markers:
pregnancy plasma protein (PAPP-A) and placental gonadotropin (hCG)
-It is characterized by early diagnosis and high sensitivity (95%).
The basic parameters assessed in the spermiogram are:
name 10
- Ejaculate volume (N >1.5 ml)
- Total sperm count (N >39 x 10^6/ejaculate)
- Sperm concentration (N >15x10^6/ml)
- Total sperm motility (N >40%)
- Progressive movement of spermatozoa (N >32%)
- Vitality (live spermatozoa) (N >58%)
- Percentage of sperm with normal morphology (N >4%)
- pH (N ≥7.2)
- Liquefaction time of the ejaculate (N <60 min.)
- Presence of leukocytes (N <1x10^6/ml) and erythrocytes (N =none)
Nomenclature related to semen quality:
Teratozoospermia
- - Spermatozoa percentage with normal morphology below 4%
Nomenclature related to semen quality:
Asthenozoospermia
- Percentage of progressively motile (PR) spermatozoa below <32%
Nomenclature related to semen quality:
Asthenoteratozoospermia
- Sperm percentage with progressive movement <32% and normal morphology <4%
Nomenclature related to semen quality:
Azoospermia -
- No sperm in ejaculate
Nomenclature related to semen quality:
Cryptozoospermia -
- Spermatozoa absent from fresh preparations but observed in a centrifuged pellet
Nomenclature related to semen quality:
Hemospermia (hematospermia) -
- The presence of erythrocytes in the semen
Nomenclature related to semen quality:
Leukospermia (leukocytospermia, pyospermia) -
- The presence of leukocytes in the ejaculate above the limit value (N = <1x10^6/ml)
Nomenclature related to semen quality:
Necrosoospermia -
- A low percentage of live, and high percentage of immotile, spermatozoa in the ejaculate
Nomenclature related to semen quality:
Oligozoospermia -
- Total sperm count below 39x10^6/ejaculate
Nomenclature related to semen quality:
Aspermia -
- No semen due to lack of ejaculation or retrograde ejaculation
TX Meds
What is the “golden standard” for ovarian cancer
- The combination of carboplatin and paclitaxel
%of cases, location, TX,
Recurrences of ovarian cancer:
- Despite the high sensitivity to chemical treatment of ovarian cancer, in about ¾ cases it recurs
- The recurrence usually occurs again in the abdomen and is often multifocal
- The basic method of treatment of recurrent ovarian cancer is chemotherapy. It is usually used as palliative treatment
- Due to the usually diffuse nature of the disease, radiotherapy does not allow to effectively destroy all foci of the disease.
Fetus lie (situs)
- the relation of the long axis of the fetus to the long axis of the uterus and the birth canal
- longitudinal
- transverse
- oblique
Fetal position (positio)-
- the relationship of an arbitrarily chosen portion of the fetal presenting part to the right or left side of the maternal birth canal
- position I - spine (head) on the left side of uterus
- position II - spine (head) on the right side of uterus
Fetal attitude (habitus)-
- the relation between the parts of the fetus
- flexed
- extension
Insertion (immissio) -
- relation of the leading part to the interspinal line
The most important systemic changes in the course of pregnancy:
cardiovascular system:
- increase in the output and the heart rate
- reduction of peripheral resistance
- increase in stroke volume
- decrease in blood pressure
-
increase in blood volume:
- 40-45% compared to a non-pregnant woman
- about 50% (the word “about” suggests that the maximum increase in blood volume is even more than 50%) in relation to the pre-pregnancy value
- by 40% compared to non-pregnant women
- decrease in hematocrit, hemoglobin, platelets,
The most important systemic changes in the course of pregnancy:
coagulation system:
- acceleration of blood coagulation
- increase in concentration of most coagulation factors
- increased tendency to thrombi
The most important systemic changes in the course of pregnancy:
respiratory system:
- increased infrasternal angle
- the diaphragm is raised by 4 cm
- increased lateral dimension of chest
- increased circumference of chest
- respiratory rate, vital capacity (VC) of the lungs do not change
- increased tidal volume (TV)
- decreased total lung capacity (TLC)
- alveolar ventilation increases by 70%
- reduction of resistance in the airways
- swelling of the mucosa of upper respiratory tract and greater predisposition to nosebleeds
The most important systemic changes in the course of pregnancy:
urinary tract:
- increase the length and volume of the kidneys
- widening of the kidney calyces
- swelling of the mucous membrane of the bladder
- reduction of bladder capacity
- widening of the ureters
- greater risk of acute pyelonephritis
- increased renal perfusion and GFR (even by half)
- higher frequency of urination
- reduction in creatinine
- reduction in Na + and K + concentrations
- reduction in reabsorption of some substances from the urine (eg glucose)
The most important systemic changes in the course of pregnancy:
digestive system:
- heartburn
- change in the oral flora, but the increase in the incidence of caries is debatable
- constipation
- hemorrhoids
- dilation of the portal vein
- increase in ALP
- decrease in GGTP
- reduced gallbladder contractility - increased risk of urolithiasis
The most important systemic changes in the course of pregnancy:
endocrine system:
- goiter
- increase in T4 and T3 concentrations
- decrease in TSH
- 3-fold enlargement of the pituitary gland
- increased concentration of PRL and MSH
- increase in RAA activity and cortisol productio
The most important systemic changes in the course of pregnancy:
musculoskeletal system:
- Increasing the mobility of joints and pelvis cartilage
- increase in lumbar lordosis and thoracic kyphosis
The most important systemic changes in the course of pregnancy:
eye:
- lowered intraocular pressure
- thickening of the cornea
- problems with accommodation
The most important systemic changes in the course of pregnancy:
metabolism:
- additional energy expenditure
- hypertrophy of pancreatic islets
- increased insulin secretion
- insulin resistance
- postprandial hyperglycemia
- fasting hypoglycemia
- positive nitrogen balance
- increased concentration of proteins in the blood
- increase in total cholesterol, phospholipid and TAG concentrations
- increase in leptin concentration
- increased appetite
- water accumulation
The most important systemic changes in the course of pregnancy:
uterus:
- increase in blood flow
Dimensions of the fetal head:
What are the Dimensions of the fetal head:
- Dimensions:
- diameter suboccipitobregmaticus: 9.5 cm
- diameter frontooccipitalis: 12 cm
- diameter mentooccipitalis: 13.5 cm
circumferences of the fetal head:
- Circumferences:
- suboccipitobregmatic: 32 cm (it is the most advantageous circumference for passing through the small pelvis)
- occipitofrontal: 34 cm
- occipitomental: 35 cm
Occiput anterior position
(occiput faces towards pubic symphysis) is a physiological position.
Langerhans cell histiocytosis
abnormal clonal proliferation of Langerhans cells, abnormal cells deriving from bone marrow and capable of migrating from skin to lymph nodes.
Symptoms range from isolated bone lesions to multisystem disease.
- caused by the growth of histiocytes and Langerhans cells
- causes the appearance of an excessive amount of cytokines and prostaglandins that lead to the formation of infiltrates
- generalized form - most often in children before 2 years.
- localized character - mostly in older children
Woman -Men
Frequency of malignant tumours - ordered from the most common ones
Women -“BCLE OCT”
Men -“LPCU SKL”
Frequency of deaths from malignant tumours - ranked from the most common ones
Women - “LBCO PSC”
Men - “LCPS UPK”
- cervical
Double test:
- performed between the what week/weeks of pregnancy?
- evaluates two biochemical markers in pregnant blood: Name
-performed between the 11th and the 14th week of pregnancy
-evaluates two biochemical markers in pregnant blood: PAPP-A and β-hCG
