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Obs&Gynae Flashcards

1
Q

What are the three tissue layers in the uterus?

A

Peritoneum, myometrium, endometrium

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2
Q

What is the innervation of the uterus?

A

Inferior hypogastric plexus: Hypogastric nerves (T10-L2) and splanchnic nerves (S2-4)

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3
Q

What is the blood supply to the uterus?

A

Uterine and ovarian arteries from the int iliac

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4
Q

What type of epithelium is the cervix?

A

Columnar which turns to squamous at the external os

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5
Q

What are the two functions of the ovaries?

A

Steroid hormone production and gametogenesis

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6
Q

Where are ovarian follicles found?

A

Cortex of ovary

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7
Q

What are the 4 parts to the fallopian tube?

A

Intramural, isthmus, ampulla, infundibulum

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8
Q

What type of epithelium is found innermost of the uterus?

A

Ciliated

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9
Q

What type of epithelium is the vagina?

A

Stratified squamous

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10
Q

Describe the hypothalamic- pituitary- ovarian axis

A

Hypothalmus releases GnRH- Acts on ant pit- Releases LH and FSH- FSH: oocyte maturation and recruitment, LH: release of egg- both increase oestrogen production

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11
Q

What does FSH act on

A

Acts on enzyme aromatase in granulose cells of oocyte- converts testosterone to E2

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12
Q

what does LH act on

A

Theca cells to form testosterone

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13
Q

Name 2 functions of oestrogen

A

Puberty development, endometrial thickening, vaginal lubrication- inhibits progesterone

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14
Q

Name 3 functions of progesterone

A

Egg implantation, vascularisation, maintenance of pregnancy- inhibits oestrogen

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15
Q

where is progesterone made

A

Corpus luteum of oocyte and placenta from 7-8wk

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16
Q

what hormone down regulates the immune response

A

Human Chorionic gonadotrophin- hCG- stops luteal regression and ensures cont progest. Causes interstitial implantation.

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17
Q

What hormone modifies maternal metabolism to increase glucose supply to the foetus

A

Human Placental lactogen

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18
Q

what do extravillous trophoblast cells do?

A

Block the spiral arteries to induce hypoxia which promotes low bore resistance vessel development- endovascular invasion and development of the placenta. Also downregulate the immune response by producing HLA-G which reduces Th1 and inc Th2. Lead to anchoring villi.

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19
Q

Where do the extravillous trophoblast cells come from?

A

Cytotrophoblast progenitor cells (stem cells)

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20
Q

Why do women often get diabetes in late pregnancy?

A

Because in late preg plasma glucose increases but there is increase insulin resistance- thought to be due to glucose sparing for the foetus

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21
Q

Name 3 RF for gestational diabetes

A

Obesity, previous large baby, 1st degree relatives with diabetes, non-Caucasian

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22
Q

How is gestational diabetes tested for and treated?

A

GTT at 24-28wks- Metformin then insulin

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23
Q

Why do women get anaemia in pregnancy?

A

Blood volume increases due to inc plasma volume= relative haemodilution. More iron is used in the first trimester so women can get microcytic anaemia due to Fe deficiency. Or folate and b12 leading to macrocytic anaemia.

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24
Q

Why is it dangerous to have a macrocytic anaemia in early pregnancy?

A

Neural tube defects

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25
Why does respiratory rate increase in pregnancy
Progesterone inc RR
26
In a Rhesus –ve mum, why is a second pregnancy dangerous
The IgM produced in the first preg switches to IgG which can cross the placenta- leads to RBC lysis- foetal anaemia and death
27
How is Haemolytic disease of the Newborn treated?
Mothers screened- given anti-D prophylaxis which destroys the IgG: given at 28wks or within 72hrs of an sensitizing event: termination, ectopics, bleeding, delivery
28
Give two methods of intermittent auscultation
Pinard stethoscope and dopper USS
29
Give 2 advantages and 2 disadvantages of intermittently monitoring
A: inexpensive and non invasive. D: mother needs to be stable for 1 min, variability and decelerations cannot be detected, not long term
30
What is the main way to continuously monitor?
Cardiotocography (CTG)
31
when is continuous monitoring used in pregnancy?
Used with high risk pregnancies that monitoring is needed to ensure safety of the baby
32
Give 1 advantage and 1 disadvantage of continuous monitoring in pregnancy
A: can closely monitor the baby and give true beat to beat data. D: expensive and when wearing the mothers are unable to move around
33
What are the 4 things interpreted in the graphs produced in continuous monitoring
Resting rate, variability, acceleration and deceleration
34
What are the normal values that produce reassuring results in continuous monitoring?
Normal: Baseline: 110-160, >5bpm variability, accelerations present and no decelerations
35
when would a continuous monitoring graph be non-reassuring
B: 100-109/161-180. V: <5 for 40-90min, early decelerations or variable decelerations
36
when would a continuous monitoring graph be abnormal?
<100/>180. <5 for >90min. Late decelerations or variable with reduced variability
37
what are the main causes of early, late and variable decelerations seen in continuous monitoring
Early: uterine contractions (head compression), Late: Placental insufficiency, variable: cord compression
38
Name 1 other method of continuous monitoring
Direct foetal ECG
39
Name the 6 stages of the cell cycle
G1, S, G2, mitosis, cytokinesis, G0
40
Name the 2 key tumour suppressor genes and what each does
P53: transcription factor, Rb: alters activity of transcription factors
41
Name a gene that can stimulate cancer development and an example
Oncogene: HER-2, RAS
42
Why is endometrial cancer rising in the incidence?
Obesity and diabetes is increasing which creates unopposed oestrogen leading to high endometrial changes
43
What is the one symptom that indicates endometrial malignancy investigations
Post-menopausal bleeding
44
Name 2 investigations you could do for endometrial malignancy
Transvaginal ultrasound and endometrial biopsy- hysteroscopy with biopsy is definitive
45
What is the most common type of endometrial cancer
Adenocarcinoma
46
How are the endometrial cancers staged?
FIGO 1/2/3/4
47
What is the main treatment for endometrial cancer?
Total hysterectomy +/ pelvic lymph node removal +/ radiotherapy and progesterone therapy for those that are unable to undergo surgery
48
What factors of endometrial malignancy are associated with a poor prognosis
Old age, advance stage, deep myometrial invasion, high grade, adenosquamous histology
49
What is the main cause of Cervical Cancer?
HPV 16 and 18
50
What are the main transforming gene products?
E6 + E7= both cause growth stimulation
51
What is the most common type of cervical cancer?
Squamous cell carcinoma
52
Name 3 other RF of cervical cancer
Early age intercourse, multiple partners, STIs, smoking, COCP, immunosuppression
53
What is the most common symptom of cervical cancer? Other symptoms?
Post coital bleeding- signifies an advanced stage of disease- most are found on smear testing. Vaginal discharge, altered bowel habits, painless haematuria
54
Name 3 treatments for cervical cancer
Dysplasia: Colposcopy or Cone biopsy. Stage 1: surgery and lymph node removal, simple hysterectomy, radiotherapy/chemotherapy. 2b+: chemoradiation therapy
55
Name 2 difficulties of treating young woman with cervical cancer
Fertility preservation and premature babies if pregnancy is successful
56
Name 2 most common aetiologies of vulval cancer
HPV and lichen sclerosis
57
Most common pathology in vulval cancer
SCC
58
name 3 symptoms of vulval cancer
vulva itching, vulva soreness, lump, bleeding, painful urination
59
How is vulval cancer treated
conservative management, radial removal and lymph node removal, radiotherapy - often too late to treat
60
Why is ovarian cancer often late to diagnosis
Often presents like IBS, bowel changes, or has no symptoms
61
Who is most at risk of ovarian cancer?
Ladies who had menarche early and menopause late- babies and breast feeding are also rf
62
Name 2 familial genes that increase the risk of ovarian cancer?
BRCA, HNPCC
63
what is the most common pathology in ovarian cancer
Epithelial cell cancer – 50% serous adenocarcinoma
64
what 2 tests would you do on presentation of ovarian cancer?
CA125 and USS
65
what is the referral for ovarian cancer based upon?
Risk of malignancy index score: 250+ = gyne oncology referral
66
Name 4 factors in pelvic floor disorders
Bowel, bladder, vaginal and sexual
67
what are the 2 main types of incontinence
Stress incontinence and detrusor overactivity- urge (OAB) (+ overflow)
68
name 2 causes of each type of incontinence
Stress: childbirth, oestrogen deficiency. Urge: idiopathic, MS, UMN
69
what are the three layers of the pelvic floor
Skin, superficial muscles: transverse perineal, deep muscles- levator ani
70
name 2 differences between the main types of incontinence in terms of symptoms
OAB: urgency, frequency and psychological, Stress: due to coughing, laughing, movement
71
Name 3 assessments commonly used for incontinence
Frequency volume charts, urinalysis, residual urine measurement
72
what is a conservative method of treatment for incontinence
Behavioural therapy- bladder training, physiotherapy, catheters, pads, skin care
73
whats the medical management for incontinence
Anticholinergic: oxybutynin (M2/3) tolteridine , B3: mirabegron, botox injection, vaginal oestrogen stress: duloxetine (SNRI)
74
what are the 4 main SE of the medical treatment for incontinence
Dry mouth, blurred vision, constipation, drowsiness
75
what is the surgical treatment of prolapse and stress incontinence
Colposuspension (S), detrusor myomectomy (OAB)
76
What is the Fraser criteria?
Contraception can be prescribed to a girl under 16 if she understands, will be at risk otherwise and is in her best interest to give it with or without parental consent
77
Name 3 user dependant contraceptives
Male condom, COOP, diaphragm, contraceptive patch
78
Name 3 non-user dependant contraceptives
Injection, implant, IUD, sterilisation
79
How does the COCP work?
Contains oestrogen and progesterone- prevents ovulation and thins the lining of the womb
80
Name 2 advantages and 2 disadvantages of COCP
A: reversible and predicatable, D: drug interactions, can be difficult to take correctly, DVT risk
81
How does the POP work?
Thickens the cervical mucus and thins endometrium, can stop ovulation
82
2 advantages and 2 disadvantages of POP
No oestrogen SE, doesn’t react with other medications. Less effective and inc risk of ectopics
83
What two things does the fertility awareness method monitor?
Temperature and vaginal secretions
84
What is in the contraceptive injection? How does this work?
IM progesterone- inhibits ovulation by suppressing LH and FSH
85
How does an IUD work?
Copper reaction is toxic to sperm and egg preventing implantation
86
Name 2 long term complications of vasectomy
Sperm granulomas, chronic scrotal pain
87
What is a form of emergency contraception?
Levonogestrel (progesterone)
88
What is screened on asymptomatic female and male
F: self swab for gonorrhoea and chlamydia (NAAT), bloods for syphilis and HIV, M: first void urine NAAT and bloods
89
what is screened in addition in men who have sex with men
Pharyngeal swab for G/C, rectal G/C + bloods for Hep B/C
90
name 2 common symptomatic sexual health presentations in females
Vaginal discharge and pain
91
name 2 common symptomatic sexual health presentations in males
Burning, pain, blisters
92
what sexual health tests would be done in a symptomatic female?
High vaginal swab, cervical swab and gonorrhoea culture
93
what sexual health tests would be done in a symptomatic male?
Urethral swab and slide, gonorrhoea culture
94
what sexual health tests would be done in a symptomatic male who has sex with men?
Urethral, rectal and pharyngeal slides and cultures
95
What is the treatment for chlamydia
Azithromycin - 1g single dose
96
what is the treatment for gonorrhoea
Ceftriaxone- 500mg IM + azithromycin 1g
97
what is the treatment for syphilis
Doxycycline 100mg BD for 14d

Women's Health (65 decks)

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