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Women's Health > Obs&Gynae > Flashcards

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
Q

Why does respiratory rate increase in pregnancy

A

Progesterone inc RR

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26
Q

In a Rhesus –ve mum, why is a second pregnancy dangerous

A

The IgM produced in the first preg switches to IgG which can cross the placenta- leads to RBC lysis- foetal anaemia and death

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27
Q

How is Haemolytic disease of the Newborn treated?

A

Mothers screened- given anti-D prophylaxis which destroys the IgG: given at 28wks or within 72hrs of an sensitizing event: termination, ectopics, bleeding, delivery

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28
Q

Give two methods of intermittent auscultation

A

Pinard stethoscope and dopper USS

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29
Q

Give 2 advantages and 2 disadvantages of intermittently monitoring

A

A: inexpensive and non invasive. D: mother needs to be stable for 1 min, variability and decelerations cannot be detected, not long term

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30
Q

What is the main way to continuously monitor?

A

Cardiotocography (CTG)

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31
Q

when is continuous monitoring used in pregnancy?

A

Used with high risk pregnancies that monitoring is needed to ensure safety of the baby

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32
Q

Give 1 advantage and 1 disadvantage of continuous monitoring in pregnancy

A

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

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33
Q

What are the 4 things interpreted in the graphs produced in continuous monitoring

A

Resting rate, variability, acceleration and deceleration

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34
Q

What are the normal values that produce reassuring results in continuous monitoring?

A

Normal: Baseline: 110-160, >5bpm variability, accelerations present and no decelerations

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35
Q

when would a continuous monitoring graph be non-reassuring

A

B: 100-109/161-180. V: <5 for 40-90min, early decelerations or variable decelerations

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36
Q

when would a continuous monitoring graph be abnormal?

A

<100/>180. <5 for >90min. Late decelerations or variable with reduced variability

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37
Q

what are the main causes of early, late and variable decelerations seen in continuous monitoring

A

Early: uterine contractions (head compression), Late: Placental insufficiency, variable: cord compression

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38
Q

Name 1 other method of continuous monitoring

A

Direct foetal ECG

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39
Q

Name the 6 stages of the cell cycle

A

G1, S, G2, mitosis, cytokinesis, G0

40
Q

Name the 2 key tumour suppressor genes and what each does

A

P53: transcription factor, Rb: alters activity of transcription factors

41
Q

Name a gene that can stimulate cancer development and an example

A

Oncogene: HER-2, RAS

42
Q

Why is endometrial cancer rising in the incidence?

A

Obesity and diabetes is increasing which creates unopposed oestrogen leading to high endometrial changes

43
Q

What is the one symptom that indicates endometrial malignancy investigations

A

Post-menopausal bleeding

44
Q

Name 2 investigations you could do for endometrial malignancy

A

Transvaginal ultrasound and endometrial biopsy- hysteroscopy with biopsy is definitive

45
Q

What is the most common type of endometrial cancer

A

Adenocarcinoma

46
Q

How are the endometrial cancers staged?

A

FIGO 1/2/3/4

47
Q

What is the main treatment for endometrial cancer?

A

Total hysterectomy +/ pelvic lymph node removal +/ radiotherapy and progesterone therapy for those that are unable to undergo surgery

48
Q

What factors of endometrial malignancy are associated with a poor prognosis

A

Old age, advance stage, deep myometrial invasion, high grade, adenosquamous histology

49
Q

What is the main cause of Cervical Cancer?

A

HPV 16 and 18

50
Q

What are the main transforming gene products?

A

E6 + E7= both cause growth stimulation

51
Q

What is the most common type of cervical cancer?

A

Squamous cell carcinoma

52
Q

Name 3 other RF of cervical cancer

A

Early age intercourse, multiple partners, STIs, smoking, COCP, immunosuppression

53
Q

What is the most common symptom of cervical cancer? Other symptoms?

A

Post coital bleeding- signifies an advanced stage of disease- most are found on smear testing. Vaginal discharge, altered bowel habits, painless haematuria

54
Q

Name 3 treatments for cervical cancer

A

Dysplasia: Colposcopy or Cone biopsy. Stage 1: surgery and lymph node removal, simple hysterectomy, radiotherapy/chemotherapy. 2b+: chemoradiation therapy

55
Q

Name 2 difficulties of treating young woman with cervical cancer

A

Fertility preservation and premature babies if pregnancy is successful

56
Q

Name 2 most common aetiologies of vulval cancer

A

HPV and lichen sclerosis

57
Q

Most common pathology in vulval cancer

A

SCC

58
Q

name 3 symptoms of vulval cancer

A

vulva itching, vulva soreness, lump, bleeding, painful urination

59
Q

How is vulval cancer treated

A

conservative management, radial removal and lymph node removal, radiotherapy - often too late to treat

60
Q

Why is ovarian cancer often late to diagnosis

A

Often presents like IBS, bowel changes, or has no symptoms

61
Q

Who is most at risk of ovarian cancer?

A

Ladies who had menarche early and menopause late- babies and breast feeding are also rf

62
Q

Name 2 familial genes that increase the risk of ovarian cancer?

A

BRCA, HNPCC

63
Q

what is the most common pathology in ovarian cancer

A

Epithelial cell cancer – 50% serous adenocarcinoma

64
Q

what 2 tests would you do on presentation of ovarian cancer?

A

CA125 and USS

65
Q

what is the referral for ovarian cancer based upon?

A

Risk of malignancy index score: 250+ = gyne oncology referral

66
Q

Name 4 factors in pelvic floor disorders

A

Bowel, bladder, vaginal and sexual

67
Q

what are the 2 main types of incontinence

A

Stress incontinence and detrusor overactivity- urge (OAB) (+ overflow)

68
Q

name 2 causes of each type of incontinence

A

Stress: childbirth, oestrogen deficiency. Urge: idiopathic, MS, UMN

69
Q

what are the three layers of the pelvic floor

A

Skin, superficial muscles: transverse perineal, deep muscles- levator ani

70
Q

name 2 differences between the main types of incontinence in terms of symptoms

A

OAB: urgency, frequency and psychological, Stress: due to coughing, laughing, movement

71
Q

Name 3 assessments commonly used for incontinence

A

Frequency volume charts, urinalysis, residual urine measurement

72
Q

what is a conservative method of treatment for incontinence

A

Behavioural therapy- bladder training, physiotherapy, catheters, pads, skin care

73
Q

whats the medical management for incontinence

A

Anticholinergic: oxybutynin (M2/3) tolteridine , B3: mirabegron, botox injection, vaginal oestrogen
stress: duloxetine (SNRI)

74
Q

what are the 4 main SE of the medical treatment for incontinence

A

Dry mouth, blurred vision, constipation, drowsiness

75
Q

what is the surgical treatment of prolapse and stress incontinence

A

Colposuspension (S), detrusor myomectomy (OAB)

76
Q

What is the Fraser criteria?

A

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
Q

Name 3 user dependant contraceptives

A

Male condom, COOP, diaphragm, contraceptive patch

78
Q

Name 3 non-user dependant contraceptives

A

Injection, implant, IUD, sterilisation

79
Q

How does the COCP work?

A

Contains oestrogen and progesterone- prevents ovulation and thins the lining of the womb

80
Q

Name 2 advantages and 2 disadvantages of COCP

A

A: reversible and predicatable, D: drug interactions, can be difficult to take correctly, DVT risk

81
Q

How does the POP work?

A

Thickens the cervical mucus and thins endometrium, can stop ovulation

82
Q

2 advantages and 2 disadvantages of POP

A

No oestrogen SE, doesn’t react with other medications. Less effective and inc risk of ectopics

83
Q

What two things does the fertility awareness method monitor?

A

Temperature and vaginal secretions

84
Q

What is in the contraceptive injection? How does this work?

A

IM progesterone- inhibits ovulation by suppressing LH and FSH

85
Q

How does an IUD work?

A

Copper reaction is toxic to sperm and egg preventing implantation

86
Q

Name 2 long term complications of vasectomy

A

Sperm granulomas, chronic scrotal pain

87
Q

What is a form of emergency contraception?

A

Levonogestrel (progesterone)

88
Q

What is screened on asymptomatic female and male

A

F: self swab for gonorrhoea and chlamydia (NAAT), bloods for syphilis and HIV, M: first void urine NAAT and bloods

89
Q

what is screened in addition in men who have sex with men

A

Pharyngeal swab for G/C, rectal G/C + bloods for Hep B/C

90
Q

name 2 common symptomatic sexual health presentations in females

A

Vaginal discharge and pain

91
Q

name 2 common symptomatic sexual health presentations in males

A

Burning, pain, blisters

92
Q

what sexual health tests would be done in a symptomatic female?

A

High vaginal swab, cervical swab and gonorrhoea culture

93
Q

what sexual health tests would be done in a symptomatic male?

A

Urethral swab and slide, gonorrhoea culture

94
Q

what sexual health tests would be done in a symptomatic male who has sex with men?

A

Urethral, rectal and pharyngeal slides and cultures

95
Q

What is the treatment for chlamydia

A

Azithromycin - 1g single dose

96
Q

what is the treatment for gonorrhoea

A

Ceftriaxone- 500mg IM + azithromycin 1g

97
Q

what is the treatment for syphilis

A

Doxycycline 100mg BD for 14d

Women's Health (65 decks)

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