Obs&Gynae Flashcards
What are the three tissue layers in the uterus?
Peritoneum, myometrium, endometrium
What is the innervation of the uterus?
Inferior hypogastric plexus: Hypogastric nerves (T10-L2) and splanchnic nerves (S2-4)
What is the blood supply to the uterus?
Uterine and ovarian arteries from the int iliac
What type of epithelium is the cervix?
Columnar which turns to squamous at the external os
What are the two functions of the ovaries?
Steroid hormone production and gametogenesis
Where are ovarian follicles found?
Cortex of ovary
What are the 4 parts to the fallopian tube?
Intramural, isthmus, ampulla, infundibulum
What type of epithelium is found innermost of the uterus?
Ciliated
What type of epithelium is the vagina?
Stratified squamous
Describe the hypothalamic- pituitary- ovarian axis
Hypothalmus releases GnRH- Acts on ant pit- Releases LH and FSH- FSH: oocyte maturation and recruitment, LH: release of egg- both increase oestrogen production
What does FSH act on
Acts on enzyme aromatase in granulose cells of oocyte- converts testosterone to E2
what does LH act on
Theca cells to form testosterone
Name 2 functions of oestrogen
Puberty development, endometrial thickening, vaginal lubrication- inhibits progesterone
Name 3 functions of progesterone
Egg implantation, vascularisation, maintenance of pregnancy- inhibits oestrogen
where is progesterone made
Corpus luteum of oocyte and placenta from 7-8wk
what hormone down regulates the immune response
Human Chorionic gonadotrophin- hCG- stops luteal regression and ensures cont progest. Causes interstitial implantation.
What hormone modifies maternal metabolism to increase glucose supply to the foetus
Human Placental lactogen
what do extravillous trophoblast cells do?
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.
Where do the extravillous trophoblast cells come from?
Cytotrophoblast progenitor cells (stem cells)
Why do women often get diabetes in late pregnancy?
Because in late preg plasma glucose increases but there is increase insulin resistance- thought to be due to glucose sparing for the foetus
Name 3 RF for gestational diabetes
Obesity, previous large baby, 1st degree relatives with diabetes, non-Caucasian
How is gestational diabetes tested for and treated?
GTT at 24-28wks- Metformin then insulin
Why do women get anaemia in pregnancy?
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.
Why is it dangerous to have a macrocytic anaemia in early pregnancy?
Neural tube defects
Why does respiratory rate increase in pregnancy
Progesterone inc RR
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
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
Give two methods of intermittent auscultation
Pinard stethoscope and dopper USS
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
What is the main way to continuously monitor?
Cardiotocography (CTG)
when is continuous monitoring used in pregnancy?
Used with high risk pregnancies that monitoring is needed to ensure safety of the baby
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
What are the 4 things interpreted in the graphs produced in continuous monitoring
Resting rate, variability, acceleration and deceleration
What are the normal values that produce reassuring results in continuous monitoring?
Normal: Baseline: 110-160, >5bpm variability, accelerations present and no decelerations
when would a continuous monitoring graph be non-reassuring
B: 100-109/161-180. V: <5 for 40-90min, early decelerations or variable decelerations
when would a continuous monitoring graph be abnormal?
<100/>180. <5 for >90min. Late decelerations or variable with reduced variability
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
Name 1 other method of continuous monitoring
Direct foetal ECG
Name the 6 stages of the cell cycle
G1, S, G2, mitosis, cytokinesis, G0
Name the 2 key tumour suppressor genes and what each does
P53: transcription factor, Rb: alters activity of transcription factors
Name a gene that can stimulate cancer development and an example
Oncogene: HER-2, RAS
Why is endometrial cancer rising in the incidence?
Obesity and diabetes is increasing which creates unopposed oestrogen leading to high endometrial changes
What is the one symptom that indicates endometrial malignancy investigations
Post-menopausal bleeding
Name 2 investigations you could do for endometrial malignancy
Transvaginal ultrasound and endometrial biopsy- hysteroscopy with biopsy is definitive
What is the most common type of endometrial cancer
Adenocarcinoma
How are the endometrial cancers staged?
FIGO 1/2/3/4
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
What factors of endometrial malignancy are associated with a poor prognosis
Old age, advance stage, deep myometrial invasion, high grade, adenosquamous histology
What is the main cause of Cervical Cancer?
HPV 16 and 18
What are the main transforming gene products?
E6 + E7= both cause growth stimulation
What is the most common type of cervical cancer?
Squamous cell carcinoma
Name 3 other RF of cervical cancer
Early age intercourse, multiple partners, STIs, smoking, COCP, immunosuppression
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
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
Name 2 difficulties of treating young woman with cervical cancer
Fertility preservation and premature babies if pregnancy is successful
Name 2 most common aetiologies of vulval cancer
HPV and lichen sclerosis
Most common pathology in vulval cancer
SCC
name 3 symptoms of vulval cancer
vulva itching, vulva soreness, lump, bleeding, painful urination
How is vulval cancer treated
conservative management, radial removal and lymph node removal, radiotherapy - often too late to treat
Why is ovarian cancer often late to diagnosis
Often presents like IBS, bowel changes, or has no symptoms
Who is most at risk of ovarian cancer?
Ladies who had menarche early and menopause late- babies and breast feeding are also rf
Name 2 familial genes that increase the risk of ovarian cancer?
BRCA, HNPCC
what is the most common pathology in ovarian cancer
Epithelial cell cancer – 50% serous adenocarcinoma
what 2 tests would you do on presentation of ovarian cancer?
CA125 and USS
what is the referral for ovarian cancer based upon?
Risk of malignancy index score: 250+ = gyne oncology referral
Name 4 factors in pelvic floor disorders
Bowel, bladder, vaginal and sexual
what are the 2 main types of incontinence
Stress incontinence and detrusor overactivity- urge (OAB) (+ overflow)
name 2 causes of each type of incontinence
Stress: childbirth, oestrogen deficiency. Urge: idiopathic, MS, UMN
what are the three layers of the pelvic floor
Skin, superficial muscles: transverse perineal, deep muscles- levator ani
name 2 differences between the main types of incontinence in terms of symptoms
OAB: urgency, frequency and psychological, Stress: due to coughing, laughing, movement
Name 3 assessments commonly used for incontinence
Frequency volume charts, urinalysis, residual urine measurement
what is a conservative method of treatment for incontinence
Behavioural therapy- bladder training, physiotherapy, catheters, pads, skin care
whats the medical management for incontinence
Anticholinergic: oxybutynin (M2/3) tolteridine , B3: mirabegron, botox injection, vaginal oestrogen
stress: duloxetine (SNRI)
what are the 4 main SE of the medical treatment for incontinence
Dry mouth, blurred vision, constipation, drowsiness
what is the surgical treatment of prolapse and stress incontinence
Colposuspension (S), detrusor myomectomy (OAB)
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
Name 3 user dependant contraceptives
Male condom, COOP, diaphragm, contraceptive patch
Name 3 non-user dependant contraceptives
Injection, implant, IUD, sterilisation
How does the COCP work?
Contains oestrogen and progesterone- prevents ovulation and thins the lining of the womb
Name 2 advantages and 2 disadvantages of COCP
A: reversible and predicatable, D: drug interactions, can be difficult to take correctly, DVT risk
How does the POP work?
Thickens the cervical mucus and thins endometrium, can stop ovulation
2 advantages and 2 disadvantages of POP
No oestrogen SE, doesn’t react with other medications. Less effective and inc risk of ectopics
What two things does the fertility awareness method monitor?
Temperature and vaginal secretions
What is in the contraceptive injection? How does this work?
IM progesterone- inhibits ovulation by suppressing LH and FSH
How does an IUD work?
Copper reaction is toxic to sperm and egg preventing implantation
Name 2 long term complications of vasectomy
Sperm granulomas, chronic scrotal pain
What is a form of emergency contraception?
Levonogestrel (progesterone)
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
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
name 2 common symptomatic sexual health presentations in females
Vaginal discharge and pain
name 2 common symptomatic sexual health presentations in males
Burning, pain, blisters
what sexual health tests would be done in a symptomatic female?
High vaginal swab, cervical swab and gonorrhoea culture
what sexual health tests would be done in a symptomatic male?
Urethral swab and slide, gonorrhoea culture
what sexual health tests would be done in a symptomatic male who has sex with men?
Urethral, rectal and pharyngeal slides and cultures
What is the treatment for chlamydia
Azithromycin - 1g single dose
what is the treatment for gonorrhoea
Ceftriaxone- 500mg IM + azithromycin 1g
what is the treatment for syphilis
Doxycycline 100mg BD for 14d
