Obstetrics and Gynaecology Flashcards
Where is oestrogen produced?
By Theca granulosa cells in the ovaries in response to LH and FSH
Where is progesterone produced? Where is it produced in pregnancy?
Corpus luteum after ovulation
In pregnancy after 10 weeks gestation the placenta produces it
What does progesterone do?
It acts on tissues which have previously been stimulated by oestrogen. It: Thickens and maintains the endometrium, thickens cervical mucus and increases body temperature
How can you determine the stage of pubertal development?
Tanners staging
There are 2 phases of the menstrual cycle, what are they?
Follicular phase: from menstruation to ovulation (first 14 days of 28 day cycle)
Luteal phase: from Ovulation to menstruation (last 14d)
What is a fibroid?
A benign tumour of the uterine myometrium (smooth muscle). They are very common and more commonly affect black women. They are oestrogen sensitive
What are the types of fibroids?
Intramural - within the myometrium
Subserosal - On the outer layer, growing into the abdominal cavity
Submucosal - In the endometrium
Pedunculated - has a stalk
What is red degeneration of the fibroids?
Ischaemia, infarction and necrosis of the fibroid due to an interruption of the blood supply
Severe abdominal pain, low-grade fever, tachycardia and vomiting
What is a chocolate cyst?
Endometriomas in the ovaries
What is endometriosis?
A oestrogen dependent, benign inflammatory condition characterised by ectopic endometrial tissue, usually with cysts and fibroids.
In endometriosis, the inflammation can lead to scarring and so adhesions, binding organs together, how might someone with this present?
Chronic, NON-CYCLICAL pain that is sharp, stabbing or pulling and associated with nausea
How might someone with endometriosis present?
Cyclical abdominal or pelvic pain (Dull, heavy or burning)
Dysmenorrhoea
Deep dyspareunia
Infertility
Cyclical bleeding from other sites such as haematuria
What is gold standard in diagnosing endometriosis?
Laparoscopic surgery with biopsy of the lesion
What is menopause?
It is a retrospective diagnosis made after a women has had no periods for 12 months
What do you need for a diagnosis of PCOS?
At least 2 of:
Anovulation, hyperandrogenism, PCOS on US
What tumour markers may you look at in a patient with an ovarian mass?
CA125
LDH, hCG, alpha-FP, CEA
What might cause a raised CA125?
Ovarian cancer, endometriosis, fibroids, pregnancy, pelvic infection, adenomyosis, liver disease
What factors are involved in the risk of malignancy index in an ovarian mass?
US findings, menopausal status, CA125 level
What are some complications of ovarian cysts?
Torsion, haemorrhage, rupture
What triad is seen in Meig’s syndrome?
Ovarian fibroma, pleural effusion, ascites
What is cervical ectropion?
When the columnar epithelium of the endocervix extends to the ectocervix. It is visible on speculum exam
What is lichen sclerosis?
A chronic inflammatory, AI skin condition that presents with patches of shiny ‘porcelain-white’ skin. Commonly affects labia, perineal and perianal area
Vulval itching and skin changes *
What is a serious potential complication of lichen sclerosis?
Squamous cell carcinoma of the vulva
What are the types of urinary incontinence?
Stress - weakness of pelvic floor muscles and sphincter muscles
Urge (OAB) - detrusor overactivity
Mixed
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