passmed 03 Flashcards
dyskaryosis
cervical screening is HPV positive and shows abnormal changes in cervix
cryotherapy
use of extreme cold to destroy cancer cells
cold coagulation
after cervical intraepithelial neoplasia what is the follow up test date?
6 months after treatment
the luteal phase of the menstrual cycle is ?
always 14 days
serum progesterone 7 days prior to period is elevated this shows ovulation has occure
>30 nmol/l
menorrhagia first line
mirena - IUD
endometrial cancer stage 2 - adenocarcinoma
total abdominal hysterectomy with bilateral salpingo-oophorectomy
> 4mm endometrial thickness suggests
endometrial cancer - hysteroscopy indicated with endometrial biopsy
what can be the location of an androgen secreting tumour?
ovary
adrenal glands
POI
causes?
idiopathic
endometriosis and fixed retroverted uterus
inflammation
routine cervical screening
every 5 years if over 50
every 3 years if 25-50
fibroid degeneration
uterine fibroids are sensitive to oestrogen and can therfore grow during pregnancy
if growth outstrips blood supply
low grade fever
pain
vomiting
role of Sex hormone binding globulin
plasma protein
binds steroid hormones oestrogen
testosterone
dihydrostestosterone
low concentrations increases concentration of unbound biologically active testosterone and dihydrotestosterone > leading ro hyperandrogenism which is associated wiht PCOS
when is colposcopy indicated when there is no cytological abnormality
on 3rd successive annual smear whichh is still HrHPV +
moa of oxybutinin
anti-muscarinic
treats detrusor muscle over activity
as contraction of detrusor muscle is controled by muscarinic cholinergic receptors
first line for hyperemesis gravidarum
antihistamines
promethazine
stress incontinence management ?
duloxetine
snri
whirl pool sign on TVUSS
ovarian torsion
free pelvic fluid
the fluid is from the transudate from ovarian capsule due to venous and lymphatic obstruction
differentiating ruptured ovarian cyst from torsion
acute onset pain / maximal at onset prior hx of cyst
torsion - gradual, progressive pain associated with hx pf sport
how to assess hyperemesis gravidarum?
pregnancy unique qauntification of emesis
PUQE
oral ondansetron during first trimester risk ?
cleft lip
what ovarian cysts should be biopsied?
multi-loculated - complex
high suspicion of ovarian malignancy
m rules for cysts
Irregular, solid tumour.
Ascites.
At least 4 papillary structures.
Irregular multilocular solid tumour with largest diameter ≥100 mm.
Very strong blood flow.
B rules for cysts
unilocular
presecence of solid components with largest diameter <7 mm
presence of acoustic shadows
smooth multilocular tumour with largest diameter
no blood flow
benign ovarian cysts can be divided into
germ cell tumours
epithelial
benign sex cord stromal tumours
management of adenomyosis
supportive - tranexamic
GnRH agonists
uterine artery embolistaion
hysterectomy
whiff test
sample of discharge mixed with potassium hydroxide - if + semlls fishy
+ vaginosis
clue cells
epithelial cells from the vagina that have loads of bacteria stuck to the surface so the edges look fuzzy
+ in vaginosis
mx - metronidazole
what is the fitz-high-curtis syndrome ?
hepatic adhesions
> inflammation of the liver capsule
medical management of ectopic
minimal symptooms
unruptured
serum less than 1500i/L
50mg of methotrexate
what is used in emergency contraception?
urlipristal
HIV +
and cervical cancer
how often to check?
increased cervical intra-epithelial neoplasia
risk
why?
decreased immune response and decreased clearance of HPV
annually
which HPV is a risk for cervical?
16
18
33
risk factors for cervical cancer?
smoking
human immunodeficiency virus
early first intercourse,
many sexual partners
high parity
lower socioeconomic status
combined oral contraceptive pill*
mechanism of HPV causing cervical cancer?
hpv produces oncogenes
e6/7
e6 inhibits p53 tumour suppressor gene
E7 inhibits RB suppressor gene
oestrogen effects on endometrium and how does this affect HRT in menopause
increased risk fo endometrial cancer as oestrogen stimualtes growth of endometrium
= endometrial hyperplasia
persistent unexplained vulval skin lesion
2 week wait referral
unexplained vaginal lump / ulceration / bleeding
lichen sclerosus management?
topical corticosteroids
causes patchy itchy white areas
itching and irritation
how does trich present?
how is it investigate
management?
offensive
yellow-green discharge
strawberry cervix
high vaginal swab
metronidazole
factors making candidiasis more likely?
DM
antibiotics
steroids
pregnancy
HIV
complete androgen insensitivity
genitals appear female
but it is 46XY
but body does not respond to testosterone
> sex development of a typical male
x linked
check sex chromosmes
check for genetic change
measure sex hormone levels
partial androgen insensitivity syndrome
where testosterone has some effect on sex development, so the genitals are often not as expected for boys or girls
enlarged clitoris
partially undescended testes
hypospadia s
gender identity and CAI
raise as what?
female genitals
no testosterone response
always identify as female gender when they’re older
what is a surgery for symptomatic fibroid in a young female patients
open myomectomy
s/e : adhesions
features of fibroids?
bulk related symptoms ?
menorrhagia
> iron deficiency anaemia
lower abdominal pain
bloating
urinary symptoms
subfertility
rare: polycythaemia
when can LNG-IUS not be used in fibroid management?
distortion of uterine cavity
how can GnRH help in fibroids?
reduced size of fibroid
pregnant women < 6 weeks with vaginal bleed and no pain?
manage expectantly
repeat urine pregnancy test after 7-10 days and reture if positive
how doe intended parents become legal parents in surrogacy ?
Parental Order, provided for in Section 30 of the Human Fertilisation & Embryology Act.
meig’s syndrome?
features?
benign ovarian tumour
ascites
pleural effusion
ovarian tumours
4 types?
surface derived
germ cell
sex cord stromal tumours
metastasis
krukenberg tumour?
metastatses from a GI tumour results in mucin-secreting signet ring cell
adenocarcinoma
sex cord stromal tumour
malignant
granulosa cell tumour
> produces oestrogen > precocious puberty
or endometrial hyperplasia
contains call-exner bodies
fibroma
solid tumour consisting of bundles of spindle shaped fibroblasts
assocuated with meigs syndrome
germ cell tumours-
teratoma
if immature > malignant
contain ectodermal (hair)
mesodermal (bone)
endodermal
dysgerminoma
associated with turner
secrete hCG, LDH
yolk sac tumour features?
malignant germ cell tumour
secretes AFP
schiller-duval bodies pathogenomic
choriocarcinoma
rare tumour that is part of GTD
spread to lungs
laparotomy
is quicker so used in haemodynamic unstable
hyperemesis gravidarum what has shown to reduce incidience?
smoking
ovarian tumour associated with development of endometrial hyperplasia?
granulosa cell tumour
migraine with aura HRT
topical cyclical
