repro - STJ

Question 1

how to remember the different hormones

Answer 1

estrogen’ = ovulation
progestrone = what if get pregnant
hCG = saviour hormone

Question 2

what does hCG do?

Answer 2

1. maintain CL
   = CL produce progestrone and estrogen
   = maintain uterine lining + supress uterine contractions
   = progestrone preps for early stages sof pregnancy

Question 3

when does the hCG peak, and why does it drop after that?

Answer 3

week 10-12 of pregnancy

drops during the lutheal placental shift
= placenta takes over the production of progestrone and estrogen
= hCG levels decline and hit a stable low lvl throughout pregnancy

Question 4

why does the estrogen level continue to rise in pregnancy?

Answer 4

1. growth of uterus
2. development of milk ducts in the breast

Question 5

draw the graph of hormones out in your head

Answer 5

Question 6

what does STD usually cause?

Answer 6

PID and salpingitis (inflammed fallopain tube)

which can lead to further complications if not treated

Question 7

what microb is an IUD usually associated with?

Answer 7

actinomyces israelii

Question 8

what physical examination is used to test for PID and endometriosis?

Answer 8

chandelier’s test
= indicates inflammation of pelvic organs
= extreme pain

chandelier’s sign: extreme cervical motion tenderness during a pelvic exam

Question 9

what are the complications (Cx) of PID and salpingitis?

Answer 9

1. adhesions
   (inflammation = more sticky = adhere)
2. peritonitis
   (bacteria enters fallopain tube –> fimbrae –> peritoneal cavity)
3. bacterimea + sepsis
4. etopic pregnancy
   (due to strictures, adhesions etc.)

Question 10

what drugs to treat gonorrhoea and chalymedia (assume co infection)

Answer 10

ceftriaxone + azithromycin

Question 11

what patho is this

Answer 11

cervical carcinoma
= cauliflower like groth of the cervix WITH NORMAL THICKNESS of uterine wall

Question 12

what increases the risk of cervical carcinoma/ cervical intraepithelial neoplasia

Answer 12

“think xmm xdd” –> anything that causes physical, emotional trauma

oral contraceptive pills
= hormonal lvl changes
= cervical cells more prone

Question 13

what signs in a gyane patient to make the dr think it MIGHT BE CANCER?

Answer 13

1. intermenstrual bleeding
2. post coital bleeding
3. dyspareunia (painful & difficult sex) –> dys = painful, pareunia = sex
4. palpable masses

Question 14

*possible MCQ

cervical cancer screening in singapore available to women

Answer 14

25-29: PAP smear cytology, every 3 years

30>: HPV DNA immunohistochemistry swab, every 5 years

**think??
from 30 years old
= immune system is weaker
= need better test to find the HPV strain

Question 15

how to classify cervical carcinoma?

Answer 15

squamous intraepithelial lesion

Question 16

endometrium sheds every month because of hormones

what are the difference in overall risk factors for cervical CA vs endometrial CA?

Answer 16

cervical: traumatic cancer
endometrial: hormonal cancer (because endometrial lining is shed due to hormone changes)

**NUMBER 1 CAUSE OF ENDOMETRIAL CANCER IS OBESITY

Question 17

what are the top 4 risk factors for endometrial carcinoma

Answer 17

1. obesity
2. peri/postmenopausal (since hormonal axis is disrupted)
3. estrogen producing ovarian tumours
4. estrogen hormone therapy

Question 18

what are the difference in types of atypial hyperplasia?

Question 19

what is PTEN and what is its role in a pathway?

Answer 19

PTEN is a TSG
= negatively regulate PI3K/ AKT pathway
= ensures no excessive cell growth, proliferation divison and survival

Question 20

is atypical hyperplasi cancer or precancerous

Answer 20

precancerous

Question 21

think: estrogen vs non estrogen factors + mutations

what is the pathogenesis of endometrial carcinoma? (of type 1 vs 2 endo CA)

Answer 21

type 1:
estrogen factors
= LoF of PTEN

estrogen factors
= atypical hyperplasia (LoF of PTEN)
= type 1 endo. CA

type 2: