Reproduction & sexual health Flashcards
What is a sclerosing lesion?
Benign proliferation of stroma and and acini cells in the breast
What is a Phyllodes Tumour?
Unilateral breast mass due to stromal overgrowth which can grow quickly.
What part of the breast does a breast carcinoma occur?
Arises in the glandular epithelium of the terminal
duct lobular unit (TDLU).
How much of the breast lobule is involved in a lobular carcinoma in situ (LCIS)?
> 50%
Which is worse LCIS or DCIS?
LCIS
What precursor lesion is likely to become invasive?
DCIS
What hormone receptors are positive and indicative of breast cancer?
Oestrogen receptor (ER), progesterone receptor (PgR), HER2
What ribs do the breasts extend between?
Rib 2 to 6
What is the lymphatic drainage of the breast?
> 75% - drains to the ipsilateral axillary lymph nodes and then to the supraclavicular nodes
Lymph from the inner breast quadrants can drain to the parasternal lymph nodes.
Lymph from the lower inner breast quadrant can drain to the abdominal lymph nodes.
What are the 3 stages of axillary node clearance?
- Level I - inferior and lateral to pectoralis minor
- Level II - deep to pectoralis minor
- Level III - superior and medial to pectoralis minor
What is post-menopausal bleeding a red flag for?
endometrial cancer
What hormone indicates ovulation?
LH surge
What is the role of progesterone in the COCP?
It inhibits follicular development and prevents ovulation
What is sentinel node biopsy used for?
To determine if a tumour has spread to surrounding lymph nodes.
For treating breast cancer what needs to be monitored when on letrozole?
Bone mineral density (aromatase inhibitor medication)
What does FSH do in males?
Acts on sertoli cells to stimulate spermatogenesis
What should never be performed in women with a low lying placenta?
Digital vaginal exam
What are the first line investigations for PID?
Vulvo-vaginal swabs and urine pregnancy test
What organism causes BV?
gardnerella vaginalis
How does CF present in newborns?
Delay in the passage of meconium
What is atrophic vaginitis?
Inflammation and thinning of the genital tissues due to a fall in oestrogen levels, and is most common after menopause.
What does a smear test screen for?
cervical cancer
If a smear test comes back positive what should be done?
Refer to colposcopy and if that is negative screen again in 12months and then after 24months.
What are the tumour markers for germ cell ovarian cancer?
raised alpha-fetoprotein and sometimes beta human chorionic gonadotrophin (B-HCG)
What is post menopausal bleeding a sign of?
endometrial cancer
What is the first line investigation for endometrial cancer?
transvaginal ultrasound (endometrial thickness)
What is the first line investigation for endometrial cancer?
transvaginal ultrasound (endometrial thickness)
What is an oophorectomy?
Removal of the ovaries
What is a salpingo-oopherectomy?
Removal of the fallopian tubes and ovaries
What is a hysterectomy?
Removal of the uterus
What causes blood tinged discharge from the nipple?
intraductal papilloma
How is thrush treated?
intravaginal clotrimazole
What are the paramesonephric (mullerian) tubules?
Paired ducts of the embryo which will go on to form the female reproductive organs at week 7.
What are the mesonephric (wolffian) tubules?
Paired ducts of the embryo which will form the male reproductive organs.
What is the genotypes for Klinefelter’s and how does it present?
47 XXY - males who have atrophic testes, azoospermia, female distribution of body hair, wide set nipples
What condition can cause premature menopause?
addison’s
What is an ectropion?
Most common cause of post-coital bleeding in pre-menopausal women. Ectocervix is lined with stratified squamous epithelium and the endocervix is lined with columnar epithelium. The oestrogen causes the columnar epithelium to be pushed down into the ectocervix causing a red ring round the external os.
What is HELLP syndrome?
haemolysis, elevated liver enzymes, low platelets
What kind of delivery should be done in a mother with HIV?
viral load <50 = vaginal
viral load >50 = elective c section
What does a molar pregnancy increase the risk of?
choriocarcinoma
What is the management for placenta praevia?
corticosteroids between 24-34 weeks
35 weeks - plans for c section at 37-38 weeks
What does lichen sclerosus increase the chance of?
vulvar cancer
Who are epithelial ovarian tumours common in?
post-menopausal women
What are the characteristics of a fibroadenoma?
small, painless, round, mobile masses
What typically presents with bilateral breast lumps and pain?
fibrocystic disease
How does gonorrhoea present on microscopy?
Gram-negative diplococci within polymorphonuclear leukocytes.
How is HIV diagnosed?
Serum HIV enzyme-linked immunosorbent assay (ELISA) and one other second test.
How does secondary syphilis usually present?
maculopapular symmetrical rash on the palms, legs, soles and face
What is the treatment for PID?
ofloxacin + metronidazole
What cancer is a pelvic mass most likely to indicate?
ovarian cancer
What cancer is a pelvic mass most likely to indicate?
ovarian cancer
What is misoprostol and what does it do?
Used for a TOP.
It is a synthetic prostaglandin which expels products of conception.
Why is mifepristone used at the end of a TOP?
It is a progesterone-receptor antagonist and is used to end the pregnancy.
What presents with a “snowstorm” appearance on US?
molar pregnancy - imbalance in the number of chromosomes from the mother and father
When is additional precautions needed when a pill is missed?
2 or > pills
When in the pregnancy is folic acid useful and why?
early pregnancy (first 12 weeks) before the neural tube closes
What cancers are BRACA genes linked to?
breast and ovarian
What treatment is given to HER2 positive breast cancer?
Trastuzumab
What medication is prescribed for ER positive cancers?
tamoxifen
How do you calculate the RMI for ovarian cancer?
A x B x C:
A - menopausal status (pre=1, post=3)
B - Us features (1 = 1, >1 = 3)
C - serum ca125
What is the common triad for vasa praevia?
Painless vaginal bleeding, rupture of membranes,
foetal bradycardia (resulting in foetal death)
What is a placenta abruption and common sx?
Premature separation of the placenta from the uterine wall. Sudden and severe abdo pain, hard uterus, bleeding.
When is Fitz-Hugh-Curtis syndrome common?
Post infection (gonorrhoea)
Which STD presents as a solitary, painless lesion?
syphilis (treponema pallidum)
How should an episiotomy be cut?
Posterior to the vagina, mediolaterally into soft tissues of the perineum and perineal skin.
How far apart do bp reading have to be to diagnose pre-eclampsia?
4-6hrs
From when in the pregnancy should symphysis fundus height be measured?
every appointment from 24 weeks
When is placenta previa likely to present?
after 24weeks
What kind of virus is HIV?
RNA retrovirus which targets and destroys CD4 cells.
Which contraceptive method should be used in a patient with epilepsy taking carbamazepine?
progesterone injection
Which lymph nodes do endometrial cancer first spread to?
para-aortic
Which blood pressure medication should be stopped in pregnancy and what should it be changed to?
ACEI (e.g. ramipril) and should be changed to a beta blocker unless contraindicated then ARB (e.g. nifedipine)
What infections are screened for in a routine infection screen in pregnancy?
Hep B, syphilis, HIV
How is severe pre-eclampsia treated?
magnesium sulphate 4g over 5-15 mins, 1g/hr for 24hrs
Why is the uterus enlarged in a molar pregnancy?
Excessive growth of trophoblasts and retained blood.
How are eclampsia seizures treated?
IV magnesium sulphate
How is an ectopic pregnancy with a b-hcg <5000 treated?
IM methotrexate
What are patients on cART at a significant risk of?
both kinds of stroke
Which lymph nodes to cervical ssc spread to first?
pelvic lymph nodes along the iliac arteries
What STI presents as a gram negative diplococci on film?
gonorrhoea
What are the initial investigations if pre-eclampsia is suspected?
FBC, U&E, LFT
When is rhesus D give to -ve women?
28 weeks
What does PCOS increase your risk of?
endometrial cancer
Which cancer does smoking have the greatest risk for?
cervical cancer
Which cancers are obesity a risk factor for?
breast and endometrial
When do you start contraception of a post-partum women?
After 21 days (POP whenever)
What is oxybutynin and what is it used for?
Anticholinergic - for urge incontinence
What is the medical option for stress incontinence?
duloxetine (SNRI)
What are the 4 degrees of urogenital prolapses?
1st degree: mild protrusion on examination (-1cm of introitus)
2nd degree: prolapse present at vagina/anus/urethra
(between -1 cm and +1cm )
3rd degree: prolapse protruding outside
4th degree: complete prolapse
What is the surgical treatment for anterior/posterior prolapse?
colporrhaphy
What form of HPV cause genital warts?
6 and 11
Where is the site of spermatogenesis?
Inside the seminiferous tubules inside the testes.
What is the precursor molecule for all steroid hormones?
cholesterol
What us LGV and how does it present?
STI by chlamydia which causes painful ulcers and inguinal lymphadenopathy.
How are eclampsia seizures treated?
magnesium sulphate
If there is any painless bleeding after 13 weeks what investigation should be done?
transvaginal ultrasound
How is gestational diabetes diagnosed?
2hr OGTT (24-28 weeks) asap after booking visit
What painkillers should be avoided in pregnancy?
NSAIDs
What is used to treat chlamydia if patients are non-compliant/penicillin allergic?
azithromycin - one oral dose
What is the most common kind of ovarian cancer?
epithelial
Which kind of ovarian cancer arises from the embryonic gonad?
germ cell
What is intermenstrual bleeding a red flag for?
endometrial cancer
What is postcoital bleeding a red flag for?
cervical cancer
When is cervical screening done from?
From 25-64yrs every 3yrs (after 49yrs every 5yrs).
When using the POP if one pill is missed what should be done?
Take the missed pill, continue pill pack and use extra protection for 48hrs.
Gravida vs parida.
Gravida is the total number of confirmed pregnancies that a female has had. Para is the number of births that a female has had after 20 weeks gestation.
What would the screening test show if the foetus has down syndrome?
PAPP-A low, aFP low, beta-hCG high, nuchal translucency measurement increased.
What test is needed to be done to diagnose PCOS?
US
What can an oestrogen deficiency cause?
weakened pelvic floor
What are the 7 cardinal movements of labour?
Engagement, Descent, Flexion, Internal rotation, Extension, External rotation and then Expulsion.
Where oestrogen produced?
ovaries, placenta and blood
What are the functions of oestrogen? [6]
~ proliferation of the endometrium
~ promotes development of genitalia
~ promotes growth of follicle
~ causes LH surge
~ fat distribution
~ increases hepatic synthesis of transport proteins
Where is progesterone produced?
corpus luteum, placenta, adrenal cortex
What does progesterone do? [5]
~ maintenance of endometrium and pregnancy
~ thickens cervical mucus
~ decreases myometrial excitability
~ increases body temp.
~ spiral artery development
What structures drain to the superficial inguinal lymph nodes? [6]
anal canal below pectinate line, perineum, skin of thigh, penis, scrotum, vagina
What structures drain to the internal iliac lymph nodes?
anal canal above pectinate line, lower part of the rectum, pelvic structures (cervix, uterus - lower part)
Where does the glans penis lymph drain?
deep inguinal lymph nodes
Describe Kallmann syndrome. (inheritance pattern, hormone indicators, symptoms)
Hypogonadotropic hypogonadism which is X-linked (low GnRH, oestrogen, LH, FSH) and associated symptoms of colorblindness, anosmia, cleft lip.
Describe Klinefelter’s?
Primary hypogonadism 47XXY (high LH, low testosterone) - often taller than average, firm testes, infertile, gynaecomastia, elevated gonadotrophin levels
What is the chromosomal pattern for Turner’s syndrome?
45XO
What cells line the endo/ecto cervix?
endo = simple columnar
ecto = stratified squamous
What part of the breast is cancer most likely to arise?
upper lateral
What do leydig cells do?
Produce testosterone in response to LH.
What electrolyte disturbances are likely to be seen in HG?
- hyponatraemia
- hypokalaemia
- hypochloraemia
- metabolic alkalosis
What is the shape of chlamydia?
gram -ve intracellular rods
What b-hcg levels indicate ectopic pregnancy or molar pregnancy?
ectopic - >1500
molar - >100,000
What is screened for at a booking appointment?
HIV, syphilis, Hep B, sickle cell, thalassaemia
What does HRT increase your risk of?
Increased risk of breast cancer, endometrial cancer, VTE, stroke and ischaemic heart disease.
What is the medical management for an ectopic pregnancy?
methotrexate
What are the lab findings for PCOS?
testosterone - high
LH - high
FSH - normal
sex hormone binding globulin - low
What does oligomenorrhea (infrequent periods) increase the risk of?
endometrial cancer
What is the treatment for PID?
doxycycline, metronidazole and ceftriaxone
A patient with new breast lump what is the correct course of referral?
<30 yrs - routine referral
>30 yrs - urgent referral
How long after birth is no contraception required?
3 weeks
When can an IUD be fitted after giving birth?
First 48hrs or after 28days.
What pill is contraindicated after giving birth for 6 weeks and why?
COCP - oestrogen
What is the gold standard test to check tubal patency?
laparoscopy
How does an erection occur?
Release of nitric oxide relaxes the smooth muscles causing vasodilation.
What is abnormal on CTG?
Variable and late decelerations
What is a common side effect of an epidural?
hypotension
When is an anomaly scan done?
18-20 +6 weeks
Who is uterine rupture more common in?
Women who have had a previous c section
What is a major complication of breech delivery?
cord prolapse
What group are more at risk of epithelial ovarian tumours vs germ cell ovarian tumours?
epithelial - post menopausal women
germ cell - younger age (less common)
