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Systems III Flashcards

1
Q

what is the most common type of physiological cysts?

A

follicular cyst

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2
Q

what are the key features of a corpus luteum cyst?

A

higher tendency to cause intraperitoneal bleeding

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3
Q

what are the two kinds and features of gynecological epithelial tumours?

A
  1. serous cystadenoma (most common and may mimic serous carcinoma)
  2. mucous cystadenoma (may be massive in size)
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4
Q

what is an endometrioma?

A

AKA chocolate cyst. this is a complication of endometriosis.

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5
Q

what is endometriosis?

A

a condition where endometrial tissue occurs outside the uterine cavity. exact cause is unknown but the present theory regards retrograde menstruation as the most likely theory
investigate with bimanual and speculum examination followed by laparoscopy

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6
Q

what are the symptoms of endometriosis?

A
  1. chronic pelvic pain
  2. retroverted uterus
  3. dysmenorrhoea
  4. deep dyspareunia
  5. ovulaiton pain
  6. dyschezia
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7
Q

what are the investigations for endometriosis?

A
  1. pelvic USS - large nodules or endometriomas may be visible
  2. MRI pelvis - if severe disease suspected and surgical planning necessary
  3. diagnostic laparoscopy (GOLD STANDARD)
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8
Q

what is endometriosis management?

A
  1. NSAIDs (first line)
    paracetamol is second line. third line is codeine.
    COCP will be used if none of the above work.
  2. danazol (weak progestogen has androgenic side effects)
  3. mirena intrauterine system
  4. GnRH agonist

SURGERY
1. aim is to diagnose and surgically remove endometriosis and can range from laparoscopic ablation of lesions to hysterectomy and bilateral salpingo-oophorectomy, total abdominal hysterectomy

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9
Q

what are bartholin’s abscess?

A

commonest cause of vulval swelling. they have a higher incidence in diabetes

caused by dilatation of the bartholin gland caused by blockage to the outflow tract. abscess formation can occur

symptoms - pain, swelling, dyspareunia, tender to palpation

management is with drainage and marsupialisation - inner cyst wall is sutured to the skin to create a new duct opening

there is a 10% risk of recurrence.

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10
Q

how do you treat stress incontinence?

A

CONSERVATIVE - patient advice, smoking cessation and weight loss etc
MEDICATION - Koestrogen may be given to post-menopausal women
FIRST LINE - Kegel pelvic floor exercises
SURGERY - urethropexy, bladder neck suspension surgery (Burch and sling procedures)

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11
Q

what is stress incontinence

A

urine is passed with any movement that increases intra-abdominal pressure - sneezing etc. it is aggravated by pregnancy, obesity and COPD

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12
Q

what si urge incontinence?

A

too much contraction of bladder detrusor. the cause may be due to a neoplasm or nerve damage (MS, parkinsons or stroke)

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13
Q

what investigations would you want to carry out for ALL kinds of incontinence?

A
  1. urinalysis
  2. post-voidal residual volume
  3. urodynamic testing
  4. endoscope testing
  5. radiology - XR and USS
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14
Q

what is the difference in treatment for urge incontinence and overflow incontinence?

A

Urge (detrusor overactivity) treat with Anticholinergic meds - oxybutynin and treatment of the underlying condition

Overflow incontinence treat with bethanecol (cholinergic) which is to improve the activity of the detrusor. overflow should also be given immediate catheterisation and conservational therapy (stopping precipitating medications etc)

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15
Q

what is the pathology of overflow incontinence?

A

too little contraction of detrussor muscle. this happens due to a marked increase in bladder residual volume.

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16
Q

what are the barrier methods of contraception - name 3

A

cap
diaphragm
condoms

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17
Q

name 5 kinds of hormonal contraception

A
  1. COCP - thicken endometrial lining and thus prevents ovulation and prevents implantation. there is effective contraception after 7 days
  2. POP - thickens cervical mucus and secretions making it inhospitable to sperm
  3. Contraception injection - depo-provera used and is given 12 weekly. there is a delay in the return of fertility once stopping the injection and can take up to 12 months to return
  4. Contraceptive implant

Radio-opaque implant (Nexplanon) is inserted subdermally in the non-dominant arm. it is the long acting contraception of choice in people with poor compliance to medication

  1. Emergency contraceptive
  2. 5mg of levenorgestrel taken within 72 hours of unprotected sex
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18
Q

the copper coil IUD will provide immediate contraception TF?

A

T

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19
Q

what hormone does the IUS mirena release?

A

levonorgestrel. it will thicken cervical mucus and secretions this preventing endometrial proliferation

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20
Q

the first antenatal booking appointment is 8-12 weeks. what happens during this appointment?

A
  1. take a general history about PMH and maternal lifestyle factors including alcohol, smoking and diet
  2. enquire woman about folic acid supplements and vitamin D supplements
  3. measure BP
  4. perform a urine dipstick and culture (for asymptomatic bacteruria)
  5. measure BMI
  6. routine blood tests such as FBC, blood group, rheesus status, red blood cell alloantibodies
  7. screen for infectious disease such as HIV, Hep B, rubella and syphilis
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21
Q

what are the 4 main infectious diseases that are screened for at the 8-12 week gestation appointment?

A

HIV
Hep B
syphilis
Rubella

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22
Q

what is checked for in the 10-13 (+6) weeks appointment?

A
  1. date confirming scan
  2. screen for multiple pregnancy
  3. screening for down’s syndrome - the combined test is offered to women 11-14 week gestation.

this is a nuchal translucency and B-hCG test and pregnancy associated plasma protein A (PAPP-A)

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23
Q

when does the fetal anomaly scan take place?

A

18-20 weeks

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24
Q

what is tested for at the 16 week appointment??

A
  1. routine blood tests- FBC - give iron supplementation is anaemic
  2. measure BP
  3. perform a urine dipstick and culture
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25
Q

what happens at the 25 and 31 week appointment??

A

this scan is only for primiparous women

measure symphysis-fundal height (SFH)
measure BP
perform a urine dipstick and culture

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26
Q

what happens at the 28 week appointment??

A
  1. measure SFH
  2. blood pressure
  3. perform a urine dipstick and culture
  4. routine blood test: FBC - give iron if anaemic and check for atypical red blood cell alloantibodies
  5. give anti D prophylaxis to Rheesus negative mother
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27
Q

what happens at the 34 week appointment??

A
  1. measure SFH
  2. BP
  3. urine dipstick and culture
  4. anti-D prophylaxis to rheesus negative mothers
  5. counsel mother about birthing plan and specific wishes or concerns
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28
Q

what happens at the 36 week appointment?

A
  1. measure SFH
  2. BP
  3. urine dipstick and culture
  4. external cephalic version for breech deliveries
  5. counsel mother about breastfeeding and post-natal depression/baby blues
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29
Q

what happens at the 38+ week appointment?

A
  1. measure SFH
  2. BP
  3. urine dipstick and culture
  4. counsel mother about induction of labour (IoL)
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30
Q

there are 3 stages of labour, describe them

A
  1. onset of contractions until full cervical dilatation

a. latent active (up to 4cm dilatation)
b. active stage (4-10cm)

  1. from full dilatation of the cervix until the delivery of the fetus (2-3h)

passive and an active phase

a. Engagement
b. Descent
c. Flexion
d. Internal Rotation
e. Extension
f. External Rotation
g. Delivery of shoulders and body

  1. from delivery of the fetus until delivery of the placenta (30 minutes)
31
Q

what are 4 important investigations during the first stage of labour?

A
  1. fetal heart rate using a CTG
  2. maternal HR
  3. ,maternal BP
  4. maternal temperature

these tests should also be monitored until the baby has been delivered (end of the 1st stage of labour)

32
Q

what are the most important investigations that should take place after the 3rd stage of labour?

A

measure the fetal response using APGAR score and check maternal vital signs

33
Q

how do you manage shoulder dystocia?

A

shoulder dystocia has a lot of associations such as diabetes mellitus, macrosomia, small maternal size and past obstetric history of shoulder history

management is with McRoberts manouvre (others include the Wood’s Screw procedure and the Zavanelli manouvre)

34
Q

name the most common endocrine, neurological, infectious and hypertensive problem in pregnancy

A

endocrine - diabetes
neurological - epilepsy
infectious - TORCH
hypertensive - pre-eclampsia and eclampsia

35
Q

name 3 problems in pregnancy relating to specific liver disease

A
  1. hyperemesis gravidum
  2. intrahepatic cholestasis of pregnancy
  3. acute fatty liver disease
36
Q

name 5 benefits for the baby if mother is breast feeding their child

A
  1. decreased risk of infection
  2. decreased risk of eczema
  3. decreased risk of diabetes mellitus
  4. decreased risk of diarrhoea and vomiting
  5. decreased risk of asthma

BENEFITS FOR MOTHER

  1. decreased risk of breast and ovarian cancer
  2. decreased risk of osteoporosis
  3. increased bonding with child
37
Q

what are the disadvantages of breastfeeding

A
  1. vertical transmission of disease (HIV)
  2. risk of mastitis
  3. mother requires additional calories
38
Q

name 3 absolute contraindications to breast feeding

A
  1. viral infections
  2. galactosaemia
  3. drugs - antibiotics (tetracycline’s), aspirin, amiodarone, benzodiazepine, cytotoxic drugs, carbimazole and sulphonylureas
39
Q

where is progesterone secreted?

A

PRODUCED BY: corpus luteum, placenta and adrenal cortex

FUNCTION - maintains pregnancy, produces cervical mucus, increases body temperature, inhibits LH and FSH, relaxes uterine smooth muscle, downregulates oestrogen receptors, increases endometrial gland secretion, increases endometrial gland secretion, increases spiral artery development. softens ligaments during pregnancy

40
Q

Name 5 functions of progesterone

A
  1. maintains pregnancy
  2. produces cervical mucus
  3. increases body temperature
  4. inhibits LH and FSH
  5. relaxes uterine smooth muscle
  6. downregulates oestrogen receptors
  7. increases endometrial gland secretion
  8. increases endometrial gland secretion
  9. increases spiral artery development.
  10. softens ligaments during pregnancy
41
Q

where is inhibin produced and what is its function?

A

inhibin is produced by the sertolli cells and it is responsible for inhibiting FSH

42
Q

where is oesterogen secreted?

A

ovaries and placenta

43
Q

name 5 functions of oestrogen

A
  1. genital development
  2. breast development
  3. follicle growth
  4. endometrial growth
  5. upregulates oestrogen, LH and progesterone receptors
  6. inhibits FSH and LH through feedback mechanism
  7. stimulates prolactin
  8. stimulates LH surge which causes ovulation
  9. increases protein transport
44
Q

where is LH and FSH produced

A

both produced by the anterior pituitary

45
Q

what is the function of LH?

A

stimulates leydig cells to produce testosterone and surge causes ovulation

46
Q

what is the function of FSH?

A
  1. stimulates sertolli cells to produce androgen binding protein
  2. stimulate sertolli cells to produce inhibin
47
Q

what is mastitis?

A

inflammation of the breast tissue. it causes milk stasis or overproduction. this causes regional infection of the breast parenchyma with staph aureus which enters the breast breast via trauma to the nipple. this in turn causes mastitis

48
Q

what are the signs and symptoms of mastitis?

A
  1. calor, dolor, rubor and tumour (heat, pain, redness and swelling)
  2. nipple discharge
  3. fever

it is diagnosed clinically and so no investigations are necessary

49
Q

what is the treatment for mastitis?

A

CONSERVATIVE - patient education. encourage mother to continue breastfeeding since this will help overcome the obstruction
MEDICAL - flucloxacillin

50
Q

name 4 renal changes to the body due to pregnancy

A
  1. increase in kidney size
  2. increase in frequency of urination
  3. increase in glomerular filtration rate
  4. increase in urinary tract infection risk due to dilated, elongated ureters
51
Q

what are some GI changes in the body due to pregnancy?

A
  1. constipation
  2. GORD
  3. increased risk of gallstones
  4. Gestational diabetes
52
Q

what are the effects of pregnancy on the cardiovascular system?

A
  1. lower BP because progesterone decreases vascular resistance by ncreasing spiral artery formation
  2. increased cardiac output
  3. increased blood volume since RAAS is sitmulated in lowered BP
  4. constriction of peripheral circulation (this is why some pregnancy women experience Raynauds phenomenon)
53
Q

a phyllodes tumour is a benign breast tumour - TF?

A

T

54
Q

name 3 types of benign breast tumour

A
  1. phyllodes - large and rapid growth. it has leaf like projections
  2. fibroadenoma
    - small and has sharp edges. most common type of breast tumour in young women
  3. intraductal papilloma
    small and under the areola. it will present with blood discharge under the nipple
55
Q

pagets disease of breast is malignant - TF?

A

T

there will be intradermal infiltration of ductal carcinoma and there may be eczemoid nipple changes

56
Q

what are the risk factors for breast cancer??

A

female
increasing age
family history of breast cancer - BRCA1 (Chr17) and BRCA2 (Chr13)
alcohol
obesity
increased oestrogen exposure - early menarche and late menopause, OCP, HRT, decreased parity and not breastfeeding

57
Q

what investigations would you like to do for breast cancer?

A

triple therapy

  1. examination - hard lump, fixed mass, tethering to skin, oedema (dimpling)
  2. imaging - mammography (soft tissue opacities, masses, microcalcifications - deposits of calcium), USS, MRI, FNAC, CXR and CT
  3. biopsy Needle core biopsy
58
Q

what is the most common invasive type of breast cancer?

A

Invasive ductal carcinoma of special type NST.

the second most common is the invasive lobular carcinoma

medullary cancers will affect the young and mucoid cacners will affect the old.

59
Q

non-invasive ductal carcinoma is an invasive cancer - TF?

A

no but it is premalignant and will be seen with microcalcifications of mammography (unifocal or widespread)

non-invasive lobular carcinoma in situ ios more rare and is usually multifocal.

60
Q

what are the signs that will be seen indicative of breast cancer?

A 
skin dimpling
p'eau d' orange
abnormal contours
nipple retraction and deviation 
eczema like skin changes (esp in pagets disease of the nipple)
oedema
61
Q

how do we assess prognosis and base treatment in breast cancer?

A

the Nottingham Prognostic index (NPI)

NPI = (0.2 x invasive size) + lymph node stage +grade of tumour

medical treatment may be split into adjuvant hormone therapy, chemotherapy or HER2 directed therapy.

HORMONE TREATMENT

  • premenopausal - tamoxifen (SERM)
  • postmenopausal women are treated with anastrazole (aromatase inhibitor)

HER2 directed therapy:
- trastuzumab (herceptin) - monoclonal antibody against the extracellular domain of HER2 receptor

SURGERY
remove invasive and non-invasive cancer with clear margins. lumpectomy followed by radiotherapy has shown to be as effective as mastectomy but mastectomy may be recommended in certain circumstances such as multifocal breast disease

the ipsilateral axilla should also be assessed by US, fine needle aspiration or core biopsy

if a women because menopausal during treatment then she will benefit from switching treatments.

62
Q

what are the main complications of breast tumours?

A
  1. death
  2. metastases
  3. complications of chemo regimen
  4. complications of radio
  5. depression
63
Q

what causes benign prostate hyperplasia?

A

hypertrophy of the epithelial and stromal cells of the prostate gland. it classically occurs in the transitional zone of the prostate gland is thought to be driven by androgen dihydrotestosterone

64
Q

what are the signs and symptoms of benign prostate hyperplasia?

A
  1. frequency
  2. urgency
  3. nocturia
  4. BOO (bladder outflow obstruction)

a. hesitancy
b. intermittent flow/poor urine stream/dribbling
c. incomplete bladder emptying

65
Q

what are the complications of benign prostate hyperplasia?

A
  1. urinary retention
  2. recurrent UTI
  3. impaired renal function
  4. haematuria
66
Q

what is the management of benign prostate hyperplasia?

A
  1. CONSERVATIVE - watch and wait in mild disease
  2. voiding diary
  3. alpha 1 adrenoreceptor blockers (tamsulosin)
  4. 5alpha reductase inhibitors (finasteride)
  5. transurethral resection of the prostate (TURP)
67
Q

what investigations do you want to carry out for benign prostate hyperplasia ?

A
  1. PR exam, to find an enlarged but smooth prostate gland with a palpable midline sulcus
  2. urine dipstick, microscopy and culture
  3. bloods: FBC, UE and creatinine (renal function)
  4. PSA usually raised
  5. US of urinary tract and a transrectal US
68
Q

in which zone of the prostate do most cancers arise?

A

peripheral zone

69
Q

what type of cancer is a cervical cancer?

A

adenocarcinoma and is most found in the peripheral zone of the prostate gland.

70
Q

what are the risk factors for prostate cancer?

A

age
family history
more common in african populations

71
Q

what are the signs and symptoms of prostate cancer?

A
  1. frequency
  2. urgency
  3. nocturia
  4. BOO (bladder outflow obstruction)

a. hesitancy
b. intermittent flow/poor urine stream/dribbling
c. incomplete bladder emptying

METASTATIC SYMPTOMS

  • weight loss
  • malaise
  • spreads to bone usually therefore bone pain and pathological fractures
72
Q

what is the management of prostate cancer?

A

CONSERVATIVE
- involvement of Macmillan nurses and psychological support

MEDICAL

  • radio and brachytherapy
  • zoladex (LH agonist)
  • antiandrogens - cyproterone

SURGICAL

  • laparoscopic radical prostactectomy
  • TURP
73
Q

what are the investigations that you should carry out in prostate cancer?

A
  1. per-rectum (PR) examination

enlarged prostate gland that may be uninodular or multinodular. the midline sulcus is usually no longer palpable

  1. urine dipstick, microscopy and culture
  2. bloods: FBC, UE and creatinine (renal function, LFTs
  3. prostate specific antigen - usually elevated
  4. radiology - transrectal US (TRUS) and biopsy. if positive for malignancy then patient sent for MRI and bone scan to look for distant metastases. it is staged using the TNM system. there may also be symptoms of BOO (bladder outflow obstruction) an US of the urinary tract is also required

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