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Medicine year 2 > Theme 10: Problems in the Pelvis > Flashcards

Theme 10: Problems in the Pelvis Flashcards

1
Q

What is the incidence of gyn cancer in NL?

A

endometrial -> ovarian -> cervical -> vulvar -> vaginal

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2
Q

what are risk factors for cervical cancer?

A
  • HPV (16 and 18)
  • smoking (weakens immune system)
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3
Q

In what age group is cervical cancer most common?

A

35-45 years old

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4
Q

What are the most common symptoms of cervical cancer?

A

postcoital bleeding and intermenstrual bleeding

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5
Q

How is cervical cancer diagnosed?

A

by histological biopsy

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6
Q

what is the treatment of early stage cervical cancer (IA-IB1)?

A

surgery

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7
Q

what is the treatment of advanced stage (>_IB2) cervical cancer?

A

chemoradiation

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8
Q

what stage is a tumor confined to the cervix?

A

stage I
IA = invasion <5 mm = microscopic

IB = invasion >5 mm = macroscopic

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9
Q

When is it stage IIA cervical cancer?

A

invades vagina (<2/3)

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10
Q

When is it stage IIB cervical cancer?

A

invades parametria, but not pelvic wall

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11
Q

When is it stage III cervical cancer?

A

Invades vagina (>2/3), parametria, pelvic wall and lymph node involvement

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12
Q

When is it stage IVA cervical cancer?

A

when it invades bladder/rectum

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13
Q

When is it stage IVB cervical cancer?

A

when is metastases to distant organs

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14
Q
A
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15
Q

what is the first symptoms of endometrial cancer?

A

postmenopausal vaginal blood loss

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16
Q

what are risk factors for endometrial cancer?

A
  • obesity: increase estrogen in the peripheral fat → will stimulate endometrial hyperplasia
  • higher age
  • lynch syndrome (genetic)
    • mutated MMR (mismatch repair) genes
    • MSH2, MLH1, MSH6 and PMS2
    • lifetime risk on endometrial cancer and colon cancer 30-70%
  • nulliparity gives more oestrogen stimulation of the endometrium
  • PCO
  • diabetes
  • hormone use (only estrogen)
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17
Q

when is a biopsy done after a transvaginal ultrasound for endometrial cancer?

A

when the endometrium is larger than 4 mm

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18
Q

what is complex atypical hyperplasia

A

effect of continuous influence of estrogen -> overgrowth abnormal cells -> malignant potential 3-40%

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19
Q

what is type 1 endometrial cancer?

A

endometrioid grade 1 and 2

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20
Q

what age group is type 1 endometrial cancer most common?

A

55-60 years

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21
Q

is type 1 endometrial cancer estrogen-dependent or not?

A

yes

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22
Q

does endometrial cancer type 1 have a good prognosis?

A

yes

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23
Q

is in endometrial cancer type 1 hyperplasia or atrophy the cause?

A

hyperplasia

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24
Q

what is type 2 endometrial cancer?

A

clear cell, serous and grade 3 endometrioid grade 3

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25
Q

what age is type 2 endometrial cancer most common?

A

older than 70 years

26
Q

what is the cause of type 2 endometrial cancer

A

atrophy

27
Q

what is in type 2 endometrial cancer an important marker?

A

P53 -> in serous always mutated

28
Q

Which abdominal wall layer forms the posterior wall of the inguinal canal?

A

Fascia transversalis

29
Q

HPV is a common virus with more than 140 genotypes. Several subtypes have been identified as carcinogenic and thus high-risk.

“The registered HPV vaccinations in the Netherlands protect against all these known carcinogenic high-risk HPV subtypes.” Is this statement true or false?

A

false

30
Q

A 75-year-old woman with no medical history is diagnosed with endometrial carcinoma. She tells the gynecologist that she has read about Lynch syndrome and that the lifetime risk of endometrial carcinoma in Lynch syndrome is 25-70%. She wants to know her risk of having Lynch syndrome.

The risk of Lynch syndrome in women with endometrial carcinoma is closest to:

A

3%

31
Q

A 14-year-old boy presents with a feeling of fullness in the scrotum. It is a unilateral problem. Sometimes there is a visible swelling. When he lies down, the swelling decreases.

How can one differentiate between an inguinal hernia and a varicocele?

A

Aspect on palpation and skin color

32
Q

In the Dutch cervical cancer screening program, a cervical smear is performed.

What is determined based on this smear?

A

The high-risk HPV (Hr-HPV) status, and if the Hr-HPV status is positive, cytology is also determined.

33
Q

Endometrial carcinoma mainly occurs in postmenopausal women and is very rare in the premenopausal phase. In premenopausal women, estrogen is primarily produced by the ovaries, leading to proliferation of the endometrium.

Which hormone counteracts this proliferation?

A

progesterone

34
Q

On which type of bladder innervation does a muscarinic agonist have an effect?

A

The parasympathetic innervation

35
Q

Gastroschisis is a congenital abdominal wall defect.

The statement “With gastroschisis, premature birth is more common” is…

A

correct

36
Q

“A blood test that measures CA-125 (cancer antigen 125) is a good method for screening ovarian cancer.”

Is this statement correct or incorrect?

A

Incorrect

37
Q

Which of the following statements regarding vulvar lichen sclerosus is most correct?

Lichen sclerosus is an acute phase skin condition.
Lichen sclerosus is usually caused by HPV.
Lichen sclerosus is likely an autoimmune skin condition.

A

Lichen sclerosus is likely an autoimmue skin condition

38
Q

“Endometrial carcinoma is the most common gynecologic tumor in high-income countries.”

Is this statement correct or incorrect?

A

correct

39
Q

Which statement regarding umbilical hernia is correct? An umbilical hernia…

closes spontaneously in most cases
is preferably corrected due to the risk of incarceration

A

closes spontaneously in most cases

40
Q

A rectal prolapse is more common in young children and the elderly.

What is a significant cause of rectal prolapse in children?

A

straining (hard persen)

41
Q

Epispadia and hypospadia are both urethral abnormalities.

In which condition is the risk of urinary incontinence increased? In…

A

only epispedia

42
Q

Which part(s) of the autonomic nervous system are involved in the regulation of micturition and control the detrusor muscle of the bladder and the internal urethral sphincter?

A

both sympathetic and parasympathetic nervous systems

43
Q

“An inguinal hernia in neonates and children is usually a direct inguinal hernia.” correct or incorrect?

A

incorrect

44
Q

What is the first-line treatment for physiological phimosis? Local application of a…

A

steroid cream

45
Q

Which statement is most correct?

Ovarian carcinoma is often diagnosed in a relatively advanced stage because the disease tends to present symptoms late and these are often nonspecific.

Ovarian carcinoma is often diagnosed in a relatively advanced stage because the disease tends to metastasize quickly.

Ovarian carcinoma is often diagnosed in a relatively advanced stage because the disease tends to present symptoms late and these are often nonspecific.

Ovarian carcinoma is often diagnosed in a relatively early stage because the disease tends to present symptoms quickly.

Ovarian carcinoma is often diagnosed in a relatively early stage due to screening for ovarian carcinoma.

A

Ovarian carcinoma is often diagnosed in a relatively advanced stage because the disease tends to present symptoms late and these are often nonspecific.

46
Q

“In the case of an indirect inguinal hernia, there is a connection between the peritoneal cavity in the scrotum and the peritoneal cavity in the abdomen.” correct or incorrect?

A

correct

47
Q

Pelvic physiotherapy aims not only to reduce incontinence symptoms but also to reduce…

A

symptoms associated with the prolapse

48
Q

The staging of a cervical carcinoma is determined based on the FIGO classification.

What is this staging based on? Findings from:

A

physical examination

49
Q

How does the myenteric plexus influence the internal anal sphincter to enable defecation?

A

By providing an inhibitory signal.

50
Q

Which neurotransmitter stimulates contraction of the detrusor muscle?

A

Acetylcholine

51
Q

The … seperates the thorax from the … . The … forms the imaginary border between the abdomen and … . The … forms the muscular boundary between the pelvis and the … .

A

diaphragm, abdomen, pelvic inlet, pelvis, pelvic floor, perineum

52
Q

where is linea alba located?

A

this white line is located in the midline of the body and is formed by the fusion of the aponeuroses of the oblique abdominal muscles of both sides.

53
Q

The rectus abdominis muscle is ensheated on the ventral and dorsal side by the aponeurosis of the oblique abdominal muscles. what is this called?

A

This is called the ventral and dorsal rectus sheat.

54
Q

what arteries supply the lateral regio of the abdominal wall?

A

the last intercostal and subcoastal arteries

55
Q

what arteries supply the anteror medial regio of the abdominal wall?

A

from the femoral artery, branches the superficial epigastric artery

56
Q

what arteries supply the posterior medial region of the abdominal wall?

A

this is the inferior epigastric artery which anastomoses with the superor epigastric artery

57
Q

What is the name of the artery at the ventral abdominal wall that is dorsal from the rectus abdominis and after piercing the posterior rectus sheet continues in the internal thoracic artery?

A

superior epigastric artery

58
Q

what nerves is the abdominal wall innervated by?

A

The abdominal wall is innervated by thoraco-abdominal nerves (arising from T7 to T11), the subcoastal nerve T12 and the iliohypogastric / inguinal nerve (arising from L1).

59
Q

why do we have an inguinal canal?

A

The inguinal canal’s primary functions are to facilitate the descent of the testes during fetal development in males and to house the round ligament in females. Despite its vital roles, it also presents a potential site for hernias due to its structure and location.

60
Q
A

Medicine year 2 (2 decks)

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