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repro and sexual health > week 3 > Flashcards

week 3 Flashcards

1
Q

what does uterine cancer develop from

A

the endometrium

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2
Q

most common type of uterine neoplasia

A

adenocarcinoma

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3
Q

risk factors for uterine neoplasia

A

PCOS
late menopause/early menarche
low parity/nulliparous
obesity
oestrogen only HRT
tamoxifen
genetics- lynch

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4
Q

presentation of uterine neoplasia

A

abnormal PV bleeding
post menopausal bleeding: endometrial carcinoma until proven otherwise
PV discharge
pain/weight loss

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5
Q

first line investigation for endometrial cancer

A

TVUS
- measure endometrial thickness (thickness <4mm is reassuring)

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6
Q

investigations for endometrial cancer

A

TVUS
endometrial biopsy/dilation and curettage
- performed to obtain a tissue sample for histology
hysteroscopy
- allows visualisation of endometrium

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7
Q

histological variation of endometrial carcinoma

A

purely glandular
areas of squamous differentiation
papillary
clear cell pattern

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8
Q

spread of endometrial carcinoma

A

usually spreads to myometrium and cervix
but can spread to blood and lymph too

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9
Q

two types of endometrial cancer

A

type I (endometrioid): most common
type II (serous and clear cell)

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10
Q

what is type I endometrial cancer

A

endometrioid
- usually diagnosed shortly after menopause
- oestrogen dependent
precursor lesion= atypical hyperplasia
PTEN, KRAS, PIK3CA mutations
Microsatellite instability – germline mutation of mismatch repair genes (Lynch
syndrome)

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11
Q

what is type II endometrial cancer

A

serous and clear cell
- older women usually
- poorer prognosis
- not associated with unopposed oestrogen
- TP53 mutation
precursor lesion= serous endometrial intraepithelial carcinoma
spreads fallopian tubes

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12
Q

endometrial sarcoma

A

rare
arise from endometrial stroma and locally aggressive
metastasizes early

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13
Q

staging used for endometrial carcinoma

A

figo staging

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14
Q

management of endometrial carcinoma

A

surgery is the principles treatment
- total hysterectomy and bilateral salpingo-oophorectomy + peritoneal washings
radiotherapy
chemotherapy

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15
Q

smooth muscle tumours of the myometrium

A

leiomyoma
leiomyosarcoma

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16
Q

leiomyoma

A

common
menorrhagia and infertility
(fibroid)

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17
Q

leiomyosarcoma

A

rare and poor prognosis
women > 50

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18
Q

peak age of ovarian cancers

A

75 years

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19
Q

genetic risks for ovarian cancers

A

HNPCC (lynch syndrome)- 12%
BRCA 1 and BRCA2
family member

20
Q

risk factors for ovarian cancers

A

nulliparity
early menarche/late menopause
HRT
smoking
obesity
endometriosis

21
Q

protective factors for ovarian cancer

A

breast feeding
COCP
multiparity
sterilisation

22
Q

presentation of ovarian cancer

A

often non-specific symptoms
bloating, weight loss, tiredness, change in bowel habit/urinary frequency, abdo pain, poor appetite
PV bleeding
abdo mass/bimanual exam
ascites + pleural effusion

23
Q

investigation for ovarian cancer

A

pelvis USS
CA125
RMI= USS score x menopausal score x CA125

24
Q

pathology of functional ovarian cysts

A

enlarged follicular/corpus luteum
< 5cm

25
Q

pathology of endometrioma

A

chocolate cyst
contains blood
associated with endometriosis

26
Q

pathology of polycystic ovaries

A

> 12 follicles

27
Q

pathology of theca lutein cyst

A

occur when levels of hCG are very high (molar pregnancy)
regress when hCG falls

28
Q

pathology serous cystadenoma

A

may appear solid
1/3 bilateral
1/3 malignant

29
Q

pathology of fribroma

A

sex cord stromal tumour
fibrous tumour
associated with meig’s syndrome (ascites and pleural effusion)
may produce oestrogen > PV bleeding

30
Q

types of epithelial ovarian tumours

A

serous
mucinous tumours
endometrioid
clear cell

31
Q

pathology of sex cord ovarian tumour

A

granulosa cell
low grade
coffee bean nuclei and gland-like spaces

32
Q

treatment of benign ovarian tumours

A

LDH, AFP and hCG should be measured in women < 40 to rule out germ cell tumours
usually excised if >5cm

33
Q

treatment of malignant ovarian tumours

A

full staging laparotomy with debulking
adjuvant chemotherapy

34
Q

aetiology of infection of high risk HPV

A

damages the action of p53

35
Q

cervicitis

A

often asymptomatic
follicular cervicitis- sub epithelial reactive lymphoid follicles present in cervix
chlamydia
herpes

36
Q

risk factors for CIN/cervical cancer

A

persistence of high risk HPV (16,18)
- many sexual partners
vulnerability of SC junction
- young age of first intercourse
- long term use of oral contraceptives
- non-sue of barrier contraception
smoking
immunosuppression

37
Q

if HPV is present on smear

A

patient referred to cytology
cytology negative: test for HPV in 12 months
cytology positive: colposcopy

38
Q

CIN I

A

abnormal cells occupying a third of the basal epithelium

39
Q

CIN II

A

abnormal cells have extended to the middle third

40
Q

CIN III

A

where the abnormal cells span the full thickness of the epithelium

41
Q

what happens if a patient had a negative cytology but a positive HPV smear again 12 months later

A

cytology again
positive: colposcopy
negative: test again in 12 months

42
Q

what strain of HPV is genital warts

A

6 and 11

43
Q

histology of CIN

A

infected epithelium remains flat, but may show koilocytosis
delay in maturation/differentiation
nuclear abnormalities

44
Q

presentation of cervical cancer

A

abnormal PV bleeding- post coital, intermenstrual, post-menopausal
unusual PV discharge
menorrhagia
pelvic pain
advanced disease features
- weight loss
- back pain
- obstruction of the ureters

45
Q

cervical cancer investigations

A

punch biopsy at colposcopy for histology
staging CT chest/abdo/pelvis
MRI
examination

46
Q

cervical cancer management stage Ia

A

to preserve fertility: local excision with cone biopsy and close follow up or radical trachelectomy
hysterectomy with lymphadenectomy

repro and sexual health (21 decks)

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