Week 6 - Core clinical problems

Question 1

What process happens during cervical erosion?

where does this process happen?

Answer 1

Exposure of endocervical columnar epithelium to acid environment of vagina - leads to squamous metaplasia
(columnar cells - squamous cells at TZ zone)

Question 2

Name some of the risk factors involved in CIN and squamous carcinoma?

Answer 2

Lots of sexual partners 
Long term oral contraceptive use 
Not using condoms 
Smoking 
Persistence of HPV infection

Question 3

CIN is the pre-invasive stage of cervical cancer? T/F

Answer 3

T

Question 4

Cervical polyp is premalignant? T/F

Answer 4

F

Question 5

What are the 3 stages of CIN and briefly describe them?

Answer 5

CIN 1 - lower third dysplasia. Low grade
CIN 2 - 2/3rds dysplasia. High grade
CIN 3 - More than 2/3rds. High grade

Question 6

Cervical cancer can either be squamous or adenocarcinoma.

a) What one is picked up by screening more often?
b) Which one has a worst prognosis?

Answer 6

a) Squamous

b) Adenocarcinoma

Question 7

What is an adenocarcinoma?

Answer 7

a malignant tumour formed from glandular structures in epithelial tissue.

Question 8

An anastomosis occurs between what 2 sets of 2 arteries in the female anatomy?

Answer 8

1) Uterine and Ovarian artery

2) Uterine and vaginal artery

Question 9

Where will most venous drainage occur into?

Answer 9

Internal iliac vein

Question 10

Will ureter damage occur more on the left side or right?

Answer 10

Left.

Because the right is constant and usually crosses the external iliac, the left is more medial and crosses common iliac

Question 11

Where do most arterial blood supply come from?

what is the exception?

Answer 11

Internal iliac artery

Gonadal arteries come from abdominal aorta

Question 12

Nerves of the lateral wall of the pelvis - what nerves supply the lower limb?
What nerve supplies the perineum?

Answer 12

Obturator nerve and Sciatic nerve - lower limb

Pudendal nerve supplies perineum

Question 13

Where do the gonadal lumphatics spread to?

Answer 13

Lumbar nodes (in the abdomen)

Question 14

What happens to FSH and LH during menopause?

Answer 14

They will rise

Question 15

What is perimenopausal dysfunctional uterine bleeding?

Answer 15

The time period prior to going through menopause where a women has irregular periods & intra menstrual bleeding.
Due to fluctuating hormone levels

Question 16

What hormone causes endometrial hyperplasia?

Answer 16

Oestrogen

Question 17

There are 2 main types of endometrial cancer:
Type 1 = endometrioid
Type 2 = serous clear cell
Where do both types spread to?

Answer 17

Type 1 - myometrium

Type 2 - peritoneal cavity (i.e. more aggressive)

Question 18

Type 1 endometrial cancer is more likely to affect older women? T/F

Answer 18

F
Type 1 = younger women with lynch syndrome
Type 2 = older women

Question 19

What is the precursor for type 1 endometrial cancer?

Answer 19

Atypical endometrial hyperplasia

Question 20

What is a sarcoma?

Answer 20

Cancer of connective tissue

Question 21

What is the name of a tumour found in the myometrium

Answer 21

Leiomyoma (fibroid)

Question 22

What 2 symptoms are associated with a fibroid?

Answer 22

Menorrhagia

Infertility

Question 23

What cell type is involved in a leiomyosarcoma?

Answer 23

Spindle cells (elongated cells)

Question 24

Ix leiomyoma’s

Answer 24

1st line - US

2nd line - MRI

Question 25

Mx for leiomyomas

Answer 25

Nothing (as they are usually asymptomatic), watch and wait. They are very common

Question 26

What is a hydrosalpinx?

Answer 26

Fallopian tube gets filled with serous clear fluid

Question 27

What is endometriosis?

Answer 27

A condition where the endometrium is found outside the womb - in ovaries or in fallopian tube

Question 28

Where do chocolate cysts come from? Where are they located?

Answer 28

Form due to endometriosis

Located on ovaries

Question 29

What 2 genetic situations are related to ovarian cancer?

Answer 29

BRCA 1 & 2

Lynch syndrome

Question 30

Symptoms of ovarian cancer

Answer 30

Early satiety 
Weight loss
Pressure symptoms 
Change in bowel habit 
SOB 
Pleural effusion
DVT

Question 31

The OCP increases your risk of ovarian cancer? T/F

Answer 31

F

It decreases your risk as it decreases the amount a woman ovulates

Question 32

1st line imaging for ovarian cancer

Answer 32

US

if mets - CT

Question 33

What 2 tumor markers increase during ovarian cancer?

Answer 33

Ca-125

CEA

Question 34

When do follicular cysts form?

Answer 34

When the follicle doesn’t go through ovulation - it just keeps growing and growing

Question 35

Gold standard Ix for endometriosis

Answer 35

Laparoscopy

Question 36

When does an ovarian tumour go from being borderline to malignant?

Answer 36

When there is stromal invasion

Question 37

How are endometroid and clear cell carcinoma diagnosed?

Answer 37

Ascitic fluid

Question 38

At what stage would an ovarian cancer have spread to the retroperitoneal lymph nodes

Answer 38

Stage 3A

Question 39

What happens during stage 2A of ovarian cancer?

Answer 39

Cancer extends to fallopian tube

Question 40

What types of HPV cause 70% of all cervical cancers?

Answer 40

16 & 18