47 Disease of female genital system 2

Question 1

What is endometriosis?

Answer 1

Ectopic endometrium causing bleeding int the tissues and fibrosis.

Question 2

How does endometriosis present? (8).

Answer 2

25% are symptomatic.
Dysmenorrhoea.
Dyspareunia (pain on sex).
Pelvic pain.
Sub fertility.
Pain on passing stool.
Dysuria.

Question 3

Epidemiology of endometriosis?

Answer 3

6-10% of women.

30 - 40 y/o.

Question 4

What are the causes of acute endometritis? (3).

Histology?

Answer 4

Retained POC, prolonged rupture of membranes, complicated labour.
Neutrophils

Question 5

What are the causes of chronic endometritis? (4).

Histology?

Answer 5

Pelvic inflammatory disease, retained gestational tissue, endometrial TB, IUCD infection.
Lymphocytes + plasma cells.

Question 6

What are the symptoms of endometritis? (5).

Answer 6

Abdo/pelvic pain.
Pyrexia.
Discharge.
Dysuria.
Abnormal vaginal bleeding.

Question 7

What is endometritis?

Answer 7

Inflammation of the endometrium.

Question 8

What are endometrial polyps?

Answer 8

Sessile/polypoid estradiol (E2) dependant uterine overgrowths.

Question 9

What are the symptoms of endometrial polyps? (5).

Answer 9

Often asymptomatic.
Intermenstrual bleeding.
Post menopausal bleeding.
Dysmenorrhoea.
Menorrhagia.

Question 10

What is a leiomyomata?

Answer 10

Benign myometrial tumour with estradiol (E2)/progesterone (P4) dependent growth.

Question 11

What are the risk factors for leiomyomata? (5).

Answer 11

Genetics.
Nulliparity.
Obesity.
PCOS.
Hypertension.

Question 12

What are the symptoms of a leiomyomata? (4).

Answer 12

Often asymptomatic.
Menometrorrhagia (prolonged, heavy bleeds).
Subfertility/pregnancy problems.
Pressure symptoms.

Question 13

What are the hormonal features of endometrial hyperplasia? (2).

Answer 13

Increased estradiol.

Decreased progesterone.

Question 14

What are the symptoms of endometrial hyperplasia? (3).

Answer 14

Intermenstrual, postmenopausal or postcoital bleeding.

Question 15

What are the risk factors for endometrial hyperplasia? (6).

Answer 15

Obesity.
Exogenous estradiol. 
PCOS.
Estradiol-producing tumours.
Tamoxifen.
HNPCC (PTEN mutations).

Question 16

Type 1 endometroid endometrial carcinoma:

Incidence, age, type, mutations, E2 status.

Answer 16

75% of endometrial carcinoma.
Pre-menopausal.
Hyperplasia.
PTEN, Kras.
E2 +ve.

Question 17

Type 2 serous endometrial carcinoma:

Incidence, age, type, mutations, E2 status.

Answer 17

25% of endometrial carcinoma.
Post-menopausal.
Atrophy.
p53.
E2 -ve.

Question 18

What is polycystic ovary syndrome?

Answer 18

Complex endocrine disorder:
Hyperandrogenism.
Menstrual abnermalities.
Polycystic ovaries.

Question 19

What hormonal changes are seen in PCOS?

Answer 19

Decreased FSH.

Increased LH, testosterone + DHEAS.

Question 20

What are the rotterdam criteria?

Answer 20

Used for PCOS. 2/3 of:
Hyperandrogenism (hirsuitism/biochem).
Irregular periods >35 days.
Polycystic ovaries.

Question 21

What is hypergonadotrophic hypogonadism?

Answer 21

Primary failure of the gonads.

Question 22

What are the congenital causes of 1o gonadal failure in females? (2).

Answer 22

Turner syndrome (XO).
Kleinfelter syndrome (XXY).

Question 23

What is hypogonadotrophic hypogonadism?

Answer 23

Hypothalamic/pituitary failure leading to 2o gonadal failure.

Question 24

What are the causes of 2o gonadal failure in females? (5).

Answer 24

Sheehan's syndrome.
PCOS.
Empty sella syndrome.
Brain injury.
Pituitary tumours.

Question 25

How does gonadal failure present in females? (4).

Answer 25

Amenorrhoea/absent menarche. Delayed puberty. Decrease sex hormone levels. ± increase in LH/FSH levels.

Question 26

What are the three origins of ovarian neoplasms?

Answer 26

Sex cord stromal tumours. Germ cell tumours. Surface epithelial stromal tumours.

Question 27

What are the three types of serous epithelial neoplasms of the ovary?

Answer 27

Serous. Mucinous. Endometroid.

Question 28

What is a malignant tumour of the ovarian epithelium called?

Answer 28

Cystadenocarcinoma.

Question 29

What is a dysgerminoma?

Answer 29

Germinomatous tumour of the ovary. Malignant.

Question 30

What are the three types of non-germinomatous tumours of the ovary? Which is the only one that can be benign?

Answer 30

Teratomas (some are benign). Yolk sac tumours. Choriocarcinomas.

Question 31

What does a teratoma differentiate towards?

Answer 31

Multiple germ layers. | If embryonal/foetal tissue present then malignant.

Question 32

What does a choriocarcinoma differentiate towards? Malignant?

Answer 32

Placenta. Yes.

Question 33

What are the three types of sex cord stomal tumours in females?

Answer 33

Thecoma/ fibrothecoma/ fibroma. Granulosa cell tumour. Sertoli-Leydig cell tumour.

Question 34

What do thecomas, fibrothecomas and granulosa cell tumours produce?

Answer 34

Estradiol (E2).

Question 35

What do sertoli-leydig cell tumours produce in females?

Answer 35

Androgens.

Question 36

What are the risk factors for ovarian tumours? (6).

Answer 36

``` FH. Increasing age. PMH breast cancer. Smoking. E2-only HRT. Lynch II syndrome. ```

Question 37

What are the protective factors for ovarian tumours? (3).

Answer 37

OCP. Breastfeeding. Hysterectomy.

Question 38

Which tumours metastasise to the ovaries?

Answer 38

Mullerian tumours (uterus, fallopian, perineum). GI, pancreatobiliary, breast, melanoma. Bladder, rectal.