Blood supply anatomy, imaging, HRT, premature ovarian failure Flashcards Preview

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Flashcards in Blood supply anatomy, imaging, HRT, premature ovarian failure Deck (78)
1

obturator foramen covered in?

obturator memrane

2

in the male, which artery supplies the majority of the male perineum?

internal pudendal

3

dorsal artery of the penis, is it on the front or the back?

front

4

most arteries supplying the penis come from the ?

internal pudendal

5

ovarian artery has 2 branches...name them?

tubal branch supplies fallopian tube and ovarian branch supplies ovary

6

in the pelvis, the veins form a number of plexus, , where do they mainly drain?

internal iliac

7

disease can penetrate through the peritoneal layer, and disseminate into the peritoneal cavity. which cancer does this, and can end up depositing in liver, under diaphragm and forming a malignant effusion in the lungs?

ovarian

8

is ultrasound in gynae safe?

yes, no ionising radiation

9

what are the two types of ultrasound used

transabdominal and transvaginal

10

frequency comparison?

transvaginal is high frequency

11

in transabdominal, why do you need a full bladder/

it acts as an acoustic window, displaces gas filled bowel loops out of the pelvis

12

transabdominal, is there any ionising radiation?

no

13

transvaginal, gives better spatial resolution, why does the transducer have to be close to the target organ?

higher frequencies are more likely t be scattered in the body

14

bladder in transvaginal?

empty, is uncomfortable if bladder is full

15

who is unsuitable for trans v us?

those who have not been sexually active

16

what is often used 2nd line in patients with abdominal pain?

CT

17

Ct scan is used to stage gynae malignancies

also assess response to chemo/radiotherapy

18

whats the downside of CT? where in particular is a significant dose delivered to?

high radiation dose (equivalent to 160 cxrs)

19

what does MRI use instead of radiation?

radio frequency (window)

20

how can different tissue compositions be defined in different parts of the body

can be weighted

21

benefit of MRI?

no ionising radation

22

what can it give an idea of?

composition of soft tissue masses (chopping board)

23

MRI is suitable for women of repro age and children

gives poor definition of lung parenchyma

24

some uses of MRI in gynae? (scroll)

cancer staging, further investigation of masses (after us), evaluation of fertility and imaging of the pituitary gland in suspected prolactinoma

25

endometriosis - why is it able to be picked up on MRI?

it has altered blood due to haemoglobin breakdown products, this causes characteristic MR changes

26

it returns a high signal on t1 (white) and a low signal on t2 (grey)

y

27

where can you get endometriosis?

bowel/bladder, uterine tunes, ovaries

28

dermoid cysts - how is it diagnosed?

predictable changes on MR but can also be diagnosed on CT

29

what is HSG used for and what is it?

close off the cervix and fill uterus with fluid, used to assess tube potency. real time image on x ray

30

ascites, peritoneal and omental nodules, liver and sub diaphragmatic deposits seen in?

ovarian cancer

31

malgnant pleural effusions can result from?

pleural peritoneal communications

32

what is the parametrium?

connective tissue and fat around the uterus and cervix

33

***what imaging is better for looking at local disease?

MRI

34

mets?

CT

35

what is the best imaging technique to establish a thickened endometrium in a post menopausal woman with PMB?

transvaginal us (hock st)

36

MRI used to look for local myometrial spread but CT used to look for distant nodal and pulmonary mets

y

37

what is the most common age to get endometrial cancer.uncommon below what age?

60 uncommon under 40

38

e1 name? e2?

oestrogen one 1, estradiol e2 di

39

e1 seen more in ?

post menopausal women (oneoone)

40

which is less biologically active? e1 or e2?

e1

41

what happens in menopause?

ovaries contain a finite number of eggs. ovaries start to become less sensitive to lh and fsh. when the serum fsh is above 30 on two separate occasions = menopause

42

loss of ovarian function leads to _______depletion?

oestradiol

43

average age of menopause?

52

44

adipocytes convert androgens into?

e1

45

why do you get dyspareunia?

vaginal dryness

46

long term effects of menopause?

COC - cardiovascular disease, cerebrovascular disease and osteoperosis

47

oestrogen effects on LDL, hdl, cholesterol and fat distribution?

decreases LDL, increases HDL, reduces cholesterol and fat distribution. also protective in terms of bone density.

48

who are the only patients suitable for an oestrogen only hormone replacement therapy?

TOTAL hystorectomy

49

if they've had a subtotal hysterectomy, they may also need progesterones

y

50

who is sequential combined given to?

perimenopausal

51

who is continuous combined given to?

post menopausal bleed free

52

what contains more synthetic oestrogen at higher dose? HRT or OCP?

HRT

53

what does progesterone reduce?

the risk of endometrial cancer

54

progesterone protects the uterus and leads to regular bleed in sequential

progesterone ogven for 10-14 days

55

which one mimics the normal cycle?

sequential

56

what hormones are given in continuous combined?

oestrogen and prog for 28 days

57

no monthly bleed after first 6 months

y

58

when should sequential treatment be started?

when required, women may still be having periods

59

why do you want them to switch to continuous asap?

prolonged use can increase risk of endometrial cancer

60

continuous should not be started until __________after LMP or after 2 year __________

1 year 2 years taking sequential if under 54

61

continuous shouldn't be taken under the age of 54, unless?

been on sequential for 2 years

62

tibolone - weak oestrogenic, progestrogenic and androgenic properties. licensed for ? (3)

vasomotor, psychological and libido problems

63

increased risk of what in over 60s

stroke

64

what does the oestrogen have a protective effect on?

bone mass

65

increased risk of?

endometrial cancer

66

broadly what does testosterone do?

helps general feeling of wellbeing and improves libido

67

HRT patient assessment at 3, 6 and 12 months

in most cases less than 5 years is sufficient

68

what sort of thing do women get checked/check themselves?

annual BP, self examination breast, cervical smears every 3 years, mammography every 3 years,

69

what cancer does HRT reduce the risk of?

colorectal. also reduces osteoporotic fractures

70

combined HRT, risk of breast cancer, returns to normal within how long stopping?

5 years

71

increased risk of VTE. which HRT and when?

combined, in the first year

72

stroke?

increased risk of stroke

73

****risk of endometrial cancer in oestrgen only, seq and con?

increased in oestrogen only, lower in seq and eliminated in continuous

74

small increased risk of ovarian cancer, but eliminated once it is stopped

y

75

pof - cessation of ovarian activity before the age of

45

76

long term effects if untreated?

cerebrovascular and cardiovascular disease, osteoporosis, infertility, reduced life ex, dementia and cognitive decline

77

causes?

chromosome and enzyme deficiency

78

treatment ?

COCP or HRT