GUM 204 & 220 Gynae & Gynae Cancer

Question 1

What happen in the late luteal/early follicular phase of the menstrual cycle? (Days 25-5)

Answer 1

The corpus luteum is regressing and dying
Decreased steroids esp. progesterone = -ve feedback to increase LH/FSH
intercyle rise in FSH = follicular selection

Question 2

What does LH stimulate? (Menstrual Cycle)

Answer 2

Theca cells in the developing follicles to stimulate testosterone production

Question 3

What converts testosterone to oestrogen and where from? (Menstrual cycle)

Answer 3

Aromatase enzyme from follicular granulosa cells

Question 4

What happens in the mid follicular phase? (days 5-10)

Answer 4

Oestrogen is increasing
-ve feedback = less FSH and there is inhibin production = no more follicular development
Dominant follicle has to have LH receptors to survive

Question 5

What happens in the mid cycle phase? (days 10-20)

Answer 5

2 days of high oestrogen switches the negative feedback to positive
= LH (and smaller FSH) surge
= follicle rupture from ovum and atresia of other follicles

Question 6

What happens to theca cells after the follicle has ruptured?

Answer 6

Undergo atrophy

Question 7

What happens to the granulosa cells after the follicle has ruptured?

Answer 7

Undergo hypertrophy

Question 8

Describe the mid luteal phase? (days 20-25)

Answer 8

Corpus luteum is formed by ruptured follicle
Oestrogen levels dropped so feedback is -ve again
Progesterone levels increase to maintain CL and endometrium

Question 9

What has happened if there is menstruation?

Answer 9

No fertilisation so corpus luteum regresses

Question 10

When does the primary oocyte finish the 1st meiotic division?

Answer 10

Ovulation - LH surge

Question 11

What feature of seminal fluid protects against the vaginas acidity?

Answer 11

It is slightly alkaline

Question 12

What two changes to sperm undergo once in the vagina/fertilisation?

Answer 12

Capacitation and the acrosome reaction

Question 13

Describe capacitation?

Answer 13

Biochemical removal of the surface glycoprotein on spermatozoa initiating whiplash movement of tail = hyperactive sperm

Question 14

What is the acrosome reaction?

Answer 14

Allows sperm to make a slit in the zona pellucida and stimulates the cortical reaction - prevents polyspermy

Question 15

What hormone maintains the corpus luteum after implantation and is responsible for maternal recognition?

Answer 15

Beta-HCG

Question 16

What do testes mostly consist of?

Answer 16

Seminiferous tubules

Question 17

What are the walls of the seminiferous tubules made up of?

Answer 17

Sertoli cells

Question 18

What lie on the basement membrane of the seminiferous tubules? What are they capable of?

Answer 18

Spermatogonia - germ cells

Can divide by mitosis or meiosis

Question 19

What happens to spermatogonia next on the pathway to becoming mature sperm?

Answer 19

They undergo mitosis to produce diploid cells committed to differentiative pathway - 46XY
Primary spermatocytes

Question 20

What happens to primary spermatocytes next?

Answer 20

Undergo 1st meiotic division to become 23X and 23Y = secondary spermatocytes

Question 21

What happens to secondary spermatocytes?

Answer 21

They undergo second round of meiosis to give 4 mature spermatozoa

Question 22

As sperm mature where do they travel from and to?

Answer 22

Away from basement membrane –> lumen where they then travel into rete/epidiymus and along route they undergo spermiogenesis - final maturation for motility and acrosomal cap

Question 23

Once the sperm fuses with the oocyte what happens to the oocyte?

Answer 23

It undergoes its second meiotic division

Question 24

What is mennorhagia?

Answer 24

Excessive blood loss during menstruation

Question 25

What is primary dysmenorrhoea?

Answer 25

Painful menstrual bleeding usually starts 1-2 years after menarche and has no underlying pathology

Question 26

What is secondary dysmenorrhoea?

Answer 26

Painful menstrual bleeding, occurs 3-4 days before menstruation and later in life - indicates pathology

Question 27

What is DUB - dysfunctional uterine bleeding?

Answer 27

Menorrhagia not associated with any disease - diagnosis of exclusion

Question 28

What are other causes of menorrhagia?

Answer 28

Fibroids Endometriosis PCOS

Question 29

What is a uterine fibroid? What are the risk factors?

Answer 29

Benign tumour of the myometrium | Risk factors tamoxifen, null-parity, obesity and family hx

Question 30

What are the 3 classifications of fibroids?

Answer 30

Intramural - within uterine wall, most common Sub-serosal - under serosal surface, can become pedunculated Sub mucosal - most likely to produce mennorhagia

Question 31

What are some general treatments for menorrhagia?

Answer 31

``` Mirena Coil/OCP Tranexamic acid Mefenamic Acid Progestogens GnRH analogues Surgical - endometrial ablation/hysterectomy ```

Question 32

What is endometriosis?

Answer 32

When endometrial tissue is found outside of the uterus

Question 33

What are chocolate cysts?

Answer 33

Ovarian cysts caused by bleeding of endometrial tissue into cysts at menstruation

Question 34

What is fecundity?

Answer 34

The ability to reproduce

Question 35

What is subfertility?

Answer 35

An involuntary failure to conceive

Question 36

What are the major reasons of subfertility?

Answer 36

Sperm dysfunction Ovulation disorder Tubal disease Endometriosis

Question 37

What is azospermia? What can it be due to?

Answer 37

No sperm in ejaculate Primary - failure of production e.g. congenital or iatrogenic Secondary - failure of sperm to reach urethra e.g. infection, absent vas deferens

Question 38

What are some ovulatory disorders responsible for subfertility?

Answer 38

Hypothalamic - anorexia/low BMI Pituitary - adenoma, prolactinomas or drugs Ovarian - PCOS

Question 39

What is PCOS?

Answer 39

Several tiny cysts on ovaries associated with increased androgens and anovulation Symptoms: hair growth, acne, weight gain

Question 40

What can cause tubal disease? How does it affect fertility?

Answer 40

Infections: mainly gonorrhoea and chlamydia Endometriosis Prevent a patent lumen or scars may prevent tube from moving ovary

Question 41

Who does vulval cancer normally present in? Is it common?

Answer 41

70 year olds - rare

Question 42

How may vulval cancer present?

Answer 42

Itching, irritation, pain, lumps, discharge and bleeding

Question 43

What are some risk factors for vulval cancer?

Answer 43

age, smoking, HPV and lichen sclerosis

Question 44

What is the most common type of vulval cancer?

Answer 44

Squamous cell carcinoma

Question 45

How do you treat vulval cancer?

Answer 45

Surgically - if > 1mm invasion then wide local incision with 15mm margin Total vulvectomy if wider - may use radiotherapy to reduce size or in inguinal lymph node involvement

Question 46

What is the most common gynae cancer worldwide?

Answer 46

Cervical cancer

Question 47

What is the 3 rd most common gynae cancer in the UK?

Answer 47

cervical cancer

Question 48

What is the next step if dyskariosis is found on a cervical smear?

Answer 48

Colposcopy

Question 49

What is the most common type of cervical cancer?

Answer 49

Squamous cell

Question 50

Name risk factors for cervical cancer

Answer 50

Sexual behaviours - Increased risk of HOV | smoking, OCP and immunosuppressants

Question 51

What is stage 1 of cervical cancer and how is it treated?

Answer 51

confined to cervix and treated with local excision

Question 52

What is stage 2 of cervical cancer and how is it treated?

Answer 52

confined to uterus - total abdominal hysterectomy

Question 53

What is stage 3 of cervical cancer and how is it treated?

Answer 53

involves pelvic side wall/lower vagina | treat with radical radio/chemo

Question 54

What is stage 4 of cervical cancer and how is it treated?

Answer 54

beyond pelvis, bladder and rectal mucosa | radical radio/chemo

Question 55

What is endometrial cancer?

Answer 55

A malignant adenocarcinoma

Question 56

What is the second most common gynae malignancy?

Answer 56

Endometrial cancer

Question 57

What are the risk factors for endometrial cancer?

Answer 57

Obesity, unopposed oestrogen, long fertile period, null parity, family history, PCOS

Question 58

How does endometrial cancer often present?

Answer 58

Older women with PMB

Question 59

What is the most common gynae malignancy?

Answer 59

Ovarian cancer

Question 60

What type of cancer is ovarian cancer usually?

Answer 60

epithelial cancer - serous ovarian cancer

Question 61

How does ovarian cancer often present?

Answer 61

Late but can also have non-specific symptoms, bloating and abdominal pain

Question 62

What are risk factors for ovarian cancer?

Answer 62

nullparity, BRCA1 gene mutation, long fertile period