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YR 3 MED > OBS & GYNAE WK 1 > Flashcards

OBS & GYNAE WK 1 Flashcards

1
Q

what are the structures of the pelvic cavity, division between greater and lesser

A

ovaries
uterine tubes
uterus
superior part of vagina

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2
Q

structures of the perineum

A

inferior part of vagina
perineal muscles
bartholin’s glands
clitoris
labia

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3
Q

what is the perineum and forms what pouches

A

shallow space between diaphragm and skin
recto-uterine aka pouch of Douglas - if woman is upright, this is the lowest point of peritoneum, so blood collecting there
vesico-uterine - men

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4
Q

broad ligament of the uterus and its function

A

double layer of peritoneum
helps maintain the uterus in its correct midline position

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5
Q

round ligament of the uterus

A

formed from embryological remnant
passes thru deep inguinal ring to attach to the superficial tissue of the female perineum

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6
Q

3 layers of the uterus and their function

A

contracts during labour
during menstrual cycle
implantation of zygote occurs in body of uterus
peri
myo
endometrium

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7
Q

implantation of zygote occurring outside of the body of uterus causes what?? presentation

A

ectopic pregnancy
common sites = fallopian tube, ampullary
more pain than bleeding
dizziness
SOB
pallor
guarding

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8
Q

most common and normal position of the uterus

A

anteverted and anteflexed = most common
retroverted and retroflexed = normal variation

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9
Q

uterus is held in position by 3 levels of support, what are they??

A

uterosacral ligaments
endopelvic fascia
muscles of pelvic floor eg. levator ani

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10
Q

where exactly does fertilisation occur?

A

ampulla - of fallopian tube

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11
Q

salpingectomy

A

salpinx is Greek for “tube”
removal of uterine tube

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12
Q

HSG

A

hysterosalpingogram
radiopaque dye
is uterine tube open or not?

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13
Q

ovary - location and shape

A

almond sized and shape
develop on posterior abdo wall

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14
Q

what hormones are secreted by ovaries??

A

secrete oestrogen and progesterone in response to:
FSH
LH

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15
Q

4 parts of the fornix

A

anterior
posterior
2 x lateral
upper end of the vagina, where it meets the cervix

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16
Q

vagina

A

muscular tube

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17
Q

cervical screening, what part is sampled??

A

squamo columnar junction aka transformation zone is sampled
use a speculum

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18
Q

vaginal digital examination, what structures can be palpated

A

ischial spines - bony landmarks of pelvis
position of uterus can be palpated
palpation of adnexae (uterine tubes and ovaries)

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19
Q

levator ani muscle - what muscle type, function, and supplied by what nerve??

A

skeletal muscle
voluntary control
dual nerve supply
pudendal nerve+perineal
S3,4,5

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20
Q

perineal body
why is it important

A

bundle of collagenous and elastic tissue
LOCATED DEEP TO SKIN
gives strength to pelvic floor
if damaged during childbirth -> prolapse

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21
Q

bartholin’s gland aka greater vestibular gland - what do they secrete

A

infection - enlarged bartholin’s gland = infection

The Bartholin’s glands secrete fluid that acts as a lubricant during sex.

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22
Q

where are the bed of breasts found? how do breasts attach to skin

A

ribs 2-6
deep fascia

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23
Q

4 quadrants of the breast

A

upper - outer and inner
lower - outer and inner

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24
Q

lymphatic drainage - where do most lymph from breast drain to??

A

ipsilateral axillary lymph nodes -> supraclavicular

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25
Q

axillary node clearance - 3 levels?? all in relation to pec minor

A

I - inferior and lateral to pec minor
II - deep to pec minor
III - superior and medial to pec minor

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26
Q

blood supply to breast

A

axillary
internal thoracic

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27
Q

ovarian cycle

A

Follicular
Ovulation
Luteal

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28
Q

uterine cycle

A

Menstrual
Proliferative
Secretory

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29
Q

corpus luteum

A

mass of cells that forms in an ovary. It produces the hormone progesterone during early pregnancy. It is a temporary organ that appears every menstrual cycle and disappears if fertilization does not occur.

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30
Q

doughnut shape

A

proliferative

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31
Q

piano key appearance

A

secretory

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32
Q

dense round clusters

A

menstrual

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33
Q

decidual change

A

stromal cells become round, and pink
in response to prolonged progesterone exposure

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34
Q

‘hairpin’ structures

A

atrophy of endometrium
post-menopausal

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35
Q

AUB - causes

A

abnormal uterine bleeding:
pregnancy / miscarriage
endometritis
bleeding disorders
infection / inflammation

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36
Q

Methods of assessing the endometrium

A

TVUS
>4mm thickness

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37
Q

DUB - most common cause

A

anovoluntary cycles
CL does not form

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38
Q

endometrial polyps

A

common
may have bleeding or discharge

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39
Q

molar pregnancy
2 types:
complete/partial mole

A

non-viable fertilised egg
complete - snowstorm appearance, swollen villi
only paternal DNA is present
no foetus
partial - both maternal and paternal DNA is present
non-viable foetus

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40
Q

leiomyoma

A

aka fibroids

group of benign smooth muscle tumors commonly present in premenopausal women.

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41
Q

endometriosis
microscopic vs macroscopic

A

micro - haemorrhage, inflammation, fibrosis

macro -
inflammation
chocolate cyst
fibrous adhesions

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42
Q

complications of endo

A

pain
cyst formation
infertility
higher risk of malignancy

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43
Q

ovarian tumours - solid vs cystic, benign vs malignant

A

solid - firm
mix of cystic and firm is more worrying
cystic -

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44
Q

ovarian tumours - classification, which one is the most common

A

epithelial - most common
germ cell
stromal
metastatic
miscellanous

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45
Q

serous carcinoma

A

high vs low grade

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46
Q

endometriod carcinoma

A

mostly low grade and early stage

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47
Q

what staging is used for cervical / endometrial cancer??

A

Figo

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48
Q

3 layers of gastrulation

A

endo
meso
ectoderm

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49
Q

female embryological development

A
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50
Q

male embryological development, what gene is present ??

A

SRY gene

51
Q

ambisexual / biopotential phase

A

mesonephric duct
para-mesonephric duct

52
Q

female congenital abnormalities

A

double uterus / vagina
unicorn ate / bicornate uterus
septated uterus

53
Q

male congenital abnormalities

A

persistent müllerian duct syndrome

54
Q

Polymenorrhoea

A

frequent periods
<21 days cycle

55
Q

Menometrorrhagia

A

prolonged or excessive uterine bleeding occurs irregularly and more frequently than normal.

56
Q

Oligomenorrhoea

A

irregular cycle
>35 days

57
Q

what structures do you need to see for a good biopsy

A

squamous epithelium
endocervical gland

58
Q

cervicitis

A

inflammation
can lead to infertility
HSV infection

59
Q

cervical polyp

A

common
inflammatory localised outgrowth. May bleed if ulcerated

60
Q

CIN - caused by what HPV types? histology

A

common
caused by HPV 16 and 18 infection
may show koilocytosis
nuclear abnormalities
excess mitotic activity

61
Q

cervical cancer

A

invasive squamous carcinoma
keratin present

62
Q

genital warts are caused by which HPV types

A

low risk
thickened papillomatous squamous epithelium w cytoplasmic vacuolation (koliocytosis)

63
Q

3 stages of CIN

A

I - BASAL 1/3rd of epithelium
II - abnormal cells extend to middle 1/3rd
III - abnormal cells occupy full thickness of epithelium

64
Q

2nd most common female cancer worldwide?? where does it develop from??

A

invasive squamous carcinoma
from pre-existing CIN - preventable by cervical screening

65
Q

symptoms of invasive carcinoma

A

abnormal bleeding - post coital, post menopausal
pelvic pain
haematuria / urinary infections
ureteric obstruction

66
Q

spread of squamous carcinoma - 3

A

local
lymphatic
haematogenous

67
Q

grading of squamous carcinoma

A

well differentiated
moderately differentiated
poorly differentiated
undifferentiated / anaplastic

68
Q

CGIN

A

cervical glandular intraepithelial neoplasia
HIGH GRADE always
worrying, must be removed
pre invasive phase of endocervical adenocarcinoma

69
Q

endocervical adenocarcinoma

A

young women
HPV 18

70
Q

VIN, VaIN, AIN

A

vulvar intraepithelial neoplasia - often history of CIN or VaIN
vaginal intraepithelial neoplasia
anal intraepithelial neoplasia

71
Q

VULVAR PAGET’S DISEASE

A

crusting rash, often sharp
painful / itchy
tumour cells in epidermis, has mucin
primary / secondary

72
Q

Most important prognostic factor for vulvar invasive squamous carcinoma

A

spread to inguinal lymph nodes

73
Q

capacity and consent in young ppl - what guidelines??

A

under 13 cannot give consent to sexual activity, must be 16 and over for consent
gillick competence - consenting to medical treatment without parents’ permission
fraser guidelines

74
Q

2 functions of the ovary

A

produce gametes termed oogenesis
produce steroids, mainly oestrogens and progestogens

75
Q

structure of the ovary - 2, what is the outer shell called?

A

medulla - has loose connective tissue, arteries, veins
cortex - scattered ovarian follicles, outer shell is called tunica albuginea, over the layer of tunica a, it is called germinal epithelium

76
Q

what is oogenesis and folliculogenesis

A

oogenesis = development of oocytes, female germ cells, from oogonia
folliculogenesis:
growth of follicle which consists of the oocyte and support cells

77
Q

follicular development

A

pre-antral follicles (flat cells become cuboidal, primordial follicles) -> antral follicles -> mature Graafian follicle

78
Q

where are primary follicles formed

A
79
Q

after ovulation, the follicle transforms into a _____ _______
why is this important

A

corpus luteum - body which is yellow in colour
secretes oestrogen and progesterone, helping uterus prepare for implantation

80
Q

what 3 layers make up the uterine wall

A

inner - endometrium
myometrium
outer - perimetrium

81
Q

endometrium is divided into 2 what??

A

SF
SB

82
Q

2 PARTS OF CERVIX

A

supravaginal part - lined by simple columnar
intravaginal - lined by stratified squamous non-keratinised epithelium

83
Q

4 layers of vagina

A

-non-keratinised stratified squamous epithelium
-lamina propria
(stratified and lamina together is called mucosal layer)
-fibromuscular
-adventitia - outer

84
Q

causes of bleeding?

A

miscarriage
ectopic
molar
implantation bleeding
cervical/vaginal causes

85
Q

miscarriage classification

A

threatened (risk to pregnancy)
Inevitable (pregnancy can’t be saved)
incomplete (part of pregnancy is already expelled)
complete (uterus empty on scan)
missed miscarriage
septic
recurrent

86
Q

what is miscarriage and what symptoms

A

loss of early pregnancy
positive urine pregnancy test
amenorrhea
period type cramps

87
Q

causes of miscarriage

A

chromosomal abnormality
APS - immune cause
infections - rubella, CMV
uncontrolled diabetes

88
Q

ix and mx of miscarriage

A

FBC, serum hCG, ultrasound

conservative - watch and wait
medical - can take tablets at home
MVA / surgical
anti-d

89
Q

NICE guidance for threatened miscarriage

A

micronised progesterone

90
Q

recurrent miscarriage ??

A

3 or more pregnancy losses
or 2 losses if over age 35
APS link
ALIFE 2 trial

91
Q

ix and gold standard for ectopic

A

FBC, G&S, ultrasound
TVS = GOLD STANDARD

92
Q

management for ectopic

A

conservative
medical - methotrexate
surgical - laparoscopic salpingectomy

93
Q

PUL

A

pregnancy of unknown location
amenorrhoea and abdo pain

M6 MODEL

94
Q

molar pregnancy - pathology

A

grape like clusters = pathology
overgrowth of placental tissue w chorionic villi swollen w fluid rich in hCG

95
Q

ix and mx for molar pregnancy

A

uss
*surgical - uterine evacuation

96
Q

implantation bleeding

A

fertilised egg implants in endometrial lining
bleeding is light or brownish

97
Q

Chorionic Haematoma

A

Pooling of blood between the chorion, a membrane surrounding the embryo, and the uterine wall
self-limiting

98
Q

HG - clinical presentation

A

Hyperemesis Gravidarum
VOMITING - 1st trimester
- Dehydration, ketosis, electrolyte and nutritional disbalance
- Weight loss, altered liver function
- Signs of malnutrition
- Emotional instability, anxiety, severe cases can cause mental health issues e.g. depression

99
Q

mx of HG

A

PUQE score - mild moderate severe
- Rehydration IV infusion, electrolyte replacement
Parenteral antiemetic:
- First line: cyclizine, prochlorperazine
- Second line: metoclopramide

100
Q

what do u give to rhesus-negative women??

A

anti-d, to prevent iso-immunisation (may result in hemolytic disease of the fetus and newborn)

101
Q

definition of infertility

2 types ??

A

Failure to achieve a clinical pregnancy after 12 months or more of regular unprotected sexual intercourse (in absence of known reason) in a couple who have never had a child

Either primary (couple never conceived) or secondary (couple previously conceived, although pregnancy may not have been successful e.g. miscarriage, ectopic pregnancy)

102
Q

what surge do you look at before ovulation?
assessing ovulation

A

LH surge

around day 21
regular cycles are suggestive of ovulation
confirm by mid-luteal serum progesterone > 30 mmol/L

103
Q

azoospermia

A

no sperm in ejaculate

104
Q

investigations in females - what do you do to check for uterine abnormalities

and for tubal patency testing ??

A

ULTRASOUND

Hysterosalpingogram (HSG) = if no known risk factors for tubal or pelvic pathology, or if laproscopy contraindicated

Diagnostic laproscopy - if possible tubal/pelvic disease, known previous pathology, history suggestive of pathology or previously abnormal HSG

105
Q

REVISED ROTTERDAMN DIAGNOSTIC CRITERIA = 2 OF…..

A

oligo/amenorrhoea
polycystic ovaries - 12 or more 2-9mm follicles, increased ovarian volume
clinical and biochemical signs of hyperandrogenism

106
Q

causes of female infertility

A

Anovulatory infertility
PCOS

107
Q

causes of male infertility

A
  • Low testicular volume
  • Reduced secondary sexual characteristics
    klinefelter’s, cystic fibrosis
108
Q

what is the first line for ovulation induction??

A

Clomifene citrate/letrozole

gonadotrophin injections and laparoscopic ovarian diathermy are other options

109
Q

ART - eligibility for this ??

A

assisted reproductive technology
female <40 yrs
3 cycles treatment max
non-smokers
no biological child
no illegal substances
female BMI 18.5-30
stable relationship

110
Q

Methods of abortion??

A

medical - most use this method, before 23+6 wks
mifepristone and one dose of misoprostol
surgical - vacuum aspiration, up to 12 wks, under local anaesthetic only up to 10 wks
dilatation and evacuation

111
Q

assessment of gestation
up to how many ___ + ___ gestation is fine for self administration

A

clinical

ultrasound

up to 11+6 weeks

112
Q

EMAH

A

early medical abortion at home
must have had misoprostol before in hospital or clinic

113
Q

surgical abortion

A

cervical priming via misoprostol
up to 13 + 6 weeks

114
Q

what drug is taken at the time of abortion

A

antibiotic prophylaxis

VTE prophylaxis

115
Q

contraception after abortion

A

pretty much all methods of contraception are safe and effective when started after an abortion.
coil

116
Q

_______ initiates follicular growth。
what 2 hormones stimulate the ovarian follicles to secrete oestrogen

A

FSH
FSH and LH

116
Q

when and what happens in the menstrual phase ??

A

first 5 days of cycle

in ovaries:
FSH influence allows primary follicles -> secondary follicles

in uterus:
fall in oestrogen and progesterone -> release of prostaglandins causing uterine spiral arterioles to constrict

stratum functionalis of endometrium sloughs off leaving the thin stratum Basilis

117
Q

pre-ovulatory phase

A

secondary follicles -> oestrogen

oestrogens released into circulation -> growth of endometrium

118
Q

ovulatory phase

A

day 14 OF CYCLE

oestrogen -> GnRH release
increase in LH and FSH

119
Q

postovulatory phase

A

most constant phase and lasts for 14 days
corpus luteum -> progesterone, oestrogen = fertilisation

P+O -> GROWTH AND COILING OF ENDOMETRIAL GLANDS

120
Q

Pre-menstrual disorders

A

impact on daily life
symptoms include - breast tenderness, headache, weight gain, fatigue, mood swings, depression, anger

121
Q

mx of ovulation suppression

A

GnRH agonists

122
Q

mx for heavy menstrual bleeding

A

1 = mirena coil
2 = tranexamic acid
COC

123
Q

causes of heavy menstrual bleeding

A

fibroids - benign
polyps
adenomyosis
coagulopathy
malignancy

YR 3 MED (23 decks)

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