Repro Flashcards
(311 cards)
1
Q
What occurs in the fetal period (breifly)
A
Growth and maturation of structures developed in embryonic period
Early = protein deposition
Late = adipose desposition
2
Q
LMP vs weeks post fertilisation?
A
LMP = fert +2
3
Q
When does the CRL increase rapidly?
A
Pre to early fetal
4
Q
Ante-natal assessment of fetal well being?
A
Mother and fetal movements
Uterine expansion - symphysis fundal height
Ultra sound
5
Q
Uses of Obstetric ultrasound scan (USS)?
A
Check age in early pregnancy
20 weeks
Fetal abnormalities and growth
6
Q
Purposes of a 7-13 week scan?
A
Estimate from CRL the EDD and the time of cenception
Check location, number and viability
7
Q
Uses of the biparietal diameter
A
Used to date pregnancies in T2/3 in combination with other measurements e.g. abdominal circumference and femur length.
Also used for anomaly detection (more AC and FL)
8
Q
Describe the classification of birth weights
A
3500g normal
4500 maternal diabetes - macrosomia
9
Q
Stages of lung development?
A
Pseudoglandular 8-16 weeks
Canalicular - 16-26
Terminal sac stage - 26+
10
Q
Describe the pseudoglandular stage
A
Duct system develops from the bronchopulmonary trunk
Bronchioles
11
Q
Describe the canalicular stage
A
Respiratory bronchioles bud off from bronchioles formed during the pseudoglandular stage
12
Q
Describe the terminal sac stage
A
Terminal sacs bud from resp bronchioles.
Differentiation of Type 1 and 2 pneumocytes (surfactant)
13
Q
What factors aid lung development?
A
Fluid filled
Breathing movements
14
Q
What are the implications for pre term survival
A
THreshold of viability is the lungs, only possible once lungs have entered the terminal sac stage >24 weeks
15
Q
What is respiratory distress syndrome?
A
Pre mature infants
insufficient surfactant pproduction
glucocorticoid treatment for mother as this increases surfactant
16
Q
Definitive fetal HR when?
A
15 weeks
17
Q
Describe development of urinary system later
A
Kidney function at 10 weeks
Not neccessary for survival but without there is oligohydramnios
18
Q
Desribe the development of the nervous system
A
Myelination of brain begins at 9 months and finishes after birth
Coordinated voluntary movement develops at 4 month
19
Q
First movement?
A
8 weeks
20
Q
What is quickening
A
at 17 weeks, increase in fetal awareness
way of antepartum surveilance
21
Q
Describe O2 supply to fetus
A
Incre pO2 in mother and low in fetus (4kPa).
Hb 70% sat at 4kPa - more hb than adults
Double bohr effect in both fetal and maternal blood??
22
Q
Describe CO2 and the fetus
A
Cannot tolerate CO2
Lower maternal CO2
Prog stimulates maternal hyperventilation
23
Q
Sat of blood and to the brain in fetus
A
Blood shunted to brain- bypass liver via Ductus venosus (70-65% with IVC) - bypass lungs via foramen ovale (directed by crista dividens- part of septum secundum, joins pulmonary flow in LA 65-60%) and ducuts arteriosus
SVC tends to go to RV as is superior to RV
24
Q
Describe functions and secretions of amniotic fluid
A
Mechanical protection Moist environment Other functions 10ml at 8 weeks 1l at 38 weeks 300ml at 42 weeks. Constant turnver - early maternal secretion and diffusion with embryo ECF. late - fetal production.
25
Production of fetal urine
100ml a day at 25 weeks to 500ml hypotonic.
| Constantly swallows amniotic fluid forming meconium
26
Fetus and bilirubin
Fetus cannot conjugate and thereofore remove bilirubin so crosses the placenta - may get jaundiced as a neonate if conjugation does not establish quickly
27
Describe rhythms in the fetus
Breathing movement and HR.
28
Function of cytotrophoblast
Repairs syncytiotrophoblast
29
Function of the syncytiotrophoblast
Invades maternal epithelium and lacunae to establish utero-placental blood flow.
Allows for diffusion - multi nucleated sheet
30
what does haemomonochromal mean?
The chorion/ membrane/ placenta is in direct contact with maternal blood
31
Describe implantation in terms of villi
Primary - invaginations of trophoblast
Secondary - invasion of a mesochyme core
Tertiary - invasion of mesenchyme core with fetal blood vessels.
Slowly cyto regresses and syncytio thins
32
How does the endometrium prepare for an implantation
Pre decidual cells
| Spiral arterial blood system - high flow, low resistance vascular bed
33
What is decidualisation
Pre decidual cells balance the invasive force of the trophoblast
34
Describe the development of fetal membranes
Initially chorion has villi all around the embryo (week 5).
Week 12 - villi only located at decidua basalis (disk shape chorion) leaving chorion laeve (smooth chorion) the other side. this is because, cytotrophoblast thins so smaller sa needed? Decidua capsularis and parietalis fuse forming composite membrane at week 22
35
Results if 2 embryoblasts vs 2 primitive streaks
2 amnions vs 1, both share a placenta
36
gross morphology of amnion
Maternal aspect - cotyledons
| Fetal aspect - umbilical cord. Covered in amnion, chorionic vessels underneath
37
Major substances that are transported across placenta by mode of travel
Simple diffusion- gases, urea, uric acid, water, electrolytes
Facillitated - glucose
Active - aa, iron, vitamins
RME - Igg (Rhesus -prophylactic treatment)
38
Common tetratogens
```
Thalidamide
Alcohol
Therapeutic drugs e.g. warfarin
Drugs of abuse
smoking
```
39
Infectious agents that can cross placenta
Varicella zoster, cytomegalovirus, treponema pallidum, toxoplasma gondii, rubella
40
Describe the metabolic functions of the placenta
Synthesise glycogen, cholesterol and fatty acids
41
Describe the endocrine functions of the placenta
```
Produces protein and steroid hormones.
Steroid: Prog and oes
Proteins:
HCG
HCS (somatomammotrophin
HCt thyrotrophin
Hgc Corticotrophin
```
42
Clin sig of HCG
Pregnancy tests
Only produces by syncytiotrophoblast
Very high HCg - hydratidiform mole (fertilised non viable implantation)
or high in coriocarcinoma
43
Function of HCs/ HPL (human placental lactogen)
Increase glucose available, affects maternal metabolism
44
How does prog alter maternal metab?
Increased appetite
45
Major causes of complications in pregnancy
Placental insufficiency
| Pre-eclampsia
46
Describe placental insufficiency
May cause pre eclampsia, stillbirth, olighydramnios or miscarriage.
Not enough blood flow
Often drop in HR later on
47
Describe pre eclampsia
Hypertension and proteinuria - impaired liver and kidney function if severe. When seizures then eclampsia.
Risk factors include hypertension, obesity, DM.
Can be causes by vasoconstriction due to defect in placentation
48
Describe gestational diabetes
Caused by HPL/ hCs increasing insulin resistance and gluconeogenesis (also O&P, prolactin and cortisol)
Decrease in fasting blood glucose normal in preg.
Can lead to macrosomic fetus, stillbirth and increased risk of congenital defects
49
Describe antenatal screening of mother
Risk factors for gestational diabetes
Blood - rhesus, hb, infection e.g. syph and HIV
Urinalysis - protein and kidney function (pre-eclampsia)
50
Describe CVS changes in pregnancy
```
From T1:
CO increases 40%
SV increases35%
HR increases 15%
TPR decreases 25-30%
Increase in BVol
BP decreases in T1/2 but returns in T3.
BP may decrease due to prog effect on systemic vascular resistance (SVR) and also compression of uterus on aortocaval but rare that systolic increases,
Endothelium dilates
Vasospasms
```
51
Describe urinary effects of prgnancy
Increase in RPF and GFR
Filtration capacity intact
Decrease in functional renal reserve.
Urea and creatinine both decrease around 50%
Urinary stasis - pressure - hydroureter
UTI - pyelophritis causing pre term labour
52
Resp effects of prgancy
Decrease functional residual capacity
AP and transverse diameters increase and physiological changes.
Same VC.
Increased tidal vol and minute and alveolar ventilation.
RR unchanged although may increase due to prog and CO2.
Hyperventilation causes alkalosis- compensated by bicarb excretion.
53
Effects of pregnancy on lipid metabolism
Increase in lipolysis from T2 so increase in plasma fa - use instead of glucose. Fas can cross placenta.
54
Effects of pregnancy on thyroid
More T3/4, hCG stims, TSH decreases
55
Effects of pregnancy on GI
Anatomical - appendix in RUQ
| Physiological - decrease in SM tone by prog so risk of biliary stasis, pancreatitis and delayed emptying,
56
Immune system effects of pregnancy
Fetus is an allograft so non specfic suppression of local immune response at materno-fetal interface needed. Transfer of antibodies can transfer haemolytic diseases and graves/ hashimotos.
57
Haematological consequences of pregnancy
Pro thrombotic, fibrin at implantation site. Increase fibrinogen and clottin factors. Reduced fibrinolysis
stasis and venodilation
Thromboembolic disease (cant have warfarin)
Anaemic - dilutional and due to Fe and folate deficiency
haemoglobinopathies
58
List the phases of coitus
Excitement
Plateau
Orgasmic
Resolution (+/- refractory phase)
59
Describe the events of the female sexual response
```
Blood engorgement and erection: clitoris, vaginal mucosa, breast and nipples
glandular activity
Sexual excitement
+/- orgasm
No physiological refractory period
```
60
Describe the main components of semen and their origins
60% seminal vesicles- fructose, clotting factors (semeogelin), alkaline to neutralise urethra and vagina, prostaglandins.
25% prostate - slightly acidic, citrate, acid phosphatase, proteolytic enzymes, (reliquify in 10-20 mins)
Bulbourethral glands - alkaline, lubricate urethra and penis,
2-4ml total.
20-200 x106 sperm per ml,
61
Describe stimulants and efferents involved in erection of the penis
Stimulants - psychogenic and tactile -penis and perineum via spinal reflex
Efferents - peudendal (somatic), pelvic (PNS)
62
Describe physiological
Central arteries of corpora cavernosa dilate due to inhibition of SNS, activation of PNS and non-adrenergic/ cholinergic autonomic nerves to arteries to release NO.
PNS - M3 (endothelial) - Ca - NO - diffuse into SM - vasodilate
63
What does viagra do?
Inhibits cGMP breakdown (cGMP inhibits MLCK)
64
What causes erectile dysfunction
Psychological - inhibition of spinal reflexes
Tears in fibrous tissue of corpora cavernosa
Alcohol, antihypertensives and diabetes blocking NO
Vascular
65
Describe mechanisms of ejaculation
Leakage of ejaculate into prostatic urethra (VD peristalsis). secretions of bulbourethral glands - EMISSION
SNS (L1-2)- spinal and cerebral reflex:
Contraction of glands and ducts.
Rhythmic contraction of bulbo/ischiospongiosus, hip and anal muscles
Bladder internal sphincter contracts.
66
Describe capacitation of sperm
Further maturation of sperm in female reproductive tract 6-8 hours.
Membrane changes allowing fusion with oocyte.
Tail from beat to whip like action
67
Describe the acrosome reaction process
Sperm moves through granulosa and head proteins bind to ZP3 on zona pellucida. Acrosome reaction, hydrolysis enzymes digest path through ZP, one sperm penetrates.
Cortical reaction blocks polysperm
68
What happens when sperm is in cytoplasm?
Meiosis 2
Fusion of pronuclei
Mitosis.
69
Why does sperm wait in uterine tube for 3 days?
Waiting for rise in prog to cause SM relaxation
70
What aids sperm transplant?
Loss of mucous plug in cervic (only with prog).
| Oestrogen makes it abundant clear non viscous mucous
71
List the phases of coitus
Excitement
Plateau
Orgasmic
Resolution (+/- refractory phase)
72
What is wrong with coitus interruptus?
Sperm in pre ejaculate
73
Describe abnormal sperm production
Testicular disease
Obstruction -surgery or infection
Hypo/ pit dysfunc
Semen analysis - >2ml, >20 mil per mil, motility >50, morphology >50
74
Describe vasectomy
Bilaterally divided
| Measure sperm before using
75
Describe ways of preventing sperm reaching the cervix from the vagina
Condoms - STDs
Diaphragm - diagonally - holds in acidic environment of vagina, needs correct fitting, does not completely occlude
Cap - Fits across cervix, physical barrier
Useful with spermicide
76
Ways of preventing ovulation and other effects
Combined OCP - prevent LH surge, inhibit follicular development via neg feedback
Depot prog - 3 monthly injections, neg feedback
Oral prog - low dose only - may inhibit ovulation, main action is to affect cervical mucus
Implant - same as oral.
All affect cervical mucus and affect receptivity of endometrium
77
Methods of female sterilisation
Tubes - rings, ligation and clips.
78
Describe post coital contraception
Combines O/P high dose or prog. Disrupt ovulation, block implantation and impair luteal functioning
79
Describe intra-uterine device
Post-coital contraception up to 5 days after.
Inert, copper or prog impregnanted.
Copper - endometrial enxymes, sperm transport and implantation
80
Define infertility and the types
Failure to conceive within 1 year of trying (15%) primary or secondary (previous pregnancy)
81
Causes of infertility
20-30% ARE UNEXPLAINED
Anovulation 15-20
Tubule occlusion 15-40
Abnormal/ absent sperm production 2-25
82
Causes of anovulation
Pituitary tumour, extremes of reproductive life, ovarian failure, weight loss, stress, exercise, hyperprolactinaemia (hypo), radiotherapy, chemotherapy, menopause.
Can be pit, hypo or ovary.
83
Describe polycystic ovarian syndrome
Not sure if pit or ovary.
Excess androgens and increased LH/ FSH
Multiple small ovarian cysts
Insulin resistance
Anovulation with possible amenorrhoea or oligomenorrhoea.
Diagnose voa serum prog and hormones - differentiate from Menopause, ovarian failure and hypo/ pit failure
84
Induction of ovulation how?
Anti oestrogen to inhibit neg feedback, plsalise GnRH agonist and Gonadotrophs (FSH)
85
Describe tubule occlusion
Cause - sterilisation, endometriosis or scarring from infection
Diagnosed laparoscopically, dye insufflation or hysterosalpingogram
Treatment - surgical reanastomosis and assisted conception
86
Describe the scrotum, its innervation, lymphatic drainage and blood supply
Develop from labioscrotal folds.
Anterior - lumbar plexus (anterior scrotal nerve)
Posterior - sacral plexus (posterior scrotal nerve)
Lymph - superficial inguinal nodes
Arteries - anterior (femoral) and posterior (internal pudendal) scrotal arteries
Vein - anterior and posterior scrotal veins
87
Common pathology of testes and scrotum
Hydrocoele - serous fluid in tunica vaginalis
Haematocoele - blood in tunica vaginalis (translumination to differentiate)
Varicocoele - varcosities of panpiniform plexus
Spermatocoele e.g. epididymal cyst
Epididymitis - inflam
Indirect hernia if processus vaginalis reopens
Testicular torsion - necrosis of testes - absent gubernaculum
88
Anatomy of the epidydimis
Head, body, tail, connects via efferent ductules and rete testis
89
Route of the spermatic cord
From deep inguinal ring to posterior boarder of the testis. Through the superficial ring and inguinal canal.
90
Contents of the spermatic cord
3x3ish
Arteries: To vas, cremasteric and testicular
Nerves: Genital branch of genitofemoral (to cremastor), testicular (symp) and ilioinguinal (outside of cord)
Other: Lymph, vas and processus vaginalis, pampiniform plexus
91
Describe the coverings of the spermatic cord
External spermatic fascia (external oblique) Cremasteric muscle and fascia (internal oblique and transversalis), Internal spermatic fascia (transversalis)
92
Describe the course of the vas
```
Ascends in spermatic cord
travels around pelvic side wall
Passes between bladder and ureter
Forms dilated ampulla
Opens into ejaculatory duct
```
93
describe the anatomy of the seminal vesicles
Between bladder and rectum.
Diverticulum of vas.
Duct of SV combines with vas to form ejaculatory duct
94
Describe the anatomical relationships of the prostate
Base - neck of bladder
Apex - urethral sphincter and deep perineal muscles
Anterior - urethral sphincter?
Posterior - ampulla of rectum
95
Describe the lobes and zones of the postate
lateral, anterior, posterior and median lobes.
| Zones - Central peripheral
96
Describe BHP
Middle lobule, nocturia, dysuria, urgency
| Obstruction of internal urethral orifice
97
Describe prostatic malignancies
Peripheral zone. mets to internal iliac or sacral nodes. venous to internal vertebral plexus - to vertebrae or brain
98
Treatment of pelvic floor dysfunction
Pelvic floor exercises
Incontinence surgery e.g. vaginal tapes, slings - overactive bladder disease and voiding difficulty.
Prolapse surgery - replace organs, restore CT, maintain function - recurrence, incontinence and dyspareunia
99
Descirbe the muscles of the superficial perineal space
Ischiocevernosus - Increase pressure on venous system to help maintain erection.
Bulbospongiosus - expell last drops of urine and helps maintain erection,
Lavator ani
External anal sphinctor
Superficial transverse perineal muscle.
Cremasteric muscle - regulation of balls temp
100
What is the most inferior part of the peritoneum and how is it accessed in a female?
Pouch of douglass/ rectouterine pouch. Posterior vaginal fornix
Culdocentesis
101
Describe the broad ligament and the round ligamnet
Broad ligament - double fold of peritoneum.
Round ligament - from uterine horns to labia major.- keeps anteflexion along with cardinal lgament (base of broad ligament). also lymph to superficial inguinal nodes along it
102
Where is the deep perineal pouch?
Between pervic diaphragm and perineal membrane. Sometimes referred to as superior and inferior fascia of pelvic diagphragm
103
contents of the deep perineal pouch
Membranous (males)/ proximal (female) urethra
Inferior part of external urethral sphincter
Anterior extension of ischio-anal fat pad.
Male - deep transverse perineal muscles, bulbourethral glands
104
Location of the superficial perineal pouch
Between perineal fascia around muscles and perineal membrane bounded laterally by ischiopubic rami.
105
Contents of the superficial perineal pouch
```
Superficial transverse perineal muscles.
Bulbospongiosus and Ischiocavernosus.
Urethra (bulbous in males)
Deep perineal branches of the internal pudendal vessels and nerves.
Females:
Vagina, clitorus
Males: Crus and bulb of penis)
```
106
Functions of the perineal body. What is it?
Anchors perineal muscles, rectum and aids pelvic support.
| A connective tissue mass in the centre of the perineum (muscle fibres too which converge from everything).
107
When can the perineal body become damaged and what would be the consequences?
During child birth
| Weakness in pelvic floor leading to prolapse of vagina and uterus. Urinary incontinence
108
How can childbirth damage the pelvic floor
Stretch pudendal nerves - neuropraxia and muscle weakness.
Damage to muscles - weakness
Stretch/ repture of ligaments and supports of muscles
109
What other factors lead to pelvic floor dysfunction
Age, menopause (atrophy from oestrogen withdrawral), obesity, chronic cough, connective tissue disorders
110
Describe blood supply to the ovaries
Ovarian artery from AA
| Right and left into IVC and left renal vein respectively
111
Describe the ligaments of the ovary
Suspensory ligament - fold in the peritoneum (terminal part of broad ligament and the ligament of the ovary
112
Describe the position of the uterus
Anteverted (at vagina) and anteflexed (cervix). May be retroflexed/ verted meaning its more likely to prolapse/ child brith complications e.g. constipation
113
Parts of the uterine tube
Abdominal ostium, infundibulum (funnel), ampulla, isthmus (thin)
114
Parts of the cervix
internal and external os with endocervical canal inbetween
115
Ligaments of the cervix
Transverse cervical ligaments (cardinal) - thickening at base of broad ligament. stabalises laterally.
Uterosacral ligament - posterior (2 of them) opposes anterior pull of round ligament assisting mantainence of anteversion
116
Blood supply to cervix
Uterine and internal pudendal (both anterial division of internal iliac)
117
Lymphatic drainage of internal female organs
Ovary - paraortic
Fundus - aortic and inguinal
Body - external iliac
Cervic - external and internal iliac and sacral
118
Describe the female external genitalia
Labia majora - encloses pudendal cleft
Labia minora - encloses vestibule
Vestibule - orifaces of vagina, urethra and greater and lesser vestibular glands
Greater vestibular glands (bartholin) secrete mucus for vaginal lubrication
119
Describe bartholinitis
From chlamyd or gonn. May cause cyst if obstructed - infection - abcess
120
Describe innervation to the vagina and external genitalia
upper 4/5 uterovaginal plexus
lower 1/5 somatic pudendal
Pain afferents vary on pelvic pain line - inferior thoracic lumbar spinal ganglia, S2-4 spinal ganglia.
Perineum - pudendal and ilioinguinal nerve
Pudendal nerve exits GSF, and enters via LSF through the pudendal canal
121
Difference between STI and STD
STD with symptoms
122
Discuss the risk factors for STIs
Young, socioeconomic group, number of parters, orientation, unsafe activity, ethnic group ect.
123
Briefly describe the prevalence of STIs
Chlamydia most common followed by papillomavirus.
| Gonorrhea and Syphilis in men who have sex with men
124
Describe the pathogen in Chlamydia infections
Chlamydia trachomatis - obligate intracellular gram negative bacterium - cocci or rods.
Serotypes D-K
125
Symptoms of Chlamydia infections
Males: Urethritis, epididymitis, prostatitis, proctitis
Females: Urethritis, Salpingitis, cervicitis, perihepatitis.
Eye - conjunctivitis
Neonate - inclusion conjunctivits and pneumonia
126
Diagnosis of chlamydia
Endocervical or urethra swab
1st void urine
conjunctiva swab
NAAT - nucleic acid amplification test
127
Treatment of chlamydia
Doxycycline or azithromycin. Erythromycin in kids
128
Pathogen in Gonorrhea
Neisseria Gonorrhoeae, gram neg diplocci
129
Symptoms of gon
Male: Urethritis, prostatitis, epididymitis, proctitis, pharyngitis
Female: Asymptomatic, Endocervitis, PID, urethritis
If diseminated then bacteraemia, skin and joint lesions
130
Diagnosis of Gonorrhea
Swab (pharyngeal), urine (NAAT)
131
Treatment of gonorrhea
Ceftriaxone and azithromycin (prevent resistance and treat chlamydia)
132
Causitive organism in Herpes
Herpes Simplex Virus2.
| HSV1 normally associated with cold sores
133
Explain symptoms of herpes infection
Primary infection - painful genital ulceration, dysuria, fever, inguinal lymphadenopathy.
Recurrent infection or ma remain latent. Asymptomatic - severe. Virus latent in dorsal root ganglia
134
Treatment of herpes (and prevention)
Aciclovir (barrier contraception helps prevent transmission)
135
Describe causes of genital warts
HPV (6 & 11). 16 & 18 are oncogenic (verical and anogenital
136
Symptoms of genital warts
Benign, painless, verucous epithelial or mucosal outgrowths (cutaneous, mucous or anogenital).
Vaccine for all common/ oncogenic straigns 99% effective
137
Diagnosis of genital warts
Clinical, biopsy and genotype analysis, hybrid capture (from cervical swab).
Screening:
Cervical pap smear cytology -cancer
Colposcopy (cervix contains any abnormal cells) + acewhite test
138
Treatment of genital warts
None
| Cryotherapy, topical podophyllin, interferon, surgery
139
Describe the pathogen in syphilis
Treponema pallidum - spirochaete
140
Describe the symtoms of syphilis
Primary - indurated (hard) ulcers (chancre) painless.
Secondary -lymphadenopathy, mucosal lesions, fever, rash, malaise
Tertiary - neurosyphilis, GPI (general paralysis of the insane) Tabes dorsalis
141
Diagnosis of syphilis
Serology
142
Treatment of syphilis
Penicillin
143
Rarer causes of inguinal lymphadenopathy
Lymphogranuloma venereum (LGV)-C trepoma
Chancroid- Haemophilus ducreyi, painful genital ulcers
Granuloma inguinale/ Donovanosis (Klebsiella glanulomatis)
144
Describe trichomonas vaginalis
Flagellated protozoan
Thin frothy and offensive discharge
Irritation, dysuria and vaginal inflammation
Vaginal wet preparation +/- culture enhancement
Treated with metronidazole
145
Describe vulvovaginal candidiasis
Candida species
Profuse, white itchy, curd like discharge
Topical azoles, oral fluconazole or nystatin
Diagnosis - high vaginal smear
Risk factors - antibiotics, DM, oral contraceptives, pregnancy, obesity, steroids
146
Describe scabies and pubic lice
Can be transferred sexually
147
Describe bacterial vaginosis
Disturbance in normal flora.
More Gardnerella, Mycoplasm and anaerobes
Scanty but offensive fishy discharge
Cervical smear and clinical diagnosis (>5pH).
Metronidazole
148
Lab diagnosis of bacterial vaginosis
Clue cells - epithelial scells studded with gram variable coccobacilli.
Less lactobacilli
Absence of pus cells
149
What is pelvic inflammatory disease?
The result of infection ascending from the endocervix causing endometritis, alpingitis, parmetritis, oophoritis, tubo-ovarian absess and/or pelvic peritonitis
150
Describe the epidemiology of PID
Gon/ Chlamyd 40% concurrent.
BV also implicated
IUCD increases risk in week 1 of infection.
COCP protective agianst symptoms
Alcohol, drugs and smoking are predicitive
151
Describe the pathophysiology of PID
Ascending infection
| Inflammation causes fibrosis and adhesions due to damage of epithelium
152
Describe the clinical features of PID
Pyrexia, dyspareuina, adnexal tenderness, cervical excitation (chandeliers sign), bilateral lower abdominal tenderness/pain
Abnormal discharge +/- blood
History- STIs
153
Differential diagnoses of PID
```
Ectopic pregnancy
Endometriosis
Ovarian cyst (complications of)
Appendicitis
IBS
UTI
Fucntional pain (unknown origin)
```
154
investigations in PID
Triple smear - chlad, gonn endocervix and high vaginal for BV trichomonas and candida
155
Management of PID
Analgesia
IM ceftriaxone, PO doxycycline and metronidazole (14 days)
Surgery if severe - US guided, laproscopic
Hospitalised if pregnant, tubo-ovarian abscess or lack of response to oral therapy
156
Risks associated with PID
Ectopic regnancy
Infertility
Chronic pelvis pain
Fitz Hugh Curtis syndrome
157
What is Fitz Hugh Curtis syndrome
RUQ pain and perihepatitis following chlamydial PID, risk increases with repeat episodes,
158
Describe the covering of the ovaries
Simple squamous epitheliam (germative epithelium)- peritoneal covering
159
Describe the cells of the cortex of the ovary
Initially primordial follicles, oocyte surrounded by a single layer of squamous follicular/ granulosa cells
160
What changes in the follicles occur in puberty and why? (up to theca folliculi)
Squamous to cuboidal graulosa cells, becomes unilaminar primary follicle.
Divides and becomes multilaminar primary follicle (FSH stimulates), ZP forms between oocyte and granulosa. Outer margin stromal cells develop into theca folliculi
161
Describe the formation of a secondary follicle
Fluid filled spaces form between the granulosa cells.
| Theca folliculi develops into theca interna (oestrogen) and theca externa (vascular CT)
162
Describe the formation of a ternary follicle and graafian follicle
Formation of an antrum - fluid filled spaces pushes granulosa to periphary
Expands so it fills encompases the oocyte (apart from cumulus oophorus) known as a graafian follicle (single large fluid filled antrum) (now ready). Corona radiata breaks down prior to ovulation.
163
What is the cumulus oophorus
Small number of graulosa cells that hold oocyte
164
What is the corona radiata
Single layer of granulosa cells surrounding oocyte
165
How does the follicle change at ovulation
Tissue around becomes ischemic, follicle ruptures, oocyte released. GC become granulosa lutein cells (secrete prog) and theca interna becomes theca lutein (oestrogen). Blood clot in the middle
166
What is a corpus albicans
Absence of hCG - denerates, fibrosed/ hyalinised to whiteness.
Can become corpus nigricans due to pigmentation from degraded erythrocytes
167
Describe the histology of the fallopian tube
Columnar cilliated epithelium and LP (mucosa). PEG cells (secrete mucus and pronounced). SM of varying thickness- less at isthmus
168
Describe the different layers of the uterus
Endometrium - stratum functionalis (coiled arteries) and stratum basali (straight arteries)
Myometrium - 4 layers of SM
169
Decribe the stages of the endometrium
Early proliferative - SF grows, glands sparse and straight
Late proliferative - glands coiled as they grown quicker than LP
Early sectretory - max thickness - very pronounced coiled glands
Late secretory- stroma becomes odematous and decidual cells develop which help create placenta and secrete prolactin in pregnancy.
If no implantation - lack of prog causes it to shed
170
Describe the histology of the cervix
Simple columnar meets stratified squamous at Squamocolumnar junction near external os. many glands on columnar side for vaginal lubrication
171
Describe the histology of the vagina
3 layers - mucosa, submucosa and muscular (skeletal and smooth). No glands. Rich in glycoproteins (especially with oestrogen)
172
Describe breasts in new born
Duct system and nipple surrounded by aerolar tissue
173
Breast changes at puberty
Development of lactiferous ducts and deposition of adipose
174
Histology of the breast
lactiferous ducts with cuboidal/columnal/ squamous (in sinuses). Myoepithelial cells
175
Function of o and p in breast development
It is believed that oestrogen results in proliferation of the duct system whilst progesterone influences development of the secretory tissues
176
Describe the outer layers of the testes
```
Tunica albuginosa - tough CT
Tunica vasculosa (vessels)
```
177
Describe histology of testes
Seminiferous tubules surrounded by perilobular CT (collagenous) in between lobules there is CT and islands of leydig cells (testosterone)
178
Briefly describe maturation of spermatogoonia
spermatogoonia - spermatocyte - spermatotid
| Outside of ST in
179
Histology of a seminiferous tubule
Spermato... out to in. Sertoli cells form blood barrier. Speratogoonia cells develop engulfed within. Cytoplasmic bridges to link and facillitate simultaneous development.
Myofibroblasts around the outside which can contract
180
Junction between seminiferous and tubuli recti
Plug of sertoli cells then simple cuboidal
181
Epithelium of rete testis
Simple cuboidal
182
Describe the histology of the efferent ductules
Ducts in LCT.
Pseudostratified cilliated to waft
Simple cudoidal cells to absorb fluids
Contractile cells around outside
183
Describe the histology of the epidydimis
Pseudostratified (sterocillia (dont waft)) and basal cells.
| outside SM gets thicker towards vas.
184
Describe the histology of the vas
Epithelium, LP, 3 layers of SM, out and in are longitudinal middle is circular.
Pseudostat with few stereocilia
folding due to tone of circular muscle
185
Describe the histology of the seminal vesicles
Coiled tubliosaccular glands - develop out of ducus deferens. highly folded mucosa, LP. Each gland covered by a muscular coat (sympathetic due ejac).
Secretes fructosa, proteins and prostaglandins
Pseudostat columnar
186
Describe the duct system in the prostate
Mucosal, submucosal, main in central middle and peripheral zones. all drain into urethra separately
187
Separation of the prostate glands by what?
Fibromuscular capsule divides into lobules
188
Describe the histology of the prostate
Hetrogenous epithelium. Copora amylacae in older men
189
What is a primary sexual characteristic
Develops before birth
190
List the order of events within puberty for females
```
Thelarche
Adrenarche
Growth spurt (12)
Menarche (12.5)
Pubic hair adult
Breast adult
```
191
List the order of events within pubery for males
```
Genital development
Adrenarche
Speratogenesis
Growth spurt
Adult genitalia
Adult pubic hair
```
192
What mechanism causes puberty
GnRH from hypo, maturation of central systems, weight gain (47kg in females), less sensitive to neg feedback, pineal gland and melatonin?
193
What causes public hair, libido and breast development and male genital development?
Public hair and libido = androgens
Breast development = oestrogens
Male genitals = testosterone
194
Define climateric
The peiod of life when fertility and sexual activity are in decline. Pre, menopause and post
195
Describe pre menopause
Early or absent ovulation, follicular phase shortens. Decrease in oestrogen and inhibin so LH and FSH(++) rise.
Reduced fertility
196
Describe changes in menopause includign vascular changes, bone, genital
No more follicles. Oestrogen decreases, LH and FSH rise.
Hot flushes due to absence of oestrogen
Osteoporosis as oestrogen inhibits osteoclasts (2.5% per year)
Involution of breast tissue, loss of vaginal rugae
Skin changes
Bladder changes
197
Describe treatment for problems of menopause
Oestrogen, HRT. Oral, topical patch or gel. Not advised for cardioprotection. Not a first line protection for osteoporosis. Prog added to prevent uterus cancers.
198
Neg affects of HRT
Headaches, indigestion, depression, Breast cancer, stroke, DVT, PE
199
Define primary amenorrhoea
Absence of ovulation by age 14 with secondary sexual characteristics or absence by age 16 with normal SSC
200
Define secondary amenorrhoea
Absence of ovulation for 3 months with normal history or cyclic bleeding or 9 months in a women with history of irregular periods (usually 40-55)
201
Desribe problems in the outflow tract that can cause primary amenorrhoea
Vaginal atresia, Mallerian agenesis, imperforate hymen
202
Describe problems in the outflow tract that can cause secondary amenorrhoea
Intrauterine adhesions (asherman's syndrome) AA to remember. trauma
203
Describe gonadal problems that can cause amenorrhoea primary
Gonadal dysgenesis e.g. turners, hypergonadotrophic amenorrhea. Receptor abnormalities FSH or LH, congential adrenal hyperplasia, adrogen insensitivity syndrome (testicular feminization syndrome)
204
Describe gonadal problems that can cause amenorrhoea secondary
Premature menopause. Polycystic ovarian syndrome. Pregnancy, drug induced
205
Hypo/ pit causing primary
Kallmann syndrome
206
Hypo/ pit secondary
Exercise, stress, weigh loss or gain, sheehan syndrome (vascular necrois of pit) hyperprolacinaemia, haemochromatosis. Hypo or hyper thyroidism.
207
Define menorrhagia
>80ml, >7 days regular.
208
Causes of menorrhagia
Distorsion of uterine cavity, organic, iatrogenic, endocrinological, haemostatic
209
Treatment of menorrhagia
Hormones/ agonists, USS if structural
210
Define dysfunctional uterine bleeding (DUB)
Heavy, frequent or prolonged uterine bleeded with no obvious organic cause. Anovulatory
211
Who normally gets DUB
Extremes of life. PCOS
212
Describe pathophysiology of DUB
HPO axis.
| No prog withdrawal so endometrium builds up and breaksdown erratically
213
DUB management
HCG TSH, tamoxifen (block oestrogen), OCP
214
Define dysmenorrhea
Painful periods
215
Define oligomenorrhoea
Less frequent periods 35 days- 6months
216
Define premenstrual syndrome
Physical (bloating, constipation) and emotional (stress, headache, fatigue) symptoms 2 weeks before menstruation (hormones in luteal phase?)
217
What is mastalgia
Breast pain
218
List the hormones involved in reproduction produced by the hypo, the ant pit, post pit and the gonads and state which cell types
Hypothalamus - GnRH
| Anterior pit - Somatotrophs-GH, Corticotrophs- ACTH, thyrotrophs - TSH, Gonadotrophs- LH/FSH
219
Control of gonadotrophin secretion
Hypothalamus - pulsatile GnRH trigger by neurones (1 hour).
Into hpophyseal portal circulation (median eminence to ant pit) (axons to ant pit also end in median eminence).
Neg feedback of gonadotrophs, androgens and oestrogens
220
Action of gonadotrophins on the testes
FSH - Sertoli to promote spermatogenesis and inulin production (via androgens tho?)
LH - Leydig cells to produce testosterone, promote spermatogenesis and maintain repro
221
Glcopeptides vs polypeptides
FSH, LH & TSH vs GH, ACTH and Prolactin
222
Action of gonadotrophins on the ovaries
FSH - granulosa cells to stim developmet, secretes inhibin
LH - secretion of oestrogen from theca interna (stim development of follicle). Surge = ovulation. LH maintains corpus luteum
223
List the phases of the menstrial cycles
Preparatory/ follicular - growth of follicle, preparation of endometrium. Changes to faciliotate sexual interactions.
Ovulation- Also formation of corpus luteum
224
Oestrogen through the menstrual cycle
Slowly increases with follicle - high for Lh surge, small decrease, rise again with CL, decrease with death of CL
225
Progesterone through menstrual cycle
Low without CL, produced by CL
226
LH and FSH through the menstrual cycle
LH relatively low, increases LH surge, slowly decreases.
| FSH, small surge, decreases (inhibin)
227
Describe the effects of oestrogen
```
Fallopian tube function
Thickening of endometrium
growth and motility of myometrium
Thin alkaline cervical mucus
Ca metabolism
Changes in hair, skin and metabolism
Vaginal changes (thicker, elastic, glycogen)
```
228
Describe the effects of progesterone
```
Augment oestrogen but,
Not motility of myometrium
Secretary phase of endometrium
Thick acidic mucus at cervic
Changes in mammary tissue
Metabolic and electrolyte changes
```
229
Describe the migration of the primordial germ cells
Arise in the caudal part of the yolk sac and migrate along the dorsal mesentary into the retro peritoneum/ gonads
230
Describe the control and development of the male testis (not ducts) and female ovary
In males SRY region on Y chromosome causes the medullary cords of the primitive gonad to develop. The absence causes the cortical cords to develop. Thick tunica albuginea vs none. Males have no cortical cords. Women medullary cords degenerate
231
Describe the development of the gonadal ducts
Wollfian duct - primitive renal function, ends at cloaca. Maintained by testosterone.
Paramesonephric (Mullerian) formed from invaginations of urogenital epithelium. Also end at cloaca but opens into the abdominal cavity. Mullarian inhibiting hormone in males causes duct to degenerate.
232
Describe the dvelopment of vagina and uterus
```
Urogenital ridge grows outwards around primitve gut and paramesonephric ducts merge forming top 1/3 of vagina, uterus and fallopian tubes.
Stimulates endoderm (urogenital sinus) to develop into lower 2/3
```
233
Describe the components of the external genitalia in their indifferent stage and what they develop into in the male and female
Genital tubercle - Clitorus vs glans
Genital fold - Fuse to form scrotal raphe and spongy urethra vs labia minora
Genital swelling - labia majora vs scrotum
Infuenced by testosterone
Mesoderm?
234
Describe the descent of the ovaries and testes
Caudal genital ligamnet (gubernaculum) attches to labiosacral folds. As trunk elongates testes are pulled through inguinal canal into scrotom. Processus vaginalis enters first.
In females this causes descent of the ovaries into the pelvis.
235
Describe common abnormalities of genital development
```
Hypospadias - incomplete fusion of urethral folds (inferior aspect of penis or scrotal raphe)
Epispadias on dorsum - associated with extrophy of bladder.
Uterus didelphys (no fusion)/ arcuatus/ bicornis (two horms) Uterus bicornis unicollis
Genotype-phenotype mismatch
```
236
Describe spermatogenesis
At puberty - spermoogonia mitose 64 times into spermatocyte. meiosis into spermatids. Remodelled through tubule, rete testis, ducti efferentes, epidydimis to spermatozoa
237
Describe the spermatogenic cycle and wave
spermatogenic cycle
duration of the cycle which separates consecutive cell divisions of spermatogonia (pig is 8 days, sheep 10, cattle 14) to produce spermatocytes.
spermatogenic wave
spermatogenesis occurs in sequential waves along the length of the seminiferous tubules so that spermatozoa are produced in waves; the phenomenon which ensures that spermatozoa are produced continuously, except for seasonal pauses when spermatogenesis is initiated and terminated each year.
238
Describe the production of ovum
Germ cells colonise gonadal cortex and become oogonia. Proliferate to 7 million. only 2 million at birth.
Meiosis is stimulated but stops at early stage (primary oocytes) until puberty- here they are primordial follicles. Aftery pubery they develpp one at a time.
First division just before released.
239
Define term and pre term labour, spontaneous abortion
Labour - expulsion of products of conception after 24 weeks
Spontaneous abortion - expulsion of products of conception at less than 24 weeks.
Pre term - before 37
Term - 37-42
240
Brief stages of pregancy
First - creation of birth canal
Second - expulsion of fetus
Third - expulsion of placenta & contraction of uterus
241
Describe the position of the uterus at 12, 20 and 36 weeks
```
12 = Palpable
20 = Umbilicus
36 = Xiphisternum
```
242
Describe the lie of the fetus
Relationship to long axis of uterus - normally longditudinal and flexed
243
Describe the presentation of the fetus
Which part is next to the pelvic inlet - cephalic (vertex/head) or breach (podalic)
244
Normal size of birth canal and of head
```
Head in normal position = 9.5
Pelvic inlet maximum = 11cm (may increase with softening of ligaments. Expansion of cervic, vagina and perineum to 10cm.
```
245
Describe cervical ripening
Reduction in collagen, increase in GAGs, reduction in aggregation of collagen fibres
Triggered by prostaglandins (pG E2 and F2x)
246
Apart from cervical ripening what else creates the birth canal and describe the process.
Contractions of the myometrium smooth muscle triggered by pacemakers. fibres get progressively shorter through repeated contraction and relaxation known as Brachystasis. Pushes fetus into cervix. Cervix thins and flattens (effacement). More oxytocin. Cervix dilates. Rupture of amnion.
247
Describe contractions throughout pregancy
Early - low amplitude - every 30 minutes (not felt)
| Late - less frequent but higher amplitude = 'Braxton-Hicks' contractions
248
Describe contractility control of the myometrium
Made more forceful by prostaglandins (more Ca) and oxytocin (positive feedback) (more action potentials due to a lower threshold)
249
Describe prostaglandin production and function
Biologically active lipids
Local hormones
Produced by endometrium
Controlled by oestrogen:progesterone. Later in pregancy progesterone production falls resulting in prostaglandins.
250
Describe oxytocin production and function in pregancy
Ferguson reflex (afferent implses from vagina and cervix). post pit but controlled by hypothalamus. Acts on SM receptors (more of which if high O:P)
251
Describe the second stage of labour
Rapid.
Urge to bear down
Presenting part appears in birth canal.
Head flexes, rotates internally.
Head stretches vagina and perineum (risking tear/ episiotomy).
Delivery involves rotating furthur (now facing mother's but) and extends.
Shoulders rotate and deliver followed rapidly by the rest.
252
Describe the third stage of labour
Uterus contracts down hard, shears off placenta. Expels it from uterus (normally 10mins).
Compresses blood vessels to reduce haemorrhage.
253
How is the third stage of labour artificially enhanced?
Giving oxytocic drug
254
Describe the establishment of independent life
Neonate takes first breath - trauma and cold stimulate
Reduces pulmonary vascular resistance and increases arterial pO2.
Formen ovale closes, DA contracts due to pO2.
255
Describe the symmetry and polarity of uterine contractions
Contractions from two poles (lat to fundus by isthmus)
256
Role of relaxin
causes changes in cervix over a period of weeks
257
Difference between effacement and dilation?
Effacement is peeling (how long the canal is), dilation is formation of gap
258
Descrbe the types of pelvis
Gynecoid - wide
Anthropoid - Narrow transverse, wide inclination of sacrum. Wide AP
Android - narrow forepelvis, forawrs sacrum, narrow pelvic outlet (sub pubic)
Platypeloid - Narrow AP, Wide pelvic outlet.
259
Describe width of different positions of head
Vertex -9.5 perfecti
Sinciput - not fully flexed 10cm
Brow - slightly extended - 13.8cm
Face - 9.5cm
260
Describe clin sig of passenge
```
Number
Weight
Presentation
Lie (longditudinal or transverse)
Attidtude (flexion or extension)
```
261
Describe breach types
Frank - feet by head
Full - cros legs
Single footing
262
Two phases in the first stage
Latent - slow dilation
| Active - faster and contractions
263
Describe the types of instrumental delivery
Forceps or Von toux (vacuum)
264
Blood in placenta separation
Intervillous space back into veins of spongy layer of decidua basilis, cant brain back into maternal bloodstream as uterus has retracted.
Living ligatures - retract around placenta to seal off blood vessels (interlacing muscle fibres. Blood clotting mechanisms
265
Describe mammary glands
Embedded in breasts
15-20 lobulated masses of tissue (Fibrous and adipose tissue in between
Lobes= alveoli, BV and Lactiferous ducts
266
Describe development of mammary glands in puberty and in pregnancy
Only a few ducts at birth
At puberty ducts sprout and branch and alveoli begin to develop
With each menstrual cycle there are changes in oestrogen and progesterone
In pregnancy - hypertrophy of ductular-lobular-alveolar system to form prominent lobules. Differentiation of alveolar cells to be capable of milk production from mid gestation. Little milk secreted - high prod:oestrogen favours growth not secretion.
267
Describe the milk secretion soon after birth
```
Colostrum produced (40ml).
Less water, fat & sugar than later milk so more protein (IgG)
```
268
Describe 2 week milk secretin
```
Mature milk - gradual change
90% water
7% sugar (lactose)
2% fat
Proteins (lactalbumin and lactoglobin)
Vit and min
Sweet and semi skimmed
Secreted by alveolar cells
```
269
Describe the control of milk secretion (briefly) and production
Secretion by fall of steroids (high prog: oestrogen in pregnancy falls)
Prolactin (Dopamine) promoted by suckling, neuroendocrine reflex. Promotes production for next feed (turgor).
Also let down reflex.
270
Describe the 'let down reflex'
Myoepitheliual cells arround alveoli contract due to oxytocin to squeeze milk out of breast. Also a neuro-endocrine reflex that becomes conditioned
271
benefits of breast feeding
Bonding
| Babies have fewer infections
272
What is a TDLU
terminal duct lobular unit.
Functional unit - end of branching duct
=acini and intralobular stroma
273
Increasing age and breasts
Describe in TDLus and stroma replaced by adipose tissue
274
Most worrying palpable breast mass
hard craggy and fixed as may be invasive carcinomas
275
Milky discharge from nipple?
Endocrine disorder e.g. pit adenoma or medication
276
Causes of densities and calcification in the breast
Densities - invasive carcinomas, fibroadenomas and cysts
| Calcification - DCIS and benign changes
277
Describe benign stromal tumours types
```
Fibroadenomas (most common) - any age by often older
Phyllodes tumour (60s)
```
278
Eoidemiology of breast cancer
Rare before 25 (unless genetic). Incidence increases with age. 1% in men
279
Describe disorders of breast development
Milk line remnants (polythelia- accessory nipples)
| Accessory axillary breast tissue
280
Describe inflammatory conditions of breast
```
Acute mastitis - Staph aureus
during lactation
Erythematous, painful, pyrexia
May result in breast abscess
Antibiotics and express mil.
```
Duct ectasia - 50/60 idiopathic, mass or discharge, duct dilation and inflam. mimic carncinoma
Fat necrosis - mass, skin changes, mammographic abnormality, history of trauma
281
Describe fibrocystic change (benign epithelial lesion)
Common
Mass
Disappears after fine needle aspiration
Histology - cyst formation, fibrosis and apocrine metaplaia (wider acini)
282
Descrube epithelial hyperplasia (benign epithelial lesion)
Incidentall often
More epithelial cells which fill and distend ducts and lobules
Slight increased risk of carcinoma
283
Describe breast papilloma (benign epithelial lesion)
Large ones near lactiferous ducts near nipple, small are often multile and deeper, slight increased risk of carcinoma.
Possible nipple discharge, small palpable mass or abnormality
May be bloody
Looks like a leaf
284
Describe fibroadenoma
Mass, usually mobile and elusive
Can be multiple or bilateral
Can replace most of breat
Macroscopcally - well circumscribed, rubbery, white
Histology - Mixture of stomal and epithelial elements
285
Describe phyllodes tumours
Rare before 40
Benign, malignant or boarderline. Most are benign.
Can involve entire breast.
Nodules of proliferating stroma covered by epithelium (phullon = leaf)
Stroma more cellular and atypical than fibroadenomas
286
Describe gynaecomastia
Unilateral or bilateral
Puberty or elderly
Relative decrease in androgen effect or increase in oestrogen effect
Can mimic male BC if unilateral
No increased risk of BC,
Occurs in neonates due to placental hormones.
Klinefelter's sydrome
Oestrogen excess in liver cirrhosis
Testicular tumour
Drug related e.g. spironolactone, heroin, alcohol
287
Describe risk factors for breast cancer
```
Age
Age of menarche and menopause (longer time period of oestrogen)
Breast feeding - protective
Age of pregancy (breast up oestrogen)
Obesity and fat
HRT
geography
atypical changes on previous biopsy
previous BC
Radiation
Hereditary e.g. RAC1/2, p53
```
288
Briefly describe classification of breast carcinoma
Either in situ or invasive and be ductal or lobar
289
Describe in situ carcinomas
Limited by basement membrane so only in ducts.
Does not invade vessels and therefore cannot metastasise
DCIS. can calcify, can spread through ducts and lobules and be very extensive.
Central necrosis and calcification
290
What is Paget's disease
Cell extend to nipple skin without crossing BM
Unilateral red and crusting nipple
Eczematous or inflammatory conditions should be suspected of being Pagets
May lead to/ be malignant
291
Describe invasive carcinomas
Invaded beyond BM
No link to DCIS.
Metastasise
More have lymphatic involvement by the time its palpable.
Peau d'oragne due to loss of lymph drainage.
May be ductal (70-80%) or Lobular (single file cellular invasion) both with similar prognosis.
292
Describe common mets sites of BC
```
Lymph - axilla
Bones
Lungs
Liver Brain
Invasive lobular can be peritoneum, leptomeninges, GI tract, ovaies uterus
```
293
Desribe the triple approach to the investigation and diagnosis of BC
Clinical - history, family, exam
Radiograph imaging - mammorgraphy and US
Pathology - FNAC and core biopsy
294
Describe treatmetn of BC
Breast surgery, axillary surgery, post op radiotherapy to axillae
Sentinal lymph node biopsy.
Chemo - may be neoadjuvant
Hormones e.g. tamoxifen is oestogen receptor positive
Herceptin - HER 2
295
Describe the pathogenesis of the cervic
Mainly HPV16 &18 infect metaplastic squamous cells in transformation zone. Increase proliferation of cells and inhibit repair.
Although most infections are transient
296
Risk factors for cervical cancer
Sex related
immunosuppressed
Smoking
OCP
297
Describe cervical screening
Easy to examine (colposcopy)
Pap test detects low stage lesions (scaped, stained and microscope)
25 years old, every 3 years then every 5 after 50.
If abnormal then colposcopy and biopsy.
Also test for HPV
298
Describe CIN and its progression and treatment
```
Cervical intraepithelial neoplasia.
Dysplasia induced by infection.
CIN I - resolves spontaneously
CIN II
CIN III - Carcinoma insitu, 10% progress to invasive carcinoma
CIN I-CIN III to 7 years
CIN I- follow up or cryotherapy
CIN II-III superficial excision
```
299
Describe cervical carcinoma (everything)
45 years
80% SCC
15% adenocarcinoma
Exophytic (outward) or infiltrative
Spreads locally, Bladder, rectum, vagina, lymph/.
Bleeding
Treatment - cervical cone excision if microinvasive (7mm wide 1mm in then 100%)
Hysterectomy, lymoh dissection and radio and chemo if invasive
300
Describe Endometrial Hyperplasia
Increase gland:stroma, precursor to carcinoma
Prolonged oestrogen exposure .
If complex and atypical then hysterectomy
301
Describe endometrial adenocarcinoma
Common
Older
Irregular post menopausal bleeding - good survival as detected earlier.
Can be endometriod or carcinoma.
Endometrioid is more common, from hyperplasia, spread via myometrial invasion.
Serous - poorly differentiated, agressive, exfoliates so spreads to peritoneum.
302
Describe tumours of the myometrium
Mostly benign (Leiomyoma). Results in fibroids. Very common. Multiple, tiny to massive.
Asymptomatic, heavy/painful periods, urinary frequency, infertility.
Not malignant.
Resembles SM, well circumscribed, firm, white
(can get uterine leiomyoma)
303
Symptoms of ovarian cancer
Asymptomatic (detected late)
Most symptoms due to mets.
Mass effect: abdominal pain, distension, urinary and GI symtoms, ascites
Hormonal problems - menstrual disturbances, ianppropriate sex hormones.
304
Descrube 4 types of ovarian tumours
1) mullarian epithelium (including endometriosis)
2) Germ cells (pluripotent)
3) Sex cord-stromal cells (endocrine apparatus of the ovary
4) mets?
305
Describe ovarian epithelial tumours including types, risk factors
Can be serous mucinous or endometriod (all may be benign, borderline or malignant) many are cystic.
Risk factors - low parity, mutations, Smoking, endometriosis
Serous - often peritoneal spread so commonly ascites
Mucinous - large, cystic, benign, pseudomyxoma peritonei, ascites, peritoneal mets, GI
Endometrioid - Can arise from endometriosis, associated with edometrial carcinoma
306
Describe Germ cell ovarian tumours
15-20% of ovarian neoplasms
tetratomas, usually benign, may be neoplastic e.g. cjoriocarcinoma or yolk sac (HCG and a-fetoprotein).
tetratomas may be mature (benign), immature (malignant and rare) or monodermal (highly specialised).
Mature are cystic, loads of different tissues.
Monodermal may be stomal ( benign and thyroid) or carcinoid (malignant and carcinoid syndrome)
307
Describe ovarian sex cord stromal tumours
Sertoli, leydig/ granulosa and theca cells from sex cord.
May be feminising or masculising respectively.
Post menopasal - large amounts of oestrogen (risk factor).
In children can cause precocious or impair depending if M or F cells.
308
Describe ovarian mets
Normally from other mullerian structures.
Also GI or breast.
Often bilateral
309
Describe the types of vulval tumours
SCC - HPV, age, inflam e.g. lichen sclerosis. From vulvar intraepithelial neoplasia (VIN) (no invasion). Spreads to lymph, lungs and liver
Extramammary paget's disease - Pruritic, red, crusted on labia majora, single or clustered malignant cells along basal layer, wide local excision required
BCC
Malignant melanoma
310
Describe tumours of gestation
Proliferation of placental tissue- villous or trophoblastic.
Hydatifiform mole (complete or partial) - Associated with other types, cystic swelling of chorionic villi (thin walled grapes_ and trophoblastic prolif, diagnosed with USS, causes miscarriage. Treatment with curettage, monitor HCG - if it doesnt fall then invasive mole.
Invasive mole- perforates uterine wall. locally destructive, vaginal bleeding and uterine enlargement, high HCG, chemo
Choriocarcinoma - malignant trophoblast derived, no vili, rapidly invasive but responds well to chemo. Often with moles, abortions but also normal. Vaginal bleeding (spotting), high HCG, uterine evacuation and chemo
311
Difference between complete and partial moles
Complete = Lost female chromosomes. embryos die, high HCG. assoc with choriocarcinoma
Partial mole = 2 sperm - foetus present. not assoc with choriocarcionoma. less chance its invasive
