Week 6 part 1 Flashcards Preview

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Flashcards in Week 6 part 1 Deck (93):
1

What do the majority of arteries of pelvis and perineum arise from?

Internal iliac artery

2

What are the exceptions for arteries supplying perineum coming from internal iliac?

Gonadal artery - L2 abdo aorta
Superior rectal artery - continuation of inferior mesenteric

3

wHAT Divisions does internal iliac split into?

[psterioor and anterior division (anterior usually visceral and posterior usually parietal)

4

What is the median umbilical ligament a remnant of which connected internal iliac to placetna through umbilical cord?

Umbilical artery

5

What artery of perineum is only present in males and its alternative in females is vaginal artery?

Inferior vesical artery

6

Internal iliac splits into anterior and posterior divisions - what comes from posterior division?

PILLS - posterior, iliolubar artery, lateral sacral arteries, superior gluteal artery

7

A branch of what artery goes to supply prostate?

Prostatic branch of inferior vesical artery

8

What are the trhee umbilical folds?

1. Lateral umbilical fold - inferior epigastric vessels
2. Medial umbilical fold - remnant of umbilical artery
3. Median umbilical fold - urachus

9

What does anterior scrotal artery branch form?

External iliac artery

10

What artery does middle rectal artery come off?

Internal pudendal artery

11

What is the uterine artery in females a homolog of?

Artery to vas deferens

12

Between whast two female arteries does an anastomosis occur between?

Uterine artery and ovarian artery
Uterine artery and vaginal artery

13

What two branches does ovarian artery split into?

Tubual branch
Ovarian branch - gives ovaries dual blood supply

14

Where does venous drainage from pelvis mainly drain to?

Internal iliac vein - some via superior rectal to hepatic protal system, some via lateral sacral veins to internal vertebral venous plexus

15

Sciatic nerve roots?

L4-S3, splits into tibial and common fibular

16

What lymph nodes does superior pelvic viscera go to?

External iliac nodes
Common liac, aortic, thoracic duct, venous system

17

What lymph nodes does inferior pelvic viscera go to?

Internal iliac nodes
Common iliac, aortic, thoracic duct, venous system

18

What lymph nodes does superficial perineum go to?

Superficial inguinal nodes

19

What nerve supplies perineum?

Pudendal

20

What is the commonest investigation n gynaecology/

Ultrasound - no ionising radiation

21

Does the patient need a full bladder for transabfdomnal ultrasound?

YES - Acts as an acoustic window, distended bladder displaceds gas filled bowel loops out of pelvis (gas scatters ultrqsound beam and degrades image wuality)

22

Higher frequency ultrasound has a shorter wavelength and better spatial resolution, but…….
…. Higher frequencies are more likely to be scattered in the body and the ultrasound transducer has to be close to the target organ

Transvaginal scanning - need empty bladder

23

Young Patient who gets admitted to a&e with acute abdominal pain that passes after 6 hours.

Ruptured ovarian cyst

24

What is second line investigation after ultrasound in patients presenting with acute abdominal pain?

CT scan

25

What imaging is used for staging of gynaecological malignancy, especially ovarian and endometrial cancers?

CT

26

What is the only fatty lesion in dermatology?

Dermoid cyst - confirmed on CT

27

wHAT ENERGY does MRI use?

Radiofrequency energy

28

What does MRI give poor depiction of?

Lung parenchyma - CT scan instead

29

What cancer is staged using MRI?

Cervical

30

Endometriosis is difficult to diagnose so patients may need what?

Diagnostic laparoscopy

31

What is used for assessment of tubal patency in patients with infertility?

Hysterosalpingography

32

What cancer are ascites, omental and peritoneal noduels common in?

Ovarian cancer

33

StGING of ovarian cancer uses what imaging?

CT

34

What is best method for extablishing abnormally thickened endometrium in post menopausal patient with PMB?

Transvaginal ultrasound

35

Average age of menopause?

51

36

Early menopause definition?

LESS than 45, premature is less than 40

37

Late menopause defnition?

Over 54

38

What cells secrete oestrogens?

Granulosa cells

39

What hormone proliferates endometrium, secondary sexual characteristics, hair distribution, body shape and fat distribution?

Oestrogen

40

What three factors can raise FSH and LH?

Prior to ovulation
Raised with stopping COCOP or dep
Raised with breastfeeding or SSRIs

41

Hot flushes - 60-80% women, average 2 yrs, last 3-5 mins
Night sweats
Palpitations
Insomnia
Joint aches
Headaches

Menopause

42

6 treatments for menorrhagia in menopause?

1. Mefenamic acid
2. Tranexamic acid
3. Protesterones
4. Intrauterine system
5. Endometrial ablation
6. Hysterectomy

43

List some benefits of HRT in menopause?

1. Symptom control
2. Reduced osteoporotc fracture
3. Reduced bowel cancer
4. Possibly protective alzheimers

44

List some disadvantages of HRT for menopause?

Breast cancer
Gallbladder disease

45

Give two uterine causes for DUB?

1. Endometrial polyps
2. Endometrial hyperplasia

46

When do endometrial [polpys often occur?

Around/after menopause

47

What might persistent oestrogen stimulation cause?

Endometrial hyperplasia

48

Peak incidence of endometrial carcinoma?

50-60 years - in young women consider underlying predisposition e.g. PCOS or lynch syndrome

49

What are most endometrial carcinomas/

Adenocarcinomas

50

What are the two main clinico-pathological types of endometrial carcinoma?

1. Endometriod - type I 80%
2. Serous (and clear cell) - type II

51

What are endometrioid carcinomas related to and associated with?

Related to unopposed oestrogen
Associated with atypical hyperplasia

52

What type of endometrial carcinoma: Not associated with unopposed oestrogen
Affect elderly post‐menopausal women
TP53 often mutated

Serous (and all clear cell, type II tumours)

53

What endometrial type tumours have PTEN, KRAS and PIK3CA mutations, associated with atypical hyperplasia as precurosr lesion, microsatellite instability

Type I tumours - endometrioid and micunous

54

Known risk factor for endometrial cancer?

Obesity - associated with endocrine and infalmmatory effects of adipose tissue, adipocytes express aromatase that converts ovarian androgens into oestrogens - inducing proliferation of endometrium

55

What is Lynch syndrome?

Cancer predisposition syndrome - high risk of colorectal cancer, endometrial cancerand ovarian.

56

What is inheritance like in Lynch syndrome?

Due to defective DNA mismatch repair gene, autosomal dominant inheritance

57

What do lynch syndrome tumours show which is a characteristic of defective mismatch repair?

Microsatellite instability MSI

58

wHAT TYPE of endometrial carcinoma has TP53 mutation and overexpression?

Type II - serous and clear cell phenotypes

59

What is precursor lesion for endometrial carcinoma type II ?

Serous endometrial intraepithelial carcinoma

60

Which type of endometrial carcinoma is more aggressive?

Type II - serous and clear cell

61

Characterised by a complex papillary and/or glandular archietecture with diffuse, marked nuclear pleomorphism

Serous carcinoma of endometrium

62

Treatment of endometrial carcinoma?

Hysterectomy: chemo/radiotherapy

63

Endometrioid carcinoma are primarily graded by architecture - what are the three grades?

1. 5% or less solid growth
2. 6-50% solid growth
4. >50% solid growth

64

What is description of stage I endometrial cancer?

COnfiend to uterus

65

What stage of endometrial cancer does it involve vaginal or parametrial involvement?

IIIB, IIIC is metastases to pelvic and/or paraaortic lymph nodes

66

What endometrial cancaer? Heterologous elements commonly seen in about 50% cases (rhabdomyosarcoma, chrondrosarcoma, osteosarcoma)
The presence of a rhabdomyosarcomatous component has the worst prognosis

Carcinosarcoma

67

A malignant smooth muscle tumour commonly displaying a spindle cell morphology

Leiomyosarcoma - the most common uterine sarcoma

68

What type of ovarian cysts are polycyctic ovaries?

Follicular

69

Chocolate cyst?

Endometriosis on ovary

70

Peritoneal spots or nodules
Fibrous adhesions
Chocolate cysts

Ovarian endometriosis

71

What are epithelial ovarian tumours catogorised as?

Benign, borderline or malignant

72

What epithelial ovarian tumour class is this: no cytological abnormalities, proliferative activity absent, no stromal invasion?

Benign

73

What epithelial ovarian tumour class is this: cytological abnomralities, proliferative, no stromal invation

Borderline

74

What epithelial ovarian tumour class is this: stromal invasion?

Malignant

75

What are the two types of serous carcinoma of ovary?

High grade
Low grade

76

What grade of serous carcinoma of ovary involves serous tubal intraepithelial carcinoma?

hIGH grade

77

What are endometrioid and clear cell carcinoma of ovary strongly associated iwth?

Endometriosis of ovary
Lynch syndrome

78

What is the diagnosis of endometrioiud and clear cell ovarian carcinoma often made on?

Ascitic fluid

79

An ovarian tumour of transitional type epithelium, usually benign

Brenner tumour

80

Give two types of germ cell ovarian tumours?

Dermoid cyst - mature, benign, cystic
Teratoma

81

What are 95% of ovarian germ cell tumours?

Dermoid cysts - cystic, containing sebum and hair

82

most common malignant primitive germ cell tumour
1-2% of all malignant ovarian tumours
Almost exclusively children and young women, average age 22

Dysgerminoma

83

A type of ovarian sex cord/stromal tumour which is benign, may produce oestrogen causing uterine bleeding?

Fibroma/thecoma

84

What ovarian sex cord/stromal tumours are rare and may produce androgens?

Sertoli-Leydig cell tumours

85

What must be considered in all cases of ovarian tumours if they are bilateral and small?

Metastatic tumours - stomach, colon, breast, pancreas

86

In FIGO staging of ovarian cancer - what is IA

tumour confined to one ovary

87

In FIGO staging of ovarian cancer - what is IB

tumour confined to both ovaries

88

In FIGO staging of ovarian cancer - what is IC

Cancer involving ovarian surface/rupture/siurgical split/tumour in washings

89

In FIGO staging of ovarian cancer - what is 2A

extension or implants on uterus/fallopian tube

90

In FIGO staging of ovarian cancer - what is 2b

Extension to other pelvic intraperitoneal

91

In FIGO staging of ovarian cancer - what is 3A

Cancer cells in lining of abdomen, retroperitoneal lymph node metastasis

92

In FIGO staging of ovarian cancer - what is 3b

tumours of 2cm or smaller in lining of abdomen

93

In FIGO staging of ovarian cancer - what is 4

Distant metastasis