Gynae

Question 1

Types of benign ovarian disease?

Answer 1

• functional cysts
  Follicular
  Corpus luteal
• Pathological cysts
  Endometrioma
  Polycystic ovaries
  Theca lutein cyst

Question 2

Corpus luteal cyst - key feature?

Answer 2

“Ring of fire” sign on US

Question 3

Endometrioma - key feature?

Answer 3

Chocolate cysts

Question 4

Polycystic ovaries - key feature on US?

Answer 4

“Ring of pearls” sing on US

Question 5

Theca lutein cyst - why does it develop?

Answer 5

Consequence of extremely high hCG (e.g. due to a molar pregnancy)

Question 6

4 type sof ovarian cancer?

Answer 6

• Epithelial cell tumours
• germ cell tumours
• sex cord/stromal tumours
• Metastatic

Question 7

Types of ovarian epithelial cell tumours?

Answer 7

• Serous type (most common)
• Mucinous
• Clear cell

Question 8

Types of ovarian Sex cord/stromal tumours?

Answer 8

• Sertoli-leydig cell
• Granulosa cell tumours

Question 9

Features of germ cell tumours?

Answer 9

• Benign
• High AFP and hCG

Question 10

Classic metastatic ovary tumour?

Answer 10

• Krunkenberg (commonly from stomach primary_
• Signet ring cells on histology

Question 11

Risk Factors for endometrial malignancy?

Answer 11

• Obesity
• Diabetes (independent risk factor)
• Polycystic ovarian syndrome (must have withdrawal bleed every 3 months)
• Increased age
• Earlier onset of menstruation (48kg)
• Late menopause
• Oestrogen-only hormone replacement therapy
• No or fewer pregnancies
• Tamoxifen (selective oestrogen receptor modulator - antagonist in the ER in breast, agonist in bone => very good to protect from osteoporosis, and agonist in endometrium - which increases risk for endometrial cancer)

Question 12

Risk factors for cervical malignancy:

Answer 12

Increased risk of catching HPV occurs with:
- Early sexual activity
- Increased number of sexual partners
- Sexual partners who have had more partners
- Not using condoms

Non-engagement with cervical screening is a significant risk factor. Many cases of cervical cancer are preventable with early detection and treatment of precancerous changes.

Other risk factors are:
- Smoking
- HIV (patients with HIV are offered yearly smear tests)
- Combined contraceptive pill use for more than five years (>8 years)
- Increased number of full-term pregnancies
- Family history
- Exposure to diethylstilbestrol during fetal development (this was previously used to prevent miscarriages before 1971)