1/10/21

Question 1

Name potential early symptoms of ovarian cancer. (8 points, name 4)

Answer 1

1. Abdominal bloating → pressure in the pelvic or lower abdomen
2. Abdominal Pain - usually mild and worse during sex
3. Change in Bowel Habits
4. Difficulty eating and feeling pull quickly
5. Indigestion
6. Anorexia + Nausea
7. Vaginal Bleeding
8. Urinary Frequency

Question 2

Alarm Symptoms in patient with excessive flatulence, bloating or abdominal distension (9 points, give me 4)

Answer 2

1. nocturnal abdominal pain (sleep awakening)
2. weight loss
3. blood in the stool
4. severely tender abdomen
5. succession splash
6. fever
7. vomiting
8. steatorrhoea
9. new onset diarrhoea

Question 3

2 Criteria in which Medical Termination of Pregnancy is indicated.

Answer 3

• Intrauterine Pregnancy → exclude ectopic pregnancy

- Gestational Age (<9/40)

Question 4

What medications are involved in medical termination of pregnancy and describe how they work.

Answer 4

• *Mifepristone** → synthetic steroid with anti-progesterone activity
  
  • competes with progesterone → pregnancy stops progressing → placenta and embryo detach from the endometrium → dilation and softening of the cervix
  • also works to increase uterine contractility
• *Misoprostol** → a prostaglandin analogue
  
  • taken 24-48 hours after mifepristone
  • induces contractions, cervical opening, evacuation of uterine contents

Question 5

How long does it take for bleeding and expulsion of products of conception? How long does it take for uterine bleeding to take place?

Answer 5

Bleeding and expulsion usually occurs within 3-4 hours of misoprostol administration.

• Vaginal bleeding declines over 10-16 days

Question 6

Clinical Presentation of Retained Products of Conception. (4 points)

Answer 6

1. uterine bleeding
   
   • if heavy (anaemia) or prolonged (>3 weeks) bleeding reasonable to assume abnormal. note hard to distinguish between normal post-loss bleeding and abnormal RPOC related bleeding
     2 + 3. pelvic pain + fever
   • necrotic RPIC are prone to infection by cervicovaginal flora
   • fever post uterine evacuation is NEVER NORMAL but common to have cramping for a few hours or days after.
2. and/or uterine tenderness

Question 7

Differential Diagnosis for PV bleeding + Pelvic Pain in the context of recent pregnancy loss (4 points)

Answer 7

• Endometritis
• Infected RPOC
• Pelvic Inflammatory Disease
• Uterine perforation - if uterus has been instrumented

Question 8

Key investigations in RPOC (3 points)

Answer 8

FBE
Blood Cultures
Pelvic U/S
consider: HVS M/C/S, consider serial beta-hcg

Question 9

Long-Term Sequelae of Primary Ovarian Insufficiency (4 points)

Answer 9

1. Infertility
2. Osteoporosis
3. Cardiovascular Disease
4. Autoimmune Disease

Question 10

General advice in regards to Sore Nipples in the context of breast-feeding mothers. (8 points, give me 4)

Answer 10

1. Try to use “chest to chest, chin on breast” feeing position
2. Vary feeding positions
3. Start feeding from less painful side first if one nipple is sore
4. Express some milk first to soften and “lubricate” the nipple
5. Gently break the suction with your finger before removing the baby from the breast
6. Ice to sore nipple
7. Keep nipples dry by exposing breasts to air
8. Soothing hydrogel pads inside the bra