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Gynae > Cancer > Flashcards

Cancer Flashcards

1
Q

Anatomy of cervix with regards to epithelium

A

The endocervix has columnar epithelium which produces mucin
Ectocervix has mature squamous epithelial cells
Separated by the squamocolumnar junction

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2
Q

What is the transformation zone

A

In the squamocolmnar junction columnar epithelial cells transform into squamous cells in squamous metaplasia

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3
Q

What process occurs at the transformation zone

A

Squamous metaplasia

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4
Q

What causes cervical intraepithelial neoplasia

A

HPV infections cause dysplasia at the TZ

Over 100 HPVs but 16 and 18 most common

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5
Q

Most common cause of CIN

A

HPV 16

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6
Q

Where do CIN occur

A

Transformation zone

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7
Q

How is CIN graded

A

CIN 1-3 on histology
CIN 1= dysplasia in lower 1/3 of epithelium
CIN 2= lower 2/3
CIN 3= full thickness but BM intact

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8
Q

Rfx for CIN

A 
Early age of first intercourse
Multiple sexual partners
Multiparity
Smoking
Immunosuppression
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9
Q

What is CGIN

A

Cervical glandular intraepithelial neoplasia

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10
Q

Difference between CIN and CGIN

A

CIN affects squamous cells

CGIN affects glandular cells

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11
Q

How is CIN differentiated from CGIN

A

Cytology

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12
Q

What is the treatment of CGIN

A

Excision of whole endocervix

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13
Q

What is the problem with excision of whole endocervix

A

Compromises fertility

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14
Q

How is CIN investigated

A

Colposcopy and biopsy

Can do cone biopsy

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15
Q

Name of procedure for CIN excision

A

LLETZ where Heated thin wire removes abnormal cells

Large loop excision of the transformation zone

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16
Q

What is risk of excisions for CIN

A

Preterm delivery

Midterm miscarriage

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17
Q

What must be done after CIN removal

A

Test of cure 6 mo later

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18
Q

What is most common type of cervical cancer

A

Squamous cell carcinoma

Adenocarcinoma and adenosquamous cell carcinomas less common

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19
Q

Non-gynae involvement of cervical cancer

A

Can extend to bowel or bladder so get related symptoms

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20
Q

Risks of radical hysterectomy

A

Bladder dysfunction- get urinary retention
Sexual dysfunction
Lymphoedema

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21
Q

When does bladder dysfunction occur after hysterectomy

A

Immediate post operative
Manage with self catheterisation

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22
Q

How is cervical IIB-IVA managed

A

Chemoradiation

  • radiation can either be external beam or brachytherapy
  • chemotherapy usual cisplatin
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23
Q

What chemotherapy used in cervical cacner

A

Cisplatin

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24
Q

What is brachytherapy

A

Internal radiation

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25
Q

How does bracytherapy work

A

Rods of radioactive selenium inserted into affected area- effects extend up to 5mm from rod

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26
Q

Side effects (short term) of radiation for cervical cancer

A

Tired
Bladder and bowel dysfunction
Erythema if external beam

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27
Q

Long term side effects of radiation for cervical cancer

A

Fibrosis
Vaginal stenosis
Cystitis symptoms
Malabsorption and mucous diarrorhoea
Radiotherapy induced menopause

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28
Q

Treatment of cervical cancer if pregnant

A

MDT approach

Delivery after 35 weeks

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29
Q

What to do if recurrent cervical cancer

A

Surgery
Palliative chemo
Supportive care

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30
Q

Why get lymphoedema after hysterectomy

A

Pelvic lymph node removal

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31
Q

How to manage lymphoedema post hysterectomy

A

Leg elevation
Good skin care
Massage

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32
Q

How is CIN 1 managed

A

Repeat smear in 1 year

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33
Q

How are CIN 2 and CIN 3 managed

A

LLETZ or cone biopsy if very large

Repeat smear in 6 months to check cure

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34
Q

Difference between operation for LLETZ and cone biopsy

A

LLETZ local anaesthetic

Cone GA

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35
Q

What age do people get cervical cancer

A

2 peaks

30-39 and over 70

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36
Q

What are the 2 layers of endometrium

A

Functional layer innermost with glands and stroma

Outer basal layer

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37
Q

What layer grows in preovulation phase

A

Functional layer from E2 growth

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38
Q

What happens to endometrium in post ovulation phase

A

Progesterone inhibits growth
Progesterone encourages production of nutrients for implantation

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39
Q

Risk factors for endometrial hyperplasia

A

Related to high oestrogen and low progesterone

  • obesity
  • early menarche
  • late menopause
  • nulliparity
  • DM
  • HTN
  • annovulatary amenorrhoea
  • tamoxifen
  • oestrogen replacement
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40
Q

Drugs which cause endometrial cancer

A

Tamoxifen

Oestrogen replacement

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41
Q

What is metorrhagia

A

Bleeding between menstrual cycles

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42
Q

Symptoms of endometrial hyperplasia/cancer

A

Menorrhagia

Metorrhagia

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43
Q

What is bleeding post menopause main concern

A

Endometrial cancer

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44
Q

What is most common cancer of gynae

A

Endometrial

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45
Q

Most important factor in progression of endometrial hyperplasia to endometrial cancer

A

Atypia

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46
Q

What does atypia mean

A

Larger nucleus and hyperchromatic

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47
Q

Management of endometrial hyperplasia without atypia

A

Address risk factors -eg stop HRT
Can either observe or treat with progesterone but higher rates of regression in treatment
Progestogen treatment
- Oral progesterone
- LNG-IUS
Biopsy every 6 months
If symptomatic then adivse progestogen treatment

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48
Q

How is endometrial hyperplasia diagnosed and surveyed

A

Hysteroscopy with biopsy of endometrium

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49
Q

How often should women with endometrial hyperplasia without atypia be surveyed

A

6 months

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50
Q

Indication for surgery in women with endometrial hyperplasia without atypia

A

Not wanting to preserve fertility and

  • no regression after 12 months
  • relapse
  • persistent bleeding
  • decline surveillance and medical management
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51
Q

What surgery is done in endometrial hyperplasia without atypia if indicated

A

Total hysterectomy and if post menopausal can offter bilateral salpingo oophorectomy

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52
Q

What determines the treatment of atypical endometrial hyperplasia

A

Whether the woman wants to preserve her fertility or is unsuitable for surgery

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53
Q

What is management principle of atypical endometrial hyperplasia

A

Should have hysterectomy due to risk of progression to malignancy- as high was 30% in 20 years

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54
Q

What is management of atypical endometrial hyperplasia if no need to preserve fertility

A

Total hysterectomy and bilateral salpingo-oophorectomy
Ablation of endometrium possible but not as successful so not recommended

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55
Q

Management of atypical endometrial hyperplasia if want to preserve fertility

A

Pretreatment investigations to rule out ovarian cancer
First line LNG-IUS
Can also give oral progestogens
Surveillance every 3 months

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56
Q

How often should women who have medical management of atypical hyperplasia be surveyed

A

3 months until 2 negative biopsies then every year

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57
Q

What method of hysterectomy is preferred

A

Laprasocopic

  • Shorter hospital stay
  • Less post op pain
  • Quicker recovery
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58
Q

What are 2 types of endometrial cancer

A

Endometrioid T1
Non-endometrioid T2

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59
Q

What factors which protect against endometrial cancer

A

Breastfeeding
COCP
Later age of giving birth

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60
Q

What are types of non-endometrioid cancer

A

Serous
Papillary
Clear cell

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61
Q

What is difference in appearance between endometrioid and non-endometrioid cancers

A

Endometrioid resembles normal glands

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62
Q

What is differnece in cause of non endometrioid vs endometrioid cancer

A

Endometrioid caused by excess oestrogen
Non-endometrioid in very old people

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63
Q

Risk factors for non-endometrioid cancers

A

Low body weight

Endometrial atrophy

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64
Q

What are the majority of endometrioid cancers

A

Adenocarcinomas

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65
Q

Symptoms of endometrial cancer

A

Abnormal vaginal bleeding

Enlargement of uterus can lead to abdo pain and cramping

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66
Q

Difference in presentation between endometrial and cervical cancer

A

Vaginal pain in cervical

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67
Q

How can vulvar cancer present

A

Noticed a mass
White plaque
Vulval itching, pain
Bleeding from ulceration

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68
Q

What will see on examination of vulval cancer

A

Irregular mass
Fungating
Groin lymph node enlargement
Ulcers or sores
White plaquw

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69
Q

What is most common type of vulval cancer

A

Squamous epithelium

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70
Q

How is vulval cancer diagnosed

A

Examination
Biopsy at least 1mm deep

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71
Q

Management plan for vulvar cancer

A

If stromal invasion of over 1mm or diameter over 2cm then vulvectomy full inguinofemoral lymphadenectomy recommended ( do separately to avoid morbidity)
If less than 2cm diameter and 1mm depth of invasion do wide local excision
If is less than 4cm and no evidence of lymph node involvement can do sentinel node biopsy but if SNLB detects metastases then must do full
If patient unfit for surgery then radical radiotherapy used
Excise any other lichen sclerosus and VIN

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72
Q

What are the 2 groups of groin lymph nodes

A

Inguinal- superficial
Femoral deep

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73
Q

Complications of groin lymphadenectomy

A

Wound healing complications
Infection
VTE
Chronic lymphoedema

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74
Q

How does sentinel lymph node biopsy work in vulvar cancer

A

Dye or radioactive nucleotide injected into tumour to identify sentinel node- first one it drains to

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75
Q

What is main prognostic factor in vulvar cancer

A

Lymph node involvement

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76
Q

What can be used as adjuvant therapy prior to vulvar cancer excision

A

Radiotherapy
Only in cases where 2 or more present groin metastases or excision margins too close

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77
Q

What are 2 precursors to vulvar cancer

A

VIN
Pagets

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78
Q

What cancers to VIN develop into versus pagets

A

Squamous cell cancer from VIN

Adenocarcinoma from pagets disease of the vulva

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79
Q

What causes VIN

A

HPV 16

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80
Q

What are the 2 types of VIN

A

Usual type

Differentiated

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81
Q

What is difference in age group presentation of usual type VIN versus differentiated type

A

Usual- 35-55

Differentiated- older women

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82
Q

What is difference in association of usual and differentiated VIN

A

Usual- warty/basaloid SCC

Differentiated- keratinising SCC

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83
Q

What is often seen before differentiated VIN

A

Lichen sclerosus

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84
Q

What happens in at a cervical screening

A

Speculum exam done and sample of transformation zone taken

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85
Q

What do at cervical screening if are 2 cervixes

A

Take a sample from both

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86
Q

When do you refer a smear test for colposcoy

A

Cervical stenosis where consider cervical dilatation
Cervix cant be visualised

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87
Q

When do you delay cervical screening

A

Menstruating
Less than 12 weeks post partum or miscarriage/abortion
Infection or discharge
Pregnant- wait 12 weeks til is done

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88
Q

How does cervical screening work

A

Initially test for high risk HPV strains
If positive do cytology
If these are negative then can return to normal waiting time
UNLESS
- test of cure pathway
- CIN 1 pathway
- follow-up for CGIN removal, stratified mucin producing intraepithelial lesion of the cervix or cervical cancer removal
- follow-up of borderline endocervical changes

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89
Q

What comes under abnormal cytology in smear test

A

Abnormal squamous or endocervical changes
Low grade dyskaryosis
Moderately high grade dyskaryosis
Severely high grade dyskaryosis
Invasive cervical carcinoma
Glandular epithelium

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90
Q

What happens if hrHPV positive but cytology negative

A

Repeat in 1 year
If this negative then return to normal schedule
If this positive and cytology abnormal colposcopy
If this positive and cytology negative repeat in 1 year

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91
Q

What are the outcomes of HPV testing at 24 months following initial pos HPV but neg cytology

A

Positive here-> colposcopy
Negative-> return to normal scedule
Inadequate-> colposcopy

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92
Q

What can cause an inadequate cytology sample

A

Was taken but the cervix was not fully visualized.
Was taken in an inappropriate manner (for example, using a sampling device not approved by the NHS Cervical Screening Programme).
Contains insufficient cells.
Contains an obscuring element (for example, lubricant, inflammation, or blood).
Was incorrectly labelled

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93
Q

What happens in inadequate sample or HPV testing unavailable

A

Repeat within 3 months

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94
Q

What happens if 2 inadequate or unavailable samples in a row

A

Refer to colposcopy

95
Q

What is used to visualise cervix

A

Colposcope

96
Q

Which stains are done during colposcopy

A

Acetic acid
Iodine

97
Q

What happens to normal and abnormal tissue when apply acetic acid and iodine solution in colpsocopy

A

Acetic acid- CIN turns white
Iodine- normal tissue stains brown

98
Q

How often are people screened with national cervical screening programme

A

25-49- every 3 years
50-65- every 5 years

99
Q

What is BV

A

Where get an overgrowth of anaerobic bacteria and loss of lactobacilli leading to increase in vagina pH

100
Q

Risk factors for BV

A

Copper IUD
Semen in vagina
Regular sex
Douches or vaginal implants

101
Q

Management of BV not pregnant

A

Asymptomatic no treatment
If symptoms use oral metronidazole for 5-7 days. If adherance an issue can use one large dose
If contraindicated or prefers can use intravaginal metronidazole or clindamycin cream

102
Q

What are uterine fibroids tumours of

A

Leiomyomas of smooth muscle cells and fibroblasts in myometrium

103
Q

Risk factors for fibroids

A

Increasing age until the menopause
Early menarche
Older age at first pregnancy
Black

104
Q

Complications of fibroids

A

IDA
Bladder and bowel compressive symptoms
Sub/infertility
Polycythaemia from autonomous EPO production

105
Q

Symptoms of fibroids

A

Heavy menstrual bleeding
Pain/pressure in pelvis
Dyspareunia
Urinary and bowel symptoms

106
Q

Examination finding of fibroids

A

Firm enlarged irregulary shaped uterus

107
Q

Investigations for fibroids

A

Pelvic US abdo or transvaginal if needed to determine number. location and severity
Checking for IDA

108
Q

When refer for fibroids

A

2WW if features of cancer clinically or on US
Arrange specialist consult if
- uncertain diagnosis
- severe bleeding or compressive sx
- confirmed fibroids over 3cm
- fertility issues
- post menopausal development of new sx

109
Q

Management options in fibroids

A

Asymptomatic- no treatment needed just safety net about new symptoms
Treating the menorrhagia
- NSAIDS
- tranexamic acid
- levonorgestel intrauterine device
- the pill
Affecting fibroids themselves
- GNRH agonists
- uterine artery embolisation
- myomectomy
- hysterectomy

110
Q

When consider fibroids for surgery

A

Rapidly growing
Large
Refractory to drugs

111
Q

Side effects of GNRH agonists

A

Flushing
Vaginal drying
Loss of bone mineral density

112
Q

Patient needs large fibroid removed however wants to maintain ability to conceive

A

Myomectomy

113
Q

How is endometrial cancer investigated

A

Trans-vaginal US
Hysteroscopy with endometrial biopsy

114
Q

Risk factors for ovarian cancer

A

BRCA1/2
Anyhting that increases number of ovulations
- nulliparity
- early pregnancy
- late menopause

115
Q

When to suspect ovarian cancer and order tests

A

A woman in particular over 50 has one of these 12 times a month
- bloating
- early satiety
- pelvic/abdo pain
- urine urgency/frequency

116
Q

How to manage suspected ovarian cancer

A

Abdo exam
- if mass or ascites 2WW
If clear measure CA125
- over 35 DO USS
- under consider other causes of raised CA125

117
Q

Causes of raised CA125

A

Ovarian cancer
Fibroids
Pregnancy
PID
Endometriosis

118
Q

What does meigs syndrome include

A

Ovarian mass
Pleural effusion
Ascites

119
Q

Most common cause of Meigs syndrome

A

Fibroma

120
Q

Management of meigs syndrome

A

Pleural effusion and ascites need drainage
Removal of ovarian tumour

121
Q

When do you refer someone for 2WW with bleeding

A

Over 55
Over 45 on hormonal contraception

122
Q

What is first investigation in PM bleeding 2WW

A

TVS looking for endometrial thickness over 5mm

123
Q

What do if endometrial hyperplasia over 5mm

A

Hysteroscopy with biopsy

124
Q

Risk factors for vulvar cancer

A

Lichen sclerosus
Immunosuppression
VIN
HPV

125
Q

Long term complication of hysterectomy

A

Vaginal vault prolapse
Enterocele

126
Q

How are ovarian cysts categorised

A

Physiological
Benign germ cell tumours
Benign epithelial tumours
Benign sex chord stroma tumours

127
Q

What are the physiological cysts

A

Follicular
Corpus luteum cyst

128
Q

What are the benign germ cell tumours

A

Dermoid cyst

129
Q

What are the benign epithelial tumours

A

Serous cystadenoma
Mucinous cystadenoma

130
Q

What are follicular cysts

A

They form from failure of degeneration of non-dominant or dominant follicles

131
Q

What are most common benign ovarian cysts

A

Follicular

132
Q

Progression of follicular cysts

A

Will degrade naturally over multiple cycles

133
Q

What are corpus luteal cysts

A

Occurs when corpus luteum does not degenerate and fills with fluid or blood

134
Q

Which of the physiological ovarian cysts is more dangerous

A

Corpus luteal as increased risk of intraperitoneal bleeding

135
Q

What is most common ovarian cyst in under 30

A

Dermoid cyst

136
Q

Which ovarian cyst most likely to present with torsion

A

Dermoid

137
Q

Which is most common epithelial benign tumour

A

Serous cystadenoma

138
Q

Which ovarian cyst often becomes massive

A

Mucinous cystadenoma

139
Q

Risk of mucinous cystadenoma

A

If ruptures get pseudomyxoma peritonei

140
Q

What is pseudomyxoma peritonei

A

Mucinous adenocarcinoma cells producing mucin and ascites into peritoneum

141
Q

Presentation of ovarian cysts

A

Normally asymptomatic and will come and go
Dull pain unilaterally in abdomen that may only occur during sex
If very large can cause compressive sx on bowel and bladder/urinary symptoms
Fullness or bloating

142
Q

Risk factors for ovarian cyst

A

Letrozole or drugs causing to ovulate
Pregnancy
PID
Endometriosis

143
Q

How are ovarian cysts assessed

A

Using IOTA criteria. Looking for B (benign) or M (malignant) signs
M
- irregular and solid
- ascites
- mutliloculated (has septum)
- strong blood flow
- diameter over 100mm
IF HAS ANY OF THESE THEN BIOPSY

144
Q

After USS what is management of cysts based on size

A

If has any M features then biopsy
If cyst between 50mm-70mm then can do yearly USS
Less than 50mm can reassure will disappear

145
Q

What is most likely diagnosis when no PCB but is PMB

A

Endometrial hyperplasia/cancer

146
Q

If are no plans for a fmaily in future, what surgical options for fibroids

A

Hysteroscopic ablation
Hysteroscopy

147
Q

Pathophysiology of endometriosis

A

When endometrial tissue migrates to places other than the endometrium most commonly in the ovaries, fallopian tubes or uterine ligaments. The endometrial cells produce lots of oestrogen and pro-inflammatory markers which can lead to adhesions and bleeding especially during menstruation

148
Q

Risk factors for endometriosis

A

Fhx
Nulliparity
Early menarche
Late menopause

149
Q

Risks of endometriosis

A

Ovarian cancer
Rupture of chocolate cysts
Infertility

150
Q

What can be seen on examination of endometriosis

A

Reduced pelvic organ mobility
Visible vaginal endometriomas

151
Q

What are chocolate cysts

A

Endometriomas which contain old blood from menstruation of the endometrial tissue

152
Q

Presentation of endometriosis

A

Deep dyspareunia
Secondary dysmenorrhoea
Subfertility
Compressive symptoms- painful bowel movements, dysuria, urgency especially around times of period
Chronic pelvic pain

153
Q

When to refer for endometriosis

A

To gynae for USS
- if severe and persistent signs of endometriosis
- pelvic signs of endometriosis
To endometriosis centre
- bladder and bowel involvement
If under 17 then to paed gynae service
Hormonal management unsucessful
Fertility a priority

154
Q

Management of endometriosis in primary care

A

Paracetamol or NSAID for pain for 3 months
Second line- hormonal treatment including COCP, progestogen or LNG-IUS
Follow-up in 3 months

155
Q

Investigations for endometriosis

A

Can do TVUSS in secondary care or abdominal if CI or not tolerated
Laparoscopy gold standard and still indicated even if TVUSS NAD

156
Q

Secondary care management of endometriosis

A

When have diagnostic laparoscopy remove peritoneal endometriosis and ovarian endometriomas
Can give GnRH agonists for 3 months as adjunct
Give COCP afterwards
If fertility not a priority and having uncontrolled bleeding/ symptoms can consider hysterectomy with or without oophorectomy.
If fertility a priority excision or ablation with adhesiolysis of endometriosis not involving bowel/bladder. Also remove cyst wall of ovarian endometriomas

157
Q

Surgical mangement of endometriosis if fertility a priority

A

Always remove peritoneal endometriosis and ovarian endometriomas but include the wall
Ablation or partial excision of endometriosis with adhesiolysis for non-peritoneal endometriosis ie fallopian tubes and ovaries

158
Q

Surgical mangement of endometriosis if fertility not a priority

A

Consider hysterectomy with or without oophorectomy if having uncontrolled symptoms or adenomysosi and remove any other endometriosis
Use COCP afterwards

159
Q

Surgical management of deep endometriosis

A

Adjunct of GNRH agonist for 3 months
Excision laparascopically
COCP afterwards

160
Q

What is given after endometriosis surgery

A

COCP unless fertility a priority

161
Q

What is adenomyosis

A

Where endometrium grows within the myometrium

162
Q

Who does adenomyosis occur in

A

Multiparous women aproaching menopause

163
Q

What is best imaging for adenomyosis

A

MRI

164
Q

How does adenomyosis present

A

Menorrhagia
Dysmenorrhoea
Bulky uterus on examination

165
Q

What is boggy uterus seen in

A

Adenomyosis

166
Q

If suspect adenomyosis what is first line investigation

A

TVUSS
If not appropriate or tolerated do MRI

167
Q

Management of menorrhagia in adenomyosis

A

LNG-IUS
2nd line- tranexamic acid or oral hormones

168
Q

How manage fibroids under 3cm

A

LNG-IUS or tranexamic acid depending on contraception desires
Consider surgery options if unsuccessful

169
Q

How manage fibroids over 3cm

A

Multifactorial but consider tranexamic acid, LNG-IUS
Or surgical namely myomectomy, hysterectomy or uterine artery embolisation

170
Q

What is management of adenomyosis

A

Treat menorrhagia
Surgical options include uterine artery embolisation and hysterectomy which is definitive

171
Q

What are the different types of fibroid

A

Submucosal- project into uterine cavity
Intramural- grow within wall
Subserosal- project out of uterus

172
Q

Management of submucosal fibroids

A

Consider hysteroscopic removal

173
Q

What is purpose of GNRH agonists pre surgery for fibroids and endometriosis

A

Pseudomenopause where little stimulation of masses

174
Q

What is an example of a GNRH agonist

A

Triptorelin

175
Q

What can happen to fibroids in pregnancy

A

Undergo carneous degeneration- as oestogen sensitive can grow which exceeds capacity of blood vascular supply therefore can have haemorrhagic infarction

176
Q

How does carneous degeneration of fibroids present in pregnancy

A

Abdo pain
Vomiting
Slight fever

177
Q

Management of endometrial cancer

A

Mainstay for localised treatment is hysterectomy
If frail have progestogen therapy

178
Q

Risk factors for cervical cancer

A

Early age of first pregnancy
Multiple partners
Lack of barrier protection
Immunosuppression
Smoking
COCP

179
Q

If you have HIV how often should you get cervical smears

A

Annually

180
Q

Which ovarian cancer is endometrial hyperplasia associated with

A

Granulosa cell tumours as produce oestrogen

181
Q

What are powder burn spots seen in

A

Endometriosis
These are brown spots on the pelvic peritoneum

182
Q

What is rotikansky protuberance seen in

A

Dermoid cyst
When tooth projects towards middle of cyst

183
Q

What are types of vulvar cancer

A

Mainly SCC
Basaloid- from HPV
Keratinising - lichen sclerosus
Can get adenocarcinoma from pagets disease of the vulva

184
Q

What lines the endometrium

A

Columnar epithelium as adenocarcinoma most common cancer

185
Q

Presentation of adenomyosis

A

Menorrhagia
Dymenorrhoea
Dyspareunia

186
Q

Where do the pelvic cancers metastasise to (lymph nodes)

A

Ovarian- para-aortic
Vulvar- inguinal
Cervical- pelvic lymph nodes along iliac arteries

187
Q

What is pathophysiology of ovarian stromal hyperthecosis

A

You get clusters of thecal cells in the ovarian stroma which respond to LH by producing excess testosterone

188
Q

Presentation of ovarian stromal hyperthecosis

A

Signs of hyperandrogenism
Older women
Bilaterally enlarged solid ovaries

189
Q

Management of lichen sclerosus

A

1st line- high potency steroids like clobetasol propionate
2nd line- calcineurin inhibitor like tacrolimus

190
Q

First line for prolactinoma

A

Cabergoline- dopamine agonist

191
Q

Why does tamoxifen cause endometrial cancer

A

Although it is anti-oestrogenic in breast it is pro in the uterus

192
Q

Can obesity itself cause menorrhagia

A

Yes

193
Q

If in TVUSS of menstrual woman endometrial thickness is 12cm but about to menstruate what do

A

Repeat post menses

194
Q

What is pipelle

A

Tool used to take biopsy from endometrium

195
Q

What does cervix easily bleeding suggest

A

Cervical cancer

196
Q

What drug can be used to cure endometriosis

A

Triptorelin

197
Q

What is a wertheimers hysterectomy

A

Removes upper third of vagina with uterus
USED FOR CERVICAL CANCER

198
Q

What is a subtotal hysterectomy

A

Where leave cervix

199
Q

What would be management of someone admitted to hospital with severe vaginal bleeding from sex who is in shock

A

Resus
Examination under GA

200
Q

If go into shock post operatively what is assumed cause and how manage

A

Bleeding
Resus and go to theatre

201
Q

Why is abdomen illuminated prior to surgery

A

To allow visulisation of vessels so can avoid them- superficial epigastric artery

202
Q

What causes umbilical distension and abdo pain after laparoscopy

A

Umbilical portal site bleed

203
Q

Management of umbilical port bleed

A

Resus
Go back to surgery

204
Q

How are low risk cysts under 5cm managed

A

Conservatively with follow up in 3 months

205
Q

Pedunculated red growths which protrude through the external OS

A

Cervical polyp

206
Q

Can you consider a hysterectomy for CIN

A

Yes if severe menorrhagia as well as finished family

207
Q

How is RMI calculated

A

Ca125 x menstrual status x USS

208
Q

How does menstrual scoring work for RMI

A

Premenopausal= 1
Post menopausal= 3

209
Q

How does USS scoring work for RMI

A

No features= 0
1 feature = 1
2 or more = 3

210
Q

What are USS points for in RMI

A

Multiloculated
Ascited
Bilateral
Solid area
Metastases

211
Q

What is RMI cutoff for an MDT

A

250

212
Q

What does iodine bind to in cells

A

Glycogen

213
Q

Lady with vaginal itching and white streaks in mouth

A

Lichen planus

214
Q

How does lichen planus appear on vagina

A

Red with excoriation marks

215
Q

What is the urgency of colposcopy after cytological analysis showed abnormalities

A

Non-urgent

216
Q

If see white plaque on vulvar what need to do

A

Take a biopsy as this is not necessarily lichen sclerosus, cancer can also present like this

217
Q

How can lichen sclerosus present

A

Dyspareunia
Itching
Skin splitting
Bleeding
Thickended skin
Adhesions leading to narrowed vaginal introitus

218
Q

2WW requirements for vulval lesions

A

Unexplained vulval bleeding, lump or ulceration

219
Q

How should submucosal fibroids be removed when wanting to preserve fertility

A

Transcervical resection of the fibroid

220
Q

What would prompt to skip Ca125 and go stragiht to 2WW

A

Mass or ascites on examination

221
Q

Which cyst most associated with bleeding

A

Corpus luteal

222
Q

What would prompt to do hysteroscopy instead of pipelle

A

Cervical stenosis
Sample inadequate
Pipelle not tolerated

223
Q

What colour does abnormal tissue stain after iodine application

A

Yellow

224
Q

How does uterine artery embolisation work

A

Using a catheter embolic agents are inserted into arteries supplying fibroids to cause infarction and subsequent degeneration

225
Q

Woman wants to avoid surgery for fibroids but maintain fertility

A

Uterine artery embolisation

226
Q

Management if have BRCA1 gene

A

Can choose between monitoring and surgery
- monitoring involves regular USS and Ca125
- surgical can involve having a bilateral salpingoophorectomy

227
Q

What are amber filled lumps seen around the cervix

A

Nabothian cysts

228
Q

What are nabothian cysts

A

Where cervical squamous cells can cover the columnar epithelium of the ectocervix. When columnar cells release mucous these become trapped under the squamous cells

229
Q

Once USS has been done for ovarian cancer alongside Ca125, what is next investigation

A

CT scan to determine extent

230
Q

In secondary care ovarian cancer investigations, what is measured in women under 40

A

AFP
bHCG

231
Q

What is preferred method of collecting cytology in ovarian cancer

A

Laparotomy

232
Q

Most common site of vulva cancer

A

Labia majora

233
Q

What is management if cervical ectropion symptoms are bothersome

A

Can refer to colposcopy non-urgently to have it cauterised

Gynae (11 decks)

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