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year 3 > Contraception + Breasts > Flashcards

Contraception + Breasts Flashcards

1
Q

What are the four most effective contraception methods (TIER 1)

A
  1. IUD
  2. Implants
  3. Vasectomy/Tubal ligation
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2
Q

What are tier 2 methods

A
  1. Pills
  2. Patches
  3. Vaginal rings
  4. Hormonal injections
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3
Q

What are tier 3 methods

A
  1. Condoms (only protection against STIs)
  2. Diaphragms
  3. Spermicides
  4. Sponges
  5. Periodic abstinences
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4
Q

What are the two types of IUDs

A

Hormonal:
Levonorgestrel

Non-Hormonal:
Copper

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5
Q

In which population are IUDs recommended for

A

Adolescents and young women who want long-term contraceptives + avoiding oestrogen exposure that could cause TE (smoking)

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6
Q

Contraindications for IUDs

A
  1. Known or suspected pregancny
  2. Uterine bleeding
  3. Pelvic infection
  4. Abnormalities of uterine cavity (fibroids and congenital defects)

Hormonal:

  • Liver disease (as hormones are metabolised by liver)
  • Breast Cancer (hormonal iud can worsen cancer or increase recurrence)

Copper:
Wilson’s disease or allergies

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7
Q

How long does a hormonal IUD last for

A

5 Years

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8
Q

How does levonorgestrel work

A

Inhibits LH secretion from pituitary glands - inhibits ovulation

  • thickens cervical mucous
  • thin endometrial lining.

This causes amenorhhoea

Benefits: Can lessen pain and blood loss during menstruation. Help with endometriosis

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9
Q

Side effects of hormonal IUD

A
  1. Headaches
  2. Nausea
  3. Weight gain
  4. Mood swings
  5. Breast tenderness
  6. Acne
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10
Q

How long does copper IUD last

A

10 Years

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11
Q

When should hormonal IUDs be given (menstrual cycle)

A
  1. days 1-5. to give immediate contraceptive effect
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12
Q

If Hormonal iud is given after day 5, what should be done to minimise risk of preganncy

A
  1. Back up contraception (condoms) for 7 days.
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13
Q

When shoudl copper IUDs be given (menstrual cycle)

A

ANY DAY - effect is immediate.

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14
Q

Side effect of IUD insertion

A

Unexpected bleeding or spotting but goes away with time

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15
Q

When should IUDs be taken out

A

Can be anytime when pregnancy is desired

HOWEVER,
must use barrier contraception for 1 menstrual cycle after removal to allow endometrium to regenerate normally.

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16
Q

What is the contraceptive implant made of

A

Ethylene Vinyl Acetate.

  • 68mg Etonogestrel
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17
Q

Where is the implant placed

A

Inner side of upper arm, slowly releases etonogestrel into circulation

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18
Q

How long does the implant provide contraception for

A

3 years

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19
Q

Contraindications of implants

A
  1. known or suspecte dpregancny
  2. Liver disease
  3. Breast cancer
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20
Q

How should contraceptive implant be given

A

Inserted by clinician under anesthesia

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21
Q

When should impant be given

A

Day 1-5

If after, barrier contraceptives for 7 days.

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22
Q

Side effects for implant

A
  1. Unpredictable menstrual bleeding pattern
  2. Headaches
  3. Bloating
  4. Weight gain
  5. Acne
  6. Breast tenderness
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23
Q

After removal of implant, how long does it take for ovulation to start again

A

1 month

If contraception is to be continued, can be delivered through same arm or other.

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24
Q

What sturcture is occluded in vasectomy

A

Vas Deferens

EFFECT IS NOT IMMEDIATE

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25
Q

Contraindicatinons to vasectomy

A
  • Scrotal haematoma
    2. GU infections

Must be resolved

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26
Q

How long should people with vasectomy’s be on barrier contraception for

A

3 Months, then semen analysis.

Person must have ejaculated 20 times for a valid result (confirmed by azoospermia).

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27
Q

What is tubal ligation involve

A
  1. Clips, rubber bands, sutures or cauterisations used to clamp down fallopian tubes
  2. OR removal of tubes
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28
Q

When is tubal ligation often done

A
  1. Postpartum setting, following birth.

2. If unrelated to childbirth - called interval proceedure.

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29
Q

Risks with tubal ligation

A

Ectopic preganncy

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30
Q

Two types of hormone contraceptives

A
  1. Oestrogen and progestin (COCP, patches and rings)

2. ONLY progestin (injections and pill).

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31
Q

How does a combined contraception work

A
  1. Inhibits GnRH hypothalamic
  2. Inhibits pituitary FSH and LH.

The higher the dose of oestrogen, the more inhibition - ovarian follicles do not develop and ovulation does not take place.

  • Thins endometrial lining
  • thickens cervical mucus
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32
Q

Non contraceptive benefits for combined contraception

A
  1. Controls menstrual bleeding, pelvic pain, ovarian cysts and PCOS symptoms (hypernadrogenism)
    HRT in turner’s and slow premature ovarian failure.
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33
Q

Contraindications to oestrogen

A
  1. DVT
  2. CV events
  3. Diabeted, HTN, CAD

Highest risk in over 35, smokers, excess oestrogen (PCOS, medications)

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34
Q

Contraindications to progestin

A
  1. Current breast cancer

2. Liver disease

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35
Q

What medications reduce the contraceptive efficiency of oestrogen and progesterone tablets

A
  1. Antibiotics
  2. Anti seizure medications
  3. HIV protease inhibitors
  4. St John’s wart
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36
Q

What oestrogen is used in the combined pill

A

Ethinyl Estradiol

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37
Q

What progestins are used in combined pill

A

Norethindrone and levonorgestrel

Drospirenone and Dienogest (antiandrogenic)

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38
Q

Where do norethindrone and levonorgestrel derive from

A

Testosterone so can alter lipid profiles (lower HDL levels)

So must be monitored regularly

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39
Q

When are Drospirenone and dienogest recommended

A

Hyperandrogenism (pcos)

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40
Q

In what amounts can pills be delivered

A
  1. Monophasic (same amount each pill)
  2. Multiphasic (different amounts each pill)

Disadvantage of 2 is that they require adherence to the order

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41
Q

What should be done before starting COCP

A
  1. Urine pregnancy test
  2. Finding the first day of last menstrual period (less than 7 days ago, can be started immediately with barrier contraception)
    >7 days, protected sex can be started immediately with barrier

unprotected (<5 days ago) requires emergency contraception, start pills the same day.

unprotected (>5 days ago) requires pregnancy test in 2 weeks and pills started same day.

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42
Q

Two start dates for cocp

A
  1. Quick start (> 5 days into menstrual cycle with back up contraception)
  2. First sunday (barrier)
  3. First day of menstruation (immediate effect, no barrier).
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43
Q

How are contraceptives taken (regimen)

A

21/7 (hormone pills for 21 days, placebo pills for 7 where menstruation happens)

24/4

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44
Q

When are placebo periods skipped

A

Extended Use (7 days of placebo pills after 3 months), or continuous (hormones every day).

  • PMDD
  • Endometriosis
  • Hyperandrogenism
  • Premature Ovarian Failure
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45
Q

What if you miss a pill (<48 hours)

A

Take missed pill as soon as remembered with the extra pill - continue as normal

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46
Q

What is you miss a pill (>48 hours)

A
  1. Only take most recent missed pill, take rest as usual.

2. Barrier until 7 consecutive pills have been taken

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47
Q

What if you miss a pill in last week of cycle (15-21)

A
  1. Skip placebo interval and go into another pack

2. Barrier contraception until 7 consec plls taken

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48
Q

Side effects of COCP

A
  1. Irregular bleeding
  2. Nausea
  3. Headaches
  4. Breast Tenderness

Resolve over time

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49
Q

Dangerous complications of cocp

A
  1. DVT
  2. PE
  3. Strokes
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50
Q

HOw often do transdermal patches need to be replaced

A

Every week for 3 weeks

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51
Q

How often do vaginal reings need replacing

A
  1. Kept in for three weeks taken out for fourth week for menstruation

Then replaced

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52
Q

Risks with patches and rings

A

Can slip

But fertility returns quickly

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53
Q

Two methods of deliverying progestin only contraceptives

A
  1. Injection

2. Pills

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54
Q

How do progestin only tablets work

A
  1. Inhibit ovulation
  2. Thicken cervical mucus
  3. Thin endometrial lining
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55
Q

What progestin is used in Progestin injections

A
  1. Depo Medroxyprogesterone acetate
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56
Q

How are injections given

A

IM or SC

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57
Q

How long do injections provide contraception for

A

12 weeks

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58
Q

Side effects of injection

A
  1. Amenorrhoea
  2. Unpredictable bleeding
  3. Headache
  4. Abdo pain
  5. Decreased libido
  6. Decrease in bone mineral density but recovers after stopping injetcions
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59
Q

Contraindications of injections

A
  1. Long term corticosteroid use (BMD)
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60
Q

How long does it take for fertility to return after injections

A

1 year

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61
Q

What are contained in progesterone only pills

A

0.35 mg of Norethindrone

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62
Q

POP vs COCP

A

No pill free day (all 28 days are hormonal)

Take same hour daily

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63
Q

Side effects of POP

A
  1. Irreular bleeding
  2. Headaches
  3. Mood swings
  4. Breast tenderness
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64
Q

Advantage of POP

A

Fertility comes back after one cycle.

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65
Q

What are diaphragms made of

A

Silicone

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66
Q

What do diaphragms cover

A

The cervix. Should be filled with spermicide gel for extra protection.

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67
Q

What do spermicides contain

A

Nonoxynol-9 - impaires sperm motility

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68
Q

When shoudl diaphragms and cervical caps be inserted

A

3 hours before intercourse, if inserted earlier, add more spermicides.

Should be kept in for 6 hours after intercourse.

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69
Q

Contraindications for driaphragms and cervical caps

A

During menstruation - can cause toxic shock syndrome

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70
Q

What are sponges

A
  1. Foam discs with spermicides and must be moistuned with water.
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71
Q

How should sponges be applied

A
  1. Add water

2. Insert less than 24 hours ahead of intercourse and keep for 6 hours afterwards.

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72
Q

Side effects of sponges

A
  1. Vaginal dryness and irritation
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73
Q

How should spermicides be applied

A
  1. Placed in vagina <10 mins before intercourse.
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74
Q

Side effects of spermicides

A
  1. Local irritation ofpenis and vagina (increase HIV infection)
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75
Q

Lowest contraception method

A
  1. Fertility based awareness and withdrawal.
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76
Q

What is fertility based awareness

A
  1. Sperm viable for less than 5 days
  2. Egg viable for less than 24 hours

Max 6 fertile days

Abstain during fertile window or barrier.

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77
Q

When does ovulation begin

A

14 days before menses.

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78
Q

Contraindications of PBA

A
  1. Not used in >32 days or <26 day windows (PCOS, irregualr cycles, breast feeding females).
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79
Q

What is emergency contraception

A
  1. Copper IUD <5 days after unprotected intercourse or 5 days within likely ovulation date.
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80
Q

What is the morning after pill

A
  1. Lovorgestrel (<72 hours) - 1.5mg

2. Ulipristal (30 mg) taken up to 5 days after intercourse.

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81
Q

SIDE EFFECT OF VOMITING IS PRESENT IN 1% OF ALL LEVORGESTREL USERS (EMERGENCY), WHAT SHOULD BE DONE IF THIS IS REPORTED

A
  1. Vomiting occurs within 3 hours, repeat the dose.
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82
Q

When is ulipristal contraindicated

A

If patient is on oral pills containing levonorgestrel

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83
Q

Warning in pregnant women using ulipristal

A

Delay breast feeding for one week (not needed with levonorgestrel).

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84
Q

Whens should levonorgestestrel dose be doubled

A
  1. BMI > 26
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85
Q

In which contraception is a history of severe asthma contraindictaed

A

Ullipristol

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86
Q

How long is barrier contraception needed in POP

A

Only 48 hours

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87
Q

Mode of action for COCP

A
  1. Inhibits ovulation
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88
Q

Mode of action of POP

A

Thickens cervical mucous

89
Q

Mod of action of desogestrel only pill

A

Inhibits ovulation

90
Q

Primary mode of action of inauterine devices

A

Decreases sperm utility and survival

91
Q

If the patch is delayed at the end of week 1 or 2, what should be done

A

<48 Hours: changed immediately no other precuations

> 48 Hours: Changed immediately, barrier protection

If woman has had UPSI in last 5 days, emergency contraception

92
Q

If the patch is delayed at the end of week 3

A
  1. Patch should be removed as soon as possible, and the new patch applied on the usual cycle start day for the next cycle, no additional contraception
93
Q

If the patch is delayed at the end of a patch free week, what should be done

A

Additional contraception should be used fro 7 days

94
Q

If a woman misses her 3-hour window for desogestrel, what should be done

A

For POP, it is actually a 12-hour window, so she can take the pill with no needed further action

95
Q

What is COCP protective against

A

Ovarian and endometrial cancer

96
Q

What cancers does COCP increase

A

Breast and cervical

97
Q

If a woman is postmenopausal but under 50, should contraceptives be gven

A

Yes, current advice is that anyone under 50 should have contraception.

98
Q

When is the injectable Progertone only not recommended

A

Women after the age of 50 as it reduces BMD

99
Q

If two or more COCP pills are missed in week 1, what should be done

A

Emergency contraception

100
Q

If two or more COCP pills are missed in week 2, what should be done

A

Continue as normal, as long as they have taken sevenconsecutive pills

101
Q

If two or more COCP pills are missed in week 3, what should be done

A

Finish pack, start a new pack and miss out interval

102
Q

What fascia form the breast tissue

A

2/3 - pectoral fascia

1/3 - Fascia covering serrates anterior

103
Q

What is the retromammary space

A

The junction between the breast and the pectorals major (separated by the.pectoral fascia

104
Q

Function of the retromammary space

A

Allows the breast to move a bit on the pectoral fascia

105
Q

Anatomy of the mammary secretion system

A

Mammary glands have lobules. At the end of each lobule we have alveoli with mammary secretory epithelial cells.

106
Q

How are all the lobules in the mammary gland connected

A

Lactiferous ducts, these join together from each mammary gland at the areola

107
Q

What is the lactiferous sinus

A

It is a tunnel at the end of the lactiferous duct where milk accunmulates (think like a hand pump - similar action)

108
Q

What is contained in the storm of breast tissue

A

Adipose tissue and fibrous connective tissue

109
Q

What are the suspensory ligaments of Cooper

A

Formed by fibrous connective tissues to attach mammary glands to the dermis (support)

110
Q

Anatomical location of the nipple

A

Along the 4th rib and lateral to the midclavicular line

111
Q

Blood supply of the breast

A

Medial Mammary branches from the internal thoracic which branches from the subclavian

Lateral thoracic artery

Thoracoacromial artery off the axillary artery

Posterior intercostal off the axillary artery

112
Q

Venous drainage of the breast

A

Axillary vein

113
Q

Lymphatic drainage of the breast

A

All structures connect to the subareolar lymphatic plexus.

Drains into the anterior nodes then into the axillary lymph nodes.

Other lymph drainage goes through the parasternal nodes or sometimes even to the opposite breast.

114
Q

Nerve supply of the breast

A
  1. Lateral and anterior cuteaneous branches of the 4th to 6th intercostal nerves.
  2. These move through the pectoral fascia to supply the breast
115
Q

Onset for breast cancer

A

Typically postmenopausal women (>50)

116
Q

Most common form of breast cancer

A

Adenocarcinomas from the. terminal duct lobular units

117
Q

Most common location for a breast mass

A

Upper lateral quadrant of the breast

118
Q

What genetic over expression can lead to breast cancer

A

Oestrogen receptors

Progesterone Receptors

HER2 receptors (most aggressive)

119
Q

What is the clinical significance for oestrogen and progesterone receptor caused breast cancer

A

More susceptible to anti oestrogen medications (tamoxifen)

120
Q

What gene causes HER2 receptor overexpression

A

erbB2

121
Q

In what other cancers are HER2 receptors overexpressed

A

Ovaries
Lungs
Stomache
Oral adenocarcniomas

122
Q

Role of HER2

A

Facilitates epithelial growth and differentiation by accelerating tyrosine kinase activity

123
Q

Treatment for HER2 receptor cancers

A

Anti-HER2 monoclonal antibodies - trastuzumab

124
Q

Most aggressive form of breast cancer

A

Osterogen negative, progesterone negative and HER2 negative - triple negative

125
Q

Where do breast cancers first metastasise to

A

Axillary lymph nodes

126
Q

Common sites for breast metastases

A

Lungs
Bone
Liver

127
Q

RF for breast cancer

A
  1. Age
  2. Family History (strongest risk factor) of breast, ovarian cancer (BRCA1 and BRCA2)
  3. Increased oestrogen exposure (nulliparity, early menarche, late menopause and late first pregnancy)
  4. Alcohol
  5. No breast feeding
  6. Obesity after menopause
  7. Caucasians
128
Q

What factor increases the risk of breast cancer in YOUNG women

A

Multiple people in immediate family with premenopausal breast cancer

129
Q

Role of BRCA1 and BRCA2 genes

A

Tumour supressors to control cell cycle, they are 70% more likely to have breast cancer!

130
Q

What ethnicity is at the highest risk of developing triple negative breast cancer

A

African descent

131
Q

How often are breast cancer screens and who are they offered to

A

Women 50 to 70 every 3 years

Yearly mammogram screens to women with previous breast cancer for 5 years

132
Q

Diagnosis for breast cancer

A

Mammography

Needle Biopsy - GOLD

133
Q

Surgery of Breast Cancer

A

Sugery:

Radical Mastectomy
Breast-Conserving: Removal of cancerous breast tissue only

Chemotherapy:
Trastuzumab for HER-2 positive invasive cancers

134
Q

Complications of trastuzumab

A

Cardiovascular issues

135
Q

Treatment of HER-2 cancer

A

Trastuzumab

136
Q

Treatment for Oestrogen receptor positive invasive breast cancers

A

Aromatase Inhibitors (anastrozole) or Ovarian Function suppressions

137
Q

Pharmacology of tamoxifen

A

Oestrogen modulator, competes with estradiol at receptor site and blocks them off

138
Q

What are non-invasive breast cancers

A

Cancers that have not crossed the basement membrane of the ducts and stay in the breasts

139
Q

Name three non invasive breast cancers

A
  1. Ductal Carcinoma in situ

Paget Disease of the Brerast

Lobular Carcnioma in situ

140
Q

What is ductal carcinoma in situ

A

Where neoplastic epithelial cells form a mass growing INTO the terminal duct lobular unit

Usually only affects one ductal system

141
Q

Two subtypes of SCIS

A
  1. Comedo and Non-Comedo
142
Q

What are comedocarcinomas of the breast

A

High grade malignant cells under go central necrosis and then calcify

This causes chronic inflammation and periductal concentric fibrosis. Eventually this can penetrate basement membranes

As they do not penetrate, comedocarcinomas do not produce a MASS LESION unless invaded.

143
Q

Three types of non-comedo DCIS

A

No central necrosis

Pappillary (finger liike projections into the ducts)

Cribriform (gaps between the malignant cells)

SOlid (no gaps and fingers, completely full duct

144
Q

What is Paget disease of the breast

A

Ductal carcinomas spread through the lactiferous ducts to the nipple and areola

145
Q

Clinical Features of pagets

A

Because of spread to the areola and nipple, eczematous skin lesions or persistent dermatitis

146
Q

Diagnosis fo pagets

A

Biopsy and Mammography to check for underlying breast cancer

147
Q

What would be seen under a microscope for pagest

A

Intraepitehlial adenocarcinomas in the lactiferous ducts

148
Q

Treatment of pagets

A

Tamoxifen

149
Q

Why are lobular carcinomas in situ found incidentally

A

Not associated with normal presentation of breast cancers (no palpable lesions) and sometimes can be found in both breasts

150
Q

Where can breast masses invade

A

Pectoral muscles and deep fascia

Infiltration to surrounding structures near the nipple causes retraction (inversion)(

151
Q

What structure causes skin dimpling in breast cancer

A

Invasion into the suspensory Cooper ligaments

152
Q

Clinical features of breast cancer

A

Peu d’orange finding

153
Q

Four types of invasive breast cancer

A
  1. Invasive ductal, invasive lobular, medullary and inflammatory
154
Q

Two histological presentations of invasive ductal carcinomas

A

Tubular (well differentiated tubular structures) or mutinous (lots of extracellular mucin) - more common in older women

155
Q

Differentiating symptoms of lobular breast carcnioma

A

OFTEN BILATERAL WITH MULTIPLE LESIONS

and has low E-Cadherin expressions

Cancer cells arranges into strands on histology and there are no duct formations

156
Q

What is dangerous about medullary carcniomas

A

They are well circumscribed so they mimic benign lesions of the breast (fibroadenoma)

157
Q

RF for medullary carcnioma

A

Younger women
BRCA1
Triple negative phenotype

158
Q

Histolgy for medullary carcnioma

A

Cells Grow in sheets

159
Q

What can inflammatory breast carcnioma be mistaken for

A

Mastitis or Paget’s diseases due to erythema and paeu d’orange appearance

No palpable mass

160
Q

Indications for annual mammography under the age of 50

A

Atypical duct hyperplasia

Lobular carcinoma in situ

Follow up for previous breast cancer

161
Q

Contraindications to mammography

A
  1. Breast pain but no lump
  2. Symmetrical thickening
  3. Before HRT
  4. Women under 40 (usually stick to ultrasound)
162
Q

Indications for MRI scanning

A
  1. Between 30 and 50 with a high risk family history of BRCA1 or 2
  2. 20-70 years of age if li fraumeni tp53 mutation carrier)
163
Q

What does P1 - 5 mean

A
  1. Normal
  2. Benign
  3. Indeterminate
  4. Suspicious
  5. Malignant
164
Q

What is the FNAC score for cancers

A
  1. Insufficient
  2. benign
  3. Atypical, possibly benign
  4. Atypical, probably malignant
  5. Malignant
165
Q

What is the core biopsy score

A
  1. Insufficient
  2. Benign
  3. Atypical, probably benign
  4. Atypical, probably malignant
  5. Malignant, in situ
  6. Malignant, invasive
166
Q

What is a triple assessment

A
  1. Clinical
  2. Radiological (US/MMG)
  3. Pathological (FNA, core biopsy)
167
Q

What scoring system is used for breast cancer prognostics

A

Nottingham Prognostic Index

168
Q

First line treatment of Oestrogen-receptor breast cancer in premenopausal women

A

Tamoxifen

169
Q

First line treatment of oestrogen positive breast cancer in post menopausal women

A

Anastrozole (need to have SEXA scans every 2 years)

170
Q

Role of bisphosphonates in breast cancer

A

Reduces bone metastases

171
Q

From what part of the body is skin and fat taken from for breast reconstruction

A

Lattisimus Dorsi

172
Q

What is duct erctasia

A

Milk duct in the breast widens and walls thicken causing it to block and fluid build up

173
Q

What are papillomas

A

Single tumours that grow in the common milk duct straight behind the nipple (felt as a mass pretty much next to. the nipple)

174
Q

What conditions is a bloody nipple discharge commonly seen in

A

Paget’s, Duct erctasia and papillomas

175
Q

First line treatment for lactational breast infection

A

Flucloxacillin

176
Q

In what women are fibroadenomas common

A

<35

177
Q

What is Li Fraumeni syndrome

A

TP53 mutation, needed for tumour suppression. Quite general and causes many differnet types of cancers including breast cancer.

178
Q

A woman smokes heavily and gets recurrent episodes of infection in her right breast with induration, what condition is most associated with smokers

A

Periductal mastitis

179
Q

What should be done with women with no palpable axillary lymphadenopathy at presentation

A

Pre operative axillary uSS

If positive = sentinel node biopsy

180
Q

What indicates a mastectomy over a local excision

A
  1. Multifocal tumour
  2. Central tumour (not peripheral, so not as easy to take out)
  3. Large lesion
  4. DCIS < 4cm
181
Q

When is a radiotherapy offered in breast cancer

A

T3-T4 tumours or four or more positive axillary nodes

182
Q

What adjuvant hormonal therapy is used for pre and perimenopausal women

A

Tamoxifen

183
Q

In post menopausal women, what adjuvant therapy is used

A

Anastrozole

184
Q

What chemotherapy is used for breast cancer

A

FEC-D

185
Q

What disease produces a halo sign on a mammogram

A

Breast cysts

186
Q

After initial excision surgery, what is the recommended course of treatment to prevent recurrence

A

Whole breast radiotherapy

187
Q

What is the colour of discharge in mammary duct ectasia

A

Green

188
Q

When is a fibroadenoma eligible for excision

A

> 3cm

189
Q

Diagnosis of Paget’s disease of the nipple

A

Punch Biopsy

190
Q

What is the likelihood of someone’s daughter and son receiving the BRCA1 gene if one parent is positive

A

50%

191
Q

What is the first line management for any breast cnacer

A

Surgery

192
Q

What endocrine therapy can be used in elderly patients who want non invasive management of breast cnacer

A

Letrozole therapy

193
Q

Onset of duct ectasia

A

Menopause.

194
Q

What does a snowstorm sign in a USS axillary lymph node indicate

A

Implant rupture.

195
Q

What is the most common gynaecological cancer in the UK

A

Endometrial!

196
Q

When can the POP be started in pregnant, breastfeeding women

A

Immediately

197
Q

When can COCP be taken in breastfeeding women

A

After 6 weeks

Or, if not breastfeeding, after 3 weeks.

198
Q

When should Mastitis be treated with flucoxacillin

A

Infective/ Systemic symptoms

199
Q

What BP is an absolute contraindication to COCP

A

160/95

200
Q

What age is considered an absolute contraindication to COCP

A

35 AND smoking 15 a day or more

201
Q

What contraceptive should be given if a patient is taking enzyme inducing drugs

A

Depo-Provera

OR

Copper IUD

Rifampicin

Anti-epileptics

Phenytoin
Barbiturates
Topiramate
Lamotrigine

202
Q

What medications are contraindicated with COCP

A

Anti-epileptics: Carbamazepine, Phenytoin and other epileptic drugs

203
Q

LGV vs Syphilis

A

LGV has an unindurated lesion vs indurated lesion

Both painless

LGV has tender, inguinal lymph nodes

Syphilis has non-tender, inguinal lymph nodes

204
Q

What is the GOLD STANDARD for testing for HSV

A

NAAT not PCR

205
Q

If a smear displays 5 or more polymorphs per high power field, what empirical treatment is given before diagnosis can be confirmed

A

Doxycycline

206
Q

Under what HIV load can a normal vaginal delivery be recommended

A

Under 50

207
Q

What should the baby be given if th emoter has a viral load of <50

A

PEP

> 50: cART

208
Q

Treatment of LGV

A

Doxycycline

209
Q

GOLD Standrad diagnostic for trichomoniasis

A

High vaginal swab from the posterior fornix

210
Q

Differential for mastitis

A

Breast Abscess, if not improving on flucloxacillin, suspect an abscess as they both have systemic features.

211
Q

First line investigation for women under 40 years old

A

USS, not a mammogram.

Because a mammogram is not as sensitive under 35 years of age.

212
Q

What scan is used to check for metastasis

A

PET scan

213
Q

What is fibroadenosis

A

Painful, lumpy breast that becomes worse around menstruation

214
Q

What neoadjuvant chemotherapy is used for Breast Disease and when is it indicated

A

To downstage a tumour (e.g., axillary node metastasise), FEC-D

215
Q

What blood test antigen can be used as a marker for breast cnacer

A

CA 15-3

216
Q

How do we calculate the Nottingham Prognostic Index

A

Tumour size x 0.2 + Nodes + Grade

217
Q

What is the prognosis of NPI > 5.0

A

50%

218
Q

What two drugs cannot be used after the age of 50 for contraception

A

Depo-Provera

COCP

year 3 (25 decks)

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