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MRCOG Gynaecology Part 2 Revision - Hay > General Gynaecology GTG - PMS, Ovarian masses, chronic pelvic pain > Flashcards

General Gynaecology GTG - PMS, Ovarian masses, chronic pelvic pain Flashcards

PMS Pre and post menopausal cyst Chronic pelvic pain

1
Q

When do core menstrual disorders present?

A

Luteal phase and abate with menstration.

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2
Q

What are the 5 subgroups of core menstrual disorders?

A

1) Pre-menstrual exacerbation of underlying disorder

2) Core menstral disorders

3) Progesterone induced PMS

4) PMD without menstruation

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3
Q

To be considered core pre-menstrual disorder instead of PMS, what must the patient describe?

A

Severe symptoms, affect daily function, interfere with work/school/interpersonal relationships

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4
Q

How many experience PMS?

A

4/10

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5
Q

How to Dx PMD?

A

Symptom diary over 2 diaries, GnRH analogues can be considered for definitive Dx if diary inconclusive

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6
Q

What are the 1st line Tx for PMD?

A

Exercise,
CBT,
Vitamin B6

Continuous or luteal SSRI (Day 15-28), low dose citalopram/esocitalopram 10mg

COCP (with drospirenon and short hormone free interval) cyclical or continuous

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7
Q

What are the 2nd line treatments offered for PMD?

A

Estradiol patches (100micrograms) + microginosed progesterone (100mg or 200mg OD (D17-28) or LNG-IUS 52mg (20mcg/day)

High dose citalopram/esocitalopram 20mg - continuous or D15-28

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8
Q

What are the 3rd line treatments offered for PMD?

A

GnRH analogues + add back therapy

(50-100 microginosed estradiol patch or 2-4 doses of estradiol gel combined) with microginosed progesterone 100mg/day (urtogestan) or tibalone 2.5mg

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9
Q

What are 4th line treatments for PMD?

A

Surgical TX and HRT

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10
Q

Which COCP should be used to treat PMS?

A

Drosprirenone containing COCs

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11
Q

Why should micronised progesterone be used? What other route can it be given?

A

Less likely to reintroduce PMS like symptoms.
Vaginally

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12
Q

What level is a normal CA125?

A

<35

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13
Q

What ovarian cancers will it be raised in? Which will it not be raised in/

A

Raised epithelial ovarian cancer

Not primary mucinpous

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14
Q

PM cyst <5cm - how many will
1) Disappear
2) Static
3) Enlarge

A

Disappear 52%
Static 28%
Enlarge 11%

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15
Q

How to calculated RMI score?

A

USS 1 point for each:
Multilocular, solid area, mets, ascites & BL lesions

U=0 (0 points, U=1 (1point) U= 3 (2-5 points)

Menopause status
Premenopause = 1
Post menopause = 3

CA125

RMI U x M X Ca125

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16
Q

Sensitivity and specificity off RMI score?

A

78% sensitive
87% specific

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17
Q

What RMI score cut off is used for low risk/high risk malignancy?

A

200

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18
Q

For low risk women, RMI < 200, when would you consider BSO?

A

Cysts with any of the features
- Symptomatic
- Non simple features
- >5cm
- Multilocular
- Bilateral

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19
Q

For low risk women, RMI < 200, and no concerning features, when would you offer repeat assessment? What tests would you perform?

A

After 4-6 months
- CA125
- TVUS/TAUS

20
Q

At the follow up at 4-6 months, what you do if
1) Resolved
2) Persistent unchanged
3) Change in featues

A

1) Discharge
2) Repeat assessment 4-6 months
3) Consider intervention

If not resolved after 1 year can either discharge or intervene, decision individualised

21
Q

If RMI > 200 what tests should be requested?

A

CT abdomen
Refer Gynae MDT

22
Q

If MDT think high risk of ovarian malignancy?

A

Full staging procedure by trained gynae oncologist

23
Q

If MDT think low risk gynae malignancy?

A

TAH + BSO + omentectomy + peritoneal cytology by suitably trained gynaecologist

24
Q

If RMI < 200, what % of cysts will resolve by 3 months?

A

50%

25
Q

If cystectomy is required in PM women, what surgery should be performed?

A

Lap (if possible) BSO
Remove through umbilical port without spill

26
Q

What is the sensitivity and specificity of the IOTA rules?

A

Sensitivity 98%
Specificity 91%

27
Q

What are the B rules?

A
  1. Unilocular
  2. Solid component <7mm
  3. Acoustic shadowing
  4. Smooth multilocular cyst <100mm diameter
  5. No blood flow on doppler
28
Q

What are the M rules

A
  1. Irregular solid tumour
  2. Ascites
  3. 4+ papillary structures
  4. Irregular multilocular cyst >100mm
  5. Prominent blood flow on doppler
29
Q

What % of women will have surgery in their life for ovarian mass?

A

10%

30
Q

List 5 types of benign ovarian cyst

A

Functional
Endometrioma
Serous cyst adenoma
Mucinous Cystadenoma
Mature teratoma

31
Q

List benign non ovarian adnexal mass

A

Paratubal cyst
Hydrosalpinges
TOA
Peritoneal pseudocyst
Appendices abscess
Diverticular abscess
Pelvic kidney

32
Q

List malignant ovarian mass

A

Germ cell tumour
Epithelial carcinoma
Sex-cord tumour

33
Q

In Germ cell tumour, what tumour markers are raised?

A

A-FP
bhCG
LDH

34
Q

Should CA125 be measure to assess ovarian mass in premenopausal women

A

No, raised in multiple conditions

Only raised 50% epithelial ovarian carcinoma

35
Q

Premenopausal cyst <50mm

A

No follow up

36
Q

Premenopausal cyst 50-70

A

yearly FU - USS

37
Q

Premenopausal cyst >70mm

A

Consider MRI or surgical intervention

Always aim laparoscopic if possible

38
Q

Endometriomas over what size should be biopsied/removed?

A

> 30mm, rule out rare cases of malignancy

39
Q

How common is chronic pelvic pain?

A

1 in 6

40
Q

What is definition of chronic pelvic pain?

A

Intermittent or constant pain for at least 6 months, not exclusively with menstruation/intercourse

41
Q

What criteria is used to Dx IBS?

A

ROME III criteria

42
Q

What does the ROME criteria ask?

A

Continuous or recurrent abdo pain/discomfort on at least 3 days/month with onset >6months with at least 2
- Improvement on defecation
- Change in frequency of stool
- Change in form of stool

43
Q

Incidence of nerve entrapment after 1 pfannestiel incision?

A

3.7%
Sharp stabbing pain, exacerbated by particular movements

44
Q

When should CA125 for screening

A

> 50yrs
Bloating, early satiety, pelvic pain, urinary urgency/frequency, new IBS

45
Q

Tx for IBS

A

Antispasmodics - mebeverine hydrochloride

46
Q
A

MRCOG Gynaecology Part 2 Revision - Hay (44 decks)

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