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Part 2 exam > GTG: Gestational trophoblastic disease > Flashcards

GTG: Gestational trophoblastic disease Flashcards

1
Q

What is the most common karyotype in a partial molar pregnancy?

A

69 chromosomes (90% triploid)

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2
Q

How is a partial mole formed?

A

Dispermic fertilisation of an empty ovum

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3
Q

What is the karyotype of a complete molar pregnancy?

A

46 chromosomes (diploid)

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4
Q

How is complete mole formed?

A

1) dispermic fertilisation of empty ovum

2) duplication of single sperm DNA in an empty ovum

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5
Q

How common is dispermic fertilsation of an empty ovum the cause of a complete mole?

A

75-80%

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6
Q

Which type of molar pregnancy is more at risk of forming a gestational trophoblastic tumour?

A

Complete molar pregnancy

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7
Q

What proportion of partial moles will need chemotherapy?

A

0.5-1%

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8
Q

What proportion of complete moles will need chemotherapy?

A

13-16%

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9
Q

What is the sensitivity of ultrasound for complete molar pregnancy?

A

95%

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10
Q

What is the positive predictive value of ultrasound for complete molar pregnancy?

A

40%

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11
Q

What is the sensitivity of ultrasound for partial molar pregnancy?

A

20%

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12
Q

What is the positive predictive value of ultrasound for partial molar pregnancy?

A

22%

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13
Q

What is present in a partial molar pregnancy but not present in a complete molar pregnancy?

A

Fetal tissue

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14
Q

What is the recommended first line treatment for molar pregnancy?

A

Dilation and curettage

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15
Q

What is the incidence of molar pregnancy in a subsequent pregnancy?

A

1%

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16
Q

What is the incidence of developing a gestational trophoblastic neoplasia after a live birth?

A

rare - 1 in 50,000

17
Q

What proportion of gestational trophoblastic neoplasias are placental site trophoblastic tumours or epithelioid trophoblastic tumours?

A

rare = 0.2% of GTN

18
Q

What is the incidence of gestational trophoblastic disease?

A

1 in 715

19
Q

What patient characteristics increase the risk of gestational trophoblastic disease?

A

<15yo, >50yo, Asian ethnicity

20
Q

What is the most common presenting symptom for GTD?

A

vaginal bleeding (60%)

21
Q

If molar pregnancy is managed medically, how much is the risk of GTN increased?

A

x16

22
Q

What proportion of GTD is not diagnosed until after the products have been removed and reviewed in the lab?

A

2.7%

23
Q

How long are partial molar pregnancies followed up for?

A

discharge after x2 normal HCG 4 weeks apart

24
Q

How long are complete molar pregnancies followed up for?

A

If HCG normal within 56 days - repeat HCG in 6 months

If HCG abnormal within 56 days, repeat HCG 6 months after a normal HCG level

25
Q

Which patients receive single agent chemotherapy for GTN?

A

= 6 on Figo score

26
Q

Which single agent chemo is used for choriocarcinoma?

A

Methotrexate

27
Q

Which patients receive multi agent chemotherapy for choriocarcinoma?

A

> /=7 FIGO score

28
Q

How long are patients typically on chemo for GTN?

A

6 weeks after achieving a normal HCG

29
Q

When can a patient get pregnant following GTD?

A

No chemo - after the HCG is normal

Chemo - after 1 year

30
Q

What are poor prognostic factors for placental site trophoblastic tumour and epithelioid trophoblastic tumour?

A

Identified >48 months after pregnancy

Stage 4 disease

31
Q

How are stage 1 placental site trophoblastic and epithelioid trophoblastic tumours managed?

A

Hysterectomy + (platinum based chemo if >48 months)

32
Q

What proportion of patients have a successful pregnancy after treatment of GTN?

A

80%

33
Q

What is the cure rate for Figo score 6 and below?

A

100%

34
Q

What is the cure rate for Figo score 7 and above?

A

94%

35
Q

Which pregnancies after GTD need to be followed up with HCG monitoring in the subsequent pregnancy?

A

Only those who required chemotherapy

36
Q

What are the risks of a twin pregnancy with a concurrent molar pregnancy?

A

Risk of preterm birth 36%
Risk of pregnancy loss 40%
Risk of pre-eclampsia 4%

Part 2 exam (39 decks)

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