Gyn Conditions

Question 1

ovarian CA - what kind/ C/RF / genetic testing criteria/ CF/ I /T / staging

Answer 1

80% cystadenoma c - genetic (BRCA 1+2), nulliparity, unsuccessful IVF, +ve FHx, no use of OCP, increased age, HRT use test for BRCA if FHx = 1 ov CA + 2 Breast CA // 2 ov CA CF - often asymp (reason why so deadly) 4 NICE criteria pain, bloating, appetite, freq up (+ other CA CF’s) I - pelvic US (solid mass) / CT scan (staging/mets) / Ca125 / biopsy T - depends on tumor type : most common is surgical excision + chemo staged 1-4 1-ovaries 2-capsule invaded but confinied 3-peritoneum 4-mets

Question 2

endometrial CA - ? / common patho / CF / I / RF / T

Answer 2

always suspect if PC is postmenopausal bleeding (this form of CA is less common than cervical CA and often presents AFTER menopause most are adenoCA (other option is leiomyosarcoma) CF - bleeding, weight loss, pain o/e often normal I - atypical cells on smear, Ca125 raised, uterus US, curettage/uterine sampling (must cover entire uterus for biopsy) If METS –> LFTs and U+E’s and cXray RF - obesity, raised age, unnopposed oestrogen (nulliparity, late menopause, HRT), tamoxifen, FHx, endometrial hyperplasia T - SURG: total hysterectomy + bilat salpingo-ooph +/- radiotherapy Palliative = radiotherapy Stage 1 - less than 1/2 myometrium 2 - cervix involved 3 - lymph nodes 4 - CA invades other organs +B = mets

Question 3

cervical CA - type / c/ RF / CF / screening / I /T (pre-malig and malig)

Answer 3

squamous CA = 70% c - HPV 16 + 18 RF - prolonged OCP / smoking / multiple sexual partners / young age first intercourse/ very multiparous CF - abnormal bleeding, pain (sex/period), cervical mass felt Screening* seperate I - examine with colposcope = if epithelium looks white when stained with acetic acid indicates CIN etc so take punch biopsies T - if CIN = cryotherapy / laser / cold co-ag / LLETZ (plus annual follow-ups for 10 years if small CA seen transitional zone take cone biopsy (may cure) if invasive CA: stage 1 = local excision +/- hysterectomy + chemo stage 2 = radical hysterectomy + lymphadencetomy +/- chemo stage 3 (+4) = chemo (+ supportive) **to preserve fertility do trachectomy instead hysterectomy? stages 1 - confiend 2 - upper 2/3 vag 3 - lower 1/3 vag 4- spread to bladder etc B-Mets

Question 4

cervical cancer screening - who, why, what seen? how, possible results and T

Answer 4

started in 1988

screening over 20 year olds every 3 years invasive CA is preceeded by CIN 1-3 (cervical intra-epithelial neoplasia) I - insuff/unclear = repeat in 3 months borderline –> repeat in 6 months mild dyskaryosis –> 6 months (CIN1) mod dyskaryosis –> refer to colposcopy (CIN2) severe dyskaryosis –> refer to colposcopy (CIN3) T - cryotherapy, laser, cold co-ag, LLETZ

Question 5

most common location for metaplasia?

Answer 5

squamo-columnar junction

Question 6

vulval CA - PC / I / T

Answer 6

PC - itch, pain, abnormal looking vulva, ulcer, dysuria, swelling I - biopsy T - wide local excision +/- radio

Question 7

DD of vulval mass

Answer 7

cyst, benign solid tumor (lipoma, fibroma)

Question 8

raised Ca125 indicates?

Answer 8

CA, endometriosis, preg, benign ovary dis, PID

Question 9

causes of pelvic mass

Answer 9

cyst, fibroids, abscess, CA, faecal loading

Question 10

other tumor markers

Answer 10

Ca125, BHcG, AFP, CEA

Question 11

PCOS - ? / c / CF / I / T

Answer 11

symptoms of hyperandrogenism, hyperandrogenaemia and oligo-ovulation + polycystic ovaries c - unkown / genetic CF - irregular periods, infertility, hirtuism, acne, obesity, hypertension I - serum total and free testosterone (UP) serum DHEAS (UP) OGTT UP, Chol UP + pelvic US showing cyts T - lifestyle mod (weight loss nad stop smoking) oral hypoglycaemics can help (metformin) + clomifene(selective oest receptor modulator)` +/- OCP

Question 12

PID - PC / o.e / c / RF / I / T

Answer 12

PC - pelvic pain (bilat) PV discharge, deep dyspareunia, abnormal menstral bleeding, signs of sepsis o/e - tender uterine/cervical/adnexal c - can be any combo of female genital tract diseases (sti, endomet, salpingitis, abscess, pelvic peritonitis) RF - prev STI, early 1st sex intercourse, unprotected sex with many partners, IUD I - FBC (WCC) vaginal secretion culture T - abx’s triple therapy (ceftriaxone, doxy, metro) + ocntact tracing, remove any IUD and give analgesia if severe admit and IV abx’s

Question 13

complications of PID

Answer 13

subfetility, recurrent PID, ectopic preg, chronic pain + dyspareunia, abscess

Question 14

sti - RF / c of each disease + CF

Answer 14

RF - age

Question 15

candida / bact vag / trichomoniasis vag - CF/ RF / T

Answer 15

Question 16

prim and secondary ? / c / I / T

Answer 16

Prim - not preg despite > year trying

Seoncary - preg before but unable now

tubal pathology 15%/ endometriosis 6%/ male is infertile 25%/ decreased ovulation (e.g PCOS) 25% unexplained 25%

I - most couples conceive <1 year of trying + 92% <2 years

start investiating after 1 year

Hx>> prev preg, menstration, contraception, abdo surg (appendix, ectopic etc) BMI >30.

MALE - sperm count (vol, motility, morphology), varicoceles, normal testis, BMI >30.

FEMALE - check hormones throughout menstral cycle, tubal patency (contrast xray and abxs) chromosomal analysis (both male and female)

T - genital tract infection –> treat

low sperm count - avoid alcohol/tobacco / consider donor insemination

erectile dysfunction - arifical insem using partners sperm

anovulation - PCOS = clomifene // ovary failure = IVF

endometriosis = see next page

tubal blockage - tubal cath

Question 17

advice before. chances, indications, process

Answer 17

screen couple for HIV and Hep B/c

chances are 20% if under 35 / 6% if >40

indications - tubal problems

process - ovaries stimulated to release egg, collected and fertilised in vitro, then 2 embryos returned to uterus

Question 18

? / RF / PC / I / T

Answer 18

chronic oestrogen dependant condition causing growth of endometrial tissue in sites other than that of the uterine cavity (ovaires, bladder are common)

RF - early menarche, late menopause, short menstral cycle, FHx

(protective = OCP, multiparity)

PC (often confused with IBS) - inflammation, chronic pelvic pain, dyspareunia, dysmenorhea, infertilty + vague symptoms (bloating, constip, back pain)

o/e fixed retroverted uterus/ uterosacral nodules

I - laparoscopy + TV US (cysts and retro peritoneal deposits) Ca 125 also raised

T - if asymp (nothing) advice decrease stress

start OCP and give analgesia

if symp - start hormone therapy <gnrh> (will decrease ovulation for 6-12 months and allow lesions to atrophy) </gnrh>

+/- mirena coil

SURG: excision or ablation of endometrial tissue or total hysterectomy + bilat salping oophrectomy

complications - recurrence, obstruction

Question 19

What are the guidelines for an effective screening program? (9)

Answer 19

1. condition should be common
2. accepted treatment available
3. history of disease understaood
4. early asymptomatic phase
5. suitable screening test available (not harmful e.g amnio)
6. facilities for diagnosis and treatment available
7. agreed policy on whom to treat
8. starting treatment before onset of symptoms must be more beneficial than waiting
9. cost doesnt outweigh benefit