Gynae

Question 1

Treatment for HMB

Answer 1

Contraceptive needed:
Mirena coil

No contraceptive needed:
Tranexamic acid (anti-fibrinolytic)
Mefanemic acid if painful (NSAID)

Question 2

For which cancer is Gleason score used to grade?

Answer 2

Prostate

Question 3

Screening tests and ages for all cancer types

Answer 3

Breast = age 50-70, mammogram 3 yearly
Cervical = age 25-50 (3 yearly), age 50-65 (5 yearly), smear test 
Colorectal = age 60-75 (2 yearly), FIT test
Prostate = age >50, if requested, PSA test

Question 4

Most common spread of breast cancer

Answer 4

Breast
Bones
Lung
Liver

Question 5

Most common spread of breast cancer

Answer 5

Breast
Bones
Lung
Liver

Question 6

Paraneoplastic presentations of small cell lung cancer

Answer 6

SIADH (hyponatraemia)
Cushing’s (ectopic ACTH production)
Eatern lambert (muscle weakness)

Question 7

What can new onset miosis, anhydrosis and ptsosis be a symptom of?

Answer 7

(Horner’s syndrome)

Pancoast tumour - apical lung tumour, presses on parasympathetic ganglion

Question 8

What can new onset hoarse voice be a symptom of?

Answer 8

Lung cancer - pressing on recurrent laryngeal nerve

Question 9

What does the triple assessment for breast cancer involve?

Answer 9

1. Clinical examination and history
2. Mammogram/ USS (<30)
3. Biopsy (FNA + lymph node biopsy)

Question 10

What is the investigation/diagnostic pathway for suspected prostate cancer?

Answer 10

1. Prostate examination
2. PSA
3. MRI
4. Transrectal USS and biopsy

Question 11

Diagnostic triad for neutropenic sepsis

Answer 11

Neutrophils <1x10^9
Temp >38
Other sign/symptoms of sepsis

Question 12

Management of neutropenic sepsis

Answer 12

BROAD SEPCTRUM ABX WITHIN 1 HOUR

BUFALO

Question 13

Investigations and Tx for MSCC

Answer 13

16mg dexamethasone + PPI cover
Urgent MRI spine (within 24h)
Neurosurgery/radiotherapy

Question 14

First line treatment for infertility in PCOS

Answer 14

Clomifene

then metformin

Question 15

When should you repeat an inadequate smear?

Answer 15

3 months

Question 16

Most common cause of post-menopausal bleeding

Answer 16

Vaginal atrophy (atrophic vaginitis)

Question 17

What endometrial thickness is worrying?

Answer 17

> 4mm

Question 18

Post-CS check up?

Answer 18

VTE prophylaxis
Check wound
Pain relief
Bowel, flatus, bladder
Eating and drinking
Baby stiff

Question 19

What organism can cause sepsis in mothers as a secondary cause of PPH?

Answer 19

Group A strep