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Phase 3a > Gynae 2 - Infection and Malignancy > Flashcards

Gynae 2 - Infection and Malignancy Flashcards

1
Q

What is a hyatidiform mole?

A

Abnormal conception - growing mass of tissue in the womb that will not develop into a foetus

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2
Q

What are the two types of hyatidiform mole and what are the risk factors?

A

Complete - extremes of reproductive life, previous history

Partial - previous history

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3
Q

What is the karyotype in complete and partial moles?

A

Complete - 46XX

Partial - 69XXX, XXY, XYY

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4
Q

What are the signs of hyatidiform mole?

A

Irregular first trimester bleeding 90%
Uterus large for dates
Exaggerated pregnancy symptoms

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5
Q

What is the serum hCG in hyatidiform moles?

A

Complete - excessively high

Partial - normal to high

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6
Q

What is seen on USS in Hyatidiform moles?

A

Snowstorm appearance

Large theca lutein cysts

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7
Q

What is the treatment of complete moles?

A

Surgical curettage and anti-D prophylaxis

Chemotherapy if persistently raised hCG/persistent symptoms

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8
Q

What is the treatment of partial moles?

A

Surgical or medical evacuation

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9
Q

What is the name of the tumour consisting of syncytiotrophoblasts and cytotrophoblasts?

A

Choriocarcinoma - cancer of the placenta

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10
Q

Where does choriocarcinoma metastasise to early?

A

Lung

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11
Q

What are the risk factors for choriocarcinoma?

A

Hyatidiform mole,
Normal pregnancy
Ectopic

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12
Q

What are the symptoms of choriocarcinoma?

A

Vaginal bleeding
Abdominal/vaginal swelling
Amenorhoea
Dyspnoea and haemoptysis

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13
Q

What is the treatment of choriocarcinoma?

A

Chemo and then hysterectomy

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14
Q

What is the most common form of ovarian cancer?

A

Epithelial

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15
Q

What demographic gets ovarian cancer?

A

75-84 years

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16
Q

What factors increase the risk of ovarian cancer?

A

Multiple ovulations (early menarche, late menopause)
BRCA1 and BRCA2 mutations
Lynch Syndrome lifetime risk 12%

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17
Q

What are the symptoms of Ovarian cancer?

A

Vague
Abdo distension
Urinary/bowel change
Abnormal vaginal bleeding

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18
Q

How is ovarian cancer diagnosed?

A

Increased CA125, CA19.9 raised in mucinous tumours
Abdo/pelvic USS
CT

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19
Q

What surgery is required in ovarian cancer?

A

Hysterectomy with bilateral salpingo-opherectomy

Stages 2-4

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20
Q

What is a risk factor for vulval squamous cell cancer?

A

Lichen sclerosis

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21
Q

What is seen in lichen sclerosis?

A

Burning pain or itching
White thickening, figure of 8
Hyperkeratosis and purpura

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22
Q

What is the treatment of lichen sclerosis?

A

Reducing course of clobetasol proprionate 0.05% OD

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23
Q

Give three risk factors for endometrial cancer

A

Endo/exogenous unopposed oestrogen - PCOS, HRT
Obesity
Nulliparity (reduced progesterone)
Lynch syndrome (40-60%)

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24
Q

What type of tumour is the most common endometrial cancer?

A

Adenocarcinoma

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25
Q

What staging is used in endometrial cancer?

A

Figo

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26
Q

How does endometrial cancer present?

A

PMB

Unless younger - menstrual disturbance

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27
Q

What thickness of endometrium indicates no pathology?

A

<4mm

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28
Q

What is the necessary precursor lesion for carcinoma of the cervix?

A

Cervical intraepithelial neoplasia (CIN)

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29
Q

What are the most common oncogenic subtypes of HPV?

A

16, 18, 31, 33

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30
Q

What are the risk factors for CIN and cervical cancer?

A

Persistent HPV
Multiple partners
Smoking
Immunocompromise

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31
Q

What is the transformation zone (TZ)?

A

The glandular epithelium of the endocervix is pushed out onto the ectocervix, and in response to low pH, undergoes physiological squamous metaplasia

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32
Q

How often are women called for their cervical screening tests?

A

25-49 - every 3 years

50-64 - every 5 years

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33
Q

What may be seen on abnormal smears?

A

Abnormal nuclei shape/density
Increased nuclear/cytoplasmic ratio
Inflammation
Dyskaryosis

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34
Q

Application of what in colposcopy magnifies the TZ?

A

5% acetic acid or Lugol’s iodine

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35
Q

Detail the histological types of CIN

A

CIN 1 - bottom 1/3 of squamous epithelium
CIN II - bottom 2/3 of squamous epithelium
CIN III - full thickness dysplasia

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36
Q

How does cervical cancer present?

A

PCB/PMB

Weight loss or bowel/urinary change

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37
Q

What is LLETZ?

A

Large loop excision of the transformation zone

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38
Q

What are uterine fibroids?

A

Common benign tumours of the myometrium

Smooth muscle and fibrous tissue

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39
Q

What is the presentation of fibroids?

A 
Dysmenorrhoea/menorrhagia
Pressure symptoms e.g. frequency
Pelvic pain
Infertility
Red degeneration in pregnancy
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40
Q

Give three types of fibroid

A

Submucous
Intramural
Pedunculated

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41
Q

How are symptomatic fibroids treated?

A

Tranexamic acid or Mirena IUS

GnRH analogues shrink fibroid before laparoscopic myomectomy or hysterectomy

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42
Q

What is a focal overgrowth of the endometrium?

A

Endometrial polyp/adenoma

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43
Q

What features would indicate abnormal ovarian cysts?

A

Woman not having periods
Symptomatic
Cyst over 5cm in size

44
Q

What does the risk of malignancy index (RMI) use in ovarian cysts?

A

Ultrasound features
CA125
Menopausal status

45
Q

What are the symptoms of ovarian cysts?

A

Chronic pain - dull ache
Acute pain - bleeding or rupture
DUB

46
Q

What are the risk factors for vulval cancer?

A

Lichen sclerosis

Vulval intraepithelial neoplasia (VIN)

47
Q

What infection is associated with VIN?

A

HPV 16

48
Q

Exposure to what in utero can cause vaginal cancer in adolescents?

A

Diethylstilbestrol (DES)

49
Q

What are the risk factors for vaginal cancer?

A

Other cancers of the genital tract
HPV 16
Smoking
HIV

50
Q

What is trichomonas vaginalis?

A

Flagellated protozoan

51
Q

What discharge is seen in trichomonas?

A

Frothy, green, offensive smelling

52
Q

How is trichomonas diagnosed?

A

Wet smear
-Posterior fornix swab - Diamond’s TYM culture
Strawberry cervix

53
Q

What is the treatment of trichomonas?

A

Metronidazole 2g single dose/500mg 5-7d

54
Q

What management is important in all STIs?

A

Contact tracing

Abstinence until treatment course is finished

55
Q

What are the risks of STIs in pregnancy?

A

PROM and prematurity
Low birth weight
Perinatal acquisition

56
Q

Which viruses cause genital warts?

A

HPV 6 and HPV 11

57
Q

What is the treatment of genital warts?

A

Podophyllotoxin paint/imiquimod 5% cream self application

Cryotherapy

58
Q

Which spirochaete causes syphilis?

A

Treponemum pallidum

59
Q

What occurs in primary syphilis?

A

Painless genital ulcer (chancre)

Inguinal lymphadenopathy

60
Q

What occurs in secondary syphilis?

A

Polymorphic rash on palms and soles
Condyloma lata
Anterior uveitis

61
Q

What are the three components of tertiary syphilis?

A

Neurosyphilis
Aortic root disease
Gummata

62
Q

Give one diagnostic test for syphilis

A

Rapid plasma reagin test (screening)

Fluorescent treponemal antibody absorption test (FTA-abs)

63
Q

How is syphilis eradicated?

A

IM benzathine penicillin OR azithromycin

64
Q

What are the symptoms of herpes simplex infection?

A

Flu
Inguinal lymphadenopathy
Vulvitis and pain
Small characteristic vesicles on the vulva

65
Q

Where does the HSV virus reside in latent periods?

A

Sacral ganglia

66
Q

How is HSV diagnosed?

A

Viral culture of vesicle fluid

67
Q

What medication reduces severity and duration of primary attack?

A

Aciclovir

68
Q

What type of bacteria is Neisseria gonorrhoea?

A

Intracellular Gram negative diplococcus

69
Q

What discharge is seen in Gonorrhoea?

A

Greenish, 2-7 days after infection

70
Q

What antibiotics are used to treat gonorrhoea?

A

IM Ceftriaxone single dose PLUS azithromycin single dose

71
Q

How is gonorrhoea diagnosed

A

Endocervical/urethral swabs

Nucleic-acid amplification test (NAAT)

72
Q

Which organism causes chlamydia?

A

Chlamydia trachomatis parasite

73
Q

What are the symptoms of chlamydia?

A

Increased vaginal discharge secondary to cervicitis, yellow/milky white/bleeding
Asymptomatic

74
Q

What antibiotic is used for chlamydia?

A

Azithromycin

75
Q

What is a consequence of chlamydia?

A

Tubal infertility

76
Q

What is the presentation of candida infection?

A

Vulval itching and soreness
Thick curd like white vaginal discharge
Dysuria
Superficial dyspareunia

77
Q

What is the treatment of candida?

A

Clotrimazole pessary and topical cream

78
Q

What causes bacterial vaginosis?

A

Overgrowth of mixed anaerobes including Gardnerella and mycoplasma hominis
Replaces the usually dominant bacterial vaginal lactobacilli

79
Q

What are the symptoms of BV?

A

Profuse white-grey offensive discharge

Fishy smell from amines

80
Q

How is BV diagnosed?

A

Increased vaginal pH>5.5

Vaginal wall swab - clue cells on microscopy

81
Q

What is the treatment of BV?

A

Metronidazole

82
Q

Infection of the upper genital tract is known as?

A

Pelvic inflammatory disease

83
Q

What are the risk factors for PID?

A

Previous STI
Multiple partners
Uterine instrumentation
Postpartum endometritis

84
Q

What are the signs of PID?

A

Cervical excitation and adnexal tenderness
fever
Vaginal discharge
Dyspareunia

85
Q

Laparoscopy is gold standard for PID. When is it indicated?

A

Tubo-ovarian abscess

86
Q

What antibiotics are needed in PID?

A

Ceftriaxone and doxycycline and metronidazole

87
Q

What are elementary bodies?

A

Attach to sperm in chlamydia

88
Q

What is the treatment of chlamydia in pregnancy?

A

Erythromycin

89
Q

What are the chances of conception per cycle?

A

14%

90
Q

What is a delayed miscarriage?

A

“missed”
Fetal demise occurs but body’s rejection of dead fetus is delayed
Slight brown discharge

91
Q

What is the first line investigation in PMB?

A

TVUS for endometrial thickness

92
Q

What is first line and second line treatment for atrophic vaginitis?

A

1st: oestrogen cream
2nd: lubricants and moisturizers

93
Q

What is the risk of chickenpox in pregnancy?

A

Maternal - 5x risk of pneumonitis

Foetal varicella syndrome - LD, skin scarring, microphthalmia

94
Q

What is the first and second line management of contact with someone with chicken pox in pregnancy?

A

Check varicella antibodies

Give varicella immunoglobulin

95
Q

What is the management of thrush in pregnancy?

A

Clotrimazole pessary

Fluconazole CI in pregnancy

96
Q

What is an absolute contraindication to the copper IUD?

A

PID

97
Q

What is the appropriate management of a woman over 45 on hormonal contraception with change in pattern of bleeding?

A

Endometrial biopsy

98
Q

Which STIs are diagnosed with a nucleic acid amplification test (first void urine)?

A

Gonorrhoea

Chlamydia

99
Q

What is the incubation for chlamydia and gonorrhoea?

A

2 weeks

100
Q

What are the symptoms of chlamydia in men?

A

Asymptomatic
Discharge
Dysuria

101
Q

What must you avoid when taking metronidazole?

A

Avoid alcohol

102
Q

Which antibiotics interact with the pill?

A

Rifampicin

103
Q

What are the long term complications of sexually transmitted diseases?

A

PID women
Subfertility
Urethral strictures men
Neurosyphilis etc

104
Q

What is the whirlpool sign?

A

Seen on ultrasound in ovarian torsion

105
Q

When should a woman with CIN have another smear?

A

6 months later

Phase 3a (18 decks)

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