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part 2 > Gynae problems > Flashcards

Gynae problems Flashcards

1
Q

PMB: overall risk of underlying endometrial Ca

A

10%

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2
Q

PMB >80yo: risk of underlying endometrial ca

A

25%

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3
Q

PMB<50yo: risk of underlying endometrial ca

A

1%

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4
Q

PMB + obesity: risk of underlying endometrial ca

A

18%

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5
Q

PMB + diabetes: risk of underlying endometrial ca

A

21%

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6
Q

PMB + obesity + diabetes: risk of underlying endometrial ca

A

29%

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7
Q

most common cause of PMB

A

atrophic endometritis and vaginitis (60-80%)

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8
Q

progression rate of EH without atypia (overall)

A

<5% over 20 y

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9
Q

progression rate of SIMPLE EH without atypia

A

1%

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10
Q

progression rate of COMPLEX EH without atypia

A

4%

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11
Q

progression rate of EH WITH ATYPIA

A

27% over 20y

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12
Q

prevalence of atypia within endometrial polyp

A

0.8% -1.2% in asymptomatic patient (up to 2%)

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13
Q

prevalence of malignancy within endometrial polyps

A

3.1% in symptomatic patients (only 0.3% in asymptomatic)

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14
Q

EH without atypia: rate of REGRESSION

A

75-80%

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15
Q

vaginal discharge following UAE

A

20-30%

16% at 12/12

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16
Q

expulsion of fibroid material following UAE

A

10%

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17
Q

endometritis following UAE

A

0.5%

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18
Q

change in sexual fxn following UAE

A

worse 10%
improved 26%
unchanged in most

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19
Q

early ovarian failure following UAE

A

1-2%

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20
Q

UAE is associated with higher rates of ____ intrapartum

A

C/S

PPH

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21
Q

GnRH for fibroids: % reduction in size at 12 weeks

A

36%

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22
Q

GnRH for fibroids: fibroid size returned to pre-treatment within ____

A

4-6 months

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23
Q

pre-test probability of Endometrial ca in TVS ET<4mm

A

<1%

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24
Q

systemic HRT benefits

A 
sx control
BMD maintenance
decreased CAD and alzheimers if started early
decreased colorectal ca
decreased T2DM
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25
Q

systemic HRT risks

A 
endometrial ca
VTE (2-3x background risk)
CHD - if started >60yo
stroke
Breast ca - slight increase after 5y
small but not significant increase ovarian ca
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26
Q

combined systemic HRT: impact on breast ca risk

A

increase by 4/1000 cases

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27
Q

oestrogen only systemic HRT: impact on breast ca risk

A

decrease by 4/1000 cases

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28
Q

prevalence of PMS

A

40%

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29
Q

severe PMS incidence

A

5-8%

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30
Q

first line management PMS

A

Exercise
CBT
Vit B6
COCP (continuous or cyclical - ideally containing drosperinelone eg Yasmin)
Continuous or luteal phase low dose SSRI (eg. citalopram 10mg)

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31
Q

Second line management PMS

A

estradiol patches 100mcg + micronised progesterone day 17-28 (or LNG-IUS)
Higher dose SSRIs (20-40mg)

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32
Q

third line management PMS

A

GnRH analogues + add back HRT

    • reserve for most severe sx
  • *need DEXA annual
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33
Q

post menopausal simple cyst <5cm: at 2y, what proportion disappear

A

53%

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34
Q

post menopausal simple cyst <5cm: at 2y, what proportion remain static

A

28%

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35
Q

post menopausal simple cyst <5cm: at 2y, what proportion increase in size

A

11%

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36
Q

post menopausal simple cyst <5cm: at 2y, what proportion decrease in size

A

3%

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37
Q

post menopausal simple cyst <5cm: at 2y, what proportion fluctuate

A

6%

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38
Q

post menopausal simple cyst <5cm, asymptomatic, unilateral, unilocular, normal Ca125 – MANAGEMENT? Risk of malignancy?

A

Ca125 and Repeat USS in 4-6/12 x 1y
Discharge at 1y if no change

Risk of malignancy <1%

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39
Q

RMI<25 – % risk malignancy?

A

<3%

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40
Q

RMI 25-250 – % risk malignancy?

A

20%

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41
Q

RMI >250 – % risk malignancy?

A

75%

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42
Q

pre-menopause ovarian cyst - lifetime risk

A

10%

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43
Q

pre-menopause ovarian cyst - % borderline appearing as simple cyst

A

20%

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44
Q

pre-menopause ovarian cyst: management of asymptomatic simple cyst <5cm

A

discharge, likely physiological

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45
Q

pre-menopause ovarian cyst: management of asymptomatic simple cyst 5-7cm

A

year USS +/- MRI +/- surgery

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46
Q

pre-menopause ovarian cyst: management of asymptomatic simple cyst >7cm

A

MRI

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47
Q

risk of recurrence ovarian cyst if aspirated

A

53-84%

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48
Q

risk of chemical peritonitis if dermoid spillage

A

0.2%

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49
Q

incidence of malignant symptomatic cyst (pre-menopause)

A

1/1000

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50
Q

differentiated VIN associated with ____

A

lichen sclerosus

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51
Q

undifferentiated VIN associated with ____

A

HPV and smoking

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52
Q

rate of re-operation for recurrent menstrual symptoms following endometrial ablation

A

20-27%

Lower rates with 2nd gen techniques, but not statistically significant

Saraswat, L, Cooper, K. Surgical management of heavy menstrual bleeding: part 1. The Obstetrician & Gynaecologist 2017; doi:10.1111/tog.12333 19: 37– 45.

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53
Q

rate of hysterectomy for recurrent menstrual symptoms following endometrial ablation

A

14-20% by 5y

Majority will occur within 2y

Saraswat, L, Cooper, K. Surgical management of heavy menstrual bleeding: part 1. The Obstetrician & Gynaecologist 2017; doi:10.1111/tog.12333 19: 37– 45.

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54
Q

re-intervention rate for UAE at 3y

A

15%

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55
Q

hysterectomy rate after UAE at 5y

A

28%

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56
Q

incidence of OAB

A

13-16%

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57
Q

proportion requiring additional management after salpingotomy

A

1/5

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58
Q

overall survival cervical cancer

A

65% (65-70%)

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59
Q

cervical cancer stage I survival

A

95%

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60
Q

cervical cancer stage IV survical

A

5%

61
Q

SCC accounts for ___% of all cervical ca

A

70%

62
Q

adenoma accounts for ___% of all cervical ca

A

20-25%

63
Q

action of ullipristal acetate on fibroids

A

induces apoptosis and inhibits proliferation

  • reduce menstrual loss in over 90% of patients after 13 weeks of treatment with either 5 or 10 mg daily.
  • 75% achieve amenorrhoea within 10 days .
  • The median change in fibroid volume is approximately 40–50% after 13 weeks of treatment
  • reduction is maintained for at least 6 months after stopping
64
Q

pNK cells

A

CD56 dim/ CD16+

65
Q

uNK cells

A

CD56 bright/CD16-

makes up >30% of stroma during secretory phase

66
Q

clinically insignificant post void volume

A

<100ml

67
Q

chlamydia isolated in what % of TOA

A

25%

68
Q

raised AFP, normal hCG, ovarian mass in young woman

A

endodermal sinus tumor

69
Q

bilateral multi cystic enlargement, normal AFP and hCG, raised Ca125, postmenopausal woman

A

mucinous cystadenoma

70
Q

action of bisphosphonate

A

decreased bone resorption by inhibition of osteoclasts and slowing bone remodelling cycle

71
Q

what neurotransmitters are associated with PMS

A

GABA and serotonin

72
Q

raloxifene: action on endometrium

A

antagonist

selective estrogen receptor modulator

73
Q

raloxifene: action on tissue/bone

A

agonist

selective estrogen receptor modulator

74
Q

raloxifene: action on breast

A

antagonist

selective estrogen receptor modulator

75
Q

what % of patients with chronic pelvic pain have IBS symptoms

A

50%

76
Q

incidence of nerve entrapment after c/s

A

3.7%

77
Q

incidence of chronic pelvic pain

A

~1/6

78
Q

prevalence of endometriosis in women of reproductive age

A

2-10%

79
Q

type I FGM

A

partial or total removal of clitoris and/or prepuce (clitoridectomy)

80
Q

type II FGM

A

partial or total removal of the clitoris and labia minor, with/without excision of labia majora (excision)

81
Q

type III FGM

A

narrowing of the vaginal orifice with creation of a covering seal by cutting and apposition of labia, with or without excision of clitoris (infibulation)

82
Q

type IV FGM

A

all other harmful procedures for non-medical purposes, including pricking, piercing, incising, scraping, cauterizing

83
Q

how many children at risk of FGM each year

A

20 000

84
Q

pathognomic feature of lichen sclerosus

A

hyalinization of upper dermis

85
Q

most common presenting symptom of cesarean niche

A

postmenstrual spotting, 30%

86
Q

niche defined as depth of?

A

> 2mm, excluding endometrium

87
Q

management options for c/s niche

A

hormonal treatment; LNG-IUS; ablation;
hysteroscopic resection of distal ridge;
laparoscopic niche repair under hysteroscopic guidance

88
Q

pregnancy post ablation

A

0.7%

89
Q

overall satisfaction rate of second generation ablations

A

80%

90
Q

expected amenorrhea rate after second generation ablation

A

50%

91
Q

overall complication rate first gen ablation

A

4.4%

92
Q

highest complication after first gen ablation

A

hemorrhage, 3%

1.2% in second gen

93
Q

highest complication after second gen ablation

A

endometritis, 2%

1.4% in first gen

94
Q

lowest complication after first gen ablation

A

cervical lacerations, 0.2%

1.1% in second gen

95
Q

lowest complication after second gen ablation

A

hematometra, 0.7%

2.4% in first gen

96
Q

top three complications in first gen ablation

A

hemorrhage 3%, hematometra 2.4%, endometritis 1.4%

97
Q

top three complication in second gen ablation

A

endometritis 2%, hemorrhage 1.2%, cervical lacerations 1.1%

98
Q

highest overall ablation complication rate

A

hemorrhage, 3% - first gen

99
Q

perforation rates with endometrial ablation, 1st ve 2nd gen

A

1.3% vs 0.3%

100
Q

complication rate for repeat ablation

A

2x as high

101
Q

success rate for repeat ablation

A

30%

102
Q

lifetime risk of fibroids for white women

A

70%

103
Q

lifetime risk of fibroids for black women

A

> 80%

104
Q

risk of dissemination of malignancy with morcellation of fibroid

A

1:350, as reported by FDA

105
Q

what % of women are symptomatic with fibroids

A

25%

106
Q

relative CI to UAE

A
  1. solitary fibroids measuring >10cm,

2. multifibroid uterus >20 week size

107
Q

relative CI to MRgFUS

A
  1. concomitant adenomyosis,
  2. > 10cm fibroids,
  3. submucosal fibroids,
  4. > 5 fibroids,
  5. anterior wall incisional scars,
  6. possible damage to bladder and bowel
108
Q

risk of leiomyosarcoma aged 40-44

A

1/405

109
Q

risk of leiomyosarcoma aged 50-54

A

1/216

110
Q

risk of leiomyosarcoma aged <30

A

<1/500

111
Q

risk of leiomyosarcoma aged 75-79

A

up to 1/100

112
Q

conversion rate from laparoscopic to open myomectomy

A

1%

113
Q

risk of emergency hysterectomy during laparoscopic myomectomy

A

0.0-0.3%

114
Q

approximate rate of overall complications of laparoscopic myomectomy

A

11%

115
Q

major complication rate of laparoscopic myomectomy

A

2%

116
Q

missed dx of leiomyosarcoma due to morcellation

A

20%

117
Q

approximate risk of uterine rupture following laparoscopic myomectomy

A

~1%

118
Q

% of PMB caused by endometrial/cervical polyps

A

2-12%

119
Q

% of PMB caused by EH

A

5-10%

120
Q

% of PMB caused by EC

A

10%

121
Q

% of PMB caused by exogenous estrogens

A

15-25%

122
Q

% of PMB caused by atrophic vaginitis/endometritis

A

60-80%

123
Q

co-existing cervical and endometrial polyps at presentation

A

24-27%

124
Q

improvement in PMS after GnRH

A

60-75%

125
Q

most common location of transverse vaginal septums

A

upper vagina

126
Q

most common symptoms of peritoneal endometriosis

A 
dysmenorrhea 62%;
chronic pelvic pain 57%;
deep dyspareunia 55%;
cyclical intestinal complaints 48%;
infertility 40%
127
Q

postablation tubal sterilization syndrome

A

cyclical unilateral/bilateral pelvic pain + vaginal spotting

128
Q

most common cause of hyperandrogenism in postmenopausal women

A

ovarian hyperthecosis

129
Q

PCOS waist circumference: ideal vs high risk

A

<80, vs >87cm

130
Q

prevalence of PCOS

A

10-15%

131
Q

% of population found to have polycystic ovaries

A

20-33%

132
Q

biochemical abnormalities in PCOS

A 
raised androgens;
raised LH;
raised FAI;
raised AMH;
normal FSH
133
Q

PCOS genetic component - % in first degree relatives

A

50%

134
Q

in PCOS women with normal glucose tolerance, what proportion developed IGT in 6y?

A

9%

135
Q

in PCOS women with normal glucose tolerance, what proportion developed T2DM in 6y?

A

8%

136
Q

in PCOS women with impaired glucose tolerance, what proportion developed T2DM

A

54%

137
Q

% of teenagers with anovulatory cycles

A

65%

138
Q

how long to wait before PCOS diagnosis in teenagers

A

2 years after menarche, should have all three criteria

139
Q

testosterone level at which to further investigate

A

> 5nmol/L

140
Q

in what % of pts does clomiphene induce ovulation (PCOS)

A

70-85%

141
Q

what % of pts will achieve pregnancy within 6 ovulatory cycles of clomifene therapy

A

60-70%

142
Q

hypersecretion of LH found in what % of PCOS women

A

40%
- associated with reduced chance of conception and increased risk of miscarriage;
most often in slim women

143
Q

USS diagnosis of PCO

A

> 12 follicles, 2-9mm in diameter, and/or ovarian volume >10cm3

144
Q

risk of multiple pregnancy with clomifene

A

10%

145
Q

risk of multiple pregnancy with GnRH (PCOS)

A

<5%

146
Q

UAE re-intervention rate at 3 years

A

15% (10% hysterectomy, 3% myomectomy, 2% repeat UAE)

147
Q

UAE hysterectomy rate at 5y

A

28%

148
Q

UAE improvement rate

A

83-84% at 6 and 24 months

149
Q

UAE fibroid volume reduction

A

40%

part 2 (21 decks)

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