Gynae problems Flashcards
1
Q
PMB: overall risk of underlying endometrial Ca
A
10%
2
Q
PMB >80yo: risk of underlying endometrial ca
A
25%
3
Q
PMB<50yo: risk of underlying endometrial ca
A
1%
4
Q
PMB + obesity: risk of underlying endometrial ca
A
18%
5
Q
PMB + diabetes: risk of underlying endometrial ca
A
21%
6
Q
PMB + obesity + diabetes: risk of underlying endometrial ca
A
29%
7
Q
most common cause of PMB
A
atrophic endometritis and vaginitis (60-80%)
8
Q
progression rate of EH without atypia (overall)
A
<5% over 20 y
9
Q
progression rate of SIMPLE EH without atypia
A
1%
10
Q
progression rate of COMPLEX EH without atypia
A
4%
11
Q
progression rate of EH WITH ATYPIA
A
27% over 20y
12
Q
prevalence of atypia within endometrial polyp
A
0.8% -1.2% in asymptomatic patient (up to 2%)
13
Q
prevalence of malignancy within endometrial polyps
A
3.1% in symptomatic patients (only 0.3% in asymptomatic)
14
Q
EH without atypia: rate of REGRESSION
A
75-80%
15
Q
vaginal discharge following UAE
A
20-30%
16% at 12/12
16
Q
expulsion of fibroid material following UAE
A
10%
17
Q
endometritis following UAE
A
0.5%
18
Q
change in sexual fxn following UAE
A
worse 10%
improved 26%
unchanged in most
19
Q
early ovarian failure following UAE
A
1-2%
20
Q
UAE is associated with higher rates of ____ intrapartum
A
C/S
PPH
21
Q
GnRH for fibroids: % reduction in size at 12 weeks
A
36%
22
Q
GnRH for fibroids: fibroid size returned to pre-treatment within ____
A
4-6 months
23
Q
pre-test probability of Endometrial ca in TVS ET<4mm
A
<1%
24
Q
systemic HRT benefits
A
sx control BMD maintenance decreased CAD and alzheimers if started early decreased colorectal ca decreased T2DM
25
systemic HRT risks
```
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
```
26
combined systemic HRT: impact on breast ca risk
increase by 4/1000 cases
27
oestrogen only systemic HRT: impact on breast ca risk
decrease by 4/1000 cases
28
prevalence of PMS
40%
29
severe PMS incidence
5-8%
30
first line management PMS
Exercise
CBT
Vit B6
COCP (continuous or cyclical - ideally containing drosperinelone eg Yasmin)
Continuous or luteal phase low dose SSRI (eg. citalopram 10mg)
31
Second line management PMS
estradiol patches 100mcg + micronised progesterone day 17-28 (or LNG-IUS)
Higher dose SSRIs (20-40mg)
32
third line management PMS
GnRH analogues + add back HRT
* * reserve for most severe sx
* *need DEXA annual
33
post menopausal simple cyst <5cm: at 2y, what proportion disappear
53%
34
post menopausal simple cyst <5cm: at 2y, what proportion remain static
28%
35
post menopausal simple cyst <5cm: at 2y, what proportion increase in size
11%
36
post menopausal simple cyst <5cm: at 2y, what proportion decrease in size
3%
37
post menopausal simple cyst <5cm: at 2y, what proportion fluctuate
6%
38
post menopausal simple cyst <5cm, asymptomatic, unilateral, unilocular, normal Ca125 -- MANAGEMENT? Risk of malignancy?
Ca125 and Repeat USS in 4-6/12 x 1y
Discharge at 1y if no change
Risk of malignancy <1%
39
RMI<25 -- % risk malignancy?
<3%
40
RMI 25-250 -- % risk malignancy?
20%
41
RMI >250 -- % risk malignancy?
75%
42
pre-menopause ovarian cyst - lifetime risk
10%
43
pre-menopause ovarian cyst - % borderline appearing as simple cyst
20%
44
pre-menopause ovarian cyst: management of asymptomatic simple cyst <5cm
discharge, likely physiological
45
pre-menopause ovarian cyst: management of asymptomatic simple cyst 5-7cm
year USS +/- MRI +/- surgery
46
pre-menopause ovarian cyst: management of asymptomatic simple cyst >7cm
MRI
47
risk of recurrence ovarian cyst if aspirated
53-84%
48
risk of chemical peritonitis if dermoid spillage
0.2%
49
incidence of malignant symptomatic cyst (pre-menopause)
1/1000
50
differentiated VIN associated with ____
lichen sclerosus
51
undifferentiated VIN associated with ____
HPV and smoking
52
rate of re-operation for recurrent menstrual symptoms following endometrial ablation
20-27%
| Lower rates with 2nd gen techniques, but not statistically significant
## Footnote
Saraswat, L, Cooper, K. Surgical management of heavy menstrual bleeding: part 1. The Obstetrician & Gynaecologist 2017; doi:10.1111/tog.12333 19: 37– 45.
53
rate of hysterectomy for recurrent menstrual symptoms following endometrial ablation
14-20% by 5y
| Majority will occur within 2y
## Footnote
Saraswat, L, Cooper, K. Surgical management of heavy menstrual bleeding: part 1. The Obstetrician & Gynaecologist 2017; doi:10.1111/tog.12333 19: 37– 45.
54
re-intervention rate for UAE at 3y
15%
55
hysterectomy rate after UAE at 5y
28%
56
incidence of OAB
13-16%
57
proportion requiring additional management after salpingotomy
1/5
58
overall survival cervical cancer
65% (65-70%)
59
cervical cancer stage I survival
95%
60
cervical cancer stage IV survical
5%
61
SCC accounts for ___% of all cervical ca
70%
62
adenoma accounts for ___% of all cervical ca
20-25%
63
action of ullipristal acetate on fibroids
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
pNK cells
CD56 dim/ CD16+
65
uNK cells
CD56 bright/CD16-
makes up >30% of stroma during secretory phase
66
clinically insignificant post void volume
<100ml
67
chlamydia isolated in what % of TOA
25%
68
raised AFP, normal hCG, ovarian mass in young woman
endodermal sinus tumor
69
bilateral multi cystic enlargement, normal AFP and hCG, raised Ca125, postmenopausal woman
mucinous cystadenoma
70
action of bisphosphonate
decreased bone resorption by inhibition of osteoclasts and slowing bone remodelling cycle
71
what neurotransmitters are associated with PMS
GABA and serotonin
72
raloxifene: action on endometrium
antagonist
| selective estrogen receptor modulator
73
raloxifene: action on tissue/bone
agonist
| selective estrogen receptor modulator
74
raloxifene: action on breast
antagonist
| selective estrogen receptor modulator
75
what % of patients with chronic pelvic pain have IBS symptoms
50%
76
incidence of nerve entrapment after c/s
3.7%
77
incidence of chronic pelvic pain
~1/6
78
prevalence of endometriosis in women of reproductive age
2-10%
79
type I FGM
partial or total removal of clitoris and/or prepuce (clitoridectomy)
80
type II FGM
partial or total removal of the clitoris and labia minor, with/without excision of labia majora (excision)
81
type III FGM
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
type IV FGM
all other harmful procedures for non-medical purposes, including pricking, piercing, incising, scraping, cauterizing
83
how many children at risk of FGM each year
20 000
84
pathognomic feature of lichen sclerosus
hyalinization of upper dermis
85
most common presenting symptom of cesarean niche
postmenstrual spotting, 30%
86
niche defined as depth of?
>2mm, excluding endometrium
87
management options for c/s niche
hormonal treatment; LNG-IUS; ablation;
hysteroscopic resection of distal ridge;
laparoscopic niche repair under hysteroscopic guidance
88
pregnancy post ablation
0.7%
89
overall satisfaction rate of second generation ablations
80%
90
expected amenorrhea rate after second generation ablation
50%
91
overall complication rate first gen ablation
4.4%
92
highest complication after first gen ablation
hemorrhage, 3%
| 1.2% in second gen
93
highest complication after second gen ablation
endometritis, 2%
| 1.4% in first gen
94
lowest complication after first gen ablation
cervical lacerations, 0.2%
| 1.1% in second gen
95
lowest complication after second gen ablation
hematometra, 0.7%
| 2.4% in first gen
96
top three complications in first gen ablation
hemorrhage 3%, hematometra 2.4%, endometritis 1.4%
97
top three complication in second gen ablation
endometritis 2%, hemorrhage 1.2%, cervical lacerations 1.1%
98
highest overall ablation complication rate
hemorrhage, 3% - first gen
99
perforation rates with endometrial ablation, 1st ve 2nd gen
1.3% vs 0.3%
100
complication rate for repeat ablation
2x as high
101
success rate for repeat ablation
30%
102
lifetime risk of fibroids for white women
70%
103
lifetime risk of fibroids for black women
>80%
104
risk of dissemination of malignancy with morcellation of fibroid
1:350, as reported by FDA
105
what % of women are symptomatic with fibroids
25%
106
relative CI to UAE
1. solitary fibroids measuring >10cm,
| 2. multifibroid uterus >20 week size
107
relative CI to MRgFUS
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
risk of leiomyosarcoma aged 40-44
1/405
109
risk of leiomyosarcoma aged 50-54
1/216
110
risk of leiomyosarcoma aged <30
<1/500
111
risk of leiomyosarcoma aged 75-79
up to 1/100
112
conversion rate from laparoscopic to open myomectomy
1%
113
risk of emergency hysterectomy during laparoscopic myomectomy
0.0-0.3%
114
approximate rate of overall complications of laparoscopic myomectomy
11%
115
major complication rate of laparoscopic myomectomy
2%
116
missed dx of leiomyosarcoma due to morcellation
20%
117
approximate risk of uterine rupture following laparoscopic myomectomy
~1%
118
% of PMB caused by endometrial/cervical polyps
2-12%
119
% of PMB caused by EH
5-10%
120
% of PMB caused by EC
10%
121
% of PMB caused by exogenous estrogens
15-25%
122
% of PMB caused by atrophic vaginitis/endometritis
60-80%
123
co-existing cervical and endometrial polyps at presentation
24-27%
124
improvement in PMS after GnRH
60-75%
125
most common location of transverse vaginal septums
upper vagina
126
most common symptoms of peritoneal endometriosis
```
dysmenorrhea 62%;
chronic pelvic pain 57%;
deep dyspareunia 55%;
cyclical intestinal complaints 48%;
infertility 40%
```
127
postablation tubal sterilization syndrome
cyclical unilateral/bilateral pelvic pain + vaginal spotting
128
most common cause of hyperandrogenism in postmenopausal women
ovarian hyperthecosis
129
PCOS waist circumference: ideal vs high risk
<80, vs >87cm
130
prevalence of PCOS
10-15%
131
% of population found to have polycystic ovaries
20-33%
132
biochemical abnormalities in PCOS
```
raised androgens;
raised LH;
raised FAI;
raised AMH;
normal FSH
```
133
PCOS genetic component - % in first degree relatives
50%
134
in PCOS women with normal glucose tolerance, what proportion developed IGT in 6y?
9%
135
in PCOS women with normal glucose tolerance, what proportion developed T2DM in 6y?
8%
136
in PCOS women with impaired glucose tolerance, what proportion developed T2DM
54%
137
% of teenagers with anovulatory cycles
65%
138
how long to wait before PCOS diagnosis in teenagers
2 years after menarche, should have all three criteria
139
testosterone level at which to further investigate
>5nmol/L
140
in what % of pts does clomiphene induce ovulation (PCOS)
70-85%
141
what % of pts will achieve pregnancy within 6 ovulatory cycles of clomifene therapy
60-70%
142
hypersecretion of LH found in what % of PCOS women
40%
- associated with reduced chance of conception and increased risk of miscarriage;
most often in slim women
143
USS diagnosis of PCO
>12 follicles, 2-9mm in diameter, and/or ovarian volume >10cm3
144
risk of multiple pregnancy with clomifene
10%
145
risk of multiple pregnancy with GnRH (PCOS)
<5%
146
UAE re-intervention rate at 3 years
15% (10% hysterectomy, 3% myomectomy, 2% repeat UAE)
147
UAE hysterectomy rate at 5y
28%
148
UAE improvement rate
83-84% at 6 and 24 months
149
UAE fibroid volume reduction
40%
