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MFSRH Part II 2022 > Gynaecology > Flashcards

Gynaecology Flashcards

1
Q

Calculate the RMI in a 54 year old who’s LMP was 2 years ago with a 4 cm unilateral multilocular cyst with no other malignant features and a Ca125 of 56.

A

RMI = 168

RMI = Ca125 x menopausal status x US score

RMI = 56 x 3 x 1 = 168

US score determined by features of malignancy

  • mass > 10 cm
  • multilocular cyst
  • solid areas
  • bilaterality
  • metastases
  • ascites

No malignant features = 0
1 malignant feature = 1
2 or more malignant features = 2

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2
Q

What would be the cancer risk of a patient with RMI score of < 25?

A

< 3% cancer risk

Low risk based on RMI

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3
Q

What is the cancer risk of a patient with an RMI of between 25 and 250?

A

20% cancer risk

Intermediate risk

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4
Q

What is the cancer risk of a patient with an RMI >250?

A

75% cancer risk

High risk

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5
Q

You are investigating a patient who has an incidental finding of a 4cm simple unilateral cyst with no concerning features. US score, Ca125 and menopausal status gives an RMI of 68. What is the next step for investigating this patient?

A

RMI = 68 therefore intermediate risk

Needs MRI to better distinguish between benign and malignant lesions

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6
Q

What would the next investigation be if the RMI is 20 in a pre-menopausal patient with a simple 6cm unilateral cyst?

A

TV US in 4-6 weeks to check for resolution or stability

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7
Q

A patient has an RMI of 267, what is the next investigation for this patient after TV US?

A

Needs CT staging

Cancer risk of 75% prior to surgical/oncological management

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8
Q

What are the Rotterdam Criteria for diagnosing PCOS?

A
  1. Hyperandrogenism (clinical or biochemical)
  2. Menstrual irregularities (<9 cycles/year or >35 days between cycles)
  3. Polycystic ovaries on US (>12 antral follicles on one ovary and/or ovarian volume > 10cm3)
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9
Q

What proportion of women with PCOS have insulin resistance?

A

65-80%

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10
Q

What investigations would you arrange to investigate suspected PCOS?

A
  1. Total testosterone (N to moderately elevated)
  2. Sex hormone binding globulin (N to low) - provides surrogate measure of degree of insulinaemia
  3. Free androgen index (N or high)
  4. Rule out other causes of oligomenorrhoea and amenorrhoea (LH, FSH, prolactin, TSH)
  5. Ultrasound scan
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11
Q

How do you calculate free androgen index?

A

FAI = 100 * (total testosterone / SHBG)

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12
Q

What does the free androgen index measure?

A

Assesses the amount of physiologically active testosterone that is present.
Normal range is < 5

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13
Q

What ultrasound findings are consistent with PCOS?

A

12 or more follicles in 1 ovary measuring 2-9mm diameter

Increased ovarian volume (greater than 10cm3)

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14
Q

In POI, would LH and FSH be higher or lower than normal?

A

Increased in women with POI due to low estrogen levels not inhibiting GnRH release from the hypothalamus

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15
Q

In hypogonadotropic hypogonadism would the LH and FSH be higher or lower than normal?

A

Lower due to decreased GnRH

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16
Q

Which presentations of endometriosis require referral to gynaecology from primary care?

A
  • primary management failed
  • severe, persistant and recurrent symptoms
  • pelvic signs of endometriosis
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17
Q

Which presentations of endomtriosis require referral to a specialist centre?

A
  • endometriosis outside of the pelvis

- deep endometriosis involving bladder, bowel or ureters

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18
Q

What are the ultrasound findings indicative of adenomyosis?

A
  • subendometrial echogenic linear striations and/or nodules (specific sign), extending from endometrium and into inner myometrium
  • hyperechoic islands
  • irregular endometrial–myometrial junction
  • tiny (1-5 mm) anechoic myometrial and subendometrial cysts (specific sign): reflecting glands filled with fluid cystic striations
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19
Q

In a 30y woman with a complex ovarian mass, which tumour markers would you perform?

A

LDH
hCG
a-FP
Ca125

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20
Q

What is the sensitivity and specificity of an RMI > 200?

A 
Sensitivity = 78%
Specificity = 87%
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21
Q

What are the B - rules for IOTA simple rules classification for ovarian masses?

A 
Unilocular cysts
solid components < 7 mm
acoustic shadowing
smooth multilocular tumour < 100mm
no blood flow
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22
Q

What are the M - rules for IOTA simple rules classification for ovarian masses?

A 
Irregular solid tumour
Ascites
4 or more papillary structures
Irregular multilocular solid tumour > 100mm
Strong blood flow
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23
Q

What follow up would you arrange for a pre-menopausal patient with a unilateral 4cm simple ovarian cyst?

A

None - almost all resolve within 3 cycles

24
Q

What follow up would you arrange for a pre-menopausal woman with an asymptomatic 6cm uilateral ovarian mass with no malignant features according to IOTA simple rules?

A

Yearly ultrasound

25
Q

How would you manage a pre-menopausal woman with an asyptomatic unilateral ovarian mass with no malignant features that is 8cm in maximal diameter?

A

MRI/CT - due to difficulties in adequately imaging the entire lesion due to size >7cm

26
Q

Does CHC promote functional cyst resolution?

A

No

27
Q

What are the 5 types of epithelial cell tumours?

A 
Cystoadenomas
- Serous cystoadenomas
- Mucinous cystoadenomas
- Endometroid tumours
Brenner tumours
Clear cell tumours
28
Q

What type of ovarian tumour would have psammoma bodies on histology?

A

Serous cystadenomas

29
Q

In what type of epithelial cell tumours are paroxyma peritoni seen?

A

mucinous cystoadenomas

30
Q

What type of epithelial cell tumour rarely transforms to SCC and hav coffee bean nuclei on histology?

A

Brenner tumour

31
Q

Which type of ovarian tumours often secrete high levels of estrogen?

A

Granulosa cell tumours

Theca cell tumours

32
Q

In what type of ovarian tumour is AFP raised?

A

Endodermal sinus tumour (yolk sac tumour)

33
Q

What are the 3 types of lichen planus?

A

Classical
Hypertrophic
Erosive

34
Q

What type of lichen planus is the most common?

A

Erosive

35
Q

What are the 2 definitions of primary amenorrhea?

A
  • Failure to menstruate by age 16y in presence of normal secondary sexual characteristics
  • Failure to menstruate by age 14y in absence of secondary sexual characteristics
36
Q

What is the most common cause of primary amenorrhea?

A

Gonadal dysgenesis (43%)
Mullerian agenesis (15%)
Constitutional (14%)
PCOS (7%)

37
Q

What hormones do the granulosa cells of the ovary secrete?

A

Estrogen and inhibin

38
Q

What is the pathogenesis of CAH?

A
  • deficiency in 21-hydroxylase causes
  • excessive 17-hydroxyprogesterone because it is not being converted into cortisol
  • low cortisol leads to increased ACTH
  • high cortisol precursors get forced down androgen pathway leading to high androgens
39
Q

What is the treatment for CAH?

A

Fludrocortisone to replace aldosterone

glucocorticoid to suppress ACTH overactivity

40
Q

A 15 y old presents with primary amenorrhea and absence of secondary sexual characteristics. You measure LH and FSH which are both < 5 IU/L. What is the diagnosis?

A

Hypogonadotropic hypogonadism

  • Kallman’s syndrome
  • Constitutional
  • Hypothyroidism
41
Q

A 15 y old presents with primary amenorrhea but has normal development of secondary sexual characteristics. FSH is > 20 and LH > 40 IU/L. What is the diagnosis?

A

Hypergonadotrophic hypogonadism

  • XXX
  • XO
  • POI
  • AIS
42
Q

A 16 y old female patient presents with primary amenorrhea with normal secondary sexual characteristics. What would be the first investigation?

A

US Pelvis

43
Q

In an GnRH stimulation test for precocious puberty, what result would be considered diagnostic for central precocious puberty?

A

LH predominance over FSH.
LH:FSH ratio > 1
Levels > 8 iu/L considered diagnostic

44
Q

What are the first line antimuscarinic drugs used in the treatment of OAB?

A

oxybutinin
tolterodine
darifenacin

45
Q

Which antimuscarinic drugs used in the treatment of OAB are non-selective antimuscarinics?

A

tolterodine

46
Q

Which antimuscarinic drugs used in OAB are selective antimuscarinic drugs?

A

solifenacin
darifenacin
oxybutinin

47
Q

What is the mechanism of action of antimuscarinic drugs in treatment of OAB?

A

Relaxation of detrusor muscle via parasympathetic muscarinic receptors

48
Q

Which drugs potentially interact with antimuscarinic drugs for OAB?

A

Other anticholinergics:

  • antiemetics
  • Parkinsons drugs
  • antispasmodics
  • mydriatics

Drugs that worsen side effects:

  • anti-arrythmics
  • antidepressants
  • antidiarrheoal
  • antipsychotics
49
Q

What is the mechanism of action of mirabegron in OAB?

A

B3 adrenergic agonist - relaxes the detrusor muscle

Caution in HTN

50
Q

How does duloxetine work in the treatment of stress incontinence?

A

As an alternative to surgery - increases tone of internal urethral sphincter

51
Q

What type of ovarian cysts exhibit Carl Exner bodies on histology?

A

Granulosa cell tumours

52
Q

What type of ovarian cysts exhibit Reinke crystals on histology?

A

Sertoli-Leydig tumours

53
Q 
Which of these ovarian masses is NOT a germ cell tumour?
Dermoid cyst
Immature teratoma
Dysgerminoma
Theca cell tumour
A

Theca cell tumour

54
Q

Which type of benign stromal sex cord tumour is associated with Meig’s syndrome?

A

Fibroma

55
Q

What are the 3 subtypes of sex cord stromal tumours?

A

Pure stromal tumours
Pure sex cord tumours
Mixed sex cord stromal tumours

MFSRH Part II 2022 (8 decks)

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