Gynaecology Flashcards
1
Q
What is the 1st line Tx for urge incontinence?
A
Bladder retraining
2
Q
What is the 1st line tx for stress incontinence
A
Pelvic floor exercise for 3 months
3
Q
What is the gold standard treatment for stress incontinence?
A
Retropubic mid urethral slings
4
Q
What is the medical treatment for urge incontinence?
A
Antimuscuranic e.g. oxybutynin/solifenacin/toltoredine
Alternative is Mirabegron (beta-3 agonist)
5
Q
What is the medical tx for stress incontinence?
A
Duloxetine
6
Q
What is the vault prolapse and what’s its tx?
A
Vault prolapse occurs in women who have had hysterectomy where top of the vagina descends into the vagina
Tx- sacrocoplexy
7
Q
What is the 1st line investigation for pelvic organ prolapse?
A
Sims speculum examination
8
Q
What is adenomyosis?
A
Presence of endometrial tissue within the myometrium- forms little pockets/nests called adenomyomas
9
Q
List 5 Sx and the 1st line, Gs, and investigation of choice for adenomyosis?
A
Dysmenorrhea
Dysparenuia
Menorrhagia
Enlarged boggy uterus
Infertility
1st line- TV USS
Gs- histological exam of uterus
Ix of choice- MRI
10
Q
What is the mx of adenomyosis in
A) women who do not want contraception
B) want contraception
C) other possible options
A
A)
Tranexamic acid- no associated pain
Mefanamic acid- with pain
B)
1st line- Mirena coil
Other- cocp, cyclical progestogen, progesterone only
C)
GnRH analogues
Endometrial ablation
Uterine artery embolisation
Definitive mx- hysterectomy
11
Q
What is endometriosis?
A
where endometrial tissue grows outside the uterine cavity
12
Q
list 5 sx of endometriosis?
A
chronic pelvic pain
Retroflexed retroverted uterus
deep dyspareniua
dysmenorrhoea
urinary sx
bowel sx
uterosacral nodulairty and tenderness
chocolate cysts
13
Q
what is the 1st line and GS ix for endometriosis?
A
1st line- TV USS
GS- diagnostic laproscopy w/ biopsy
14
Q
what is the mx of endometriosis?
A
Paracetamol or Ibuprofen
1st line- COCP
other- Depo, Mirena
GnRH analogues e.g. gosrelin
surgery- Laprascopic examination and ablation
Hysterectomy with bilateral salpigo-oopherectomy
15
Q
List 5 possible causes of post menopausal bleeding?
A
Vaginal atrophy
HRT Usage
Endometrial hyperplasia
Endometrial cancer
ovarian cancer
Vaginal Cancer
Trauma
Cervical cancer
16
Q
List 5 RF for endometrial cancer?
A
Nulliparity
Increasing age
Early menarche
Late menopause
Unopposed oestrogen therapy
obesity
Diabetes
HNPCC/Lynch syndrome
17
Q
List 5 RF for endometrial hyperplasia?
A
Early menarche
late menopause
Nulliparity
age >35
current smoker
obesity
unopposed oestrogen use
Tamoxifen
PCOS
Diabetes
18
Q
When should women with PMB be urgently reffered?
A
> 55 w/ PMB should be urgently reffered and ix within 2 weeks by USSfor endometrial cancer
19
Q
What are the results that are gaged from the TV USS which is a negative for endometrial cancer?
A
endometrial lining thickness <4mm
20
Q
what are uterine fibroids?
A
benign smooth muscle tumours of the uterus
21
Q
list 5 sx of uterine fibroids?
A
may be asymptomatic
menorrhagia –> (IDA)
Bulk related sx (lower abdo pain, cramping, often during menstruation, urinary sx)
Pelvic pain
Intermentsrual bleeding
22
Q
what is the choice of Ix, and management of uterine fibroids in:
a) asymptomatic patients
b)pateints with menorrhagia
c) who want shrinkage and removal
A
ix- TV USS
Management in asymptomatic- monitor
Menorrhagia secondary to fibroids
1st line- LNG-IUS
others include- mefanamic acid, TXA, COCP, oral progestogone, Depot
Tx for shrinkage/remove
GnRH analoguese.g. Triptorelin (short term use)
more than 3cm and uterine distrortion
-myomectomy
-endometrial ablation
-Hysterectomy
-uterine artery embolisation
23
Q
what drug class and drug is used to shrink fibroids?
A
GnRH analogue- Triptorelin
24
Q
What is premature ovarian failure/insufficciency?
A
The onset of menopausal sx and elevated gonadotrophin levels before age of 40
25
What are the gonadotrophin levels found in someone with premature ovarian failure?
High levels of FSH (sometimes LH)- needs to be eleveated on 2 occasions which are more than 4 weeks apart
low oestrodial
26
What is the mx of primary ovarian insufficiency?
HRT or COCP until 51
27
What sign can be seen on USS in someone with ovarian torsion?
Whirlpool sign
28
What condition is a 'enlarged boggy uterus' indicative of?
Adenmyosis
29
What ABx are offered in PID?
IM Ceftriaxone + oral doxycycline + Oral Metronidazole
30
What would be the level of FSH and LH in turners syndrome
High FSH/LH
31
List the protective factors against endometrial cancer
multiparity
COCP
Smoking
32
WHta is the rx that is offered 1st line in PCOS for fertility issues?
Clomifene
33
list the stereoptypical PCOS results
Raised LH:FSH ratio
Normal/raised testosterone
Normal/Low SHBG
34
List the order of anti-emetics that should be trialled in nausea and vomiting in preggers?
1st -Antihistamine e.g. promethazine OR cyclizine
2nd- Prochlorperazine
3rd- Ondansetron
4th- Metoclopramide
35
WHta are the instructions for metoclopramide usage?
should be used for less than 5 days sue to its extrpyramidal se
36
What is the 1st line tx fo primary dysmenorrhoea?
Mefenamic acid
37
What is the mx of TOP?
Mifeprostone + Misoprostol (In this order)
38
What is the common causative organisms that increased the risk of cervcial cancer
HPV 16,18
39
What ix may be carried out in recurrent miscarrigaes?
Antiphospholipid antibodies
Thrombophillia screening
Pelvic USS
Cytogenic analysis of product of conception
40
What is a threatened miscarriage?
When a lady experiences bleeding +/- pain but the cervical os is closed.
41
What is an inevitable miscarriage?
When a lady experiences heavy bleeding, clots, pain and the cervical os is open.
42
Define complete miscarriage.
When all the products of conception leave the body.
43
Define recurrent miscarriage.
> 3 consecutive miscarriages.
44
Give 4 potential causes of miscarriage.
Abnormal foetal development.
Uterine abnormality.
Incompetent cervix.
Placental failure.
Multiple pregnancy.
45
Give 3 risk factors for miscarriage.
Age >30.
Smoking.
Excessive alcohol consumption.
Uterine surgery.
Obesity
Poorly controlled diabetes.
46
What is the most common type of endometrial cancer?
Endometrial adenocarcinoma
47
What type of staging is used for endometrial cancer?
FIGO Staging
48
Describe the treatment for endometrial cancer.
Hysterectomy +/- pelvic lymph node removal.
Adjuvant radiotherapy and progesterone therapy.
49
Why is the incidence of cervical cancer decreasing?
Screening - cervical smears.
HPV vaccine.
50
Name 2 oncoproteins associated with HPV.
E6 - blocks p53.
E7 - blocks Rb.
HPV 16 & 18 produces the oncogenes E6 and E7 genes respectively
51
Give 5 risk factors for HPV and so cervical cancer.
Early age intercourse (<16).
Multiple sexual partners.
STIs.
Smoking.
Multiparity.
OCP.
52
What is the most common type of cervical cancer?
Squamous (90%).
53
Describe the treatment for cervical cancer.
<2cm - loop removal, just removing part of the uterus.
> 2cm - radical hysterectomy.
> 4cm - radiotherapy, chemotherapy, palliative care.
54
Give 3 potential risks of performing a radical hysterectomy.
Bowel problems.
Sexual problems.
Bladder problems.
Lymphoedema.
55
Give 5 symptoms of vulval cancer.
Itching.
Soreness.
Lump.
Bleeding.
Pain on micturition.
56
Give 4 risk factors for developing ovarian cancer?
Early menarche.
Late menopause.
Nulliparity.
Genetics e.g. BRCA1/2.
Smoking/Obesity
HRT usage
Increasing age
57
What are the commonest types of ovarian cancer?
Epithelial (85%).
Sex cord.
Germ cell.
58
Give 5 symptoms of ovarian cancer.
Bloating.
Abdominal pain.
Change in bowel habit.
Urinary frequency.
Bowel obstruction.
Can often be asymptomatic.
59
What investigations might you do in a patient who you suspect has ovarian cancer?
Measure CA125.
Trans-vaginal USS.
Calculate the RMI (risk of malignancy index) - if this is >250 the patient should be referred under the 2 week wait system.
60
What is the functional bladder capacity?
400ml
61
What hormone is responsible for thickening the endometrium?
Oestrogen
62
What hormone is responsible for thinning the endometrium?
Progesterone
63
A surge in which hormone leads to ovulation?
LH
64
Give 3 causes of menorrhagia.
Fibroids/polyps.
Coagulation problems.
Endometriosis/adenomyosis.
Hypothyroidism.
Infection.
Ovulatory problems.
Endometrial dysfunction.
65
What investigations might you do on a lady who is presenting with menorrhagia?
FBC, B12/Folate/Iron, TSH, STI screen.
Smear if due.
Transvaginal USS.
66
What is the rotterdam diagnostic criteria for PCOS
Anovulation/oligomenorrhoea (>35days)
Polycystic ovaries seen on imaging (>=12 follicles or ovarian volume >10cm3).
Increased androgens - clinically or biochemically (hIRSUITISM/aCNE)
67
Why does endometriosis tend to get better after the menopause?
Endometriosis relies on oestrogen and so when oestrogen levels fall after the menopause the symptoms of endometriosis tend to improve.
68
What anatomical areas are most likely to be affected by endometriosis?
The pouch of douglas and the uterosacral ligaments.
69
What grading classification is used in endometriosis?
AFS classification.
70
Give 4 risk factors for the development of fibroids.
Obesity.
Afro-carribean
Early menarche.
Family history.
Increasing age.
71
Define Menopause
The cessation of menstruation normally around 51 years old. Menopause is diagnosed retrospectively after 12 months of amenorrhoea or 12 months after the onset of symptoms if the patient has had a hysterectomy.
72
Give 2 vasomotor symptoms of the menopause.
Hot flushes.
Night sweats.
palipitations
This can impact on sleep, mood and QOL.
73
Give 3 local affects of the menopause.
Vaginal atrophy ->
Vaginal dryness.
Dyspareunia.
Recurrent UTI’s.
PMB.
74
Give 3 advantages of HRT being used to treat the menopause.
Relief of symptoms.
BMD protection.
Prevents long term morbidity.
75
Give 3 disadvantages of HRT being used to treat the menopause
Increased breast cancer risk.
Increased VTE risk with oral HRT.
Increased CV disease risk.
76
What hormone should be given to women with a uterus who are prescribed HRT?
Progesterone.
This protects the endometrium from the stimulatory effects of unopposed oestrogen.
77
Give 3 gynaecological causes of acute pelvic pain
PID.
Abscess.
Ovarian cyst rupture/haemorrhage/torsion.
78
Give 5 gynaecological causes of chronic pelvic pain.
Endometriosis/adenomyosis.
Fibroids.
Adhesions.
PID.
Ovarian cysts.
79
What is the most common type of ovarian cancer?
Epithelial (serous) ovarian cancer
80
Smoking is protective against which type of cancer?
Endometrial cancer
81
How long does it take for the Progesterone only pill to become effective after consumption?
48 hours
82
What blood test results would be indicative of menopause? (in terms of FSH, LH, and Oestrogen)
High FSH
High LH
Low Oestrogen
83
How do aromatase inhibitors work to limit the growth of cancers?
Reduces peripheral oestrogen synthesis
84
What are the histological changes seen in cervical ectropians?
Elevated oestrogen levels result in a larger are of columnar epithelium in the transformational zone
85
Fitz-Hugh Curtis syndrome is a complication of what disease?
PID
86
Which method of contraception is proven to be associated with weight gain?
Depo provera (Progesterone injection)
87
What pharmacological management is given to patients with stress incontinence?
Duloxetine
88
What pharmacological management is given to patients with urge incontinence?
Oxybutinin or Mirabegron
89
What is Meig's syndrome?
Meigs syndrome is a benign ovarian tumour (usually a Fibroma), associated with ascites and pleural effusion
90
What is the most common benign ovarian tumour in women under the age of 25?
Dermoid cyst (teratoma)
91
What is the most common cause of ovarian enlargement in women of reproductive age?
Follicular cyst
92
What is the most common cause of PMB ?
Vaginal atrophy
93
What is the most likely diagnosis for a woman presenting with menorrhagia, bloating/urinary frequency, and fatigue?
Uterine fibroids
94
What contraception method would you prefer in the following scenarios:
A) Woman suffering from oligomenorrhoea and PCOS
B)Woman suffering from irregular periods and symptoms of PCOS
a) LNG-IUS or Combined oral contraceptive- induces withdrwal bleed
b) The COC would be appropriate in this patient in managing both her symptoms of hyperandrogenism and irregular periods
95
What is the enxt step management in this patient ?Cervical cancer screening: sample is hrHPV +ve + cytologically normal
Repeat cervcial smear in 12 months
96
In which gorup of people should oxybutynin be avoided?
Frail elderly women- instead use Mirabegron
97
what is the gold standard investigation for endometriosis?
Laproscopy
98
List 3 symptoms of endometriosis
Deep dysparenuia
chronic pelvic pain
Secondary dysmenorrhoea (painful periods)
Urinary symptoms
Dyschezia (painful bowel movements)
99
what is the mainstay treatment for endometrial cancer?
Total abdominal hysterectomy with bilateral salpingooopherectomy
elderly frail women who are not suitable for surgery may get progsterone therpay
100
Name 3 RF and PF for endometrial cancer?
RF:
Nulliparity
early menarche/laet emnopause
Obesity
PCOS
Tamoxifen
PF:
Multiparity
Smoking
COCP
101
List 3 causes of secondary dysmenorrhoea?
PID
Endometriosis
Adenomyosis
Fibroids
IUDs
102
What is the approproate first line investigation for a woman presenting with menorrhagia?
Transvaginal USS
103
What is the management of menorrhagia in those who
a) do not want contraception
b) want contraception ?
If they do not reuire contraception:
- Mefanamic or Tranexamic acid
If they reuqire contraception
- 1st line- IUS (Mirena)
- COCP
- Long acting progestogens
104
According to UKMEC, which contraception method is the most suitable for a woman who suffers form migraine with aura?
Copper IUD
105
What are the three components of the RMI?
CA125
Menopausal status
USS Findings
The RMI is the pre-surgical prognostic criteria recommended by NICE
106
What is the major advantage of taking transdermal HRT in comparison to oral?
Transdermal HRT is not associated with and increased risk of VTE
107
What is the most common type of uterine fibroids
Intramural
108
What risks are increased by taking progetogens
VTE
Cardiovascular disease
Breast cnacer
109
How long does it take for the POP to become effective?
2 days
110
How long does it take the IUD to becoem effective?
Immediately
111
How long does it take the COC/Depot/Implant and IUS to become effective?
7 days
112
List the forms of emergency contraception and state how long after UPSI they can be used?
1) IUD- 5 days from UPSI
2) Levonogestrel- 72 hours form UPSI
3) Ulipristal (ellaone)- 5 days from UPSI
113
What are the contraindictaion for ellaone use?
should be avoided in Patients with severe asthma
also breastfeeding should eb avoided for atleast 1 week
114
What should happen if after taking emergency contraception, you vomit in<3 hours?
Repeat taking pill
115
How long is the following contraception lisenced for use:
a) IUS
B) Implant
c) IUD
A) 5 years
B) 3 years
C) 10 years
116
COCP can increase and decrease risks of certain cancers, what are they?
COCP increases risk of Breast and Cervical cancers
COCP decreases risk of Endometrial and Ovarian cancers
117
How soon after taking levonogestrel can contraception be started?
Immediately
118
How soon after taking ellaone can contraception be started?
5 days after
119
What is the regime advised for those using the contrceptive patch?
Change patch weekly w/ a week free after 3 patches
120
List 2 advantages and disadvantages of nexaplanon?
Nexaplanon= Implant
advantages
1) Can improve dysmenorrhoea
2) Not daily
3) does not cause WG (unlike depot)
4) Fertility returns normally quickly
disadvantages
1) minor operation
2) cane lead to worsening of acne
3) no protection agaisnt STIs
4) implants can be bent or fractured
5) cause problematic bleeding
121
List 2 advantages and disadvantages of medroxyprogesterone acetate?
medroxyprogesterone acetate=depot
advantages:
1) improves dysmenorrhoea
2) reduces risk of endometrial and ovarian cancer
3)Improves endometriosis sx
disadvnatages:
1) associated with v.small risk of breast cancer and cervical cnacer
2) increased risk of osteoporosis and WG
3) fertility takes 12 months to return
122
What are the two types of POP?
1) Traditional e.g. Norgeston or Noriday
* pill cannot be delayed for more tahn 3 hours
2) Desogestrel only e.g. cerazette
* pill can be taken upto 12 hours late
123
What is the Pearl Index?
The Pearl Index is the most common technique used to describe the efficacy of a method of contraception.
124
How does progesterone work in contraceptives?
interferes with ovulation, thickens the cervical mucus and thins the lining of the uterus.
125
What is androgen insensitivity syndrome (AIS)
X linked recessive condition where cells unable to repsond to hormones due to lack of androgen receptors
(Person is phonetically female, but genetically male)
126
What would be the hormone profile be in AIS?
Raised LH
Raised oestrogen
Raised/Normal FSH
Raised/Normal testosterone
127
What are the adverse outcomes of having a bicornuate uterus
Miscarriage
Premature birth
Malpresentation
128
What area of the vagina is most affected by vulval cnacer?
Labia majora
129
WHta is the GS Ix of asherman syndrome?
Hysteroscopy
130
Gold standard ix for lichen sclerosis?
vulval biopsy
131
What are the protective factors for ovarian cancer?
Parity
COCP
Breastfeeding
Early Menopause
132
What tumour markers may be raised in ovarian germ cell tumours
AFP and BhcG
133
What is the most common type of ovarian cancer?
Epithelial tumours
134
What is the most common type of ovarian cancer in young women?
Germ cell tumours (raised tumour markers- AFP, AND bHCG)
135
List 5 sx of ovarian cancer?
Early satiety
Bloating
urinary frequency
Change in bowel habits
Weight loss
Abdomianl discomfort
Ascites (late stage)
136
List 5 RF of ovarian cancer
Older age
Smoking
Early menarche
Late menopause
Obesity
HRT usage
137
List 3 causes of post coital bleeding?
Cervical ectropian
Endocervical and cervical polyps
Cervical cancer
STIs
Arophic vaginitis
138
Breast cancer can increaset he risk of what other type of cancer?
Ovarian cancer
139
Whta type of breast cancer is the most common
Invasive Ductal carcinoma
140
What is the investigations done as part of the 'triple assessment' for breast cancer
1) Clinical examination
2) Radiological examination- usually mammogram
3) Biopsy
141
What biologic can be given to HER2 +ve type cancers
Trastuzumab
142
What hormonal tx can be given to those with oestrogen +ve breast cancers?
postmenopasual- anastrazole
perimenopausal- Tamoxifen
143
How often is breast screening done and who for?
every 3 years for women between the ages of 50-70
144
What is the criteria for screening
Wilson and Junger criteria
145
What is specificity?
proportion of people w/o disease who are correctly excluded by screening test d/b+d
146
What is sensitivity?
proportion of people with disease who are correctly identified by screening test a/a+c
147
What is PPV?
Proportion of people with a +ve result who actually have the disease a/a+b
148
What is NPV
Proportion of people with a -ve result who do not have disease d/c+d
149
What strains of HPV does the vaccine protect you from, also when is it given?
Protects agianst strains 6, 11, 16, 18
6 + 11 - genital warts
16 + 18 - Cervical cancer
given to girls and boys aged 12/13
150
what is CIN
Cervical Intraepithelial Neoplasia is a grading system for level of dysplasia
CIN1- mild dysplasia- unliely to go and become cancer- will reolsve on own
CIN2- moderate dysplasia- likely to go on and become cancer
CIN3- severe dysplasia (aka cervical carnicinoma in situ)
151
What is the 1st line ix for suspected cervical cancer?
Colposcopy
152
What is the most common tyoe of cervical cnacer?
Squamous cell cancer
153
what is the 1st line and GS ix for endometrial cancer
1st line- TVUSS
GS- Hysteroscopy w/ biopsy
154
What histological changes are seen in cervical ectropians?
Presence of everted endocervcial coliumnar epithelium on ectocervix
155
In preganant women who are called for cervical screening, when should they reschedule for?
3 months postpartum
156
What is the aim of cervical screening?
Screenign for HPV and abnormal cells indicatove of pre invansive (dyskaryosis) disease cervical intraepithelial neoplasia
157
List findings on cervical examination that could suggest malignancy?
Mass
Ulceration
Inflammation
Bleeding
158
What is the mx of PCOS?
Lifetsyle advice- weight loss
In women who are not seeking to get pregnant- COCP/Metformin/Co-cyprinidol
In women attempting to get pregnant- Clomifene/metformin/Ovarian drilling
159
List 3 causes of premature ovarian failure?
FHX
Chemotheraphy
Radiotherphy
Idiopathic
Autoimmune infections
160
List the contraindications for HRT?
Past or present breast cancer
Undiagnosed vaginal bleeding
Any oestrogen sensitive cancer
Untreated edometrial hyperplasia
161
List 5 menopausal sx?
Hot flushes
Night sweats
Palpitations
Anxiety
Mood swings
Reduced libido
Dyspareunia
Vaginal dryness
162
What age range for menopause?
45-55 years
163
What age identifiese arly menopause?
40-44 years
164
What are important questions to ask when prescribing HRT?
Does woman have uterus
Has woman had breast cnacer or currently has?
Hx of DVTs?
165
What non-HRT management can be indicated for menopause?
Vasomotor sx- Fluoxetine, citalopram, venlafaxine
Vaginal dryness- vaginal lubricants and mouisturisers
UG sx- Vaginal oestrogen aand lubricant and mosturisers
166
What cancer risk is increased by progesterone HRT?
Breast cancer
167
what lifestyle advice can be given to women who suffer sx of menopause?
Lose weight (if indicated)
wear looser clothes, reduce stress, avoid triggers (caafiene, spicy foods)
168
What signs may indicate PID on exmaination?
Pelvic tenderness
Cervcial motion tenderness
Cervicitis
Discahrge
Cervicla excitation
169
List 3 sx of PID?
Deep Dysparenunia
Fever
Dysuria
Abdominal pain
Vaginal discharge
Post-coital/Intermenstrual bleeding
170
List 3 RF fr PID?
Unprotected sex
IUD use
Prior PID
Prior Infection chlamydia/gonorrhoea
171
What is the definition of primary amenorrhoea?
the absence of meneses in:
- girls age 15 who have normal pubertal development
or
- girls age 13 who have absence of pubertal maturation
172
What is Kallmans syndrome?
X linked rescessive trait which shows
Hypogonadotrophic Hypogonadism (low level of hormones)
+ ANOSMIA
173
What is Klienfelters syndrome?
47XXY- Tall, small testes, gynecomastia
Hypergonatrophic hypogonadism
174
List the complications with adenomysosis?
SGA
Miscarriage
Infertility
PPH
175
What grading tool is used in pelvic organ prolapses?
POP-Q
176
List the indications for early fertility refferal?
Age >35
Menstrual issues
Previous surgery
Previous STI/PID
177
According to the UKMEC at what age is the COCP contraindicated for its use in women?
over the gae of 50- must be switched to alternative contraception
178
What conditions must be listed in a patients fhx taht may consider them at an increased risk of Breast cnacer which warrants a refferal?
anyone of these below;
1) BC in a first degree (fd) male relative
2) BC in fd relative under the age of 40
3) Bilateral BC in fd relative under age of 40
4) BC in more than 2 fd relatives
179
What is a radial scar, and how does it show up on mammography?
benign breast condition (idioipathic sclerosing hyperplasia) which can mimic breast carcinoma.
on mammography- star or rosette shaped lesion
180
What breast disease is mostly synonymous with green/yellow nipple discahrge?
Mammary duct ecstasia
181
What breast disease is mostly synonymous with blood stained nipple discahrge?
Intraductal papilloma
182
When should an urgent breast refferal be made?
in women >30 with new breast lump
183
What is a mucinous cystadenoma and its main complication?
Second most common benign epithelial tumour
Typically large and if it ruptures may cause pseudomyxoma peritonei
184
What type of breast cancer presents as a smooth, firm, painless mobile lump. Especially in women from teenage years to age 40
Fibroadenoma
185
What is the medical Mx of premenstrual syndrome?
New-generation combined oral contraceptive pill
186
What are the main symptoms of Hydatidiform moles (molar pregnancy)?
Hydatidiform moles lead to pronounced pregnancy symptoms:
Uterus enlarges
Elevated bHCG
Hypertension
Hyperthyroidism
Causes severe hyperemesis gravidum
187
What are the risk factors for hyperemesis gravidum?
increased levels of beta-hCG
multiple pregnancies
trophoblastic disease
nulliparity
obesity
family or personal history of NVP
188
What is the diagnostic criteria of hyperemesis gravidarum>fova
5% pre-pregnancy weight loss
dehydration
electrolyte imbalance
189
What is the classic ovarian cancer case?
Over 50 with IBS like symptoms in last 12 months
190
What is the treatment of CIN (Cervical intraepithelial neoplasia)?
Large loop excision of transformation zone (LLETZ)
191
By what parameters can you diagnose a confirmed miscarriage?
No cardiac activity
AND
Crown-rump length>7mm
Gestational sack >25mm
192
What infectious disease presents with fever on alternating days?
Malaria
193
