Gynaecology Flashcards
1
Q
How long is a typical menstrual cycle?
A
23-35 days
2
Q
What is the structure of the ovarian menstrual cycle?
A
Follicular (d1-13), ovulation (d14), luteal phase (d15-28)
3
Q
What is the structure of the uterine menstrual cycle?
A
menses (d1-5, proliferative (d6-14), secretory (d15-28)
4
Q
What happens in the follicular phase?
A
- Folliculogenesis
- Follicle maturation
- Thickening of the uterine lining
5
Q
What happens in the luteal phase?
A
- Corpus luteum forms
- Increased progesterone
6
Q
During the menses and follicular phase are the levels of oestrogen and progesterone high or low?
A
Low
7
Q
During the proliferative phase and ovulation are the levels of oestrogen and progesterone high or low?
A
High oestrogen
8
Q
What causes high oestrogen during ovulation?
A
LH surge on day 12-13, 36 hours pre-ovulation
9
Q
During the luteal and secretory phase are oestrogen levels high or low?
A
high progesterone
10
Q
What is the best marker of ovulation?
A
Mid-luteal progesterone levels (cycle length minus 7 days e.g. day 21)
11
Q
What hormones are involved in the menstrual cycle and released by the pituitary?
A
LH, FSH
12
Q
What is the role of oestrogen?
A
- Female body composition
- Builds up endometrium
- Improves bone mineral density
- Increases spiral arterioles
13
Q
What is the role of progesterone?
A
- increase uterine mucus secretion
- maintains endometrial lining
- myometrium smooth muscle relaxation
14
Q
What is the role of LH?
A
Acts on theca cells to produce oestrogen
15
Q
What is the role of FSH?
A
Acts on granulosa cells for folliculogenesis
16
Q
What needs to happen for the LH surge to occur?
A
An isolated raised oestrogen
17
Q
What is primary amenorrhoea?
A
When a pt has never had a period either >13 with no primary sexual characteristics or >15 with no secondary sexual development
18
Q
What is hypergonadotrophic amenorrhoea?
A
- Raised LH and FSH
- primarily in TURNERS (45X)
- Can be ovarian dysgenesis/agenesis
19
Q
What is hypogonadotrophic amenorrhoea?
A
- Decreased LH and FSH
- primarily in Kallmann’s syndrome (+anosmia)
- Failure to thrive
- Androgen insensitivity syndrome
20
Q
What is secondary amenorrhoea?
A
> 6 months of no periods in a normally menstruating female
21
Q
What can cause secondary amenorrhoea?
A
- Sheehan’s syndrome (pituitary necrosis after PPH)
- Asherman’s syndrome (uterine adhesions post surgery)
- Eating disorders
- Hyperthyroid
- Hyperprolactinaemia
- PCOS
- Pregnant?
- Pre menopause?
22
Q
How is amenorrhoea diagnosed?
A
- History and examination
- Bloods- oest, prog, test, FSH, LH, prolactin, SHBG, TPT, IGF1
- HbA1C (PCOS)
- Urine bHCG (pregnant?)
23
Q
How is amenorrhoea treated?
A
- Hypogonadotrophic = COCP
- Hypergonadotrophic = GnRH analogue
- Refer to secondary care to treat underlying cause
24
Q
What is a bicornate uterus?
A
Congenital defect, heart shaped uterus
- Increases risk of miscarriage + intra uterine growth restriction
25
What is transverse vaginal septum?
Sheath of tissue across vaginal opening
- Perforate (bleed) or imperforate (no bleed)
- Increased risk of infertility and endometriosis
26
What chromosome abnormality is Mullerian agenesis?
46XX
27
What is menorrhagia?
Subjectively heavy menses (normal 30-80ml)
28
What are the causes of menorrhagia?
- dysfunctional uterine bleeding - mc idiopathic
- uterine fibroids
- copper coil (IUD)
- hypothyroidism
29
What are the investigations for menorrhagia?
- Bloods - FBC, clotting screen, ferritin, TFT
- Trans vaginal ultrasound
- History and exam
30
What are fibroids?
Uterine leiomyomas
Typically 30-50 years old
31
What are the types of fibroids?
- Pedunculated
- Subserosal
- Submucosal
- Intramural
32
What are the risk factors for fibroids?
- Increased oestrogen
- nulliparity
- obesity
- early menarche
- late menopause
- afrocaribbean
33
What are the symptoms of fibroids?
- Menorrhagia
- bloating
- pelvic pressure
- subfertility
(+ risk of IUGR and abnormal foetal lie
34
How are fibroids diagnosed?
- Bimanual - large, irregular, non tender uterus
- Transvaginal ultrasound - mass
- MRI can be used
35
What is the treatment for fibroids?
- First line - IUS - CI if uterus distorted
- Second line - COCP
- If they don't want contraception give tranexamic acid
36
What is the best treatment for a subfertile female with fibroids who wants a child?
Myomectomy
37
What are the complications of fibroids?
- Red degeneration - low fever, lower abdo pain, N+V
- Calcification
- Subfertility/infertility
38
What is dysmenorrhoea?
A subjectively painful period
39
What are the causes of dysmenorrhoea?
- Endometriosis
- Adenomyosis
- PID?
40
What is endometriosis?
Ectopic endometrial tissue that is displaced
Typically 20-40 yr old (mean 28)
1/10 Females UK
41
Where can you get endometriosis?
- Ovaries
- Bladder
- Bowel (incl pouch of douglas)
- Abdomen
- Thorax (thoracic endometrial syndrome)
42
What are the theories behind endometriosis?
- Halberns - Haematogenous and lymphatic spread
- Samsons - retrograde menstruation
- Meyers - Metaplasia
43
What are the risk factors for endometriosis?
- Nulliparity
- autoimmune disease
- early menarche
- late menopause
- FH
- vaginal outflow obstruction
44
What are the symptoms of endometriosis?
- dysmenorrhoea
- menorrhagia
- subfertility
- deep dyspareunia
- dysuria
- dyschezia
- haemoptysis
- fatigue
- SOB
45
How is endometriosis diagnosed?
- First line - TVUSS
- Gold standard - laparoscopy
- Bimanual - adnexal motion tenderness + fixed retroverted uterus
46
How is endometriosis treated?
1. NSAIDS
2. COCP
3. Surgery - fertility preserving - ablation
no saving fertility - hysterectomy
47
What is adenomyosis?
Endometrial invasion into the myometrium
35-45 yrs old w history of uterine surgery
48
What are the risk factors for adenomyosis?
- uterine surgery
- early menarche
- late menopause
- nulliparity
49
What are the types of adenomyosis?
- Focal (one site)
- Diffuse (throughout)
- Adenomyoma (benign focal mass)
50
What are the symptoms of adenomyosis?
- dysmenorrhoea
- cyclical pain
- deep dyspareunia
- menorrhagia
- subfertility
51
How is adenomyosis diagnosed?
- Bimanual - BOGGY uterus
- TVUSS
- GS - post excisional biopsy
52
What is PCOS?
2/3 Rotterdam criteria
- hirsutism + signs of hyperandrogenism
- menstrual disturbance (oligo or anovulation)
- polycystic ovaries on TVUSS
53
What are the risk factors for PCOS?
- FH
- obese
- insulin resistance (T2DM)
54
What are the symptoms of PCOS?
- hirsutism (acne, facial hair)
- mood swings
- amenorrhoea/oligomenorrhoea
- subfertility
- hyperpigmentation of neck folds and armpit folds
55
How is PCOS diagnosed?
- 2/3 Rotterdam criteria (can be clinical)
- Bloods - FBC, U+E, TFT, LFT, Test, Oest, Prog, SHBG
- Ratio of LH:FSH = 2:1
- TVUSS - >12 polycystic ovaries arranged like beads on a string
56
How is PCOS treated?
Not fertility planning:
- lose weight and exercise
- COCP
- consider metformin
Fertility planning:
- consider clomifene (induce ovulation)
57
What are the possible complications of PCOS?
- Infertility
- metabolic syndromes
- T2DM
- endometrial hyperplasia and endometrial cancer!!!
58
How are gynae malignancies staged?
FIGO 1-4 staging
59
What are the main gynae malignancies?
- endometrial
- ovarian
- cervical
- vulval
60
What are the types of endometrial cancer?
Adenocarcinoma - 80%
- Type 1 - more common, better prognosis, raised oestrogen
- Type 2 - atrophic, p53 mutations
61
What are the risk factors for endometrial cancer?
Unopposed oestrogen:
- Oestrogen only HRT!!!
- PCOS
- T2DM
- Tamoxifen use
- nulliparity
- obese
- early menarche
- late menopause
Genetics:
- Lynch syndrome (HNPCC)
- KRAS mutation
- p53 mutation
-PTEN mutation
62
What are protective factors for endometrial cancer?
- COCP
- IUS
- breast feeding
- multiparity
63
What are the symptoms of endometrial cancer?
50+ postmenopausal bleeding
64
How is endometrial cancer diagnosed?
- Bimanual - large + irregular
First line - TVUSS - thick uterine lining
Gold standard - hysteroscopy + biopsy
65
How is endometrial cancer staged?
1. Confined to the uterus
2. + cervix
3. + pelvis
4. + extrapelvic e.g. bladder, lungs, liver
66
How is endometrial cancer treated?
Stage 1 or 2 - hysterectomy with bilateral salpingoopherectomy
Stage 3+4 - debulking surgery and adjuvant chemotherapy
67
What are the types of ovarian cancer?
- Epithelial (70%) - serous (mc) and mucinous
- Germ cell (20%) - teratoma and dysgerminoma
- Sex cord (10%)
68
What are the risk factors for ovarian cancer?
- BRCA 1+2
- nulliparity
- obese
- early menarche
- late menopause
69
What are protective factors for ovarian cancer?
- COCP
- breast feeding
- multiparity
70
What are the symptoms of ovarian cancer?
- 50+ postmenopausal female with new onset IBS/GI/urinary symptoms
- bloating
- severe constipation
- indigestion
- abdominal pain
- jaundice if metastasised
71
How is ovarian cancer diagnosed?
First line - TVUSS - multiloculated bilateral free fluid containing heterogeneous and blood test - CA125
Gold standard - pipelle biopsy
RMI - menopausal status + CA125 + USS findings >250 needs specialist referral for biopsy
72
What can cause a raised CA125?
- ovarian cancer
- menstruation
- PID
- benign cysts
73
What is the FIGO staging for ovarian cancer?
1. ovaries
2. + pelvis
3. + peritoneum/ lymph nodes
4. + distant mets - liver, brain, bowel
74
What is the treatment for ovarian cancer?
Stage 1 - hysterectomy + B/L S.O
Stages 2-4 - optimal debulking adjuvant chemo
75
What needs to be done before any gynae surgery?
- FBC
- U+E
- clotting screen
- crossmatch group and save
76
What are the possible complications of ovarian cancer?
- struma ovarii - ovarian tumour releasing T4
- meigs syndrome
77
Who is most affected by cervical cancer?
sexually active 30-45 yrs old
78
What are the types of cervical cancer?
- Squamous cell (90%)
- adenocarcinoma (10%)
79
What are the risk factors for cervical cancer?
- high risk HPV strains (16+18, 31, 45)
- unprotected sexual intercourse
- people who don't screen
- HIV
- COCP use
80
Which conditions should a PAP smear be avoided?
- menstruating
- PID
- within 12 weeks of giving birth/ termination/ miscarriage
81
What are symptoms of cervical cancer?
- Caught early - asymptomatic
- post-coital bleeding
- intermenstrual bleeding
- abnormal vaginal discharge
- vaginal discomfort
82
How is cervical cancer diagnosed?
- Speculum exam - erosions, masses, ulcers
- Colposcopy + biopsy
83
What is the FIGO staging for cervical cancer?
1. cervix (a. microscopic b. visible)
2. + upper 2/3 vagina
3. + lower 1/3 vagina or pelvic wall
4. + bladder/ rectum/ extrapelvic
84
How is cervical cancer treated?
CIN - LLETZ
1-2a - hysterectomy + LN removal
2b-4a - chemo + radiotherapy
4b - palliative chemo
85
What are the types of vulval cancer?
- Squamous - 90%
- melanoma - 10%
86
Who is most affected by vulval cancer?
35-55 yrs
87
What are the risk factors for vulval cancer?
Younger female - HPV association
Older female - lichen sclerosis
88
What are the symptoms of vulval cancer?
- vulvodynia
- superficial dyspareunia
- ulcers
- inguinal lymphadenopathy
89
What is the diagnosis for vulval cancer?
2 ww for biopsy
90
What is the treatment for vulval cancer?
wide local excision + LN removal
91
Who is most affected by ovarian cysts?
Pre-menopausal women
92
What are the types of ovarian cysts?
- follicular cyst
- corpus luteum cyst
- neoplastic
- non-functional cyst- PCOS
93
What are the symptoms of ovarian cysts?
- bloating
- painful periods
- dysuria
- decreased fertility
94
What is the most common type of ovarian cyst?
Teratoma
95
What are the possible complications of ovarian cysts?
- Meigs syndrome
- cyst rupture
- cyst haemorrhage
- ovarian torsion
- progression to ovarian cancer
96
What is ovarian torsion?
When an ovary twists around itself on a longitudinal axis
97
Who is most affected by ovarian torsion?
15-45 yrs
98
What are the risk factors for ovarian torsion?
- cysts
- IVF
- pelvic surgery
99
What are the symptoms of ovarian torsion?
- Severe unilateral RIF/LIF pain
- N+V
- Painful walk
100
How is ovarian torsion diagnosed?
- Urine bHCG -ve
- colour doppler TVUSS - whirlpool sign + free fluid around ovary
101
How is ovarian torsion treated?
surgical detorsion
102
What is cervical ectropion?
Cervical glandular columnar epithelium around the external os
103
What are the symptoms of cervical ectropion?
- post-coital bleeding
- increased discharge
104
How is cervical ectropion diagnosed?
Speculum - red ring around cervical os
105
What is the treatment for cervical ectropion?
Reassurance:
- consider stopping COCP
- consider ablative surgery - last line
106
What are the types of pelvic organ prolapse?
- Cystocele
- urethrocystocele
- rectocele
- vault prolapse
107
What are the risk factors for pelvic organ prolapse?
- multiparity
- uterine surgery
- obesity
- aging
- strenuous activity
108
What are the symptoms of pelvic organ prolapse?
Cystocele - urinary retention, incontinence, urinary symptoms
Rectocele - constipation, diarrhoea, faecal symptoms
109
How is pelvic organ prolapse diagnosed?
Speculum exam and bimanual
110
What are the grades of pelvic organ prolapse?
1. >1cm from hymen
2. <1cm from hymen
3. >1cm outside hymen
4. total uterine prolapse
111
What is the treatment for pelvic organ prolapse?
Conservative - weight loss, keigel exercises
Med - ring pessary
Surgical - pelvic floor repair or hysterectomy
112
Who is most affected by premenstrual syndrome?
Menstruating females, typically 20-45 yrs
113
What is premenstrual syndrome?
Behavioural and psychological symptoms associated with the luteal phase
114
What are the risk factors for premenstrual syndrome?
- FH depression
- personal history depression
- smoking
- alcohol
- mood disorders
115
What are the symptoms of premenstrual syndrome?
Hormonal - bloating, tired, hot flushes
Low serotonin - depressed, anxious, irritable, fatigue, constipation
116
How is premenopausal syndrome diagnosed?
- clinical diagnosis
- > 2 cycles like this associated with the luteal phase
- Gold standard = GnRH analogue for 3 months - +ve test = complete resolution of symptoms
117
What is the treatment for premenstrual syndrome?
Conservative - regular sleep, stop alcohol + smoking
Meds - NSAIDs, COCP, CBT +SSRI
118
What are the possible complications of premenstrual syndrome?
Premenstrual dysphoric disorder - severe mood swings, agitation, +/- psychosis
119
What is menopause?
The cessation of the menstrual cycle >12months in 45-55yrs or post hysterectomy
120
What is perimenopause?
1-11 months of amenorrhoea in 45-55 yr old female with vasomotor symptoms
121
What is classed as early menopause?
40-45 yrs
122
What is premature ovarian insufficiency?
Abnormal cessation of the menstrual cycle in a female younger than 40
123
How is premature ovarian insufficiency measured?
High FSH levels
124
What are the risk factors for premature ovarian insufficiency?
- Cancer
- severe infection
- chemo
- PCOS
- Raised T4
- Family history
- Fragile X syndrome
125
How is premature ovarian insufficiency treated?
Give HRT at least until age 51
126
What can be causes of menopause?
- idiopathic
- hysterectomy
- PCOS
- eating disorders
- sheehan's + asherman's
127
What are the symptoms of menopause?
Vasomotor - flushing + night sweats
General - mood swings, brain fog, fatigue, decreased libido, increased urination, bloated
128
How is menopause diagnosed?
- Clinical - amenorrhoea >12months
- uncertainty - FHS serum levels
129
How is menopause treated?
- unproblematic - don't treat
- problematic:
- oest+prog transdermal continuous combined HRT
- oest only if post hysterectomy (endometrial cancer risk)
130
How is atrophic vaginitis treated?
Consider topical oestrogen
131
What are the positives of HRT?
- decreased bowel cancer risk
- decreased risk of endometrial and ovarian cancer
- improve quality of life
- decrease the risk of osteoporosis
132
What are the negatives of HRT?
- increased risk of breast cancer (if taken for > 5 years)
- increased risk of VTE
133
What can cause post-menopausal bleeding?
- Atrophic vaginitis - most common
- Endometrial cancer - most serious
134
What can cause post-coital bleeding?
- Cervical ectropion - mc young pts
- Atrophic vaginitis - mc older pts
135
What can cause superficial dyspareunia?
- Vulvodynia
- Vulval cancer
- Lichen sclerosis
- Atrophic vaginitis
136
What can cause deep dyspareanunia?
- Endometriosis
- Adenomyosis
- PID
- Cervical cancer
137
What are the types of urine incontinence?
- Urge - 2nd
- Stress - mc
- Overflow
138
What is a differential for urge incontinence?
Overactive bladder
139
What is urge incontinence?
A sudden and intense urge to pass urine that cannot be controlled or delayed
140
Where is urge incontinence most commonly seen?
- Younger females
- UTIs
- DM
- Pregnancy
141
What are the symptoms of urge incontinence?
- nocturnal symptoms
- detrusor overactivity
- key in door syndrome
- handwashing trigger
142
How is urge incontinence diagnosed?
- urine dip + mc/s
- bladder diary - nocturnal symptoms
- urodynamic studies
143
How is urge incontinence treated?
- bladder training 6w
- then try oxybutynin
- then cystoplasty and botox injections
144
When is stress incontinence most commonly seen?
- Older pts
- surgery history
- multiple births
- weight lifts
- obese
145
What are the symptoms of stress incontinence?
- incontinence with Valsalva manoeuvre
- no nocturnal symptoms
146
How is stress incontinence diagnosed?
- urine dip and mc/s
- bladder diary
- urodynamic studies
- +ve q-tip test
147
What is the treatment for stress incontinence?
- kegel exercises first
- then try duloxetine
- surgery last line - mesh sling etc.
148
What is overflow incontinence?
Nocturnal leakage with total detrusor voluntary control loss
149
What are the symptoms of overflow incontinence?
- poor stream
- incomplete emptying
150
How is overflow incontinence diagnosed?
- Urine dip + mc/s
- bladder diary
- urodynamic studies - high post residual volume of urine
151
What is the treatment for overflow incontinence?
Catheterise
152
What is Asherman's syndrome?
Uterine adhesions after surgery causing secondary amenorrhoea
153
What are the risk factors for Asherman's syndrome?
- C-section
- PID
- Endometriosis
154
What are the symptoms of Asherman's?
- Secondary amenorrhoea
- infertility
155
How is Asherman's diagnosed?
1st line - TVUSS
GS - laparoscopy
156
How is Asherman's syndrome?
Surgical - adhesionolysis
157
What is a Bartholin cyst?
An internal blockage of a bartholin gland resulting in a build-up of mucus and secretions at labia majora
158
How are Bartholin cysts treated?
Incision + drainage
159
Where is the most common site of lumps in the breast?
The upper outer quadrants and the tail of spence
160
What are suspicious signs of breast cancer in the nipples?
- Dimpling
- Deviation
- Depression
- Discolouration
- Discharge
- Tethering
- Nipple eczema persisting with treatment
161
What is the breast screening programme?
A 3 yearly mammogram for 47-73yr olds
A form of secondary prevention
162
Who is high risk for breast cancer?
BRCA gene carriers - screened 25-60
163
Is the BRCA gene autosomal dominant or recessive?
Autosomal dominant
164
Which chromosome does BRCA 1 affect?
C17
165
What is the most common inherited cause of breast cancer?
BRCA 1
166
How can patients with the BRCA1 gene be treated?
- prophylactic mastectomy
- tamoxifen
167
What chromosome does BRCA2 affect?
C13
168
What is there an increased risk of with BRCA2 gene?
- male breast cancer
- ovarian cancer
- pancreatic cancer
169
What is the triple assessment for breast cancer?
- History and exam
- Imaging (USS, XR, mammogram, MRI)
- Cytology analysis
170
For breast cancer imaging when is an USS and mammogram used?
USS - <40 in young dense breast
Mammogram - >40
171
When is a mammogram not useful for breast imaging?
Not good at picking up in younger dense breast or in females with increased HRT
172
Why is MRI increasingly used for breast imaging?
Increasingly used for females with breast implants
173
What are the methods of cytology analysis for breast?
- Fine needle aspiration biopsy (FNAC)
- Core biopsy
174
What are the positives and negatives of FNAC?
Positives:
- Less invasive
- detects cancer
Negatives:
- No receptor status
175
What are the positives and negatives of a core biopsy?
Positives:
- detects cancer
- can tell receptor status
Negatives:
- less invasive
- painful
176
What is the lifetime risk of breast cancer in females?
1 in 8, median age 62
177
What family history can increase the risk of breast cancer?
Primary relative:
- Female <50 bilateral breast cancer
- Female <40 unilateral breast cancer
- Male any age
177
What are the risk factors for breast cancer?
- Nulliparous
- early menarche
- late menopause
- obesity
- smoking
- alcohol
- HRT for 5+ years
- BRCA
- Lifraumeni gene
178
What is a protective factor for breast cancer?
exercise
179
What are the types of breast cancer?
- Mostly adenocarcinoma (99%) - ductal (90%) or lobular (10%)
- tubular
- mucinous
- medullary
180
How well are grades of breast cancer differentiated?
Grade 1 - well differentiated
Grade 3 - poorly differentiated
181
When are patients sent on an urgent 2wk wait referral for breast malignancy?
>30+ with unexplained breast lump
>50+ with unilateral suspicious nipple changes
182
How is breast cancer staged?
TNM staging (tumour, nodes, metastases)
1. T1 N0 M0
2. T2/3 N1 M0
3. T4 N>1 M0
4. T4 N>1 M1
183
What can be used to measure breast cancer response to treatment?
B15-3
184
What is the receptor status for breast cancers?
- 75% are oestrogen +ve
- 10-15% HER-2 +ve
185
How do you treat a breast cancer that is oestrogen positive?
Pre menopause - tamoxifen
Post menopause - anastrozole/ letrozole
186
What are the side effects of tamoxifen treating breast cancer?
- Hot flushes
- VTE
- Endo cancer
187
What are the side effects of anastrozole/ letrozole treating breast cancer?
- Osteoporosis (give vit D + Calcium)
- vaginal dryness
- hot flushes
188
How do you treat breast cancer that is HER-2 positive?
Trastuzumab (herceptin)
189
What are the side effects of trastuzumab when treating breast cancer?
Cardiotoxicity - baseline ECHO needed
190
How is breast cancer treated surgically?
- Mastectomy (1/3)
- Lumpectomy + adjuvant radiotherapy(1/3)
- Lymph node clearance with both surgeries
191
When will a mastectomy be used to treat breast cancer?
- If the pt opts for it
- If more than 20% of the breast is affected
- If radiotherapy is contraindicated
192
When is a lumpectomy used to treat breast cancer?
- If the pt opts for it
- If less than 20% of the breast is affected
- If radiotherapy is an option
193
How can a pregnant woman with breast cancer be treated?
- Surgically
- Chemo in the 2nd and 3rd trimester
194
How is the prognosis of breast cancer measured?
- Nottingham prognosis index
- NHS predict
195
What is a fibroadenoma?
30 with a mobile unilateral benign breast lump
196
How are fibroadenomas diagnosed?
Routine triple assessment
197
What is the treatment for fibroadenoma?
lumpectomy
198
What is mammary dysplasia?
40-45 with with lumpy grain of rice breasts
199
What is the treatment for mammary dysplasia?
Supportive bra, NSAIDS, COCP?
200
What is a phyllodes tumour?
30-40 with a rapidly growing fibroadenoma - not cancerous initially but 10% may develop into a sarcoma
201
What is intraductal papilloma?
35-55 with bloody-watery nipple discharge
202
How is intraductal papilloma diagnosed?
Triple assessment
203
How is intraductal papilloma treated?
Surgery
204
What is mastitis +/- abscess
Inflammation of the milk glands in the breast, wedge shaped distribution +/- fever
205
How is mastitis +/- abscess treated?
- Lactating - fluclox
- Not lactating - fluclox + metronidazole
206
Should women with mastitis continue breast feeding?
Yes
207
What is mammary duct ectasia?
Sticky brown-green nipple discharge due to clogged ducts
208
What are the types of breast cyst?
- Galactocele
- simple
- blood
209
What is pagets disease?
Unrelenting nipple eczema persisting after 2 or more weeks of steroid/antifungal
210
What are the symptoms of pagets disease?
- Nipple and areola eczema, then rest of breast
- +/- straw colour DC
- Nipple inversion
211
How is pagets disease diagnosed?
- Triple assessment
- +ve for paget cells (90% HER2 +ve)
212
How is pagets disease treated?
Mastectomy or lumpectomy or wide local excision
213
What are silicone breast implant complications?
- Ruptures
- Capsular contractures
- Breast implant associated large cell lymphoma
