Gynaecology

Question 1

HPV

Answer 1

6+11 cause condylomas
16+18 cause cervical cancer (upregulate E6 and E7 which inactivate p53 and RB1)
Cleared by immune system

Question 2

Vulval Intraepithelial Neoplasia

Answer 2

1-3 depending on appearance
Due to HPV
Differentiated VIn due to lichen sclerosus (causes SCC)

Question 3

Vulval SCC

Answer 3

Most common
Associated with VIN, CIN and LC
Eroded plaques and ulcers
Spreads to vagina, urethra and nodes

Question 4

Vulval Malignant Melanoma

Answer 4

Recurs
Spreads to urethra
Invades nodes and blood

Question 5

Extramammary Paget’s

Answer 5

Burning and itchy
In-situ adenocarcinoma
Recurs and invades

Question 6

Cervical Intraepithelial Neoplasia

Answer 6

Pre-invasive SCC
Graded 1-3
In TZ
Looked at in screening programme

Question 7

SCC of Cervix

Answer 7

RFs= HPV, multiple partners, smoking, losing virginity early

Question 8

Adenocarcinoma of Cervix

Answer 8

Precursor= CGIN
Treated same but worse prognosis (radioresistant)
Spreads
Mets to nodes, lungs, bones

Question 9

Endometriosis

Answer 9

Causes= regurg, metaplasia, differentiation, mets
Treatment= COCP, GnRH agonist/antagonist, progesterone antagonist, surgery

Question 10

Endometritis

Answer 10

Acute= retained foetus, complicated labour, lots of neutrophils
Chronic= PID, TB, IUCD, more lymphocytes
Treatment= analgesia, abx, remove cause

Question 11

Endometrial Polyps

Answer 11

Polypoid overgrowths
Causes= tamoxifen
Treatment= progesterone or GnRH antagonists, surgery

Question 12

Leiomyomata

Answer 12

RFs= genetics, no kids, obesity, PCOS, high BP
Subfertility
Pressure symps
Treatment= IUS, NSAIDs, OCP, progesterone, iron, ablation, hysterectomy

Question 13

Hyperplasia

Answer 13

RFs= obese, high oestrogen, PCOS, tamoxifen, HPNCC
Non-atypical or atypical
Treatment= IUS, progesterone, hysteretomy
Risk of cancer

Question 14

Endometrial Cancer

Answer 14

Type 1= endometriod (oestrogen-dependent)

Type 2= serous (atrophy, grade 3)

Question 15

Polycystic Ovarian Syndrome

Answer 15

2/3 of hyperandrogenism, menstrual abnormalities, polycystic ovaries
Treatment= metformin, OCP, ovarian drilling
Comps= hyperplasia and adenocarcinoma

Question 16

Ovarian Failure

Answer 16

Primary= infection, surgery, radio, toxins, Turner's, Klinefelter's
Secondary= Sheehan's, pit tumours, brain injury, PCOS

Question 17

Ovarian Cancer

Answer 17

Protective factors= OCP, breastfeeding, hysterectomy

Often have TAH/BSO and chemo

Question 18

Epithelial Ovarian Tumour

Answer 18

Serous, mucinous or endometrioid
Benign= cystadenoma, fibroma or cystadenofibroma
Malignant= cystadenocarcinoma

Question 19

Germ Cell Ovarian Tumour

Answer 19

Germinomatous= malignant

Non- germinomatous= teratoma, yolk sac (malignant) or choriocarcinoma (malignant)

Question 20

Sex Cord Stromal Tumour

Answer 20

Thecoma, fibrothecoma and fibroma benign (make oestrogen)
Granulosa cell malignant+ makes oestrogen
Sertoli-Leydig malignant+ makes androgens

Question 21

Ovarian Mets

Answer 21

Mullerian= uterus, fallopian, peritoneum, other ovary
Lymph/Haem= bowel, stomach, pancreas, breast, melanoma, kidney, lung
Direct= bladder, rectal

Question 22

Breast Cancer

Answer 22

RFs= obese, alcohol, HRT, radiation, height, digoxin

Get puckered skin, indrawn nipple, inflam, infections and nipple discharge

Question 23

Mammary Paget’s

Answer 23

Overexpression of HER2

Question 24

Fibrocystic Change

Answer 24

Duct hyperplasia
Apocrine metaplasia
Cysts
Calcified lump

Question 25

Fibroadenoma

Answer 25

Mobile lump

Controlled growth of glandular and connective tissue

Question 26

Phyllodes Tumour

Answer 26

Rare neoplasm
Spectrum of lesions
Stromal overgrowth

Question 27

Infections transmitted to baby

Answer 27

Blood= CMV, syphilis, VZV, zika, tosmoplasmosis, parvovirus
Labour= Strep, HSV, gonorrhoea, chlamydia, HIV, Hep B

Question 28

UTIs in pregnancy

Answer 28

More common
Asymp bacteriuria treated
7 days amoxicillin (cephalexin if have folate and 2-3 trimester)

Question 29

Chorioamnionitis

Answer 29

Inflam of cord, placenta and membranes
RFs= membrane rupture, amniocentesis, cordocentesis, cerclage, BV
Causes= B strep, enterococci, e coli, listeria

Question 30

Abx in Pregnancy

Answer 30

Safe= penicillins, cephalosporins
Unsafe= chloramphenicol, tetracyclines, fluoroquinolones, trimethoprim

Question 31

Endometritis in Puerprium

Answer 31

RFs= C section, long labour
Causes sepsis
Causes= e coli, anaerobes, group B strep

Question 32

Mastitis

Answer 32

S aureus

Keep nursing, drain abscess+ give flucloxacillin

Question 33

Neonatal Sepsis

Answer 33

Men happens

Causes= group b strep, e coli, listeria

Question 34

N Gonorrhoea

Answer 34

Gram -ve
Attaches to mucosal epithelium
Get discharge+ dysuria
Comps= PID, Fitz-Hugh-Curtis, miscarraige, conjunctivitis
Can disseminate
Treatment= b lactams, cephalosporins, fluoroquinolones (ceftriaxone and azithromycin)

Question 35

Chlamydia

Answer 35

Intracellular bacteria
Targets squamocolumnar junction, conjunctiva, urethra, rectum, resp tract
Symp= urethritis, cervicitis, dysuria, frequency
Comps= PID, infertility
Treatment= azithromycin or doxycycline

Question 36

Genital Herpes

Answer 36

HSV1 (slightly 2)
Symps= pain, itch, dysuria, discharge, ulcers
Lies dormant before reactivation
Treatment= aciclovir
Comps= men, encephalitis, retention, paraesthesia

Question 37

Syphilis (treponema pallidum)

Answer 37

Penetrate mucous membranes or broken skin
Disseminate in lymph or blood
Primary= chancre at entry site
Secondary= rash, fever and infectious condylomata lata
Tertiary= neuro, paresis, tabes dorsalis, aortitis
Can be congenital
Treatment= penicillin (Jarish-herxheimer)

Question 38

Trichomoniasis

Answer 38

Vaginal protozoan
Symps= green frothy discharge+ inflam
Treatment= metronidazole

Question 39

Bacterial Vaginosis

Answer 39

Less lactobacilli, more Gardnerella and anaerobes
Watery fishy discharge
Treatment= metronidazole, amoxicillin, clindamycin

Question 40

Candidiasis

Answer 40

RFs= OCP, DM, abx
Treatment= topical co-trimazole and fluconazole

Question 41

HIV

Answer 41

Lose CD4
CD4 below 200= AIDS
Treatment= AZT, nevirapine