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EOY4 > Gynaecology > Flashcards

Gynaecology Flashcards

1
Q

What condition is the risk of malignancy index used in?

A

For ovarian tumours to determine the likelihood of them being malignant

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2
Q

What are some risk factors and protective factors for ovarian cancer?

A

Risk factors: FHx, obesity, nulliparity, early menarche and late menopause, Oestrogen only HRT, smoking, Lynch II syndrome, BRCA 1/2
Protective: COCP, multiparity, breast feeding

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3
Q

BRCA 1 & 2 increases the risk of developing what?

A

Breast and ovarian cancer

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4
Q

What is the inheritance pattern of Lynch II syndrome?

A

Autosomal dominant

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5
Q

Lynch II syndrome predisposes to which cancers?

A

Colorectal
Endometrial
Ovarian
Breast

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6
Q

What is the most common type of malignant ovarian tumour?

A

Serous cystadenoma

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7
Q

What are chocolate cysts?

A

A type of non-neoplastic ovarian cyst seen in those with endometriosis

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8
Q

Meig’s syndrome is an association between ascites + pleural effusion + which type of ovarian cyst?

A

Fibroma

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9
Q

Are follicular cysts neoplastic?

A

No

They occur in the first half of the menstrual cycle and represent the developing follicle

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10
Q

What histologically type are most cervical carcinomas?

A

Squamous cell carcinoma

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11
Q

What causes cervical cancer?

A

HPV, serotypes 16 and 18 mainly

Progressed over 10-20 year period from CIN to Ca

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12
Q

Whereabouts is the most likely location of an ectopic pregnancy?

A

Ampulla of the Fallopian tube

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13
Q

What is the next step in a female found to have borderline dyskariosis on her routine screening cervical smear?

A

HPV testing
If +ve: colposcopy
If -ve: back to routine recall
(If moderate or severe, refer for urgent colposcopy)

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14
Q

A perimenopaual woman who has not had a hysterectomy would like to try HRT for her menopausal symptoms. Which type of HRT is most appropriate?

A

Cyclical combined HRT
This will still produce a withdrawal bleed rather then unpredictable bleeding with continuous HRT

(Can then transfer to use continual combined HRT once amenorrhoeic for 1yr or aged 54)

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15
Q

What is the tumour marker for ovarian Ca?

A

CA-125

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16
Q

What investigation is first line in suspected endometrial Ca?

A

Trans vaginal USS

Biopsy if endometrial thickness >4mm

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17
Q

A 55 yr old woman has a normal smear on screening. When should her next call for smear test be?

A

In 5 years
For women aged 25 to 49 screen every 3 years
For women aged 50 to 64 screen every 5 years

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18
Q

What is the drug of choice for medical management of an unruptured ectopic pregnancy?

A

Methotrexate

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19
Q

What is the gold standard investigation for patients with suspected endometriosis?

A

Laparoscopy

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20
Q

What is the mechanism of action of oxybutynin and what is it’s indication?

A

Antimuscarinic

Used in urge urinary incontinence

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21
Q

What are the recommended treatment options for stress urinary incontinence?

A

Conservative: weight loss, pelvic floor exercises, pads, smoking cessation
Medical: Duloxetine, tx of chronic cough
Surgical: tension free vaginal tape, fascial sling procedures

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22
Q

When is methotrexate indicated for use in gynaecology?

A

Medical mx of small, unruptured ectopic pregnancy

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23
Q

What is the first line treatment for menorrhagia?

A

NSAIDs e.g. mefenamic acid
IUS (Mirena)
TXA if the woman does not require contraception

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24
Q

What class of drug is mefenamic acid and what is it’s indication?

A

NSAID

Indicated for use in menorrhagia for women who do not requir contraception

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25
Q

Which ligament attaches the ovaries to the uterus?

A

Ovarian ligament

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26
Q

Endometriosis commonly affects which ligaments?

A

Uterosacral ligaments, which can be palpated through the posterior vaginal fornix

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27
Q

Smoking and the COCP are protective against which gynaecological condition?

A

Endometrial Ca

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28
Q

What medication is used for Oestrogen receptor positive Breast Ca?

A

Tamoxifen

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29
Q

What is the different between a partial mole and a complete hydatidiform mole?

A

Partial mole: normal egg is fertilised by 2 sperm, hence 69 chromosomes in cells

Complete mole: empty egg fertilised by one sperm and chromosome duplicates, hence 46 chromosomes all of paternal origin

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30
Q

What are some presenting features of a molar pregnancy?

A
  • PV bleeding and abdominal pain
  • raised hCG
  • large for dates
  • exaggerated symptoms of pregnancy e.g. hyperemesis (due to raised hCG)
  • hyperthyroidism
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31
Q

How would a molar pregnancy be diagnosed?

A

Urine dip and blood test would show raised hCG
USS would show grape like sac
Can do histology on products

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32
Q

What is the concern with molar pregnancies?

A

That they can develop into invasive moles or malignant choriocarcinoma

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33
Q

A miscarriage is a loss of pregnancy before what gestation?

A

24 weeks

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34
Q

What type of miscarriage will have a closed cervical os?

A

Threatened miscarriage

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35
Q

What is a missed miscarriage?

A

When the foetus dies but remains in utero
May be previously Hx of threatened miscarriage, or may be small for dates uterus or have ongoing discharge (or can be asymptomatic)

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36
Q

What are the features of an inevitable miscarriage?

A

Pain and PV bleeding
Cervical os is open on examination
Foetus can be viable or non-viable on TVUSS
Will progress to complete/ incomplete miscarriage

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37
Q

What is the difference between a complete and a incomplete miscarriage?

A

Incomplete: Hx of passing clots, but still some remaining products of conception seen on TVUSS, endometrial diameter >15mm

Complete: Hx of bleeding and clots which have settled, endometrial diameter <15mm, no remaining products of conception seen on TVUSS

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38
Q

What are some risk factors for miscarriage?

A 
Increasing maternal age
Previous miscarriage
Coagulopathies
Smoking
Obesity
Chromosomal abnormalities 
Uterine abnormalities
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39
Q

How are miscarriages managed?

A

Conservative/ expectant: wait for products to pass spontaneously
Medical: mifepristone and vaginal misoprostol, analgesia and antiemetic
Surgical: manual vacuum aspiration if <12 weeks, evacuation of retained products

Follow up with pregnancy test 3/52 later

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40
Q

What causes genital warts?

A

HPV types 6 and 11

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41
Q

Which serotypes of HPV are oncogenic?

A

16 and 18

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42
Q

What are some risk factors for genital warts?

A

Early age at first sexual intercourse
Multiple sexual partners
Smoking
Immunosuppression

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43
Q

How may trichomonas vaginalis present?

A

Females: itchy, offensive yellow discharge, dyspareunia, strawberry cervix, vulvovaginitis

Males: urethral discharge, pain/ itching, dysuria

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44
Q

How is trichomonas vaginalis treated?

A

Metronidazole
(2g single dose of 500mg BD for 5-7 days)
Treat both partners at same time!
Full STI screen

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45
Q

What is bacterial vaginosis?

A

Not an STI!
Disturbance of normal vaginal Flora reduces number of lactobacilli and subsequent increase in vaginal pH
Allows growth of other organisms, commonly Gardnerella vaginalis
Most common causes of abnormal vaginal discharge

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46
Q

What are some risk factors for bacterial vaginosis?

A 
Sexual activity
Vaginal douching
IUD
Recent Abx use
STI
Smoking
African American
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47
Q

How does bacterial vaginosis present?

A

Offensive, fishy vaginal discharge

Thin white/ get discharge

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48
Q

Clue cells are indicative of what infection?

A

Bacterial vaginosis

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49
Q

What are some features of bacterial vaginosis on high vaginal swab?

A

Clue cells
Reduced lactobacilli
pH >4.5
Also positive KOH whiff test

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50
Q

KOH whiff test can be used in what infection?

A

Bacterial vaginosis

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51
Q

What antibiotic is used for bacterial vaginosis?

A

Metronidazole

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52
Q

What management advice would you give to a patient with bacterial vaginosis?

A

Avoid douching

Avoid scented shower gels

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53
Q

What medical treatment options are available for menorrhagia?

A

If requiring contraception: 1st line = mirena IUS, 2nd = COCP, 3rd = long acting progestogens e.g. depot/ implant

If not requiring contraception: TXA or mefenamic acid

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54
Q

What is menorrhagia defined as?

A

Blood loss >80ml per menses

Although now moving towards definition of excessive blood loss for the woman that impacts her quality of life

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55
Q

What are some causes of menorrhagia?

A

PALM-COEIN (structural and functional)

Polyps,adenomyosis, leiomyoma, malignancy and hyperplasia
Coagulopathy (eg VW), ovarian (PCOS, hypothyroid), endometriosis, iatrogenic (copper IUD), dysfunctional uterine bleeding

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56
Q

What is the inheritance pattern of von Willebrands disease?

A

Autosomal dominant

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57
Q

How can Von Willebrands disorder be treated?

A

TXA (antifibrinolytic)
Desmopressin (increases vWF)
Factor VIII concentrate

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58
Q

What are some investigations that can be done for a woman presenting with menorrhagia?

A 
FBC (anaemia)
TFTs (hypothyroid)
USS (pelvic or TVS)
Hormone levels (if predicting PCOS
Clotting tests
Cervical smear if not up to date
Swans for infection
Endometrial biopsy
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59
Q

How will bleeding time and APTT be in Von Willebrands disease?

A

Prolonged

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60
Q

What are some management options for a patient with PCOS?

A 
Weight loss and dietary advice
COCP
Clomifene for infertility 
Laser hair removal 
Anti-androgens
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61
Q

Which hormones are raised in PCOS?

A

Luteinising hormone

This stimulates ovarian production of androgens, hence raised testosterone

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62
Q

Where is luteinising hormone produced in the body?

A

In the anterior pituitary gland

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63
Q

Why is sex hormone binding globulin reduced in PCOS?

A

Due to high insulin, which suppressed the hepatic production of SHBG

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64
Q

What are some presenting features of PCOS?

A 
Oligo/amenorrhoea 
Acanthosis nigricans
Obesity
Hirsutism
Infertility
Depression
Chronic pelvic pain
Acne
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65
Q

Is the LH:FSH ratio low or high in PCOS?

A

High

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66
Q

Would progesterone be low or high in PCOS?

A

Low, due to oligo-amenorrhoea

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67
Q

What are some protective factors for endometrial Ca?

A

Smoking

COCP

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68
Q

Why does endometrial Ca develop?

A

Due to unopposed Oestrogen

69
Q

Which genetic condition can predispose to endometrial Ca?

A

Lynch syndrome

70
Q

Endometrial carcinoma that has extended to the cervix is what stage?

A

Stage 2

Stage 1 confined to uterine body, stage 2 to cervix, stage 3 beyond uterus but still in pelvis, stage 4 metastasised

71
Q

What are the different stages of endometrial Ca?

A

1 confined to uterine body
2 extended to cervix
3 still within pelvis but outside of uterus
4 metastasised

72
Q

How would stage 1 endometrial carcinoma be treated?

A

Hysterectomy + bilateral saplingo-oophorectomy

73
Q

Are most cervical cancers squamous or adeno carcinoma?

A

Squamous cell carcinoma

74
Q

What causes cervical squamous cell carcinomas?

A

Persistent HPV infection

75
Q

A lady with stage 1 cervical Ca wishes to opt for treatment that will preserve her fertility. What is the best option for her?

A

Radical trachelectomy (removal of cervix and upper vagina)

Other options not preserving fertility would include hysterectomy, brachytherapy/ external beam radiotherapy alongside chemotherapy (gold standard)

76
Q

What is the gold standard treatment for cervical cancer.

A

Chemo radiotherapy (stages 1b to 3)

77
Q

What are some risk factors for cervical Ca?

A 
HPV 
Smoking
Many sexual partners
Lower socioeconomic status
COCP
Early first intercourse
78
Q

For cervical cancer not diagnosed through routine screening, what is the most common symptom?

A

Abnormal PV bleeding (post coital, intermenstrual, postmenopausal)

79
Q

What result on routine cervical smear test would warrant urgent 2 week referral for colposcopy?

A

If moderate or severe dyskaryosis or suspected invasive cancer

80
Q

What is Asherman’s syndrome?

A

Formation of adhesions in the uterus following dilation and curettage
Can result in amenorrhoea/ dysmenorrhea, infertility and recurrent, miscarriage

81
Q

What will hormone levels show in premature ovarian failure?

A

Low Oestrogen, high FSH and high LH (due to -ve feedback)

82
Q

Premature ovarian failure is defined as undergoing the menopause before what age?

A

40 years old

83
Q

What happens to the LH and FSH levels in PCOS?

A

LH raised, LH to LSH ratio raised

Also can have high testosterone, low SHBG

84
Q

What is the indication for metformin in PCOS?

A

To treat infertility

85
Q

What are some causes of amenorrhoea?

A
  • primary (turners, androgen insensitivity syndrome)
  • secondary:
    hypothalamic (anorexia, excessive exercise )
    pituitary (prolactinoma, Sheehan’s syndrome, post contraception)
    ovarian (PCOS, menopause, premature ovarian failure)
    genital (ashermans syndrome, imperforate hymen)
    thyroid
    Pregnancy
86
Q

Will GnRH be high or low in a patient with a prolactinoma?

A

Low

87
Q

A 42 yr old px with menorrhagia has an USS which confirms presence of a large uterine fibroid. She wishes to undergo a hysterectomy. What medication would be appropriate to shrink her fibroid prior to surgery?

A

GnRH agonist

88
Q

How does hyperprolactinaemia result in anovulation?

A

High levels of prolactin inhibit hypothalamic GnRH release so less FSH and LH is released from the anterior pituitary

89
Q

What are some causes of hyperprolactinaemia?

A

Pituitary tumour (prolactinoma)
Hypothyroid
Antipsychotics

90
Q

What is infertility defined as?

A

Unable to become pregnant after at least 1 year of regular, unprotected sex
Primary if unable to have first child
Secondary if already had at least one child

91
Q

What are some male causes of infertility?

A 
Impotence
Abnormal sperm
Testicular tumour
Varicocele 
Orchitis
Hyperprolactinaemia 
Undescended testes
Retrograde ejaculation
92
Q

Anti-mullerian hormone is best to measure what?

A

Ovarian stores (high = good reserve)

93
Q

What hormone can be used to check if someone is ovulating, and what day of the cycle is this measured?

A

Progesterone
Measure on day 21
High levels confirm ovulation

94
Q

What are some structural causes of infertility?

A 
Adhesions
Polyps
Fibroids
Vaginal septum 
Blocked tubes (PID, adhesions)
95
Q

What investigation can test Fallopian tube patency?

A

Hysterosalpingogram

Used x Ray with contrast dye

96
Q

What drug should be prescribed for a patient with Trichomonas vaginalis?

A

Metronidazole

97
Q

What drug treatment should be used for gonorrhoea?

A

IM ceftriaxome single dose

Oral azithromycin single dose

98
Q

What drug treatment should be used for bacterial vaginosis?

A 
Oral metronidazole 
(2g single dose or 400mg BD 5-7 days)
99
Q

What are some differences in the presentation of trichomonas vaginalis and bacterial vaginosis for women?

A

TV: yellow/ green frothy discharge, itch, dyspareunia, dysuria, vulvovaginitis, strawberrry cervix
BV: fishy thin white/ grey discharge, clue cells, ph >4.5 (not associated with itchiness or soreness unlike TV)

100
Q

Strawberry cervix is a sign seen in what?

A

Trichomonas vaginalis infection

101
Q

How is urge urinary incontinence managed?

A

Conservative: bladder retraining (at Keats 6/52 increasing intervals between voiding), reduce caffeine and fluid intake
Medical: oxybutynin (anticholinergics)
Surgical: Botox toxin to detrusor

102
Q

What is cervical excitation?

A

Aka cervical motion tenderness/ chandelier sign
Excruciating pain upon bimanual examination
Indicates pelvic pathology e.g. PID, ectopic pregnancy

103
Q

What is the most useful investigation for suspected endometriosis?

A

Laparoscopy

Chocolate cysts

104
Q

By how much should bHCG rise approximately in a normal pregnancy?

A

Double every 48 hours

105
Q

What is a cystocele?

A

Defect in the anterior vaginal wall causing prolapse of the bladder

106
Q

What is the name of the genitourinary prolapse associated with a defect in the posterior vaginal wall?

A

Rectocele, allows rectum to prolapse

107
Q

What are the different types of pelvic prolapse?

A

Uterine prolapse: uterine prolapses into vagina
Cystocele: defect in anterior vaginal wall causes prolapse of bladder
Urethrocele:defect in anterior vaginal wall causes prolapse of urethra
Rectocele: defect in posterior vaginal wall causes prolapse of rectum

108
Q

What are some management options for genitourinary prolapse?

A

Conservative e.g. pelvic floor exercise, tx incontinence, weight loss
Pessary
Surgical repair

109
Q

What Ca is a nulliparous women who suffers with primary infertility and has undergone repeated cycles of ovarian stimulation at most risk of?

A

Ovarian Ca

110
Q

What is the next step for a woman with 3 consecutive borderline smear tests?

A

Refer for colposcopy

111
Q

What chemical is thought to be the cause of dysmenorrhea?

A

Prostaglandins (causing spiral artery vasospasm and increased myometrial contractions)

112
Q

What management options are available for patients with primary dysmenorrhea?

A

Conservative: quit smoking, hot water bottle

Medical: NSAIDs 1st line (inhibit prostaglandin synthesis which causes the pain) +/- paracetamol, 2nd line is COCP/ IUS

Transcutaneous nerve stimulation

113
Q

What are some causes of secondary dysmenorrhea?

A 
Endometriosis
Adenomyosis 
Adhesions 
Pelvic inflammatory disease
Copper IUD
Fibroids
114
Q

Cervical excitation is suggestive of which conditions?

A

Pelvic inflammatory disease

Ectopic pregnancy

115
Q

What is adenomyosis?

A

The presence of functional endometrial tissue within the myometrium of the uterus

116
Q

How does adenomyosis usually present (history and examination?)

A 
Dysmenorrhea
Menorrhagia
Dyspareunia
Irregular bleeding
Enlarged, boggy uterus (symmetrical, unlike asymmetry with fibroids)
117
Q

What are some risk factors for adenomyosis?

A

High parity, uterine surgery, previous C section

Most commonly occurs in multiparous women at the end of their reproductive life

118
Q

What is the mechanism of GnRH agonists and what can they be used in?

A

Downregulate the GnRH receptors so after a while of usage they cause pituitary de-sensitisation, so less LH and FSH so less gonadotrophic hormones
Used in menorrhagia, adenomyosis, fibroids (also prostate Ca, precocious puberty, IVF)

119
Q

What is the mechanism of action of duloxetine?

A

Serotonin and noradrenaline reuotake inhibitor

Antidepressant and also indicated for stress urinary incontinence

120
Q

Which ligaments are responsible for holidaying the uterus in place in the pelvis?

A

Pubocervical ligaments attaches to pubic symphysis
Transverse ligaments attach to pelvic side wall
Uterosacral ligaments attach to sacrum
Broad ligaments is a sheet of peritoneum that covers the uterus
Pelvic floor muscles hold it in place inferiorly

121
Q

Which pelvic ligament is a sheet of peritoneum?

A

Broad ligament, covers the uterus anteriorly and posteriorly

122
Q

What side effects would you earn a women having an oophorectomy?

A

Vasomotor symptoms
Subfertility
Reduced Oestrogen:
Risk of oesteoporosis
CVD risk risk
Menopausal mood swings, insomnia
Thin hair, skin
Adhesions can lead to chronic pelvic pain
Vaginal dryness, reduced libido
Surgery: Risk of injury to bladder and bowel, Infection, Bleeding, VTE
Reduced testosterone: reduced concentration, aches and pains

123
Q

What can happen when an ovarian mucous cystadenoma ruptures?

A

Psuedomhxoma peritonei (jelly like contents irritating the peritoneum)

124
Q

What are some type of ovarian cysts?

A 
Follicular (associated with menstruated cycle)
Teratoma (contain hair and teeth)
Theca lutein (associated with molar pregnancy, regress when bHCG lowers)
Fibroma (associated with Meigs syndrome
Endometrioma (chocolate cysts)
Corpus luteal cyst
Polycystic (ring of pearl sign
Serous cystadenoma
Mucous cystadenoma
125
Q

What factors does the risk of malignancy index look at?

A

CA125, ultrasound scan results, woman’s age

126
Q

How would you manage an ovarian cyst?

A

If pre menopausal and small, rescan in 6/52 to see if resolution. If large of persistent, offer laparoscopic cystectomy/ oophorectomy

If postmenopausal, follow up if low, surgery if high

127
Q

What are some differentials for chronic pelvic pain?

A 
Adhesions
PID
Endometriosis
Adenomyosis 
Pelvic congestion 
Psychosexual e.g. unwanted children, childhood sexual abuse
128
Q

When is large loop of excision of the the transformation zone offered to women?

A

LLETZ offered in >CIN 1, then f/u and HPV test at 6 months

129
Q

Which medication can be used to reduce the size of a fibroid prior to surgery?

A

GnRH analogues e.g. goserelin

But can only be used for 6/12 due to risk of osteoporosis

130
Q

What surgical options can be offered for fibroids?

A

Transcervical resection (good for submucosal)
Myomectomy
Hysterectomy
Uterine artery embolisation

131
Q

What is the Rotterdam criteria used in the diagnosis of?

A

Polycystic ovarian syndrome

132
Q

What is the rotterdam criteria for PCOS?

A

Polycystic ovaries (>12)
Oligo/amenorrhoea
Signs of hyperandrogenism

133
Q

What are some causes of recurrent miscarriage?

A 
Antiphospholipid syndrome
Factor V Leiden
Protein C and S deficiency
Uterine abnormalities e.g. fibroids, septum, adhesions, cervical weakness
Chromosomal abnormalities
Teratogens
134
Q

What treatment options are available for a women miscarrying a pregnancy?

A

Conservative/ expectant: analgesic and wait for products to pass (can be done at home not guaranteed and will cause pain and bleeding)
Medical: mifepristone and misoprostol to expel products (avoids surgery but CN be in pain and bleed for a few weeks)
Surgical: suction curette to empty uterus (quickest option but risks of surgery)

135
Q

What will transvaginal USS scan show in ectopic pregnancy?

A

No uterine pregnancy seen

136
Q

What would you advise a px who is prescribed methotrexate for medical management of her ectopic pregnancy?

A

That she must comply with liver function tests

And that she can not get pregnant for a further 6 months

137
Q

What bacteria causes syphilis?

A

Treponema pallidum

138
Q

What are the stages of a syphilis infection?

A

Primary syphilis: painless chancre forms after a couple of weeks (can cause obliterating arteritis is left untreated)

Secondary syphilis: develops 3 months post infection with generalised symptoms e.g. fever, weight loss, arthralgia, malaise, lymphadenopathy, non itchy rash

Tertiary syphilis: years after initial infection, neurosyphilis, cardiovascular syphilis, gummatous syphilis

139
Q

What drug is used to treat syphilis?

A

Penicillin

140
Q

What cells does HIV infect?

A

CD4 T helper cells

141
Q

How can HIV be vertically transmitted?

A

In utero
During delivery
Breastfeeding

142
Q

What are some examples of AIDS defining illnesses?

A

Pneumocystitis jiroveci pneumonia
TB
Non Hodgkin’s lymphoma
Kaposi’s sarcoma

143
Q

What test is used to diagnose HIV?

A

Fourth generation ELISA test (tests for HIV antibody)

144
Q

How long after HIV infection until ELISA test will be positive?

A

4-6 weeks

145
Q

How is HIV managed?

A

Highly active anti retroviral therapy
Reduces virus counts to undetectable levels so px has very good prognosis and minimal chance of onwards transmission
Must take everyday for the rest of their lives
Regular testing of viral load, CD4 count, LFTs, U+Es, FBC, urinalysis

146
Q

CD4 count less than what is an indicator to start HAART?

A

Less than 350

147
Q

What is post exposure prophylaxis?

A

Medication to reduce likelihood of infection if someone thinks that may have been exposed HIV
Must be taken within 72 hours of exposure, for one month

148
Q

What measures must be taken for the pregnancy of a HIV +ve mum to reduce risk of transmission to her baby?

A
  • take antiretrovirals during pregnancy and delivery
  • avoid breastfeeding
  • neonatal post exposure prophylaxis
  • can still deliver vaginally, unless viral load is above 50
149
Q

How do genital warts present?

A

Painless fleshy lesions

Can present weeks/ months/ years after infection

150
Q

What causes genital warts?

A

HPV types 6 and 11

151
Q

What management advice would you give to a patient presenting with genital warts?

A

Likely to resolve spontaneously
Full STI screen due to likelihood of co infection
Can give antiviral creams
If persistent, cryotherapy or surgery possible

152
Q

What first line investigations should be ordered for a couple presenting with infertility?

A

Semen analysis

Day 21 serum progesterone

153
Q

What is the FIGO staging for endometrial carcinoma?

A

Stage 1: confined to uterine body
Stage 2: extend to cervix
Stage 3: extended beyond the uterus but still within the pelvis
Stage 4: metastasised

154
Q

What surgical management would you perform for a woman with stage 2 endometrial cancer?

A

Radical hysterectomy

Also removing the vaginal tissue surrounding the cervix as the cancer has extended here for stage 2

155
Q

In what categories of miscarriage would the cervical os be closed?

A

Threatened
Complete
Missed

156
Q

How does a history of PCOS act as a risk factor for endometrial Ca?

A

Increased periods of anovulation, so more unopposed Oestrogen

157
Q

How does obesity increase the risk of endometrial and breast cancer?

A

Increased peripheral conversion of androgens to Oestrogens

158
Q

What are some causes of postmenopausal PV bleeding?

A 
Endometrial Ca
Endometrial hyperplasia
Cervical Ca
Endometrial polyp
Cervical polyp
Vulval carcinoma
159
Q

What organisms can a high vaginal swab test for?

A

Gardnerella vaginalis
Trichomonas vaginalis
Group B strep
Candida

160
Q

What is suitable medical management for chlamydia infection?

A

PO azithromycin 1g STAT

Or, 7 day course doxycycline 100mg BD

161
Q

What is suitable medical management of gonorrhoea?

A

IM ceftriaxone + P.O. azithromycin

162
Q

What is the diagnostic investigation for chlamydia and gonorrhoea?

A

NAAT
Via first catch urine sample in men and endocervical swab in women
(Can also swab rectum and oropharynx)

163
Q

What is the management of chlamydia infection?

A 
1g PO azithromycin STAT
OR
7/7 doxycycline BD
OR
7/7 ofloxacin
OR
14 days erythromycin 
PLUS contact tracing and partner notification
Avoid sex until both parties are tested and treated
164
Q

What are some complications of a chlamydia infection?

A

PID (-> ectopics, subfertility, perihepatitis)
Epididymitis
Reactive arthritis (more common in men)

165
Q

What are the incubation periods for chlamydia and gonorrhoea?

A

7-21 days chlamydia

2-5 days gonorrhoea

166
Q

What is the recommended management of gonorrhoea?

A 
IM ceftriaxone 1g STAT
(No longer recommend stat azithromycin)
Partner notification and contact tracing
Avoid sex until treated
Test of cure via NAAT 2 weeks later
167
Q

What is the causative organism of syphilis?

A

Treponema pallidum

168
Q

What investigations would you do for a patient newly positive for HIV?

A

Viral load (baseline and to measure tx response)
CD4 count (establish stage and their immune status)
Drug resistance testing
Hepatitis B and C serology
Tuberculin skin test (+ve -> BCG)

169
Q

Other than HAART, what other aspects are key in HIV management?

A 
Counselling 
Up to date vaccines e.g. HPV, pneumococcal, influenza, hepatitis B (live vaccines eg BCG are CI)
Nutrition
Annual cervical smear
Prophylactic co-trimoxazole
Statin for CVD risk

EOY4 (15 decks)

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