Gynaecology

Question 1

postmenopausal bleeding DDx (6), Ix (1), Mx(1)

Answer 1

DDx:

 - Endometrial cancer
 - Vaginal atrophy
 - Cervical cancer
 - Ovarian cancer
 - endometrial/cervical polyp
 - Vaginal trauma

Ix: to assist in diagnosis —> vaginal Ultrasound (ET > 4mm)
Mx: referral to gynaecology team for endometrial biopsy

Question 2

ovarian cancer - high-risk group (2) and screeing

Answer 2

no screening

High risk:

 - 1st degree with ovarian cancer
 - BRCA genes

Question 3

ovarian cancer - who is at risk

Answer 3

(anything lead to increase estrogen exposure)

 - Nulliparous
 - PCOS
 - Early menarche
 - Late menopause
 - HRT 
 - No use of OCP in the past (OCP contain progesterone)
 - Family history of ovarian cancer
 - Family/personal history of colon or breast cancer
 - smoking
 - Breastfeeding (protective factor)

Question 4

ovarian cancer - early non-specific symptoms

Answer 4

• Abdominal bloating
  
  • Pelvic pain
  • Feeling full (early satiety)
  • Urinary urgency, frequency
  • Constipation
  • PR bleeding
  • PV bleeding
  • Dyspareunia

Question 5

ovarian cancer - possible physical finding

Answer 5

• Adnexal mass on bimanual pelvic examination
  
  • Palpable abdominal mass
  • Ascitis
  • Pleural effusion
  • Enlarged liver
  • Palpable LN

Question 6

ovarian cancer- other causes of elevated CA 125

Answer 6

• Idiopathic
  
  • Ovarian cancer
  • Ovarian cyst
  • Endometrial cancer
  • Endometrial fibroid
  • PID
  • Colon cancer
  • Breast cancer
  • Liver disease/cirrhosis

Question 7

ovarian cancer - advises to pt with late diagnosis

Answer 7

• Early symptoms of ovarian cancer are non-specific
  
  • There is no test available for diagnosis of early-stage ovarian cancer
  • Over-investigation for ovarian cancer can lead to over-treatment and complication

Question 8

ovarian cancer - advises to relatives of ovarian cancer

Answer 8

• There is no screen for ovarian cancer
  
  • Need to increase screening of colon and breast cancer
  • Need to educate about vague early non-specific symptoms of ovarian cancer
  • Admit that they have a high risk of ovarian cancer
  • Screening for ovarian cancer is associated with risk