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Obs and Gynae > Lectures > Flashcards

Lectures Flashcards

1
Q

4 risk factors for incontinence in women?

A

age
parity
obesity
smoking

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2
Q

what are the 2 main types of incontinence and what is their pathophysiology?

A

urge urinary incontinence: can be caused by overactive bladder syndrome
- involuntary bladder contractions (detrusor overactivity is urodynamics finding)

stress urinary incontinence - sphincter weaknes: damage to pubourethral ligament

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3
Q

other than stress incontinence and overactive bladder what are the other things which may be causing incontinence?

A 
fistula 
neurological 
overflow 
functional 
mixed incontinence
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4
Q

describe how overactive bladder symptoms might present

A

urgency with urgency incontinence
frequency
nocturia
nocturnal enuresis

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5
Q

describe how stress incontinence would present

A

involuntary leakage on:

  • cough
  • laugh
  • lifting
  • exercise
  • movement
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6
Q

name some simple assessments you might do when someone presents with incontinence in clinic?

A

frequency volume chart (FVC)/bladder diary

urinalysis (MSU) and urine dip

residual urine measurement (RU) - in and out catheter or ultrasound

questionnaire (ePAQ- electronic Personal Assessment Questionnaire, there is a specific one for pelvic floor)

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7
Q

what is recorded in a bladder diary?

when would you use a bladder diary?

A 
voided volume 
frequency of urination 
quantity and frequency of leakage 
fluid intake 
diurnal variation

when someone is presenting with urge incontinence

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8
Q

what 4 domains are on an ePAQ questionnaire for pelvic floor?

what sort of things are looked at in each domain?

A

urinary - pain, voiding, overactive bladder, stress incontinence, QoL

bowel - IBS, constipation, evacuation, continence, QoL

vaginal - pain, capacity, prolapse, QoL

sexual - urinary, bowel, vaginal, dyspareunia, overall sex life

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9
Q

what two normal daily activities can trigger urge incontinence

A

washing hands

‘key in door’ - needing it as soon as you’ve got to the door of the house

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10
Q

first line treatment for stress incontinence?

A

pelvic floor muscle exercises (physiotherapy)

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11
Q

first line treatment for urge incontinence?

what can it be combined with?

what other things would you advise?

A

anti muscarinic - oxybutynin
with
bladder training/drill

+ simple measures
- avoid alcohol, caffeine, lose weight, smoking cessation

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12
Q

if there is no improvement to stress incontinence after 6 months of PFMEs and there is no urge aspect, what treatment can be offered?

what is the aim of this?

A

surgery

  • tension free vaginal tape - first line
  • colposuspension
  • retropubic midurethral tape

to elevate bladder neck and proximal urethra to support bladder neck

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13
Q

what lifestyle measures should be recommended to women presenting with incontinence?

A
  • weight loss
  • smoking cessations
  • reduced caffeine inftake
  • avoidance of straining and constipation
  • can use pads and pants
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14
Q

if antimuscarinics fail for urge incontinence what else can be done?

A

botox injections (expensive and retreat every 6 months)
or
sacral nerve stimulation

or
bladder bypass (catheters)
leakage barriers (pads and pants)
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15
Q

what do antimuscarincs do to treat urge incontinence?

what are the side effects?

how might you reduce the side effects?

A

direct relaxant on urinary smooth muscle

dry mouth, dry eyes, blurred vision, drowsy, constipated
uncommon: urine retention with overflow incontinence

PRN only (immediate release)

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16
Q

which antimuscarinic is first line for urge incontinence?

who should you be careful prescribing it in?

A

oxybutynin

elderly - because can cause cognitive impairment

Do not offer oxybutynin (immediate release) to older women who may be at higher risk of a sudden deterioration in their physical or mental health. [2013, amended 2019]

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17
Q

what is mirabegron? and what does it do?

who is it used in?

A

Beta-3 adrenergic receptor agonist - Relaxes smooth muscle detrusor and increases bladder capacity

treat women with overactive bladder but ONLY for people in whom antimuscarinic drugs are contraindicated or clinically ineffective, or have unacceptable side effects.

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18
Q

how does PFMEs work in reduces stress incontinence?

A 
Pelvic floor muscle contraction
=
Clamping / compression of urethra
=
Increased urethral pressure
=
Reduced leakage
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19
Q

when would you do urodynamics?

when would you not do urodynamics?

A

prior to surgery if:
suspicion of detrusor overactivity (TVT would be useless)

previous surgery for stress incontinence

suspicion of incomplete bladder emptying

wouldn’t do if you’re just going to conservatively manage this patient

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20
Q

what happens in urodynamics?

A

probe in bladder and rectum

void in front of investigators (cystometry)

instilling the bladder with normal saline and participant telling the investigators of desires to void

jumping/coughing being observed for leakage

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21
Q

what are the 5 types of prolapse and categorise into which compartment they come from

A

anterior: urethrocoele, cystocoele

middle compartment: utero-vaginal prolapse

posterior: rectocoele
enterocoele

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22
Q

what piece of equipment do you need to examine a suspected prolapse?

A

sim’s speculum

+ sponge forceps

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23
Q

what symptoms might someone describe coming in with prolapse?

A 
'something coming down'
feeling of fullness 
sexual dysfunction 
urinary symptoms 
bowel symptoms

NB: always ask about bowel symptoms! esp rectocoele may cause problems with defecation ‘digitate to defecate’

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24
Q

what are risk factors for prolapse?

A

obesity
multiparity
menopause
(chronic raised pressure - COPD/constipation)

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25
Q

what measurement is used to describe a prolapse?

A

pelvic organ prolapse quantification (POP-Q)

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26
Q

what are the management options for prolapse?

when would you move to the second option?

A

conservative: weight loss, pessary

surgical - repair (e.g anterior repair) or total vaginal hysterectomy with vault suspension

only surgical if:
symptomatic (dyspareunia, discomfort, obstruction, bothersome)
or
severe (outside vagina, ulcerated, failed conservative measures)

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27
Q

what are the 2 consequences or that can occur with pelvic floor damage?

A

stress incontinence

prolapse

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28
Q

types and examples of analgesia for labour

A

non-pharmacological therapies

  • trained support
  • acupuncture
  • hypnotherapy
  • massage
  • TENS
  • hydrotherapy

pharmacological therapies
- oral - paracetamol, codeine
- inhalational - entonox (nitrous oxide)
- single shot parenteral opioids (morphine/diamorphine injection)
- PCO opioids - pressed just as contraction comes (remifentynyl)
regional techiniques - epidurals

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29
Q

what nerves are related to uterine contractions

A

T10-L1

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30
Q

challenge of analgesia in labour

A

providing analgesia that matches the waxing and waning of the labour pain (waves of really strong pain, then little)

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31
Q

entonox

- what is it, describe its use and possible effects

A

50% n2o, 50% o2 ‘gas and air’

rapid onset of analgesia
minimal side effects
self limiting - breath in to get the effects, breath out effect wears off
theoretical risk of bone marrow suppression
green house gas

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32
Q

systemic analgesia for labour

A

simple analgesia:
paracetamol and codeine

opioids -
single shot, usually IM - morphine, diamorphine, pethidine
or patient controlled analgesia via IV cannula (remifentanil)

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33
Q

regional techniques

A

epidural and spinal - numbing nerves leading from the

spinal goes into CSF

epidural goes into the epidural space - MORE COMMON IN LABOUR WARD - analgesia but not anathesia - so she can move around still

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34
Q

what level do you insert epidural for labour into and why?

A

L3/4 (tuffiers line) because the spinal cord terminates at L2

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35
Q

indications of epidural for labour

A
  • maternal request
  • pregnancy induced hypertension/ pre-eclampsia
  • cardiac/other medical disease (anyone that you don’t want to have massive surges in BP)
  • augmented labour with oxytocin infusion (they experience more pain in their contractions)
  • multiple births
  • instrumental/operative delivery likely
    (may need the second delivery to be under anaesthesia, quicker to get this and take them to theatres)
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36
Q

contraindications to epidural labour

A

absolute - maternal refusal, local infection, allergy to local anaesthetic (but make sure clarify), severe coagulopathy (risk of epidural hematoma which can lead to cauda equina)

relative - systemic infection, hypovolaemia, abnormal anatomy, fixed cardiac output (aortic and mitral stenosis)

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37
Q

what drugs do you put in a epidural/spinal?

A

bupivacaine - local anaesthetic

fentanyl and diamorphine - opioid

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38
Q

adverse effects of regionals

A

cardiovascular
respiratory (SOB/resp depression)
neurological
drug related - adverse effects/if you put the wrong drug in
headache - CFS leaks out and cause a headache from low CSF pressure

may prolong labour, may increase instrumental delivery rates but NO increased in c-section rates!

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39
Q

anaesthesia for operative delivery

A

regional anaesthesia

  • epidural top up
  • spinal (into the CSF) –> more commonly for c-section
  • CSE

general anaesthesia

but better for regional because mum can be awake for baby and see immediately, partner present, improved post op analgesia

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40
Q

indication for GA in delivery

A
  • imminent threat to mother and/or foetus
  • contraindication to regional
  • maternal preference
  • failed regional technique
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41
Q

what anaesthesia are you most likely to use for a c-section?

A

spinal

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42
Q

what regional analgesia are you most likely to use for labour pains on the ward?

A

epidural

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43
Q

what is menorrhagia?

A

heavy menstrual bleeding occurring at the expected intervals of the menstrual cycle - subjective, interfere with their quality of life

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44
Q

intermenstrual bleeding

A

bleeding between periods - abnormal, requires investigation

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45
Q

abnormal uterine bleeding

A

summary term for
volume or length of bleeding for
intermenstrual bleeding, post coital bleeding etc etc

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46
Q

causes of heavy menstrual bleeding?

A

coagulopathy
ovulatory
endometrial dysfunction

fibroids (benign tumours of myometrium - often asymptomatic)

polyps (benign localised growths of the endometrium)

adenomyosis (endometrial tissue within the myometrium - like endometriosis)

(endometriosis but not normally the PC)

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47
Q

how does gynae malignancy present?

A

prolonged intersmenstual bleeding
post coital bleeding
post menopausal bleeding

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48
Q

what is dysfunctional uterine bleeding?

A

heavy menstrual bleeding in the absence of pathology

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49
Q

investigations of menorrhagia?

A

FBC +/- hematinics
coat screen
TFT

TVS
hysteroscopy

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50
Q

when to biopsy in hysterectomy

A

indicated if aged >45yr and any of: inter menstrual bleeding, unresponsive to treatment and new onset/change in menstrual pattern

consider at any age if: 
persistent IMB ro irregular bleeding 
infrequent heavy bleeding who are obese or PCOS
women taking tamoxifen 
treatment for HMB has been unsuccessful 
new onset/change in menstrual pattern
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51
Q

treatment of heavy menstrual bleeding

A

reassurance

if wanting baby soon:
methanamic acid
tranexamic acid
progestagens - northesiterone

if not wanting baby soon:
mirena coil
COCP (back to back for 3 years)
POP

hysterectomy in older women

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52
Q

methanamic acid is better for

A

NSAIDs

better just for pain symptoms

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53
Q

tranexamic acid is?

A

good for bleeding

inhibits tissue plasminogen activitor

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54
Q

what is the first line treatment for HMB?

A

mirena coil (unless wanting to get pregnant)

55
Q

when to refer women to secondary care?

A

pathology
fibroids >3cm
failed primary care treatment
wanting surgery

56
Q

endometrial ablations

A

laser, electrosurgery, and balloons

57
Q

inidcation for endometrial abalations?

A

heavy mentrsual loss
completed family
….

58
Q

CI to endometrial ablatiion

A

malignancy
acute PID
wanting to have a baby
….

59
Q

how to treat fibroids >3cm with fertility sparing surgery?

A

myomectomy/resection of fibroids

uterine artery embolisation

60
Q

obstetric emergencies - what are they?

A

maternal - APH, PPH VTE, Pre-eclam

fetal- fetal distress, cord prolapse, shoulder dystochia

61
Q

antepartum hemorrhage define and what are the common causes

A

bleeding from anywhere in the genital tract after 24th week of pregnancy

can be from: 
uterus (low lying/placenta previa, abruption, vasa previa)
cervix (tumour, polyp, ectropion)
vagina (vagina tear, infection) 
vulval (lesions)

no identifiable cause in 40%

62
Q

when is low lying placenta diagnosed?

what should you do?

A

20 week anomaly scan

repeat scan at 32 weeks (if major) then 36 weeks (if minor, or again after major)

DO NOT DO BIMANUAL
safety net for PV bleeds

plan
if <2cm from os - c section at 37 weeks (before if bleeding)
if 2-3cm - consider NVD/c-section
>3cm - NVD

if rhesus neg = give anti D injection

63
Q

acute bleeding placenta preavia mx

A

ABCDE

examination - general and abdo, speculum but not bimanual

USS to diagnose preavia

fetal monitoring - CTG
+/- delivery with steroids if <34 weeks

64
Q

if there is accreta how do you deliver?

what do you need to make sure you have done before?

A

c-section between 36-37 weeks at a tertiary centre

discussed and consented for hysterectomy, leaving placenta in place, cell salvage and interventional radiology (uterine artery embolisation)

cross matches and blood ready in theatre

65
Q

what is the biggest risk factors for accreta?

A

previous c-section

66
Q

who does vasa praevia normally present?

A

rupture of membranes at the same time the bleeding starts

CTG anomalies

67
Q

what is placental abruption?

how might it present?

A

premature separation of the placenta from the uterine wall before delivery of the baby

can be concealed or revealed haemorrhage
woody-hard, tense uterus
TENDER abdo/uterus
fetal distress on CTG
maternal shock out of proportion to bleeding (concealed haemorrhage)

68
Q

complications of APH?

A 
premature labour/delivery 
blood transfusion 
acute tubular necrosis (+/- renal failure) 
DIC 
PPH!!! risk 
ITU admission 
fetal morbidity (hypoxia) and mortality
69
Q

what is primary post partum hemorrhage?

A

within 24 hours of delivery, blood loss >500mls

70
Q

what is secondary PPH?

A

after 24 hours and up to 12 weeks post delivery

71
Q

whats the difference between minor and major PPH?

A

minor = 500ml-1L
major < 1L

massive = >1.5L

72
Q

4 Ts for PPH and how do you manage these?

A

tone (boggy) - ensure uterus contracted (bimanual compression massage, uterotonics - last resort is hysterectomy)

tissue - ensure placenta complete (manual removal of placenta/POC)

trauma - look for tears (repair)

thrombin - check clotting (transfuse)

73
Q

risk factors for PPH?

A 
big baby 
polyhydramnios 
grand multiparity 
multiple pregnancy
prolonged labour 
maternal pyrexia 
instrumental delivery 
shoulder dystochia 
previous PPH
74
Q

severe pre-eclamspia

A

hypertension + proteinuria

+/- at least one of the following

  • severe headache
  • visual dis
  • papiloedma
  • clonus /brisk reflexes
  • liver tenderness
  • abnormal liver enemies
  • platelet count falls to <100 x10^9
75
Q

treatment of severe pre-eclampsia

A

stabilised blood pressure (labetalol or nifedipine if asthma)

check bloods including platelets, renal and liver function

magnesium sulphate - prevention of eclampsia

monitor urine output (+fluid restrict)

treat coag defects

fetal wellbeing (CTGS, USS for metal growth)

DELIVERY IS DEFINITIVE MANAGEMENT

76
Q

what is definition of eclampsia and how do you prevent it?

how do you treat?

A

hypertension and proteinuria WITH seizures
magnesium sulphate

also treat with magsul
stabilise blood pressure

77
Q

how do you monitor fetal compromise?

A

CTG

78
Q

cord prolapse

what should you do?

A

occurs when the cord is presenting after rupturing of membrane

999 if at home
trendelenburg position - feet higher than head

79
Q

complications of shoulder dystocia?

A

maternal: PPH, extensive vaginal tear, psycholocial
neonatal: injury to brachial plexus injury (erbs palsy) hypoxia, fits, CP

80
Q

risk factors for shoulder dystocia

A

macrosomia
high maternal BMI
….

81
Q

what women are high risk antenatally and therefore should be seen by a consultant?

A

any medical condition basically: diabetes, hypertension, cardiovascular, renal, respiratory

older women and younger women - extremes of age

obese and underweight

substance misuse/smoking
(domestic violence - specialist midwives tho)

previous obstetrics complications - 3/4th degree tear, small baby, big baby, recurrent miscarriages

82
Q

what puts baby at risk of growth restriction?

A

smoking, pre-eclampsia, previous small baby,

83
Q

how can be monitor foetus antenatally?

A

USS - head circumference, abdominal circumference, growth (plot on personalised growth chart)

liquor volume - black space around the baby on USS

doppler - resistance in the placenta and flow through the umbilical cord

CTG - cardiotocography (heart of baby, and uterine contractions - only how often the uterine contractions are not the strength)

84
Q

how to monitor the foetal heart rate intrapartum?

A

intermittent auscultation - pinard or doppler device
(for low risk women in labour - every 15 mins for 1 minute in the first stage, then after every contraction in stage 2)

continous monitoring with a CTG
(for higher risk women)

scalp ECG - GOLD STANDARD FOR DIRECT FHR monitoring BUT it is invasive and increased risk of infection and requires membranes to be ruptured

abdominal fetal ECG - non invasive and being researched

85
Q

benefits drawbacks or intermittent vs continuous auscultation of foetus?

A

CTG can see variability and decelerations better, which can be done longer term

but there is no benefit of using it in low risk women

86
Q

what should the baseline heart rate be on a CTG

A

110-160bpm

87
Q

what should variability be on CTG

A

> 5bpm

poor variability could be hypoxia or might be asleep (max 40 mins)

88
Q

how many contractions should you be having in 10 minutes?

A

max 4 - if you are 5 in 10, you are hyperstimulating the uterus and might consider giving tocolysis

89
Q

what pneumonic is used to describe a CTG?

A

DR C BRAVADO

define risk
contractions

baseline HR
variability
accelerations
declerations

90
Q

late decelerations - what are they and what do it mean?

A

trough of decel is after the contraction peak

sign of hypoxia in themselves

further intervention to monitor or just deliver!

91
Q

early decelerations are…
normal/abnormal?
why do they happen?

A

normal

due to pressure on the baby head

92
Q

what is FGM?

A

all precedures involving partial or total removal or female external genital or other injury to the female orangs for non-medical reasons

93
Q

types of FGM

A

type 1 - cliteroidectimy
type 2 - excision of cit and labia minora
type 3- infibulation: narrowing/sowing up of the vaginal orifice
type 4 - anything else - pricking, piercing, inciting, scraping and cauterisation

94
Q

why is FGM done?

A

in some places -

social norm/expected
status and respect
preserves girls chastity/virginity
part of being a women
its rite of passage
upholds family honour
cleanses and purifies the girl
fulfils a perceived religious requirement (but there is no religious text saying this, actually forbidden in islam even though its there)
gives them the sense of belonging to the community
it gives the girl social acceptance - esp for marriage

95
Q

what countries most often still ahem FGM?

A

most commonly in african continent - somalia (T3), eygpt (T1-2), ethiopia, sudan

96
Q

FGM hotspots in the UK

A

london, cardiff, manc, sheffield (lots of somalian), birmingham, oxford, reading…

97
Q

the law and FGM

A

offence to perform FGM in england, wales and northern ireland (and scotland but not in the same documents????)

AND traveling for FGM if you are a UK national/permanent UK resident - under child act 198…

98
Q

is it mandatory to record on health records if they have had FGM?

who’s responsibility to inform?

A

yes - from sept 2014 have to record in records

under 18 - phone call to the police force in the next working day

in both cases even if its a clitoral piercing

99
Q

what are the gynaecological complications of FGM?

A 
dyspareunia
sexual dysfunction with anorgasmia 
chronic pain 
keloid scar formation 
dysmenorrhoea
urinary outflow obstruction 
PTSD 
difficulty conceiving
100
Q

what are the obstetric complications of FGM?

A

fear of child birth

increased risk of:
C section, PPH, episiotomy, severe vaginal lacerations

extended hospital stay

difficulty in monitoring in labour:
difficultly performing vaginal exams in labour, applying metal scalp electrodes, metal blood sampling, catherterising the bladder

101
Q

how do you management infibulation?

A

DE-INFIBULATION

ideally pre-conception reversal of infibulation
ideally done by 20 weeks antenatally

DO NOT RE-INFIBULATE EVEN IF HEMORRHAGING

102
Q

what is our responsibilities in terms of FGM in the UK?

A

report all cases of FGM in he medical notes/police

103
Q

whats the normal age of menarche?

A

12-13 years old but (11-14.5)

precedent by breast development and pubic hear development and peak higher velocity

104
Q

what are the first few periods like?

A

normally pain free and often long gaps in between( >45 days)

105
Q

ameorrhoea and what are the causes

A

no menstruation bya e 16 in the presence of secondary characteristics (turners dryndrome, pre ovarian failure, HPO disorders, anatomical issues - imperforate hymen/septum, Mullerian agenesis, congenital adrenal hyperplasia, complete androgen insensitivity syndrome(will have undescended testicles)

or absence of secondary sexual characteristics and amonorhoeic at aged 13

seconddary amenorrhoea: cessations of menses for … (weight loss, exessive exercise, PCOS - olingoammenorrhoea = >35 days apart)

106
Q

precocious puberty is:

A

early onset of puberty

puberty before age 8 in girls and 9 in boys

107
Q

what is the difference between central PP or pseudopuberty PP?

A

central: gonadotropin - dependent (CNS abnormalities)
psuedo: gonatotropin - independent (CAH< tumours of adrenals)

108
Q

delayed puberty what tests do you do?

A 
FBC (anaemia, malnutrition), CRP (inflammatory disease) , 
U+E and LFT - renal and liver disease 
bone profile 
coeliac screen antibodies 
TSH and free T4
109
Q

what process is evaded by a cell in cancer?

how does it do this?

A

apoptosis

lengthening telomeres instead of shortening them with each replication

110
Q

what genes prevent cancer?

A

tumour supressor genes - p53/Rb

111
Q

what genes stimulate cancer?

A

oncogenes - BRAC or HER2

112
Q

most common gynae cancer in the UK?

A

endometrial cancer (used to be ovarian)

113
Q

risk factors for endometrial cancer?

what is the main underlying pathophys which causes all of these?

A 
obesity (adipose tissue converts androgens into oestrogen) 
diabetes 
nulliparity 
late menopause 
ovarian tumours 
HRT 
pelvic irradiation 
tamoxifen 
PCOS
HNPCC (hereditary non polyposis coli)

(unopposed oestrogen)

114
Q

main reason to refer for suscpeted to endometrial cancer? (RED FLAG!!!)

A

POST MENOPAUSAL BLEEDING

115
Q

how do you assess someone with post menopausal bleeding?

A

history and examination

investigations - transvaginal ultrasound (wants the endometrium to look thin = good)
endometriial biopsy
and hysteroscopy

116
Q

what type of cancer is endometrial normally?

A

adenocarcinoma most commonly

117
Q

treatment for endometrial cancer?

A

surgery
hysterectomy +/- pelvic lymph nodes
radiotherapy

progesterone therapy (to stabalise, can reverse but more likely to use in older ladies where the malignancy is unlikely to kill them as they are so old and have other comorbidiites which will kill first)

118
Q

what causes cervical cancer? and risk factors?

what underlies all of these?

A

HPV!!!! -
16 and 18 (+31,33,45,51,53)

vaccine does: 6,11,16 and 18

missed vaccination 
early age intercourse 
multiple sexual partners 
STDs 
previous CIN 
multiparity

increased exposure to HPV ^^^

multiparity/OCP/cigarette smoking(more persistant HPV)

119
Q

what happens in HPV infection?

A

75% of pop will come into contact with HPV at some point

most infections are transient and will be cleared within a year

but persistent infection is associated with increased risk of high grade CIN

120
Q

what are the two oncoprotein from HPV which cause the cancer?

A

E6 - blocks p53 tumour suppressor gene

and E7 - blocks rb gene

121
Q

most common cancer in women under 35?

A

cervical cancer

122
Q

what type of cell cancer is cervical cancer?

A

squamous cell normally

123
Q

what staging is used in endometrial and cervical cancer?

A

FIGO

1-4

124
Q

best method of reducing risk of cervical cancer in the UK?

A

screening (smears)

125
Q

what is done in colposcopy to treat stage 1A cervical cancer?

A

LLETZ

large loop excision

126
Q

how do you treat higher grade cervical cancers?

A

hysterectomy with vaginal cuff, and parametrial tissue plus nodes etc

radiotherapy, chemotherapy and palliative care if much higher grader

127
Q

what issues may need to be considered when managing a 25 year old woman with a diagnosis of cervical cancer?

A

fertility
bowel bladder sexual function
her life and her work

128
Q

causes of vulval cancer?
symptoms?
what type of cell is it?

A

high risk HPV
lichen sclerosis

vulval itching, soreness, persistant lump, bleeding, pain on passing urine, past history of VIN or lichen sclerosis

squamous cell carcinoma

129
Q

what is protective against ovarian cancer?

what is the underlying reason these are protective?

A

COCP
multiparity

the more times you have ovulated the higher the risk of ovarian cancer - anything that makes you not ovulate/reduces the amount you ovulate will be protective then

130
Q

suspected ovarian cancer mx?

A

CA125
USS
symptoms and age

calculate risk of malignancy index -
CA125 x USS score x pre or post menopausal (1 or 3) - a score of RMI >250 referral to gynae oncology

131
Q

what else raises CA125?

A

very non specific - raised in endometriosis, heart failure, pneumonia, diverticulitis, liver disease etc

so much take age and history into account mostly, never use it on its own

132
Q

if an old lady comes in complained of soreness of passing urine and has been treated for UTI multiple times but keep coming back? what must you do?

A

examine the vagina!!!

might be vulval cancer

133
Q

21 year old complaining with IBS like symptoms what much you make sure you do?

A

pregnancy test

ask history around ovarian cancer!!! often present non specific
FH of ovarian, breast or bowel
bleeding

take full gynae history basically

Obs and Gynae (5 decks)

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