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MRCOG part 2 * > Mixed TOGS > Flashcards

Mixed TOGS Flashcards

Surgical causes abdo pain, nonepithalial ovarian cancers, IBD in pregnancy, vAMA, peripartum hyponatraemia, VIN

1
Q

Presentation of leaking abdominal aneurysm in pregnancy?

A

Unexplained collapse preceded by severe acute abdo/back pain, typically intercapsular

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2
Q

Who is more at risk of abdominal aneurysm?

A

Marfan’s

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3
Q

What is murphy’s sign and what does it indicate?

A

Tenderness increased on inspiration while palpating RUQ
Acute cholecystitis

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4
Q

Typical presentation of pancreatitis?

A

Upper abdominal pain eased by leaning forward
Often history of biliary colic/cholecystitis

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5
Q

Types of non-epithelial ovarian cancer

A

Malignant ovarian germ cell tumours - dysgerminoma, embryonal, immature teratoma, choriocarcinoma, yolk sac tumour

Sex cord-stromal tumours - thecoma, granuloa cell, sertoli-leydig

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6
Q

Most common germ cell tumour?

A

Dysgerminoma

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7
Q

Features of dysgerminoma?

A

20-30s
Fish flesh cut surface
Haemorrhage and necrosis common
SOlid, round, lobulated
90% 5 year survival
LDH used to monitor disease

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8
Q

Tumour markers in immature teratoma?

A

AFP, LDH, DHEA can be raised

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9
Q

Features of endodermal sinus tumour/YS tumour?

A

Elevated AFP
Malignant
Radioresistant
Unilateral
Large, solid, lobulated
Schiller-Duvall bodies (glomerulois tufts)

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10
Q

Pathognomomic feature of granulosa cell tumour?

A

Call-exner bodies
Isosexual precococious puberty in 50%

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11
Q

Features of immature teratoma?

A

Malignant
Elements from all 3 germ cell layers
May coexist with mature teratoma

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12
Q

Features of mature teratoma?

A

95% benign, rarely undergo malignant transformation
Cystic masses with focal solid areas - rokitansky’s protuberance
hair, sebum, teeth

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13
Q

Features of choriocarcinoma (non-gestational type)

A

Very rare
Isosexual precocity
High hCG
Large haemorrhagic masses
Derived from syncytiotrophoblas and cytotrophoblast

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14
Q

Which NEOCs may have raised testosterone?

A

granulosa cell, sertoli-leydig

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15
Q

Which NEOCS have raised hCG?

A

choriocarcinoma, embryonal

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16
Q

Yolk sac tumour will have raised…

A

AFP, LDH

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17
Q

In which NEOC can you have raised AMH?

A

granulosa cell tumour
(inhibin also raised)

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18
Q

How are NEOCs managed?

A

Surgery and chemotherapy
Unilateral salpingo-oophorectomy if fertility preservation required

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19
Q

Which medications should be stopped prior to conception in women with IBD?

A

Mycophenolate mofetil and methotrexate

20
Q

Drugs used for UC that are safe in pregnancy?

A

Sulfasalazine
Metronidazole short courses
Steroids

21
Q

Sulfasalazine MoA?

A

interferes with folate synthesis by inhibiting dihydrofolate reductase
Therefore need to give high dose folic acid

22
Q

Risks to fetus with sulfasalazine use?

A

Bloody diarrhoea in infant, avoid >3g/day due to fetal nephrotoxicity, theoretical risk kernicterus in newborn

23
Q

What are the key challenges with use of biologics in IBD in pregnancy?

A

Minimal data
Infliximab crosses placenta at high rates in 3rd trimester which can cause immunosuppression in newborns for 6 months. Therefore often discontinued at 32w

24
Q

Considerations for labour in IBD?

A

Avoid episiotomy as can trigger perinanal disease

25
Q

Definition of very advance maternal age?

A

> 45 years at time of delivery

26
Q

Main risks of pregnancy in women with very advanced maternal age?

A

Caesarean section delivery 50%
Hypertension/ PET - especially in egg donation conception
GDM
Fetal growth restriction
Pre-term delivery
Placenta praevia
Higher risk of admission to ICU

27
Q

If Na 125-130 in labour- what should you do?

A

Fluid restrict to 80ml/h
Repeat Na in 4 hours
Inform obs team/NNU

28
Q

If Na <125 in labour - what should you do?

A

Fluid restrict to 30ml/h
Stop oxytocin
Repeat Na in 2 hours
MDT involvement

29
Q

If after initial measures Na <125 and worsening/symptomatic, what should you do?

A

CCU involvement
Consider 2.7% saline 200ml in 30mins
Consider furosemide 20mg IV if fluid overload

30
Q

Post-natally, at what Na level should you fluid restrict/stop oxytocin?

A

<125
Restrict to 30ml/h
MDT involvement

31
Q

Signs/symptoms of hyponatraemia

A

headache, nausea, no appetite, apathy
disorientation, agitation, seizures, coma, respiratory arrest, pulmonary oedema

32
Q

Most common vulval malignancy?

A

vulval squamous cell carcinoma

33
Q

What are the 2 main precursors to vulval squamous cell carcinoma?

A

HPV dependent - vulval high grade squamous intraepithelial lesion (vHSIL) >10% 10year risk ca

HPV independent - differentiated type vulval intraepithelial lesion (dVIN) >50% 10 year risk ca

34
Q

Which HPV types are high risk for vulval ca?

A

HPV 16 and HPV 33

35
Q

Main risk factors for HPV independent vulval ca?

A

lichen sclerosus and age

36
Q

How to biopsy suspected VIN

A

Incisional punch biopsy 4mm width, 5mm depth
Ensure biopsy is mapped

37
Q

Management of VIN

A

Surgical - local excision if small/defined OR vulvectomy if extensive disease

Medical management - imiquimod 5% cream

38
Q

MoA imiquimod?

A

Immunomodulator - agonism of toll-like receptors 7+8

39
Q

Risk of recurrence after treament of VIN?

A

26%

40
Q

Features of usual type (HPV dependent) VIN?

A

basaloid, warty, multifocal
35-55 years old
RFs: HPV, smoking, immunodeficiency

41
Q

Features of differentiated VIN?

A

Unifocal
Post-menopausal

42
Q

Lichen sclerosis is associated with what other immune conditions?

A

Thyroid disease
T1DM

43
Q

What is extra mammary paget’s?

A

Rare vulval lesion in 60-80yo
Associated with adenocarcinoma e.g. breast or GO
Strawberries and cream appearance - erythematous and scaly patches
Paget cells seen on biopsy
High recurrence - excision is treatment

44
Q

Nodes affected in vulval cancer?

A

Inguino-femoral nodes

45
Q

Incision type to remove vulval cancer?

A

Triple incision with primary closure

46
Q

Appearance of squamous vulval ca?

A

Warty, rolled edges

47
Q

Treatment for vulvodynia?

A

gabapentin
amitriptyline

MRCOG part 2 * (54 decks)

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