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Complex Care 2 > Neuro, Gynae, Neoplasia > Flashcards

Neuro, Gynae, Neoplasia Flashcards

1
Q

What are the symptoms of an ovarian cyst?

A

Can be no symptoms or:

Lower abdo or pelvic pain - rupture, rapid growth, stretching, bleeding or tortion
Indigestion
Early satiety - feeling full sooner than normal
Urinary and bowel urgency
Painful bowel movements
dyspareunia

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2
Q

What is an ovarian cyst?

A

A fluid filled sac on the ovary.

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3
Q

How are ovarian cysts diagnosed and treated?

A

Diagnosed by palpation, utrasound, MRI or CT scan.

Normally resolve spontaneously, but may need laparoscopy or laparotomy to remove a complex cyst.

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4
Q

What is a Bartholin’s cyst?

A

A blockage in the ducts leading from the Bartholin glands.

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5
Q

How is a bartholin’s cyst treated?

A

Surgical draining and antibiotics.

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6
Q

What are fibroids?

A

Also known as leiomyoma or myomas, they are benign growths on the uterus wall.

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7
Q

What are the risk factors for fibroids?

A

Family hx, ethnicity (african), 30 - 40 years old, obese, hypertension.

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8
Q

What complications could arise due to fibroids?

A

Increased fetal malpresentation, labour dystocia, LSCS and PPH.

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9
Q

What symptoms may occur with fibroids?

A 
Could be none or:
constipation
rectal pain
abdo pain
breakthrough bleeding in menstrual cycle, heavy clots
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10
Q

What is the most common neurological condition in pregnancy?

A

Epilepsy - 0.5% of pregnancies

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11
Q

What is the effect of pregnancy on epilepsy?

A

Generally increases seizure incidence but is unpredictable.

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12
Q

AED’s are teratogenic, with effects increasing with the number of drugs being taken. T or F?

A

True

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13
Q

What is the management of epilepsy in pregnancy?

A

Preconception care including folate supplement - 5 mg/day (AEDs increase risk of deficiency) and drug review.

Pregnancy - ongoing measurement of drug levels (due to haemodilution effects of pregnancy - doseage may need to be titrated), fetal survelliance for malformations, continue folate, Vitamin K in late pregnancy as AEDs can affect production.

Labour - avoid pethidine as may induce a seizure and avoid dehydration

Vit K for newborn! Review medication postpartum and advice on safety when caring for the newborn.

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14
Q

What can trigger an epileptic fit?

A 
Stress,
Sleep deprivation
lack of food
hypoglycaemia
Excessive alcohol consumption
Illegal drug abuse
Non-compliance with medication regime
Flickering lights (rare)
Health condition that causes high temp
Certain medications
Hormonal changes with menstrual cycle
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15
Q

What is SUDEP?

A

Sudden unexpected death in epilepsy - where someone with epilepsy dies unexpectedly with no identifiable cause. Most important risk factor is uncontrolled generalised tonic clonic seizures

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16
Q

If a woman is seizure free for 9 months prior to pregnancy it is likely that she _______ have a seziure in pregnancy.

A

won’t have a seziure

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17
Q

A woman with epilepsy that is NOT taking any medications is at a ________ risk of fetal malformation compared to a low risk woman.

A

HIGHER risk - 3.5% compared to 1-2%.

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18
Q

Which drugs have the highest risk of major congenital malformations and which has the lowest?

A

Sodium valproate - highest risk

Carbamazepine - lowest risk

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19
Q

What is status epilepticus?

A

Medical emergency - A seizure that lasts longer than 30 minutes or a series of seizures without regaining consciousness inbetween.

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20
Q

During the first 24 hours postpartum, the risk of a tonic clonic seizure ________

A

Increases by 1 - 2%

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21
Q

Postpartum considerations for epilepsy?

A

AED serum levels may rise due to reversal of pregnancy changes;
Breastfeeding is recommended as low levels cross to milk;
Note combined OCP interferes with some AEDs;
New onset seizures should be investigated to rule out other causes such as eclampsia, infection, intracerebral haemorrhage;

22
Q

What are the known causes of epilepsy?

A 
birth injury
metabolic disorder
genetic predisposition
infection
postnatal trauma
brain tumour/trauma
motor syndromes
congenital malformation
23
Q

What is multiple sclerosis?

A

A chronic inflammatory autoimmune disease of the central nervous system.
Destruction of the myelin sheaths in the brain and spinal cord.

24
Q

What is the effect of pregnancy on MS?

A

Protective effect - however increased chance of relapse postpartum.

Postpartum risk is mitigated by exclusive breastfeeding which suppresses menstruation.

25
Q

What is Bell’s Palsy?

A

An idiopathic inflammatory reaction involving the facial nerve and resulting in facial paralysis.

May be caused by oedema, hypertension or secondary to infection.

Treatment - most resolve without treatment - eye care (due to inability to close one eye), high dose steriods and emotional support.

26
Q

What are the three types of MS?

A

Relapsing-remitting - clearly defined relapses, with good recovery in between. Most common (85%)

Secondary progressive - initially as above, then progression with/without occasional relapse. 50% of above go on to develop this within 10 years.

Primary progressive - progresses from diagnosis with short/temporary improvements.

27
Q

What is the treatment for MS?

A

Acute episodes treated with steriods. Other drugs depending on severity - antispasmodics, analgesics, and medication for bladder urgency.

28
Q

Considerations for MS in pregnancy, labour and postpartum?

A

Regular screening for asymptomatic bacteriuria;
Likely to become exhausted quickly in labour
Urinary retention?
Immobile - risk of DVT and pressure ulcers
Increased risk of relapse postpartum
Infection can trigger relapse
Contraception!

29
Q

What are the three types of stroke?

A

Ischaemic - from decreased blood flow
Thrombotic - from a venous event
Haemorrhagic - haemorrhage for example from ruptured vessel

30
Q

What are the signs and management of stroke?

A

Sudden onset neurological symptoms.

Investigate with CT/MRI, thrombophilia screening, CSF studies and urine/blood toxicology.

Ischaemic stroke - treat with anti-platelet medication
Thrombotic - anti-coag medication and/or surgery to remove clot
Hemorrhagic - surgery if secondary to ruptured aneurysm.

Refer to neurologist/rehab services.

Stop anti-coags prior to labour and recommence postpartum.

31
Q

What are the most common cancers in pregnancy?

A 
Melanoma
Hodgkin's lymphoma
Breast
Cervical
Ovarian
32
Q

How does pregnancy usually affect cancer?

A

Can worsen the progression - oestrogen is an established growth factor.

33
Q

What is the usual approach when cancer is diagnosed in pregnancy?

A

If possible, elective preterm delivery between 32 - 34 weeks gestation to allow appropriate investigations and treatment.

34
Q

Should cervical screening been done in pregnancy?

A

Yes - if the woman has never had a pap smear, or is not current.

35
Q

What is the new cervical screening test in Australia?

A

Now tests for HPV and if normal, only retest every five years.

Screening now starts at age 25.

36
Q

What are the stages of cervical cancer?

A

Stage 1 - Strictly confined to the Cx - 1a = microscopically invasive; 1b = clinically visible.

Stage 2 - Goes beyond Cx into immediate surrounding tissue including upper 2/3rds of vagina;

Stage 3 - Extends to pelvic wall and lower vagina

Stage 4 - Extends beyond pelvis to bladder, rectum or even the lungs.

37
Q

What are the treatments when pre-cancerous cells are identified?

A

Remove or destroy the cells by:
Freezing (cryotherapy);
Laser ablation;
Hot probe (cold coagulation).

Large loop excision of the transformation zone (LLETZ) this allows a sample to be sent for histological examination

38
Q

What are the treatment of cervical cancer?

A

Excision if early stages - full investigation with MRI under anaesthetic to ensure not further spread.

More advanced - chemotherapy and radiotherapy

39
Q

How does previous treatment for cervical cancer impact on pregnancy?

A

Repeated treatments increase risk of preterm birth. Cervical cerclage may be needed.

Radiotherapy for invasive cancer precludes future pregnancy - may be able to do an IVF/Surrogate cycle.

40
Q

What are symptoms of cervical cancer in pregnancy?

A

Bleeding

41
Q

Labour considerations for cervical cancer?

A

Increased risk of haemorrhage if a tumour present.

Risk of cervical dystocia from scar tissue - active monitoring of progress required. Note augmentation in this case may increase risk of uterine rupture.

Monitor for intrapartum bleeding.

42
Q

What is pregnancy associated breast cancer?

A

That which is diagnosed during pregnancy or within 1 year postpartum.

43
Q

How is breast cancer detected and diagnosed?

A

Mostly through self-examination.

Ultrasound is more reliable (93% detection) than mammography (68%) in pregnancy.

Diagnosis is made by using fine needle aspiration or biopsy.

44
Q

What are the s/s of breast cancer?

A 
fatigue
anaemia
anorexia,
depression
sepsis
pain
metastasis
45
Q

What are the main treatments for breast cancer?

A 
Radiotherapy (usually delay until postpartum), 
chemotherapy (contraindicated in first trimester), 
hormonal therapy (delay to postpartum due to fetal outcomes), 
surgery (can be done during pregnancy).
46
Q

Management considerations for breast cancer?

A

Consider delaying birth until 2 - 3 weeks after last chemo

Corticosteriods for preterm delivery

Breastfeeding contraindicated with treatment

47
Q

What factors increase and decrease the risk of ovarian cancer?

A 
Decrease:
multiparity
OCP
tubal ligation
hysterectomy
Increase:
Nulliparity
Endometriosis
Obesity
Infertility
48
Q

What are the symptoms of ovarian cancer?

A 
Bloating
Abdo and pelvic discomfort
increasing abdo girth
decreasing appetite
Severe pain if tortion of the tumour
49
Q

How is ovarian cancer treated in pregnancy?

A

Aim for standard cancer treatment. If late stage cancer, then discuss TOP as delay in treatment can have poor maternal outcomes.

Standard treatment = hysterectomy and removal of ovaries. Chemo contraindicated early in pregnancy.

If complex mass identified - remove by surgery in second trimester - 19-20 weeks

If presents with tortion - emergency - urgent ultrasound assessment and surgery

Thrombo-prophylaxis postpartum!

50
Q

What are the three classifications of epileptic seizures?

A
  1. Partial (focal) seizures: Originate from one part of the brain and may spread to become generalised - may or may not involve loss of conciousness.
  2. Generalised seizures: involve the brain diffusely at onset. Usually impaired conciousness and involuntary muscle movement.
  3. Unclassified: not either of above - includes neonatal seizures and febrile convulsions.
51
Q

What might cause increases in epileptic seizure activities in pregnancy?

A

Hormonal changes - oestrogens are thought to decrease seizure thresholds, progesterone decreases neuronal excitability.

changes in concentration of AEDs in the blood stream

Non-compliance (fear of teratogenosis)

Sleep deprivation

Alcohol consumption

52
Q

What is a tonic-clonic seizure?

A

One that involves loss of consciousness and involuntary muscle movement.

Complex Care 2 (15 decks)

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