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FINALS > OBGY > Flashcards

OBGY Flashcards

1
Q

When is hormone therapy offered to women with breast cancer? Which drugs are used?

A

If tumours are positive for hormone receptors:

  • Tamoxifen in pre/peri-menopausal women
  • Anastrozole in post-menopausal women
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2
Q

When should you refer to the 2WW breast cancer pathway?

A

> 30 unexplained lump with or without pain

>50 in one nipple: discharge, retraction, other changes of concern

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3
Q

When should you consider a referral to 2WW breast cancer pathway?

A

Skin changes that suggest breast cancer

>30 lump in axilla

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4
Q

When should you complete a non-urgent referral to breast clinic?

A

<30 lump with or without pain

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5
Q

Which contraceptive is most associated with weight gain?

A

Depo-provera injections

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6
Q

What is the management of intrahepatic cholestasis of pregnancy?

A
  1. Ursodeoxycholic acid

2. Elective induction from 37 weeks

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7
Q

What is a fibroadenoma?

A

common benign tumours of stromal/epithelial breast duct tissue

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8
Q

What are the features of a fibroadenoma?

A

Painless
Smooth
Round
Well circumscribed (well-defined borders)
Firm
Mobile (moves freely under the skin and above the chest wall)
Usually up to 3cm diameter

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9
Q

Why are fibroadenomas more common in younger women?

A

They respond to the female hormones (oestrogen and progesterone), which is why they are more common in younger women and often regress after menopause.

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10
Q

Which breast lump fluctuates with the menstrual cycle?

A

Fibrocystic Breast Changes

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11
Q

What are the symptoms of fibrocystic breast changes?

A

10 days before period, resolve when period ends:

Lumpiness
Breast pain or tenderness (mastalgia)
Fluctuation of breast size

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12
Q

What is the management of fibrocystic breast changes?

A

exclude cancer
manage symptoms:
- Wearing a supportive bra
- Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen
- Avoiding caffeine
- Applying heat to the area
- Hormonal treatments (e.g., danazol and tamoxifen) under specialist guidance

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13
Q

What is the most common cause of breast lumps?

A

Breast cysts

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14
Q

What are the features of breast cysts?

A

Smooth
Well-circumscribed
Mobile
Possibly fluctuant (change size around period)

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15
Q

What is fat necrosis of the breast?

A

an oil cyst, containing liquid fat. Fat necrosis is commonly triggered by localised trauma, radiotherapy or surgery, with an inflammatory reaction resulting in fibrosis and necrosis (death) of the fat tissue. It does not increase the risk of breast cancer.

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16
Q

What are the features of fat necrosis of the breast?

A 
Painless
Firm
Irregular
Fixed in local structures
There may be skin dimpling or nipple inversion
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17
Q

What might look similar to breast cancer on US or mammogram?

A

Fat necrosis

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18
Q

What is the management for fat necrosis?

A
  1. exclude cancer

2. conservative (resection if symptoms)

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19
Q

What are the features of lipoma?

A

Soft
Painless
Mobile
Do not cause skin changes

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20
Q

What is the management of lipomas?

A

Reassurance

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21
Q

What is a galactocele?

A

breast milk filled cysts that occur when the lactiferous duct is blocked, preventing the gland from draining milk.

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22
Q

What are the features of a galactocele?

A

irm, mobile, painless lump, usually beneath the areola

benign - usually resolve without treatment

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23
Q

What is a Phyllodes tumour?

A

rare tumours of the connective tissue (stroma) of the breast, occurring most often between ages 40 and 50

surgical removal, wide-excision + chemo

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24
Q

What are the two types of mastalgia?

A

Cyclical

Non-cyclical

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25
Q

Name three causes of non-cyclical breast pain.

A

Medications (e.g., hormonal contraceptive medications)
Infection (e.g., mastitis)
Pregnancy

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26
Q

Give three differentials for breast pain

A

Cancer (perform a thorough history and examination)
Infection (mastitis)
Pregnancy (perform a pregnancy test)

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27
Q

What hormonal treatments can be used to treat breast pain?

A

danazol and tamoxifen (under specialist)

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28
Q

What are the risk factors for breast cancer?

A

Female (99% of breast cancers)
Increased oestrogen exposure (earlier onset of periods and later menopause)
More dense breast tissue (more glandular tissue)
Obesity
Smoking
Family history (first-degree relatives)

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29
Q

Which genes can predispose to breast cancer?

A 
BRCA1 = CX17
BRCA2 = CX13

TP53
PTEN

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30
Q

Name 5 types of breast cancer

A 
Ductal carcinoma in situ
Lobular carcinoma in situ
Invasive ductal carcinoma
Invasive lobular carcinoma
Inflammatory breast cancer
Paget's disease of the Nipple
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31
Q

What is the management of lobular carcinoma in situ?

A

close monitoring (e.g., 6 monthly examination and yearly mammograms)

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32
Q

What is the most common type of invasive breast cancer?

A

Invasive ductal carcinoma

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33
Q

What should be considered if mastitis does not respond to antibiotics?

A

Inflammatory breast cancers

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34
Q

How does Paget’s disease of the nipple present?

A

Looks like eczema of the nipple/areolar

Erythematous, scaly rash

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35
Q

Describe the breast cancer screening programme in the UK

A

offers a mammogram every 3 years to women aged 50 – 70 years.

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36
Q

What are the risk factors for high-risk breast cancer?

A

A first-degree relative with breast cancer under 40 years
A first-degree male relative with breast cancer
A first-degree relative with bilateral breast cancer, first diagnosed under 50 years
Two first-degree relatives with breast cancer

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37
Q

What should be done before genetic testing for breast cancer?

A

Counselling

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38
Q

What can be offered to people who are high risk for breast cancer?

A

Annual MMG >30years

Tamoxifen if premenopausal
Anastrozole if postmenopausal (except with severe osteoporosis)

Risk-reducing bilateral mastectomy or bilateral oophorectomy

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39
Q

How does breast cancer present?

A

Lumps that are hard, irregular, painless or fixed in place
Lumps may be tethered to the skin or the chest wall
Nipple retraction
Skin dimpling or oedema (peau d’orange)
Lymphadenopathy, particularly in the axilla

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40
Q

What is the triple assessment?

A

Clinical assessment (history and examination)
Imaging (ultrasound or mammography)
Biopsy (fine needle aspiration or core biopsy)

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41
Q

What are the three types of breast imaging?

A

US - younger women
MMG - older women
MRI - high risk

42
Q

What is a sentinel node biopsy?

A

Sentinel node biopsy is performed during breast surgery for cancer. An isotope contrast and a blue dye are injected into the tumour area. The contrast and dye travel through the lymphatics to the first lymph node (the sentinel node). The first node in the drainage of the tumour area shows up blue and on the isotope scanner. A biopsy can be performed on this node, and if cancer cells are found, the lymph nodes can be removed.

43
Q

Name three breast cancer receptors

A

Oestrogen receptors (ER)

Progesterone receptors (PR)

Human epidermal growth factor (HER2)

44
Q

What is triple-negative breast cancer?

A

cancer cells do not express any of these three receptors

carries a worse prognosis

45
Q

Who should receive gene expression profiling?

A

women with early breast cancers that are ER positive but HER2 and lymph node negative

46
Q

What mnemonic can be used to remember notable locations of breast cancer mets?

A

2 Ls and 2 Bs:

L – Lungs
L – Liver
B – Bones
B – Brain

47
Q

What system is used for staging of breast cancer?

A

TNM system

T - tumour
N - nodes
M - mets

48
Q

What are the options for breast surgery in breast cancer?

A

Breast-conserving surgery (e.g., wide local excision), usually coupled with radiotherapy

Mastectomy (removal of the whole breast), potentially with immediate or delayed breast reconstruction

49
Q

What can cause chronic lymphoedema?

A

Axillary clearance after breast cancer surgery

50
Q

When should surgical excision be offered for fibroadenomas?

A

> 3cm

51
Q

What should be offered after a wide-local excision of breast cancer to reduce recurrence?

A

Whole breast radiotherapy

52
Q

What is duct ectasia?

A

Duct ectasia is a dilatation and shortening of the terminal breast ducts within 3cm of the nipple

53
Q

How do patients present with duct ectasia?

A

greenish nipple discharge with a peri-areolar lump

54
Q

What is indicated by a ‘snowstorm’ sign on breast US?

A

Implant rupture

55
Q

What is the purpose of neoadjuvant therapy in breast cancer?

A

downsize the tumour before surgery

56
Q

What are the differentials for pelvic pain?

A

Gynae: PID, ectopic pregnancy, ovarian cyst/torsion/rupture/haemorrhage, endometriosis

Urological: pyelonephritis, appendicitis, diverticulitis, IBD/IBS

57
Q

What is the definition of a APH?

A

PV bleeding >24 weeks into pregnancy

58
Q

Name the causes of APH

A 
Placental abruption
Placenta praaevia 
Genital tract pathology
Uterine rupture
Vasa praaevia
59
Q

What are the causes of a PPH?

A

4Ts

Tone - atonic uterus
Trauma - uterine rupture
Tissue - retained tissue
Thrombin - coagulopathy

60
Q

What is the definition of a miscarriage?

A

Loss of pregnancy in the first 24 weeks

61
Q

What is the most common cause of miscarriage int he 1st trimester?

A

Chromosomal abnormalities

62
Q

What is the most common cause of miscarriage in the 2nd trimester?

A

Cervical incompetence

Also:
Drugs - smoking, alcohol, caffeine
Infection

63
Q

Name some differentials for PV bleeding during the first 24 weeks of pregnancy

A

Implantation bleeding
Cervical pathology
UTI
Ectopic pregnancy

64
Q

What is the general management of a miscarriage?

A
  1. ABCDE
  2. TV US, serum hCG, pelvic examination
  3. Expectant/medical/surgical management
65
Q

What are the 5 types of miscarriage?

A 
Threatened
Inevitable
Incomplete
Missed
Complete
66
Q

What might be seen on US in a miscarriage?

A

POC
Gestational sac >25mm with no yolk sac
Adnexal mass
FHR

67
Q

What might be seen on serum hCG in a miscarriage?

A

hCG does not double in 48 hours

68
Q

What is the medical management of miscarriage?

A

Misoprostol (vaginal)

69
Q

What is the surgical management of a miscarriage?

A

Suction curettage

ERPC (GA)

70
Q

Who should receive surgical management of miscarriage?

A

Personal choice

Increased risk: bleeding, infection, unstable

71
Q

What is a recurrent miscarriage?

A

> 3 miscarriages in a row

72
Q

What are the risk factors for recurrent miscarriage?

A

Obesity
Age
Smoking

73
Q

What is the most common cause of recurrent miscarriage?

A

Anti-phospholipid syndrome

74
Q

How can recurrent miscarriages be investigated?

A

Bloods - clotting factors

Hypsteroscopy

75
Q

What are the risk factors for an ectopic pregnancy?

A 
Previous ectopic
Endometriosis
IUCD
POP
IVF
PID
Maternal age (>35)
Smoking
76
Q

When can an ectopic pregnancy be managed medically? What is the management?

A

Serum hCG <3000
no FHR
unruptured
no pain

IM methotrexate

77
Q

What are the features of placenta praaevia?

A

Non-tender

Painless

Shock consistent with bleeding

Normal FHR

Breach/transverse lie

Red blood

78
Q

What are the features of placental abruption?

A

‘woody’ hard uterus

Painful

Shock inconsistent with bleeding

Foetal distress

Normal lie

Dark blood

79
Q

What are the risk factors for placenta praaevia?

A

More common in twins, high parity, age and scarred uterus

80
Q

What are the risk factors for placental abruption?

A

Pre-eclampsia
Smoking/cocaine
Previous abruption
Intrauterine growth restriction

81
Q

What is the general management of an APH?

A
  1. Maternal welfare (ABCDE)
  2. Monitor foetal condition (CTG, US)
  3. Early delivery (section/induce labour
82
Q

What is the definitive management of placental abruption?

A

<37 weeks: foetal distress = c-section, no distress = corticosteroids (< 34 weeks)

> 37 weeks: foetal distress = c-section, no distress = vaginal delivery

83
Q

What should be given to rhesus negative women in APH?

A

Anti-D

84
Q

What is the definition of a PPH?

A

Loss of >500ml of blood <24 hours after delivery

85
Q

What are the risk factors for PPH?

A 
Previous Hx/caesarean
Clotting disorder/anti-coagulant therapy
Retained placenta
Instrumental delivery
APH (placenta praevia)
Uterine malformation/fibroids
Maternal age
Prolonged/induced labour
Large BMI
Anaemia
Shoulder dystocia
86
Q

What is the most common cause of PPH?

A

Atonic uterus

87
Q

What is the management of PPH?

A

ABCDE
RESUSITATE (crystalloid, fluids)

STOP BLEEDING:

  • Ergometrine (not with HTN), oxytocin
  • Uterus contraction (fundal massage, bi-manual compression)
  • catheter (empty bladder)

INVESTIGATE CAUSE:

  • Examination
  • Bloods: FBC, G&S, U&E, clotting

PERSISTENT BLEEDING/MAJOR HAEMORRHAGE: = major haemorrhage protocol

88
Q

What is included in booking bloods at 10 weeks?

A

Infectious disease: HIB, Hep B, syphilis

Blood disorders: sickle cell, thalassaemia

Hb

Blood group: ABO, rhesus status

88
Q

What is included in booking bloods at 10 weeks?

A

Infectious disease: HIB, Hep B, syphilis

Blood disorders: sickle cell, thalassaemia

Hb

Blood group: ABO, rhesus status

89
Q

How is anaemia of pregnancy treated?

A

Fe

Folic acid

90
Q

When should anti-D be given to pregnant women?

A

give anti-D @ 28 and 34 and within 72 hours of a sensitizing event

91
Q

What is the purpose of the 12 week scan?

A
  1. Due date (depending on crown-rump length)
  2. Diagnose multiple pregnancies
  3. Offer screening: trisomy 21 (down’s syndrome), 18 (Edward’s) and 13 (Patau’s)
92
Q

Describe the testing for Down’s syndrome

A
  1. Combined screening - maternal blood test (hCG/PAPP-A); nuchal translucency; maternal risk factors
  2. Quadruple test - maternal blood test for 4 hormones: oestriol; hCG; AFP; inhibit A
93
Q

What is offered if antenatal screening is deemed high risk?

A

Further testing is offered:

  • Chorionic villous sampling
  • Amniocentesis
94
Q

What is looked for on the anomaly scan at 20 weeks?

A

11 physical conditions e.g. spina bifida, cleft lip, diaphragmatic hernia

Congenital visceral malformation: gastroschisis, exophalos

95
Q

What are the options for a termination of pregnancy?

A

<9 weeks = mifepristone

<13 weeks = surgical D&C

> 15 weeks = D&C or late medical abortion

96
Q

What are the risk factors for cervical cancer?

A

HPV - sexual partners, risky sexual behaviours, no vaccine

OCP

Smoking
Family history

97
Q

What are the risk factors for endometrial cancer?

A 
Increased age
Earlier onset of menstruation
Late menopause
Oestrogen only hormone replacement therapy
No or fewer pregnancies
Obesity
Polycystic ovarian syndrome
Tamoxifen
98
Q

What are the risk factors for ovarian cancer?

A 
Early menarche
Late menopause
No pregnancies
Obesity
Age 
Smoking
BRCA genes
Clomifene
99
Q

Vulval cancer risk factors?

A

Age
Lichen sclerosis
Immunosuppressioin
HPV

100
Q

What is the tumour marker for ovarian cancer?

A

CA125

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