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3a > Obs > Flashcards

Obs Flashcards

1
Q

How long is normal gestation?

A

37-42 weeks

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2
Q

What is the first stage of labour?

A

From the first true contractions (onset of labour) to 10cm dilation

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3
Q

What is the second stage of labour?

A

From 10 cm dilation until delivery

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4
Q

What is the third stage of labour?

A

From delivery until the birth of the placenta

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5
Q

What effects do prostaglandins have during labour?

A
  • They play a key role in menstruation and labour by stimulating contraction of the uterine muscles.
  • They also have a role in the ripening of the cervix before delivery
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6
Q

Which progesterone is used to induce labour as a pessary?

A

E2- dinoprostone

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7
Q

What are the 3 phases of stage 1 labour?

A
  • Latent phase: From 0-3cm dilation. Progresses at about 0.5cm/hr. There are irregular contractions.
  • Active phase: From 3-7cm dilation. About 1cm/hr and there are regular contractions
  • Transition phase: From 7-10 cm dilation. Again progressing at roughly 1cm/hr, there are strong and regular contractions.
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8
Q

How long should stage 2 of labour last?

A

• Should take <3 hrs nullip and ,2hrs multip. Consider C-section or instrumentation 1 hr before these times

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9
Q

What causes contractions?

A 
Oxytocin release (nerve stimulation as cervix stretches)
Local prostaglandin release
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10
Q

What is involved in active management of phase 3 labour?

A

Active management involves giving a dose of intramuscular oxytocin to help the uterus contract and expel the placenta. Careful traction is applied to the umbilical cord to guide the placenta out of the uterus and vagina.

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11
Q

What would indicate active management in phase 3?

A

Haemorrhage or over 60 min delay in placental delivery

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12
Q

A ladies waters break, (SROM) but the liquor is smelly and green, what do you do?

A

Set up a continuous CTG- this is a sign of meconium in the amniotic fluid- you would be concerned of apsirational pneumonitis

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13
Q

What are you looking for in a foetal scalp blood to show F distress?

A

Acidosis- suggests hypoxia

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14
Q

DR C BRAVADO:

A

o Define Risk: Is it high or low risk
o Contractions: Are they regular?
o Baseline Rate: Try and visualise the baseline FHR. Normal is 110-160. Ten either side is non reassuring <100 or >180 is abnormal.
o Accelerations: Should be occasional jumps in FHR in response to environment
o Variability: >5 is normal. <5 for >40 mins is abnormal, for >90 mins is abnormal
o Decelerations: Early decel, in time with contraction, are normal. Late decel, 20-30 seconds after contraction, are suggestive of hypoxia. Variable decels suggest cord compression and are classified as abnormal is>50% atypical.
o Overall assessment

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15
Q

What reading of foetal scalp pH means C-section?

A

<7.2

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16
Q

What does 99% effective mean in regards to contraception?

A

99% means that id the average person used this method correctly with a regular partner for a single year, there would only be a 1% chance of pregnancy.

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17
Q

Specific RF for contraception?

A
  • Breast cancer: Avoid any hormonal contraception and go for copper coil/barrier
  • Cervical/ endometrial Ca: Avoid the IUD
  • Wilson’s disease: Avoid the use of copper coil
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18
Q

A mother is breast feeding how long PP can they start the COCP?

A

Has to be >6 weeks, POP or implant is far safer.

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19
Q

How is early miscarriage defined?

A

<12 weeks gestation

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20
Q

How is late miscarriage defined?

A

12-24 weeks gestation

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21
Q

At what crown-rump length is a FHB expected?

A

> 7mm, if not present then repeat in 1 week to confirm non viable

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22
Q

What is the key investigation for suspected miscarriage?

A

TVUS

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23
Q

What is given to medically manage miscarriage?

A

Misoprostol (softens cervix and stimulates uterine contraction- prostaglandin analogue)

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24
Q

SE of misoprostol?

A
  • Heavier bleed
  • Pain
  • Vomiting
  • Diarrhoea
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25
Q

What is the legal framework around abortion?

A

TOP is legal as long as it occurs before the 24th week of gestation. (1990 Human fertilisation and embryology act)

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26
Q

• Mifepristone

A

antioprogesterone)- halts pregnancy and relaxes cervix

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27
Q

• Misoprostol

A

(prostaglandin analogue) 1-2 days later- softens the cervix and stimulates contraction. (if used in abortion over 10 weeks, give every three hours till expulsion)

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28
Q

What week does the uterus reach the height of the umbilicus?

A

20 weeks

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29
Q

What week does the uterus reach the Xiphisternum?

A

36 weeks

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30
Q

Which hormone leads to N+V- which pathologies are associate with hyperemesis gravidarum?

A

hCG,

Multiple pregnancies and molar pregnancies

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31
Q

Criteria for diagnosis of hyperemesis gravidarum?

A

Extended NVP plus all 3 of:

More than 5% weight loss before pregnancy
o Dehydration
o Electrolyte imbalance

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32
Q

How is severity of hyperemesis judged?

A

Severity is assessed using the Pregnancy-Unique Quantification of Emesis score. This gives a score out of 15:
o <7 Mild
o 7-12 Moderate
o >12 severe

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33
Q

Complementary treatment for hyperemesis?

A
  • Ginger

* Acupressure on the wrist at point PC6

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34
Q

What might patients in hospital need if prolonged vomiting (minus electrolytes and anti-emetics IV)?

A

Thiamine supplementation (risk of wernicke korsakoff syndrome)

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35
Q

Name 2 antiemetics used to control N+V

A
  1. Prochlorperazine- (phenothiazine-block various receptors including D2 in CTZ and gut, H1 and muscarinic in the vomiting centre- big range of efficacy)
    a. SE: Nausea, Postural Hypotension. (FGAP)
  2. Cyclizine (H1receptor antagonist- H1 and antimuscarinic receptors predominate the vomiting centre and coms to the vestibular centre- good for motion sickness)
    a. SE: drowsiness- dry mouth and throat
  3. Ondansetron (serotonin 5-HT3 antagonists- High density in CTZ- chemoreceptor trigger zone and key release in the gut, usually these act to stimulate vagus nerve and vomiting- good for chemo causes of vom)
    a. Rare- constipation, diarrhoea and vomiting
  4. Metoclopramide (D2- receptor antagonist, D2 is main receptor in CTZ but also promote relaxation of peristalsis in stomach and LES- blocking this promotes gastric emptying and reduces stimulation of vom)
    a. SE: Diarrhoea, EPSEs- especially young and children
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36
Q

• First trimester:

A

LMP  12 weeks gestational age

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37
Q

• Second trimester:

A

13 weeks  26 weeks gestational age

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38
Q

• Third trimester

A

27 weeks  birth

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39
Q

At what gestation are foetal movements normally felt?

A

20+0

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40
Q

When is the booking clinic? (normal)

A

10+0

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41
Q

When is the dating scan? (normal)

A

Between 10+0 and 13+6

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42
Q

When is the first antenatal appointment? (normal)

A

16+0

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43
Q

When is the anomaly scan? (normal)

A

Between 18+0 and 20+6

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44
Q

When are the rest of the antenatal appointments? (normal)

A

25, 28, 31, 34, 36, 38, 40, 41 and 42 weeks

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45
Q

What can drinking in early pregnancy cause?

A

o Miscarriage
o Small for dates
o Preterm delivery
o Foetal alcohol syndrome

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46
Q

Foetal alcohol syndrome?

A 
o	Microcephaly 
o	Thin upper lip
o	Short fat philitrum 
o	Short palpebral fissure
o	Learning disablility 
o	Behavioural difficulties 
o	Hearing and vision issues 
o	Cerebral palsy.
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47
Q

What bloods are taken at booking clinic?

A

• Blood group, Ab and rehesus D status
• FBC- anaemia
• Screen for thalassaemia (all women) and sickle cell disease (when women at high risk)
If indicated then HIV, Hep B, Syphilis

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48
Q

When are bloods taken for downs syndrome (combined test)?

A

11 weeks

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49
Q

What bloods are taken at booking clinic?

A

• Blood group, Ab and rehesus D status
• FBC- anaemia
• Screen for thalassaemia (all women) and sickle cell disease (when women at high risk)
If indicated then HIV, Hep B, Syphilis

50
Q

When are bloods taken for downs syndrome (combined test)?

A

11 weeks

51
Q

What is involved in the combined test for downs syndrome?

A

Performed between week 11 and 14. Maternal blood test (beta HCG [high] and pregnancy associated alpha protein A [low]) and US (nuchal fold - if over 6 mm)

52
Q

What HTN treatment can you switch to during pregnancy?

A
  • Labetelol (a beta-blocker)
  • CCB (nifedipine)
  • Alpha blockers (doxazosin)
53
Q

Anti-epileptic treatment during pregnancy?

A
  • Levetiracetam, lamotrigine and carbemzapine are the safer anti-epileptics of choice.
  • Sodium valproate is avoided as it can cause neural tube defects and developmental delays
  • Phenytoin is avoided due to causing cleft lip and palate
54
Q

What HTN treatment can you switch to during pregnancy?

A
  • Labetelol (a beta-blocker)
  • CCB (nifedipine)
  • Alpha blockers (doxazosin)
55
Q

How is small for gestational age defined?

A

fetes under the 10th centile for their gestational age.

56
Q

What 2 measures are used to estimate foetal weight?

A
  • Estimated Fetal Weight (EFW)

* Fetal abdominal circumference (AC)

57
Q

How is small for gestational age defined?

A

fetes under the 10th centile for their gestational age.

58
Q

What is low birth weight?

A

Baby weighs under 2,500g

59
Q

What is severe SGA?

A

is when the fetus is below the 3rd decile for their gestational age

60
Q

What are the 2 key categories of FGR, give 3 examples of each?

A 
•	Placenta mediated growth restriction- condition affecting nutrients across placenta
o	Idiopathic 
o	Pre-eclampsia 
o	Maternal smoking 
o	Maternal alcohol
o	Anaemia
o	Malnutrition 
o	Infection 
o	Maternal health conditions 
•	Non-placenta mediated growth restrictions:
o	Genetic abnormalities 
o	Structural abnormalities
o	Fetal infection 
o	Errors of metabolism
61
Q

What are the 2 categories causing SGA?

A
  • Constitutionally small, matching the mother and others in the family and growing appropriately on the growth chart.
  • Fetal growth restriction- IUGR FGR is when there is a small fetus or a foetus growing in an unexpected way due to a pathology affecting the amounts of nutrients and oxygen being delivered to the foetus through the placenta.
62
Q

What are the 2 key categories of FGR, give 3 examples of each?

A 
•	Placenta mediated growth restriction- condition affecting nutrients across placenta
o	Idiopathic 
o	Pre-eclampsia 
o	Maternal smoking 
o	Maternal alcohol
o	Anaemia
o	Malnutrition 
o	Infection 
o	Maternal health conditions 
•	Non-placenta mediated growth restrictions:
o	Genetic abnormalities 
o	Structural abnormalities
o	Fetal infection 
o	Errors of metabolism
63
Q

What are the indicators for early delivery with SGA?

A

 UA abnormal after 32 weeks deliver with C-section and antenatal steroids.
 If UA normal, delivery at 37 weeks, induction or C-section

64
Q

What are the 2 key things to remember about macrosomia?

A

CAUSED BY DM, SIGNIFICANT RISK OF SHOULDER DYSTOCIA DURING BIRTH

65
Q

Management of UTI in pregnancy?

A

• UTI needs 7 days of treatment
o Nitrofurantoin (avoid in 3rd trimester- can cause neonatal haemolysis)
o Amoxicillin (after sensitivity)
o Cefalexin
• Avoid trimethoprim- works as a folate antagonist- can lead to congenital abnormality and neural tube defects

66
Q

What are the 2 key things to remember about macrosomia?

A

CAUSED BY DM, SIGNIFICANT RISK OF SHOULDER DYSTOCIA DURING BIRTH

67
Q

How would you treat a B-12 deficient pregnant woman?

A

o Advice should be sought from a haemotologist re further Ix and treatment of a low B-12 in pregnancy. Treatment options are:
 IM hydroxocobalamin injections
 Oral cyanocobalamin tablets

68
Q

Indications for prophylactic VTE management?

A

 Previous VTE
 Hospital admission during pregnancy
 High risk thrombophilia
 Prothrombic morbididty (cancer, SLE, IBD)
 Ovarian hyperstimulation syndrome (OHSS)
 >3 of the others

69
Q

How would you treat a B-12 deficient pregnant woman?

A

o Advice should be sought from a haemotologist re further Ix and treatment of a low B-12 in pregnancy. Treatment options are:
 IM hydroxocobalamin injections
 Oral cyanocobalamin tablets

70
Q

Indications for prophylactic VTE management?

A

 Previous VTE
 Hospital admission during pregnancy
 High risk thrombophilia
 Prothrombic morbididty (cancer, SLE, IBD)
 Ovarian hyperstimulation syndrome (OHSS)
 >3 of the others

71
Q

What is given as VTE prophylaxis?

A

LMWH (enoxaparin, daltaparin, Tinzaparin)

72
Q

Management (massive PE): (in pregnancy)

A
  • Thrombolysis then unfractionated heparin
  • UF heparin alone may be sufficient if non life threatening
  • If really severe consider surgical embolectomy
73
Q

Management: (DVT/PE) (in pregnancy)

A
  • Elevate leg and use compression stocking
  • Start treatment with LMWH (base on weight at booking clinic) and continue till 6 weeks post natally
  • Should be started immediately if suspect DVT/PE even before doppler/CTPA confirmation.
  • Can switch to oral meds (warfarin or DOAC) after birth
74
Q

Management: (DVT/PE) (in pregnancy)

A
  • Elevate leg and use compression stocking
  • Start treatment with LMWH (base on weight at booking clinic) and continue till 6 weeks post natally
  • Should be started immediately if suspect DVT/PE even before doppler/CTPA confirmation.
  • Can switch to oral meds (warfarin or DOAC) after birth
75
Q

What factors determine pre emptive treatment of pre eclampsia?

A

These RF determine if aspirin is given as prophylaxis to pre eclampsia. Women are offered aspirin from 12 weeks gestation if they have one high risk factor or more than 1 moderate.

76
Q

HTN management in pre-eclampsia?

A

o Indications and targets:
 Use anti HTN for all >140/90 aim for 135/85
 If severe (>160/110), admit and check BP every 15 min till <160/110 , the 4 times daily
o Anti HTN drug choice:
 1st line Labetelol PO (IV if severe)
 2nd line: Nifedipine PO, Hydralazine IV or methyldopa PO (monitor LFT for methyldopa

77
Q

HTN management in pre-eclampsia?

A

o Labetolol is first line as Anti-HTN
o Nifedipine is commonly used as second line
o Methyldopa is third line (stop within 2 days of birth)

78
Q

What is HELLP?

A

Syndrome of features as a complication of pre eclampsia presents with:
• Haemolysis
• Elevated liver enzymes
• Low Platelets
Use IV Dexamethasone and IV MgSO4 (seizure prophylaxis)

79
Q

What is HELLP?

A

Syndrome of features as a complication of pre eclampsia presents with:
• Haemolysis
• Elevated liver enzymes
• Low Platelets
Use IV Dexamethasone and IV MgSO4 (seizure prophylaxis)

80
Q

Process for OGTT and cut off for GDM?

A 
	Starve overnight
	Check plasma glucose
	Give 75g glucose
	Measure plasma glucose after 2 hours
	Normal are: (5-6-7-8)
•	Fasting: <5.6 mmol/L
•	At 2 hrs: <7.8 mmol/L
	Higher values than this lead to diagnosis
81
Q

RF for GDM? When do you perform OGTT?

A

• Previous gestational DM
• Previous macrosomic baby (>4.5kg)
• BMI >30
• Ethnic origin (Black, middle eastern, South Asian)
• FH of DM
o If previous GDM or BMI >40 test at 18 weeks and again at 28 weeks, any other once at 24-28 weeks.

82
Q

What is the antenatal management of GDM?

A

o MDT: Obs, Specialist midwife, endocrinologist, dietician
o Self-monitor glucose daily
o If fasting glucose 5.6-6.9:
 1st line  diet and exercise
 2nd line  metformin if not controlled after 2 weeks
 3rd line  insulin if still uncontrolled
o If fasting glucose >7:
 1st line Insulin and metformin
 2nd line  Insulin and glibenclamide (sulfonylurea)
o Serial growth scan from 28 weeks

83
Q

What is the antenatal management of GDM?

A

o MDT: Obs, Specialist midwife, endocrinologist, dietician
o Self-monitor glucose daily
o If fasting glucose 5.6-6.9:
 1st line  diet and exercise
 2nd line  metformin if not controlled after 2 weeks
 3rd line  insulin if still uncontrolled
o If fasting glucose >7:
 1st line Insulin and metformin
 2nd line  Insulin and glibenclamide (sulfonylurea)
o Serial growth scan from 28 weeks

84
Q

What is the main treatment for cholestatic jaundice?

A

• Ursodeoxycholic acid

85
Q

What is the main treatment for cholestatic jaundice?

A

• Ursodeoxycholic acid

86
Q

What vitamin level should be checked in obstetric cholestasis?

A

• Water soluble vit K can be given if the PTT is deranged. This can occur as bile salts are vital in the absorption of fat soluble vitamins such as Vit K. Therefore deficiency can lead to low blood Vit K levels and therefore impaired blood clotting.

87
Q

• Low lying placenta

A

Within 20 mm of the internal cervical os

88
Q

Management of Vasa praaevia?

A

• Asymptomatic:
o Corticosteroids, given from 32 weeks gestation to mature foetal lungs
o ECS: planned for 34-36 weeks gestation
Symptomatic ==> emergency c-section (often not quick enough and foetus dies)

89
Q

Management of Vasa praaevia?

A

• Asymptomatic:
o Corticosteroids, given from 32 weeks gestation to mature foetal lungs
o ECS: planned for 34-36 weeks gestation
Symptomatic ==> emergency c-section (often not quick enough and foetus dies)

90
Q

What are the 3 categories of placenta accreta?

A
  • Superficial placenta accreta: into surface of myometrium
  • Placenta increta: Implanted deeply into myometrium
  • Placenta percreta: Past the myometrium and perimetrium, potentially to other organs such as bladder
91
Q

What are the 3 categories of placenta accreta?

A
  • Superficial placenta accreta: into surface of myometrium
  • Placenta increta: Implanted deeply into myometrium
  • Placenta percreta: Past the myometrium and perimetrium, potentially to other organs such as bladder
92
Q

Management of known Placenta accreta:

A

• Delivery is planned between 35 and 36+6 to reduce risk of spontaneous delivery and labour. Antenatal steroids given to mature the foetal lungs
• Options during C-section are:
o Hysterectomy with placenta remaining in the uterus (recommended)
o Uterus preserving surgery- resect only part of the myometrium with the placenta
o Expectant management- leave placenta to be reabsorbed over time
(IF FOUND AFTER BIRTH == HYSTERECTOMY)

93
Q

Process of ECV?

A

Used in babies that are breech:
• After 36 weeks for nulliparous
• After 37 weeks in women that have given birth previously
Women are given tocolysis to relax the abdomen pre procedure.
This is given in the form of SC Terbutaline.
Terbutaline is a beta agonist (similar to salbutamol) reduces the contractility of the myometrium, making it easier for the baby to turn.
Rhesus-D women need anti-D prophylaxis when receiving ECV. Kleihauer test is used to quantify the volume of foetal blood in circulation and titrate the volume of immunoglobulins

94
Q

Types of breech?

A
  • Complete breech- where the legs are fully flexed at the hips and knees
  • Incomplete breech- one leg flexed at hip and extended at the knee
  • Extended breech- frank breech, both legs flexed at hip and then extened at the knee
  • Footling breech- the foot present through cervix and its extended
95
Q

How is onset of labour diagnosed?

A 
Diagnosis of the onset of labour:
•	Show (mucus plug from the cervix)
•	Rupture of membranes 
•	Regular, painful contractions 
•	Dilating cervix on examination
96
Q

How is onset of labour diagnosed?

A 
Diagnosis of the onset of labour:
•	Show (mucus plug from the cervix)
•	Rupture of membranes 
•	Regular, painful contractions 
•	Dilating cervix on examination
97
Q

Pre-term labour prophylaxis?

A

Vaginal progesterone:
o Progesterone can be given as a vaginal gel or a pessary
o Decreases the myometrial contractility and prevents the cervical remodelling.
o Offered to women with cervical length under 25mm on TVUS and if they are between 16-24 weeks
Cervical cerclage:
o Putting a stitch in the cervix to provide support and keep it closed (need to have a spinal/general Anaesthetic). The stitch is the removed at term or if the woman goes into labour.
o Offered to all women with CL under 25mm on US , also between 16-24 weeks gestation, had a previous premature birth or cervical trauma (colposcopy, cone biopsy)
o “RESCUE CERVICAL CERCLAGE” may also be offered between 16 and 27+6 weeks when there is cervical dilation without the rupture of membranes, prevent progression and premature delivery

98
Q

Pre-term labour prophylaxis?

A

Vaginal progesterone:
o Progesterone can be given as a vaginal gel or a pessary
o Decreases the myometrial contractility and prevents the cervical remodelling.
o Offered to women with cervical length under 25mm on TVUS and if they are between 16-24 weeks
Cervical cerclage:
o Putting a stitch in the cervix to provide support and keep it closed (need to have a spinal/general Anaesthetic). The stitch is the removed at term or if the woman goes into labour.
o Offered to all women with CL under 25mm on US , also between 16-24 weeks gestation, had a previous premature birth or cervical trauma (colposcopy, cone biopsy)
o “RESCUE CERVICAL CERCLAGE” may also be offered between 16 and 27+6 weeks when there is cervical dilation without the rupture of membranes, prevent progression and premature delivery

99
Q

What can you test for if in doubt of PPROM?

A

Insulin like growth factor-binding protein-1 (IGFBP-1) is a protein that is present in high levels within the amniotic fluid, can be tested on the vaginal fluid if in doubt

Placental alpha-microglobin-1 (PAMG-1) similar alternate

100
Q

What Abx is used with P-PROM

A

Erythromycin 250 mg QDS until labour

Induce labour from 34 weeks

101
Q

What test other than TVUS and cervical length can be used to assess prematurity?

A

Fetal fibronectin is an alternative test to US. It is the “glue” between the chorion and the uterus, found in the vagina during labour.
 Test the fluid from the vagina: result of <50ng/ml is negative and shows preterm labour is unlikely.

102
Q

Use of MgSO4 for prematurity?

A

• Giving the mother IV magnesium sulphate helps to protect the fetal brain in prematurity. It reduced the risk of cerebral palsy.
• It is given within 24 hrs of delivery for preterm babies of under 34 weeks gestation.
• Given as a bolus then followed up with infusion for up to 24 hrs or until birth.
• Mother needs close monitoring for magnesium toxicity at least 4 hrly:
o Obs monitoring plus tendon reflexes.
• Key signs of Mg toxicity:
o Reduced RR
o Reduced BP
o Absent reflexes

103
Q

Diagnosis of preterm labour with intact membranes?

A

1st speculum and PV to look for cervical dilation:
Less than 30 weeks, clinical assessment alone is enough to offer management of preterm labour
 More than 30 weeks, a TVUS can be used to assess the cervical length. When the cervical length is under 15 mm then management of preterm can be offered If the cervical length is more than 15 mm indicates preterm labour is likely.

104
Q

Which 3 P’s are involved in failure to progress?

A
  • Power (uterine contractions)
  • Passenger (size, presentation and position of the baby)
  • Passage (the shape and size of the pelvis and soft tissues)
105
Q

What would indicate failure to progress in the first stage of labour?

A

o Less than 2 cm dilation in 4 hours

o Slowed progress in a multiparous woman

106
Q

Failure to progress stage 3 labour?

A

• Failure to progress at this stage:
o More than 30 mins with active
o Over 60 mins with physiological

107
Q

2 key complications of dilation and cutter age of RPOC?

A

 Endometritis

 Ashermanns syndrome

108
Q

Treatment of PP anaemia

A

o Hb under 100 g/l- start oral iron (ferrous sulphate- 200mg TDS for 3/12)
o Hb under 90 g/l- consider an iron infusion in addition to oral iron (e.g. Monofer, Cosmofer or Ferinject)
o Hb under 70g/l- blood transfusion in addition to oral iron

109
Q

What is a CI to IV iron?

A

Active infection- bacteria feed of the iron, worsen the infection, important to wait until the treatment for infection is done

110
Q

What is a SE of SSRI’s in pregnancy?

A

• SSRI AD taken in pregnancy can lead to neonatal abstinence syndrome. (neonatal adaptation syndrome). It presents within the first few days of birth  Irritability and poor feed

111
Q

Why measure levels of anti0mullerian hormone if testing for fertility?

A

 Measure anytime in the cycle and most accurate marker of the ovarian reserve. Released by the granulosa cells in the follicles and falls as the eggs are depleted. A high level indicated a good ovarian reserve.

112
Q

What are the grades for ovarian hyper stimulation syndrome (OHSS)?

A

The severity is determined based on the clinical features:
o Mild: Abdo pain and bloating
o Moderate: Nausea and vomiting with ascites seen on US
o Severe: Ascites, low urine output (oliguria) low serum albumin high potassium and raised haematocrit (>45%)
o Critical: Tense ascites, no urine output (anuria), thromboembolism and acute respiratory distress symptoms (ARDS)

113
Q

Ductal carcinoma in situ (DCIS)- breast

A
  • Pre-cancerous or cancerous epithelial cells of the breast ducts
  • Localised to a single area
  • Often picked up on mammogram screen
  • Potential to spread locally over years
  • Potential to become invasive cancer (30%)
  • Good prognosis if fully excised with adjuvant treatment
114
Q

Lobular Carcinoma In Situ (LCIS)

A
  • Also known as lobar neoplasia
  • Pre-cancerous state typically presents in pre-menopausal women
  • Asymptomatic and undetectable on mammogram
  • Usually incidentally diagnosed on breast biopsy
  • Represents an increased risk of invasive breast cancer in the future (about 30%)
  • Usually managed with close monitoring (6 monthly examination and yearly mammogram)
115
Q

Invasive Lobular Carcinomas (ILC)

A
  • Around 10% of invasive cancers
  • Originate in cells from the breast lobules
  • Not always seen on mammograms
116
Q

Inflammatory Breast Cancer:

A
  • 1-3% of breast cancers
  • Presents similarly with breast abscess or mastitis
  • Swollen, warm, tender breast with pitting skin (peau d’orange)
  • Does not respond to Abx
  • Worse prognosis then other breast cancer
117
Q

NHS Breast Cancer Screening:

A
  • Offered to women aged 50 to 70 (extended in some areas)
  • Individual offered screen every 3 years
  • Involves a simple mammogram
  • Roughly 1 in 100 screened are diagnosed with Ca
118
Q

Fibroadenoma:

A
  • AKA “breast mouse” as they are small and mobile
  • Benign tumours of stromal/epithelial breast duct tissue
  • Common in younger patients (<40 years)
  • A smooth, well circumscribed, firm, mobile lump.
  • Usually up to 3 cm
  • Hormone dependent, regress after menopause
  • 10% disappear every year
119
Q

Two Week Wait Referral Criteria (Urgent Cancer Referrals

A
  • A discrete lump with fixation, that enlarges and/or with any concerns (e.g. family history)
  • Women over 30 with a persistent breast or axillary lump or focal lumpiness after their menstrual period
  • Previous breast cancer with new suspicious symptoms
  • Skin or nipple changes suggestive of breast cancer
  • Unilateral bloody discharge
120
Q

Breast Cysts:

A
  • A discrete collection of fluids in the breast tissue
  • Most common between ages 30-60
  • A smooth, well circumscribed, mobile and possibly fluctuant lump
  • Benign
  • Can fluctuate in size over the menstrual cycle
  • Treat conservatively, with needle aspiration or local excision
121
Q

What happens after a 2 week wait?

A

Once patient has referred for specialist services under a two week wait referral for suspected cancer they should initially receive a triple diagnostic assessment comprising of:
o Clinical Assessment
o Breast imaging (US/mammography)
o Biopsy (fine needle or core)

3a (7 decks)

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