OBS AND GYNAE

Question 1

What is HELLP syndrome?

Answer 1

HELLP syndrome (haemolysis, elevated liver enzymes and low platelets), a serious manifestation of pre-eclampsia. The clinical features of hypertension, vomiting and abdominal pain support the diagnosis but are not pre-requisites. The abdominal pain here may be a sign of liver inflammation and resulting stretch of the liver capsule.

Question 2

What are the causes of cervical cancer?

Answer 2

• HPV 16,18
• Smoking
• Early first episode of Sexual Intercourse
• COCP use
• Multiple sexual partners
• Immunosuppression

Question 3

What does HPV vaccination involve?

Answer 3

All girls 11-13
2 injections needed at least 6 months apart
GARDISAL quadrivalent vaccine

Question 4

Describe cervical screening programme

Answer 4

25-65y
3yearly (25-49)
5yearly >50

if HPV positive every 12 months
If sample not viable 3 months later

Question 5

What do you have to do if cervix visibly abnormal?

Answer 5

Biopsy: punch, Large loop excision of transformation zone (LLETZ)

Question 6

What happens when smear is abnormal? (Cervix)

Answer 6

Refer for colposcope (binocular microscope) with ACETIC ACID or LUGOL’S IODINE
Biopsy + Treatment with excision technique

Question 7

What is CIN?

Answer 7

Cervical Intraepithelial Neoplasia

CIN 1,2,3
2and 3 high grade and needs treatment

After treatment do follow up in the community at 6 months with HPV test

Question 8

How is CIN 2 and 3 treated?

Answer 8

Destructive: cold coagulation, cryotherapy
Excisional: LLETZ, cold knife cone, laser excision

Question 9

What type of cervical cancer is most common?

Answer 9

Squamous cell carcinoma

Question 10

How does cervical cancer present?

Answer 10

Unscheduled vaginal bleeding
Sero-sanguineous offensive vaginal discharge
Obstructive renal failure
Supraclavicular node

ASYMPTOMATIC

Question 11

CERVICAL STAGES

Answer 11

Do before exam!

Question 12

What is the management of cervical cancer?

Answer 12

• Surgery: think about fertility desires, if early stage, simple or radical surgery
• Chemotherapy and radiotherapy: cisplastin, EBRT, VBT

Question 13

How to spare fertility in cervical cancer management?

Answer 13

• In early disease if confined to cervix
  LLETZ and tracheae to my, radical tracheotomy
  With pelvic lymphadenectomy. In 1A2 and 1B1

Question 14

What are the factors influencing vulval cancer?

Answer 14

• smoking
• HPV
• altered immune system
• chronic skin conditions like lichen sclerosus

Question 15

What is the most common vulval cancer?

Answer 15

Squamous cell carcinoma