Obs&Gynae 3A Flashcards
PAPPA blood test?
when and what
Offer PAPP-A blood test during the 12-week dating scan
⇒ Down’s syndrome, Patau’s & Edward’s (Trisomy 21, 13 + 18)
PAPPA is a hormone produced by placenta = low levels are abnormal
Breast cancer triple assessment
- Clinical (exam/history)
- Imaging (mammography/ultrasound)
- Biopsy
Common sites of metastasis for breast cancer?
- L–Lungs
- L–Liver
- B–Bones
- B–Brain
Breast cancer receptors?
- Oestrogen receptors(ER)
- Progesterone receptors(PR)
- Human epidermal growth factor(HER2)
Triple-negative breast canceris where the breast cancer cells do not express any of these three receptors. This carries a worse prognosis, as it limits the treatment options for targeting the cancer.
Hormone treatment for oestrogen-receptor positive breast cancer? (ER)
There are two main first-line options for this:
given for5 – 10 yearsto women with oestrogen-receptor positive breast cancer.
Tamoxifenforpremenopausal women
- Aromatase inhibitorsforpostmenopausal women(e.g., letrozole, anastrozole or exemestane)
After menopause, the primary source of oestrogen is from the action of aromatase in fat cells. Aromatase inhibitorswork by blocking the creation of oestrogen in fat tissue.
Treatments used for HER2 positive breast cancer?
- Trastuzumab(Herceptin) - mAb
- Pertuzumab(Perjeta) - mAb
- Neratinib(Nerlynx) - tyrosine kinase inhibitor
Presentation of mammary duct ectasia?
Inflammation = dilation of the large ducts in the breasts = nipple discharge
- Nipple discharge (white, grey or green)
- Tenderness or pain
- Nipple retraction or inversion
- A breast lump (pressure on the lump may produce nipple discharge)
It may be picked up incidentally on a mammogram, leading to further assessment and investigations.
Diagnosis of mammary duct ectasia?
he initial priority is to exclude breast cancer, as they can present in similar ways. This involves triple assessment with:
- Clinical assessment(history and examination)
- Imaging(ultrasound, mammography and MRI)
- Histology(fine needle aspiration or core biopsy)
Microcalcificationsare a key finding to remember on a mammogram, although they are not specific to mammary duct ectasia.
Presentation of intraductal papilloma?
- May be ASYMPTOMATIC and the warty lesiosn just picked up on mammogram.
- Clear or blood-stained nipple discharge
- Pain/tenderness
- Palpable lump
Management of intraductal papilloma?
Complete surgical excision.
After removal, the tissue is examined for atypical hyperplasia or cancer that may not have been picked up on the biopsy.
How do some antipsychotic drugs cause gynaecomastia?
Dopamine antagonists.
Dopamine normally block prolactin production => therefore DA antagonist = less DA = more prolactin
=> gynaecomastia + galactorrhoea
(metoclopramide + olanzapine + haloperidol)
Causes of gynaecomastia (men) linked to increased oestrogen?
- Testicular cancer(oestrogen secretion from aLeydig cell tumour)
- Obesity(aromataseis an enzyme found in adipose tissue that converts androgens to oestrogen)
- Liver cirrhosisandliver failure
- Hyperthyroidism
- Human chorionic gonadotrophin(hCG)secreting tumour, notably small cell lung cancer
Causes of gynaecomastia (men) linked to reduced testosterone?
- Testosterone deficiencyinolder age
- Hypothalamusorpituitaryconditions that reduce LH and FSH levels (e.g., tumours, radiotherapy or surgery)
- Klinefelter syndrome(XXY sex chromosomes)
- Orchitis(inflammation of the testicles, e.g., infection withmumps)
- Testicular damage(e.g., secondary to trauma or torsion)
Medications that can cause gynaecomastoa?
- Spironolactone(inhibits testosterone production and blocks testosterone receptors)
- Anabolic steroids(raise oestrogen levels)
- Antipsychotics(increase prolactin levels)
- Digoxin(stimulates oestrogen receptors)
- Gonadotrophin-releasing hormone(GnRH)agonists(e.g., goserelin used to treat prostate cancer)
- Opiates(e.g., illicit heroin use)
- Marijuana
- Alcohol
46-year-old woman - thickened area of breast tissue on her right breast. Inverted nipple and dimpling of the skin. She has unintentionally lost 4kg in weight.
A mammogram has not shown any evidence of malignancy.
Invasive lobular breast cancer is the second most common type of breast cancer. It presents with a thickened area of breast tissue alongside changes to the nipple or to the skin. It is difficult to detect using a mammogram and most women have a MRI scan of their breast to confirm/exclude the diagnosis.
Diagnosis? Pregnant woman with a history of fibroids presenting with severe abdominal pain and a low-grade fever.
The diagnosis is likely to be red degeneration
Ischaemia, infarction and necrosis of fibroid due to disrupted blood supply.
⇒ severe abdominal pain, low grade fever, tachycardia and often vomiting.
=> management is supportive, with rest, fluids and analgesia.
Treatment for infective mastitis?
Flucloxacillin - if there are breaks in the skn (i.e. nipple fissure)
If not, then conservative management.
A 32-year-old woman presents to the GP with a vulval mass. She denies any bleeding or abnormal discharge.
1.5 cm mass is palpated at the inferior aspect of the labia majora in the 7 o’clock position. There is no overlying skin changes or lymphadenopathy.
The mass is mildly tender on palpation.
Which of the following is the most appropriate management for the likely diagnosis?
The most likely diagnosis is a Bartholin’s cyst, which forms when the Bartholin gland becomes blocked.
These cysts are typically asymptomatic or mildly tender, as described.
First-line management for small, uncomplicated Bartholin’s cysts includes warm salt water baths, which can help the cyst drain naturally.
Complication of shoulder dystocia that causes waiters tip?
Myotome affected?
C5 C6 Erbs palsy
(elbow extension, forearm pronation, wrist and finger flexion = waiters tip)
C5alt and C6epper are (h)erb’s
What makes COCP UKMEC3?
BMI > 35
Any migraines, without aura
(risks generally outweigh the benefits)
What makes COCP UKMEC4?
- Uncontrolled hypertension (particularly ≥160 / ≥100)
- Migraine with aura (risk of stroke)
- History of VTE
- Aged over 35 and smoking more than 15 cigarettes per day
- Major surgery with prolonged immobility
- Vascular disease or stroke
- Ischaemic heart disease, cardiomyopathy or atrial fibrillation
- Liver cirrhosis and liver tumours
- Systemic lupus erythematosus (SLE) and antiphospholipid syndrome
Management of eclampsia?
IV magnesium sulphateis used to manage the seizures
This woman now has eclampsia which is defined by presumed or confirmed pre-eclampsia with seizure activity. The drug of choice is Magnesium Sulphate, given as an initial loading dose, then a slow IV infusion
What is HELPP syndrome?
Complication of pre-eclampsia and eclampsia.
- Haemolysis
- ElevatedLiver enzymes
- LowPlatelets
Baby in NICU on ventilator.
Which consequence of artificial ventilation is routinely screened for?
Retinopathy of prematurity
This is caused by the uncontrolled proliferation of blood vessels within the retina due to over oxygenation
