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4MB Medicine > Obstetrics > Flashcards

Obstetrics Flashcards

1
Q

What is meant by gravidity?

A

No. of pregnancies a woman has had

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2
Q

What is meant by parity?

A

No. of pregnancies that went beyond 28 weeks’ gestation that resulted in delivery

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3
Q

What is meant by “para 2+1”?

A

Woman has had 2 pregnancies beyond 28 weeks and 1 pregnancy terminated/miscarried before 28 weeks

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4
Q

How do you calculate an estimated date of delivery (EDD) of a baby?

A

1 year + 7 days after LMP, minus 3 months

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5
Q

What happens to red cell volume during pregnancy and what is the consequence of this?

A

Red cell volume increases, causing dilution of Hb and a physiological anaemia
Treat with iron supplements

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6
Q

What happens to blood pressure during pregnancy?

A

High in 1st trimester
Falls in 2nd trimester until about 22 weeks
Steady rise to normal by end of term
High blood pressure should normalise within 6 weeks post-partum

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7
Q

When is a pregnancy test +ve?

A

9 days post-conception until 20 weeks gestation

Can be positive up to 5 days after miscarriage

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8
Q

When is the booking antenatal visit?

A

8-12 weeks

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9
Q

When is the dating USS done?

A

Around 10 weeks

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10
Q

When is the Down’s syndrome nuchal thickness test done?

A

Can be done with dating scan around 10-11 weeks

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11
Q

When is the anomaly scan done?

A

18 weeks

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12
Q

When is the first routine check-up antenatal visit?

A

25 weeks

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13
Q

When may a woman receive anti-D prophylaxis?

A

28 and 34 weeks’ gestation

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14
Q

When is the triple assessment for Down’s syndrome carried out and what does it measure?

A

11-13 weeks

Nuchal thickness, bHCG and PAPPA levels

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15
Q

Tricyclics are usually OK to prescribe in pregnancy. True/False?

A

True

but may have withdrawal effects in the foetus

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16
Q

Which SSRI has the lowest risk for use in pregnancy?

A

Fluoxetine

Avoid paroxetine

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17
Q

Breastfeeding is contraindicated in those taking psychiatric drugs. True/False?

A

Generally true, especially citalopram and fluoxetine

Consult psychiatrist for specialist advice

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18
Q

When is lithium most teratogenic in pregnancy?

A

First trimester

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19
Q

BZD use is contraindicated in pregnancy. True/False?

A

True

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20
Q

How much folic acid is recommended during pregnancy?

A

0.4mg until 12th week at least

5mg if increased risk of NTD’s (diabetes, epilepsy, obese)

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21
Q

Radioiodine and carbamazepine are safe in pregnancy. True/False?

A

False

Contraindicated - use propylthiouracil instead

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22
Q

When should trimethoprim and nitrofurantoin be avoided in pregnancy?

A

Avoid trimethoprim in the first trimester

Avoid nitrofurantoin in the third trimester

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23
Q

In which trimester is there an increased risk of seizures?

A

First trimester

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24
Q

Which anti-epileptic drug has the lowest risk in pregnancy?

A

Lamotrigine

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25
Q

Breastfeeding is safe in those taking anti-epileptics. True/False?

A

True

Except barbiturates

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26
Q

When should methotrexate be stopped with regards to pregnancy?

A

3 months before trying to conceive

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27
Q

Why should NSAID’s be avoided in the 3rd trimester?

A

Can cause premature closure of the ductus arteriosus

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28
Q

Which rheumatological antibodies can cross the placenta and cause congenital heart block?

A

Anti Ro

Anti La

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29
Q

What should patients with antiphospholipid syndrome take in pregnancy?

A

Aspirin and enoxaparin from 6-34 weeks’ gestation

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30
Q

When can the uterus typically be first felt in pregnancy?

A

Around 12 weeks

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31
Q

How is gestation estimated according to symphiseal-fundal height?

A

Gestation = SFH +/- 2cm

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32
Q

Describe foetal movements during labour

A

Increased flexion and descent as head enters pelvic cavity
Internal rotation at ischial spines, increased head flexion
Head extension to reach out of vulva
Restitution: shoulders rotate and head externally rotates the opposite way
Lateral flexion to deliver shoulders
Deliver buttocks and legs

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33
Q

Describe the basics of a normal CTG trace

A

Heart rate 110-160 beats/min
Variability greater than 5 beats/min
2 or more accelerations

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34
Q

What might cause reduced variability on a CTG?

A

Preterm
Sleeping foetus
Drug effects (BZD, opioids)
Hypoxia

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35
Q

What might cause tachycardia on a CTG?

A 
Maternal fever
B-agonists
Chorioamnionitis
Hypoxia
Arrhythmia
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36
Q

What might cause bradycardia on a CTG?

A

Increased vagal tone of foetus
Heart block
Cord compression

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37
Q

What are late decelerations on a CTG a sign of?

A

Foetal hypoxia

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38
Q

What does DR C BRAVaDO stand for with regards to a CTG?

A 
Determine Risk
Contractions
Baseline Rate
Accelerations
Variability
Decelerations
Overall impression
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39
Q

Blood pressure should normalise within 6 weeks postpartum. True/False?

A

True

If not, may indicate chronic hypertension

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40
Q

What is pre-eclampsia?

A

Triad of pregnancy-induced hypertension, proteinuria and oedema
Occurs after 20 weeks gestation, typically resolves within 10 days postpartum

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41
Q

Describe the pathophysiology of pre-eclampsia

A

Failure of trophoblastic invasion causes failure of normal vascular remodelling: spiral arteries remain high-resistance low-capacitance vessels, causing endothelial damage and dysfunction

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42
Q

List aetiology/risk factors for pre-eclampsia

A 
Maternal/family history
Primiparity
Twin/multiple pregnancy
IVF, ICSI
Short stature
Obesity
Migraine history
Hypertension, renal disease
Hydatidiform mole
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43
Q

List clinical features of pre-eclampsia

A 
Headaches
Visual disturbance
Epigastric/RUQ pain
Nausea, vomiting
Sudden oedema and weight gain
Generalised seizure (eclampsia)
HELLP syndrome
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44
Q

What investigations would you do for pre-eclampsia?

A 
Bloods: FBC, U+E, LFT's, urate, coag screen
Foetal CTG
USS, uterine artery Doppler
Urinalysis
Regular BP checks
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45
Q

Outline management of pre-eclampsia

A

Admit if BP rises 30/20 from booking BP, or if 140/90 + proteinuria
Treat if systolic over 160: labetolol, methyldopa, nifedipine, hydralazine
Steroids to promote foetal lung development
MgSO4 if eclampsia (prophylactically can half the risk of eclampsia)
Definitive management: delivery the baby!

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46
Q

If a woman is at increased risk of pre-eclampsia, what can she take during pregnancy?

A

Aspirin from 12 weeks until birth

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47
Q

List aetiology/risk factors for foetal distress

A

Prolonged pregnancy or labour
Small foetus
Antepartum haemorrhage
Hypertension, pre-eclampsia

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48
Q

List clinical features of foetal distress

A

Meconium passage in labour
Foetal tachycardia persistently above 160bpm
Loss of variability, late decelerations on CTG

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49
Q

Outline management of foetal distress

A 
Change maternal position
IV fluids
Stop syntocinon/tocolytics
Foetal blood sample
Deliver promptly!
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50
Q

Antepartum haemorrhage is defined as bleeding that occurs when?

A

After 24 weeks’ gestation

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51
Q

What is placental abruption?

A

Separation of a normally implanted placenta from the uterus

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52
Q

List aetiology/risk factors for placental abruption

A 
Subsequent pregnancies
Pre-eclampsia
Smokers
Previous C-sections
Thrombophilia
Cocaine use
Trauma
Polyhydramnios
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53
Q

List clinical features of placental abruption

A

Bloody cervix
Painful, tender uterus
Backache
Placental insufficiency leads to foetal anoxia/death

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54
Q

How would you diagnose placental abruption?

A

Clinical diagnosis

Can do transvaginal USS

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55
Q

Outline management of placental abruption

A

Deliver - C-section if unstable, NVD if stable

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56
Q

What is placenta praevia?

A

Implantation of placenta in the lower uterine segment, over or near to the cervical os

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57
Q

Describe minor and major placenta praevia

A

Minor: not covering os but near it
Major: partially or completely covering os

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58
Q

List aetiology/risk factors for placenta praevia

A 
Multiple pregnancy
Prior C-sections
Uterine abnormalities (fibroids)
Smoking
Older mum
Twin pregnancy
IVF
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59
Q

List clinical features of placenta praevia

A

Painless bleeding
Non-tender uterus
High presenting part

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60
Q

Outline management of placenta praevia

A

If less than 2cm from os, do C-section
If more than 2cm from os, consider NVD
Do not examine vagina!

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61
Q

What is placenta accreta?

A

Placenta invades and adheres to myometrium

Associated with previous C-sections

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62
Q

List clinical features of placenta accreta

A

Massive bleeding

Pain

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63
Q

Outline management of placenta accreta

A

C-section delivery

May need to do hysterectomy

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64
Q

What is vasa praevia?

A

Foetal blood vessels overlie internal cervical os, causing increased risk of tearing of vessels and foetal hypoxia

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65
Q

How would you diagnose vasa praevia?

A

Colour Doppler USS

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66
Q

What is the most common liver disease of pregnancy?

A

Obstetric cholestasis

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67
Q

List clinical features of obstetric cholestasis

A

Pruritis in 2nd half of pregnancy
Usually affecting palms and soles
No rash

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68
Q

Outline management of obstetric cholestasis

A

Vitamin K to mother and baby
Orsodeoxycholic acid
Induce labour at 37 weeks

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69
Q

What is HELLP syndrome?

A

Haemolysis, Elevated Liver enzymes, Low Platelets

Complication of pregnancy

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70
Q

List clinical features of HELLP syndrome

A 
Upper abdo pain
Jaundice
Malaise
Vomiting
Headache
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71
Q

Describe stage 1 of labour

A

Period from the onset of regular contractions to full dilation of the cervix
Latent phase: 0-3cm dilation, takes ~6h
Active phase: 3-10cm dilation, takes ~1cm/h
3-4 contractions every 10 mins

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72
Q

Describe stage 2 of labour

A

Period from complete cervical dilation to delivery of baby
Generally lasts 45m-2h in primip, 15-45m in multip
Mother has urge to push, uses abdo muscles, Valsalva maneuvre

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73
Q

Why is cord clamping delayed after delivery?

A

Delayed for 60s to increase perfusion and O2 to baby

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74
Q

Describe stage 3 of labour

A

Delivery of placenta and membranes

Generally 30 mins with oxytocin/ergometrine support

75
Q

How often is foetal heart rate, contractions, maternal pulse, maternal BP + temp, vaginal exam and urine analysis done during labour?

A 
Foetal heart rate (CTG): every 15 mins
Contractions: every 30 mins
Maternal pulse: every 60 mins
Maternal BP + temp: every 4h
Vaginal exam: every 4h
Urinalysis: every 4h
76
Q

List contraindications to induction of labour

A 
Cephalopelvic disproportion
Malpresentation other than breech/facial presentation
Foetal distress
Placenta praevia
Cord prolapse
Vasa praevia
Pelvic tumour
77
Q

What is measured on the Bishops score?

A 
Measure of cervical ripeness to estimate likelihood of spontaneous labour
Cervical dilation
Cervical consistency
Cervical position
Cervical length
Station of head
78
Q

Describe factors on Bishops score that would score a point of 0

A 
Cervical dilation: 0cm
Cervical consistency: firm
Cervical position: posterior
Cervical length: more than 2cm
Station of head: -3
79
Q

Describe factors on Bishops score that would score a point of 1

A 
Cervical dilation: 1-2cm
Cervical consistency: medium
Cervical position: middle
Cervical length: 1-2cm
Station of head: -2
80
Q

Describe factors on Bishops score that would score a point of 2

A 
Cervical dilation: 3-4cm
Cervical consistency: soft
Cervical position: anterior
Cervical length: less than 1cm
Station of head: -1
81
Q

What Bishops score indicates that labour is unlikely to occur spontaneously?

A

Score of 9 indicates likely spontaneous labour

Score of less than 5 indicates labour is unlikely to occur spontaneously

82
Q

Outline the stepwise approach to induction of labour

A

Membrane sweep
Vaginal prostaglandin
Amniotomy + start foetal heart rate monitoring/pulse oximetry through scalp clip
Syntocinon

83
Q

What pain relief can be used during labour?

A 
Supportive, massage, relaxation
Entonox
Water immersion
TENS electrode placed on back
Pudendal block (S2,3,4) inject below and medial to ischial spine
IM diamorphine
IV remifentanyl
Epidural block (T11-S5)
84
Q

Define failure to progress in stage 1 of labour

A

Less than 2cm dilation in 4h in a primip

Less than 2cm dilation in 4h or slowing progress in a multip

85
Q

Define failure to progress in stage 2 labour

A

No delivery in 2h (no epidural) or 3h (epidural)

No delivery in 1h (no epidural) or 2h (epidural)

86
Q

List aetiology/risk factors for failure to progress in labour

A

Power: inadequate contractions, low strength +/- frequency of contractions
Passage: narrow pelvis, short stature, pelvic trauma)
Passenger: macrosomia, malposition, malpresentation

87
Q

What is assessed on a partogram?

A 
Assesses progression of labour
Foetal heart rate
Amniotic fluid
Cervical dilation
Foetal descent
Contractions
Obstruction (moulding, caput)
Maternal observations
88
Q

What is cord prolapse?

A

Umbilical cord descends ahead of presenting part of foetus, potentially causing foetal asphyxia and death

89
Q

List aetiology/risk factors for cord prolapse

A 
Prematurity
Nulliparity
Polyhydramnios
Twins
Cephalopelvic disproportion
Malpresentation
Placenta praevia
High foetal station
90
Q

List clinical features of cord prolapse

A

Foetal bradycardia
Variable decelerations
Palpable cord in vagina

91
Q

Outline management of cord prolapse

A

Keep cord in vagina (do not push it back)
Presenting part may be pushed back
Mother on all fours position (use gravity to assist)
Instrument delivery may be possible if cervix fully dilated and head is low
Tocolytics help bradycardia + reduce contractions
Plan C-section

92
Q

What are dizygotic and monozygotic twins?

A

Dizygotic: non-identical, 2 separate ova fertilised at same time
Monozygotic: identical, 1 fertilised ova divides into 2 embyros

93
Q

List aetiology/risk factors for multiple pregnancy

A 
Previous twins
Family history of twins
Increased maternal age
IVF
Induced ovulation
Race (Afro-Caribbeans)
94
Q

List clinical features of multiple pregnancy

A

Uterus larger for dates
Polyhydramnios
More than 2 foetal poles felt
Spontaneous miscarriage/perinatal mortality
Malformations
IUGR
Twin-twin transfusion (one twin born plethoric, the other anaemic)
Pregnancy-induced hypertension, pre-eclampsia
Prematurity
Malpresentation

95
Q

What is the commonest malpresentation of a foetus?

A

Breech (buttocks) where caudal end occupies lower uterus

96
Q

List aetiology/risk factors for breech presentation

A 
Contracted pelvis
Bicornuate uterus
Uterine malformations, fibroids
Placenta praevia
Prematurity
Foetal abnormality
97
Q

Outline management of breech presentation

A

If less than 36 weeks most will turn spontaneously
External cephalic version if 36w (primip) or 37w (multip)
Planned C-section or NVD

98
Q

List some contraindications to external cephalic version

A 
Placenta praevia
Twins
Antepartum haemorrhage in last 7 days
Ruptured membranes
Growth restricted babies
Abnormal CTG
Uterine abnormality
99
Q

A woman with a long anthropoid pelvis is at particular risk of which foetal malpresentation?

A

Occipitoposterior

100
Q

A foetus with anencephaly and/or short neck muscles is at risk of which malpresentation?

A

Facial presentation

101
Q

Which malpresentation typically are always delivered by C-section?

A

Brow presentation

Transverse lie

102
Q

What is shoulder dystocia?

A

Inability to deliver shoulders after head, requiring additional maneuvers to release the shoulders after downwards traction fails

103
Q

List aetiology/risk factors for shoulder dystocia

A 
Large/postmature foetus
Maternal BMI over 30
Induced labour, oxytocin
Prolonged labour
Assisted vaginal delivery
Previous shoulder dystocia
104
Q

List clinical features of shoulder dystocia

A

Maternal + foetal morbidity
Postpartum haemorrhage
Brachial plexus injury
Perineal tear

105
Q

Outline management of shoulder dystocia

A

McRobert’s maneuver (hyperflexed lithotomy position): flex and abduct maternal hips, thighs towards abdomen, apply suprapubic pressure
Episiotomy can allow better access for internal manoeuvres

106
Q

What is hyperemesis gravidarum?

A

Persistent vomiting in pregnancy which causes weight loss and ketosis, related to high bHCG levels
Usually occurs 8-12 weeks but may persist up to and beyond 20 weeks

107
Q

List aetiology/risk factors for hyperemesis gravidarum

A 
Young, primiparous
Non-smokers
Eating disorder
Multiple pregnancy
Molar pregnancy
Hyperthyroidism
Obesity
108
Q

Outline management of hyperemesis gravidarum

A

Admit to hospital
IV rehydration
Antihistamine, antiemetic (promethazine, cyclizine)
Thiamine supplementation

109
Q

List indications for forceps delivery

A

Delayed stage 2 of labour
Foetal or maternal distress in stage 2 of labour
Control head in breech delivery
Dense epidural block with reduced urge to push
Assisted delivery for malpresentation
Prolapsed cord

110
Q

Ventouse vacuum extraction delivery causes less maternal trauma than forceps delivery. True/False?

A

True

111
Q

What are the 2 types of C-section?

A

Lower segment CS (most common): horizontal incision 3cm above symphysis pubis with subsequent blunt dissection
Classical CS: vertical incision

112
Q

What layers are cut/separated and then stitched in a lower segment CS?

A 
Skin + fascia
Anterior rectus sheath
Separation of recti (not cut)
Fascia + peritoneum
Retract bladder
Uterine wall
Amniotic sac
Stitch uterine wall with visceral peritoneum, close rectus sheath, fascia and skin
113
Q

List complications of C-section

A 
Need for further surgery/hysterectomy
VTE
Bladder/ureteric injury
Increased uterine rupture in future pregnancies
Increased risk of stillbirth
Wound infections, abdo discomfort
Need for repeat C-sections
114
Q

List indications for C-section

A 
Known cephalo-pelvic disproportion
Placenta praevia
Breech presentation
Twin pregnancies
Malpresentation
Pre-eclampsia
IUGR
Foetal distress
Failure to progress in labour
115
Q

What is primary postpartum haemorrhage?

A

Loss of greater than 500ml blood during first 24h after delivery

116
Q

List aetiology/risk factors for primary PPH

A 
Uterine atony
Genital tract trauma
Clotting disorder
Retained placenta
Halothane anaesthesia
Large placental site (twins, macrosomia)
Prolonged labour
Poor 2nd stage contractions
Older mum
Uterine malformation
117
Q

Outline management of primary PPH

A

IV oxytocin
High-flow O2
Blood transfusion if shocked
If placenta not delivered, attempt by cord traction

118
Q

What is secondary postpartum haemorrhage?

A

Excess blood loss after 24h from delivery, usually between 5-12 days

119
Q

List aetiology/risk factors for secondary PPH

A

Retained placental tissue
Clot
Secondary infection

120
Q

Outline management of secondary PPH

A

Uterine exploration if heavy
Crossmatch blood
Ampicillin/metronidazole if infection
Uterine curette for histology

121
Q

When is a placenta defined as being “retained”?

A

If not delivered by 30 mins

122
Q

Describe a 1st degree perineal tear

A

Superficial tear

No muscle damage

123
Q

Describe a 2nd degree perineal tear

A

Laceration involves perineal muscle

124
Q

Describe a 3rd degree perineal tear

A

Damage involves anal sphincter muscle

3a: less than 50% of EAS
3b: more than 50% of EAS
3c: tear of EAS and IAS

125
Q

Describe a 4th degree perineal tear

A

Tear to anal sphincter and rectal mucosa

126
Q

What is cut in an episiotomy and why is it done?

A

Incise vaginal epithelium, perianal skin, bulbocavernosus, superficial and deep transverse perineal muscles
Done to enlarge pelvic outlet to hasten birth of distressed baby, for breech and to prevent 3rd degree perineal tear

127
Q

Outline management of preterm rupture of membranes

A

Oral erythromycin for 10 days
Antenatal steroid
Tocolysis (nifedipine) to reduce contractions

128
Q

What is baby blues and how long does it last?

A

Depressive/anxiety -like symptoms seen around 3-7 days after birth, usually lasts no more than 72h
Give reassurance and health visitor support

129
Q

What is postnatal depression and how long does it last?

A

Depression symptoms starting within 1 month of pregnancy, peaking at 3 months, resolving by 6 months

130
Q

Outline management of postnatal depression

A

Reassurance and support
CBT
SSRI (sertraline, paroxetine)
Lithium/ECT may be tried

131
Q

What is puerperal psychosis and when does it start?

A

Severe mood swings (similar to BPD) and altered perception and delusions, occurring 2-3 weeks after birth
Mums can have delusions regarding child and suicidal ideation

132
Q

Outline management of puerperal psychosis

A

Admit to hospital/mother-baby unit

133
Q

What is puerperal pyrexia?

A

Temperature greater than 38’C in first 14 days after delivery

134
Q

List aetiology/risk factors for puerperal pyrexia

A 
Endometritis
UTI
Wound infection (perineal tear, C-section)
Mastitis
VTE
135
Q

List clinical features of puerperal pyrexia

A

Lower abdo pain
Tender uterus
Lochia (endometrial slough passed per vaginum)

136
Q

What does “triple assessment” of a breast lump entail?

A

Clinical examination
Imaging (USS if under 40, mammogram if over 40)
Biopsy (core/vacuum/FNA)

137
Q

List aetiology/risk factors for mastaglia

A

Low progesterone
High oestrogen, prolactin, fatty acids
Caffeine excess
Poor diet

138
Q

List clinical features of mastalgia

A

Cyclical: pre-menopausal, outer 1/2 of breast, may be unilateral
Non-cyclical: older women, continuous/random distribution
Breast discomfort
Fullness, heaviness
Burning pain

139
Q

Outline management of mastalgia

A

Mild-mod: reassurance, well-fitting bra, topical NSAID

Severe: danazol, gamolenic acid, bromocriptine, tamoxifen, evening primrose oil

140
Q

List aetiology/risk factors for nipple discharge

A

Duct ectasia
Intraductal papilloma
Carcinoma
Lactation

141
Q

What is gynaecomastia?

A

Breast development in a male, with ductal growth but without lobular development

142
Q

List aetiology/risk factors for gynaecomastia

A 
Hypogonadism
Puberty
Drugs (spironolactone, cannabis)
Cirrhosis
Testicular tumours
143
Q

Outline management of gynaecomastia

A

Resolve spontaneously after 2 years
Surgery
Stop drugs
Tamoxifen, danazol

144
Q

Which breast condition is common in postpartum lactating women?

A

Breast abscess

145
Q

Which organisms are associated with breast abscess?

A

Staph aureus

Strep pyogenes

146
Q

List clinical features of breast abscess

A 
Pain
Swelling
Tenderness
Mobile mass
Overlying skin necrosis
147
Q

Outline management of breast abscess

A

Continue breastfeeding

Flucloxacillin +/- aspiration

148
Q

What is duct ectasia?

A

Dilation of sub-areolar ducts

149
Q

List aetiology/risk factors for duct ectasia

A

Smokers

Elderly parous women

150
Q

List clinical features of duct ectasia

A

Coloured (thick green) discharge
Acute/episodic
Nipple changes
Reduced milk production

151
Q

Outline management of duct ectasia

A

Treat infection
Exclude malignancy
Stop smoking
Duct excision

152
Q

Periductal mastitis presents in an older age group compared to duct ectasia. True/False?

A

False

Typically presents in younger women

153
Q

List clinical features of periductal mastitis

A 
Pain
Abscess
Duct fistula
Pus discharge
Redness
154
Q

Outline management of periductal mastitis

A

Co-amoxiclav

Drain abscess

155
Q

List aetiology/risk factors of fat necrosis of breast

A

Post-trauma
Obesity
Large breasts

156
Q

List clinical features of fat necrosis of breast

A

Hard, firm lesion/lump
Scarring
Foamy macrophages and damaged adipocytes on histology

157
Q

Which benign breast tumour is best described as a painless, firm, discrete mobile mass?

A

Fibroadenoma

158
Q

Describe the pathology of fibroadenoma

A

Develop from whole lobule
Circumscribed, rubbery
Grey-white biphasic tumour (consists of epithelium and stroma)

159
Q

Which benign breast tumour is best described as a slow-growing unilateral mass?

A

Phyllodes tumour

160
Q

Describe the pathology of Phyllodes tumour

A

Occur in older people
Malignant potential
Stromal overgrowth +/- infiltration

161
Q

Outline management of Phyllodes tumour

A

Wide local excision

Mastectomy if large

162
Q

Which benign breast tumour is best described as a smooth discrete lump associated with cyclical pain?

A

Fibrocystic change

163
Q

Describe the pathology of fibrocystic change

A

Occur in middle-aged
Several 1mm cysts
Blue-domed with pale fluid

164
Q

Which benign breast tumour is best described as having blood-stained discharge, a central solitary nodule or multiple peripheral nodules?

A

Intraductal papilloma

165
Q

Describe the pathology of intraductal papilloma

A

Occur in middle-aged
Local epithelial proliferation in sub-areolar ducts
Fibrovascular core

166
Q

Outline management of intraductal papilloma

A

Microdochectomy or total duct excisionm

167
Q

Describe the pathology of sclerosing adenosis/radial scars

A

Extra tissue growth in lobules as part of ageing
Epithelial proliferation, stromal fibrosis and sclerosis
Radial scar: stellate architecture, central puckering, radiating fibrosis

168
Q

List clinical features of sclerosing adenosis

A

Recurring pain
Firmness
Small lump

169
Q

List aetiology/risk factors for malignant breast cancer

A 
Increasing age
Familial history
BRCA mutation
Early menarche, late menopause
Nulliparity
HRT, COCP
Alcoholism
Obesity
Not breastfeeding
170
Q

List clinical features of malignant breast cancer

A 
Asymptomatic
Lump
Mastalgia
Nipple discharge
Skin changes, dimpling
Lymphoedema
171
Q

What is ductal carcinoma in situ (DCIS)?

A

Precursor to invasive carcinoma involving malignant epithelial cells confined within the basement membrane of the duct
Precursors: atypical duct hyperplasia, epithelial hyperplasia

172
Q

What would a mammogram of DCIS show?

A

Microcalcifications

173
Q

Outline management of DCIS

A

If less than 4cm, wide local excision + SN biopsy
If more than 4cm, mastectomy + SN biopsy
+/- adjuvant radiotherapy

174
Q

What is lobular carcinoma in situ?

A

Precursor to invasive carcinoma involving intralobular proliferation
Usually multifocal + bilateral, not visible or palpable grossly
Precursor: atypical lobular hyperplasia

175
Q

What is the screening schedule for breast cancer?

A

47-73 year-olds get 3-yearly mammograms
If increased risk, can screen earlier
e.g. if age less than 40, bilateral, ovarian Ca history, first-degree family/relative

176
Q

Where does invasive breast carcinoma arise from?

A

Epithelial cells in terminal duct lobular unit

177
Q

What is the most common form of invasive breast carcinoma?

A

Ductal carcinoma (adenocarcinoma)

178
Q

Describe staging of breast carcinoma

A

1: confined to breast
2: confined to breast + axillary LN involved
3: fixed to muscle + axillary LN involved
4: fixed to chest wall

179
Q

Describe T1-T4 staging of breast carcinoma

A

T1: less than 2cm
T2: 2-5cm
T3: more than 5cm
T4: fixed to chest wall

180
Q

What is the Nottingham Prognostic Index for breast carcinoma?

A

NPI = (tumour size x 0.2) + LN score + grade score
Grade 1 = 0 lymph nodes
Grade 2 = 1-3 lymph nodes
Grade 3 = 4+ lymph nodes

181
Q

Which circumstances would favour wide local excision of breast carcinoma?

A

Solitary
Peripheral
Small lesion on big breast
DCIS less than 4cm

182
Q

Which circumstances would favour mastectomy of breast carcinoma?

A

Multifocal
Central
Large lesion on big breast
DCIS more than 4cm

183
Q

Which drugs are given for HER2 and ER +ve cancers?

A

HER2: Trastizumab (Herceptin)
ER: tamoxifen

184
Q

What types of breast reconstruction may be done following mastectomy?

A 
Implants
Flaps (latissimus dorsi, transverse rectus abdominis musculocutaneous)

4MB Medicine (19 decks)

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