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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
Breastfeeding is safe in those taking anti-epileptics. True/False?
True | Except barbiturates
26
When should methotrexate be stopped with regards to pregnancy?
3 months before trying to conceive
27
Why should NSAID's be avoided in the 3rd trimester?
Can cause premature closure of the ductus arteriosus
28
Which rheumatological antibodies can cross the placenta and cause congenital heart block?
Anti Ro | Anti La
29
What should patients with antiphospholipid syndrome take in pregnancy?
Aspirin and enoxaparin from 6-34 weeks' gestation
30
When can the uterus typically be first felt in pregnancy?
Around 12 weeks
31
How is gestation estimated according to symphiseal-fundal height?
Gestation = SFH +/- 2cm
32
Describe foetal movements during labour
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
33
Describe the basics of a normal CTG trace
Heart rate 110-160 beats/min Variability greater than 5 beats/min 2 or more accelerations
34
What might cause reduced variability on a CTG?
Preterm Sleeping foetus Drug effects (BZD, opioids) Hypoxia
35
What might cause tachycardia on a CTG?
``` Maternal fever B-agonists Chorioamnionitis Hypoxia Arrhythmia ```
36
What might cause bradycardia on a CTG?
Increased vagal tone of foetus Heart block Cord compression
37
What are late decelerations on a CTG a sign of?
Foetal hypoxia
38
What does DR C BRAVaDO stand for with regards to a CTG?
``` Determine Risk Contractions Baseline Rate Accelerations Variability Decelerations Overall impression ```
39
Blood pressure should normalise within 6 weeks postpartum. True/False?
True | If not, may indicate chronic hypertension
40
What is pre-eclampsia?
Triad of pregnancy-induced hypertension, proteinuria and oedema Occurs after 20 weeks gestation, typically resolves within 10 days postpartum
41
Describe the pathophysiology of pre-eclampsia
Failure of trophoblastic invasion causes failure of normal vascular remodelling: spiral arteries remain high-resistance low-capacitance vessels, causing endothelial damage and dysfunction
42
List aetiology/risk factors for pre-eclampsia
``` Maternal/family history Primiparity Twin/multiple pregnancy IVF, ICSI Short stature Obesity Migraine history Hypertension, renal disease Hydatidiform mole ```
43
List clinical features of pre-eclampsia
``` Headaches Visual disturbance Epigastric/RUQ pain Nausea, vomiting Sudden oedema and weight gain Generalised seizure (eclampsia) HELLP syndrome ```
44
What investigations would you do for pre-eclampsia?
``` Bloods: FBC, U+E, LFT's, urate, coag screen Foetal CTG USS, uterine artery Doppler Urinalysis Regular BP checks ```
45
Outline management of pre-eclampsia
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!
46
If a woman is at increased risk of pre-eclampsia, what can she take during pregnancy?
Aspirin from 12 weeks until birth
47
List aetiology/risk factors for foetal distress
Prolonged pregnancy or labour Small foetus Antepartum haemorrhage Hypertension, pre-eclampsia
48
List clinical features of foetal distress
Meconium passage in labour Foetal tachycardia persistently above 160bpm Loss of variability, late decelerations on CTG
49
Outline management of foetal distress
``` Change maternal position IV fluids Stop syntocinon/tocolytics Foetal blood sample Deliver promptly! ```
50
Antepartum haemorrhage is defined as bleeding that occurs when?
After 24 weeks' gestation
51
What is placental abruption?
Separation of a normally implanted placenta from the uterus
52
List aetiology/risk factors for placental abruption
``` Subsequent pregnancies Pre-eclampsia Smokers Previous C-sections Thrombophilia Cocaine use Trauma Polyhydramnios ```
53
List clinical features of placental abruption
Bloody cervix Painful, tender uterus Backache Placental insufficiency leads to foetal anoxia/death
54
How would you diagnose placental abruption?
Clinical diagnosis | Can do transvaginal USS
55
Outline management of placental abruption
Deliver - C-section if unstable, NVD if stable
56
What is placenta praevia?
Implantation of placenta in the lower uterine segment, over or near to the cervical os
57
Describe minor and major placenta praevia
Minor: not covering os but near it Major: partially or completely covering os
58
List aetiology/risk factors for placenta praevia
``` Multiple pregnancy Prior C-sections Uterine abnormalities (fibroids) Smoking Older mum Twin pregnancy IVF ```
59
List clinical features of placenta praevia
Painless bleeding Non-tender uterus High presenting part
60
Outline management of placenta praevia
If less than 2cm from os, do C-section If more than 2cm from os, consider NVD Do not examine vagina!
61
What is placenta accreta?
Placenta invades and adheres to myometrium | Associated with previous C-sections
62
List clinical features of placenta accreta
Massive bleeding | Pain
63
Outline management of placenta accreta
C-section delivery | May need to do hysterectomy
64
What is vasa praevia?
Foetal blood vessels overlie internal cervical os, causing increased risk of tearing of vessels and foetal hypoxia
65
How would you diagnose vasa praevia?
Colour Doppler USS
66
What is the most common liver disease of pregnancy?
Obstetric cholestasis
67
List clinical features of obstetric cholestasis
Pruritis in 2nd half of pregnancy Usually affecting palms and soles No rash
68
Outline management of obstetric cholestasis
Vitamin K to mother and baby Orsodeoxycholic acid Induce labour at 37 weeks
69
What is HELLP syndrome?
Haemolysis, Elevated Liver enzymes, Low Platelets | Complication of pregnancy
70
List clinical features of HELLP syndrome
``` Upper abdo pain Jaundice Malaise Vomiting Headache ```
71
Describe stage 1 of labour
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
72
Describe stage 2 of labour
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
73
Why is cord clamping delayed after delivery?
Delayed for 60s to increase perfusion and O2 to baby
74
Describe stage 3 of labour
Delivery of placenta and membranes | Generally 30 mins with oxytocin/ergometrine support
75
How often is foetal heart rate, contractions, maternal pulse, maternal BP + temp, vaginal exam and urine analysis done during labour?
``` 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
List contraindications to induction of labour
``` Cephalopelvic disproportion Malpresentation other than breech/facial presentation Foetal distress Placenta praevia Cord prolapse Vasa praevia Pelvic tumour ```
77
What is measured on the Bishops score?
``` Measure of cervical ripeness to estimate likelihood of spontaneous labour Cervical dilation Cervical consistency Cervical position Cervical length Station of head ```
78
Describe factors on Bishops score that would score a point of 0
``` Cervical dilation: 0cm Cervical consistency: firm Cervical position: posterior Cervical length: more than 2cm Station of head: -3 ```
79
Describe factors on Bishops score that would score a point of 1
``` Cervical dilation: 1-2cm Cervical consistency: medium Cervical position: middle Cervical length: 1-2cm Station of head: -2 ```
80
Describe factors on Bishops score that would score a point of 2
``` Cervical dilation: 3-4cm Cervical consistency: soft Cervical position: anterior Cervical length: less than 1cm Station of head: -1 ```
81
What Bishops score indicates that labour is unlikely to occur spontaneously?
Score of 9 indicates likely spontaneous labour | Score of less than 5 indicates labour is unlikely to occur spontaneously
82
Outline the stepwise approach to induction of labour
Membrane sweep Vaginal prostaglandin Amniotomy + start foetal heart rate monitoring/pulse oximetry through scalp clip Syntocinon
83
What pain relief can be used during labour?
``` 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
Define failure to progress in stage 1 of labour
Less than 2cm dilation in 4h in a primip | Less than 2cm dilation in 4h or slowing progress in a multip
85
Define failure to progress in stage 2 labour
No delivery in 2h (no epidural) or 3h (epidural) | No delivery in 1h (no epidural) or 2h (epidural)
86
List aetiology/risk factors for failure to progress in labour
Power: inadequate contractions, low strength +/- frequency of contractions Passage: narrow pelvis, short stature, pelvic trauma) Passenger: macrosomia, malposition, malpresentation
87
What is assessed on a partogram?
``` Assesses progression of labour Foetal heart rate Amniotic fluid Cervical dilation Foetal descent Contractions Obstruction (moulding, caput) Maternal observations ```
88
What is cord prolapse?
Umbilical cord descends ahead of presenting part of foetus, potentially causing foetal asphyxia and death
89
List aetiology/risk factors for cord prolapse
``` Prematurity Nulliparity Polyhydramnios Twins Cephalopelvic disproportion Malpresentation Placenta praevia High foetal station ```
90
List clinical features of cord prolapse
Foetal bradycardia Variable decelerations Palpable cord in vagina
91
Outline management of cord prolapse
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
What are dizygotic and monozygotic twins?
Dizygotic: non-identical, 2 separate ova fertilised at same time Monozygotic: identical, 1 fertilised ova divides into 2 embyros
93
List aetiology/risk factors for multiple pregnancy
``` Previous twins Family history of twins Increased maternal age IVF Induced ovulation Race (Afro-Caribbeans) ```
94
List clinical features of multiple pregnancy
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
What is the commonest malpresentation of a foetus?
Breech (buttocks) where caudal end occupies lower uterus
96
List aetiology/risk factors for breech presentation
``` Contracted pelvis Bicornuate uterus Uterine malformations, fibroids Placenta praevia Prematurity Foetal abnormality ```
97
Outline management of breech presentation
If less than 36 weeks most will turn spontaneously External cephalic version if 36w (primip) or 37w (multip) Planned C-section or NVD
98
List some contraindications to external cephalic version
``` Placenta praevia Twins Antepartum haemorrhage in last 7 days Ruptured membranes Growth restricted babies Abnormal CTG Uterine abnormality ```
99
A woman with a long anthropoid pelvis is at particular risk of which foetal malpresentation?
Occipitoposterior
100
A foetus with anencephaly and/or short neck muscles is at risk of which malpresentation?
Facial presentation
101
Which malpresentation typically are always delivered by C-section?
Brow presentation | Transverse lie
102
What is shoulder dystocia?
Inability to deliver shoulders after head, requiring additional maneuvers to release the shoulders after downwards traction fails
103
List aetiology/risk factors for shoulder dystocia
``` Large/postmature foetus Maternal BMI over 30 Induced labour, oxytocin Prolonged labour Assisted vaginal delivery Previous shoulder dystocia ```
104
List clinical features of shoulder dystocia
Maternal + foetal morbidity Postpartum haemorrhage Brachial plexus injury Perineal tear
105
Outline management of shoulder dystocia
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
What is hyperemesis gravidarum?
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
List aetiology/risk factors for hyperemesis gravidarum
``` Young, primiparous Non-smokers Eating disorder Multiple pregnancy Molar pregnancy Hyperthyroidism Obesity ```
108
Outline management of hyperemesis gravidarum
Admit to hospital IV rehydration Antihistamine, antiemetic (promethazine, cyclizine) Thiamine supplementation
109
List indications for forceps delivery
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
Ventouse vacuum extraction delivery causes less maternal trauma than forceps delivery. True/False?
True
111
What are the 2 types of C-section?
Lower segment CS (most common): horizontal incision 3cm above symphysis pubis with subsequent blunt dissection Classical CS: vertical incision
112
What layers are cut/separated and then stitched in a lower segment CS?
``` 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
List complications of C-section
``` 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
List indications for C-section
``` Known cephalo-pelvic disproportion Placenta praevia Breech presentation Twin pregnancies Malpresentation Pre-eclampsia IUGR Foetal distress Failure to progress in labour ```
115
What is primary postpartum haemorrhage?
Loss of greater than 500ml blood during first 24h after delivery
116
List aetiology/risk factors for primary PPH
``` 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
Outline management of primary PPH
IV oxytocin High-flow O2 Blood transfusion if shocked If placenta not delivered, attempt by cord traction
118
What is secondary postpartum haemorrhage?
Excess blood loss after 24h from delivery, usually between 5-12 days
119
List aetiology/risk factors for secondary PPH
Retained placental tissue Clot Secondary infection
120
Outline management of secondary PPH
Uterine exploration if heavy Crossmatch blood Ampicillin/metronidazole if infection Uterine curette for histology
121
When is a placenta defined as being "retained"?
If not delivered by 30 mins
122
Describe a 1st degree perineal tear
Superficial tear | No muscle damage
123
Describe a 2nd degree perineal tear
Laceration involves perineal muscle
124
Describe a 3rd degree perineal tear
Damage involves anal sphincter muscle 3a: less than 50% of EAS 3b: more than 50% of EAS 3c: tear of EAS and IAS
125
Describe a 4th degree perineal tear
Tear to anal sphincter and rectal mucosa
126
What is cut in an episiotomy and why is it done?
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
Outline management of preterm rupture of membranes
Oral erythromycin for 10 days Antenatal steroid Tocolysis (nifedipine) to reduce contractions
128
What is baby blues and how long does it last?
Depressive/anxiety -like symptoms seen around 3-7 days after birth, usually lasts no more than 72h Give reassurance and health visitor support
129
What is postnatal depression and how long does it last?
Depression symptoms starting within 1 month of pregnancy, peaking at 3 months, resolving by 6 months
130
Outline management of postnatal depression
Reassurance and support CBT SSRI (sertraline, paroxetine) Lithium/ECT may be tried
131
What is puerperal psychosis and when does it start?
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
Outline management of puerperal psychosis
Admit to hospital/mother-baby unit
133
What is puerperal pyrexia?
Temperature greater than 38'C in first 14 days after delivery
134
List aetiology/risk factors for puerperal pyrexia
``` Endometritis UTI Wound infection (perineal tear, C-section) Mastitis VTE ```
135
List clinical features of puerperal pyrexia
Lower abdo pain Tender uterus Lochia (endometrial slough passed per vaginum)
136
What does "triple assessment" of a breast lump entail?
Clinical examination Imaging (USS if under 40, mammogram if over 40) Biopsy (core/vacuum/FNA)
137
List aetiology/risk factors for mastaglia
Low progesterone High oestrogen, prolactin, fatty acids Caffeine excess Poor diet
138
List clinical features of mastalgia
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
Outline management of mastalgia
Mild-mod: reassurance, well-fitting bra, topical NSAID | Severe: danazol, gamolenic acid, bromocriptine, tamoxifen, evening primrose oil
140
List aetiology/risk factors for nipple discharge
Duct ectasia Intraductal papilloma Carcinoma Lactation
141
What is gynaecomastia?
Breast development in a male, with ductal growth but without lobular development
142
List aetiology/risk factors for gynaecomastia
``` Hypogonadism Puberty Drugs (spironolactone, cannabis) Cirrhosis Testicular tumours ```
143
Outline management of gynaecomastia
Resolve spontaneously after 2 years Surgery Stop drugs Tamoxifen, danazol
144
Which breast condition is common in postpartum lactating women?
Breast abscess
145
Which organisms are associated with breast abscess?
Staph aureus | Strep pyogenes
146
List clinical features of breast abscess
``` Pain Swelling Tenderness Mobile mass Overlying skin necrosis ```
147
Outline management of breast abscess
Continue breastfeeding | Flucloxacillin +/- aspiration
148
What is duct ectasia?
Dilation of sub-areolar ducts
149
List aetiology/risk factors for duct ectasia
Smokers | Elderly parous women
150
List clinical features of duct ectasia
Coloured (thick green) discharge Acute/episodic Nipple changes Reduced milk production
151
Outline management of duct ectasia
Treat infection Exclude malignancy Stop smoking Duct excision
152
Periductal mastitis presents in an older age group compared to duct ectasia. True/False?
False | Typically presents in younger women
153
List clinical features of periductal mastitis
``` Pain Abscess Duct fistula Pus discharge Redness ```
154
Outline management of periductal mastitis
Co-amoxiclav | Drain abscess
155
List aetiology/risk factors of fat necrosis of breast
Post-trauma Obesity Large breasts
156
List clinical features of fat necrosis of breast
Hard, firm lesion/lump Scarring Foamy macrophages and damaged adipocytes on histology
157
Which benign breast tumour is best described as a painless, firm, discrete mobile mass?
Fibroadenoma
158
Describe the pathology of fibroadenoma
Develop from whole lobule Circumscribed, rubbery Grey-white biphasic tumour (consists of epithelium and stroma)
159
Which benign breast tumour is best described as a slow-growing unilateral mass?
Phyllodes tumour
160
Describe the pathology of Phyllodes tumour
Occur in older people Malignant potential Stromal overgrowth +/- infiltration
161
Outline management of Phyllodes tumour
Wide local excision | Mastectomy if large
162
Which benign breast tumour is best described as a smooth discrete lump associated with cyclical pain?
Fibrocystic change
163
Describe the pathology of fibrocystic change
Occur in middle-aged Several 1mm cysts Blue-domed with pale fluid
164
Which benign breast tumour is best described as having blood-stained discharge, a central solitary nodule or multiple peripheral nodules?
Intraductal papilloma
165
Describe the pathology of intraductal papilloma
Occur in middle-aged Local epithelial proliferation in sub-areolar ducts Fibrovascular core
166
Outline management of intraductal papilloma
Microdochectomy or total duct excisionm
167
Describe the pathology of sclerosing adenosis/radial scars
Extra tissue growth in lobules as part of ageing Epithelial proliferation, stromal fibrosis and sclerosis Radial scar: stellate architecture, central puckering, radiating fibrosis
168
List clinical features of sclerosing adenosis
Recurring pain Firmness Small lump
169
List aetiology/risk factors for malignant breast cancer
``` Increasing age Familial history BRCA mutation Early menarche, late menopause Nulliparity HRT, COCP Alcoholism Obesity Not breastfeeding ```
170
List clinical features of malignant breast cancer
``` Asymptomatic Lump Mastalgia Nipple discharge Skin changes, dimpling Lymphoedema ```
171
What is ductal carcinoma in situ (DCIS)?
Precursor to invasive carcinoma involving malignant epithelial cells confined within the basement membrane of the duct Precursors: atypical duct hyperplasia, epithelial hyperplasia
172
What would a mammogram of DCIS show?
Microcalcifications
173
Outline management of DCIS
If less than 4cm, wide local excision + SN biopsy If more than 4cm, mastectomy + SN biopsy +/- adjuvant radiotherapy
174
What is lobular carcinoma in situ?
Precursor to invasive carcinoma involving intralobular proliferation Usually multifocal + bilateral, not visible or palpable grossly Precursor: atypical lobular hyperplasia
175
What is the screening schedule for breast cancer?
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
Where does invasive breast carcinoma arise from?
Epithelial cells in terminal duct lobular unit
177
What is the most common form of invasive breast carcinoma?
Ductal carcinoma (adenocarcinoma)
178
Describe staging of breast carcinoma
1: confined to breast 2: confined to breast + axillary LN involved 3: fixed to muscle + axillary LN involved 4: fixed to chest wall
179
Describe T1-T4 staging of breast carcinoma
T1: less than 2cm T2: 2-5cm T3: more than 5cm T4: fixed to chest wall
180
What is the Nottingham Prognostic Index for breast carcinoma?
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
Which circumstances would favour wide local excision of breast carcinoma?
Solitary Peripheral Small lesion on big breast DCIS less than 4cm
182
Which circumstances would favour mastectomy of breast carcinoma?
Multifocal Central Large lesion on big breast DCIS more than 4cm
183
Which drugs are given for HER2 and ER +ve cancers?
HER2: Trastizumab (Herceptin) ER: tamoxifen
184
What types of breast reconstruction may be done following mastectomy?
``` Implants Flaps (latissimus dorsi, transverse rectus abdominis musculocutaneous) ```

4MB Medicine (My version) (19 decks)

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