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Year 5-Gynaecology > passmed 25/03 > Flashcards

passmed 25/03 Flashcards

1
Q

stage 3 ovarian cancer?

A

tumour outside pelvis within abdomen

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2
Q

70% of ovarian cancers are?

A

epithelial
serous carcinomas

distal end of fallopian tube is often the site

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3
Q

symptoms of ovarian cancer

A

very vague unfortunately
adbominal distension and bloating
pain
urinary symptoms
early satiety
diarrhoea

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4
Q

investigation for ovarian cancer

A

ca125
>35iu/ml > USS

diagnostic laportomy

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5
Q

what level of ca125 indicates its raised?

A

> 35

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6
Q

lump or ulcer on the labia majora
inguinal lymphadenopathy
may be associated with itching, irritation

A

vulval carcinoma

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7
Q

laparoscopy is performed, where is the ectopic pregnancy most likely to be found?

A

ampulaa of fallopian tube

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8
Q

medical termination
what to do to confirm

A

multi level pregnancy test
measures level of hcg

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9
Q

medical management of miscarriage
> how to confirm

A

repeat pregnancy test after 3 weeks

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10
Q

expectant management of miscarriage

A

7-14 days
early first term

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11
Q

medical management for miscarriage indications?

A

risk of infection
risk of coaguloapthy / haemorrhage
late first trimester

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12
Q

medical management of miscarriage

A

200 mg oral mifepristone
48 horus later

800 micrograms misoprostol

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13
Q

how does mifepristone work?

A

progetserone receptor antagonist > weakens attachment to enndometrial walla and ecrvical softening and dilation and induction of uterine contractions

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14
Q

most common cause of postmenopausal bleed?
what do you have to rule out

A

vaginal atrophy
but rule out cervical cancer

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15
Q

pouch of douglas is where?

A

area between uterus and rectum
free fluid seen here often in ruptured ectopic

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16
Q

ovarian cancer mx
stage 2-4

A

surgical excision > chemo

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17
Q

PCOS and endometrial cancer

A

oligo/amenorrhoea in presence of pre menopausal levels of oestrogen

oestrogenic effects on endometrial lining > hyperplasia

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18
Q

HNPCC and lynch syndrome

A

often called hereditary nonpolyposis colorectal cancer (HNPCC), is an inherited disorder that increases the risk of many types of cancer

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19
Q

surgical management of miscarriage is indicated when

A

haemodynamic unstability
late first trimester
risk of haemorrhage
evidnece if infection

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20
Q

mild oligospermia

A

(sperm concentration of 10 to 15 million per ml

repeat 3 months to confirm

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21
Q

NICE advise that the rates of venous thromboembolism (VTE) in patients on _____ HRT are no greater than in the baseline population

A

transdermal hrt
first-pass metabolites from orally-ingested oestrogens might promote VTE

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22
Q

does progesterone increase risk of VTE

A

yes
women at risk of VTE should be referred to haematology before starting treatment

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23
Q

in patients with urinary incontinence make sure to ?

A

urine dipstick and culture
cap glucose

rule out UTI and Dm

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24
Q

how do climphene and metformin help treat infertility in PCOS

A

oculation induced - stimulates FSH/LH > maturation of ovarian follicles> corpus luteal

insulin

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25
stage 1a cervical cancer but wants to maintain fertility?
cone biopsy
26
grade 1 cervical cancer treatment options?
hysterectomy with node removal cone biopsy LETTZ
27
stage 1b of cerical cancer management?
Radical trachelectomy (for small tumour) or radical Wertheim's hysterectomy and bilateral salpingectomy ± bilateral oophorectomy with bilateral pelvic lymphadenopathy
28
LLETZ is used to treat?
only cerical intraepithelial neoplasia not invasive cervical cancer
29
most common causative for PID?
chlamydia trachomatis
30
how does ovarian cancer spread?
local invasion
31
most common lyphatic spread of ovarian?
para aortic lymph nodes
32
if suspecting PID how to investigate
bimanual to assess for adnexal tenderness speculum to visualise cervix pregnancy test high vaginal swabs antibiotics smear test if over 25
33
74 year old women presenting with PMB should be investigating for ? ix?
endometrial cancer speculum : obvious abnormalities endometrial biopsy hysterescopy >40 years of age
34
first line for endomteriosis mx?
NSAIDS / paracetamol then hormonal treatment which the purpose is to reduce oestrogenic effects so COCP POP? mirena
35
most common sites for endometrial tissue to grow?
pouch of douglas adhesions between uterus and bowel
36
fixed retroverted uterus
1/5 of women hav eit
37
NICE guidelines suggest that a woman who has been called for routine smears screening - pregnant
wait 12 weeks post partum
38
cervical screening in pregnancy is usually
delayed until 3 months post-partum unless missed screening or previous abnormal smears.
39
role of mifepristone
steroid based sensitises myometrium > contractions induced by subsequent prostaglandins > ripes cervis MOA > progesterone antagonist effects taken 36-48 hours prior to protaglandins bleeding and cramps start intensely after misoprostol 36-48 hours
40
misoprostol
E1 analogue stimulates myometrial contractions
41
current law on terminating a pregnancy
1967 abortion act amended in 1990 24 weeks 2 registered medical practitioners that the termination is necessary to prevent grave permanent injury to the physical or mental health of the pregnant woman
42
The female genital mutilation Act 2003
all forms of female genital cutting/modification for non-medical reasons is illegal
43
discuss FGM with a 22 year old
explain the law state it is illegal, victim Will have to record this as per the UK law even if they don't want to - please let me support you FGM Enhanced Dataset- commited to preventing and ending FGM; presents a national picture of prevalence; not anonymised to prevent duplication but completely anonymised at point of statistical and publictaion
44
Ruptured ovarian cyst presents
sharp unilateral pain immediately following intercourse or strenuous exercise. Bimanual examination in non-severe cases is generally unremarkable but tender lower abdomen Ultrasound shows free fluid in the pelvic cavity
45
torsion presenst with?
colicky abdominal pain vomiting adnexal tenderness on uss - large oedematous ovary
46
ohss presents with?
GI symptoms nausea, vomiting, abdo pain and bloating and diarrhoea sob, oliguria peripheral oedema
47
why would ectropion result in excessive discharge vagina?
glandular cells make mucus increased of these cells on exterior surface = increased discharge
48
Ectopic pregnancy localised to the _____ increases the risk of rupture
isthmus isthmus of the fallopian tube is least able to expand to accommodate the growing embryo/fetus and is therefore most prone to rupture
49
poi defn?
The onset of menopausal symptoms and elevated gonadotrophin levels before the age of 40 years
50
urge incontinence managed by?
anticholinergics Darifenacin, Oxybutynin, and Tolterodine
51
why are anticholinergics contraindicated in elderly people when managing incontinence?
confusion can occur use mirabegron instead
52
mirabegron is a ?
potent and selective agonist of beta-3 adrenergic receptors.
53
vaginal vault prolapse?
long term complication of vaginal hysterectomy
54
surgical TOP most common risk
infection abx given to reduce risk
55
UTI in pregnancy
linked to premature birth localised inflammatory mediators associated w UTI trigger pre-term labour by irritating the neck of the uterus and cervix
56
hyperemesis gravidarum fluid balance
IV normal saline with added potassium as hypokalaemia is common
57
ix for hyperemesis gravidarum
U&Es renal function urine ketones and USS
58
ondansetron risk to pregnancy
cleft lip/palate in newborn used in first trimester association found
59
urge incontinence is treated pharmacologically
darifenic oxybutinin tolterodine anti muscarinics - help muscle relax take away the urge > but in elderly patient can cause confusion > mirabegron (beta-3-agonsit)
60
stress incontinence
pelvic floor training surgical procedure duloxetine

Year 5-Gynaecology (20 decks)

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