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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
Q

stage 1a cervical cancer but wants to maintain fertility?

A

cone biopsy

26
Q

grade 1 cervical cancer treatment options?

A

hysterectomy with node removal
cone biopsy
LETTZ

27
Q

stage 1b of cerical cancer management?

A

Radical trachelectomy (for small tumour) or radical Wertheim’s hysterectomy and bilateral salpingectomy ± bilateral oophorectomy with bilateral pelvic lymphadenopathy

28
Q

LLETZ is used to treat?

A

only cerical intraepithelial neoplasia not invasive cervical cancer

29
Q

most common causative for PID?

A

chlamydia trachomatis

30
Q

how does ovarian cancer spread?

A

local invasion

31
Q

most common lyphatic spread of ovarian?

A

para aortic lymph nodes

32
Q

if suspecting PID how to investigate

A

bimanual to assess for adnexal tenderness

speculum to visualise cervix

pregnancy test
high vaginal swabs
antibiotics
smear test if over 25

33
Q

74 year old women presenting with PMB should be investigating for ?

ix?

A

endometrial cancer
speculum : obvious abnormalities
endometrial biopsy
hysterescopy
>40 years of age

34
Q

first line for endomteriosis mx?

A

NSAIDS / paracetamol
then
hormonal treatment which the purpose is to reduce oestrogenic effects so COCP
POP? mirena

35
Q

most common sites for endometrial tissue to grow?

A

pouch of douglas
adhesions between uterus and bowel

36
Q

fixed retroverted uterus

A

1/5 of women hav eit

37
Q

NICE guidelines suggest that a woman who has been called for routine smears screening - pregnant

A

wait 12 weeks post partum

38
Q

cervical screening in pregnancy is usually

A

delayed until 3 months post-partum unless missed screening or previous abnormal smears.

39
Q

role of mifepristone

A

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
Q

misoprostol

A

E1 analogue
stimulates myometrial contractions

41
Q

current law on terminating a pregnancy

A

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
Q

The female genital mutilation Act 2003

A

all forms of female genital cutting/modification for non-medical reasons is illegal

43
Q

discuss FGM with a 22 year old

A

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
Q

Ruptured ovarian cyst presents

A

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
Q

torsion presenst with?

A

colicky abdominal pain
vomiting
adnexal tenderness
on uss - large oedematous ovary

46
Q

ohss presents with?

A

GI symptoms nausea, vomiting, abdo pain and bloating and diarrhoea

sob, oliguria
peripheral oedema

47
Q

why would ectropion result in excessive discharge vagina?

A

glandular cells make mucus
increased of these cells on exterior surface = increased discharge

48
Q

Ectopic pregnancy localised to the _____ increases the risk of rupture

A

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
Q

poi defn?

A

The onset of menopausal symptoms and elevated gonadotrophin levels before the age of 40 years

50
Q

urge incontinence managed by?

A

anticholinergics

Darifenacin, Oxybutynin, and Tolterodine

51
Q

why are anticholinergics contraindicated in elderly people when managing incontinence?

A

confusion can occur

use mirabegron instead

52
Q

mirabegron is a ?

A

potent and selective agonist of beta-3 adrenergic receptors.

53
Q

vaginal vault prolapse?

A

long term complication of vaginal hysterectomy

54
Q

surgical TOP most common risk

A

infection
abx given to reduce risk

55
Q

UTI in pregnancy

A

linked to premature birth
localised inflammatory mediators associated w UTI
trigger pre-term labour by irritating the neck of the uterus and cervix

56
Q

hyperemesis gravidarum

fluid balance

A

IV normal saline with added potassium as hypokalaemia is common

57
Q

ix for hyperemesis gravidarum

A

U&Es
renal function
urine ketones and USS

58
Q

ondansetron risk to pregnancy

A

cleft lip/palate in newborn used in first trimester

association found

59
Q

urge incontinence is treated pharmacologically

A

darifenic
oxybutinin
tolterodine

anti muscarinics - help muscle relax take away the urge

> but in elderly patient can cause confusion
mirabegron (beta-3-agonsit)

60
Q

stress incontinence

A

pelvic floor training
surgical procedure

duloxetine

Year 5-Gynaecology (20 decks)

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