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Obs and Gynae > PMB > Flashcards

PMB Flashcards

1
Q

Define PMB

A

Bleeding at least 6 months after menopause

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2
Q

What is the main worry about PMB

A

endometrial carcinoma

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3
Q

Uterine causes of PMB?

A

HRT therapy, endometrial polyps/fibroids/hyperplasia/carcinoma

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4
Q

Cervical causes of PMB?

A

carcinoma/polyps/trauma

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5
Q

Vaginal causes of PMB?

A

Atrophy, carcinoma, trauma

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6
Q

Vulval causes of PMB?

A

Trauma, carcinoma

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7
Q

Ovarian cause of PMB?

A

estrogen secreting tumour of the theca cells

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8
Q

Associated symptoms to ask about with PMB?

A

cramps, sickness, pain

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9
Q

Most common type of endometrial cancer?

A

Endometrial adenocarcinoma

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10
Q

Types of endometrial cancer?

A

endometrial adenocarcinoma, papillary serous adenocarcinoma, clear cell adenocarcinoma, mixed adenocarcinoma

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11
Q

3 management options of suspected endometrial cancer?

A

transvaginal USS, endometrial biopsy, hysteroscopy

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12
Q

At what endometrial thickness would you send for endometrial sampling?

A

5mm or more

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13
Q

What do you use to take a sample in an endometrial biopsy?

A

Pipelle sampler

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14
Q

When can a women not be investigated via TVS and need a hysteroscopy first line?

A

If they are on Tamoxifen

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15
Q

What is the staging system is used for endometrial cancer?

A

FIGO staging

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16
Q

Stage 1a,1b,1c?

A

1a - confined to endometrium, 1b - invades less than half the myometrium, 1c - invades more than half

17
Q

What is the 5 year survival of stage 1 endometrial cancer?

A

85%

18
Q

What is the 5 year survival of stage2,3,4?

A

2 - 75%, 3 - 45%, 4 - 25%

19
Q

What is stage 2 endometrial cancer?

A

Spread to the cervix

20
Q

What is stage 3 endometrial cancer?

A

Spread outside the uterus but within the pelvis but not the bladder or rectum

21
Q

What is stage 4 endometrial cancer?

A

Spread to the bladder and rectum or distant metastases

22
Q

What investigations do you need to undertake with a confirmed endometrial cancer?

A

MRI for staging, CXR, blood - LFTs, U/E, FBP

23
Q

Difference in surgery for stage 1 vs stage 2 endometrial cancer?

A

Stage 1 - TAH+BSO+lymph nodes whereas stage 2 - modified radical hysterectomy + BSO + lymph nodes

24
Q

2 types of radiotherapy?

A

External beam radiotherapy and brachytherapy

25
Q

When is progesterone hormonal therapy used as treatment for endometrial cancer?

A

When contraindicated for surgery, radiotherapy, chemo

26
Q

What is the lymphatic drainage of the upper uterus?

A

paraaortic nodes

27
Q

What is the lymphatic drainage of the fundus of the uterus?

A

inguinal nodes

28
Q

What is the lymphatic drainage of the lower uterus?

A

paracervical, obturator, iliac nodes

29
Q

What is the follow up like after a endometrium carincoma removal?

A

6 week post op check, 3 months for 1 year then 6 monthly for second year to 5 years

30
Q

What investigations are performed at endometrial cancer follow up?

A

Speculum exam, PV, PR

31
Q

What infections can cause vulval itch?

A

BV, candidiasis, BV, lice, scabies, threadworm ,HSV

32
Q

Dermatological conditions that can cause vulval itch?

A

Contact dermatitis, psoriasis, eczema, lichen sclerosis, lichen planus, squamous cell hyperplasia

33
Q

Neoplastic conditions that can cause vulval itch?

A

VIN, SCC

34
Q

Why is it important to ask about time of day when questioning about vulval itch?

A

Lichen sclerosis is worse at night

35
Q

How do you confirm lichen sclerosis diagnosis?

A

Vulval biopsy under LA with Keyes biopsy knife

36
Q

Why is it important to ask about acute/chronicity of vulval itch?

A

Acute suggestive of contact dermatitis

37
Q

Topical treatments for lichen sclerosis?

A

topical steroids, clobestasol propionate, soap substitutes, barrier creams

38
Q

Systemic illnesses that can cause vulval itch?

A

Hepatic failure, renal failure, anaemia

39
Q

What type of infection is lichen sclerosis?

A

lymphocyte mediated dermatosis

Obs and Gynae (27 decks)

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