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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?

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
When is progesterone hormonal therapy used as treatment for endometrial cancer?
When contraindicated for surgery, radiotherapy, chemo
26
What is the lymphatic drainage of the upper uterus?
paraaortic nodes
27
What is the lymphatic drainage of the fundus of the uterus?
inguinal nodes
28
What is the lymphatic drainage of the lower uterus?
paracervical, obturator, iliac nodes
29
What is the follow up like after a endometrium carincoma removal?
6 week post op check, 3 months for 1 year then 6 monthly for second year to 5 years
30
What investigations are performed at endometrial cancer follow up?
Speculum exam, PV, PR
31
What infections can cause vulval itch?
BV, candidiasis, BV, lice, scabies, threadworm ,HSV
32
Dermatological conditions that can cause vulval itch?
Contact dermatitis, psoriasis, eczema, lichen sclerosis, lichen planus, squamous cell hyperplasia
33
Neoplastic conditions that can cause vulval itch?
VIN, SCC
34
Why is it important to ask about time of day when questioning about vulval itch?
Lichen sclerosis is worse at night
35
How do you confirm lichen sclerosis diagnosis?
Vulval biopsy under LA with Keyes biopsy knife
36
Why is it important to ask about acute/chronicity of vulval itch?
Acute suggestive of contact dermatitis
37
Topical treatments for lichen sclerosis?
topical steroids, clobestasol propionate, soap substitutes, barrier creams
38
Systemic illnesses that can cause vulval itch?
Hepatic failure, renal failure, anaemia
39
What type of infection is lichen sclerosis?
lymphocyte mediated dermatosis

Obs and Gynae (27 decks)

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