Repro wk 6

Question 1

What is FGM?

Answer 1

All procedures that involve partial or total removal of external female genitalia
Or other injury to female genital organs for cultural or non-medical reasons

Question 2

How many types of FGM are there?

Answer 2

4

Question 3

What is type 1 FGM?

Answer 3

Clitoridectomy (partial/total removal of clitoris)

Question 4

What is type 2 FGM?

Answer 4

Excision
Parital/total removal of clitoris and labia minor
+/- removal of labia majora

Question 5

What is type 3 FGM?

Answer 5

Infibulation - narrowing of vaginal opening through creation of covering seal
Seal formed by cutting + re-positioning inner/outer labia
+/- removal of clitoris

Question 6

What is type 4 FGM?

Answer 6

All other harmful procedures to female genitalia for non-medical purposes

Question 7

What is de-infeibulation?

Answer 7

Surgical procedure to opening up the closed vagina of FGM type 3?

Question 8

What are the complications fo FGM?

Answer 8

Severe pain/shock
Infection
Injury to adjacent tissues
Sprains, disolcations, broken bones/injuries from being restrained
Immediate fatal haemorrhaging
Infection by blood bourne virus

Question 9

What are the long term complications of FGM?

Answer 9

Urine retention
Difficulties with menstration
Uterine, vaginal, pelvic infections
Cysts /neuromas
INcreased risk of fistula
On-going impact of trauma/PTSD
Sexual dysfunction

Question 10

What are the psychological effects of FGM?

Answer 10

PTSD
Anxiety
Depression
Fear of intimacy
Loss of trust
Unresolved anger
NIghtmares
Flashbacks

Question 11

What increases the risk of FGM?

Answer 11

Mother has FGM
Siblings/cousins undergone FGM
MOther/father request reinfibulation
Parents express views valuing practice
Girl withdrawn from teaching classes on personal/social/health education

Question 12

What are the types of breast cancer?

Answer 12

In situ carcinoma
Invasive carcinoma
>Ductal
>Lobular
>Tubular
>Cribriform
>Medullary

Question 13

When are women screened for breast cancer?

Answer 13

Aged 50-70 every 3 years

Through GP practice

Question 14

What is looked for in breast screening?

Answer 14

Lump/thickening in breast (often painles)
Discharge/bleeding from nipple
Change in size/contours of breast
Change in colour or appearance of areola
Redness or pitting of skin

Question 15

What tests are used to diagnose breast cancer?

Answer 15

Clinical exam
Mammography
Ultrasound
FNA cytology

Question 16

What is sentinel lymph node biopsy?

Answer 16

Checking the first lymph nodes to recieve lymph from breast tumour
If negative then rest of the nodes in the basin will aslo be negative

Question 17

How do you treat breast cancer?

Answer 17

Resection (mastectomy/just affected tissue)
Micromets treatment
>Hormone therapy - oestrogen if receptors present
>Chmo
>Targetted therapy (HER2 - trastuzumab)

Question 18

What are the risk factors for vulva intra-epithelial neoplasia?

Answer 18

Smoking
Previous related malignancy
Immunosuppression
Other genital intra-epithelial neoplasia

Question 19

Who gets lower genital tract intra-epithelial neoplasia?

Answer 19

Decreasing age of presentation
Younger women with multi-focal with HPV +
Older women unifocal with HPV -

Question 20

What is the presentation of VIN?

Answer 20

Raised papular or plaques lesions
Erosions, nodules, warty 
Keratotic roughened appearance
Sharp border
Differentiated VIN tends to be unifocal ulcer or plaque
Discoloration

Question 21

How do you diagnose VIN?

Answer 21

Punch biopsy

Question 22

How do you manage VIN?

Answer 22

Prevent cancer
Eliminate symptoms
Preserve sexual function 
Preserve body image
Surveilence
Surgery
Laser ablation
Topical treatments

Question 23

What topical treatments can be used in VIN?

Answer 23

Imiquimod
Photodynamic therpay
5FU, alpha-interferon, cidofivir

Question 24

What are the types of vulva cancer?

Answer 24

Mostly SCC (caused by:)
>VIN
>Lichen sclerosus

Also BCC

Question 25

What is the presentation of vulval cancer?

Answer 25

pain
itch
bleeding
lump/ulcer

Mostly over 60
Younger women with VIN

Question 26

What is groin node dissection?

Answer 26

Inguinal and upper femoral nodes
Separate node incisions
Staging and remove nodal disease

Associated with significant morbidity
>Wound infection
>Lymphocysts
>Nerve damage

Question 27

What are the risk factors for urinary incontinence?

Answer 27

Age
Parity
Menopause
Smoking
Medical problems
Raised Intra abdo pressure
Pelvic floor trauma
Denervation
Connective tissue disease
Surgery

Question 28

What examinations should you do with complaint of urinary incontinence?

Answer 28

General
Abdominal
Neurological
Gyanae
Pelvic floor

Question 29

How do you manage stress urinary incontinence?

Answer 29

PT - pelvic floor training
Surgery (Tension-free vaginal tape )
Pharmacological - duloxetine