UM Quick Notes

Question 1

What family history to ask for ovarian cancer?

Answer 1

1. BRCA1/BRCA2
2. HNPCC

Question 2

What are the signs of the spread of tumour?
Mnemonic: BALLO

Answer 2

B -> Bowel obstruction
A -> Ascites
L -> Lymph node (Para-aortic)
L -> Liver capsule
O -> Omental caking

Question 3

What are the red flags for ovarian tumour?

Answer 3

1. IBS
2. Prolapse
3. New onset of urinary incontinence
4. Paraneoplastic syndrome (Dermatomyositis)
5. Loss of appetite

Question 4

What are the investigations of ovarian tumour?

Answer 4

• Tumour markers
  1. CA-125
  2. AFP
  3. CA 19-9
  4. CEA
• B-HCG -> Choriocarcinoma, dysgerminoma
• LDH -> dysgerminoma
• Inhibin -> Granulosa
• USS Abdo/Pelvis -> Look for papillary projections

Question 5

What staging is used for ovarian tumour?

Answer 5

FIGO staging

Question 6

What are the management plan for ovarian tumour?

Answer 6

1. Exploratory staging laparotomy
   - Peritoneal washing, TAHBSO, infracolic omentectomy, lymph node biopsy
   - Primary pelvic clearance and tumour debulking
2. Metastasis: Surgical debulking and chemotherapy
   - E.g: PACLITAXEL, CARBOPLATIN
3. Biological
   E.g: BEVACIZUMAB, OLAPARIB (poly ADP-ribose polymerase inhibitors)

Question 7

What is the pre-menopausal management for ovarian cyst/tumour?

Answer 7

Conservative management
- <5cm (small) and simple: rescan in 12 weeks
- 5 - 10cm/increase size/symptomatic: Diagnostic laparoscopy/laparotomy

Question 8

What is the pre-menopausal management for ovarian cyst/tumour?

Answer 8

Refer
- Low RMI/small/simple: rescan every 4 months
- Intermediate RMI: laparotomy oophorectomy (stage if malignant)
- High: full staging laparotomy

Question 9

What are the complications of ovarian cyst/tumour?

Answer 9

1. Rupture
2. Torsion
3. Hemorrhage

Question 10

Define pre-existing hypertension in pregnancy

Answer 10

• Hypertension history before pregnancy or BP>140/90
• Period of gestation <20 weeks

Question 11

What are the risk factors of pre-existing hypertension?

Answer 11

• Renal disease
• Increase age
• DM
• BP >160/110 (<20w)

Question 12

What are the investigations done to manage pre-existing hypertension in pregnant ladies?

Answer 12

• Exclude secondary hypertension
• Prevent pre-eclampsia (Aspirin from 12w)
  1. Increase antenatal appointments with regular BP monitoring
  2. Proteinuria: urine dipstick, PCR, 24h urine protein
  3. Uric acid levels
  4. Doppler US -> uterine artery
• Foetal: serial growth scan -> growth restriction

Question 13

State the management for pre-existing hypertension in pregnant ladies

Answer 13

1. Medical
   - 1st: LABETOLOL (Side effect: Neonatal hypoglycemia)
   - 2nd: NIFEDIPINE
   - 3rd: METHYLDOPA (Contraindicated in depression)
2. Only Oxytocin in labour, ergometrine -> Increase in BP
3. Avoid ACEI, ARB & diuretics (teratogenic)

Question 14

Why is ACEI, ARB and diuretics avoided in the treatment of pre-existing hypertension for pregnant lady?

Answer 14

• Teratogenic
• Decrease in placental perfusion
• Furosemide crosses placenta (use in pulmonary oedema)
• Atenolol is contraindicated (It causes IUGR)

Question 15

What are the maternal complications of pre-existing hypertension in pregnant ladies?
Mnemonic: HIPP

Answer 15

• Heart failure
• Intracerebral hemorrhage
• Placental abortion
• Pre-eclampsia

Question 16

What is the management for PIH?

Answer 16

Mild: 140-149/90-99
- Treat conservatively
- Regular BP monitoring and check for protein
Moderate: 150-159/100-109
- Treat
- Monitor 2X
- Start medication -> Continue drugs for 6 week to <130/80
- FBC, U&E, LFT
Severe: 160/110
- Admit and treat
- Monitor BP 4X a day, check for proteinuria
- FBC, U&E, LFT