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Phase 3a > Women's Health > Flashcards

Women's Health Flashcards

1
Q

What is uterine prolapse?

A

Loss of anatomical support for the uterus, typically surrounding the apex of the vagina.

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2
Q

What is a cystocele?

A

Bladder prolapse

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3
Q

What is a rectocele?

A

Prolapse of the rectum or large bowel

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4
Q

What is an enterocele?

A

Prolapse of the small bowel

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5
Q

What grading system is used for uterine prolapse?

A

POP-Q
- Grade 0 - Normal
- Grade 1 - Lowest part is <1cm above introitus
- Grade 2 - Lowest part is within 1cm above or below introitus
- Grade 3 - Lowest part is >1cm below introitus, but not fully descended
- Grade 4 - Full descent with eversion of the vagina

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6
Q

What is the management for uterine prolapse?

A

Vaginal pessary

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7
Q

What are the risk factors for urinary incontinence?

A

Advancing age
Previous pregnancy and childbirth
High BMI
Hysterectomy
Family history

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8
Q

What are the difference types of urinary incontinence?

A

Urge incontinence
Stress incontinence
Mixed incontinence
Overflow incontinence
Functional incontinence

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9
Q

What is urge incontinence and what it is caused by?

A

The urge to urinate quickly followed by an uncontrollable leakage ranging from a few drops to complete emptying.

Due to detrusor muscle overactivity.

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10
Q

What is stress incontinence and what is it caused by?

A

Leaking small amounts when coughing or laughing, due to a high abdominal pressure

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11
Q

The urge to urinate quickly followed by an uncontrollable leakage ranging from a few drops to complete emptying would be what type of incontinence?

A

Urge incontinence

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12
Q

Urine leaking out when coughing or laughing, due to a high abdominal pressure would be what type of incontinence?

A

Stress incontinence

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13
Q

What is mixed incontinence?

A

A mixture of both stress and urge incontinence

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14
Q

What is overflow incontinence?

A

AKA neurogenic bladder - the bladder doesn’t empty completely which leads to an eventual leak e.g. prostate enlargement

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15
Q

If the bladder doesn’t completely empty and causes an eventual leak, what type of incontinence is this?

A

Overflow incontinence - AKA neurogenic bladder

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16
Q

What is the main cause of overflow incontinence?

A

Damage to the peripheral nerves or nerves of the brain and spinal cord

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17
Q

What are the classic signs/symptoms of urge incontinence?

A

Frequent urination, especially at night

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18
Q

Frequent urination, especially at night, would indicate what type of incontinence?

A

Urge incontinence

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19
Q

What is functional incontinence?

A

Co-morbid physical conditions impair the patient’s ability to get to a bathroom in time

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20
Q

What are some causes of functional incontinence?

A

Dementia
Sedating medication
Injury / illness resulting in decreased ambulation

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21
Q

What are the classic signs/symptoms of overflow incontinence?

A

There is a weak or intermittent stream / hesitancy

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22
Q

If there is a weak or intermittent stream / hesitancy when urinating, what type of incontinence is this?

A

Overflow incontinence

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23
Q

What are the initial investigations for urinary incontinence?

A

Bladder diaries for a minimum of 3 days
Vaginal examination
Kegel exercises
Urine dipstick and culture
Urodynamic studies

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24
Q

What is the first line intervention for urge incontinence?

A

Bladder retraining for 6 weeks minimum

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25
Q

What is the first line pharmacological agent for urge incontinence?

A

Oxybutynin (immediate release)

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26
Q

What class of drugs are used first line in urge incontinence?

A

Antimuscarinics (anticholinergics)

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27
Q

What is a contraindication of using oxybutynin for urge incontinence?

A

Frail elderly women due to an increased risk of falls

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28
Q

What is the second line pharmacological intervention for urge incontinence?

A

Tolterodine or Solifenacin

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29
Q

What is a contraindication for Tolterodine or Solifenacin for urge incontinence?

A

Closed-angle glaucoma

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30
Q

If a female patient is elderly with closed angle glaucoma, what is the pharmacological agent which can be given?

A

Mirabegron

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31
Q

What class of drug is Mirabegron?

A

A beta-3-agonist

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32
Q

What is the first line management for stress incontinence?

A

Pelvic floor retraining (Kegel exercises)

8 contractions performed 3 times per day for a minimum of 3 months

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33
Q

What is the second line management for stress incontinence?

A

Surgical procedures: e.g. retropubic mid-urethral tape procedures

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34
Q

What is the second line management for women for stress incontinence if they decline surgical procedures?

A

Duloxetine

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35
Q

What class of drug is Duloxetine?

A

A combined noradrenaline and serotonin reuptake inhibitor

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36
Q

What is the mechanism of action of Duloxetine?

A

Increased synaptic concentration of noradrenaline and serotonin within the pudendal nerve → increased stimulation of urethral striated muscles within the sphincter → enhanced contraction

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37
Q

What is the management for overflow incontinence?

A

Re-establish a clear pathway for urine flow e.g. catheterisation or medications like alpha blockers, which relax smooth muscle e.g. Tamsulosin

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38
Q

What are the most common type of renal stones?

A

80% of stones are composed of calcium oxalate or phosphate stones

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39
Q

What is the gold standard investigation for renal / urinary stones?

A

Non-contrast CT within 24 hours of presentation

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40
Q

What would the management be for renal stones that are less than less than 5mm?

A

Watchful waiting

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41
Q

In what case would you use watchful watching for the management of renal stones?

A

If they are less than 5mm

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42
Q

What would the management be for renal stones that are less than more than 10mm?

A

Surgical management

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43
Q

In what case would you use surgical intervention in the management of renal stones?

A

If they are more than 10mm.

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44
Q

What pharmacological agent may aid in the passage of renal stones?

A

Alpha blocker e.g. Tamsulosin

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45
Q

What is androgen insensitivity syndrome?

A

X-linked recessive condition due to end-organ resistance to testosterone causing genotypically male children (46XY) to have a female phenotype.

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46
Q

What is the inheritance pattern of androgen insensitivity syndrome?

A

X-linked recessive

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47
Q

What are the classical signs/symptoms of androgen insensitivity syndrome?

A

Primary amenorrhoea with little or no axillary or public hair.
Undescended testes may be felt in the suprapubic region.

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48
Q

Primary amenorrhoea with little or no axillary or public hair. Alongside
undescended testes felt in the suprapubic region would indicate what?

A

Androgen insensitivity syndrome

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49
Q

What is the management for androgen insensitivity syndrome?

A

Raise the child as a female
Bilateral orchidectomy
Oestrogen therapy

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50
Q

Why is a bilateral orchidectomy performed in patients with androgen insensitivity syndrome?

A

There is an increased risk of testicular cancer due to undescended testes.

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51
Q

Define bicornate uterus?

A

A bicornuate uterus is where there are two “horns” to the uterus
Gives the uterus a heart-shaped appearance

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52
Q

What are some complications of bicornate uterus?

A

Miscarriage
Premature birth
Malpresentation

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53
Q

Define imperforate hymen?

A

This is where the hymen at the entrance of the vagina is fully formed without an opening

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54
Q

What is the management for imperforate hymen?

A

Diagnosed on clinical examination

Management is with surgical incision to create an opening in the hymen

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55
Q

What is the potential complication of an imperforate hymen?

A

Retrograde menstruation which could lead to endometriosis

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56
Q

Define transverse vaginal septae?

A

Where aseptum(wall) formstransverselyacross the vagina

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57
Q

What are the investigations for transverse vaginal septea?

A

Clinical examination
Ultrasound
MRI

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58
Q

What are the main complications of transverse vaginal septae?

A

Infertility
Pregnancy-related conditions

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59
Q

Define vaginal hypoplasia?

A

Abnormally small vagina

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60
Q

Define vaginal agenesis?

A

An absent vagina

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61
Q

What is spared in vaginal agenesis and hypoplasia?

A

Ovaries are usually spared = normal female sex hormones

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62
Q

What is the management for vaginal hypoplasia and agenesis?

A

Vaginal dilator over a prolonged period to create an adequate vaginal size and alternative is vaginal surgery

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63
Q

What is menarche?

A

Menarche is the first menstrual cycle, or first menstrual bleeding, in female humans.

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64
Q

Define thelarche?

A

‘Breast budding’ - onset of secondary breast development

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65
Q

Define pubarche?

A

Development of pubic hair

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66
Q

What is the normal endometrial thickness in pre-menopausal women during menstruation?

A

2-4mm

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67
Q

What is the normal endometrial thickness in pre-menopausal women during the early proliferative phase (day 6-14)?

A

5-7mm

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68
Q

What is the normal endometrial thickness in pre-menopausal women during the late proliferative phase (day 14-18)?

A

Up to 11mm

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69
Q

What is the normal endometrial thickness in pre-menopausal women during the secretory phase (day 18-28)?

A

7-16mm

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70
Q

A endometrial thickness of 2-4mm would indicate a woman is in what part of their cycle?

A

Menstruation

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71
Q

A endometrial thickness of 5-7mm would indicate a woman is in what part of their cycle?

A

Early proliferative phase (day 6-14)

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72
Q

A endometrial thickness of up to 11mm would indicate a woman is in what part of their cycle?

A

Late proliferative phase (day 14-18)

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73
Q

A endometrial thickness of 7-16mm would indicate a woman is in what part of their cycle?

A

Secretory phase (day 18-28)

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74
Q

When can menopause be diagnosed?

A

Cessation of menses for at least 12 consecutive months

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75
Q

When does menopause usually occur in women, what is the average age?

A

40-60 years old. Average age is 51 years.

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76
Q

What is considered to be pre-menopausal?

A

Menopause before the age of 40 years.

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77
Q

When is contraception needed until after menopause?

A

12 months after the last period in women > 50 years

24 months after the last period in women < 50 years

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78
Q

What are some contraindications of HRT?

A

Current or past breast cancer.
Any oestrogen sensitive cancer.
Undiagnosed vaginal bleeding.
Untreated endometrial hyperplasia.

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79
Q

Unopposed oestrogen HRT can be given to women under what conditions?

A

If they do not have a uterus.

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80
Q

Combined HRT should be given to women who have what?

A

A uterus

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81
Q

What is a complication of oral HRT?

A

Increased risk of VTE, no increased risk with transdermal

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82
Q

Which two cancers are associated with an increased risk due to HRT use?

A

Ovarian and breast

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83
Q

What pharmacological agent can be given for women suffering from vasomotor symptoms (non-HRT)?

A

Fluoxetine

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84
Q

What is oestrogen HRT called when it is given in oral form?

A

Estradiol

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85
Q

What is progesterone HRT called when given in oral form?

A

Utrogestan (micronised progesterone)

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86
Q

Define adenomyosis?

A

Adenomyosis is characterised by the presence of endometrial tissue within the myometrium

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87
Q

What are the classical features of adenomyosis?

A

Dysmenorrhoea
Menorrhagia
Enlarged, boggy uterus

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88
Q

What is the first-line investigation for adenomyosis?

A

Transvaginal ultrasound

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89
Q

What is the management for adenomyosis?

A

Tranexamic acid to manage ammenhorea
GnRH agonists
Uterine artery embolisation

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90
Q

What is the definitive treatment for adenomyosis?

A

Hysterectomy

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91
Q

What is Asherman’s syndrome?

A

Also referred to as intrauterine adhesions or intrauterine synechiae, occurs when scar tissue (adhesions) forms inside the uterus and/or the cervix

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92
Q

How is Asherman’s syndrome diagnosed?

A

Hysteroscopy - Gold standard

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93
Q

What is the management for Asherman’s syndrome?

A

Dissection of adhesions during hysteroscopy

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94
Q

What would the classical signs/symptoms of lichen sclerosis be?

A

Intense itching, especially worse at night, and presents with white, shiny patches, thinning of the vulvar skin, and areas of atrophy.

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95
Q

What demographic is lichen sclerosus most common in?

A

Elderly females

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96
Q

What is the first line management for lichen sclerosus?

A

Gold standard - Clobetasol proprionate 0.05%

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97
Q

What is the second line management for lichen sclerosus?

A

Topical calcineurin inhibitors e.g. Tacrolimus 0.1%
Topical retinoids e.g. Tretinoin 0.025-0.1%

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98
Q

Why is there a need for follow up in patients with lichen sclerosus?

A

There is an increased risk of vulval cancer

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99
Q

What is the most common cause of vaginal itching?

A

Contact dermatitis

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100
Q

Define atrophic vaginitis?

A

Inflammation of the vagina due to changes in the composition of the vaginal micro-environment due to hormonal deficiency (oestrogen)

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101
Q

Atrophic vaginitis most commonly occurs in women at what stage in life?

A

Post-menopausal

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102
Q

What is the management of atrophic vaginitis?

A

Vaginal lubricants and moisturisers - if these do not help then topical oestrogen cream can be used.

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103
Q

What investigation should you always perform before a diagnosis of atrophic vaginitits?

A

Transvaginal ultrasound - endometrial cancer

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104
Q

What are the causes of infertility?

A

Male factor 30%
Unexplained 20%
Ovulation failure 20%
Tubal damage 15%
Other causes 15%

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105
Q

What is the investigation for infertility in males?

A

Semen analysis

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106
Q

What is the investigation for infertility in females?

A

Serum progesterone 7 days prior to expected next period.

Day 21 for 28 day period

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107
Q

How would you interpret a serum progesterone in females for infertility?

A

< 16 nmol/l - Repeat, if consistently low refer to specialist
16 - 30 nmol/l - Repeat
> 30 nmol/l - Confirms ovulation

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108
Q

What are the key counselling points for infertility?

A

Folic acid
Aim for BMI 20-25
Advise regular sexual intercourse every 2 to 3 days
Smoking/drinking advice

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109
Q

What is the most common type of vulval cancer?

A

Squamous cell carcinoma

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110
Q

What are the risk factors for vulval cancer?

A

Increased age
HPV infection
Vulval intraepithelial neoplasia (VIN)
Immunosuppression
Lichen sclerosus

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111
Q

What are the classical features of vulval cancer?

A

Lump or ulcer on the labia majora
Inguinal lymphadenopathy
May be associated with itching, irritation

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112
Q

What is the management of vulval cancer?

A

Wide local excision to remove the cancer
Chemotherapy - Erlotibib

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113
Q

What are the two types of cervical cancer?

A

Squamous cell cancer (80%)
Adenocarcinoma (20%)

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114
Q

What serotypes of HPV are associated with increased risk of cervical cancer?

A

16,18 & 33

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115
Q

What staging system is used for cervical cancer?

A

FIGO staging

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116
Q

What is stage IA cervical cancer classified as?

A

Confined to cervix, only visible by microscopy and less than 7 mm wide

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117
Q

What is stage IB cervical cancer classified as?

A

Confined to cervix, clinically visible or larger than 7 mm wide

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118
Q

What is stage II cervical cancer classified as?

A

Extension of tumour beyond cervix but not to the pelvic wall

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119
Q

What is stage III cervical cancer classified as?

A

Extension of tumour beyond the cervix and to the pelvic wall
A = lower third of vagina
B = pelvic side wall

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120
Q

What is stage VI cervical cancer classified as?

A

Extension of tumour beyond the pelvis or involvement of bladder or rectum
A = involvement of bladder or rectum
B = involvement of distant sites outside the pelvis

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121
Q

What is the gold standard treatment for stage IA cervical cancer?

A

Hysterectomy +/- lymph node clearance

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122
Q

What is the management option for patients with stage IA cervical cancer and wanting to preserve fertility?

A

Cone biopsy with negative margins

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123
Q

What are the management choices for stage II and above cervical cancer?

A

Chemotherapy - cisplatin
Radiotherapy

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124
Q

What type of cervical cancer is frequently not detected in cervical cancer screening?

A

Adenocarcinoma

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125
Q

At what age are women offered cervical smears?

A

All women between the ages of 25-64 years

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126
Q

At what ages is 3 yearly screening performed for cervical cancer screening?

A

25-49 years: 3-yearly screening

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127
Q

At what ages is 5 yearly screening performed for cervical cancer screening?

A

50-64 years: 5-yearly screening

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128
Q

Explain how cervical cancer screening works?

A

HPV first system, i.e. a sample is tested for high-risk strains of human papillomavirus (hrHPV) first and cytological examination is only performed if this is positive

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129
Q

When is cervical cancer screening performed during pregnancy?

A

Usually delayed until 3 months post-partum unless missed screening or previously abnormal smears

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130
Q

What is the protocol of an inadequate sample is obtained during cervical cancer screening?

A

Repeat test in 3 months

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131
Q

What is the protocol in cervical cancer screening if there is a negative result for high-risk HPV?

A

Return to normal recall

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132
Q

What is the protocol in cervical cancer screening if there is a positive result for high-risk HPV?

A

Samples are examined cytologically

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133
Q

If cytological samples are normal following a positive high-risk HPV sample in cervical cancer screening, what is the protocol?

A

Test is repeated in 12 months

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134
Q

If cytological samples are normal following 2 x positive high-risk HPV sample after 12 months in cervical cancer screening, what is the protocol?

A

Test is repeated in 12 months

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135
Q

If cytological samples are normal following 3 x positive high-risk HPV sample after 12 months in cervical cancer screening, what is the protocol?

A

If positive after 24 months = Colposcopy

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136
Q

If cytological samples are abnormal following a positive high-risk HPV sample in cervical cancer screening, what is the protocol?

A

Colposcopy

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137
Q

When is the HPV vaccine offered in schools and to whom?

A

Boys and Girls at ages 12-13

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138
Q

What is the treatment for cervical intraepithelial neoplasia?

A

Large loop excision of transformation zone (LLETZ)

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139
Q

What should happen for all women > 55 years old who present with post-menopausal bleeding?

A

All women >= 55 years who present with postmenopausal bleeding should be referred using the suspected cancer pathway

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140
Q

What is the most common identifiable cause of postcoital bleeding?

A

Cervical ectropion

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141
Q

What is endometrial hyperplasia?

A

Defined as an abnormal proliferation of the endometrium in excess of the normal proliferation that occurs during the menstrual cycle

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142
Q

What is the management for simple endometrial hyperplasia without atypia?

A

High dose progestogens with repeat sampling in 3-4 months
The levonorgestrel intra-uterine system may be used

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143
Q

What is the management for endometrial hyperplasia with atypia?

A

Hysterectomy is usually advised

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144
Q

What are the risk factors for endometrial cancer?

A

Nulliparity
More periods - early menarche, late Menopause
Unopposed oestrogen
Tamoxifen
HNPCC

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145
Q

What are some protective factors against endometrial cancer?

A

Multiparity
COCP
Smoking

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146
Q

What is the classic symptom of endometrial cancer?

A

Postmenopausal bleeding

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147
Q

What are some axillary features of endometrial cancer?

A

Pain (uncommon - signifies extensive disease)
Vaginal discharge - unusual

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148
Q

How may endometrial cancer present in premenopausal women?

A

Premenopausal women may develop menorrhagia or intramenstrual bleeding
pain is not common and typically signifies extensive disease

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149
Q

What is the first line investigation for endometrial cancer?

A

First-line investigation is trans-vaginal ultrasound

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150
Q

What is the management for endometrial cancer?

A

Surgery - total abdominal hysterectomy with bilateral salpingo-oophorectomy

High-risk - posteroperative radiotherapy

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151
Q

Define endometriosis?

A

Characterised by the growth of ectopic endometrial tissue outside of the uterine cavity

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152
Q

What are the features of endometriosis?

A

Chronic pelvic pain
Secondary dysmennhorea - starts before bleeding
Dysparenuria

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153
Q

What is the investigation of choice for endometriosis?

A

Laparoscopy is the gold-standard investigation

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154
Q

What is the first-line management for endometriosis?

A

NSAIDs and/or paracetamol

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155
Q

What is the second line management for endometriosis?

A

Combined oral contraceptive pill or progestogens e.g. medroxyprogesterone acetate

GnRH analogues CAN be tried

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156
Q

What is the management for endometriosis for patient who are trying to conceive?

A

Laparoscopic excision or ablation of endometriosis plus adhesiolysis

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157
Q

What are uterine fibroids?

A

Fibroids are benign smooth muscle tumours of the uterus

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158
Q

What demographic are uterine fibroids most common in?

A

More common in Afro-Caribbean women

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159
Q

How are uterine fibroids diagnosed?

A

Transvaginal ultrasound

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160
Q

What is the management for asymptomatic uterine fibroids?

A

No treatment is needed other than periodic review to monitor size and growth

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161
Q

What are some management options of menorrhagia secondary to uterine fibroids?

A

Levonorgestrel intrauterine system (LNG-IUS)
NSAIDs e.g. mefenamic acid
Tranexamic acid
Combined oral contraceptive pill
Oral progestogen
Injectable progestogen

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162
Q

What are some management options for shrinking / removal of uterine fibroids?

A

GnRH analogues
Myomectomy
Endometrial ablation
Hysterectomy

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163
Q

Why are GnRH analogues only used short-term?

A

Due to side-effects such as menopausal symptoms (hot flushes, vaginal dryness) and loss of bone mineral density

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164
Q

What is the most common cause of postmenopausal bleeding?

A

Vaginal atrophy

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165
Q

What is a hydatidiform mole?

A

Molar pregnancies (hydatidiform moles) are chromosomally abnormal pregnancies that have the potential to become malignant

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166
Q

What is a complete hydaitdiform mole?

A

Complete hydatidiform moles have a 46 XX or 46 XY karyotype that is derived entirely of paternal DNA.

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167
Q

What is an incomplete hydatidiform mole?

A

Partial hydatidiform moles contain a karyotype of either 69 XXX or 69 XXY, and contain both maternal and paternal genetic material

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168
Q

What are the classical features of complete hydatidiform mole?

A

Vaginal bleeding
Uterus size greater than expected for gestational age

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169
Q

What are the investigations for hydatidiform mole?

A

Pelvic ultrasound
Serum hCG - will be abnormally high

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170
Q

What would a complete hyaditidiform mole show on ultrasound?

A

‘snow storm’ appearance of mixed echogenicity

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171
Q

A ‘snow storm’ appearance of mixed echogenicity would indicate what?

A

Complete hyatidiform mole

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172
Q

What is the management for hydatidiform mole?

A

Evacuation of the uterus - referral to specialist care

Products of conception need to be sent for histological examination

173
Q

What is recommended after pregnancy with a hydatidiform mole?

A

Effective contraception is recommended to avoid pregnancy in the next 12 months

174
Q

What is a prolactinoma?

A

A type of pituitary adenoma, a benign tumour of the pituitary gland.

175
Q

What are the size ranges for a pituitary micro- and macroadenoma?

A

Microadenoma is <1cm and a macroadenoma is >1cm

176
Q

What is the management for a prolactinoma?

A

Dopamine agonists (e.g. cabergoline, bromocriptine) they inhibit the release of prolactin from the pituitary gland

177
Q

What type of drugs are cabergoline and bromocriptine?

A

Dopamine agonists

178
Q

What is the management for patients with a pituitary gland who cannot tolerate or fail therapy?

A

A trans-sphenoidal surgery

179
Q

Why does ovarian cancer carry a poor prognosis?

A

Poor prognosis due to late diagnosis.

180
Q

What are the risk factors for ovarian cancer?

A

BRCA1 and BRCA2
Many ovulations - early menarche, late menopause, nulliparity

181
Q

What are the investigations for ovarian cancer?

A

CA125 - if above 35IU/mL then urgent ultrasound of abdomen and pelvis

182
Q

How is ovarian cancer diagnosed?

A

Diagnostic laparotomy

183
Q

What is the management for ovarian cancer?

A

Usually a combination of surgery and platinum-based chemotherapy

184
Q

Define ovarian torsion?

A

Ovarian torsion may be defined as the partial or complete torsion of the ovary on it’s supporting ligaments that may in turn compromise the blood supply

185
Q

What are the classical features of ovarian torsion?

A

Sudden onset of deep-seated colicky abdominal pain
Associated with vomiting and distress
Adenexal tenderness

186
Q

What will ovarian torsion show on ultrasound?

A

Whirlpool sign

187
Q

What would whirlpool sign on an ultrasound be suggestive of?

A

Ovarian torsion

188
Q

What is the management for ovarian torsion?

A

Laparoscopy is usually both diagnostic and therapeutic

189
Q

Define pelvic inflammatory disease?

A

Pelvic inflammatory disease (PID) is a term used to describe infection and inflammation of the female pelvic organs including the uterus, fallopian tubes, ovaries and the surrounding peritoneum

190
Q

What are the features of pelvic inflammatory disease?

A

Lower abdominal pain
Fever
Deep dyspareunia
Dysuria and menstrual irregularities may occur
Vaginal or cervical discharge
Cervical excitation

191
Q

What are the causative organisms for PID?

A

Chlamydia trachomatis - most common
Neisseria gonorrhoeae
Mycoplasma genitalium
Mycoplasma hominis

192
Q

What are the investigations for pelvic inflammatory disease?

A

Pregnancy test - exclude ectopic pregnancy
High vaginal swab - often negative
Screen for Chlamydia and Gonorrhoea

193
Q

What are the complications of pelvic inflammatory disease?

A

Perihepatitis (Fitz-Hugh Curtis Syndrome) - 10%
Infertility
Ectopic pregnancy

194
Q

What is the first line management for PID?

A

Stat IM ceftriaxone +
14 days of oral doxycycline + oral metronidazole

195
Q

What is the second line management for PID?

A

Oral ofloxacin + oral metronidazole

196
Q

What are the features of PCOS?

A

Subfertility and infertility
Senstrual disturbances: oligomenorrhoea and amenorrhoea
Hirsutism, acne (due to hyperandrogenism)
Obesity
Acanthosis nigricans

197
Q

What are the investigations for PCOS?

A

Pelvic ultrasound
Various bloods
Glucose tolerance test

198
Q

What bloods should be checked in PCOS and what would they show?

A

LH:FSH will be raised
Prolactin - raised
Testosterone - Normal / mildy elevated
SHGB (sex hormone-binding globulin) normal

199
Q

What is the Rotterdam criteria used for?

A

To confirm a diagnosis of PCOS.

200
Q

What are the Rotterdam criteria?

A

Diagnosis can be made if 2/3:

Infrequent or no ovulation
Clinical / biochemical signs of hyperandrogenism
Polycystic ovaries on ultrasound (≥12) in one or both

201
Q

What is the general management of PCOS?

A

Weight reduction if appropriate
COCP may help regulate cycle and induce bleed

202
Q

What is the management for hirtuism and acne in PCOS?

A

COCP for hirtuism
Topical eflornithine may be used if above fails

203
Q

Define fistula?

A

A fistula is a connection or hole that forms between two organs

204
Q

Define vesicovaginal fistula?

A

Opening between the vagina and the bladder

205
Q

Define rectovaginal fistula?

A

Opening between the vagina and rectum/lower part of the large intestine

206
Q

Define colovaginal fistula?

A

Opening between the vagina and colon

207
Q

Define enterovaginal fistula?

A

Opening between the vagina and small intestine

208
Q

Define uterivaginal fistula?

A

Opening between the vagina and the tubes (ureters) that carry urine from your kidneys to your bladder

209
Q

Define urethrovaginal fistula?

A

Opening between the vagina and urethra, a part of the bladder

210
Q

What score is used to assess postpartum mental health problems in pregnancy?

A

The Edinburgh Postnatal Depression Scale may be used to screen for depression

211
Q

What score in the Edinburgh Postnatal Depression Scale would indicate a ‘depressive illness of varying severity’

A

Score of > 13

212
Q

A score of > 13 in the the Edinburgh Postnatal Depression Scale would indicate what?

A

A ‘depressive illness of varying severity’

213
Q

When is ‘baby-blues’ most likely to occur?

A

Typically seen 3-7 days following birth

214
Q

When is post-natal depression most likely to occur?

A

Most cases start within a month and typically peaks at 3 months

215
Q

When is puerperal psychosis most likely to occur?

A

Onset usually within the first 2-3 weeks following birth

216
Q

What is the management for ‘baby blues’?

A

Reassurance and support, the health visitor has a key role

217
Q

What is the management for postnatal depression?

A

Reassurance and support are important
CBT may be beneficial
Paroxetine SSRI may be used if severe

218
Q

What is the management for puerperal psychosis?

A

Admission to hospital is usually required, ideally in a Mother & Baby Unit

219
Q

Define ectopic pregnancy?

A

Implantation of a fertilised ovum outside the uterus results in an ectopic pregnancy

220
Q

What are some risk factors for ectopic pregnancy?

A

Damage to tubes (PID, surgery)
Previous ectopic
Endometriosis
IUCD
Progesterone only pill

221
Q

What are the signs / symptoms of an ectopic pregnancy?

A

6-8 weeks of amenorrhoea with lower abdominal pain (usually unilateral) initially and vaginal bleeding later

222
Q

6-8 weeks of amenorrhoea with lower abdominal pain (usually unilateral) initially and vaginal bleeding later would indicate what?

A

Ectopic pregnancy

223
Q

What signs / symptoms ‘may’ be present in an ectopic pregnancy?

A

Shoulder tip pain and cervical excitation

224
Q

What is the primary investigation for a ectopic pregnancy?

A

Transvaginal ultrasound

225
Q

What would the options be for an ectopic pregnancy with no foetal heartbeat?

A

Expectant or medical management.

226
Q

What would the options be for an ectopic pregnancy with a a visible foetal heartbeat?

A

Surgical management.

227
Q

What would the management be for an ectopic pregnancy with a hCG of <1000?

A

Expectant management

228
Q

What would the management be for an ectopic pregnancy with a hCG of <1500?

A

Medical management. Can only be done so if the patient is willing to attend a follow up appointment.

229
Q

What would the management be for an ectopic pregnancy with a hCG of >5000?

A

Surgical management

230
Q

What would the hCG level need to be for expectant management to be commenced for an ectopic pregnancy?

A

hCG of <1000

231
Q

What would the hCG level need to be for medical management to be commenced for an ectopic pregnancy?

A

hCG of <1500

232
Q

What would the hCG level need to be for surgical management to be commenced for an ectopic pregnancy?

A

hCG of >5000?

233
Q

What is the only intervention of choice for an ectopic pregnancy if there is a ruptured fallopian tube?

A

Surgical management (salplngotomy, salplngectomy)

234
Q

When is a salpingotomy preferred over a salpingectomy?

A

Salpingotomy should be considered for women with risk factors for infertility such as contralateral tube damage

Patients will also require methotrexate

235
Q

Where do most ectopic pregnancies implant?

A

Tubal in the ampulla

236
Q

What is the most dangerous type of ectopic pregnancy?

A

Isthmus

237
Q

What is the classic feature of threatened miscarriage?

A

Painless vaginal bleeding occurring before 24 weeks, but typically occurs at 6 - 9 weeks
Cervical os is closed

238
Q

Painless vaginal bleeding occurring before 24 weeks, but typically occurs at 6 - 9 weeks would indicate what?

A

Threatened miscarriage

239
Q

Define missed (delayed) miscarriage?

A

A gestational sac which contains a dead foetus before 20 weeks without the symptoms of expulsion

240
Q

What would the symptoms of missed (delayed) miscarriage)?

A

May have light vaginal bleeding / discharge
Cervical os is closed

241
Q

What are the classical features of inevitable miscarriage?

A

Heavy bleeding with clots and pain
Cervical os is open

242
Q

What would heavy bleeding with clots and pain with an open cervical os indicate?

A

Inevitable miscarriage

243
Q

Define incomplete miscarriage?

A

Not all products of conception have been expelled

244
Q

What are the classical features of incomplete miscarriage?

A

Pain and vaginal bleeding
Cervical os open

245
Q

Define chronicity?

A

The number of chorionic membranes, or outer membranes.

246
Q

Define amnioticity?

A

The number of amnions, or inner membranes.

247
Q

What would a lambda sign indicate on ultrasound?

A

This indicates dichorionic twins

248
Q

What would a T sign indicate on ultrasound?

A

This indicates a monochorionic twin pregnancy

249
Q

Define twin-twin transfusion syndrome?

A

One foetus become the recipient and receives the majority of the blood supply

One foetus becomes the donor and is starved of blood

250
Q

What may occur to the recipient foetus in twin-twin transfusion syndrome?

A

Excess fluid causes fluid overload, heart failure and polyhydramnios

251
Q

What may occur to the donor in twin-twin transfusion syndrome?

A

This causes growth restriction, anaemia and oligohydramnios

252
Q

What is twin anaemia polycythaemia sequence?

A

Similar to twin-twin transfusion syndrome but less acute.

One twin becomes anaemia whilst the other develops polycythaemia

253
Q

What is the current law for abortion based around?

A

1967 Abortion Act

In 1990 the act was amended, reducing the upper limit from 28 weeks gestation to 24 weeks

254
Q

What must happen during a termination of pregnancy?

A

Two registered medical practitioners must sign a legal document (in an emergency only one is needed)

255
Q

When should anti-D prophylaxis be given for termination of pregnancy?

A

Should be given to women who are rhesus D negative and are having an abortion after 10+0 weeks’ gestation

256
Q

What are the medical options for termination of pregnancy?

A

Mifepristone (anti-oestrogen) followed 48-hours later by misoprostol (prostoglandins)

Pregnancy test required 2 weeks later to confirm loss (should detect hCG rather than just positive / negative)

257
Q

When would a medical abortion usually occur?

A

Before 10 weeks gestation

258
Q

What are the surgical options for termination of pregnancy?

A

Vacuum aspiration (MVA)
Electric vacuum aspiration (EVA)
Dilatation and evacuation (D&E)

259
Q

What should also be given alongside surgical termination of pregnancy?

A

Cervical priming with misoprostol +/- mifepristone

260
Q

What is the first line investigation for gestational diabetes?

A

Oral glucose tolerance test

261
Q

At what weeks should an oral glucose tolerance test be performed for gestational diabetes?

A

Screening is offered at 24-28 weeks

262
Q

At what weeks should an oral glucose tolerance test be performed for gestational diabetes if there are risk factors present?

A

Women who’ve previously had gestational diabetes: OGTT should be performed as soon as possible after booking and at 24-28 weeks if the first test is normal.

263
Q

What is the target blood glucose level for pregnant women (pre-existing and gestational diabetes) at fasting?

A

5.6 mmol/l

264
Q

What is the target blood glucose level for pregnant women (pre-existing and gestational diabetes) 1 hour after meals?

A

7.8 mmol/l

265
Q

What is the target blood glucose level for pregnant women (pre-existing and gestational diabetes) 2 hour after meals?

A

6.4 mmol/l

266
Q

What is the management of pre-existing diabetes in pregnancy?

A

Stop oral hypoglycaemic agents, apart from metformin, and commence insulin

267
Q

What is the management of gestational diabetes with a fasting glucose of > 7 mmol/L?

A

Insulin ±metformin

268
Q

What is the management of gestational diabetes with a fasting glucose of > 6 mmol/L with Macrosomia or Other Complications?

A

Insulin ±metformin

269
Q

If the woman declines insulin therapy or cannot tolerate metformin what is second line for gestational diabetes?

A

Glibencalmide (sulfonylurea)

270
Q

What is the management of gestational diabetes with a fasting glucose of <7mmol/L?

A

Trial of diet and exercise for 1-2 weeks, followed by metformin, then insulin

271
Q

A diagnosis of gestational diabetes would be made with what levels of blood glucose following an oral glucose tolerance test?

A

Fasting glucose is >= 5.6 mmol/L, or
2-hour glucose level of >= 7.8 mmol/L

272
Q

What type of insulin is gestational diabetes treated with and why?

A

Gestational diabetes is treated with short-acting, but not longer-acting SC insulin due to lower risk of hypoglycaemia, and better post meal blood glucose control

273
Q

What risk factors will women be screened for during their booking appointment for gestational diabetes?

A

BMI above 30 kg/m²
Previous macrosomic baby weighing 4.5 kg or more
Previous gestational diabetes
Family history of diabetes (first-degree relative with diabetes)
An ethnicity with a high prevalence of diabetes

274
Q

Define hypertension in pregnancy?

A

> 140 / >90 mmHg

275
Q

What is the target blood pressure for gestational hypertension?

A

<135 / 85 mmHg

276
Q

What is the management for pre-existing hypertension in pregnancy?

A

Oral labetalol

ACE inhibitor or angiotensin II receptor blocker (ARB) for pre-existing hypertension this should be stopped immediately

277
Q

What is the management for gestational hypertension?

A

Lebatalol

278
Q

Define pre-eclampsia?

A

New-onset blood pressure ≥ 140/90 mmHg after 20 weeks of pregnancy

Pregnancy-induced hypertension AND

Proteinuria / oedema or other organ involvement

279
Q

Define severe pre-eclampsia?

A

New onset hypertension: typically > 160/110 mmHg
Proteinuria: dipstick ++/+++
Oedema may be seen

280
Q

What medication should be given to reduce the risk of developing pre-eclampsia?

A

Low dose aspirin (75-150mg) from 12 weeks gestation until birth

281
Q

When would a woman with pre-eclampsia be admitted?

A

Blood pressure ≥ 160/110 mmHg are likely to be admitted

282
Q

What is the first-line management of pre-eclampsia?

A

Oral labetalol

283
Q

What is a contraindication to labetalol?

A

Asthma

284
Q

What is the management of pre-eclampsia if the patient is asthmatic?

A

Nifedipine

285
Q

Define eclampsia?

A

Development of seizures in association pre-eclampsia

286
Q

What is the pharmacological management for eclampsia?

A

IV magnesium sulphate bolus - 4g over 5-10 minutes then 1g infusion over an hour

287
Q

How long should treatment be for eclampsia?

A

24-hours after last seizure activity

288
Q

What is a complication of magnesium sulphate, for eclampsia, and what is the management for this?

A

Magnesium sulphate induced respiratory depression

Calcium gluconate

289
Q

What is the most common organism that causes UTI in pregnancy?

A

Escherichia coli

290
Q

What organisms can cause UTI in pregnancy?

A

KEEPS

E. coli (60-82.5%)
Klebsicalla pneumonia (11%)
Proteus (5%)
Staphylococcus
Streptococcus
Enterococcus

291
Q

What is the first-line management for LUTI in pregnancy?

A

Nitrofurantoin 100mg for 7 days

292
Q

What is the second line management for LUTI in pregnancy?

A

Amoxicillin or Cefalexin

293
Q

What is the management for UUTI in pregnancy?

A

Cefalexin PO 500mg for 7-10 days

IV if unable to take orally

294
Q

What is the VTE prophylaxis of choice during pregnancy?

A

Low molecular weight heparin

295
Q

When should VTE prophylaxis be given during pregnancy for those in which it is indicated?

A

From 28 weeks and continued until six weeks postnatal.

296
Q

What is the causative organism of bacterial vaginosis?

A

Gardnerella vaginalis

297
Q

What disease can gardnerella vaginalis cause?

A

Bacterial vaginosis

298
Q

Describe the pathophysiology behind bacterial vaginosis?

A

An overgrowth of predominately anaerobic organisms leading to a consequent fall in lactic acid producing aerobic lactobacilli resulting in a raised vaginal pH.

299
Q

What are the classical features of bacterial vaginosis?

A

Vaginal discharge: ‘fishy’, offensive
Asymptomatic in 50% of patients

300
Q

What criteria is used for the diagnosis of bacterial vaginosis?

A

Amsel’s criteria (3/4):

Thin, white homogenous discharge
Clue cells on microscopy: stippled vaginal epithelial cells
Vaginal pH > 4.5
Positive whiff test (addition of potassium hydroxide results in fishy odour)

301
Q

What is the management of bacterial vaginosis in an asymptomatic patient?

A

If the woman is asymptomatic, treatment is not usually required
Exceptions include if the patient is undergoing termination of pregnancy

302
Q

What is the first line management of bacterial vaginosis in a symptomatic patient?

A

Oral metronidazole for 5-7 days
Single oral dose of 2g may be used if adherence is an issue

303
Q

What are the alternative management options for bacterial vaginosis?

A

Topical metronidazole or topical clindamycin

304
Q

What medication for RA should be stopped when trying to conceive?

A

Methotrexate: must be stopped at least 6 months before conception in both men and women

305
Q

What is the Bishop scoring system used for?

A

The Bishop score is used to help assess whether induction of labour will be required.

306
Q

What points are given in the Bishop score for cervical position?

A

0 - Posterior
1 - Intermediate
2 - Anterior

307
Q

What points are given in the Bishop score for cervical consistency?

A

0 - Firm
1 - Intermediate
2 - Soft

308
Q

What points are given in the Bishop score for cervical effacement?

A

0 - 0-30%
1 - 40-50%
2 - 60-70%
3 - 80%

309
Q

What points are given in the Bishop score for cervical dilation?

A

0 - <1 cm
1 - 1-2 cm
2 - 3-4 cm
3 - >5 cm

310
Q

What points are given in the Bishop score for foetal station?

A

0 - -3
1 - -2
2 - -1,0
3 - +1,+2

311
Q

What does a Bishop score of <5 indicate?

A

Indicates that labour is unlikely to start without induction

312
Q

What does a Bishop score of ≥ 8 indicate?

A

That the cervix is ripe, or ‘favourable’ - there is a high chance of spontaneous labour, or response to interventions made to induce labour

313
Q

What would the management be for a Bishop score of ≤ 6?

A
  • Vaginal prostaglandins or oral misoprostol
  • Mechanical methods such as a balloon catheter can be considered if the woman is at higher risk of hyperstimulation or has had a previous caesarean
314
Q

What would the management be for a Bishop score of >6?

A

Amniotomy and an intravenous oxytocin infusion

315
Q

What is the definition for the first stage of labour?

A

From the onset of true labour to when the cervix is fully dilated

316
Q

What is the definition for the second stage of labour?

A

From full dilation to delivery of the foetus

317
Q

What is the definition of the third stage of labour?

A

From delivery of foetus to when the placenta and membranes have been completely delivered

318
Q

What is the active management choice for the third stage of labour? and what is the reason for this?

A

10 IU oxytocin by IM injection
Reduce the risk of PPH

319
Q

Define post-partum haemorrhage?

A

Postpartum haemorrhage is defined as blood loss of 500 ml after a vaginal delivery

320
Q

What are the causes of PPH?

A

4 T’s
- Tone (uterine atony)
- Trauma
- Tissue (retained placenta)
- Thrombin (clotting / bleeding disorder)

321
Q

What is the management for PPH secondary to uterine atony?

A

IV oxytocin (syntocinon)
IM ergometrine
IM carboprost
Misoprostol sublingual

322
Q

What is the surgical management for PPH, secondary to uterine atony, if medical intervention fails?

A

Intrauterine balloon tamponade

B-lynch suture

323
Q

What is a contraindication for administration of ergometrine for PPH?

A

Hx of hypertension and cardiac diseases

324
Q

What is a contraindication for administration of carboprost for PPH?

A

Hx of asthma

325
Q

What investigation should be performed if there is no amniotic fluid in the posterior vaginal vault following a speculum examination for PPROM?

A

Placental alpha microglobulin-1 protein (PAMG-1)
OR
Insulin-like growth factor binding protein-1

326
Q

What is the medical management for PPROM?

A
  • Oral erythromycin / 10 days
  • Antenatal corticosteroids to reduce the risk of respiratory distress syndrome (IM dexamethasone)
327
Q

When should delivery be considered for PPROM?

A

34 weeks gestation

328
Q

What is the most common complication of shoulder dystocia?

A

Erb’s palsy occurs due to damage to the upper brachial plexus most commonly from shoulder dystocia.

329
Q

What is the most common pattern of shoulder placement due to a complication of shoulder dystocia?

A

Damage to these nerve roots results in a characteristic pattern: adduction and internal rotation of the arm, with pronation of the forearm. This classic physical position is commonly called the ‘waiter’s tip’.

330
Q

What is the management of shoulder dystocia?

A

McRoberts manoeuvre - supine with both hips fully flexed and extended

331
Q

What is the management for intrahepatic cholestasis of pregnancy?

A

Intrahepatic cholestasis of pregnancy increases the risk of stillbirth; therefore induction of labour is generally offered at 37-38 weeks gestation

332
Q

Define cephalopelvic disproportion?

A

Condition where the baby’s head or body is too large to fit through the mother’s pelvis.

333
Q

What is the management for cephalopelvic disproportion?

A

Cesarean section

334
Q

Define placenta accreta?

A

Describes the attachment of the placenta to the myometrium, due to a defective decidua basalis.

335
Q

What is the main risk in placenta accreta?

A

Risk of postpartum haemorrhage.

336
Q

Define placental incetra?

A

Chorionic villi invade into the myometrium

337
Q

Define placenta percreta?

A

Chorionic villi invade through the perimetrium

338
Q

Define placenta praevia?

A

Describes a placenta lying wholly or partly in the lower uterine segment

339
Q

What are the signs / symptoms of placenta praevia?

A

Vaginal bleeding with no pain, the uterus will be non-tender but the presentation and lie may be abnormal.

340
Q

Vaginal bleeding with no pain, a non-tender uterus but with presentation and lie abnormal would indicate what?

A

Placenta praevia.

341
Q

What would a grade I placental praevia indicate anatomically?

A

Placenta reaches lower segment but not the internal os

342
Q

What would a grade II placental praevia indicate anatomically?

A

Placenta reaches internal os but doesn’t cover it

343
Q

What would a grade III placental praevia indicate anatomically?

A

Placenta covers the internal os before dilation but not when dilated

344
Q

What would a grade IV placental praevia indicate anatomically?

A

Placenta completely covers the internal os

345
Q

When would the last ultrasound scan be performed in patients with placental praevia?

A

Final ultrasound at 36-37 weeks to determine the method of delivery

346
Q

What would a grade I placenta praevia indicate for type of birth?

A

If grade I then a trial of vaginal delivery may be offered

347
Q

What would a grade III-IV placenta praevia indicate for type of birth?

A

Elective caesarean section for grades III/IV between 37-38 weeks

348
Q

If a woman with placenta praevia goes into labour prior to the 37-38 week scan what is the management?

A

Emergency caesarean section should be performed due to the risk of post-partum haemorrhage

349
Q

Define placental abruption?

A

Describes separation of a normally sited placenta from the uterine wall, resulting in maternal haemorrhage into the intervening space

350
Q

What are the signs / symptoms of placental abruption?

A

Constant lower abdominal pain. Woman may be more shocked than is expected by visible blood loss. Tender, tense uterus. Foetal heart may be distressed.

351
Q

Constant lower abdominal pain. Woman may be more shocked than is expected by visible blood loss. Tender, tense uterus. Foetal heart may be distressed. Would indicate what?

A

Placental abruption

352
Q

What is the management for placental abruption when the foetus is alive and <36 weeks and showing no signs of distress?

A

Admit and administer steroids

353
Q

Define vasa praevia?

A

Vasa praevia describes a complication in which foetal blood vessels cross or run near the internal orifice of the uterus.

354
Q

What are the signs / symptoms of vasa praevia?

A

Rupture of the membranes followed immediately by vaginal bleeding. Foetal bradycardia is classically seen.

355
Q

Rupture of the membranes followed immediately by vaginal bleeding and foetal bradycardia would indicate what?

A

Vasa praevia.

356
Q

Define oligohydramnios?

A

Reduced amniotic fluid

357
Q

What are the causes of oligohydramnios?

A

PROM
Potter sequence
Intrauterine growth restriction
Post-term gestation
Pre-eclampsia

358
Q

Define oligohydramnios?

A

Increased amniotic fluid

359
Q

Define lie?

A

The relationship between the long axis of the foetus and the mother.

360
Q

Define presentation?

A

The foetal part that first enters the maternal pelvis.

361
Q

Define position?

A

The position of the fetal head as it exits the birth canal.

362
Q

What is the management for abnormal foetal lie?

A

External Cephalic Version (ECV) - between 36 and 38 weeks gestation

363
Q

When is ECV contraindicated?

A

Recent APH
Ruptured membranes
Uterine abnormalities
Previous C-section

364
Q

What is the management for breech presentation?

A

Attempt ECV before labour, vaginal breech delivery or C-section

365
Q

What is the management for brow presentation?

A

C-section is necessary

366
Q

What is the management for shoulder presentation?

A

A C-section is necessary

367
Q

What is the management for malposition?

A

90% of malpositions spontaneously rotate

Rotation can be attempted vaginally

Alternatively C-section can be performed

368
Q

What is the biggest cause of cord prolapse?

A

Artificial amniotomy - around 50% of cord prolapses are due to this

369
Q

What is the biggest risk factor when performing an artificial amniotomy?

A

Cord prolapse

370
Q

Define rhesus disease of the newborn?

A

Rh incompatibility occurs in an Rh-negative mother carrying an Rh-positive fetus

371
Q

What is the investigation for rhesus incompatibility?

A

Test for D antibodies in all Rh -ve mothers at booking

372
Q

What is the management for rhesus incompatibility?

A

Anti-D immunoglobulin to to non-sensitised Rh -ve mothers at 28 and 34 weeks

373
Q

What is HELPP syndrome?

A

Haemolysis, Elevated liver enzymes and Low platelets

374
Q

What are the features of HELLP syndrome?

A

Nausea & vomiting
Right upper quadrant pain
Lethargy

375
Q

What is the management for HELLP syndrome?

A

Delivery of the baby

376
Q

What agent, usually used to treat hyperthyroidism, is contraindicated in pregnancy and why?

A

Carbimazole, may be associated with an increased risk of congenital abnormalities

377
Q

What is the agent of choice for treatment of hyperthyroidism in pregnancy, what is it associated with?

A

Propylthiouracil, associated with an increased risk of severe hepatic injury

378
Q

What is a category 1 caesarean section?

A

An immediate threat to the life of the mother or baby
Delivery of the baby should occur within 30 minutes of making the decision

379
Q

What is a category 2 caesarean section?

A

Maternal or foetal compromise which is not immediately life-threatening
Delivery of the baby should occur within 75 minutes of making the decision

380
Q

What is a category 3 caesarean section?

A

Delivery is required, but mother and baby are stable

381
Q

What is a category 4 caesarean section?

A

Elective caesarean

382
Q

What are some indications for a category 1 caesarean section?

A

Suspected uterine rupture
Major placental abruption
Cord prolapse
Foetal hypoxia
Persistent foetal bradycardia

383
Q

Describe a fibroadenoma?

A

Mobile, firm breast lumps

384
Q

What would a mobile, firm breast lump indicate?

A

Fibroadenoma

385
Q

What is the management for fibroadenoma?

A

If >3cm surgical excision is usual

386
Q

Describe a breast cyst?

A

Usually presents as a smooth discrete lump (may be fluctuant)

387
Q

A smooth, discrete breast lump (may be fluctuant) would indicate what?

A

Breast cyst

388
Q

What would you see on mammogram of breast cysts?

A

Halo sign

389
Q

What would halo sign on mammogram indicate?

A

Breast cysts compress the underlying fat and produce a radiolucent area (halo sign)

390
Q

What is the management for breast cysts?

A

Aspiration - if blood stained or persistently refill then biopsy and removal

391
Q

Describe duct ectasia?

A

A harmless, age-related breast change which causes the milk duct under the nipple to become blocked or clogged with a thick, sticky substance.

392
Q

In what demographic does fat necrosis usually occur?

A

Obese women with large breasts
Usually follows trauma

393
Q

Define breast abscess?

A

A localised collection of pus within the breast.

Can be either lactational or non-lactational

394
Q

Define mastitis?

A

Painful inflammatory condition of the breast

395
Q

What is the first-line management for mastitis?

A

Continue breastfeeding

396
Q

What is the management for mastitis that does not improve after effective milk removal?

A

Oral flucloxacillin 10-14 days

Breastfeeding or expressing should continue through Abx treatment

397
Q

What is the most common causative organism of infective mastitis?

A

Staphylococcus aureus

398
Q

Define fibroadenosis?

A

‘Lumpy’ breasts which may be painful.
Symptoms may worsen prior to menstruation

399
Q

When should a patient definitely be referred using the suspected breast cancer pathway?

A

Aged 30 and over and have an unexplained breast lump with or without pain or
Aged 50 and over with any of the following symptoms in one nipple only: discharge, retraction or other changes of concern

400
Q

When should a patient be considered for referral using the suspected breast cancer pathway?

A

Skin changes that suggest breast cancer or
Aged 30 and over with an unexplained lump in the axilla

401
Q

When should a patient be put forward for non-urgent referral for breast changes?

A

Consider non-urgent referral in people aged under 30 with an unexplained breast lump with or without pain.

402
Q

What hormonal therapy should be offered to breast cancer patients who are oestrogen-receptor-positive and are post-menopausal?

A

Letrozole / Anastrozole

403
Q

What biological therapy should be offered to breast cancer patients who are HER2 receptor positive? What is a contraindication of this therapy?

A

Trastuzumab (Herceptin)
cannot be used in patients with Hx of heart disorders

404
Q

What hormonal therapy should be offered to breast cancer patients who are oestrogen-receptor-positive and are pre- or perimenopausal?

A

Tamoxifen

405
Q

What is management recommended after a patient has undergone a wide-local excision for breast cancer?

A

Whole breast radiotherapy

406
Q

When is FEC-D chemotherapy used for breast cancer?

A

FEC-D chemotherapy is used for breast cancer that is node +ve

407
Q

When is FEC chemotherapy used for breast cancer?

A

Used for node -ve breast cancer that requires chemotherapy

408
Q

What complication is associated with axillary node clearance?

A

Arm lymphedema and functional arm impairment

409
Q

What age does the breast cancer screening programme start?

A

50-70 years old
After 70 years old patients are ‘encouraged to make their own appointments’

410
Q

How often are women screened for breast cancer under the breast cancer screening programme?

A

Women are offered a mammogram every 3 years.

411
Q

What is the most common type of breast cancer?

A

Invasive ductal carcinoma (no special type)

412
Q

What are the features of Paget’s disease of the breast?

A

Erythematous rash and associated thickening of the nipple

413
Q

An erythematous rash and associated thickening of the nipple would indicate what?

A

Paget’s disease of the breast

414
Q

What is the management for Paget’s disease of the nipple?

A

Urgent referral to breast clinic

415
Q

Define intraductal papilloma?

A

Benign tumour found within breast ducts. The abnormal proliferation of ductal epithelial cells causes growth.

416
Q

What are the features of intraductal papilloma?

A

May present with blood stained discharge

417
Q

What is the management of intraductal papilloma?

A

Surgical excision and complete removal of the tumour

418
Q

What is a contraindication for injectable progesterone contraceptives?

A

Breast cancer

419
Q

What is a contraindication for the combined oral contraceptive pill?

A

Smoking >15 cigarettes a day
Migraine with aura

420
Q

The COCP increases risk of which cancers?

A

Breast and cervical

421
Q

The COCP decreases risk of which cancers?

A

Endometrial and ovarian

422
Q

What is a contraindication for the IUD and IUS?

A

Unexplained vaginal bleeding

423
Q

When will the IUD be an effective method of contraception?

A

Instantly, even if not first day of period

424
Q

When will the POP be an effective method of contraception?

A

In 2 days, if not on first day of period. If first day then instantly

425
Q

When will the COC, injection, implant, IUS contraceptives be an effective method of contraception?

A

In 7 days, if not on the first day of period. If first day then instantly

426
Q

By what inheritance pattern is the BRCA gene inherited?

A

Autosomal dominant

427
Q

What would the imaging modality of choice be for a breast lump in an under-35-year-old patient?

A

Ultrasound

428
Q

What would the imaging modality of choice be for a breast lump in an over-35-year-old patient?

A

Mammogram

Phase 3a (8 decks)

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