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Phase 3A > Womens Health > Flashcards

Womens Health Flashcards

1
Q

List 5 factors that increase the risk of breast cancer

A
  • Alcohol
  • Increased radiation
  • Increasing age
    INCREASED OESTROGEN
  • Obesity (post-menopausal)
  • COCP
  • Having children in later life, early
  • Late menopause
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2
Q

What 2 genes are linked with breast cancer? (main ones)

A
  • BRAC1, BRAC2
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3
Q

List 4 signs of breast cancer (nipple)

A
  • Painless lump (hard and irregular)
  • Dimpling of the skin (pea de orange)
  • bleeding from the nipple
  • Nipple discharge
  • Nipple inversion
  • Rash or napple around the risk
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4
Q

Does breast cancer screening occur, and if so for what age?

A

Yes

Currently 47-73.

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5
Q

How do you screen for breast cancer?

A
  • Mammogram > 40
  • US /MRI < 40 due to dense breasts
  • Core needle biopsy - sentinel nodes, spread to lymph (mainly axilla)
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6
Q

Why should you give women with breast cancer bisphosphonates?

A

High risk post menopausal women due to risk of metastatic disease to bone

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7
Q

Other than breast cancer, what other cancer are BRAC1/2 carriers at an increased risk of?

A

Ovarian

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8
Q

What are the treatments for breast cancer?

A
  • Lumpectomy
  • Mastectomy
  • Radiotherapy
  • Chemotherapy
  • Targeted drugs
  • Axillary clearance
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9
Q

What are the indiciations of doing a mastectomy / lumpectomy?

A
  • Tumour > 25% of the breast
  • Multiple cancers
  • Large family history
  • Patient choice
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10
Q

What are protective factors against breast cancer?

A
  • Early pregnancy

- Breast feeding

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11
Q

What drug can be used for women with oestrogen receptor positive breast cancer?
(list one for both pre and post menopausal)

A
  • Tamoxifen - premenopausal

- Aromatase inhibitors - postmenopausal women

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12
Q

Name 3 causes of bleeding during pregnancy (antepartum)

A
  • Placenta Praevia
  • Placental abruption
  • BE AWARE OF DOMESTIC VIOLENCE
  • Local causes - trauma to vagina, etc
  • Vasa Praevia
  • Miscarriage
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13
Q

What are the 2 main types of breast cancer?

A
  • Ductal

- Lobular

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14
Q

What staging system is used?

A

TNM Staging
Tumour
Nodes
Metastise

  • Stage: where it is / spread to
  • Grade: what it looks like down the microscope
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15
Q

What is a specifcally nasty type of breast cancer?

A

HER2 receptor positive - treat with herceptin (trastuzumab) and chemotherapy

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16
Q

What should you give a women with bleeding during pregnancy?

A

ANTI-D (28 weeks)

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17
Q

A woman presents to the ED with profuse vaginal bleeding during pregnancy. You feel her abdomen and it feels ‘woody’ and tense. What is this likely to be?

A

Placental abruption

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18
Q

What should all mothers birthing premature babies be given?

A

Steroids - mature babies lungs (type 2 pneumocytes to produce surfactant)

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19
Q

List 3 causes of polyhydramnios

A
  • Duodenal atresia - baby (increased in Downs)

- Gestatonal Diabetes

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20
Q

What is a miscarriage?

A

Loss of pregnancy < 24 weeks

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21
Q

List 4 T’s causes of post-partum haemorrhage

A
  • TONE (uterine atony, distended bladder)
  • TISSUE (retained placenta or clots)
  • TRUAMA (lacerations of the uterus, cervix or vagina)
  • THROMBIN (pre-exisitng or acquired blood disorder)
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22
Q

What is HELLP syndrome?

A
  • Haemolysis
  • Elevated liver enzymes
  • Low platelets
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23
Q

What is the classic triad of vasa praevia?

A
  1. Membrane rupture
  2. Painless vaginal bleeding
  3. Fetal bradycardia or fetal death
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24
Q

List 4 indications for giving Anti-D (SENSITISING SITUATIONS)

A
  • Miscarriage > 12 weeks
  • Abortion
  • Amniocentesis
  • Ectopic pregnancy
  • Abdominal trauma
  • Bleeding during pregnancy
  • At birth mother and babies blood mixes
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25
Q

Describe the pathophysiology of Anti-D

A

Rhesus negative mum
Rhesus postive baby
Antibodies against rhesus positive - attack babies blood cells, causing jaundice and neurological problems

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26
Q

How do you check Anti-D?

A

Indirect coombs test

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27
Q

What test tells you the amount of Anti-D that you need?

A

Kleihaeur betke test

measures the amount of foetal Hb transferred from foetal to mothers blood stream

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28
Q

What medication can you give women with gestational diabetes?

A

Insulin and metformin

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29
Q

How do you check for Downs, Patuas, Edwards?

A
  • Nucchal translucency - 12 weeks

-

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30
Q

What are the two cardinal signs of pre-eclampsia?

A

HIGH BP AND PROTEINURIA

oedema now not included in the triad

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31
Q

List 5 symptoms of pre-eclampsia

A
  • headache
  • visual distrubance
  • papilloedema
  • ankle oedema
  • RUQ / epigastric pain (hepatic inflammation)
  • Hyperreflexia (sustained ankle clonus)
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32
Q

How do you manage pre-eclampsia?

A

DELIVERY OF THE BABY only way to cure.

  • IV magnesium sulphate
  • Oral labetalol - BP
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33
Q

Can you use labetalol for women with asthma?

A

NO!
Beta blocker narrow airways
First line for these women = nifedipine.

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34
Q

What is the scale used to screen for post-natal depression?

A

Edinburgh Scale

Max score =30

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35
Q

How do you know the menopause has started?

A

12 months since the cessation of the last period

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36
Q

List 6 periomenopasual symptoms

A

Irregular periods

Short term → vasomotor (hot flushes, night sweats), mood changes / irritability, loss of memory / concentration (loss of oestrogen on brain cell function), headaches, dry and itchy skin, joint pains (loss of collagen)

Medium term → urogenital atrophy (painful intercourse, vaginal dryness, UTI’s, PMB?, urinary incontinence and prolapse (lack of collagen)

Long term → OSTEOPAROSIS (oestrogen effects on the bone → , cardiovascular disease (adverse changes in lipid, oestrogen plays a role in lipid degradation)
Loss of libido
Difficulty sleeping

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37
Q

What is HRT?

A

Hormonal replacement therapy

Used to improve menopausal symptoms

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38
Q

Name 4 contraindications for HRT

A
  • VTE
  • Breast cancer
  • Ovarian cancer
  • Stroke
  • CV disease
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39
Q

What is FGM?

A

Female genital mutilation

Partial or total removal of the external female genitalia with no medical reason

NO acceptable justification for it

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40
Q

What is a type 1 FGM?

A

Clitoris removal

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41
Q

What is a type 2 FGM?

A

Clitoris and labia minora removal

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42
Q

What is a type 4 FGM?

A

Piercings, prickings, etc.

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43
Q

List 4 gnaey and 4 obstetric complications of FGM

A

GYNAEY

  • Infection, e.g. UTI
  • Keloid scar formation
  • Psychological damage e.g. PTSD
  • Sexual dysfunction, e.g. vaginismus, pain
  • Incontinence

OBS

  • Problems with pregnancy - Too narrow for childbirht
  • Increased likelihood of PPH
  • Increased likelihood of C-section
  • Difficulty performing vaginal examinations
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44
Q

Can anything be done for FGM?

A
  • Damage permanent

- Only symptomatic management - deinfibulation (opening up the vagina)

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45
Q

Name 3 differentials for pelvic pain

A

GYNAEY

  • PID
  • Ovarian cysts
  • Endometroisis
  • Fibroid degeneration
  • Ovarian torsion

OBS
- Ectopic pregnancy

BOWEL - rememver this can present as pelvic pain!

  • IBS
  • IBD
  • UTI
  • Appendicitis
  • Diverticulitis
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46
Q

What is the key differential for endometriosis?

A

Adenomyosis

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47
Q

Name 3 differences between endometriosis adenomyosis?

A

Adenomysosis –> often seen in those who have had children, older. Lots of fluid in the myometrium with many holes.

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48
Q

What is the cause of PID?

A

CHLAMYDIA

gonorrhoea

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49
Q

What are the investigations for PCOS and what would you find?

A

LH: FSH = 3:1

Testosterone = raised

Sex hormone binding globulin = low (therefore increased free testosterone)

US = massive ovaries with many cysts

Fasting glucose and OGTT = diabetic / insulin resistance

Fasting lipid levels

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50
Q

What is mittelschmertz?

A

Ovulation paon

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51
Q

Where is the most common place for an ectopic pregnancy to occur?

A

AMPULLA of the fallopian tube

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52
Q

Name 3 things that can increase the risk of an ectopic pregnancy

A

Anything that slows the passage of the agg to the uterus:

  • IVF
  • PID increases the risk (STI)
  • Causes inflammation in the tube → occlusion → increased likelihood of egg implantation in the tube
  • IUCD USE
  • Adhesions
  • Endometriosis
  • Previous surgery on the tubes
  • Previous ectopic pregnancy ^^^
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53
Q

What is a molar pregnancy?

A

Non viable egg implants into the uterus, creates a mass.

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54
Q

What is most common pathology of cervical cancer?

A

Squamous cell carcinoma

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55
Q

What is the prognosis for ovarian cancer?

A

POOR –> Non-specific symptoms

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56
Q

What should you worry about if post-menopausal women present with bleeding?

A

GYNAECOLOGICAL CANCER

  • Endometrial
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57
Q

What is the key differential for ectopic pregnancy, and how would you distinguish?

A

Miscarriage - bleeding would come first here, and then the pain would come second

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58
Q

Name 2 places outside of the uterus that you may find endometriosis

A
  • Pouch of douglas
  • Colon
  • Bladder
  • Lungs
  • CNS
  • Pericardium
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59
Q

How is it thought that endometriosis occurs?

A
  • Retrograde menstruation
  • Dysfunction of immune system
  • lymph / blood spread
  • Metaplasia
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60
Q

How would you treat fibroids?

A
  • TXA
  • Mirena coil - shrinks fiborids and reduces blood loss
  • GnRH can be used to shrink the fibroids before removal

Patients that want to reamin fertile:
- myomectomy

Older patients who dont want childrne:
- Hysterectomy

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61
Q

What is a serious complication of fibroids?

A

Red degeneration - causes pain, uterine tenderness, vomiting, severe pain, fever. Lead to necrosis.

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62
Q

Name 3 causes of miscarriage

A
  • Thrombophillias
  • Infection
  • Chromosomal abnroamlities (why seen in women of increasing age)
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63
Q

What is a threatened miscarriage?

A
  • Cervical os closed
  • Bleeding during pregnancy
  • Pregnancy may still be viable
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64
Q

What is a missed / delayed miscarriage?

A
  • Fetus is dead but retained within the uterus.
  • Uterus is small for dates
  • Picked up on US
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65
Q

What is an incomplete miscarriage?

A

Cervical os open, some of the POC have come out of the vagina.

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66
Q

What is an inevitable miscarriage?

A

Cervical os is open - miscarriage will occur, progress to either complete or incomplete.

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67
Q

What is a complete misscarriage?

A

US, no POC in the uterus.

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68
Q

What is the treatment for miscarriage

medical and non-medical

A

Management:

  • EPAU
  • Counselling

Medical
- MISOPRISTOL (opens the cervix)

Surgical and equipment-

  • Forceps
  • Surgery
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69
Q

List 3 factors associated with miscarriage

A
  • Smoking
  • Maternal age
  • Previous miscarriages
  • Stress/ anxiety
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70
Q

Define primary PPH

A

Severe blood loss < 24 hours of birth

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71
Q

Which test is used to determine ovulation?

A

Mid luteal progesterone 7 days before end of cycle (bleeding)
USUALLY DAY 21.

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72
Q

How does COCP work?

A
  • Small risk of breast and endometrial and cervical cancer
  • Risk of VTE
  • Doesnt protect against STI
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73
Q

What are the most common causes of heavy mesntrual bleeding?

A
  • Ovulatory
  • Coagulation disorders
  • Endometrial dysfunction
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74
Q

What are fibroids?

A

Benign tumours of the MYOMETRIUM

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75
Q

What are polyps?

A

Benign localised growths of the endometrium

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76
Q

Define primary PPH

A

Severe blood loss < 24 hours of birth, > 500mls

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77
Q

Define secondary PPH

A

after 24 hours, > 12 weeks delivery

Can be minor < 500mls or major > 1000mls

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78
Q

What is adenomyosis?

A
  • Endometrium in the myometrium

- LOTS OF PAIN

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79
Q

How do you treat adenomyosis?

A
  • Hysterectomy definitive treatment -
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80
Q

Why do you need to know if the uterus is retroverted or. anterior?

A

Surgery = may damage it with intrsuments that push trhough the wall

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81
Q

List causes of heavy menstrual bleeding

A
  • Hypothyroid
  • Fibroids
  • Polyps
  • Ovarain cyst
  • Endometriosis
  • PID
  • Medications - blood thinners
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82
Q

What is the treatment for fibroids?

A

< 3cm then MIRENA COIL

If a woman wants children:

  • Myomectomy
  • Uterine artery ablation

If a women doesn’t want children, older
- May do hysterectomy if there is loads

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83
Q

What investigations would you do for someone with irregular menstrual bleeding?

A
  • FBC / haemanitics
  • Coagulation
  • TFTs
  • TVUS
  • US abdo and pelvis
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84
Q

What is the first line treatment for heavy menstrual bleeding?

A
  • COCP (if no contraindications)
  • Progesterone only pill
  • Mirena
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85
Q

Why do you need to know if the uterus is retroverted or. anterior?

A

May damage it with intrsuments that push though the wall e.g. surgery, insertion of the coil

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86
Q

What is the first line treatment for heavy menstrual bleeding?

A
  • Mirena
  • COCP (if no contraindications)
  • Progesterone only pill

Women that want to get pregnant soon:

  • TXA
  • Mefanamic
  • Progestins e.g. northisterone

Women that don’t want any more children / are older:

  • Hysterectomy
  • Endometrial ablation
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87
Q

What type of drug is TXA?

A

Antifibrinolytic

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88
Q

What type of drug is mefenamic acid?

A

NSAID

COX inhibitor

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89
Q

Why is Danazol not a mainstay treatment?

A

Can cause male hair growth in women

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90
Q

What would the levels of FSH and LH be like in post-menopausal women?

A

HIGH (no inhibition from oestrogen)

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91
Q

What 3 infections are screened for antenatally?

A

Blood test

HIV, Hep B, Syphillis

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92
Q

What are the risk factors for PPH?

A
  • Macrosomia
  • Multiple pregnancies
  • Infections
  • Shoulder dystocia
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93
Q

How are babies that present in the breech position delivered?

A

Elective C-section

94
Q

What haemoglobinopathies are tested for in pregnancy?

A
  • Sickle Cell

- Thalassemia

95
Q

What happens if a chromosomal abnormality is picked up on NT?

A
  • Amniocentesis
  • CVS
    Test babies cells.
96
Q

What is sepsis 6?

A 
Blood cultures 
Urine output
Fluids
ABx
Lactate
Oxygen
97
Q

List 3 causes of obstretric emergencies (maternal)

A
  • PPH
  • APH
  • Pre-eclampsia
  • VTE / PE
98
Q

What is the treatment for an ectopic pregnancy?

A

METHOTREXATE

If not, can do surgery to remove the tubes, or remove the implantation.

99
Q

List 3 causes of obstretric emergency (fetal)

A
  • Cord prolapse
  • ## Shoulder dystocia
100
Q

How do you interpret a CTG? (7)

A

Dr CBraVADO

DR: Define Risk 
C: Contractions
Bra: Baseline HR
V: Variability
A: Acceleration 
D: Decceleration 
O: Outcome
101
Q

What is the treatment for cord prolapse?

A

CAT 1 C-SECTION

102
Q

What is a braxton hicks contraction?

A

Practice contractions

Remain concentrated towards the front of the abdomen

Not regular and will subside

103
Q

What does a reassuring CTG look like?

A

Reassuring
110-160
> 5
Present

104
Q

What features would you see in an abnormal CTG?

A

Non-reassuring ( 1 FEATURE) or Abnormal (2 FEATURES)

BPM: < 110 or > 160
Variability: < 5
Acceleration: Early deceleration > 90 minutes

105
Q

Diabetes

A

Increased risk of endometrial cancer and PCOS

106
Q

How do you date a baby?

A
  • Start with the LMP - work out when to do the dating scan from there
  • Scan at 12 weeks –> crown rump length
107
Q

What measurements do you need (from mother) to come up with a personalised growth chart for a mothers baby?

A

Height, weight and ethnicity

108
Q

What are indicators for giving aspirin during pregnancy?

75 once per day, from 12 weeks

A

High risk (1+).

  • CKD
  • Preeclampsia
  • Autoimmune disease
  • Type 1/2 diabetes
  • Chronic hypertension

Moderate risk, 2< risk factors:

  • first pregnancy
  • Older women
  • BMI > 35
  • Family history of pre-eclampsia
109
Q

What is gravida?

A

Total number of pregnancies that you have had

110
Q

What is parity?

A

Delieries after > 24 weeks

+ indicates loss before 24 weeks
- indicates loss after 24 weeks
Termination included

111
Q

GBS

A
  • ABx

- Penzylbenicillin

112
Q

What would you class as a preterm baby?

A

< 37 weeks

113
Q

What would you class as a post-term baby?

A

> 42 weeks

114
Q

What is the first stage of labour?

A

4cm - 10cm cervix

Latent and active

115
Q

What is the second stage of labour?

A

Cervix is fully dilated - birth of fetus

116
Q

What are the cardinal movements that a baby makes to get through the pelvic inlet?

A
  1. Decent: Downward movement of the foetus into the pelvic inlet
  2. Engagement
  3. Flexion: foetus pushes its chin against its chest
  4. Internal rotation: shoulders internally rotate so they are in the widest part of the pelvic inlet
  5. Extension: foetal head changes from flexion to extension. Head emerges.
  6. Restitution: head externally rotates so shoulders can pass through the pelvis
  7. Expulsion: anterior shoulder slips under the symphysis pubis and the rest of the body comes out of the vagina
117
Q

What is the third stage of labour?

A

Birth of fetus - placental delivery.

Normally takes 5 minutes (could be longer)

118
Q

What is Bishops score?

A

Determines whether you will need an induction of labour

119
Q

What is a partogram?

A

Key maternal and fetal data during labour.

  • Cervical dilation
  • Fetal heart rate
  • Contractions
  • Whether induction was needed - oxcytocin, how much was needed, when given
  • Any drugs given
  • Urine dips (protein and urine output)
  • Mums vital signs
  • Duration of labour
120
Q

What is a babies normal heart rate?

A

110 -160 BPM

121
Q

How do you usually describe contractions?

A

How many in 10 minutes

3/10 = 3 in 10.

122
Q

What should a normal tocogram show?

A

Variability > 5
Accelerations present
Fetal HR = 110-160BPM
Decelerations

123
Q

Give 5 indications for consultant led care during pregnancy

A

MATERNAL MEDICAL CONDITIONS

  • Coagulation disorders
  • Diabetes
  • Hypertension
  • Epilepsy

LAST PREG PROBS

  • Microsomia
  • C-section
  • Emergency situation
  • Tears
124
Q

When do you need to assess women for risk during pregnancy?

A
  • At the start of pregnancy

- At the start of labour

125
Q

What ways can you monitor the fetus during pregnancy?

A
  • CTG
  • Growth chart
  • Doppler of the placenta
126
Q

What two signs would you see on a CTG that would make you worry about fetal hypoxia?

A
  • Late deccelerations

- Reduced variability

127
Q

What 3 measurements are needed to measure fetal growth?

A
  • Femur length
  • Abdominal length
  • Head circumference
128
Q

What happens to the serum hCG of those with viable pregnancy

A
  • Double in 36-48 hours during the first few weeks
129
Q

What is an ectopic pregnancy?

A

Pregnancy that occurs OUTSIDE the uterus

130
Q

What would you see in the serum hCG levels of someone with an ectopic pregnancy?

A

Levels fall dramatically

< 50% drop from previously level

131
Q

What would you expect to see on a swab contaminated with gonorrhoea?

A

Gram negative diploccoci

132
Q

A pregnant lady comes in in shock. You feel her uterus and it feels ‘woody’ and hard. What do you suspect the diagnosis it?

A

Placental abruption

133
Q

What are the investigations you can do for infertility?

A
  • Serum 21 progesterone
  • Hysterosalpingoscopy
  • Semen analysis
134
Q

What is hyperemesis gravidum associated with?

A

High levels of serum hCG

135
Q

What is the treatment of hyperemesis gravidum?

A
  • IV fluids (normal saline)
  • IV anti-emetics
  • Oral anti-emetics at home, frequently
  • Frequent small meals

OTHERS:

  • THIAMINE
  • LMWH - dehydration and hospitalised, also pregnancy is a hypercoagulable state
136
Q

What is the difference between a partial and complete molar pregnancy?

A

Complete = empty ovum.

Partial = some fetal products. Ovum is fertilised by TWO sperms and therefore

137
Q

What is the origin of the name hydatiform mole?

A

Molar pregnancies characterised by large fluid filled vesicles in the placenta

138
Q

What would you expect to see on the serum hCG of someone with a molar pregnancy?

A

EXCESSIVELY HIGH levels of hCG

139
Q

What is the typical presentatoin on US of a molar pregnancy?

A

SNOW STORM APPEARANCE

140
Q

What might be the cause of hyperemesis gravidum?

A

High levels of serum hCG

141
Q

What is the treatment of hyperemesis gravidum?

A
  • IV fluids (normal saline) +/- K+
  • IV anti-emetics
  • Oral anti-emetics at home, frequently
  • Frequent small meals

OTHERS:

  • THIAMINE (vitamin B1) - can lead to wernickes encepalopathy
  • LMWH - dehydration and hospitalised, also pregnancy is a hypercoagulable state
142
Q

What is the difference between a partial and complete molar pregnancy?

A

Complete = empty ovum.

Partial = some fetal products. Ovum is fertilised by TWO sperms. 69 chromsomes.

143
Q

What is the treatment for a molar pregnancy?

A

Only surgical - empty the uterus.

Chemo offered to all women in whose hCG levels do not fall to a satisfactory level.

144
Q

What are the indications of hyperemesis gravidum (as opposed to normal vomitting)

A
  • Persistent and severe vomiting
  • Fluid and electrolyte disturbance
  • Ketonuria
  • Nutritional deficiency
  • Weight loss.
145
Q

What is your responsibility as a doctor regarding FGM?

A

Must report it in individuals < 18 - police force within 24 hours.

146
Q

List 4 causes of primary ammenhorea

A
  • Turners
  • CAH
  • CAI (complete androgen insensitivity syndrome)
  • Hypothalamic: pituiatary axis - prolactinoma
  • Anatomical
147
Q

List 3 causes of secondary ammenhoroea

A
  • PCOS
  • Weight loss
  • Exessive exercise
148
Q

List 3 causes of heavy periods

A
  • Endometriosis

-

149
Q

What is the name of programmed cell death?

150
Q

What increases the risk of developing endometrial cancer?

A 
UNOPPOSED OESTROGEN (progesterone protected effect on the endomertrium) - oestrogen causes it to grow and grow:
- early menopause
151
Q

Why is obesity linked to problems with periods, infertility, etc?

A

Adipose cell converts androgens to oestrogen, increasing the levels
of oestrogen in the body.

152
Q

An elderly woman presents to the GP with POST-MENOPAUSAL bleeding. What are you thinking?

A

Endometrial cancer

153
Q

What is the main cause of cervical cancer?

A

High risk HPV (16)

154
Q

What are the 7 criteria needed for a screening programme (Wilson and Jugner)

A
  1. important health problem
  2. accepted treatment
  3. facilities for diagnosis and treatment
  4. recognisable latent r early symptomatic stage
  5. suitable test
  6. test acceptable to population
  7. natural history of the disease well understood
155
Q

What is the vaccination used for HPV?

A

Gardasil (covers 6,11,16,18)

dont learn really as they change the vaccines every year

156
Q

What are the two main types of HPV (causing cervical cancer?)

157
Q

Who is at increased risk of HPV?

A
  • Multiple sexual partners
  • Previous STDs
  • Immunosuppression
  • Lack of vaccination
  • Most women come into contact with HPV but the immune system clears the infection within 2 years
  • Smoking → Prevents immune system from clearing HPV infection
158
Q

What is the most common pathology of cervical cancer?

A

SQUAMOUS CELL CARCINOMA (90%)

159
Q

What issues might you need to consider when managing a 25 year old woman with a diagnosis of cervical cancer?

A
  • fertility
  • bowel and bladder
  • impact on life
160
Q

What is the most common form of vulval cancer?

A

Squamous cells

161
Q

Name 3 cancers that can result from HPV

A
  • Cervical
  • Vulval
  • Penile
  • Anal
  • Head
  • Neck
162
Q

What is the most common form of vulval cancer?

A

Squamous cell carcinoma

163
Q

What is the most common type of ovarian cancer?

A

Epithelial cells

164
Q

What things may show a rise in CA125

A
  • Diverticulitis
  • Liver disease
  • Endometriosis
  • Menstruation
  • PID
  • Pregnancy
  • Ovarian cancer
  • Fibroids
165
Q

What 3 things are done as part of the triple breast examination?

A
  • Clinical assessment
  • Imaging (US/MRI)
  • Pathological assessment (core biopsy, FNA)
166
Q

When are women screened for breast cancer in the UK (NHS breast screening programme)?

A

47 - 73

Every 3 years.

167
Q

What are the two most common types of breast cancer?

A
  • Ductal (70%)

- Lobular (10%)

168
Q

What are the 3 receptors related to breast cancer?

A
  • Oestrogen
  • HER2
  • Ki67
169
Q

What is the prognostic index for breast cancer?

A

Nottinghma prognostic index

170
Q

List 3 SE of chemotherapy

A

Alopecia

Mouth ulcers

Tiredness

Nausea and vomitting

171
Q

What is the hormonal first line treatment for breast cancer for:

a) pre-menopsual women
b) post-menopausal women

A

a) tamoxifen
b) aromatase inhibitor

*aromatase - enzyme that converts adrenal and adrogens to oestrogen in the fatty tissue - the only source of oestrogen in postmenopusal women. No effect on the endometrium.

172
Q

What are the most common places for cancer to metastasise?

A
  • Bone
  • Lung
  • Liver
  • Brain
  • Lymph
  • Skin
173
Q

Is breast pain a sign of cancer?

174
Q

What is mastalgia?

A

Breast pain

175
Q

List 4 causes of breast lumps

A
  • Fibroadenoma
  • Cyst
  • Fat Necrosis
  • Malignancy
176
Q

Define thelarce

A

Appearance of breast development in girls

177
Q

Wghat 3 things make up RMI?

A

Menopause age
US findings
CA125 markers

178
Q

When are women invited for cervical screening?

A

Age 25 - 49 every 3 years

50 - 64 every 5 years

179
Q

List two side effects of HRT

A

-Breast tenderness

-

180
Q

What cancer does HRT reduce the risk of?

A

Colorectal

181
Q

List 4 risks associated with HRT

A
  • Increased risk of breast cancer
  • VTE
  • Endometrial cancer with unopposed oestrogen
  • galbladder disease
182
Q

What type of gynaelocigcal cancer is HPNCC associated with?

A

Endometrial

183
Q

What are the most common types of high risk oncongenic subtypes of HPV?

A

16,18,31,33

184
Q

A 62 year old lady presents with IBS like symptoms. What should you be worried aboiut?

A

OVARIAN CANCER

185
Q

What is the marker of CAH

*need to distinguish from PCOS, could be late onset and also presents with hirtuism

A

17 hydroxyprogesterone

186
Q

What would you see on an US of someone with an ovarian tumour?

A

adnexal mass (mass within the uterus, ovary, fallopian tubes) - fixed, nodular, irregular, solid, bilateral, ascites within the abdominal cavity.

187
Q

What are three tests you would do if you suspect a DVT?

A
  • US doppler of the leg
  • D dimer
  • Wells scoring to assess the risk

(bringing this up in gynaey as COCP and pregnancy can increase the risk of a PE)

188
Q

When is a womens most fertile period (menstrual cycle)?

A

5 days before ovulation (sperm can live up to 7 days) and up to 1-2 days after

189
Q

Where are FSH and LH produced from?

A

Anterior pituitary

190
Q

What hormone causes the release of gonadotrpphins (FSH and LH) and where is this released from?

A

GnRH

Hypothalamus

191
Q

What produces bHCG in a woman?

A

The placenta after the ovum has implanted into the endometrium.

192
Q

Define primary ammenhorroea

A

Never had a period > 16 years old.

193
Q

Define secondary ammenhorroea

A

> 6 months without period having previously had one

194
Q

List 4 causes of secondary ammenorrhoea

A
  • Thyrotoxicosis
  • PCOS
  • Hypothalamus causes - increased exercise, loss of weight
  • Prolactinoma
  • Turners
  • Ashermaans
  • Sheehans
  • PREGNANCY = main one!
195
Q

List 5 tests you would do in someone with ammenhorroea

A
  • FSH and LH
  • Prolactin
  • TSH
  • Fasting glucose / lipid ratio - diabetes (PCOS)
196
Q

A woman presents to EPAU with a very large uterus for dates, vomitting profusely and vaginal bleeding. What investigations would you do and what might you find? What do you suspect has happened?

A

Molar pregnancy

bHCG - very high levels (complete)

US - snowstorm appearance

197
Q

What us the NHS breast screening programme?

A

Women aged 47-73 invited every 3 years for a mammogram / US.

198
Q

What is the triple assessment for breast cancer?

A

Imaging
Clinical assessment
Score on biopsy

199
Q

List 4 causes of breast lumps

A
  • Cyst
  • Fibroadenoma
  • Breast cancer
  • Lipoma
  • Fat necrosis
200
Q

What are the three stages of labour?

A
  1. First (latent and active) - cervix dilates fully to 10cm, regular contractions
  2. Second stage = cervix dilated to 10cm - birth of the baby
  3. Third stage = birth of the baby - birth of the placenta.
201
Q

What is Bishops score?

A

Scoring system used to determine if you need any help inducing labour.

> 8 means that the woman is ready for labour.

202
Q

List 3 reasons why a woman might fail to progress during labour

A
  • Fetal malpresentation
  • Uterine contractions not coordinated / strong enough
  • Cervical stenosis
  • Babies head / body too large to fit through the birth canal - cephalopelvic disproportion
203
Q

Give 3 non-pharmalogical methods of pain releif that can be used during labour

A

Water immersion

Aromatherapy

Massage

Hypnobirthing

204
Q

What methods can be used to induce labour?

A
  • Membrane Sweep
  • AROM
  • Oxcytocin
  • Misopristol (prostaglandin - used for miscarriage / abortion)
205
Q

What is the name of the medication used to suppress labour?

A

Tocolytics
(premature birth - delay so that the fetal lungs can mature)
Usually prospone pregnancy by around 2 days - enough time to allow the administration of steroids that will help the babies lungs mature.

206
Q

What are braxton hicks contractions?

A

Practice contractions, helps to prepare the uterus for labour. Irregular.

Not all pregnant mothers feel them

207
Q

After doing a CTG for 30 minutes you notice that there has been no accelerations. What should you do?

A

In order to find out whether there is a pathological cause for this you must continue doing the CTG - babies can be resting for > 40 minutes and so it may be that this is completely normal.

208
Q

What vitamin should women avoid in pregnancy?

209
Q

What diseases are tested for during the first antenatal booking appointment?

A
  • Hep b
  • HIV
  • Syphillis
  • Rubella
210
Q

How does clomifene work?

A

Blocks oestrogen receptors in the pituitary and hypothalamus

211
Q

What is a good marker of preterm delivery?

A

Fetal fibrinectin - glue that sticks the placenta to the uterus, high levels indicate a preterm delivery.

212
Q

What medication changes should diabetic women make during pregnancy?

A
  • Add folic acid
  • Increase insulin dose as hey are at risk of hypoglycaemia
  • Add metformin if not on this previously
  • Take away all other hypoglcyaemic agents instead of insulin (including AceI, ARBs, etc)
  • Statins need to be stopped
  • Swap antihypertensives for labetalol, as this has proven safe in pregnancy
  • Add aspirin - due to hypertension and therefore potential risk of preeclampsia ?
213
Q

List 3 pregnancy complications and 3 fetal complications that may result from uncontrolled diabetes during pregnancy

A

Pregnancy:

  • Polyhydramnios
  • Infection
  • Abortion and prematurity
  • Preeclampsia
  • C-section delivery

Fetal complications:

  • Macrosomia - SHOULDER DSYTOCIA?
  • Congenital malformation - neural tube or heart defect
  • Neonatal hypoglycaemia - may need to give them dextrose when they are born
  • RDS
  • Still birth
214
Q

What happens when a baby has IUGR in utero?

A
  • Serial growth scans (fortnightly)

- Weekly scans to measure doppler flow (blood flow tp the placenta) and the amniotic fluid volume.

215
Q

What are the risks associated with IUGR?

A

Impaired development in pregnancy

Intrauterine death

Distress in labour

Oxygen deprivation in labour (asphyxia)

Meconium aspiration during the birth

Low blood sugar after birth and consequent complications

216
Q

How would you be able to tell between mastititis / breast abcess and inflammatory breast cancer?

A

Hard as they can present veyr similarly.

With an abcess, would usually feel a lump whhereas in many cases of inflammatory breast cance rthis is not the case - there is diffuse swelling and inflammation.

Mastitis tends to occur around breast feeding - staph aureus invades the skin.

217
Q

What is the first line method of induction in women past due by date?

A

Prostaglandins

218
Q

What are the 5 assessment criteria on Bishops scoring?

A
  • Effacement
  • Position
  • Dilation
  • Consistency
  • Fetal station (where it is in relation to ischial spine)
219
Q

Why would you want to induce a woman that has gone past term - what are the complications?

A

BABY:

  • IUGR (placenta begins to move away from the wall)
  • Macrosomia (baby continues to grow)
  • Meconium aspiration

MOTHER:

  • C-section
  • Instrumental delivery
  • PPH
  • Tears
220
Q

How often do women having had a cervical smear test?

A

Also known as repeat recall

3 years 25 -49
5 years 50 - 64

221
Q

What happens if your results come back positive for HPV on cervical smear?

A

Cytology

If cells normal on this, then you will be reviewed in 12 months.

If positive - go on for firther Ix and explore treatment.

222
Q

What happens if your sample is inadequate om cervical smear?

A

Repeat the sample in 3 months.

If this happens twice, need to do colposcopy

223
Q

What is fitz-hugh curtis syndrome?

A
  • Rare complication of PID
  • Liver capsule inflammation, leading to hepatic adhesions
  • Always keep on the lookout in exams - RUQ pain aggrevated by breathing / laughing
224
Q

What do variable cord compressions suggest (CTG)?

A

Cord compression

225
Q

What AB would you give a woman with PPROM?

A

Erythromycin

226
Q

How would you treat a woman with PPROM?

A
  • Admit
  • Give AB (erythromycin)
  • Give steroids (foetal lungs)
  • Get her to give birth by 34 weeks (before then increased complicatiosn of baby)
227
Q

What is mcroberts manoeuvre?

A
  • Flex

- Abduction

228
Q

What are the complications of diabetes during pregnancy?

A

SMASH

  • Shoulder dystocia
  • Macrosomia
  • Amniotic fluid excess
  • Stillbirth
  • Hypertension / hypoglycaemia baby
229
Q

What are the causes of small for gestational age babies?

A

SWAN

  • Starved small
  • Wrong small
  • Abnormal small
  • Normal small
230
Q

What are the risks associated with COCP?

A
  • Increased risk of breast and cervical cancer (but less likely to use barrier contraception?)
  • Increased risk of VTE, stroke, ischemic heart disease
231
Q

What is a side effect of the depot injection?

A

Weight gain

232
Q

What is the treatment for heavy menstrual bleeding?

A

Contraception: Mirena, COCP

No contraception: TXA or NSAIDs

Phase 3A (17 decks)

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