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AKT > Gynaecology & Breast > Flashcards

Gynaecology & Breast Flashcards

1
Q

What proportion of women aged 30-49 present to their GP each year for help with heavy menstrual bleeding or menstrual problems?

A

1 in 20

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2
Q

What one investigation is indicated for all women complaining of heavy menstrual bleeding?

A

FBC

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3
Q

When are TFTs recommended to be checked in a woman with heavy menstrual bleeding?

A

If there are additional signs and symptoms of thyroid disease

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4
Q

When is a coagulation profile recommended to be checked in a woman with heavy menstrual bleeding?

A

If the problem is lifelong or there is family hx of bleeding disorder

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5
Q

When might an ultrasound scan be recommended in a woman with heavy menstrual bleeding?

A

If there are symtpoms/signs of uterine enlargement e.g. pressure symptoms affecting bladder

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6
Q

If an ultrasound is requested for heavy menstrual bleeding, which method of ultrasound is preferred?

A

Trans-vaginal

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7
Q

When is hysteroscopy recommended for investigation of heavy menstrual bleeding?

A

With a history of intermenstrual bleeding to check for fibroids/polyps

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8
Q

What are the potential iatrogenic causes of heavy menstrual bleeding?

A

-Anticoagulants
-Copper IUD

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9
Q

What is the PALM-COEIN classification system?

A

Classification system for causes of abnormal uterine bleeding

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10
Q

What are the structural causes of abnormal uterine bleeding as per PALM-COEIN classification?

A

Polyp
Adenomyosis
Leiomyoma
Malignancy and hyperplasia

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11
Q

What are the non-structural causes of abnormal uterine bleeding as per PALM-COEIN classification?

A

Coagulopathy
Ovulatory dysfunction
Endometrial
Iatrogenic
Not yet classified

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12
Q

What non-hormonal methods can be used to managed heavy menstrual bleeding?

A

Tranexamic acid
NSAIDs

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13
Q

What hormonal methods can be used to managed heavy menstrual bleeding?

A

-Levonorgestrel-releasing IUS
-Combined hormonal contraception
-Long-cycle progestogens (oral or depot)

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14
Q

What method of treatment for heavy menstrual bleeding causes the largest decrease in menstrual blood flow?

A

Levonorgestrel-releasing IUS - up to 96% reduction

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15
Q

If methods in primary care do not work to manage heavy menstrual bleeding, or are not suited to the patient, what can the patient be referred for?

A

Endometrial ablation

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16
Q

What are the 2 main benefits of endometrial ablation for heavy menstrual bleeding?

A

-Highly effective & minimally invasive

-Quick recovery post procedure

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17
Q

Can endometrial ablation be reversed?

A

No

18
Q

Is amenorrhoea guaranteed after endometrial ablation?

A

No - depends on the technique used

19
Q

What does the patient need to be informed regarding pregnancy after endometrial ablation?

A

High risk for miscarriage and placenta accreta

20
Q

When does endometrial hyperplasia occur?

A

When oestrogen stimulates endometrial cell growth unopposed by progesterone

21
Q

Is endometrial hyperplasia a pre-malignant condition?

A

Yes

22
Q

Why is the occurrence of endometrial cancer increasing?

A

Due to increasing rates of obesity

23
Q

What is the biggest preventable risk factor for endometrial cancer?

A

Obesity

24
Q

What is a leiomyoma?

A

A fibroid - tumours of the myometrium

25
Q

What percentage of women are affected by fibroids by the time of menopause?

A

70-80%

26
Q

Which ethnic group are fibroids most common in?

A

African and Caribbean groups

27
Q

What are the 4 types of fibroid?

A

Subserosal
Intramural
Pedunculated
Submucosal

28
Q

Where do subserosal fibroids sit?

A

Arise from myometrium but extend into serosal surface

29
Q

Where do intramural fibroids sit?

A

Within the myometrium

30
Q

Which types of fibroid are usually asymptomatic?

A

Intramural and subserosal - unless they’re huge or lots of them

31
Q

Where do pedunculated fibroids sit?

A

Connected by a stalk to myometrium

32
Q

What symptoms can a pedunculated fibroid cause?

A

Pressure symptoms
Acute pain from torsion

33
Q

Which type of fibroid is most likely to cause abnormal uterine bleeding?

A

Submucosal

34
Q

Where do submucosal fibroids sit?

A

In the endometrium

35
Q

Which type of fibroid is most likely to cause fertility problems?

A

Submucosal

36
Q

How is HMB caused by a fibroid <3cm diameter best managed?

A

LNG-IUS or medical management

37
Q

How is HMB caused by a fibroid >3cm diameter best managed?

A

In seoncdary care with recetion, morcellation, uterine artery embolisation or ulipristal acetate

38
Q

Why does ulipristal acetate require initiation by secondary care?

A

Causes hepatotoxicity

39
Q

What needs to be done before ulipristal acetate can be commenced for HMB?

A

Liver function tests

40
Q
A

AKT (22 decks)

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