19: PMB

Question 1

History for PMB

Answer 1

• Bleeding history - LMP, amount, frequency, trauma (e.g. PCB), on hormone replacement or hysterectomy
• Pain
• Associated symptoms: bowel and bladder, vaginal itch, dryness
• Constitutional sx: weight loss, lethargy, fevers, night sweats
• Obs: parity, breast feeding
• Gynae: fibroids, PCOS, smears, pelvic surgery, sexual activity
• General: coagulation disorders, medication, personal hx breast cancer
• FHx: breast, bowel, ovarian
• Shx: smoking, drugs alcohol

Question 2

Common causes of PMB

Answer 2

• Uterus: endometrial hyperplasia, endometrial cancer, fibroids
• Cervix: ectropion, cervical cancer, polyp
• Vagina: atrophic vaginitis, STI
• Systemic: anticogulant, exogenous oestrogen

Question 3

Endometrial biopsy is indicated if >= ___mm or ____

Answer 3

5mm or persistent symptoms

Question 4

Imaging for PMB

Answer 4

• TVUSS + endometrial thickness

Question 5

What is the most common gynae cancer in NZ?

Answer 5

Endometrial

Question 6

Risk factors for endometrial cancer

Answer 6

Demographic: Maori and pacific
Obs: nulliparity, no breast feeding
Gynae: PCOS, early menarche, late menopause
PMHx: tamoxifen, diabetes, BMI ++
FHx: endometrial, bowel, bladder
SHx: smoking, alcohol drugs

Question 7

Tx for endometrial cancer

Answer 7

1. Hysterectomy (if confined to uterus) and bilateral salpingo-oophorectomy
2. Adjuvant therapy based on risk of recurrence