23/03 Flashcards

Question

IOTA rules

Answer 1

When the rules can be applied (~75% of masses), there is a sensitivity of ~90% and a specificity of ~95%, which is similar to subjective expert evaluation. If one or more M features are present in absence of B feature(s), the mass is classified as malignant If one or more B features are present in absence of M feature(s), the mass is classified as benign If both M features and B features are present, or if no B or M features are present, the result is inconclusive and a second stage test is recommended

Answer 2

Grapes - like wine Glass of the theca lutein pls Luteinized follicle cysts that form as a result of overstimulation in elevated human chorionic gonadotropin (hCG) levels Occur in pregnant women, women with GTD, multiple gestation, ovarian hyperstimulation Almost always bilateral

Answer 3

Epithelial cell benign tumours Mucinous cystadenomas tend to be larger than serous cystadenomas Mucinous - multilocular with numerous thin septations Serous - usually appear as large unilocular anechoic cyst Diameter 10 cm on average

Answer 4

Ovarian dermoid cyst = purely ectodermal in origin, so contains dermal and epidermal elements (hence the name) Ovarian mature cystic teratoma = tissue can arise from any of the three germ cell layers (mesoderm, endoderm and ectoderm). Normally 2 of the 3 are seen.

Answer 5

Low oestrogen Low FSH Low LH Normal/ low LH:FSH ratio Normal testosterone

Answer 6

Elevated prostaglandin F2 alpha (PGF2 α) and E2 (PGE2) levels in the secretory endometrium Results in uterine hypercontractility, therefore severe cramping During menses, these contractions decrease uterine blood flow and cause ischemia and sensitization of pain fibers

Answer 7

>> Suppress ovulation and endometrial proliferation >> Progestin component also blocks the production of the precursor to prostaglandin formation >> Thinned endometrium then contains less arachidonic acid (precursor to prostaglandins) >> Less uterine contractility and resultant pain with menses

Answer 8

DEPTH OF AT least 2.5 mm from the basalis layer of the endometrium The presence of endometrial glands and stroma in the myometrium defines adenomyosis

Answer 9

Asymmetrically enlarged, globular uterus Posterior wall is usually involved more than the anterior wall Irregular endometrial–myometrial junction, tiny (1-5 mm) anechoic myometrial and subendometrial cysts (specific sign) - reflecting glands filled with fluid Prostaglandin level in endometriosis implants is significantly higher than in normal tissue

Answer 10

Aromatase inhibitors (anastrozole, letrozole, exemestane) Inhibits conversion of androgens into estrogens by aromatase Aromatase enzymes available in ovary, adipose tissue, liver, muscle, brain, skin, bone, endometrium, and breast tissue Endometriosis (oestrogen-dependent disease) - refractory to other medical options Indications: Endometrial Ca Infertility/ovulation induction Hormone-dependent breast cancer (post-menopausal) CI Susceptibility to osteoporosis SE Menopausal sx Alopecia; arthralgia; bone fracture; depression; hot flush; hypercholesterolaemia; hypertension; malaise; myalgia; osteoporosis; vaginal haemorrhage

Answer 11

Acute intermittent porphyria is a rare disorder characterised by acute attacks often precipitated by drugs. Estrogen and progestogen have been implicated. Combined hormonal contraception is shown to reduce attacks for some women. Natural fluctuations in estrogen and progesterone appear to be associated with acute attacks more often than exogenous hormones. Only in UKMEC for EC UKMEC 1 Cu-IUD 2 for both PO options

Answer 12

Reduces testosterone level by direct inhibition of 17α-hydroxylase enzyme. Also inhibits 5α-reductase, which is the enzyme that converts testosterone to the more potent DHT hormone. Indications: Anti-androgens could be considered to treat hirsutism in women with PCOS, if there is a suboptimal response after a minimum of six months of COCP and/or cosmetic therapy Cautions Also aldosterone antagonist (antimineralocorticoid) disrupting the sodium/potassium balance Hyperkalaemia risk SE AKI Chronic use - metabolic acidosis (aldosterone antagonist)

Answer 13

Mechanism of action Insulin sensitiser Inhibits production of hepatic glucose, decreases lipid synthesis, increases fatty acid oxidation and inhibits gluconeogenesis - decreased circulating insulin and glucose Enhances insulin sensitivity at the cellular level and also appears to have direct effects within the ovary Indications Considered in adults with PCOS and a BMI for anthropometric, and metabolic outcomes including insulin resistance, glucose, and lipid profiles (off-label use) Reduces serum androgen levels, improves insulin sensitivity, restores menstrual cyclicity, and triggering ovulation SE Nausea, vomiting, abdominal pain, diarrhoea, dizziness and unusual tiredness

Answer 14

case control Starting point = outcome - go back to look at exposures. start by collecting cases (e.g. rare disease) - with the outcome then look back at exposure. Find RF Adv: rare, correlation, cheap, quick Disadv: confounding (cant say causation) contrOl O for odds O for outcome (start with outcome) cohort Start with exposure (RF) and follow over time see what outcomes come Adv: rare exposures, multiple outcomes of interest, ethical Dis: time and cost, stronger than c-c CohoRt R for Risk R for RF/ exposure start with

Answer 15

True Positives (TP) = Sensitivity * Prevalence * Total Population True Negatives (TN) = Specificity * Prevalence * Total Population

Answer 16

If you have prev, spec and sens (1) Work out TP from (make up total pop) Sensitivity * Prevalence * Total Population (2) Work out TN from Sensitivity * Prevalence * Total Population (use above made up total pop) (3) Work out FP Prevalence - (Prevalence * Total Population) - TN (4) Work out PPV (TP +FP) / TP

Answer 17

(i) First-degree relative age <45 years 3 (ii) First-degree relative age ≥45 years 2

Answer 18

Only CHC when goes from 4 to 3 Rest of PO methods are 2 for both

Answer 19

Only really matters in CHC methods <35 all UKMEC 2 >= 35 (i) <15 cigarettes/day 3 (ii) ≥15 cigarettes/day 4 (iii) Stopped smoking <1 year 3 (iv) Stopped smoking ≥1 year 2

Answer 20

Total LNG content Initial release rate/day End of license release rate/day 52 mg 20 mcg 8.6-9 mcg 19.5 mg 17.5 mcg 7.4 mcg after 5yr 13.5 mg 14 mcg (for the first 24 days) 5 mcg after 3 years

Answer 21

Oestrogen may reduce thyroid levels by increasing thyroid binding globulin and increasing thyroxine requirements. Thyroid levels should be checked within 6 weeks of initiating combined hormonal contraception.