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Med School Finals > Gynaecology & Breast > Flashcards

Gynaecology & Breast Flashcards

1
Q

Features and management of a breast fibroadenoma?

A

Highly mobile (“breast mouse”)
Firm, smooth, non tender
< 3cm = watch and monitor
> 3cm = surgical excision

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2
Q

Mammogram feature of breast cysts and radial scar?

A

Breast cyst = halo appearance
Radial scar = stellate pattern

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3
Q

Breast conditions associated with thick green discharge, bloody discharge, lumpy breasts, eczematous nipple, trauma and obesity?

A

Thick green discharge = duct ectasia
Bloody discharge = duct papilloma, carcinoma
Lumpy breasts = fibrocystic disease
Eczematous nipple = Paget’s disease of the breast
Trauma/obesity = fat necrosis

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4
Q

Features and management of lactational mastitis?

A

Red, hot and tender breast
1st line = continue breastfeeding/expressing
2nd line = continue breastfeeding/expressing + oral flucloxacillin

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5
Q

Risk factor for breast abscess, common pathogen and management?

A

Untreated mastitis
Staphylococcus aureus
Management = antibiotics + aspiration

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6
Q

Tender breast lump in women who recently stopped breastfeeding?

A

Galactocele

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7
Q

Most common type of breast cancer?

A

Invasive ductal carcinoma

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8
Q

Outline the NHS Breast Screening Programme.

A

Mammogram every 3 years for women 50-70
N.B. over 70s are still eligible but must self-refer

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9
Q

Risk factors for breast cancer?

A

BRCA1/BRCA2
p53 gene mutation
1st degree pre-menopausal relative
Nulliparity or first child when > 30 years
Early menarche
Late menopause
Obesity
CHRT and COCP
Not breastfeeding

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10
Q

Criteria for urgent breast cancer referral (2 week pathway)?

A

Skin changes suggestive of cancer
≥ 30 with unexplained breast or axillary lump
≥ 50 with unilateral nipple symptoms

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11
Q

Management of patients < 30 years with an unexplained breast lump?

A

Non-urgent referral to breast assessment clinic

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12
Q

Triple assessment provided by breast assessment clinic?

A

Physical exam
Imaging (US/mammogram)
Biopsy (core/FNAC)

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13
Q

Receptors tested for in breast cancer and targeted treatment?

A

Progesterone (PR)
Oestrogen (ER) = tamoxifen (pre- and peri-menopausal), anastrozole (post-menopausal)
HER2 = traztuzumab (herceptin)

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14
Q

Drug class and side effects of tamoxifen, anastrozole and herceptin?

A

Tamoxifen (oestrogen receptor antagonist) = increased risk of endometrial cancer, VTE, menopausal symptoms
Anastrozole (aromatase inhibitor) = osteoporosis
Herceptin (monoclonal antibody) = cardiac disease

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15
Q

Axillary lymphadenopathy guidance for breast cancer surgery?

A

None = axillary US +/- biopsy
Lymphadenopathy = axillary node clearance during primary surgery

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16
Q

Complications of axillary node clearance?

A

Lymphoedema
Brachial plexus injury

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17
Q

Types of contraception?

A

Barrier method
→ condom
Daily method
→ COCP, POP
Long-acting methods (LARCs)
→ implantable, injectable or intrauterine

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18
Q

Mechanism of action, benefits and risks of the COCP?

A

Inhibits ovulation
Benefits = highly effective, makes periods lighter/less frequent, reduces risk of ovarian/endometrial cancer
Risks = increased risk of VTE and breast/cervical cancer

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19
Q

Guidance on taking the COCP?

A
  • If started within first 5 days of cycle, no need for additional contraception
  • If not started within first 5 days of cycle, additional contraception for 7 days
  • If 1 pill missed, take it alongside regular daily pill
  • If 2 or more pills missed, take the last one alongside daily regular pill and use condoms or abstain for sex for 7 days
  • Emergency contraception may be required if 2 or more pills are missed during the first week of the cycle
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20
Q

How is the COCP taken?

A

21 days on, 7 days off
3 packets consecutively, 7 days off
Continuously with no break

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21
Q

List some contraindications to the COCP?

A

Age > 35 smoking > 15/day
Breastfeeding < 6 weeks post-partum
CVD e.g. hypertension
Immobility
BRCA +ve
Migraine with aura
Antiphospholipid antibody +ve

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22
Q

Mechanism of action of the POP?

A

Thickens cervical mucus

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23
Q

Guidance on taking the POP?

A
  • If started within first 5 days of cycle, no need for additional contraception
  • If not started within first 5 days of cycle, additional contraception for 2 days
  • If pill missed < 3 hours ago, continue as normal
  • If pill missed > 3 hours ago, take the last one alongside regular daily pill and use condoms or abstain from sex for 2 days
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24
Q

How is the POP taken?

A

Continuously with no pill break

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25
Q

Options for emergency contraception?

A

“Morning after” pill
→ levonorgestrel (Levonelle) or ulipristal (EllaOne)
Intrauterine device (IUD)
N.B. both pills are ineffective if ovulation has occured

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26
Q

Timescales of emergency contraception?

A

Levonorgestrel = within 3 days of UPSI
Ulipristal = within 5 days of UPSI
IUD = within 5 days of UPSI or within 5 days after ovulation

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27
Q

Side effects of emergency contraception?

A

Pills = nausea and vomiting, delayed or early menses
IUD = infection, expulsion, heavy bleeding, perforation

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28
Q

Commencing contraception after levonorgestrel vs ulipristal?

A

Levonorgestrel = can be started immediately
Ulipristal = can be started after 5 days

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29
Q

Most effective type of contraception?

A

Implantable e.g. Nexplanon

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30
Q

Nexplanon mechanism of action?

A

Inhibits ovulation and thickens cervical mucus

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31
Q

Guidance on using Nexplanon and duration of effectiveness?

A
  • If inserted more than 5 days into menstrual cycle, additional contraception needed for 7 days
  • Lasts for 3 years
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32
Q

Depo Provera mechanism of action and main side effects?

A

Inhibits ovulation and thickens cervical mucus
Main side effects = irregular bleeding, weight gain, takes up to a year for fertility to return

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33
Q

How is Depo Provera given?

A

IM every 12 weeks (up to 14 without need for additional contraception)

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34
Q

Most effective method of emergency contraception?

A

Intrauterine device (IUD)
a.k.a copper coil

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35
Q

Mechanism of action of IUD vs IUS?

A

IUD = decreases sperm motility and survival
IUS = inhibits endometrial proliferation

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36
Q

Guidance on the IUD (copper coil) start and duration of effectiveness?

A
  • Immediately effective
  • Lasts for 5-10 years
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37
Q

Guidance on the IUS (Mirena coil) start and duration of effectiveness?

A
  • Effective after 7 days
  • Lasts 4 years (if on oestrogen only HRT) or 5 years
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38
Q

Complications of IUD/IUS insertion?

A
  • Dysmenorrhoea, amenorrhoea
  • Increased risk of PID within first 20 days
  • 1 in 20 risk of expulsion
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39
Q

Only contraception options for PMH or FH of breast cancer or BRCA mutation?

A

Barrier e.g. condom
Copper coil

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40
Q

Options for starting postpartum contraception?

A

POP = immediately
COCP = after 21 days
IUD/IUS = within 48 hours or after 4 weeks
N.B. if commenced after 21 days postpartum, additional contraception required for 7 days (COCP/IUS) or 2 days (POP)

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41
Q

Amenorrhoea vs dysmenorrhoea vs oligomenorrhoea?

A

Amenorrhoea = absent periods
Dysmenorrhoea = painful periods
Oligomenorrhoea = irregular periods

42
Q

Primary vs secondary amenorrhoea and most common causes?

A

Primary = no period by age 15
→ gonadal dysgenesis e.g. Turner’s
Secondary = absence of periods in women who have previously menstruated
→ pregnancy

43
Q

Investigations for amenorrhoea?

A

bHCG
Gonadotrophins (LH/FSH)
Prolactin
Androgens
Oestradiol

44
Q

Primary vs secondary dysmenorrhoea?

A

Primary = no underlying pathology
Secondary = pathological e.g. endometriosis

45
Q

Management of primary dysmenorrhoea?

A

1st line = NSAID e.g. mefenamic acid
2nd line = COCP

46
Q

Most common cause of menorrhagia?

A

Dysfunctional uterine bleeding (DUB)

47
Q

Management of menorrhagia?

A

1st line = IUS (Mirena)
2nd line = NSAID, COCP

48
Q

Features, investigation and management of endometriosis?

A

Chronic pelvic pain
Dysmenorrhoea
Deep dyspareunia
Painful bowel movements
Investigation = laparoscopy
Management = NSAID/paracetamol (1st line), contraception (2nd line), GnRH analogue or surgery (3rd line)

49
Q

Features, investigations and management of PCOS?

A

Oligomenorrhea
Ameonorrhoea
Fertility issues
Hirsutism
Obesity
Investigations = TVUS, LH/FSH, androgens, prolactin
Management = weight loss, COCP

50
Q

Biochemical features of PCOS?

A

Raised LH:FSH
Raised androgens
Raised prolactin
Raised insulin

51
Q

Drug options for ovulation induction?

A

1st line = letrozole
2nd line = clomiphene citrate
3rd line = pulsatile GnRH therapy

52
Q

Rotterdam criteria for PCOS?

A

Need 2 out of these 3:
→ irregular or no menstruation
→ hyperandrogenism e.g. hirsutism, acne
→ ≥ 12 follicles in one or both ovaries

53
Q

Management of uterine fibroids?

A

Asymptomatic = monitor
Symptomatic = contraception, GnRH analogue before surgery e.g. myomectomy

54
Q

Antenatal complication of uterine fibroids, features and management?

A

Red degeneration
Features = low-grade fever, pain, N&V
Management = self-resolving

55
Q

Features, investigation and management of ovarian cancer?

A

Abdominal distension
Early satiety
Urinary symptoms
Diarrhoea
Investigation = CA125, USS, CT
Management = surgery + chemotherapy

56
Q

Feature, investigations and management of endometrial cancer?

A

Postmenopausal bleeding
Investigation = TVUS +/- hysteroscopy with biopsy
Management = hysterectomy with bilateral salpingo-oophorectomy +/- chemotherapy, radiotherapy

57
Q

Normal endometrial thickness?

A

< 5mm

58
Q

Management of endometrial hyperplasia?

A

No atypical cells = mirena coil
Atypical cells = hysterectomy

59
Q

List causes of PMB?

A

Vaginal atrophy
HRT
Endometrial hyperplasia
Endometrial cancer
Other gynae cancers

60
Q

Features, investigations and management of menopause?

A

Changes in periods
Hot flushes, night sweats
Vaginal dryness, atrophy
Urinary frequency
Anxiety, depression
Memory problems
Investigations = FSH (raised)
Management = lifestyle changes, HRT, SSRIs, topical oestrogen

61
Q

Which hormone “protects” the endometrium and clinical implication?

A

Progestogen
Women with a uterus must have progestogen in their HRT treatment

62
Q

Which type of HRT to give?

A

Oestrogen = oral, transdermal or topical
Progestogen = oral, transdermal or IUS
Combined (both of above) = cyclical (perimenopausal) or continuous (postmenopasual)

63
Q

Risks associated with HRT?

A

VTE (not transdermal)
Stroke
Breast cancer
Ovarian cancer

64
Q

Features, investigation and management of ovarian torsion?

A

Sudden colicky abdo pain
Low-grade fever, N&V
Adnexal tenderness
Investigation = abdominal USS
Management = laparoscopy

65
Q

USS feature of ovarian torsion?

A

“Whirlpool” sign

66
Q

Most common identifiable cause of postcoital bleeding?

A

Cervical ectropion

67
Q

What is cervical ectropion and management?

A

Increased area of columnar epithelium present on the endocervix
Management = ablation (only if symptomatic)

68
Q

Features and management of adenomyosis?

A

Dysmenorrhoea
Menorrhagia
Enlarged, boggy uterus
Management = symptomatic e.g. TXA

69
Q

HPV serotypes associated with cervical cancer?

A

16, 18 and 33

70
Q

Features, investigation and management of cervical cancer?

A

Vaginal bleeding
Suprapubic pain
Urinary symptoms
Investigation = colposcopy
Management = hysterectomy +/- lymph node clearance, radiotherapy, chemotherapy

71
Q

Cervical screening in Scotland?

A
  • Offered every 5 years for women aged 25-64
  • Smear taken and tested for HPV
  • Cytology only if HPV +ve
  • Colposcopy if abnormal cytology
72
Q

Screening of HPV -ve vs HPV +ve but cytology -ve vs cytology +ve?

A

HPV -ve = routine recall in 5 years
HPV +ve and cytology -ve = repeat cytology in 12 months
Cytology +ve = colposcopy

73
Q

Screening of inadequate cervical sample?

A

Repeat within 3 months
If inadequate again = colposcopy

74
Q

Management of cervical intra-epithelial neoplasia (CIN)?

A

Large loop excision of transformation zone (LLETZ) or cone biopsy

75
Q

Screening of woman with PMH of CIN1, CIN2 or CIN3?

A

Cervical sample 6 months post-treatment

76
Q

Investigations for infertility?

A

Men = semen analysis
Women = serum progestogen (day 21)

77
Q

Serum progestogen level which indicates ovulation?

A

> 30nmol/l

78
Q

Types of anovulatory disorders and main causes?

A

Class I (hypogonadotropic hypogonadal anovulation) = hypothalmic dysfunction
Class II (normogonadotropic normoestrogenic anovulation) = PCOS
Class III (hypergonadotropic hypoestrogenic anovulation) = premature ovarian failure

79
Q

Features of OHSS?

A

Hypovolaemia
Tense ascites
Thromboembolism
Renal failure

80
Q

Investigations for everyone attending a sexual health clinic, regardless of presentation?

A

Chlamydia (NAAT)
Gonorrhoea (NAAT, microscopy)
HIV (blood sample)
Syphilis (blood sample)

81
Q

Types of GUM swabs and what they are used for?

A

Charcoal swabs (high-vaginal or endocervical)
→ microscopy, culture and sensitivities
NAAT swabs (endocervical or vulvovaginal)
→ detecting gonorrohoea and chlamydia

82
Q

Where is a vulvovaginal vs endocervical vs high-vaginal swab taken from?

A

Vulvovaginal = 5cm inside vaginal canal
Endocervical = cervical os
High-vaginal = posterior fornix

83
Q

Features and management of chlamydia?

A

Women = discharge, bleeding, dysuria
Men = discharge, dysuria
Management = oral doxycycline (1st line), oral azithromycin (2nd line)

84
Q

Investigation for chlamydia?

A

NAAT:
→ vulvovaginal swab for women
→ first void urine sample for men

85
Q

Features and management of gonorrhoea?

A

Women = discharge, dysuria
Men = discharge, dysuria
Management = IM ceftriaxone

86
Q

Investigation for gonorrhoea?

A

NAAT:
→ vulvovaginal swab for women
→ first void urine sample for men
Charcoal swab for microscopy

87
Q

Features and management of trichomonas?

A

Yellow/green, frothy discharge
Inflamed vulva
Strawberry cervix
Vaginal pH > 4.5
Management = oral metronidazole

88
Q

Main organism associated with BV?

A

Gardnerella vaginalis

89
Q

Features and management of BV?

A

Fishy, white discharge
Clue cells
Vaginal pH > 4.5
Management = none (asymptomatic), oral metronidazole (symptomatic)

90
Q

Features of primary vs secondary vs tertiary syphilis and management?

A

Primary = painless chancre, local non-tender lymphadenopathy
Secondary = fevers, rash, buccal ulcers
Tertiary = aortic aneurysms, granulomatous lesions, neurosyphilis
Management = IM benzathine penacillin

91
Q

Cause, investigation and management of genital warts?

A

HPV 6 and HPV 11
Investigation = clinical diagnosis
Management = none, podophyllum, imiquimod, cryotherapy

92
Q

Cause, investigation and management of genital herpes?

A

HSV-1 and HSV-2
Investigation = clinical diagnosis or swab base of ulcer
Management = oral aciclovir

93
Q

Features and management of thrush?

A

Cottage cheese discharge
Dyspareunia
Vaginal itch
Inflamed vulva
Management = oral fluconazole (1st line), clotrimazole pessary (2nd line)

94
Q

Features and management of PID?

A

Lower abdo pain
Deep dyspareunia
Fever, N&V
Discharge
Period changes
Management = IM ceftriaxone + oral ofloxacin or metronidazole + oral doxycycline

95
Q

Fitz-Hugh-Curtis syndrome?

A

Inflammation of the liver capsule (perihepatitis) typically secondary to an STI or PID

96
Q

Features, investigation and management of HIV seroconversion?

A

3-12 weeks post-exposure
Sore throat
Lymphadenopathy
Malaise, myalgia
Maculopapular rash
Investigation = HIV p24 antigen + HIV antibody
Management = ART (combination of at least 3 drugs)

97
Q

When should an asymptomatic patient be screened for HIV?

A

4 weeks post-exposure
Offer 12 week re-test if -ve

98
Q

Additional care offered to HIV patients?

A

PCP (co-trimoxazole)
Annual cervical smear

99
Q

Monitoring of HIV and target values?

A

CD4 count = > 500
Viral load = undetectable

100
Q

HIV prevention during birth?

A

Maternal viral load < 50 = normal delivery
Maternal viral load > 50 = C-section
Prophylactic zidovudine for babies after birth

Med School Finals (18 decks)

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