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Med School Finals > Gynaecology & Breast > Flashcards

Gynaecology & Breast Flashcards

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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
Options for emergency contraception?
"Morning after" pill → levonorgestrel (Levonelle) or ulipristal (EllaOne) Intrauterine device (IUD) N.B. both pills are ineffective if ovulation has occured
26
Timescales of emergency contraception?
Levonorgestrel = within 3 days of UPSI Ulipristal = within 5 days of UPSI IUD = within 5 days of UPSI or within 5 days after ovulation
27
Side effects of emergency contraception?
Pills = nausea and vomiting, delayed or early menses IUD = infection, expulsion, heavy bleeding, perforation
28
Commencing contraception after levonorgestrel vs ulipristal?
Levonorgestrel = can be started immediately Ulipristal = can be started after 5 days
29
Most effective type of contraception?
Implantable e.g. Nexplanon
30
Nexplanon mechanism of action?
Inhibits ovulation and thickens cervical mucus
31
Guidance on using Nexplanon and duration of effectiveness?
- If inserted more than 5 days into menstrual cycle, additional contraception needed for 7 days - Lasts for 3 years
32
Depo Provera mechanism of action and main side effects?
Inhibits ovulation and thickens cervical mucus Main side effects = irregular bleeding, weight gain, takes up to a year for fertility to return
33
How is Depo Provera given?
IM every 12 weeks (up to 14 without need for additional contraception)
34
Most effective method of emergency contraception?
Intrauterine device (IUD) a.k.a copper coil
35
Mechanism of action of IUD vs IUS?
IUD = decreases sperm motility and survival IUS = inhibits endometrial proliferation
36
Guidance on the IUD (copper coil) start and duration of effectiveness?
- Immediately effective - Lasts for 5-10 years
37
Guidance on the IUS (Mirena coil) start and duration of effectiveness?
- Effective after 7 days - Lasts 4 years (if on oestrogen only HRT) or 5 years
38
Complications of IUD/IUS insertion?
- Dysmenorrhoea, amenorrhoea - Increased risk of PID within first 20 days - 1 in 20 risk of expulsion
39
Only contraception options for PMH or FH of breast cancer or BRCA mutation?
Barrier e.g. condom Copper coil
40
Options for starting postpartum contraception?
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)
41
Amenorrhoea vs dysmenorrhoea vs oligomenorrhoea?
Amenorrhoea = absent periods Dysmenorrhoea = painful periods Oligomenorrhoea = irregular periods
42
Primary vs secondary amenorrhoea and most common causes?
Primary = no period by age 15 → gonadal dysgenesis e.g. Turner's Secondary = absence of periods in women who have previously menstruated → pregnancy
43
Investigations for amenorrhoea?
bHCG Gonadotrophins (LH/FSH) Prolactin Androgens Oestradiol
44
Primary vs secondary dysmenorrhoea?
Primary = no underlying pathology Secondary = pathological e.g. endometriosis
45
Management of primary dysmenorrhoea?
1st line = NSAID e.g. mefenamic acid 2nd line = COCP
46
Most common cause of menorrhagia?
Dysfunctional uterine bleeding (DUB)
47
Management of menorrhagia?
1st line = IUS (Mirena) 2nd line = NSAID, COCP
48
Features, investigation and management of endometriosis?
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
Features, investigations and management of PCOS?
Oligomenorrhea Ameonorrhoea Fertility issues Hirsutism Obesity Investigations = TVUS, LH/FSH, androgens, prolactin Management = weight loss, COCP
50
Biochemical features of PCOS?
Raised LH:FSH Raised androgens Raised prolactin Raised insulin
51
Drug options for ovulation induction?
1st line = letrozole 2nd line = clomiphene citrate 3rd line = pulsatile GnRH therapy
52
Rotterdam criteria for PCOS?
Need 2 out of these 3: → irregular or no menstruation → hyperandrogenism e.g. hirsutism, acne → ≥ 12 follicles in one or both ovaries
53
Management of uterine fibroids?
Asymptomatic = monitor Symptomatic = contraception, GnRH analogue before surgery e.g. myomectomy
54
Antenatal complication of uterine fibroids, features and management?
Red degeneration Features = low-grade fever, pain, N&V Management = self-resolving
55
Features, investigation and management of ovarian cancer?
Abdominal distension Early satiety Urinary symptoms Diarrhoea Investigation = CA125, USS, CT Management = surgery + chemotherapy
56
Feature, investigations and management of endometrial cancer?
Postmenopausal bleeding Investigation = TVUS +/- hysteroscopy with biopsy Management = hysterectomy with bilateral salpingo-oophorectomy +/- chemotherapy, radiotherapy
57
Normal endometrial thickness?
< 5mm
58
Management of endometrial hyperplasia?
No atypical cells = mirena coil Atypical cells = hysterectomy
59
List causes of PMB?
Vaginal atrophy HRT Endometrial hyperplasia Endometrial cancer Other gynae cancers
60
Features, investigations and management of menopause?
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
Which hormone "protects" the endometrium and clinical implication?
Progestogen Women with a uterus must have progestogen in their HRT treatment
62
Which type of HRT to give?
Oestrogen = oral, transdermal or topical Progestogen = oral, transdermal or IUS Combined (both of above) = cyclical (perimenopausal) or continuous (postmenopasual)
63
Risks associated with HRT?
VTE (not transdermal) Stroke Breast cancer Ovarian cancer
64
Features, investigation and management of ovarian torsion?
Sudden colicky abdo pain Low-grade fever, N&V Adnexal tenderness Investigation = abdominal USS Management = laparoscopy
65
USS feature of ovarian torsion?
"Whirlpool" sign
66
Most common identifiable cause of postcoital bleeding?
Cervical ectropion
67
What is cervical ectropion and management?
Increased area of columnar epithelium present on the endocervix Management = ablation (only if symptomatic)
68
Features and management of adenomyosis?
Dysmenorrhoea Menorrhagia Enlarged, boggy uterus Management = symptomatic e.g. TXA
69
HPV serotypes associated with cervical cancer?
16, 18 and 33
70
Features, investigation and management of cervical cancer?
Vaginal bleeding Suprapubic pain Urinary symptoms Investigation = colposcopy Management = hysterectomy +/- lymph node clearance, radiotherapy, chemotherapy
71
Cervical screening in Scotland?
- 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
Screening of HPV -ve vs HPV +ve but cytology -ve vs cytology +ve?
HPV -ve = routine recall in 5 years HPV +ve and cytology -ve = repeat cytology in 12 months Cytology +ve = colposcopy
73
Screening of inadequate cervical sample?
Repeat within 3 months If inadequate again = colposcopy
74
Management of cervical intra-epithelial neoplasia (CIN)?
Large loop excision of transformation zone (LLETZ) or cone biopsy
75
Screening of woman with PMH of CIN1, CIN2 or CIN3?
Cervical sample 6 months post-treatment
76
Investigations for infertility?
Men = semen analysis Women = serum progestogen (day 21)
77
Serum progestogen level which indicates ovulation?
> 30nmol/l
78
Types of anovulatory disorders and main causes?
Class I (hypogonadotropic hypogonadal anovulation) = hypothalmic dysfunction Class II (normogonadotropic normoestrogenic anovulation) = PCOS Class III (hypergonadotropic hypoestrogenic anovulation) = premature ovarian failure
79
Features of OHSS?
Hypovolaemia Tense ascites Thromboembolism Renal failure
80
Investigations for everyone attending a sexual health clinic, regardless of presentation?
Chlamydia (NAAT) Gonorrhoea (NAAT, microscopy) HIV (blood sample) Syphilis (blood sample)
81
Types of GUM swabs and what they are used for?
Charcoal swabs (high-vaginal or endocervical) → microscopy, culture and sensitivities NAAT swabs (endocervical or vulvovaginal) → detecting gonorrohoea and chlamydia
82
Where is a vulvovaginal vs endocervical vs high-vaginal swab taken from?
Vulvovaginal = 5cm inside vaginal canal Endocervical = cervical os High-vaginal = posterior fornix
83
Features and management of chlamydia?
Women = discharge, bleeding, dysuria Men = discharge, dysuria Management = oral doxycycline (1st line), oral azithromycin (2nd line)
84
Investigation for chlamydia?
NAAT: → vulvovaginal swab for women → first void urine sample for men
85
Features and management of gonorrhoea?
Women = discharge, dysuria Men = discharge, dysuria Management = IM ceftriaxone
86
Investigation for gonorrhoea?
NAAT: → vulvovaginal swab for women → first void urine sample for men Charcoal swab for microscopy
87
Features and management of trichomonas?
Yellow/green, frothy discharge Inflamed vulva Strawberry cervix Vaginal pH > 4.5 Management = oral metronidazole
88
Main organism associated with BV?
Gardnerella vaginalis
89
Features and management of BV?
Fishy, white discharge Clue cells Vaginal pH > 4.5 Management = none (asymptomatic), oral metronidazole (symptomatic)
90
Features of primary vs secondary vs tertiary syphilis and management?
Primary = painless chancre, local non-tender lymphadenopathy Secondary = fevers, rash, buccal ulcers Tertiary = aortic aneurysms, granulomatous lesions, neurosyphilis Management = IM benzathine penacillin
91
Cause, investigation and management of genital warts?
HPV 6 and HPV 11 Investigation = clinical diagnosis Management = none, podophyllum, imiquimod, cryotherapy
92
Cause, investigation and management of genital herpes?
HSV-1 and HSV-2 Investigation = clinical diagnosis or swab base of ulcer Management = oral aciclovir
93
Features and management of thrush?
Cottage cheese discharge Dyspareunia Vaginal itch Inflamed vulva Management = oral fluconazole (1st line), clotrimazole pessary (2nd line)
94
Features and management of PID?
Lower abdo pain Deep dyspareunia Fever, N&V Discharge Period changes Management = IM ceftriaxone + oral ofloxacin or metronidazole + oral doxycycline
95
Fitz-Hugh-Curtis syndrome?
Inflammation of the liver capsule (perihepatitis) typically secondary to an STI or PID
96
Features, investigation and management of HIV seroconversion?
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
When should an asymptomatic patient be screened for HIV?
4 weeks post-exposure Offer 12 week re-test if -ve
98
Additional care offered to HIV patients?
PCP (co-trimoxazole) Annual cervical smear
99
Monitoring of HIV and target values?
CD4 count = > 500 Viral load = undetectable
100
HIV prevention during birth?
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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