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Flashcards in Obs Gyne Deck (198)
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1

Red flags of Breast lumps

• Hard lump with fixation +/- skin tethering
• Phx of Breast CA
• Lump getting bigger
• Eczematous skin not responsive to topical tx
• Bloody nipple discharge
• Unilateral discharge
Nipple inversion

2

Explain Screening program of breast CA

Women 50-70:
2 view mammography every 3 years

High risk women <50:
• If FHx of breast cancer
• 40-49 - annual 2 view mammography
• Genetic mutation of BRCA1/2 - annual MRI from 30y+

3

Tx of mild/moderate cyclical breast pain

• Diet - reduce caffeine and sat fat
• Simple analgesia
Changing/stopping contraceptives

4

Tx of non cyclical breast pain - well localised and generalised

• Well localised - consider ill fitting bras, breast abscess, cyst, mastitis, CA
Generalised - consider lung disease, nerve root pain

5

Give epi, S&S, Ix, and Tx of fibroadenoma

Epidemiology:
Peak 16-24

S&S:
Discrete, firm, non tender and highly mobile

Ix:
• Mammogram
• USS
FNAC

Tx:
Refer for confirmation

6

Patho of sclerosing adenosis

Overproliferation of duct lobules. Results in pain and small firm nodules.

7

S&S, epi, tx, ix of phyllodes tumour

Epi:
40-50 peak

S&S:
Lump forms grows large and quickly

Ix:
USS, mamography, FNAC

Tx:
Wide surgical excision

8

hx and S&S of fat necrosis. Ix and tx?

S&S:
• Hx of injury and bruising
Scarring results in firm lump in breast

ix - uss, mammography, FNAC
tx - none needed once confirmed

9

Breast cyst Ix and S&S

S&S:
Firm round lump not fixed and no skin tethering

1st cyst - urgent referral to exclude CA
hx of cysts - FNAC and referral if blood stained or non resolving

10

Galactocoele patho

Patho - obstruction of lactiferous duct results in cyst containing milk

11

S&S and tx of galactocoele

S&S:
• Cyst on examination
Occurs whilst or shortly after lactation

Tx:
Aspiration

12

Duct ectasia patho and S&S

• Occurs around menopause
• Ducts become blocked and secretions stagnate
Discharge which may be blood stained +/- breast lump +/- nipple retraction +/- breast pain

13

duct ectasia ix and tx

Ix:
Urgent referral to exclude CA

Tx:
• Self resolving
Surgery may be needed to confirm diagnosis

14

Breast abscess hx and S&S. tx?

Hx:
• Usually occurs in lactating breast following mastitis
Presents as gradual onset pain in one breast segment with hot tender swelling of area.

tx - aspiration

15

RFs of breast CA

Age, denser boobs, obesity, alcohol, smoking, FHx, HRT, Genetics

16

S&S of breast ca

Presentation:
• Breast lump - 90%
• Nipple skin changes - 10%
• Painful lump - 21%, pain alone 1%
Nipple discharge - 3%

17

Ix and tx of breast cancer. cx of ix?

Ix:
• Lymph node biopsy
Can result in lymphoedema

Tx:
• Tamoxifen - if oestrogen receptor +ve
• Aromatase inhibitors eg anastrozole - blocks synthesis of oestrogen for oestrogen +ve
• Herceptin - Monoclonal Ab directed at HER2
Surgical, axillary lymph node clearance

18

Emergency contraception options and when they can be used?

Copper IUCD - <5 days
Levonorgestrel - 1.5mg PO. <3days OTC.
Progesterone receptor modulator - <5 days oral

19

Contraindications COCP?

Venous disease, arterial disease, liver disease, cancer, drug interactions

20

If missed 1 pill of COCP what do? Missed 2+ pills?

Missed doses:
• If 1 pill missed - take ASAP even if 2 in 1 day. Continue
If 2+ pills missed - Take most recent missed pill even if 2 in 1 day. Leave earlier missed pills and use barrier contraceptives for next 7 days.

21

Define antepartum hemorrhage, miscarriage, and PPH

APH - Bleeding from uterus after 24th week
Miscarriage - Bleeding <24 wks
PPH - Bleeding after birth of baby

22

Causes of APH

• Placenta praevia
• Placental abruption
Local infection

23

S&S of APH

• Pain (suggests abruption)
• Painless (suggests placenta praevia)
• Failure of fetal head to engage with praevia
• Signs of fetal distress
Signs of shock if severe bleeding.

24

Ix of APH

• Always admit for assessment, even if small bleed
• No VE until praevia ruled out
• USS
• Resus if severe bleed
• Blood tests - FBC (Initial Hb may not reflect sudden blood loss), G&S, X match, clotting studies
• Fetal monitoring
Maternal corticosteroids if at risk of preterm birth

25

Placenta Praevia S&S, RFs, Ix. What must you never do if suspected?

S&S:
• No pain
• Uterus non tender
• Lie and presentation may be abnormal
• Small PV bleeds before large

RFs:
• Multiparity
• Multiple pregnancy
Previous C section

Ix:
• Usually picked up at 20 wk abdo scan
If suspect - TV scan

26

RFs for GBS?

RFs for GBS:
• Premature
• Prolonged rupture of membranes
• Previous sibling GBS infection
Maternal pyrexia

27

Define early and late miscarriage

Loss of pregnancy <24 wks gestation
Early <12 wks. Late 13-24 wks.

28

Classify - threatened, inevitable, incomplete, complete, missed, recurrent miscarriages

Classification:
• Threatened miscarriage - Mild bleeding. Closed cervical os
• Inevitable miscarriage - Heavy bleeding and clots. Open cervical os.
• Incomplete miscarriage - POC partially expelled.
• Complete miscarriage - POC completely expelled.
• Missed miscarriage - Fetus is dead but retained.
Recurrent miscarriage - 3+ consecutive miscarriages

29

Common causes of miscarriage

• Most iatrogenic - COCP
• Abnormal fetal development
• Poorly controlled diabetes
• Poorly controlled thyroid disease
• PCOS
• Antiphospholipid syndrome
Uterine abnormality

30

RFs for miscarriage

• Age
• Smoking
• Alcohol
• Low BMI
Drugs