Flashcards in Obs Gyne Deck (198)
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
Explain Screening program of breast CA
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+
Tx of mild/moderate cyclical breast pain
• Diet - reduce caffeine and sat fat
• Simple analgesia
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
Give epi, S&S, Ix, and Tx of fibroadenoma
Discrete, firm, non tender and highly mobile
Refer for confirmation
Patho of sclerosing adenosis
Overproliferation of duct lobules. Results in pain and small firm nodules.
S&S, epi, tx, ix of phyllodes tumour
Lump forms grows large and quickly
USS, mamography, FNAC
Wide surgical excision
hx and S&S of fat necrosis. Ix and tx?
• Hx of injury and bruising
Scarring results in firm lump in breast
ix - uss, mammography, FNAC
tx - none needed once confirmed
Breast cyst Ix and 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
Patho - obstruction of lactiferous duct results in cyst containing milk
S&S and tx of galactocoele
• Cyst on examination
Occurs whilst or shortly after lactation
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
duct ectasia ix and tx
Urgent referral to exclude CA
• Self resolving
Surgery may be needed to confirm diagnosis
Breast abscess hx and S&S. tx?
• Usually occurs in lactating breast following mastitis
Presents as gradual onset pain in one breast segment with hot tender swelling of area.
tx - aspiration
RFs of breast CA
Age, denser boobs, obesity, alcohol, smoking, FHx, HRT, Genetics
S&S of breast ca
• Breast lump - 90%
• Nipple skin changes - 10%
• Painful lump - 21%, pain alone 1%
Nipple discharge - 3%
Ix and tx of breast cancer. cx of ix?
• Lymph node biopsy
Can result in lymphoedema
• 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
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
Venous disease, arterial disease, liver disease, cancer, drug interactions
If missed 1 pill of COCP what do? Missed 2+ pills?
• 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.
Define antepartum hemorrhage, miscarriage, and PPH
APH - Bleeding from uterus after 24th week
Miscarriage - Bleeding <24 wks
PPH - Bleeding after birth of baby
Causes of APH
• Placenta praevia
• Placental abruption
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.
Ix of APH
• Always admit for assessment, even if small bleed
• No VE until praevia ruled out
• 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
Placenta Praevia S&S, RFs, Ix. What must you never do if suspected?
• No pain
• Uterus non tender
• Lie and presentation may be abnormal
• Small PV bleeds before large
• Multiple pregnancy
Previous C section
• Usually picked up at 20 wk abdo scan
If suspect - TV scan
RFs for GBS?
RFs for GBS:
• Prolonged rupture of membranes
• Previous sibling GBS infection
Define early and late miscarriage
Loss of pregnancy <24 wks gestation
Early <12 wks. Late 13-24 wks.
Classify - threatened, inevitable, incomplete, complete, missed, recurrent miscarriages
• 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
Common causes of miscarriage
• Most iatrogenic - COCP
• Abnormal fetal development
• Poorly controlled diabetes
• Poorly controlled thyroid disease
• Antiphospholipid syndrome