Clinical Presentation
68F p/w new onset vaginal bleeding. LMP 15 years ago. Main DDx to exclude?
endometrial hyperplasia/ca
What is the first-line investigation tool for any abnormal uterine bleeding?
TVUS
Define oligomenorrhoea, primary amenorrhoea, secondary amenorrhoea, and postmenopausal bleeding
Oligomenorrhea: <9 periods/yr
Primary amenorrhea: Absence of menarche
Secondary amenorrhea: No periods >3/12 if regular, >6/12 if irreg
PMB: bleed/spotting >12/12 since LMP
27F presents with 4/7 of lower abdominal pain radiating to the shoulder and light vaginal bleeding. BhCG +ve, but no intrauterine pregnancy seen on transvaginal ultrasound. Outline the diagnosis, and 2 pelvic examination features you may identify.
ectopic pregnancy
O/E may identify palpable mass, cervical motion tenderness, adnexal tenderness
What is the main tumour marker used in investigating ovarian cancer?
CA125
27F presents with 4/7 of lower abdominal pain radiating to the shoulder and light vaginal bleeding. BhCG +ve, but no intrauterine pregnancy seen on transvaginal ultrasound. Outline the management of this case.
You are an ED intern in this case.
Nonpharm: admit, notify seniors, O&G consult, ABCDE/supportve tx/IV access
Pharm: symptomatic management
Surgery
Specific Mx (not needed to score):
- nonpharmacological (stable, no rupture, can f/u, low/falling BHCG (<1500), tubal mass <3cm): expectant, BHCG r/v until -ve
- pharmacological (stable, no rupture, can f/u, BHCG <3000, no MTX CI; caution if BHCG>5000 or mass>3cm): IM MTX, no pregnancy for 4mths (counsel on contraception)
- surgical (unstable, rupture, mass>3cm, CI above, heterotropic pregnancy): salpingectomy/salpingostomy
51F asks if she's going through through menopause. List 5 clinical features of menopause.
any of: oligomenorrhea, vasomotor symptoms (heat intolerance, night sweats), changes in urinary frqeuency/urgency, changes in psyche (sleep/mood/libido changes), vulvovaginal atrophic changes (PCB, dryness, pruritic changes)
Outline the diagnostic criteria of PCOS
Rotterdam criteria - 2/3 of:
oligo/amenorrhoea,
hyperandrogenism (clinical features/investigations),
TVUS (>20 cysts/ovary or increased ovarian size >10cc)
Outline the definitive management for endometrial hyperplasia without atypia vs with atypia vs carcinoma
Hyperplasia without atypia: mirena
With atypia: total hysterectomy with bilateral salpingo-oophorectomy
Carcinoma: total hysterectomy with bilateral salpingo-oophorectomy +/- LN assessment, chemo/rad, etc