TEALE FENNING Medical Education    FAQ   Search   Memberlist   Usergroups   Register   Profile   Log in to check your private messages   Log in  mrcog courses for doctors Cervical screening Goto page Previous  1, 2, 3  Next          TEALE FENNING Forum Index -> MRCOG Part 2: EMQs - Extended Matching Questions View previous topic :: View next topic   Author Message wolverine Century Club Joined: 16 Jan 2007 Posts: 394 Posted: Fri Feb 23, 2007 5:52 pm    Post subject: I said colposcopic opinion. Well actualy I should have said High Grade Colposcopy Back to top vani s Century Club Joined: 20 Jan 2007 Posts: 141 Posted: Fri Feb 23, 2007 6:04 pm    Post subject: or suspected CIN 2 on colpo. well colpo opinion is also ok.. I didnt read that. Back to top vani s Century Club Joined: 20 Jan 2007 Posts: 141 Posted: Fri Feb 23, 2007 6:06 pm    Post subject: sorry, my mistake.. Back to top wolverine Century Club Joined: 16 Jan 2007 Posts: 394 Posted: Fri Feb 23, 2007 6:07 pm    Post subject: wolverine wrote: sea and treat! ..... I'm dreaming my country... Back to top Abik Century Club Joined: 15 Jan 2007 Posts: 243 Location: Poole Posted: Fri Feb 23, 2007 6:13 pm    Post subject: Stop dreaming and concentrate!! How do people do colposcopy and smear? (I have not done any) I thought colp ruined the smear and smear ruined the colp - have always wondered how you do them both together? And the one with CIN III on biopsy, negative Lletz? is she treated? Doesn't she need MDT discussion? to check the biopsies and lletz sample? Back to top vani s Century Club Joined: 20 Jan 2007 Posts: 141 Posted: Fri Feb 23, 2007 6:32 pm    Post subject: First take the smear while visualizing through colposcope and then proceed with colpo. No they do not ruin each other... I think either Wolverine's imagination of CIN3 with negative LLETZ is not right. OR the CIN III was focal and got removed in the biopsy. Back to top vani s Century Club Joined: 20 Jan 2007 Posts: 141 Posted: Fri Feb 23, 2007 6:34 pm    Post subject: OR the pathologist didn't see the LLETZ specimen properly..... Back to top wolverine Century Club Joined: 16 Jan 2007 Posts: 394 Posted: Fri Feb 23, 2007 7:02 pm    Post subject: No! It happens! Firstlyi it could be focal and removed with the biopsy or treated with the healing process or by itself. It could also be missed on the examination of the specimen if it's low volume and the slices don't include it. (unfortunately you cannot repeat the histopatholic examination as the specimen would be gone..). Lastly even a vigorous cervical prep with the betadine before the procedure can scrape superficial layers including tha abnormal ones! (no, this technique cannot be used yet as a treatment!..) For all these reasons it's wise to always perform colposcopy before a LLETZ (some people don't..) and do as little manipulations as possible. Back to top vani s Century Club Joined: 20 Jan 2007 Posts: 141 Posted: Fri Feb 23, 2007 7:03 pm    Post subject: wolverine wrote: A 55 year old menopausal woman with severe dyskaryosis smear and normal colposcopy Women referred with moderate or severe dyskaryosis (high grade) on their test result are at significant risk of CIN 2 or 3, even in the presence of normal colposcopy. Biopsy should be undertaken in > 95% of women with high grade abnormalities (see section 6.3). If treatment is not undertaken, close surveillance with colposcopy and cytology every six months is advised. If at follow-up a high grade cytological abnormality persists, excisional treatment is recommended (90%). BUT WHICH FORM OF BIOPSY?????? LLETZ? CONE? KNIFE? Back to top vani s Century Club Joined: 20 Jan 2007 Posts: 141 Posted: Fri Feb 23, 2007 7:27 pm    Post subject: A 33 year old woman with CIN3 on biopsies and negative LLETZ Agreed , It's possible Next Q: A 30 yr old woman( family completed) diagnosed as Ca Cx Ia 1, treated by LLETZ. Margins positive. Further management a simple hysterectomy b radical hysterectomy c repeat cone d colposcopy and smear imediately e colpo and smear after 6 months Back to top wolverine Century Club Joined: 16 Jan 2007 Posts: 394 Posted: Fri Feb 23, 2007 8:57 pm    Post subject: You could repeat the cone but once family is completed... What's the point? Get the whole lot out! Ok you can leave the ovaries.. Back to top wolverine Century Club Joined: 16 Jan 2007 Posts: 394 Posted: Fri Feb 23, 2007 8:59 pm    Post subject: that means a.Simple hesterectomy Back to top wolverine Century Club Joined: 16 Jan 2007 Posts: 394 Posted: Fri Feb 23, 2007 9:03 pm    Post subject: But this should be on a different thread with Cervical Ca. Going back to cervical screening... A 27 year old Nuliparus african woman with HIV and CIN2 on punch biopsy Back to top wolverine Century Club Joined: 16 Jan 2007 Posts: 394 Posted: Fri Feb 23, 2007 9:06 pm    Post subject: A 38 year old with mild CGIN smear and unsatisfactory colposcopy with CIN3 on biopsy. (Re-read the option list please) Back to top vani s Century Club Joined: 20 Jan 2007 Posts: 141 Posted: Sat Feb 24, 2007 8:28 am    Post subject: wolverine wrote: You could repeat the cone but once family is completed... What's the point? Get the whole lot out! Ok you can leave the ovaries.. U have to go for a repeat cone as you have to confirm what's left ... is it CIN or Invasion. According to BSCCP: ' If the invasive lesion is excised but CIN extends to the excision margin then a repeat excision should be performed to confirm excision of the CIN and to exclude further invasive disease. This should be performed even in those cases planned for hysterectomy to exclude an occult invasive lesion requiring radical surgery.' Back to top vani s Century Club Joined: 20 Jan 2007 Posts: 141 Posted: Sat Feb 24, 2007 8:31 am    Post subject: wolverine wrote: A 27 year old Nuliparus african woman with HIV and CIN2 on punch biopsy LLETZ Back to top vani s Century Club Joined: 20 Jan 2007 Posts: 141 Posted: Sat Feb 24, 2007 8:35 am    Post subject: By the way, is punch bx a good idea? 'shouldn't we not use it?' Back to top vani s Century Club Joined: 20 Jan 2007 Posts: 141 Posted: Sat Feb 24, 2007 8:46 am    Post subject: wolverine wrote: A 38 year old with mild CGIN smear and unsatisfactory colposcopy with CIN3 on biopsy. (Re-read the option list please) Well what she needs is the removal of a cylinder taking upto 1 cm above the TZ. depending on the symptoms and 'looks ' of cx .. u can go for EB as well.. so either a large loop cone OR Large loop cone and hysteroscopy OR hysterectomy I'll go with LLC with h'scopy Back to top wolverine Century Club Joined: 16 Jan 2007 Posts: 394 Posted: Sat Feb 24, 2007 11:01 am    Post subject: vani s wrote: U have to go for a repeat cone as you have to confirm what's left ... is it CIN or Invasion. You're absolutely right! I was still dreaming I think.. I have to come back to reality!! Back to top wolverine Century Club Joined: 16 Jan 2007 Posts: 394 Posted: Sat Feb 24, 2007 11:02 am    Post subject: vani s wrote: By the way, is punch bx a good idea? 'shouldn't we not use it?' What do you do in your department vani? I agree that punch is a pain in the..... 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