Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

finals > gynae > Flashcards

gynae Flashcards

1
Q

what is a krunkenburg tumour

A

development of mets to the ovary

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

what to do when having surgery if on the pill

A

stop 4 wks before

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

first line for urge incontinence

A

bladder retraining for a min of 6 wks (gradually increasing the time between voiding)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

first line for stress incontinence

A

pelvic floor muscle training
8 contractions 3x/day for at least 3 mths

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

first-line in the management of nausea & vomiting in pregnancy/hyperemesis gravidarum

A

antihistamines - oral cyclizine or promethazine

ondansetron is second line

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

RFs of Hyperemesis gravidarum

A

increased levels of beta-hCG
- multiple pregnancies
- trophoblastic disease
nulliparity
obesity
family or personal history of NVP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Referral criteria for nausea and vomiting in pregnancy

A

Continued nausea and vomiting and is unable to keep down liquids or oral antiemetics

Continued nausea and vomiting with ketonuria and/or weight loss (greater than 5% of body weight), despite treatment with oral antiemetics

A confirmed or suspected comorbidity (for example she is unable to tolerate oral antibiotics for a urinary tract infection)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

dx of Hyperemesis gravidarum

A

5% pre-pregnancy weight loss
dehydration
electrolyte imbalance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

cervical smear: what to do if the sample is Positive hrHPV

A

samples are examined cytologically

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

cervical smear: what to do if the sample is Positive hrHPV and abnormal cytology

A

colposcopy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

cervical smear: what to do if the sample is Positive hrHPV and normal cytology

A

repeat test at 12 months
if the repeat test is now hrHPV -ve → return to normal recall
if the repeat test is still hrHPV +ve and cytology still normal → further repeat test 12 months later:
If hrHPV -ve at 24 months → return to normal recall
if hrHPV +ve at 24 months → colposcopy

(ie test HPV 3x b4 colposcopy)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

what to do if cervical smear sample is inadequate

A

repeat the sample within 3 months
if two consecutive inadequate samples then → colposcopy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

medical mx of abortion

A

mifepristone (an anti-progestogen)

followed by misoprostol (a prostaglandin) 48 hrs later

take a multi-level preg test after 2 wks to check (Quantitative hCG measurement )

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

causes of primary amenorrhoea

A

gonadal dysgenesis (e.g. Turner’s syndrome) - the most common causes
testicular feminisation
congenital malformations of the genital tract
functional hypothalamic amenorrhoea (e.g. secondary to anorexia)
congenital adrenal hyperplasia
imperforate hymen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

causes of secondary amenorrhoea (after excluding pregnancy)

A

hypothalamic amenorrhoea (e.g. secondary stress, excessive exercise)
polycystic ovarian syndrome (PCOS)
hyperprolactinaemia
premature ovarian failure
thyrotoxicosis*
Sheehan’s syndrome
Asherman’s syndrome (intrauterine adhesions)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

what is gonadal dysgenesis + what might be the examination findings

A

congenital condition in which the gonads are atypically developed, and may be functionless
e.g. turners syndrome

Due to the abnormal gonads, androgens are not produced in response to FSH and LH from the anterior pituitary gland. -> absent 2ndary sex characteristics

FSH + LH remain high as no -ve feedback

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

ix for ectopic preg

A

transvaginal ultrasound

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

when to do expectant mx for ectopic

A

size < 35mm
unruptured
asx
no fetal heartbeat
hCG <1,000IU/L
Compatible if another intrauterine pregnancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

what does expectant mx for ectopic involve

A

closely monitoring the px over 48 hours and if B-hCG levels rise again or symptoms manifest intervention is performed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

when to do medical mx for ectopic

A

Size <35mm
unruptured
no signif pain
no fetal heartbeat
hCG <1,500IU/L
Not suitable if intrauterine pregnancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

what does medical mx for ectopic involve

A

methotrexate
needs to attend follow up

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

when to do surgical mx for ectopic

A

Size >35mm
can be ruptured
pain
visible fetal heartbeat
hCG >5,000IU/L
Compatible with another intrauterine pregnancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

what does surgical mx for ectopic involve

A

Salpingectomy is first-line for women with no other risk factors for infertility (full fallopian tube out)

Salpingotomy (tube not acc removed, opening made) should be considered for women with risk factors for infertility such as contralateral tube damage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

PCOS test results

A

raised LH:FSH ratio
testosterone may be normal or mildly elevated
SHBG is normal to low

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

rotterdam criteria for PCOS

A

two out of three of the following:
Oligo and/or anovulation
Clinical and/or biochemical signs of hyperandrogenism
Polycystic ovaries

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

risk factors for endometrial cancer

A

excess oestrogen
- nulliparity
- early menarche
- late menopause
- unopposed oestrogen. The addition of a progestogen to oestrogen reduces this risk (e.g. In HRT). The BNF states that the additional risk is eliminated if a progestogen is given continuously

metabolic syndrome
- obesity
- diabetes mellitus
- polycystic ovarian syndrome

tamoxifen

hereditary non-polyposis colorectal carcinoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

protective factors for endometrial cancer

A

multiparity
combined oral contraceptive pill
smoking (the reasons for this are unclear)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

how long should women take HRT for premature menopause

A

until the age of 50

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

presentation of intraductal papilloma

A

clear or blood-stained nipple discharge
tenderness or pain
palpable lump (maybe)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

what is intraductal papilloma

A

warty lesion that grows within one of the ducts in the breast - benign tumour

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

what is a fibroadenoma

A

common benign tumours of stromal/epithelial breast duct tissue

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

features of fibroadenoma

A

Painless
Smooth
Round
Well circumscribed (well-defined borders)
Firm
Mobile (moves freely under the skin and above the chest wall)
Usually up to 3cm diameter

more common ages 20-40

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

what to do in fibroadenomas >3cm

A

surgical excision

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

what is Mammary duct ectasia

A

dilation of the breast ducts, often resulting in blockage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

features of Mammary duct ectasia

A

Most common in menopausal women
Discharge typically thick and green in colour
Most common in smokers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

clinical features of breast cancer

A

Lumps that are hard, irregular, painless or fixed in place
Lumps may be tethered to the skin or the chest wall
Nipple retraction
Skin dimpling or oedema (peau d’orange)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

two week wait referral for suspected breast cancer for:

A

An unexplained breast lump in patients aged 30 or above

Unilateral nipple changes in patients aged 50 or above (discharge, retraction or other changes)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

what forms part of a triple assessment

A

Clinical assessment (history and examination)
Imaging (ultrasound or mammography)
Histology (fine needle aspiration or core biopsy)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

what pill to use in PCOS + why

A

COCP - co-cyprindrol
- reduceS hirsutism, acne and regulates periods

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

what to do in PCOS if wanting preg

A

weight loss
clomifene - induces ovulation
- Try metformin with it
Laparoscopic ovarian drilling
IVF

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

most common ovarian cyst

A

follicular

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

what is a follicular cyst

A

type of functional cyst

non-rupture of the dominant follicle
usually regresses after several menstrual cycles

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

what is a corpus luteum cyst

A

type of functional cyst

when it does not break down in a cycle w no preg and fills with blood/fluid

may cause pelvic discomfort, pain or delayed menstruation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

what is a dermoid cyst

A

most common benign ovarian tumour
mature cystic teratomas (come from germ cells + contain various tissue types)

assoc w ovarian torsion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

what do you see on imaging with a dermoid cyst

A

rokitansky protuberance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

what is a serous cystadenoma

A

most common benign epithelial tumour

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

what is the triad in Meig’s syndrome

A

Ovarian fibroma (a type of benign ovarian tumour)
Pleural effusion
Ascites

Typically occurs in older women. Removal of the tumour results in complete resolution of the effusion and ascites.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

when do you need post-partum contraception

A

21 days after birth

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

when can you insert IUD after childbirth

A

within 48 hrs
or
after 4 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

candida pres

A

cottage cheese discharge
vulvitis
itch

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

tx candida

A

oral fluconazole single dose

CI in preg
- use detrimazole pessary

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

trichomonas vaginalis pres

A

offensive yellow/green frothy discharge
vulvovaginitis
strawberry cervix

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

trichomonas vaginalis tx

A

oral metronidazole

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

bacterial vaginosis pres

A

offensive thin white/grey fishy discharge

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

bacterial vaginosis tx

A

oral metronidazole

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

gonorrhoea tx

A

IM ceftriaxone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

what increases your risk of breast cancer

A

anything that increases oestrogen exposure
- early onset periods
- late menopause

  • combined HRT
  • COCP
  • smoking
  • obesity
  • more dense breast tissue
  • FHx
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

risk factors for cervical cancer

A

COCP
multiparity
HPV 16, 18, 33
smoking
early sex, increased no of sexual partners
FHx
non attendance to screening

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

risk factors for ovarian cancer

A

increased amount of ovulations
age
early onset periods
late menopause
no pregnancies

SO COCP, breastfeeding and pregnancy are protective

BRCA 1 + 2 genes
smoking
obesity
clomifene use

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

presentation of PID

A

pelvic pain
abnormal bleeding
dyspareunia
dysuria
fever
cervical excitation
purulent discharge

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

ix PID

A

a pregnancy test should be done to exclude an ectopic pregnancy
high vaginal swab
these are often negative
screen for Chlamydia and Gonorrhoea

62
Q

mx PID

A

or intramuscular ceftriaxone (for ghonorrhoea) + oral doxycycline 100mg 2x daily 14 days (for chlamydia) + oral metronidazole 400mg 2x daily 14 days

63
Q

what is a chronic manifestation of PID

A

Fitz-Hugh Curtis Syndrome
- inflam of liver capsule w adhesion formation
RUQ pain

64
Q

chlamydia presentation

A

asymptomatic in around 70% of women and 50% of men
women: cervicitis (discharge - strong odour, bleeding - intermenstrual or post coital), dysuria, pelvic pain
men: urethral discharge, dysuria, reactive arthritis

65
Q

chlamydia ix

A

nuclear acid amplification tests (NAATs)
for women: the vulvovaginal swab is first-line
for men: first catch urine test is first-line

66
Q

gonorrhoea presentation

A

90% of men and 50% of women are symptomatic
women: odourless purulent discharge (green/yellow), dysuria, pelvic pain
men: odourless purulent discharge (green/yellow), dysuria, testicular pain or swelling (epididymo-orchitis)
rectal infection
pharyngeal infection

67
Q

gonorrhoea bacteria

A

gram -ve diplococcus

68
Q

chlamydia tx

A

doxycycline 100mg twice a day for 7 days

CI in preg + breastfeeding
azithromycin 1g stat

69
Q

order of preference of where to take a NAAT sample

A

women: endocervical, vulvovaginal, and then first catch urine
men: first-catch urine sample/urethral swab
Rectal and pharyngeal NAAT swabs can also be taken to diagnose chlamydia in the rectum and throat

70
Q

gonorrhoea ix

A

NAAT
- endocervical, vulvovaginal or urethral swabs, or in a first-catch urine sample. Rectal and pharyngeal swab are recommended in all men who have sex with men (MSM), and in those with risk factors (e.g. anal and oral sex) or symptoms of infection in these areas

standard charcoal endocervical swab should be taken for microscopy, culture and antibiotic sensitivities before initiating antibiotics

71
Q

which STIs need a test of cure

A

gonorrhoea due to high abx resistance
72 hours after treatment for culture
7 days after treatment for RNA NAAT
14 days after treatment for DNA NAAT

72
Q

why do you get overactive bladder/urger incontinence

A

overactive detrusor muscle
causes urger to urinate followed by uncontrollable leakage

73
Q

why do you get stress incontinence

A

weak pelvic floor muscles and sphincter muscles
causes urinary leakage when laughing, coughing or surprised

74
Q

what is overflow incontinence

A

can occur when there is chronic urinary retention due to an obstruction to the outflow of urine
incontinence occurs without the urge to pass urine
more common in men

75
Q

what to do in women w overflow incontinence

A

refer for urodynamic testing and specialist management

76
Q

what to do for all types on incontinence

A

3 day bladder diary
vaginal exam (to exc prolapse + see ability for kegels)
urine dipstick + culture - to rule out UTI + DM (do urinalysis is >65)

77
Q

meds to use in overactive bladder/urge incontinence

A

anticholinergic meds - OXYBUTYNIN, tolterodine, solifenacin

Mirabegron as an alt (less anticholinergic burden) - B-3 agonist

78
Q

when is oxybutynin CI

A

elderly/frail
glaucoma

79
Q

when is mirabegron CI

A

uncontrolled HTN
need to monitor BP during tx

80
Q

anticholinergic SEs

A

dry mouth, dry eyes, urinary retention, constipation and postural hypotension
can’t see, can’t pee can’t shit, can’t spit

they can also lead to a cognitive decline, memory problems and worsening of dementia

81
Q

further mx in stress incontinence

A

Surgery - Tension-free vaginal tape (TVT) etc

DULOXETINE (SNRI) if surgery no approp/declined

82
Q

when to suspect a vesicovagal fistulae

A

in px w continuous dribbling incontinence after prolonged labour + country w poor obstetric services

83
Q

ix vesicovagal fistulae

A

urinary dye studies

84
Q

when to ix infertility

A

after 1 yr of trying

85
Q

how to ix infertility

A

semen analysis
measure serum progesterone 7 days prior to expected next period (ie on day 21 on a typical 28 day cycle)

86
Q

serum progesterone results when testing infertility

A

<16 = repeat, if consistent -> specialist
16-30 = repeat
>30 = indicates ovulation

87
Q

key counselling pts when trying to conceive

A

folic acid
BMI 20-25
sex every 2-3 days
smoking + drinking advice

88
Q

PMS mx

A

General healthy lifestyle changes, such as improving diet, exercise, alcohol, smoking, stress and sleep
Combined contraceptive pill (COCP) - new gen containing drospirenone eg yasmin
SSRI antidepressants
Cognitive behavioural therapy (CBT)

89
Q

HRT
uterus + post-menopause (12 mths w/o periods)

A

continuous combined
oral / patch

90
Q

HRT
uterus + perimenopause

A

sequential (cyclical progesterone + reg breakthrough bleeds)
oral / patch

91
Q

HRT
hysterectomy (no uterus) / mirena in situ

A

estradiol / conjugated equine oestrogens
oral / patch

the mirena is liscenced for use as the progesterone component of HRT for 4 yrs

92
Q

comps of oestrogen + progesterone HRT

A

increased risk of breast cancer (increases w duration of use, decreases when stopped)
increased risk of VTE (transdermal does not)
- if px has increased risk of this anyway refer to haematology 1st

93
Q

comps of oestrogen only HRT

A

increased risk of endometrial cancer
DO NOT GIVE TO WOMEN W UTERUS

94
Q

comps of all HRT

A

increased risk of stroke
increased risk of IHD if 10 + yrs after menopause

95
Q

Non-Hormonal Treatments for Menopausal Symptoms

A

Lifestyle changes such as improving the diet, exercise, weight loss, smoking cessation, reducing alcohol, reducing caffeine and reducing stress

CBT

Clonidine, which is an agonist of alpha-adrenergic and imidazoline receptors - lowers BP + reduces HR - helpful for vasomotor symptoms and hot flushes

SSRIs (e.g. fluoxetine)

Venlafaxine (SNRI)

Gabapentin

96
Q

Indications for HRT

A

Replacing hormones in premature ovarian insufficiency, even without symptoms
Reducing vasomotor symptoms such as hot flushes and night sweats
Improving symptoms such as low mood, decreased libido, poor sleep and joint pain
Reducing risk of osteoporosis in women under 60 years

97
Q

CI ulipristal acetate (ellaone)

A

severe asthma

98
Q

how soon after unprotected sex for

levonorgestrel

ulipristal acetate (ellaone)

A

72 hrs (double dose if BMI > 26, weight > 70)

120 hrs

99
Q

when can you start hormonal contraceptive after emergency one w

levonorgestrel

ulipristal acetate (ellaone)

A

immediately

5 days

100
Q

2 types of endometrial hyperplasia

A

precancerous condition involving thickening of the endometrium (5% go to cancer most return to normal):

Hyperplasia without atypia
Atypical hyperplasia (higher risk of malignancy)

101
Q

how to tx endometrial hyperplasia

A

using progestogens, with either:
Intrauterine system (e.g. Mirena coil)
Continuous oral progestogens (e.g. medroxyprogesterone or levonorgestrel)

repeat sampling in 3-4 mths

102
Q

endometrial cancer presentation

A

POSTMENOPAUSAL BLEEDING

Postcoital bleeding
Intermenstrual bleeding
Unusually heavy menstrual bleeding
Abnormal vaginal discharge
Haematuria
Anaemia
Raised platelet count

103
Q

referral criteria for endometrial cancer

A

The referral criteria for a 2-week-wait urgent cancer referral for endometrial cancer is:
Postmenopausal bleeding (more than 12 months after the last menstrual period)

Referral for a transvaginal ultrasound in women over 55 years with:
Unexplained vaginal discharge
Visible haematuria plus raised platelets, anaemia or elevated glucose levels

104
Q

ix endometrial cancer

A

Transvaginal ultrasound for endometrial thickness (normal is less than 4mm post-menopause)

Pipelle biopsy, which is highly sensitive for endometrial cancer making it useful for excluding cancer

Hysteroscopy with endometrial biopsy

105
Q

stages of endometrial cancer

A

International Federation of Gynaecology and Obstetrics (FIGO) staging system
Stage 1: Confined to the uterus
Stage 2: Invades the cervix
Stage 3: Invades the ovaries, fallopian tubes, vagina or lymph nodes
Stage 4: Invades bladder, rectum or beyond the pelvis

106
Q

mx endometrial cancer

A

total abdominal hysterectomy with bilateral salpingo-oophorectomy (TAH and BSO (removal of uterus, cervix and adnexa))
for stage 1 + 2

Other treatment options depending on the individual presentation include:
A radical hysterectomy involves also removing the pelvic lymph nodes, surrounding tissues and top of the vagina
Radiotherapy
Chemotherapy
Progesterone may be used as a hormonal treatment to slow the progression of the cancer

107
Q

UKMEC4 conditions for COCP (unacceptable risk)

A

> 35 yrs + 15 cigs/day
migraines w aura
hx of thromboembolic dis/mutation
hx of stroke/IHD
breastfeeding < 6 wks post partum
uncontrolled HTN
breast cancer
major surgery w prolonged immobilisation
+ve antiphospholipid antibodies (eg SLE)

108
Q

UKMEC3 conditions for COCP (risks>advs)

A

> 35 <15 cigs / day
BMI > 35
FHx thromboembolism dis
controlled HTN
immobility (wheelchair)
BRCA1/BRCA2 mutation

109
Q

POP + abx

A

no change

**unless the antibiotic alters the P450 enzyme system, for example, rifampicin

110
Q

starting POP

A

if commenced up to + inc day 5 = immediate protection
day 6+ = additional contraceptive for the first 2 days

if switching from COCP = immediate protection if continued directly from the end of a pill packet (i.e. Day 21)

111
Q

taking POP

A

should be taken at the same time every day, without a pill-free break

112
Q

missed pills POP

A

if < 3 hours* late: continue as normal
*for Cerazette (desogestrel) a 12 hour period is allowed

if > 3 hours*: take the missed pill as soon as possible, continue with the rest of the pack, extra precautions (e.g. condoms) should be used until pill taking has been re-established for 48 hours

113
Q

vaginal atrophy

A

the thinning, drying, and inflammation of the walls of the vagina due to a reduction in oestrogen following the menopause can result in vaginal bleeding

114
Q

what is used to rehydrate if admitted w hyperemesis gravidarum

A

normal saline with added potassium is used to rehydrate

115
Q

limit for abortion

A

24 wks

116
Q

surgical abortion options

A

vacuum aspiration (MVA), electric vacuum aspiration (EVA) and dilatation and evacuation (D&E)
cervical priming with misoprostol +/- mifepristone b4
an intrauterine contraceptive can be inserted immediately after evacuation of the uterine cavity

117
Q

choice of abortion procedure

A

women are offered a choice between medical or surgical abortion up to and including 23+6 weeks’ gestation

likelihood of women seeing products of conception pass and decreased success rate
before 10 weeks medical abortions are usually done at home

118
Q

abortion act

A

2 registered medical practitioners are of the opinion:
- the pregnancy has not exceeded its 24th week + the continuance of the pregnancy would involve risk, greater than if the pregnancy were terminated, of injury to the physical or mental health of the pregnant woman or any existing children of her family
- the termination is necessary to prevent grave permanent injury to the physical or mental health of the pregnant woman
- the continuance of the pregnancy would involve risk to the life of the pregnant woman, greater than if the pregnancy were terminated
- substantial risk that if the child were born it would suffer from such physical or mental abnormalities as to be seriously handicapped.

119
Q

electrolyte imbalance w vomiting

A

hypokalaemia

120
Q

RFs for ectopic preg

A

(anything slowing the ovum’s passage to the uterus)
damage to tubes (pelvic inflammatory disease, surgery)
previous ectopic
endometriosis
IUCD
progesterone only pill
IVF (3% of pregnancies are ectopic)

121
Q

1 missed COCP

A

take the last pill even if it means taking two pills in one day and then continue taking pills daily, one each day
no additional contraceptive protection needed

122
Q

2+ missed COCP

A

take the last pill even if it means taking two pills in one day, leave any earlier missed pills and then continue taking pills daily, one each day

the women should use condoms or abstain from sex until she has taken pills for 7 days in a row.

123
Q

2+ missed COCP in week 1

emergency contra?

A

emergency contraception should be considered if she had unprotected sex in the pill-free interval or in week 1

124
Q

2+ missed COCP in week 2

emergency contra?

A

after seven consecutive days of taking the COC there is no need for emergency contraception

125
Q

2+ missed COCP in week 3

interval?

A

she should finish the pills in her current pack and start a new pack the next day; thus omitting the pill free interval

126
Q

most common type of ovarian cancer

A

Epithelial Cell Tumours
- eg. serous tumour

127
Q

protective factors ovarian cancer

A

Factors that stop ovulation or reduce the number of lifetime ovulations
Combined contraceptive pill
Breastfeeding
Pregnancy

128
Q

ovarian cancer presentation

A

non-spec sx, often dx late

Abdominal bloating
Early satiety (feeling full after eating)
Loss of appetite
Pelvic pain
Urinary symptoms (frequency / urgency)
Weight loss
Abdominal or pelvic mass
Ascites

An ovarian mass may press on the obturator nerve and cause referred hip or groin pain.

129
Q

referral criteria for ovarian cancer

A

Refer directly on a 2-week-wait referral if a physical examination reveals:

Ascites
Pelvic mass (unless clearly due to fibroids)
Abdominal mass

130
Q

Carry out further investigations before referral in women presenting with symptoms of possible ovarian cancer:

which ix

who to refer

A

CA125
uss?

women over 50 years presenting with:
New symptoms of IBS / change in bowel habit
Abdominal bloating
Early satiety
Pelvic pain
Urinary frequency or urgency
Weight loss

131
Q

ix ovarian cancer

A

CA125 blood test (>35 IU/mL is significant)
Pelvic ultrasound

CT scan to establish the diagnosis and stage the cancer
Histology (tissue sample) using a CT guided biopsy, laparoscopy or laparotomy
Paracentesis (ascitic tap) can be used to test the ascitic fluid for cancer cells

132
Q

risk of malignancy index (RMI)

A

estimates the risk of an ovarian mass being malignant, taking account of three things:

Menopausal status
Ultrasound findings
CA125 level

133
Q

Women under 40 years with a complex ovarian mass

A

require tumour markers for a possible germ cell tumour:

Alpha-fetoprotein (α-FP)
Human chorionic gonadotropin (HCG)

134
Q

postmenopausal women w cysts

A

any postmenopausal woman with an ovarian cyst regardless of nature or size should be referred to gynaecology for assessment

135
Q

premenopausal women w cysts

A

If the cyst is small (e.g. < 5 cm) and reported as ‘simple’ then it is highly likely to be benign. A repeat ultrasound should be arranged for 8-12 weeks and referral considered if it persists.

136
Q

how many women who undergo a salpingotomy for an ectopic pregnancy require further treatment

A

20%

137
Q

what is adenomyosis

A

endometrial tissue within the myometrium

more common in later repro yrs + women who are multiparous

138
Q

features of adenomyosis

A

dysmenorrhoea
pain during sex
menorrhagia
enlarged, boggy uterus

139
Q

ix adenomyosis

A
  1. transvaginal ultrasound
    MRI
140
Q

mx adenomyosis

A

symptomatic treatment
- tranexamic acid to manage menorrhagia
- mefenamic acid to manage menorrhagia + dysmenorrhoea
hormone contraception
GnRH agonists
endo ablation
uterine artery embolisation
hysterectomy
- considered the ‘definitive’ treatment

141
Q

causes of recurrent miscarriage

A

antiphospholipid syndrome
endocrine disorders: poorly controlled diabetes mellitus/thyroid disorders. Polycystic ovarian syndrome
uterine abnormality: e.g. uterine septum
parental chromosomal abnormalities
smoking

142
Q

most effective emergency contraception

A

copper intra-uterine device

143
Q

features of fibroids

A

may be asx
menorrhagia
may result in iron-deficiency anaemia
bulk-related symptoms
- lower abdominal pain: cramping pains, often during menstruation
- bloating
- urinary symptoms, e.g. frequency, may occur with larger fibroids
subfertility
rare features:
- polycythaemia secondary to autonomous production of erythropoietin

144
Q

what are fibroids

A

benign smooth muscle tumours of the uterus. T

hey are thought to occur in around 20% of white and around 50% of black women in the later reproductive years

145
Q

dx fibroids

A

transvaginal ultrasound

146
Q

mx fibroids

A

asx = none

menorrhagia =
levonorgestrel intrauterine system (LNG-IUS)
- useful if the woman also requires contraception
- cannot be used if there is distortion of the uterine cavity
NSAIDs e.g. mefenamic acid
tranexamic acid
combined oral contraceptive pill
oral progestogen
injectable progestogen

to shrink / remove =

147
Q

Indications for early referral to fertility specialist

A

> 35
Has a menstrual disorder
Previous surgery
Previous STI/PID

148
Q

mastitis mx

normal

+ if worse

A

ctu breastfeeding
analgesia
warm compresses

if systemically unwell/nipple fissure present/sx do not improve after 12-24 hours of effective milk removal/culture indicates infection
- oral flucloxacillin for 10-14 days

149
Q

most common cause of infective mastitis

A

s aureus

150
Q

mastitis presentation

A

typically assoc w breast feeding

painful, tender, red hot breast
fever, and general malaise may be present

151
Q

tx periductal mastitis

A

co-amoxiclav

152
Q

characteristics of periductal mastitis

A

smokers
freq infections

finals (27 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions