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General Flashcards

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1
Q

Features of Low Oestrogen

A

Vaginal dryness
Dyspareunia
Decline in bone mineral density - osteopenia/porosis

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2
Q

Sheehan’s Syndrome

A

Postpartum hypopituitarism

3 Fs Failure of lactation, fatigue, failure to resume menstruation

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3
Q

Asherman’s Syndrome

A

Intrauterine adhesions
1-2% of 2nd amenorrhoea.
Frequently after DandC.
Ix- hysteroscopy, hormone studies Normal

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4
Q

D and C

A

Dilation and Curettage
Opening the cervix and removing contents of the uterus
Done after miscarriage usually if over 10 weeks old.

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5
Q

Cervical Smear Testing

A

Routine every 3 or 5 years depending on age
Borderline change - repeat in 6-12 months
Mild Dyskaryosis (CIN1) - Colposcopy or repeat in 6 months
Mod Dyskaryosis (CIN2)- Refer for colposcopy
Severe Dyskaryosis (CIN3) - colposcopy
Suspected invasive CA - Urgent colposcopy
Inadequate - repeat, after 3x then colposcopy

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6
Q

Leiomyoma (Fibroids)

A

Benign Smooth muscle tumours of the uterus
20-50% of women over 30 yrs
Most are aymptomatic and only 10-20% need tx
Sx- abdo cramps, menorrhagia.
Tx - Meds or surgery

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7
Q

Pharmacological Tx of fibroids

A

NSAIDS - mefanamic acid reduce menstrual blood loss
Antifibrinolytic agents - tranexamic acid do the same
COCP
Danazol
GnRH agonists

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8
Q

Surgical Tx of fibroids

A

Myomectomy
Hysteroscopic endometrial ablation
Total hyseterectomy
Uterine artery embolisation

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9
Q

Adenomyosis

A

Ectopic endometrial tissue within the myometrium
Endometrial glands 1 high power field deeper than E-M junction
Sx- heavy freq periods, dysmenorrhoea, pelvic pain

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10
Q

Ruptured Ovarian Cyst

A

History of mild trauma after fall or intercourse.
Mild chronic lower abdo discomfort that suddenly worsen
USS- fluid in space between falopian tubes and ovaries

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11
Q

Red Degeneration of Fibroid

A

5-10& of pregnant women with myomas
Acute significant localised abdo pain.Vomiting and fever
USS- mixed echodense or echolucent appearance.

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12
Q

Hyperemesis Gravidarum

A 
Intractable vomiting in early pregnancy
Ix- raised haematocrit, low Na, low K, low urea, high creat
high AST. high free t4, low TSH
Urine - ketonuira
Tx- Promethazine, ginger
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13
Q

Acute fatty liver of pregnancy

A

Rare life threatening in 3rd trimester.
Disordered metabolism of fatty acids causing liver failure
Raised AST
Tx- prompt delivery of the baby.

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14
Q

Placental Abruption

A

Premature separation of the placenta from the uterus
Present with bleeding (some have concealed bleeding), tender tense uterus, foetal distress
Should be considered in bleeding 2nd half of pregnancy

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15
Q

Placenta Praevia

A

Implantation of the placenta over the internal cervical os

Painless vaginal bleeding,

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16
Q

Vasa Praevia

A

Foetal vessels crossing or close to inner cervical os

Antepartum haemorrhage immediately after artifical rupture.

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17
Q

Bleeding in 1st Trimester

A

Spontaneous abortion
Ectopic pregancy
Hydatidiform mole

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18
Q

Bleeding in 2nd Trimester

A

Spontaneous abortion
Hydatidiform mole
Placental abruption

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19
Q

Bleeding in 3rd Trimester

A

Placental abruption
Bloody show
Placenta praevia
Vasa praevia

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20
Q

Hydatidiform mole

A

Gestational trophoblastic disease

Non viable fertilised egg implants in the uterus

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21
Q

Antenatal USS times

A

11-14 weeks for dating and nuchal translucency

18 weeks is the anomaly scan.

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22
Q

Amniocentesis

A

Measure alpha fetoprotein at 16 weeks to detect neural tube defects (1% risk of foetal loss)

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23
Q

Combined Test

A

Between 10-13 weeks to screen for Downs.
Includes Nuchal translucency, free B-HCG, pregnancy associated plasma protein, women’s age
If high risk then offered CVS (if less than 13 weeks) or amniocentesis (if beyond 15 weeks)

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24
Q

Uterine Prolapse

A

1st degree - Cervix remains within vagina
2nd deg - Cervix protrudes through introitus
3rd deg - Uterus lies entirely outside introitus
Should be examined using Sims’s speculum.
Tx- pelvic floor exercises, ring pessary

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25
Dysfunctional uterine bleeding
Abnormal uterine bleeding in the absence of organic dx Heavy menstrual bleeding around menarche and perimenopause Tx - Levonorgestrel-releaseing IU system, tranexamic acid, norethisterone.
26
Bartholin's glands
Pair of peas sized glands whose secretions maintain moisture of the vestibular surface of the vagina At 4 and 8 o'clock position Cyst - rapid onset painful lump size of a walnut.
27
Pre-eclampsia
Pregnancy induced hypertension in the 2nd half (after 20 weeks) associated with proteinuria +/- oedema RF- age >40, nulliparity, FH, BMI over 30, HTN, Renal disease. Only cure is terminate pregnancy and deliver the placenta.
28
Eclampsia
Occurrence of one or convulsions during pre-eclampsia
29
HELLP syndrome
Haemolysis Elevated liver enzymes Low platelets Occurs in severe pre-eclampsia
30
Ectopic Pregnancy
Triad 1. Pain 2. Amenorrhoea 3. Vaginal bleeding. only 50% present like this. IX- transvaginal USS. hCG levels. Tx- Methotrexate
31
Endometrial Cancer
Post menopausal bleeding is endometrial cancer until proven otherwise. Peak incidence 60 years. 75% occur after menopause RF - obesity, nulliparity, late menopause, fh, tamoxifen, HRT, DM, PCOS Offensive discharge rare (unlike cervical carcinoma) PAIN - late sx showing extensive disease IX- USS and endometrial sampling.
32
Threatened Misscarriage
Minimal pain Minimal bleeding Cervix closed Foetal heart visualised.
33
Inevitable Misscarriage
Pain + More bleeding than regular period Cervix open Foetal heart may or may not be visualised
34
Complete Misscarriage
No pain Less bleeding than period Cervix - closing Uss - empty
35
Incomplete Misscarriage
Pain +/- A lot more bleeding than normal period Cervix open Retained products, no foetal heart
36
Missed Misscarriage
No pain Minimal bleeding Cervix closed No foetal heart
37
Bacterial Vaginosis
Caused by mixture of bacteria Fishy smelling discharge, commonly after sex Microscopy - CLUE CELLS Tx- Metronidazole
38
Gonorrhoea
Gram -ve diplococcus Neisseria Gonorrhoeae 2nd most common STI after chlamydia in the UK Tx - ceftriaxone and azithromycin
39
Trichomonas Vaginalis
2nd most common cause of vag discharge after candida 18-35 yr old females, sexually acquired. Discharge -yellow/green offensive, frothy 2% have strawberry cervix Tx - Metronidazole
40
Cervical Carcinoma
6th most common malignancy in females 45-55 yrs commonly. 1st sx- post coital bleeding. dysuria, malodorous discharge ix- colposcopy, biopsy.
41
Risk factors for Cervical Carcinoma
``` HPV 16, 18, 33. Smoking HIV Young age of first coitus Young age of first pregnancy Lots of sexual partners High parity Low Socioeconomic class. ```
42
Round Ligament Pain
Brief sharp, stabbing pain or dull ache that pregnant women feel in the lower abdomen or groin in 2nd trimester Due to uterus pulling on the round ligament
43
Braxton Hicks Contraction
Tightening rather than pain after 20 weeks
44
Rectus Muscle Haematoma
Rupture of inferior epigastric vessels | Sudden severe abdo pain after coughing or trauma
45
Listeriosis
Gram +ve Listeria Monocytogenes Ingestion of contaminated food - meat, dairy, seafood Soft cheese and unpasteurised milk Chorioamnionitis, premature labour, spon abortion, stillbirth Tx - Amoxicillin and Gentamicin
46
Syphillis
Treponema Pallidum In pregnancy can cause stillbirth, abortion, prm delivery Tx in pregnancy - Benzylpenicillin
47
Congenital Toxoplasmosis
Infection can occur in utero or during vag delivery Early infection - foetal death, or newborn with CNS issues Tx- Spiramycin
48
Depo-Provera
Long acting progestogen given IM For pts who have CIs to oestrogen therapy S/Es - Delayed return of fertility and irregular cycles, heavy bleeding
49
POP
Mini pill with just progestogen Common in breastfeeding, BMI>35, smokers, migraines Causes plug of mucus in the cervix that blocks sperm, also thins lining of the uterus and stop ovulation. Major complaint - Irregular periods
50
Post Pill Amenorrhoea
Stopping oral contraceptive does not lead to resumption of normal menstrual cycle. Usually settles spontaneously in 6 months.
51
PCOS
``` Presence of 2 out of 3: 1. Polycystic ovaries 2. Oligo or anovulation 3. Signs of hyperandrogenism Mx- clomiphene COC Dianette or cypoterone for hirsutism. ```
52
Blood results in PCOS
High LH High LH:FSH ration (FSH Normal) High testosterone Oestriol reduced
53
Combined Pill
Contains oestrogen and progesterone Prevents GnRH from hypothalamus Therefore no FSH/LH released from pituitary Prevents ovulation
54
Mirena Coil
Inhibits endometrial proliferation | Causes cervical mucous thickening
55
Morning after pill
Contain levonorgestrel Inhibits ovulation Should be within 12 hours and no later than 72 hours after
56
Melasma
Generally between age 30-40 commoner in tanned pts Affects forehead, cheeks and upper lips. Triggers - pregnancy, contraceptives, sun
57
First line Tx of Menorrhagia
1. Mirena 2. Tranexamic acid, mefanamic acid, COC 3. Norethisterone
58
HRT
Effective tx for menopause related sx Replaces oestrogen in the post menopausal women Types- no uterus - oestrogen only Uterus - need progestogen to prevent endometrial thicken Used for 3-5 years. DOESN'T ACT AS A CONTRACEPTIVE
59
Tibolone
Man made hormone as an alternative to HRT in those who cannot take oestrogen.
60
Risks of HRT
VTE Breast Cancer Endometrial Cancer May inc risk of stroke and heart disease
61
Benefits of HRT
Stops hot flushes and night sweats Reverses changes around vagina Dec risk of osteoporosis
62
Contraindications of HRT
``` Previous endometrial, breast or ovarian cancer Previous clots Prevous IHD, Stroke Uncontrolled high BP Severe liver disease ```
63
Missed COC Pill
Defined as >24 hours 1 missed pill - take pill now even if means 2 together. Resume normal pill taking no extra precautions 2 missed pills - take pill now even if 2 together. Resume normal pill taking and use extra precautions (condoms) for 7 days if from first 7 tablets, need morning after pill if from last 7 tablets, run packs back to back.
64
Missed POP Pill
>3 hours overdue | 1 pill missed - take pill now and use extra precautions for next 48 hours
65
Post Coital Bleeding
Cervical causes: Ectropion (commonest cause) Vaginal: Vaginitis
66
Secondary Amenorrhoea
Menstruation has previously occurred by now stopped for consecutive 6 months FSH>20 in women 5 could be androgen secretion tumour
67
Polyurethan condoms
For people with latex allergy.
68
Physiological Change in Pregnancy
Hb Falls Prolactin inc, WBC, platelets ESR all rise BP falls in 2nd trim and then normal by term.
69
Sexual Offences Act
Rape as non consensual penetration of the vagina mouth or anus by a penis. Child under 13 cannot consent to sex
70
Endometriosis
Presence of endometrial like tissue outside the uterine cavity. Peak age presentation 40-44. Sx- Pelvic pain, infertility, dysmenorrhoea, dyspareunia Ix- laparoscopy Tx- COC, danazol, medroxyprogesterone acetate. IUS
71
Nutrition in Pregnancy
Folic acid 400mcg before conception and 12weeks Importance of Vit D No iron supplementation Risk of birth defects with too much Vitamin A
72
Pregnancy Dates
Term 37 -42 weeks Preterm before 37 weeks Postterm after 42 weeks.
73
COC pill harmful effects
VTE, MI, Stroke Breast cancer Cervical cancer
74
Metorrhagia
Normal volume of menstrual flow at irregular intervals
75
Menometrorrhagia
Frequent and excessive flow
76
Polymenorrhoea
Bleeding at intervals less than 21 days
77
Pregnancy Test
OTC testing will become +ve 9 days post conception until about 20 weeks
78
Goserelin
GnRH agonist Used to suppress production of sex hormones (oestrogen and testosterone) Used to tx hormone sensitive cancers like breast and prostate.
79
HB in Pregnancy
Anaemia defined as Hb
80
Gravida
Total number of times a women has been pregnant including the present one. Twins or triplets still counted as one.
81
Para X+Y
X- Number of pregnancies beyond 24 weeks (twins count as one, still birth over 24 weeks count as one) Y- No. of losses before 24 weeks (terminations, abortions, ectopic).
82
Breast Cancer Screening
Mammogram every 3 years for women 50-70
83
Cervical Cancer Screening
Every 3 years between age 25-49 | Every 5 years for age 50-64.
84
Bowel Cancer Screening
Faecal occult blood every 2 years between 60-74
85
UTI in pregnancy
Nitrofurantoin safe except at term Penicillins and cephalosporins also safe Trimethoprim has a teratogenic risk in 1st trimester Sulphonamides - interfere with bile conjugating Quinolones and tetracyclines - stain developing bone and teeth.
86
Bishop Score
``` Pre labour scoring to help decided if induction needed Max score of 10. 9 labour most like to start itself PEDSS Position of cervix Effacement or length of cervix Dilation of cervix Softness or consistency of cervix Station of the foetus ```
87
HCG Levels
Detectable at day 11 Peak at 10-12 weeks. rise again at 22weeks until term Remain +ve 5 days after miscarriage High in trophoblastic disease

Reproductive Health (1 decks)

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