General Gynae Flashcards

Question

What are routine recommendations for reducing the risk of surgical site infections?

Answer 1

-Patient to wash day before or day of surgery -Consider nasal decolonisation alongside 2% ChlorHex if Staph aureus significant risk of infection -Do not routinely hair remove - if necessary then clippers on the day -Antibiotic prophylaxis if clean-contaminated or contaminated surgery -Use sutures over staples in C/S to reduce risk of wound infection -Use sterile saline 48 hours post op, then water OK to be used

Answer 2

-suspected or proven peripheral arterial disease -peripheral arterial bypass grafting -peripheral neuropathy or other causes of sensory impairment -any local conditions in which anti-embolism stockings may cause damage – for example, fragile 'tissue paper' skin, dermatitis, gangrene or recent skin graft -known allergy to material of manufacture -severe leg oedema -major limb deformity or unusual leg size or shape preventing correct fit.

Answer 3

Consider stopping HRT and oestrogen containing contraceptives 4 weeks pre-op for elective procedures to reduce VTE risk

Answer 4

Risk assess If high risk - 7 days LMWH or Fondaparinux If cancer - 28 days LMWH

Answer 5

In absence of secondary sexual characteristics - age 14 (more likely to be endocrine) If secondary sexual characteristics - age 16 (more likely to be anatomical)

Answer 6

Obstructed HemiVagina Ipsilateral renal agenesis Normal menarche - normally present age 15/16 Gradually increasing pelvic pain, mass arising from pelvis

Answer 7

Endometriosis is an important cause of infertility, with a prevalence of 25–40% in infertile women, compared with 0.5–5% in fertile women

Answer 8

Oxidized regenerated cellulose

Answer 9

Section 2 - assessment, detain 28 days 2 x doctors and AMHP Section 3 - treatment, 6 months 2 x doctors and AMHP 5(2) - holding power, by a single doctor for up to 72 hours 5(4) - holding power, by a nurse for up to 6 hours Section 135 - public officers into a home Section 136 - public officers from public space

Answer 10

If over 45 and otherwise healthy, then diagnose on symptoms alone: -perimenopause based on vasomotor symptoms and irregular periods -menopause in women who have not had a period for at least 12 months and are not using hormonal contraception -menopause based on symptoms in women without a uterus. Do not use: anti-Müllerian hormone inhibin A inhibin B oestradiol antral follicle count ovarian volume. Don't use FSH if woman is taking combined contraception or high dose progestogen If under 45, then consider use of FSH Need 2 x samples 8-12 weeks apart

Answer 11

Unscheduled vaginal bleeding is a common side effect of HRT within the first 3 months of treatment but should be reported at the 3-month review appointment, or promptly if it occurs after the first 3 months Will need TVUS +/- biopsy

Answer 12

-Refer to expert - Do not prescribe SSSRI in women on Tamoxifen

Answer 13

VTE -Increased risk of VTE with oral HRT than baseline risk -This is negated by transdermal HRT - offer to those with risk factors including BMI >30 Cardiovascular -HRT does not increase risk of cardiovascular disease risk when started in those under 60 -does not affect risk of dying from CVD -Oral Oestrogen is associated with a small increase in risk of stroke (but background risk is low) Breast Ca - Oestrogen only HRT is associated with little or no change in the risk of breast cancer -Combined HRT can be associated with an increase in the risk of breast cancer, more likely with prolonged use >5 years - Any increase in the risk of breast cancer is related to treatment duration and reduces after stopping HRT. Type 2 DM - No association with T2DM or sugar control Osteoporosis -Risk of fragility fracture reduced whilst on HRT

Answer 14

Indications for Transdermal Therapy Individual preference Poor symptom control with oral GI disorder affecting oral absorption Previous or family history of VTE BMI >30 Variable blood pressure control Migraine Current use of hepatic inducing enzymes medication Gall bladder disease

Answer 15

Do not prescribe hormone replacement therapy (HRT) in women with: Current, past, or suspected breast cancer. Known or suspected oestrogen-dependent cancer. Undiagnosed vaginal bleeding. Untreated endometrial hyperplasia. Previous idiopathic or current venous thromboembolism (deep vein thrombosis or pulmonary embolism), unless the woman is already on anticoagulant treatment. Active or recent arterial thromboembolic disease (for example angina or myocardial infarction). Active liver disease with abnormal liver function tests. Pregnancy. Thrombophilic disorder.

Answer 16

Produces light that can be transmitted through fiberoptic systems The zone of damage produced by the incident beam of a Nd:YAG laser causes a homogeneous zone of thermal coagulation and necrosis up to 4 mm deep and lateral from the surface, making precise control difficult/ This laser is an excellent surgical instrument with which to perform tissue coagulation of large volumes of tissue - less good at vaporisation/incision

Answer 17

Double dose of progestogen Represcribe sequential if newly on continuous HRT

Answer 18

Cefuroxime + Metronidazole Co-Amox Clinda + Gent/ Quinolone BUSY SPR states Gent + Metro During the hour before skin incision Repeat dose if blood loss >1500mls or 3 hours intra op

Answer 19

The ureter can be identified at the pelvic brim where it crosses the iliac vessels at their bifurcation. It continues below the infundibulo-pelvic ligament on the posterior medial leaf of the broad ligament, and crosses under the uterine vessels before turning anterior and medially to enter the bladder.

Answer 20

Primary resection (normally segmental) and repair Easier to identify areas of damage with diathermy - with monopolar there is higher risk of lateral spread Injury from verses not always repaired Primary closure in two layers using 3/0 Vicryl or PDS is sufficient for majority of small bowel injuries Non-thermal injury Bowel injury is less than 2 cm can be repaired transversely or longitudinally, although transverse closure to reduce the risk of stenosis is recommended When the injury is more than 2 cm, it should be repaired transversely When laceration is more than half of the diameter of the lumen, or when mesenteric blood supply is involved (regardless of the length of laceration), segmental resection and anastomosis is indicated.

Answer 21

In general - don't delay Increased risk to mother and foetus from non-operation (in appendicitis) than from operation Laparoscopic surgery safe - most evidence for this in second trimester In first trimester - normal entry then operate at 12mmHg If risk of preterm birth, consider steroids Don't instrument uterus Consider port placement based on gravid uterus Ovarian cysts can generally be managed conservatively unless torted

Answer 22

8 years (after death) 25 years in maternity CTGs - forever

Answer 23

Black cohosh & isofalvones (but poor evidence) No evidence to support: St John's Wort, Ginseng, Vitamin E (can be harmful) and Kava Kava (causes liver damage)

Answer 24

-Chromosome analysis (to look for Turners or Y chromosome), Fragile X -Endocrine: Thyroid, 21-OHAb (if immune suspected)

Answer 25

Risks Cognition - HRT Bone Health - Exercise and diet, Calcium, Oestrogen/COCP Cardiovascular - HRT, annual monitoring of BMI and smoking Sexual - Oestrogen, may require topical, counsel regarding Testosterone, lubricants Fertility - spontaneous conception can still occur, oocyte donation and IVF Pregnancy - If turners or post anthracycle chemo these will be high risk, need echo + consultant led care HRT: -Not been found to increase Breast Ca in pre-menopausal use -17β-estradiol is preferred to ethinylestradiol or conjugated equine estrogens -Use progestogen alongside

Answer 26

Puberty should be induced or progressed with 17β-estradiol, starting with low dose at the age of 12 with a gradual increase over 2 to 3 years. Transdermal oestrogen is preferred, start progestogens after 2 years or when breakthrough bleeding COCP is contraindicated for induction

Answer 27

Ethnicity - higher African-americans and hispanic than caucasian Smoking Socio-economic - higher rates in more deprived populations No correlation with age of menarche

General Gynae Flashcards

(51 cards)