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Gynae Flashcards

(47 cards)

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1
Q

Mechanism of POP

A

Thickens cervical mucus

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2
Q

Mechanism of injection

A

Prevents ovulation

Thickens mucus

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3
Q

Mechanism of IUD

A

Decreases sperm motility and survival

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4
Q

Mechanism of IUS

A

Prevents endometrial proliferation

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5
Q

COCP missed pill

A

Take ASAP even with next one
Miss two - take as soon as remember but use condoms for 1 week
7-day condom rule for d/v

Emergency contraception if two missed from first 7

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6
Q

Contraindications to COCP

A 
Smoker over 35
Migraine with aura
Current cancer 
History of VTE 
Stroke and TIA 
HCC
Major surgery with prolonged immobilisation 
BP 160/95
Breastfeeding
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7
Q

POP Window

A

3 hours

Cerazette - 12 hours

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8
Q

Time until effective

If not first day of period

A

Instant: IUD
2 days : POP
7 days: COC, injection, implants, IUS

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9
Q

Emergency contraception things to ask

A
  1. Details of unprotected sex
  2. Current contraception?
  3. Menstrual history
  4. Any chance that they could already be pregnant?
Discuss reasons 
Future contraception 
Risk of STIs
Leaflet 
3 week follow up and pregnancy test 
Next period may be early or late 
Seek attention for lower abdominal pain
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10
Q

Levonelle

A

1.5mg levonorgesterol
Prevents ovulation and disrupts implantation

Within 3 days

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11
Q

EllaOne

A

30mg ulipristal acetate

Inhibits ovulation and thins endometrium

Contra indicated in under 18 year olds

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12
Q

Gynae history aspects

A 
Menstrual history 
Vaginal bleeding 
Pain 
Discharge 
Sexual history 
Obstetric history
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13
Q

Mechanism of action of COCP

A

Inhibits ovulation
Increases cervical mucus
Thins endothelium

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14
Q

Vaginal discharge differentials

A 
Physiological discharge 
STI 
Non-STI - candida/thrush and BV 
PID 
Foreign body 
Genital tract malignancy
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15
Q

Bacterial vaginosis diagnosis

A

KOH whiff test
pH >4.5
Saline wet-mount

Clue cells and absent leukocytes

Gardenerella

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16
Q

Bacteria vaginosis treatment

A

Metronidazole

400-500mg BD 5-7 days
Or 2g one dose

Vaginal gel

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17
Q

Normal pH of vagina

A

3.8 - 4.2

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18
Q

Candidiasis diagnosis

A

PH

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19
Q

Candidiasis treatment

Study These Flashcards
A

Topical clotrimazole
Oral fluconazole

Pregnant - only use topicals

Resistant try topical nystatin

May need prophylaxis

20
Q

Treatment of genital warts

Study These Flashcards
A 
Podophyllia paint 
Podophyllotoxin cream 
Cryocauterisation
Surgery 
Laser therapy
21
Q

HPV strands

Study These Flashcards
A

6/11 - warts

16/18 - cervical cancer

22
Q

Order of swabs

Study These Flashcards
A
  1. High vaginal charcoal - BV, TV, Candida, group b strep
  2. Endocervical gonorrhoea - charcoal
  3. Endometrial chlamydia
23
Q

Long term complications of pelvic inflammatory disease

Study These Flashcards
A

Infertility
Chronic pid
Ruptured TOAs
Ectopics

24
Q

Causes of post coital bleeding

Study These Flashcards
A

Cervical polyp
Cervical ectropion
Cervical cancer

STIs

25
Causes of post menopausal bleeding
Endometrial cancer Atrophic vaginitis Endometrial hyperplasia
26
Intermenstrual bleeding differentials
Ectopic Spontaneous abortion Sexually transmitted infections
27
Management of stress incontinence
Conservative Pelvic floor muscle training - for at least 3 months Surgical - tapes/colposuspension
28
Management of urge incontinence
Bladder retraining Antimuscarinics Sacral nerve stimulation
29
Amenorrhoea differentials
``` Primary Pregnancy Drug-induced PCOS hyper/hypothyroid Hypogonadotropic hypogonadism (hypothalamic) Menopause Hypperprolactinaemia Premature ovarian failure Sheehans Ashermans ```
30
Fibroid symptoms
``` May be asymptomatic Menorrhagia Lower abdominal pain Bloating Urinary symptoms Sub fertility ```
31
Ectopic pregnancy management
Small and unruptured - methotrexate IM. (Serial b-hcg measurements) Surgical - for haemodynamically unstable. Salpingectomy vs conservative. Can be laparoscopic,
32
Risk factors for ectopic pregnancy
``` Previous ectopic pregnancies Pelvic inflammatory disease Prior tubal surgery IUD Increasing age Smoking ```
33
Causes of cervical excitation
PID | Ectopic
34
Cervical cancer screening ages
25 - 49 every 3 years | 50 -64 smear every 5 years
35
Cervical ectropion
Squamocolumnar Junction extends under hormonal influence COCP, pregnancy, puberty
36
Incontinence history taking
Onset frequency nocturnal amount urge stress pads access Urological hx for men - start middle and end of urination Obstetric - prolapse, parity and delivery, menopause Red flags: haemturia, pain, fever, bone pain, weakness, constipation Ice Sh - fluid type and intake, effect on life
37
Causes of stress incontinence | Management
Cause - weak, damaged pelvic floor Management - pelvic floor muscle training (atleast 3 months) Surgical - tapes
38
Causes of urge incontinence | Management
Detrusor over activity, BPH, prostate cancer, autonomic neuropathy, infection, stool impaction Management - bladder retraining Antimuscarinics Sacral nerve stimulation Conservative methods - lifestyle
39
Meigs syndrome
Benign ovarian tumour and ascites and pleural effusion (transudate)
40
PCOS features
Hyperandrogenic chronic anovulation ``` Hirsutism Obesity Acanthosis nigricans Sub/infertility Menstrual disturbance ```
41
PCOS investigations
FSH LH prolactin TSH testosterone Glucose tolerance LH:FSH ratio raised: Prolactin normal or mildly raised Testosterone - normal or mildly raised
42
Premature ovarian failure definition
Cessation of menses for 1 year, onset of menopausal symptoms and elevated gonadotropin levels before 40 ``` Causes : Idiopathic Radiation Chemotherapy Autoimmune ```
43
Suspected ovarian cancer investigation
Ascites or a palpable mass - 2 weeks No mass/ascites - measure ca-125 If >35 then do ultrasound abdo/pelvis and refer within 2 weeks
44
Sub fertility investigations
Semen analysis Mid-luteal progesterone in female
45
Male causes of sub/infertility
``` Testicular torsion Testicular trauma Bilateral undescended testes Chemo Mumps and orchitis STIs Retrograde ejaculation post TURP ```
46
Female causes of subfertility
``` Age Overweight Iatrogenic - pelvic surgery Ovulatary problems - PCOS thyroid Hyperprolactinaemia Premature menopause Hypothalamic Tubal pathology Uterine pathology ```
47
Male causes of sub fertility
``` Bilateral undescended Mumps STIs Retrograde ejaculation post TURP Testicular torsion Trauma ```

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