Gyneacology Flashcards
(296 cards)
1
Q
In an ectopic pregnancy what fetal size would be considered for expectant management
A
Ectopic size < 30mm
2
Q
In an ectopic pregnancy what fetal size would be considered for medical management with methotrexate
A
Ectopic size < 35mm
3
Q
In an ectopic pregnancy what fetal size would be considered for laproscopic salpingectomy or salpingotomy
A
Ectopic size ≥ 35mm
4
Q
In an ectopic pregnancy what serum hcg would be considered for laproscopic salpingectomy or salpingotomy
A
serum hcg ≥ 5000 iu/l
5
Q
In an ectopic pregnancy what serum hcg would be considered for medical management with methotrexate
A
Serum hcg < 5000 iu/l
6
Q
In an ectopic pregnancy what serum hcg would be considered for expectant management
A
serum hcg < 1500 iu/l
7
Q
CHLAMYDIA & GONORRHEA
STIs
A
CHLAMYDIA & GONORRHEA
STI
8
Q
What is the most prevalent STI in the UK?
A
Chlamydia
9
Q
What percentage of men are asymptomatic after initial infection with chlamydia ?
A
> 50% of men are asymptomatic
10
Q
What percentage of women are asymptomatic after initial infection with chlamydia ?
A
> 80% of women are asymptomatic
11
Q
What type of bacteria is chlamydia
A
Chlamydia is a obligate intracellular bacteria
12
Q
What age group has the highest rates of chlamydia infection?
A
Age 20 - 24 years has the highest rate of chlamydia infection
13
Q
According to SIGN guidelines, in symptomatic males with chlamydia infections, who is contact tracing done for?
A
Sexual partners in the past 1 month
14
Q
According to SIGN guidelines, in asymptomatic males with chlamydia infections, who is contact tracing done for?
A
Sexual partners in the past 6 months
15
Q
According to SIGN guidelines, in symptomatic females with chlamydia infections, who is contact tracing done for?
A
Sexual partners in the past 6 months
16
Q
According to SIGN guidelines, in asymptomatic females with chlamydia infections, who is contact tracing done for?
A
Sexual partners in the past 6 months
17
Q
What fraction of people who have sexual intercourse with an asymptomatic chlamydia partner will contract chlamydia?
A
2/3
18
Q
What percentage of people who have sexual intercourse with an asymptomatic chlamydia partner will contract chlamydia?
A
65%
19
Q
What is the gold standard for the detection of chlamydia by BASHH
A
NAAT
Nucleic Acid Amplification Test
20
Q
In the management of chlamydia infections in non pregnant adults and aged ≥ 13 years old, what is FIRST line?
A
Doxycyline 100mg po bd x 1/52
NICE guideline Feb 2025
21
Q
In the management of chlamydia infections in non pregnant adults and aged ≥ 13 years old, what is Second line?
A
Azithromycin 1gram stat
then 500mg po od x 2/7
NICE guideline Feb 2025
22
Q
In the management of chlamydia infections in non pregnant adults and aged ≥ 13 years old, what dosage of erythromycin is given?
A
Erythromycin 500mg po bd x 10 - 14/7
NICE guideline Feb 2025
23
Q
In the management of chlamydia infections in non pregnant adults and aged ≥ 13 years old, what dosage of ofloxacin is given?
A
Ofloxacin 200mg bd x 1/52
or
Ofloxacin 400mg od x 1/52
NICE guideline Feb 2025
24
Q
In the management of chlamydia infections which groups are Ofloaxcin contraindicated ?
A
- Pregnant women
- Children
- Growing adolescents
NICE guideline Feb 2025
25
In the management of chlamydia infections in pregnant women what dosage of Erythromycin is given?
Erythromycin 500mg po qid x 1/52
or
Erythromycin 500mg po bd x 2/52
NICE guideline Feb 2025
26
In the management of chlamydia infections in pregnant women what dosage of Amoxicillin is given?
Amoxiciliin 500mg po tds x 1/52
NICE guideline Feb 2025
27
In the management of gonococcal infections in pregnant women what dosage of Ceftriazone is given?
Ceftriazone 1g IM stat
BASHH
28
In the management of gonococcal infections in pregnant women what dosage of Spectinomycin is given?
Spectinomycin 2g IM stat
Mnemonic: specs like 2 lens in eyeglasses. Therefore 2grams
29
In the management of gonococcal infections in pregnant women what dosage of Azithromycin is given?
Azithromycin 2g po stat
30
In the management of uncomplicated anogenital and pharyngeal gonococcal infections in adults when is ceftriazone given
Ceftriazone is given when antimicrobial susceptibility is NOT known prior to treatment
BASHH
31
In the management of uncomplicated anogenital and pharyngeal gonococcal infections in adults when is ciprofloxacin given
ciprofloxacin is given when antimicrobial susceptibility is known prior to treatment and organism not resistant
BASHH
32
In the management of uncomplicated anogenital and pharyngeal gonococcal infections in non pregnant adults what dose of ciprofloxacin given
ciprofloxacin 500mg po stat
BASHH
33
In the management of uncomplicated anogenital and pharyngeal gonococcal infections in adults what dose of ceftriazone given
ceftriazone 1g Im stat
BASHH
34
Gonorrhea is primarily associated with uncomplicated infections of the lower genital tract, what % of men are symptomatic?
90%
Most men will show symptoms of genital gonorrhea
Source NICE 2024
35
Gonorrhea is primarily associated with uncomplicated infections of the lower genital tract, what % of women are symptomatic?
50%
Source NICE 2024
36
Gonorrhea is primarily associated with uncomplicated infections of the lower genital tract, what % of men are asymptomatic?
<10%
Source NICE 2024
37
Gonorrhea is primarily associated with uncomplicated infections of the lower genital tract, what % of women are asymptomatic?
50%
Source NICE 2024
38
What % of women will present with increased or altered vaginal discharge with uncomplicated endocervical gonorrhea infection?
50%
Source NICE 2024
39
What is the % tubal infertility rate following 1 episode of PID?
12%
40
What is the % tubal infertility rate following 3 episodes of PID?
50%
41
OVULATORY DISORDERS
PCOS
OVULATORY DISORDERS
PCOS
42
Inregards to treating a patient with PCOS, what is the maximum duration that Clomifene can be given?
Clomifene should not be given for more than 6 months
43
What is the FIRST line treatment(s) for infertility associated with PCOS?
1. Clomifene
2. Metformin
44
What is the SECOND line treatment(s) for infertility associated with PCOS?
1. Gonadotrophins
2. Laparoscopic ovarian drilling
45
Define WHO group 1 ovulatory disorders
This refers to hypothalmic pituitary failure.
Due to stress, anorexia or excessive exercise
46
Define WHO group 2 ovulatory disorders
Hypothalmic pituitary ovarian dysfunction as seen in PCOS
47
Define WHO group 3 ovulatory disorders
Refers to ovarian failure
48
According to NICE guidelines which WHO group will benefit from pulsative GnRH?
WHO group 1 people with hypothalmic pituitary disorder
49
What radiological feature is seen in early menopause/ ovarian failure?
The ovarian volumes will decrease to around 2 cm3
50
What biochemical feature is seen in early menopause/ ovarian failure?
1. low progesterone
2. high FSH and LH
51
What criteria is used to diagnose PCOS?
Rotterdam criteria
52
With regards to the diagnosis of PCOS using Rotterdam criteria, how many criteria must be present to make a diagnosis
Atleast 2 of the 3 must be present
53
With regards to the diagnosis of PCOS using Rotterdam criteria, how many criteria are present
3
54
With regards to the diagnosis of PCOS cite Rotterdam's criteria
1. Polycystic ovaries ≥12 peripheral follicles OR increased ovarian volume >10cm3
2. oligo ovulation or anovulation
3. Clinical and or biochemical signs of hyperandrogenism
55
What is oligo ovulation?
Oligoovulation refers to a condition characterized by infrequent or irregular ovulation, meaning the ovaries release eggs less frequently than normal
56
What is the typical biochemistry seen in PCOS
1. Elevated LH
2. LH:FSH ratio > 2
57
What endocrine disorders are associated with PCOS?
1. Hypothyroidism
2. Diabetes
58
What is the normal LH:FSH ratio
1:1
59
With regards to PCOS, what does the RCOG recommend for treating oligo or amenorrhea?
Gestogens or progestogens are given to induce a withdrawal bleed every 3 to 4 months
60
With regards to PCOS, according to RCOG how often should gestogens be given to induce a withdrawal bleed?
Gestogens or progestogens are given to induce a withdrawal bleed every 3 to 4 months
61
With regards to PCOS, what BMI would qualify for surgery according to RCOG
BMI ≥40
BMI ≥ 35 plus high risk obesity related condition
unit kg/m2
62
What are common causes of hyperprolactinemia?
1.Pituitary ademona
2. Medication such as antipsychotics
63
FIBROIDS
FIBROIDS
64
Why do fibroids undergo degeneration?
They outgrow their blood supply
65
List the 5 histological degenerations that are seen with fibroids
1. Hyaline
2. Myxoid / cystic
3. Red
4. Calcific
5. Sarcomatous
66
With regards to fibroids what is the most common histological degeneration seen?
Hyaline degeneration
67
With regards to fibroids what is the most common histological degeneration seen in pregnancy?
Red degeneration
68
With regards to fibroids what is the LEAST common histological degeneration feature seen?
Sarcomatous degeneration accounting for 0.1 - 0.8%
69
What percentage of white women have fibroids by the age of 50 years
Nearly 70% of
white women have fibroids by the age of 50 years
70
What percentage of black women have fibroids by the age of 50 years
> 80% of
black women have fibroids by the age of 50 years
71
List five risk factors for fibroids
1. Black ethnicity
2. Nulliparity
3. Early puberty
4. Increasing age from puberty to menopause
5. Obesity
72
List 2 protective factors for fibroids
1. Pregnancy
2. Increasing number of pregnancy
73
What % of white women will have fibroids by age 35 years
40%
source mrcog
74
What % of BLACK women will have fibroids by age 35 years
60%
source mrcog
75
GESTATIONAL TROPHOBLASTIC DISEASE
Partial vs complete mole
Choriocarcinoma
GESTATIONAL TROPHOBLASTIC DISEASE
Partial vs complete mole
Choriocarcinoma
76
In complete mole what phenotype is typically expressed?
46 XX
77
In partial mole what phenotype is typically expressed?
69 XXY
78
What % of choriocarcinomas occurs after a molar pregnancy?
70%
79
What % of choriocarcinoma occurs after a termination of pregnancy?
20%
80
What % of choriocarcinoma occurs after a normal pregnancy?
10%
81
What is the incidence in % of hyperthryoidism in complete molar pregnancy?
3%
82
What advice is given to women who are treated with chemotherapy for gestational trophoblastic disease re trying to concieve
Women are advised not to concieve for ONE year after completion of treatment.
RCOG green top 38
83
ADDITIONAL GTD QUESTIONS AFTER READING GREENTOP GUIDELINES #39
ADDITIONAL GTD QUESTIONS AFTER READING GREENTOP GUIDELINES #39
84
What is gestational trophoblastic disease?
GTD comprises a group of disorders spanning the premalignant conditions of complete and partial mole through to malignant conditions of invasive mole and choriocarcinoma
85
List the malignant conditions of Gestational Trophoblastic Disease
1. Invasive mole
2. Choriocarcinoma
3. Placental site trophoblastic tumour
4. Epithelioid trophoblastic tumour
86
What is Gestational trophoblastic neoplasia?
Evidence of persistence of Gestational trophoblastic disease after primary treatment.
Most commonly defined as a persistent elevation of hCG.
87
Regarding gestational trophoblastic disease list the conditions that need histological confirmation
1. Complete mole
2. Partial mole
3. Atypical PSN - Placental site nodule
4. PSTT
4. ETT
88
Molar pregnancy can be subdivided based on which two factors?
1. Genetic features
2. Histopathological features
89
With regards to complete mole, comment on the ploidy status
Diploid
Typically 46 XX
90
With regards to complete mole, comment on the fetal tissue
No evidence of fetal tissue
91
With regards to complete mole, explain what happens at fertilization in most cases
Duplication of a single sperm following fertilization of an empty ovum. 80%
92
With regards to complete mole, explain what happens at fertilization in 20% of cases
Dispermic fertilization of an empty egg
93
Regarding partial moles what ploidy status is commonly seen?
Triploid in 90%
94
90% of partial moles are triploid in origin.
Explain how this triploid is formed
Two sets of paternal haploid chromosome and one set of maternal haploid chromosome
95
With regards to partial mole, explain what happens at fertilization
Dispermic fertilization of an ovum
96
With regards to partial mole, comment on the fetal tissue
Evidence of fetus or fetal red blood cells
97
True or False
All triploid or tetraploid pregnancies are partial moles
False
98
What criteria must be met for a diagnosis of partial mole to be made regardless of ploidy status
Trophoblast hyperplasia on histopathology
99
List two risk factors for gestational trophoblastic disease (GTD)
1. Asian ethnicity
2. Extremes of age
<15 years old
> 50 years old
100
According to green top guidelines # 38, what is the incidence of GTD
1 in 714 live births
101
How does molar pregnancies common present?
1. Irregular vaginal bleed
2. Positive pregnancy test
3. Supporting ultrasonographic evidence
102
List 5 less common presentations of molar pregnancies
1. Hyperemesis
2. Excessive uterine enlargement
3. Hyperthyroidism
4. Early onset pre eclampsia
5. Abdominal distension due to theca lutein cyst
103
What are theca lutein cysts?
These are large bilateral cyst common seen in GTD
Due to overstimulation of the ovaries by high levels of hCG
104
List 2 rare presentation of molar pregnancy
Metastatic disease
1. Lung involvement with hemoptysis
2. Brain involvement with seizures
105
What symptom is most commonly seen in molar pregnancy
1. Vaginal bleed in 60% of presentation
106
With regards to molar pregnancy, which type of molar pregnancy is easier to diagnose with ultrasound
Complete mole
107
With regards to partial molar pregnancy, list 2 soft markers that are seen on ultrasound
1. Cystic spaces in the placenta
2. Ratio of transverse to anteroposterior dimension of the gestational sac > 1: 1.5
108
Comment on hCG levels with regards to molar pregnancy
Significantly higher levels.
109
List the histopathological features of a complete mole
1. Absence of fetal tissue
2. Extensive hydropic changes to villi
3. Excessive trophoblast proliferation
110
List the histopathological features of a partial mole
1. Presence of fetal tissue
2. Focal hydropic changes to villi
3. Excessive trophoblast proliferation
111
What is the method of choice for the removal of complete molar pregnancy?
Suction curettage
112
True or False
For complete moles suction removal is the method of choice for uterine removal irrespective of uterine size
True
113
With regards to complete moles, comment on the use of medical removal
This should be avoided if possible irrespective of the agents used.
114
Why is medical management avoided in complete mole?
The risk of developing GTN and requiring chemotherapy is higher with medical removal compared to surgery
115
List 2 advanatges of ultrasound guidance during suction curettage
1. Minimize the chance of perforation
2. Ensure maximal tissue removal
116
What is the method of choice for removal of a partial molar pregnancy?
1. Suction curettage
117
Suction curettage is the method of choice for removal of a partial molar pregnancy.
When is this inappropriate?
Size of fetal parts deters the use of suction curettage
118
In the management of a partial molar pregnancy the size of the fetal parts make suction curettage inappropriate.
What other option is available?
Medical management.
Typically with agent such as methotrexate
119
With regards to twin pregnancies involving co-existing molar pregnancy when can medical removal be used?
1.Non molar pregnancy + molar pregnancy + termination decided + fetal parts deters the use of suction curettage
2. Molar pregnancy + demise of co existing twim + fetal parts deters the use of suction curettage
120
Comment on the routine use of potent oxytocic agents in the management of GTD.
This is not encouraged.
There is a risk of embolization of trophoblastic tissue to the lungs leading adult respiratory distress syndrome.
121
The routine use of potent oxytocics in the management of GTD have the risk of embolization of trophoblastic tissue to the lungs leading adult respiratory distress syndrome.
What can cause a similar presentation?
Amniotic fluid embolism
122
What is the % risk of the need for treatment for GTN when medical methods are used to manage complete molar pregnancies?
13 - 16%
123
What is the % risk of the need for treatment for GTN when medical methods are used to manage partial molar pregnancies?
0.5 - 1.0 %
124
Is Anti D prophylaxis needed for complete molar pregnancy?
No
125
Comment on the rationale for the decision regarding Anti D prophylaxis and complete molar pregnancy?
Not required because poor vascularizaton of the chorionic villi and absence of the D antigen on trophoblast.
126
Is Anti D prophylaxis needed for partial molar pregnancy?
YES
127
Comment on the rationale for the decision regarding Anti D prophylaxis and partial molar pregnancy?
Due to the presence of fetal red blood cells with D antigen
128
What is the time line in which anti D prophylaxis can be given for partial molar pregnancy according to RCOG
Within 72 hours
129
In the surgical management of molar pregnancies, is cervical preparation prior to uterine removal safe?
Yes
130
In the surgical management of molar pregnancies, what methods of cervical preparation can be used?
1. Physical dilators
2. Prostaglandins
131
What is another name for ripening of the cervix?
Cervical preparation
132
True or False
In the surgical management of molar pregnancies the use of oxytocic infusion prior to completion of the removal is not recommended
True
133
In normal pregnancies, when can trophoblastic tissue be embolized?
During placenta abruption when uterine activity is increased
134
Explain the mechanism for trophoblastic tissue embolization?
The contraction of the myometrium may force tissue into the venous space at the site of the placental bed
135
When can oxytocic infusions be used in the management of molar pregnancies?
1. Life threatening hemorrhage
2. Ongoing bleeding
136
In the surgical management of molar pregnancies, when is a repeat surgery done?
1. Presistent heavy vaginal bleed
2. Repeat evidence of retained pregnancy tissue on ultrasound
137
What methods can be used to preserve fertility in women with heavy bleeding with prior surgical management for GTD
1. Ballon tamponade
2. Uterine artery embolization
138
In the surgical management for GTD, how can bleeding from vaginal metastases be handle?
Compression from a vaginal pack
139
When would pregnancy tissue be sent for histological assessment for women who have medical or surgical management of miscarriages?
If no fetal parts are identified at any stage of the pregnancy
140
When would pregnancy tissue NOT be sent for histological assessment for women who have medical or surgical management of miscarriages?
If fetal parts are identified at any stage of the pregnancy
141
Why is histological assessment done of fetal tissue for women who had medical or surgical management of miscarriages?
To exclude trophoblastic neoplasia
142
What is the recommendation regarding doing a pregnancy test for women who had medical or surgical management of miscarriages
Pregnancy test should be done 3 weeks after miscarriage
143
If a pregnancy test is found positive 3 weeks after treatment for miscarriage, what is the next step
Serum hCG levels should be tracked.
144
If a pregnancy test is found positive 3 weeks after treatment for miscarriage and serum hCG levels are rising.
What is the next step?
Arrange ultrasound to look for further pregnancy tissue
145
If a pregnancy test is found positive 3 weeks after treatment for miscarriage and serum hCG levels are falling.
What is the next step?
No intervention
146
When would pregnancy tissue NOT be sent for histological assessment for therapeutic abortions ?
Fetal parts have been identified:
1. At the time of surgical abortion
2. Prior ultrasound examination
147
What is the recommendation regarding doing a pregnancy test after therapeutic abortions?
Should be done 3 weeks after the procedure
148
What tumours are low levels rise in serum hCG associated with?
1. Malignant female germ cell tumours
2. Epithelial Caners
149
What epithelial tumours are low levels rise in serum hCG associated with?
1. Breast
2. Lung
3. Bladder
4. Gastric
5. Colorectal
150
Which women are at risk of developing GTN after after a pregnancy event?
If persistent vaginal bleed
151
What is the cut off period to investigate persistent or irregular vaginal bleed after a pregnancy event?
> 8 weeks after pregnancy event
152
List the pregnancy events that GTN can occur after?
1. Miscarriage
2. Therapeutic abortion
3. Term pregnancy
153
What is the most common presenting symptom of GTN?
Vaginal bleeding
154
True or False
It is uncommon < 1% for GTN to develop if normal HCG (urine or serum) within 8 weeks of removal of a molar pregnancy
True
155
Comment on the prognosis of GTN that develops after normal pregnancy
Generally worse prognosis
156
Explain why the prognosis of GTN that develops after normal pregnancy is generally worse.
1. Usually delay in diagnosis
2. Advanced disease such as liver or CNS disease at presentation
157
How should ectopic pregnancy suspected to be molar in nature managed?
Follow ectopic pregnancy management
158
True or False
Ectopic molar present is not a rare event
False
Ectopic molar present is a rare event
159
True or False
The symptoms and signs of ectopic molar pregnancy is the same as any other ectopic pregnancy
True
160
The features of an early complete ectopic pregnancy can be confused with what?
Choriocarcinoma
161
With regards to molar pregnancies when can prenatal invasive testing for fetal karyotype done?
Prenatal invasive testing for fetal karyotype should be done if it is unclear
1. If the pregnancy is a complete mole with a coexisting normal twin
OR
2. Singleton partial molar pregnancy
162
Prenatal invasive testing for fetal karyotype done can be done in diagnostic uncertainty for molar pregnancy.
When else can it be done?
Abnormal placenta
163
What is the risk factors associated with twin pregnancy of a viable fetus and coexisting molar pregnancy
1. Increased risk of early fetal loss 40%
2. Premature birth 36%
3. Pre eclampsia
164
What are PSTT and ETT?
Rare forms of GTD
165
How is Placental site trophoblastic tumour and Epithelioid trophoblastic tumour diagnosed?
Histological examination of retained pregnancy tissue
166
In localised disease of Placental site trophoblastic tumour and Epithelioid trophoblastic tumour, what treatment is curative?
Hysterectomy
167
In the management of Placental site trophoblastic tumour and Epithelioid trophoblastic tumour when does intensive chemotherapy play a role?
1. Long time period since the antecedent pregnancy
2. Distant or extensive metastatic disease
168
How is atypical placental site nodules be managed?
Review and further investigations by GTD center
169
How is typical placental site nodules be managed?
NO further investigations or reviews needed
170
What placenta nodules are associated with cancers (PSTT or ETT)?
Atypical placental site nodules
May occur in 10 - 15% of women
171
How does atypical placental site nodules usually present?
Vaginal bleeding
172
Regarding follow up for complete moles, how long is follow up?
6 months
173
In complete molar pregnancy if the hCG HAS reverted to normal within 56 days of the pregnancy event, what is next?
Follow up will be for 6 months from the date of uterine removal
174
In complete molar pregnancy if the hCG has NOT reverted to normal within 56 days of the pregnancy event, what is next?
Follow up will be for 6 months from the date from normalization of the hCG levels
175
True or False
Re complete moles
If the hCG has returned to normal within 56 days of the pregnancy event, then follow up for 6 months from uterine evaculation
True
176
True or False
Re complete moles
If the hCG has NOT returned to normal within 56 days of the pregnancy event, then follow up for 6 months from normalization of the hCG
True
177
What is the criteria for follow up for Partial mole?
Follow up concluded once the hCG has returned to normal on two samples atleast 4 weeks apart
178
True or False
The incidence of GTD in a subsequent pregnancy is very low if NO chemotherapy for a prior molar pregnancy.
True
179
RETURN!
180
CONTRACEPTION part 1
CONTRACEPTION part 2
181
What effects does combined oral contraception have on serum FSH
Reduced
Patient on cocp will have low serum fsh
182
What effects does combined oral contraception have on serum LH
Reduced
Patient on cocp will have low serum LH
183
What effects does combined oral contraception have on serum estradiol
Reduced
Patient on cocp will have low serum estradiol
184
How does combined oral contraception lower serum estradiol
COCP contain estradiol and progestins.
Progestin have a negative feedback on the HPO axis decreasing GnRH and subsequently FSH and LH
Estradiol also have a negative feedback on FSH
NO FSH = NO follicile development and LOW serum estradiol
185
How does combined oral contraception lower serum FSH
COCP contain estradiol and progestins.
Progestin have a negative feedback on the HPO axis decreasing GnRH and subsequently FSH and LH
Estradiol also have a negative feedback on FSH
186
How does combined oral contraception lower serum LH
COCP contain estradiol and progestins.
Progestins have a negative feedback on the HPO axis decreasing GnRH and subsequently FSH and LH
187
What is antimullerian hormone?
Antimullerian hormone is produced by follicles in the ovaries. Measurement can indicate ovarian reserve.
188
How does combined oral contraceptive pills affect antimullerian hormone
Levels are not significanlty changed (passmrcog)
Levels can be reduced as less follicles are developed (google)
189
What is the effect of the combined oral contraceptive pill on ovarian androgen synthesis
Reduced
190
What is the effect of the combined oral contraceptive pill on adrenal androgen synthesis
Reduced
191
How does the combined oral contraceptive pill reduce ovarian androgen synthesis
Reduced LH secretion results in decrease ovarian synthesis of androgen
192
What is the effect of the combined oral contraceptive pill on sex hormone binding globulins
Increase production
193
How does the combined oral contraceptive pill increase sex hormone binding globulins levels
The estrogen in COCP stimulate the liver to produce more sex hormone binding globulins
194
List the FIVE ways the combined oral contraceptive pill reduce hyperandrogenism
1. decrease ovarian synthesis of androgens
2. decrease adrenal synthesis of androgens
3. increase production of sex hormone binding globulin
4. inhibition of peripheral conversion of testosterone to dihydrotestosterone
4. reduce binding of dihydrotestosterone to androgen receptors.
195
What dose of levenogestrel / levonelle is given for emergency contraception
1.5mg po stat
given as a single dose
196
levenogestrel / levonelle can be given up to ________ hours of unprotected sex for emergency contraception
72 hours
197
With regards to the emergency contraception levenogestrel / levonelle, if vomiting occurs when is the dose repeated given?
Repeated dose given if vomiting occurs with TWO hours of taking levonelle
198
With regards to the emergency contraception ulipristal/ ellaone if vomiting occurs when is the dose repeated given?
Repeated dose given if vomiting occurs with THREE hours of taking ulipristal
199
What is the emergency contraception levenogestrel / levonelle ?
Synthetic progesterone
200
How does the emergency contraceptive levenogestrel / levonelle work?
1. Delays or prevents ovulation
2. Thins the lining of the uterus making implantation unfavorable
201
What is the emergency contraception ulipristal / Ellaone?
It is a selective progesterone receptior modulator
In other words it binds to progesterone receptors
202
How does the emergency contraception ulipristal / Ellaone work?
1. Delays or prevents ovulation
2. Thins the lining of the uterus making implantation unfavorable
203
What dose of the emergency contraception ulipristal / Ellaone is given?
30mg po stat
204
The emergency contraceptive ulipristal / Ellaone can be given up to ________ days of unprotected sex
five days
205
The copper IUD for emergency contraceptive can be inserted up to ________ days of after unprotected sex
five days
206
List THREE options for emergency contraception
1. levenogestrel/ levenelle
2. Ulipristal / ellaone
3. Copper IUD
207
What drugs reduce the effectiveness of emergency contraceptions such as levenogestrel or ulipristal
P450 enzyme induces such as Phenytoin
208
If a patient is on an enzyme inducer such as Phenytoin what are the options for emergency contraception
1. Copper IUD
2. Increased dose of levenogestrel 3grams stat
209
In a patient taking the antiepileptic phenytoin, what UKMEC category is combined oral contraceptive pill
UKMEC 3
210
In a patient taking the antiepileptic phenytoin, what UKMEC category for progesterone only pill
UKMEC 3
Risks outweight the benefits of this method
211
In a patient taking the antiepileptic phenytoin, what UKMEC category for progesterone only implant
UKMEC 2
Benefits outweight the risks of this method
212
In a patient taking the antiepileptic phenytoin, what UKMEC category is the progesterone injectable medroxyprogesterone acetate
UKMEC 1
No restriction to using this method
213
In a patient taking the antiepileptic phenytoin, what UKMEC category is the progesterone injectable norethisterone enanthate
UKMEC 2
Benefits outweight the risks
214
In a patient taking the antiepileptic phenytoin, what UKMEC category is the levenogestrel IUS
UKMEC 1
No restriction to using this method
215
In a patient taking the antiepileptic phenytoin, what UKMEC category is the copper IUD
UKMEC 1
No restriction to using this method
216
What effects if any does combined contraceptives have on antiepileptics lamotrigine and sodium valproate
Combined contraceptives DECREASE the plasma concentration levels of antiepileptics lamotrigine and sodium valproate therefore
INCREASES seizure risk
How? The estrogen component decreases antiepileptic
217
Is lamotrigine a P450 liver enzyme inducer?
NO
218
Does lamotrigine affect the pharmokinetics of combined oral contraceptives?
NO
219
Does combined oral contraceptives affect the pharmokinetics of lamotrigine?
If so how?
YES
The estrogen component of COC reduce the plasma concentration of lamotrigine leading to risk of seizures
220
Regarding the concomittant use of lamotrigine and combined oral contraceptive what UKMEC category is it?
UKMEC 3
Risks outweigh benefits
221
MENORRHAGIA
MENORRHAGIA
222
According to NICE guidelines what is considered 1st line for treatment of menorrhagia
1. Levonorgestrel intrauterine system
example mirena
223
According to NICE guidelines what is considered 2nd line for treatment of menorrhagia
1. Tranexamic acid
2. NSAIDs such as Mefenamic acid
3. Combined oral contraceptive pill
4. Progestogens
224
According to NICE guidelines what is considered 3rd line for treatment of menorrhagia
1. Injected long acting progestogens
225
Considering the non pharmacological management of menorrhagia when is endometrial ablation considered
1. Menorrhagia has severe impact on the woman's life
2. No desire for future fertility
3. Small Fibroids < 3cm
226
Considering the non pharmacological management of menorrhagia, what treatment options are available for HMB associated with fibroids > 3cm
1. Uterine artery embolization
2. Myomectomy
3. Hysterectomy
227
Regarding hysterectomy and heavy menstrual bleed , what considerations should be weighted before hysterectomy is offerred
1. other treatment options have failed, contraindicated or declined
2. There is wish for amenorrhea
3. Fully informed woman has requested it
4. No desire for future fertility
228
What is the average amount of menstrual blood loss per cycle
40mls
229
What is the maximum normal menstrual blood loss per cycle in mls
80mls
tip it is twice the normal blood loss per cycle 40mls x 2
230
TRICHOMONIASIS
TRICHOMONIASIS
231
What organism cause trichomoniasis?
Trichomoniasis vaginalis
232
What is Trichomoniasis vaginalis?
Flagellate protozoan
233
How is Trichomoniasis vaginalis transmitted?
Sexually transmitted
234
What % of women are asymptomatic with trichomoniasis infection?
Up to 50% are asymptomatic
source RCOG
235
In trichomoniasis a strawberry cervix occurs in what percentages of cases
A strawberry cervix occurs in only 2% of cases in trichominasis
236
What % of women with trichomoniasis present with a vaginal discharge?
70%
237
Of the 70% of women with trichomoniasis what percent presents with the classical green frothy discharge?
Only 20% of women present with the classical green frothy discharge
238
List six symptoms of trichomoniasis EXCLUDING vaginal discharge
1. vulvovaginal soreness
2. vulvovaginal itching
3. dysuria
4. dyspareunia
5. lower abdomial pain
6. offensive odour
239
How is trichomoniasis diagnosed?
1. Wet smear microscopy
2. Culture
3. PCR
240
What is the treatment for trichomoniasis in breastfeeding and symptomatic pregnant women?
Metronidazole 400mg po bd x 1/52
241
What is an alternative for treating trichomoniasis apart from the one week treatment for nonpregnant or breastfeeding?
Metronidazole 2grams stat
242
Is high dose metronidazole 2g stat recommended for treating pregnant and breastfeeding women?
NO
243
How is trichomoniasis treated in both pregnant and nonpregnant women with HIV?
Metronidazole 500mg po bd x 1/52
244
BACTERIAL VAGINOSIS
BACTERIAL VAGINOSIS
245
What is the most common cause of abnormal vaginal discharge in women of child bearing age?
Bacterial vaginosis
246
Describe the vaginal pH in bacterial vaginosis
Alkali pH> 4.5
247
List THREE criteria that can be used to diagnose bacterial vaginosis
1. Amsel criteria
2. Nugent criteria
3. Hay - Ison criteria
248
What is the Amsel criteria?
Used in the diagnosis of bacterial vaginosis.
Atleast 3 of the 4 must be present to make a diagnosis
1. Thin gray white homogenous discharge
2. Fishy odour when 10% KOH added
3. Clue cells on microscopy
4. Vaginal pH > 4.5
249
What is the Nugent criteria?
A scoring system used to diagnose bacterial vaginosis based on the gram stain of vaginal fluid.
Scored based on the abundance of lactobacillus, gardnerella and mobiluncus morphotypes in microscope field
Score 7 - 10 indicating bacterial vaginosis
250
In bacterial vaginosis __________ is replaced with ______________ or _____________
In bacterial vaginosis *lactobacillus is replaced with *gardnerella or *mobiluncus
251
What type of bacteria is garnerella?
anerobic gram variable rod
252
What type of bacteria is lactobacillus?
large uniform gram positive rod
primarily known as facultatively anaerobic or microaerophilic bacteria, meaning they can survive in the presence or absence of oxygen, but prefer anaerobic environments.
253
What is mobiluncus species?
curved gram variable rod
254
What is Hay - Ison criteria?
Used in the diagnosis of bacterial vaginosis based on microscopic findings
255
What is dianette licence to use for?
Severe acne and moderately severe hirsutisn
256
HORMONAL CONTRACEPTION part 2
HORMONAL CONTRACEPTION part 2
257
What is the Dianette / co-cyprindiol?
Cyproterone acetate and ethinyl estradiol
258
What is cyproterone acetate ?
This is an antiandrogen with progestin properties
259
What is Marvelon?
Desogestrel and Ethinyl estradiol
## Footnote
Mnemonic monty / marlon driving DIESELgestrel truck
260
What is the brand name for desogestrel and ethinylestradiol combination?
Marveol
261
Is it appropriate to use norethisterone combined oral pill combinations to treat ance?
Why?
NO.
Norethisterone is a FIRST generation progestin and have strong androgenic effects that will worsen acne
262
What is Norimin?
norethisterone and ethinylestradiol
263
What is the brand name for norethisterone and ethinylestradiol combination?
Norimin
264
What is norethisterone?
This is a first generation synthetic progesterone
265
What are the effects of progestins on the female body
1. Progestational effects
Help prevent ovulation and lessen monthly bleed
2. ANDROGENIC effects leading to unwanted side effects such as acne or hirsutism
266
What is desogestrel?
This is a third generation progestin
compared to 1st and 2nd generation progestins it would have fewer androgenic properties
267
What preparation is desogestrel sold as?
Cerazette
This is progesterone only tablet
268
Are progesterone only tablets such as cerazette which contain desogestrel used to treat ance?
And why?
NO, POP should not be usd to treat acne.
Progestins have androgenic effects therefore unopposed androgenic effects will lead to worsening of acne.
Acne is triggered by excess androgens.
269
What is norethisterone?
This is a first generation synthetic progesterone
270
What is the infertility rate in patients with endometrosis?
40%
271
What is the prevalence in % of endometriosis in women?
3- 10% source NICE
Therefore 3 - 10 per 100 women
272
What is stage 1 endometriosis by the revised American Society of Reproductive Medicine?
Superficial lesions and filmy adhesions
273
What is stage 2 endometriosis by the revised American Society of Reproductive Medicine?
Deep lesions at cul de sac
Space between uterus and bowel
274
What is stage 3 endometriosis by the revised American Society of Reproductive Medicine?
Stage 1 & 2 plus
ovarian endometriomas
An ovarian endometrioma, also known as a "chocolate cyst," is a fluid-filled cyst that forms on the ovary due to endometriosis, a condition where tissue similar to the uterine lining grows outside the uterus. These cysts are filled with old menstrual blood, giving them a dark, chocolate-like appearance. (google)
275
What is stage 4 endometriosis by the revised American Society of Reproductive Medicine?
Stage 1,2 &3 plus
extensive adhesions
276
A lady with diagnosed endometriosis presents with lower back pain and pain on opening her bowels (dyschezia), explain the pathophysiology of this
Endometriod deposits on the uterosacral ligament presents with lower abdominal and back pain, leg pain and dyschezia
277
With regards to endometrioid deposits on the uterosacral ligament, how does this present on pelvic examination?
Tender nodules which can be palpated during pelvic exam
278
ABORTION
ABORTION
279
At what gestational age should Anti D prophylaxis be given for medical abortion?
AFTER gestation 10 + 0 weeks
280
What prophylatic antibiotic is recommended for medical abortions?
Antibiotic prophylaxis is NOT routinely offered to women having medical abortion
281
What does NICE 2019 advice regarding timing of rhesus anti D immunoglobulins following abortion
Anti D IgG must be given AT TIME of abortion
282
What is RCOG advice regarding timing of rhesus anti D immunoglobulins following abortion
Anti D IgG given within 72 hours following abortion
283
According to NICE guidelines 'Abortion care' 2019 which group SHOULD recieve routine antibiotic prophylaxis for abortion
Surgical abortion
Offer antibiotic prophylaxis for surgical abortion
284
According to NICE guidelines 'Abortion care' 2019 which group should NOT recieve routine antibiotic prophylaxis for abortion
Medical abortion
DONOT offer antibiotic prophylaxis for meical abortion
285
According to NICE guidelines 'Abortion care' 2019 which antibiotic (s) can be given for prophylaxis in medical or surgical abortions
1. Doxycycline
2. Metronidazole
286
According to NICE guidelines 'Abortion care' 2019 which tetracycline class of antibiotic can be given for prophylaxis in medical or surgical abortions
Also state dose and duration
1. Doxycycline 100mg po bd x 3/7
287
According to RCOG what is the advice re Metronidazole as a antibiotic prophylaxis for surgical or medical abortion
Given before or at the time of infection for women tested negative for Chlamydia trachomatis
288
According to RCOG what dose of Metronidazole is adviced as a antibiotic prophylaxis for surgical or medical abortion
Metronidazole 800mg po stat
OR
Metronidazole 1g PR stat
289
True or False
According to NICE guidelines 'Abortion care' 2019 Metronidazole should be routinely combined with another broad spectrum antiotic for prophylaxis in abortion.
FASLE
290
GYNAE STATISTICS
GYNAE STATISTICS
291
Per 1000 pregnancies per year how many are molar pregnancies?
1 in 1000 pregnancies per year are molar
292
What is the incidence of choriocarcinoma in the UK?
1 in 50,000 pregnancies
293
What is the percentage cure rate for choriocarcinoma in the UK
98 - 100%
294
What % of choriocarcinoma occurs after molar pregnancy?
70%
295
What % of choriocarcinoma occurs after termination of pregnancy?
20%
296
What % of choriocarcinoma occurs after normal pregnancy?
10%
