which hormone increases greater than the others during pregnancy: - LH - FSH - oestrone - oestradiol - oestriol

oestriol - increases 1000 fold - least potent of three oestrogens oestrogen needed to control LH and FSH - stimulate & control placental growth

- haemolysis - elevated liver enzymes - low platelet count

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30 y/o

increasingly painful periods
ibuprofen useless
worsened on intercourse
adnexal tenderness

diagnosis:

first line IX:

endometriosis

IX: transvaginal USS

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turners syndrome is associated with what genotype:

45 XO

primary & secondary amenorrhoea due to premature ovarian failure
failure to develop secondary sexual characteristics

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Fragile X syndrome is what type of disorder:

X-linked dominant

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Which condition is associated with the following features:

narrow face
large ears
large testicles
significant mental retardation
developmental delay
men affected more

Fragile X syndrome

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which hormone increases greater than the others during pregnancy:

LH
FSH
oestrone
oestradiol
oestriol

oestriol

increases 1000 fold
least potent of three oestrogens

oestrogen needed to control LH and FSH
- stimulate & control placental growth

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classical marker of colorectal cancer

CEA

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POP is associated with increased risk of ectopic pregnancy.

what other method of contraception is also associated with this:

depo-provera
- progesterone only injectable contraceptive

side effects

weight gain
irregular bleeding
amenorrhoea

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most common type of vulval malignancy:

squamous cell carcinoma

peak age of incidence 60 years
vulval discomfort and itching

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classical triad of pre-eclampsia

proteinuria

hypertension

oedema

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recap symptoms of pre-eclampsia

frontal headache

blurring, flashing in vision

epigastric / upper abdo pain

vomiting

oedema : face hands and feet

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what is HELLP

haemolysis
elevated liver enzymes
low platelet count

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first line for pre-eclapmsia

labetalol

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complications of pre-eclampsia

DR COG

D- disseminated intravascular coagulation –> HELLP

R- renal failure

C- cerebral haemorrhage

O- oligohydraminos

G- growth restriction (intrauterine growth restriction)

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most common cause of bacterial vaginosis

gardnerella vaginalis

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Pelvic inflammatory disease is usually due to:

chlamydia or gonorrhoea infection

signs

bilateral lower abdo pain
deep dyspareunia
abnormal bleeding or discharge

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treatment for a patient with PID who is otherwise wel:

stat IM ceftriaxone

then 2 week course of doxycycline and metronidazole

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treatment for patient with PID who has severe disease, including pyrexia >38c

IV therapy

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54 y/o

pc: 3 day hx increased urinary frequency + urgency , urinary incontinence
pmh: T2DM, heavy drinker
obs: 104bpm, lower abdo discomfort , perineal sensation and anal tone are normal

likely cause of incontinence:

urinary tract infection

urge incontinence!
- overactive detrusor muscle

acute onset, mildly t.cardic, generalised lower abdo pain –> UTI most likely cause

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high risk factors for pre-eclampsia

personal history of pre-eclampsia
essential HTN
T1DM / T2DM
CKD
AUTOIMMUNE: antiphospholipid syndrome and SLE

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moderate risk factor for pre-eclampsia:

BMI > 35kg/m

FH of pre-eclampsia

> 40 in 1st -pregnancy

multiple pregnancy

interpregnancy interval of > 10 years

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Fluoxetine has licensed use in treatment of:

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hot flushes
severe menopausal symptoms
in patients with breast cancer

CONTRAINDICATED

if patient with history of breast cancer is receiving tamoxifen therapy
fluoxetine reduces efficacy of tamoxifen

patient with hx breast cancer.

dh: tamoxifen therapy

low mood, sleep disturbance secondary to hot flush

best management:

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cognitive behaviour therapy

accompanied by lifestyle modifications

regular exercise
weight loss if applicable
relaxation exercises
good sleep hygiene

urinary incontinence differential diagnoses:

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UTI

bladder carcinoma

pharmalogical treatment of urge incontinence

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antimuscarinics

- oxybutinin

pharamological treatment in stress incontinence

duloxetine - SSRI - 2nd line when conservative measures fail

duloxetine is contraindicated in patients with:

uncontrolled hypertension

17 y/o female - primary amenorrhoea - phenotypically female - absent uterus likely to have:

androgen insensitivity syndrome karyotype of 46 XY

first line treatment for lichen sclerosis:

high potency steroids such as clobestasol proprionate. 3 month trial of topical steroid then review.

if patient with lichen sclerosis fails to respond to first line tx of high potency steroid, what might be given next?

topical calcineurin inhibitors such as tacrolimus - immunosuppressant - inhibits secretion of IL-2 (so T cell proliferation inhibited) - reduces inflammation

first line tx for UTI in pregnancy

nitrofurantoin safe to use in pregnancy, should be avoided near term, don't use in breast feeding note: - trimethoprim contraindicated. - interferes with folate metabolism in first trimester

what causes microcytic anaemia:

iron deficiency anaemia

what would give rise to macrocytic anaemia?

- folic acid or b12 deficiency | - raised MCV

in a fit and well 39 week pregnant lady, the following findings are consistent with: - low Hb - normal MCV - normal platelets - normal WCC

dilutional anaemia of pregnancy - disproportional rise in plasma volume for RBC are diluted out

difference between urge and stress incontinence:

stress incontinence - weakening or damage of pelvic floor muscles urge incontinence - overactivity of detrusor muscle - anti-muscarinics: oxybutinin

ectopic pregnancies most common in:

ampulla HOWEVER - rupture more likely in isthmus because its narrower

what is placenta accreta?

- placenta grows into the myometrium rather than in decidua

40 y/o female - hot flushes - nausea - palpitations - sweatiness which is a recognised cause of premature menopause: a) addisons disease b) PCOS c) mutliparity d) recurrent miscarriage e) hyperthyroidism

addisons disease associated with premature ovarian failure

PCOS clinical presentation

PCOS PAL P-polycystic ovaries on USS C- cycles erratic O- obesity and hirustism S- subfertility P- prolactin A- androgens elevated L - LH elevated

3 weeks post partum, 31 y/o female requests contraception. breastfeeding. which method is most practical?

progesterone implant 4-6 weeks - barrier method - POP - progesterone implant - copper coil, IUS COCP contraindicated - risk of thromboembolism

sheehans syndrome is

- ishcaemic necrosis of anterior pituitary

difference between laparoscopic salpinectomy or laparocopic salingotomy

salpingectomy - removal of fallopian tube salpingotomy - removes only ectopic pregnancy - leaves fallopian tube in place - in attempt to preserve fertility

what is recommended for patients as prophylaxis for pre-eclampsia

aspirin 75mg daily

which is the earliest possible diagnostic test for downs syndrome?

11 weeks onwards - Chorionic villus sampling for karyotyping 15 weeks onwards - amniocentesis if baby high risk for downs 18-21 weeks - anomaly scan screening tests - nuchal translucency test - quadruple blood test (15-22 weeks)

bacterial vaginosis treatment

metronidazole 400mg twice a day for week

treatment of severe pre-eclampsia proteinuria with ongoing headache

magnesium sulphate

55 y/o obese post menopausal - voice deepened - severe hirsutism and clitoral enlargement - elevated testosterone - bilaterally enlarged, solid appearing ovaries - simple endometrial hyperplasia likely diagnosis

ovarian stromal hyperthecosis peripheral adipose tissue - conversion of androgen to oestrogen --> hyperoestrogenic state ---> endometrial hyperplasia

most common cause of cervical cancer:

human papillomavirus

which virus caused slapped cheek syndrome?

parovirus b19 commonly affects paeds general malaise + erythematous rash on cheeks

which hormone regulates development of male structures in womb

anti-mullerian hormone suppresses development of female structures

causes and risk factors of infertility

INFERTILE Idiopathic No ovulation, PCOS, menopause... Fibroids Endometriosis Regular bleeding pattern disrupted - oligo/amenorrhoea Tubal disease Increasing age > 35 Large size Excessive weight loss - anorexia nervosa

first line management for prolactinoma:

dopamine receptor agonist - cabergoline if conservative management fails then surgical excision

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