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O&G Flashcards

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1
Q

At how many weeks gestation should should anti-D prophylaxis be given if needed?

A

28 weeks

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2
Q

How long should women take folic acid for?

A

From the moment of trying until 12 weeks (400mcg) standard dose. 5mg if have risk factors

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3
Q

Define primary amenorrhoea

A

Not starting menstruation by the age of 13 with no other evidence of pubertal development
or
Age of 15 with other signs of puberty

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4
Q

Age what age are boys and girls considered to have precocious puberty?

A

Signs of puberty before 8 in girls and 9 in boys

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5
Q

What is Kallman syndrome?

A

Hypogonadotrophic hypogonadism and failure to start puberty. Associated with reduced/absent sense of smell

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6
Q

What is hypogonadism?

A

Lack of oestrogen and testosterone

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7
Q

What are the 2 types of hypogonadism?

A

Hypogonadotropic - deficiency of LH and FSH
And
Hypergonadotropic - testes and ovaries do not respond to LH and FSH

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8
Q

What can cause hypogonadotropic hypogonadism?

A
  • Abnormal functioning of hypothalamus or pituitary gland
  • Chronic conditions such as CF and IBD
  • Endocrine disorders such as GH deficiency, hypothyroidism, Cushing, hyperprolactinaemia
  • Kallman syndrome
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9
Q

What can cause hypergonadotrophic hypogonadism?

A
  • Abnormal functioning of gonads (torsion, cancer, infection)
  • Congenital absence of ovaries
  • Turner syndrome
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10
Q

Which enzyme is deficient in congenital adrenal hyperplasia?

A

21 hydroxylase enzyme

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11
Q

What is the pathophysiology of amenorrhoea in congenital adrenal hyperplasia?

A

21 hydroxylase enzyme deficiency = no cortisol = increased ACTH from pituitary = increased production of adrenal androgens = primary amenorrhoea

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12
Q

Features of congenital adrenal hyperplasia?

A

Girls are:

  • Tall for age
  • Facial hair
  • Deep voice
  • Early puberty
  • Primary amenorrhoea
  • Ambiguous genitalia
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13
Q

What is androgen insensitivity syndrome?

A

Tissues are unable to respond to testosterone, so typical male characteristics do not develop. Results in female phenotype in males

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14
Q

Features of androgen insensitivity syndrome?

A

Female external genitalia

  • Breast tissue
  • Testes in abdomen
  • Absent uterus, upper vagina, fallopian tubes, ovaries
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15
Q

What are the 3 components of the Rotterdam criteria? How many are needed for a diagnosis?

A

1) oligomenorrhoea
2) symptoms of hyperandrogenism (hirsutism, acne)
3) polycystic ovaries on US

At least 2/3 is needed for PCOS

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16
Q

Presentation of PCOS?

A
  • Oligomenorrhoea/amenorrhoea
  • Hirsutism and acne
  • Male pattern hair loss
  • Obesity
  • Infertility
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17
Q

What drug can be given to aid infertility in PCOS?

A

Clomifene

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18
Q

What other features and complications are seen in PCOS?

A
  • Diabetes
  • Acanthosis nigricans
  • CVD
  • Hypercholesterolaemia
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19
Q

What can be given to help symptoms of acne and hirsutism?

A

COCP

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20
Q

How long is Levonorgestrel licensed for use as emergency contraception?

A

Up to 72hrs after UPSI

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21
Q

How long is EllaOne licensed for use as emergency contraception?

A

Up to 5days after UPSI

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22
Q

How long do you have to wait before returning to normal contraception after taking levonorgestrel?

A

Restart within 12 hours

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23
Q

How long do you have to wait before returning to normal contraception after taking EllaOne

A

Wait 5 days before returning to normal contraception

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24
Q

What is the mode of action of the POP?

A

Inhibits implantation, thickens cervical mucus, inhibits ovulation

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25
What is the mode of action of the IUS?
Inhibits implantation, thickens cervical mucus
26
What is the mode of action of the IUD?
Inhibits fertilisation, inhibits implantation
27
What is the mode of action of the implant?
Inhibits implantation, inhibits ovulation, thickens cervical mucus
28
What is the mode of action of the injection?
Inhibits implantation, inhibits ovulation, thickens cervical mucus
29
How long is the IUS licensed for?
5 years
30
How long is the IUD licensed for?
10 years
31
What contraindications for use of IUD are there?
PID, heavy menstrual bleeding, distortion of uterine cavity/fibroids
32
Which age group should attend smear tests every 3 years?
25-49
33
Which age group should attend smear tests every 5 years?
50-65
34
Which types of HPV are associated with cervical cancer?
16, 18, 33
35
Which types of HPV are associated with genital warts?
6, 11
36
What does a smear test look for?
Identifies presence of high-risk strains of HPV only (cytological testing is only done if HPV positive)
37
What happens next if a cervical smear comes back negative for hrHPV (high risk HPV)?
Return to normal recall (3 or 5 years)
38
What happens next if a cervical smear comes back positive for hrHPV but cytology is normal ?
Repeat test in 12 months. If hrHPV negative then normal recall. If cytology normal again then repeat again at 12 months
39
What happens next if a cervical smear comes back positive for hrHPV, normal cytology, and the same results again 12 months later?
Repeat again in 12 months (24 months since original test). If hrHPV negative then return to normal recall. If hrHPV +ive then colposcopy regardless if cytology is normal at 24 months
40
What happens next if a cervical smear comes back positive for hrHPV and has abnormal cytology?
Colposcopy
41
What happens if a cervical smear sample is inadequate?
Repeat in 3 months
42
What happens if a cervical smear sample is inadequate and then 3 months later is inadequate again?
Colposcopy
43
What is the most common treatment for cervical intraepithelial neoplasia?
LLETZ procedure (large loop excision of transformation zone)
44
What are advantages of COCP?
- Highly effective if taken correctly (>99%) - Doesn't interfere with sex - Contraceptive effects are reversible upon stopping - Makes periods lighter, regular, less painful - Protective against ovarian and endometrial cancer
45
What are disadvantages of COCP?
- Relies on you to remember to take it - No protection against STIs - Increased risk of VTE - Increased risk of breast and cervical cancer - Increased risk of stroke and ischaemic heart disease (especially in smokers)
46
How many weeks gestation should the booking visit take place?
8-12 weeks
47
How many weeks gestation should dating scan take place?
10-14 weeks
48
How many weeks gestation should Down syndrome screening take place?
11-14 weeks
49
How many weeks gestation should anomaly scan take place?
18-21 weeks
50
Which tests does the combined scan consist of and when should this be done?
nuchal translucency/thickness measurement serum bHCG PAPP-A Done between 11-14weeks
51
What results of the combined test indicate increased risk of Down Syndrome?
- increased nuchal translucency - increased bHCG - decreased PAPP-A
52
What results of the triple (and quadruple) test indicate Down syndrome?
- increased bHCG - decreased AFP - decreased oestriol - (increased inhibin A)
53
When is the triple/quadruple test done?
If women book later in pregnancy at 15-20 weeks
54
If there is a risk greater than 1 in __ then amniocentesis/chorionic villus sampling is done
1 in 150
55
When would amniocentesis be done and when would CVS be done?
amniocentesis if >15 weeks gestation because there would be enough amniotic fluid to do so CVS is done between 11-14 weeks. Before 11 weeks can lead to fetal limb abnormality
56
What is the criteria for expectant management of ectopic pregnancies?
- No fetal heartbeat - HCG level <1500IU/L - Adnexal mass <35mm - No significant pain and no rupture - Ensure follow up is possible
57
What is the criteria for medical management for ectopic pregnancy?
Same as for expectant but - HCG level <5000IU/L - Confirmation of absent intrauterine pregnancy on US
58
Criteria for surgical management of ectopic pregnancy?
- Pain - Adnexal mass >35mm - Visible heartbeat - HCG level >5000IU/L
59
What is the triad of pre-eclampsia?
NEW ONSET Hypertension (>20 weeks gestation) Oedema Proteinuria
60
Other features of pre-eclampsia?
Headache Visual disturbance N&V Brisk reflexes
61
Management of pre-eclampsia?
Labetalol 1st line (contraindicated in asthmatics)
62
What do you give asthmatics with pre-eclampsia?
Nifedipine
63
What do you give in severe pre-eclampsia?
IV hydralazine/IV magnesium sulphate
64
What is HELLP syndrome?
Features that occur as a complication of pre-eclampsia and eclampsia: Haemolysis Elevated Liver enzymes Low Platelets
65
Presentation of placenta praevia?
Painless, bright red vaginal bleeding
66
Management of placenta praevia?
Corticosteroids at 34-36 weeks due to risk of preterm delivery Planned C section at 36/37 weeks Emergency C section if premature labour or haemorrhaging
67
Suitable and unsuitable investigations of placenta praevia?
Suitable: transvaginal US Unsuitable: digital vaginal exam (provokes haemorrhage)
68
Presentation of placental abruption?
Sudden onset, severe abdominal pain and vaginal bleeding Tense, hard, woody uterus on palpation Shock CTG abnormality
69
Risk factors for placenta accreta/increta?
``` Previous placenta accreta/increta Previous C-Section Placenta praevia Increased maternal age Multigravida ```
70
Management of placenta accreta/increta?
- Corticosteroids given - Planned C-section35-37 weeks to reduce risk of spontaneous labour and delivery At C-section, hysterectomy is recommended, however patients can choose to have some myometrium resected with placenta to preserve uterus
71
Definition of postpartum haemorrhage?
Loss of >500ml blood after delivery of baby
72
Most common cause of PPH?
uterine atony
73
Contraindications to COCP?
Breastfeeding, migraine with aura, smoker >35yo, history of VTE, breast cancer
74
What should be prescribed after the fixation of a perineal tear?
Laxatives to prevent constipation and comprisation of the tear
75
Difference between 3a, 3b and 3c perineal tears?
3a: <50% external sphincter torn 3b: >50% external sphincter torn 3c: internal sphincter torn
76
Women with gestational diabetes have a significantly increased risk of what?
Still birth
77
Women with gestational diabetes should give birth by when?
40+6 weeks
78
What is the management if a pregnant mother tests positive for GBS?
Give antibiotics intrapartum (during labour and delivery) to prevent transmission to fetus. Giving antibiotics antenatally does not have effect
79
What hormone imbalances are seen in PCOS?
- Increased testosterone - Increased LH - Normal FSH
80
Indications for assisted delivery?
- Fetal distress in 2nd stage labour - Fetus stuck in birth canal (birth not progressing) - Exhaustion
81
Complications and risks of assisted delivery?
- Vaginal tears +/- episiotomy - Urinary/anal incontinence - VTE risk post birth - Cephalohaematoma in baby
82
When used in pregnancy, SSRIs can cause what birth defect?
- Gastroschisis, omphalocele | - Skull defects (craniosynostosis, anencephaly)
83
When used in pregnancy, TCAs can cause what birth defect?
-Neonatal irritability and convulsions
84
When used in pregnancy, lithium can cause what birth defect?
-Cardiac abnormalities (Ebsteins anomaly)
85
When used in pregnancy, benzodiazepines can cause what birth defect?
cleft lip and palate, neonatal withdrawal
86
Treatment for infertility in endometriosis?
-Surgery
87
Treatment for endometriosis?
- Analgesia 1. COCP or progesterone injection or IUS 2. Goserelin (GnRH analogue) to induce a medical menopause 3. Surgery to remove adhesions and endometrial tissue 4. Hysterectomy and bilateral salpingo-oophorectomy

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