O+G Flashcards

Question

Pre-eclampsia definition

Answer 1

3-8% of pregnancies in NZ New HTN after 20 weeks AND: -proteinuria (+/- oedema) -LFT dysfunction -renal impairment -haematological dysfunction eg low platelets, haemolysis -neurological dysfunction eg headaches, flashing lights, clonus -maternal organ dysfunction

Answer 2

Major: Existing HTN Diabetes Personal history of pre-eclampsia FHx pre-eclampsia SLE or antiphospholipid syndrome Oocyte donation Minor: BMI >35 Age >40 African, Indian, Maori or PI Primip Multiple pregnancy Change in partner Sperm donation FHx PET on fathers side

Answer 3

Pregnancy >20 weeks AND any of: -new oedema -severe headache -visual sx eg scotoma -chest pain -SOB -vomiting -upper abdominal pain esp RUQ -reduced urine output -reduced foetal movements Exam -HTN - 140/90, severe if 160/110 -hyperreflexia -abdominal tenderness -oedema

Answer 4

Refer to hospital, do not do bloods Control BP with nifedipine, labetalol, hydralazine Magnesium sulphate

Answer 5

Check date of LMP and calculate date of likely ovulation Check timing of UPSI Consider possibility of non-consensual sexual activity Consider pregnancy test Consider STI test Consider whether ECP or IUCD (copper only) ECP: 1.5mg levonorgestrel single dose Check no contraindications eg VTE hx, active breast cancer Higher risk of failure in: -UPSI close to ovulation -subsequent UPSI in same cycle -missed first week of COCP -weight >70kgv(consider double dose) -increased time since UPSI (12 hours ideal, 72-96 is limit IUCD can be used up to 120 hours post UPSI, is most effective. Use ECP while organising

Answer 6

Azithromycin 1g stat or doxy 1/52 If purulent add ceftriaxone

Answer 7

Use condoms for 14 days post treatment and 7 days post partner treatment 3/12 partner tracing Repeat bimanual in 3/7 - if still sore refer to O&G Repeat STI check in 3/12

Answer 8

20% of carriers will have no lesions Transfer can occur without lesions but 100-1000x more likely with lesions Fomite transfer highly unlikely as virus does not survive at room temperature Lesions last 4-15 days Recurrences can be triggered by: -sunlight -stress -minor trauma -pre-menstrual Complications include: -urethritis -proctitis -neurogenic -leg and thigh pain -meningitis -widespread if immunocompromised

Answer 9

Initial presentation: -7-10/7 valaciclovir Recurrence can be either episodic if not severe symptoms or suppressive if severe or frequent symptoms Refer if herpes proctitis or pregnant

Answer 10

Partner infection does not necessarily indicate infidelity Use salt washes Dilute urine by drinking more Pee in bath/shower Topical anaesthetic - may sting initially No cancer risk Avoid sex until lesions healed Printed information

Answer 11

Long latency 75% of population affected Pain, bleeding and itch common sx Self-treatment with podophyllotoxin or imiquimod. Clinic treatment with cryotherapy

Answer 12

Pregnant Extensive Cervical Immunosuppressed/HIV Diabetes Intra-urethral Treatment failure

Answer 13

50% asymptomatic Incubation 10-90 days Chancre, not always painless, not always solitary 30% multiple lesions Inguinal LN

Answer 14

2-24 weeks latency 90% involve skin changes -usually trunk but can be palms and soles -can be confused with guttate psoriasis or pityriasis rosea -alopecia -condylomata lata -neurological signs Some constitutional sx

Answer 15

Gumma Aortitis Neuro sx: paraesthesia, ataxia, dementia, deafness, visual impairment

Answer 16

Doxycycline first line as better at treating rectal chlamydia (which is asymptomatic in 90% of women) Azithromycin second line for those unlikely to take full course. Also contributes to resistance

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