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O&G Flashcards

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1
Q

Cancer screening:
- cervical
- breast
-bowel
-targeted lung

A

Cervical: every 3 years (25-49yo), every 5years (50-64yo)

Breast: every 3 years(50-70yo)

Bowel: one off flexisig 55yo, home kit (FIT test) every 2 years (60-74yo in England).

Targeted lung: low dose CT scan offered to 55-74yo at high risk of cancer & reinvited every 2 years

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2
Q

How do you test if someone has ovarian failure as a cause of secondary amenorrhoea?

A

FSH>=20IU/l

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3
Q

Emergency contraception ?options
(UPSI - unprotected sexual intercourse)

A

FIRST LINE - Copper IUD: use 5days post UPSI or within 5days of expected ovulation. Directly toxic to sperm, reduce sperm numbers that reach uterus, damage embryo before implant, interfere with implantation.

Levonorgestrel: progesterone only pill. Used within 3days of UPSI. Inhibit ovulation.

Ullipristal acetate: selective progesterone receptor modulator. Use 5days UPSI. Inhibit/delay ovulation.

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4
Q

Causes of post coital bleeding

A

Cervical ectropion (most common)
Vaginits
Vaginal cancer
cervical cancer (most malignant cause)
Cervicitis
Cervical polyps
Trauma

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5
Q

Types of miscarriage: threatened, complete, incomplete, missed, inevitable

A

Threatened: minimal pain, less bleeding compared to menstruation, closed cervix, fetal heart visualised

Complete: no pain, less bleeding compared to menstruation, closing cervix, empty uss

Incomplete: pain +/-, a lot more bleeding compared to menstruation, open cervix, retained products/no fetal heart

Missed: no pain, minimal bleeding, closed cervix, small uterine size, no fetal heart

Inevitable: pain +, more bleeding compared to menstruation, open cervix, fetal heart may/may not be visualised

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6
Q

Normal physiological changes of blood test when comparing pregnancy and pre-pregnancy state

A

Hb drops
Haematocrit drops
WBC increase
Platelet count drops
Urea and creat drops
GFR increases
Albumin, ALT, AST drops - dilutional effect
ALP rise due to placental production

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7
Q

Cause of chancroid

A

Haemophilia ducreyi
-painful genital ulcer
- tender inguinal lymphadenopathy

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8
Q

Cause of chancre

A

Treponema pallidum (syphilis)
- small painless ulcer

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9
Q

Cause of strawberry cervix

A

Trichomonas vaginalis
- frothy greenish discharge with fishy odour
- tx: metronidazole

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10
Q

Cause of lymphogranuloma venereum

A

Chlamydia trachomatis
- painless genital ulcer
- painful lymphadenopathy ‘buboes’ or abscess

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11
Q

Risk factor for endometrial cancer

A

Obesity
Nulliparity
Late menopause
Fhx
Tamoxifen
HRT
Pelvic irradiation
Diabetes
Pcos

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12
Q

Red degeneration of fibroid

A

Degeneration of myoma
Uss shows mixed echodense or echolucent appearance
Tx: supportive - analgesia, rehydration

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13
Q

How to check cervical ripeness?

A

PEDSS
Position
Effacement
Dilation
Softness/consistency
Station of foetus

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14
Q

Risk factor of hyperemesis gravidarum

A

Nulliparity
Fhx
Personal history
Multiple pregnancy
Female foetus
Age<30yo
Trophoblastic disease
Maternal obesity
Non smoker

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15
Q

Smoking in pregnancy - what are the features?

A

Miscarriage 2x risk
Preterm labour
Lighter for date babies
Reduced reading ability up to 11yo
Reduced ovulation
Abnormal sperm production

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16
Q

Definition of preterm, term and postterm delivery

A

<37 week
37-42 week
>42 week

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17
Q

Asthenozoospermia
Oligospermia
Azoospermia
Hypospermia
Teratospermia

A

Asthenozoospermia: reduced sperm motility
Oligospermia: low sperm count
Azoospermia: no sperm in ejaculate
Hypospermia: reduced semen volume
Teratospermia: poor sperm morphology

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18
Q

Iron supplement - what are the indication during pregnancy

A

Hb<100
MCV<84

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19
Q

What and when to check that one is ovulating?

A

Progesterone
Mid-luteal phase (ie one week before period - IE day 21 out of 28day cycle or day 28 out of 35day cycle)

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20
Q

Tx of menorrhagia

A

Mirena 1st line
Trenaxamic acid
Nsaids - only take during menstruation
Cocp
Norethisterone

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21
Q

Mechanism of action of:
COCP
MIRENA
POP (emergency)

A

Cocp- prevent ovulation via HPO axis

POP (except desogestrel)- increase volume and viscosity of cervical mucus, endometrial changes, reduction in cilia activity

POP (desogestrel): suppress ovulation, also thickens cervical mucus

Mirena- changes to cervical mucus, endometrial changes (atrophy)

Copper coil - toxic to ovum and sperm, anti-implantation effect

Pop (emergency)- delays ovulation, prevent follicular rupture and causes luteal dysfunctuon

Ullipristal (emergency) - delays ovulation for at least 5 days

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22
Q

Difference between lentigo and malasma

A

Lentigo - flat brown lesions which do not darken in sun exposure

Malasma aka chloasma - macules and larger patches that is brought on by pregnancy or sun exposure

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23
Q

Test for downs

A

Combined testing - mum’s age, nuchal translucency, HCG, Papp

If greater than 1:200, offered either chorionic villus sampling (<13 weeks) or amniocentesis (>15 weeks gestation)

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24
Q

When & whom do you give anti -d

A

Rhesus negative mothers
28 & 34 weeks

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25
Definition of: Dysmenorrhagia - primary Vs secondary Menorrhagia - metrorrhagia, menometrorrhagia, dub
Primary dys - cramping pain due to menstruation (NO pelvic pathology) Secondary dys - menstrual related pain due to another medical or physical condition such as endometriosis/fibroids Metrorrhagia - breakthrough bleeding either between periods or not related to periods Menometrorrhagia - heavy and prolonged bleeding that occurs in irregular intervals Dub - excessive bleeding due to hormonal problems usually lack of ovulation
26
Placental abruption Placenta praevia Vasa praevia
Premature separation of placenta from uterus. Praevia - implantation of placenta over the internal cervical os. Vasa - foetal vessels running close to internal cervical os.
27
Cocp and cancer HRT and cancer
COCP: Protective for endometrial, ovarian and colorectal cancer. Can increase risk of breast and cervical cancer. HRT: Increase risk for breast and endometrial cancer.
28
Tx options of endometriosis
COCP (for those who wanted contraception) or NSAIDs (for those who didn't want contraception) Danazol (once tried COCP/POP/NSAIDs but no response) Oral or depot medroxyprogesterone acetate Levonorgestrel IUS GnRH analogues (before surgical procedure) Laparoscopic ablation (most effective method)
29
Fibroadenoma Vs lipoma Vs breast cancer in signs
Fibroadenoma - small, smooth, rubbery, firm, mobile. breast mice. Found in 20-30yo Lipoma - small, mobile, palpable, painless. Found in 40-60yo. Cancer- dimpling Fat necrosis - similar to cancer. Only a biopsy can differentiate
30
Catamenial epilepsy
Seizures linked with menstrual period
31
Which hormone (sexual) have effect on seizure (specifically the catamenial)?
Oestrogen lowers seizure threshold Progesterone increases seizure threshold
32
what is the Amstel criteria?
- clue cells on saline smear - pH >4.5 - thin, grey and homogenous discharge - positive whiff test if 3 or more present, patient has bacterial vaginosis
33
treatment of maternal hyperthyroidism when pregnant
carbimazole or propylthiouracil (as these can cross the placenta and cause fetal hypothyroidism) BUT carbimazole can be teratogenic -> therefore, avoid in 1st trimester & can be started in 2nd trimester.
34
when would you do block and replace for maternal hyperthyroidism?
when maternal TSH antibody is affecting the fetus (in a mum who had ablative therapy for Grave's disease) and causes fetal hyperthyroidism. so give anti-thyroid drug (for the fetus) and levothyroxine (for the mum)
35
side effect when used during pregnancy
tetracycline -> teeth discolouration- (if taken in 2nd/3rd trimester) ACEi -> impaired fetal renal function, oligohydramnios, skull abnormalities Streptomycin -> auditory and vestibular nerve damage beta-blockers -> intrauterine growth retardation, bradycardia, neonatal hypoglycaemia NSAIDs -> closure of ductus arteriosus, persistent pulmonary hypertension of newbown, delay labour, impair placenta blood flow
36
blood-stained discharge from nipple and small lumpy mass ?diagnosis
duct papilloma local areas of epithelial proliferation in large mammary ducts. hyperplastic lesions rather than malignant or premalignant
37
fibroadenosis - what is it?
fibrocystic disease OR benign mammary dysplasia - seen in middle aged women - painful, lumpy breast that flare during menstruation
38
which one is associated with male infertility? - sodium valproate - varicocele - epididymal cyst - hydrocele
varicocele (the most correct answer from the list)
39
painless penile sore with weight loss ?diagnosis
squamous cell carcinoma syphillis chancre does NOT cause weight loss
40
PCOS - which is higher - LH or FSH
LH is higher than FSH
41
triad of abdo pain, uterine rigidity, vaginal bleeding ?diagnosis
placental abruption
42
USS at these weeks - what for? - 11-14 weeks - 18 weeks
11-14 weeks: dating scan 18 weeks: anomaly scan
43
how to detect neural tube defects during pregnancy?
ultrasound for at risk ladies amniocentesis if uncertain USS images -> measure alpha-fetoprotein and neuronal acetylcholinesterase
44
how to screen for Down's in pregnancy?
combined test at 11-13 weeks - include nuchal transclucency, free b-hcg, pregnancy associated plasma protein and the woman's age if >1:200, then offered chorionic villus sampling (<13 weeks gestation) or amniocentesis (>15 weeks gestation)
45
what antibodies would be raised in maternal hyperthyroidism during pregnancy?
thyroid peroxidase auto-antibodies (if this is positive, then 50% chance of postpartum thyroiditis)
46
Adenomyosis - what is it? treatment?
ectopic endometrial tissue and stroma within the tissue myometrium risk factors: increase parity, early menarche, short menstrual cycles, increase BMI, OCP, tamoxifen, prior to uterine surgery tx: check if they want to be pregnant or not (definitive tx: hysterectomy) - NSAIDs - OCP - levonogestrel intrauterine system - danazol - aromatase inhibitors (eg anastrozole) - endometrial ablation - adenomyomectomy -
47
Painful ulcer with tender inguinal lymphadenopathy
haemophilus ducreyi - causes chancroid
48
painless ulcer with painful lymphadenopathy 'buboes' or abscess
chlamydia trachomatis - causes lymphogranuloma venereum
49
small painless ulcer - chancre ?diagnosis
syphilis caused by treponema pallidum
50
post-coital bleeding. no cervical motion tenderness, friable cervix when scraped with a swab. mucopurulent discharge from cervical os. cervix can be moved from side to side post-coital bleeding and offensive discharge. ulcerated lesion on cervix. ?diagnosis
urogenital chlamydia causing cervicitis cervical cancer
51
how to write gravida and para?
gravida- total nubmber of times pregnant including the current one para- X + Y (X= no of pregnancies beyond 24 weeks) (Y= no. of losses before 24 weeks)
52
Fetal alcohol syndrome
microcephaly thin upper lip indistinct philtrum flat midface low nasal bridge micrognathia small palpebral fissures
53
investigation for endometrial cancer
USS may be suggestive BUT definitive diagnosis is made on endometrial sampling or currettage
54
UKMEC - what is it?
UKMEC 1: a condition for which there is no restriction for the use of the contraceptive method UKMEC 2: advantages generally outweigh the disadvantages UKMEC 3: disadvantages generally outweigh the advantages UKMEC 4: represents an unacceptable health risk Examples of UKMEC 3 conditions include more than 35 years old and smoking less than 15 cigarettes/day BMI > 35 kg/m^2* family history of thromboembolic disease in first degree relatives < 45 years controlled hypertension immobility e.g. wheel chair use carrier of known gene mutations associated with breast cancer (e.g. BRCA1/BRCA2) current gallbladder disease Examples of UKMEC 4 conditions include more than 35 years old and smoking more than 15 cigarettes/day migraine with aura history of thromboembolic disease or thrombogenic mutation history of stroke or ischaemic heart disease breast feeding < 6 weeks post-partum uncontrolled hypertension current breast cancer major surgery with prolonged immobilisation positive antiphospholipid antibodies (e.g. in SLE) Diabetes mellitus diagnosed > 20 years ago is classified as UKMEC 3 or 4 depending on severity Changes in 2016 breast feeding 6 weeks - 6 months postpartum was changed from UKMEC 3 → 2
55
In miscarriage situation - which rhesus negative mums should STILL be given anti-D injection?
surgical or medical terminations of pregnancy spontaneous miscarruage followed by medical or surgical evacuation spontaneous complete miscarriage >12 weeks gestation significant transplacental haemorrhage (due to procedures or trauma) ectopic pregnancy threatened miscarriage >12 weeks
56
breast lump - small, hard, tethered to skin and skin puckering ?diagnosis
breast cancer
57
what are the normal ECG changes in pregnancy?
LAD small Q waves & inverted T wave in lead III ST depression & inversion or flattening of T wave in inferior & lateral leads atrial and ventricular ectopics
58
bleeding, tender tense uterus and fetal distress ?diagnosis
placental abruption
59
painless vaginal bleeding with non-tender abdomen and no fetal distress ?diagnosis
placental praevia
60
continuous vaginal bleeding during induction of labour and fetal distress ?diagnosis
vasa praevia
61
Up to how many weeks can you request for abortion?
24 weeks gestation
62
what is the age for: - NEVER able to consent for sex - consent for sex
13 16
63
what is the UKMEC for progesterone only pill?
UKMEC 3: IHD & stroke, past breast cancer, severe decompensated cirrhosis, liver tumours (benign adenoma and malignant) UKMEC 4: current breast cancer
64
Leiomyoma VS leiomyosarcoma VS adenomyosis
Leiomyoma - fibroids (benign tumours in the myometrium) Leiomyosarcoma: rare malignancies that are difficult to distinguish from fibroids Adenomyosis: extension of endometrial tissue and stroma into uterine myometrium
65
20 weeks gestation - lower abdominal discomfort following a minor fall. pain increased over time and tender in the lower abdomen. USS shows fluid in the lower pelvis below the fallopian tubes and the ovaries. ?diagnosis
ruptured ovarian cyst
66
alternatives to hormone replacement therapy to control/reduce hot flushes in menopause?
citalopram/anti-depressants! clonidine gabapentin other lifestyle changes: increase exercise, lighter clothing, sleeping in cooler room, reduce spicy food, caffeine, smoking, alcohol
67
Goserelin - what is it used for and what are the side effects?
LHRH agonists/GnRH agonist used for prostate cancer, breast cancer, endometriosis, for endometrial thinning prior to endometrial ablation or resection, before surgery to remove fibroids SE: osteoporosis
68
types of POP - give examples and what happens if missed one pill?
traditional- levonogestrel (LNG), norethisterone (NET) newer- desogestrel (DSG), drospirenone (DRSP) what constitutes a missed pill: LNG/NET: 3 hours late DSG: 12 hours late DRSP: 24 hours late take the missed pill and take extra precautions for 48hrs
69
what is the normal results for pregnancy? - WCC - FBC - platelet - U&E (sodium, potassium, urea, creat, eGFR) - albumin - bilirubin - ALT - AST - ALP - TFT (T3, T4, TSH) - total calcium - magnesium - cardiac output - tidal volume - urinary frequency
WCC increased FBC decreased (but if Hb is <110 at booking or <105 at 28 weeks with normal/low MCV, need to start iron supplementation) platelet decreased U&E decreased (but GFR increased) albumin decreased bilirubin decreased ALT, AST unchanged/slightly decreased ALP increased TSH decreased in 1st trimester, normal in 2nd and increased in 3rd T3/T4 unchanged Total calcium decreased Magnesium unchanged CO increases Tidal volume increases Urinary frequency increases
70
how long can you detect HCG in pregnancy?
as early as 8/9 days and in 98% patients, by day 11 level peak at 10-12 weeks gestation and until 20 weeks of gestation will be positive 5days post miscarriage also positive in trophoblastic disease
71
treatment of these antenatal infections: - listeria - syphilis - toxoplasmosis
listeria: amoxicillin & gentamicin syphilis: benzathine benzylpenicillin toxoplasmosis: spiramycin (for tetus: pyrimethamine & sulfadiazine)
72
treatment of UTI in pregnancy
nitrofurantoin (but avoid this at term due to risk of neonatal haemolysis) trimethoprim
73
risk factors for cervical cancer
HPV 16 & 18 & 33 smoking HIV young age of first coitus high number of sexual partners young age of first pregnancy high parity low socioeconomic class a sexual partner with multiple sexual partners
74
what drugs cause these: - Ebstein's anomaly - placental abruption - jitteriness,fits, irritability
- benzodiazepines/lithium - coccaine use - heroin
75
24yo, deep dyspanerunia and dysmenorrhoea and not secual active until 2 months ago ?diagnosis
endometriosis
76
24 yo dysmenorrhoea, irregular periods and recurrent episodes of yellow-green vaginal discharge ?diagnosis
chronic pelvic inflammatory disease
77
Tx of fibroids
transcervical resection of fibroid- for submucous fibroid & helps retain fertility myomectomy - for large intramural fibroid
78
Foetal hydrops - caused by what viral infection during pregnancy? - how do we investigate?
- parvovirus b19 - USS first and then cordocentesis
79
how would the baby turn out if these occur in pregnancy? - maternal diabetes - trisomy 18 - valproate ingestion
- sacral agenesis, fetal cardiomyopathy, cardiac defects, cleft palate - Edward's syndrome! - cleft palate and learning difficulties
80
treatment of primary dysmenorrhagia
NSAIDs - mefenamic acid, ibuprofen COCP
81
treatment of primary postpartum haemorrhage
apply pressure to uterus IV oxytocin/ergometrine IM/intrauterine carboprost (unless asthmatic) rectal/SL misoprostol surgical - balloon tamponade, ligation of uterine arteries, B-lynch suture OR hysterectomy
82
risk factors for pre-eclampsia
age >40 nulliparity pregnancy interval >10years FHx previous medical history BMI>30 HTN/other pre-existing vascular disease pre-existing renal disease multiple pregnancy
83
what type of vaccines are these: - gardasil - ceravix - gardasil 9
gardasil : HPV 6,11,16,18 ceravix : HPV 16 &18 gardasil 9 : 9 variants (6,11,16,18, 31,33, 45, 52, 58)
84
what is acute fatty liver of pregnancy?
rare life threatening complication of pregnancy - ALT and AST raised (<500U/L) - due to disordered metabolism of fatty acid - deficiency of LCHAD. - Abdo USS -> fat deposition of liver & microvascular steatosis - liver biopsy is rarely needed Tx: delivery of foetus
85
which HRT to start for the lady?
No uterus: oestrogen-only (Elleste-Solo) Uterus present: - if no period for >1year: continuous progesterone (Elleste-Duet Combi) - if still having periods/finishing: cyclical progesterone given monthly or 3 monthly (Elleste-Duet)
86
once the lady enters menopause, do they still need contraception?
Yes - still need contraception for 1 year after the last period if >50yo or 2 years if <50yo.
87
contraceptive - when would they be effective? (these are not on 1st day period) - IUD - POP - COCP
IUD: instantly POP: 2 days (*if they have taken this in the first 5 days of cycle - no need to wait) COCP: 7 days Injection, implant, IUS: 7 days
88
which emergency contraceptive pill cannot be use for asthmatics?
ullipristal
89
how long post-partum can you have unprotected sex & not needing contraception for? and what type of contraception is allowed after?
21 days post-partum POP: can start anytime post-partum. but if taken post-21 days, then need alternative protection for 2 days. COCP: start 6weeks-6months post-partum & breastfeeding(UKMEC 2) and alternative protection for 7 days IUD/IUS: inserted 48hours post-partum or after 4 weeks.
90
what type of contraception do you need if >40yo?
DON'T PRESCRIBE implantable contraceptive device (eg Depo-Provera) as it can cause lost of bone mineral density. If using COCP (<50yo) -> switch to non-hormonal or progesterone-only-pill (>50yo) If using depo-provera (<50yo) -> Switch to either a non-hormonal method and stop after 2 years of amenorrhoea OR switch to a progestogen-only method and follow advice below If using implant, POP, IUS (<50yo) -> - Continue - If amenorrhoeic check FSH and stop after 1 year if FSH >= 30u/l or stop at 55 years - If not amenorrhoeic consider investigating abnormal bleeding pattern
91
what type of CYP450 effect does st john's wart do?
CYP450 inducer!
92
intrauterine system VS intrauterine device
IUD: copper IUD IUS: contain levonogestrel
93
which contraceptive option causes weight gain?
implantable device - ie Depo Provera
94

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