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O+G Flashcards

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1
Q

Primary amenorrhoea

A

No periods by age 16

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2
Q

Secondary amenorrhoea

A

Periods stop for 6 moths or more

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3
Q

Precocious puberty

A

Menstruation before age 10 or Secondary sex characteristics before age 8

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4
Q

McCune-Albright

A

Precocious puberty, cafe-au-lait spots and bone+ovarian cysts (fibrous dysplasia)

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5
Q

Endometrial Ca staging

A

Stage 1= Confined to uterus (A=less than 50%, B=>50%)
Stage 2= Cervical invasion
Stage 3= Invasion through uterus
Stage 4= Distant spread (A= bowel or bladder, B=further)

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6
Q

Nabothian follicle

A

Squamous epithelium (metaplasia) over columnar endocervix -> cysts (i.e reverse ectropion)

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7
Q

Ectropion

A

Metaplasia of squamous to columnar

Sx: contact bleed, PCB + cervical excitation

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8
Q

CIN staging

A 
CIN1= mild dyskaryosis - lower 1/3 of epithelium
CIN2= Mod dyskaryosis - 2/3 epithelium
CIN3= Dyskaryosis throughout epithelium= Ca in situ
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9
Q

UK smear programme dates

A

Age 25-49: every 3 years
Age 50-64: every 5 years
Age 65+: only if recent abnormal or no smear since 50

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10
Q

UK smear programme triage

A

Inadequate: repeat w/i 3 months + Tx any infection
Borderline + Mild: HPV triage, +ve colposcopy, -ve routine recall
Moderate+ Severe: Colposcopy

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11
Q

Colposcopy results

A

CIN1: 6 monthly f/u
CIN2: LLETZ + HPV test of cure
CIN3: LLETZ + HPV test of cure

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12
Q

Cervical Ca Staging

A 
1= confined to cervix
2= Invasion into vagina but not pelvic side wall
3= Invasion of lower vagina or pelvic side wall -> ureteric obstruction
4= Invasion into bladder or rectal mucosa or beyond true pelvis
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13
Q

Cervcial Ca Tx

A 
Stage 1a(i)= Cone Bx
Stage 1 (other)= Surgery vs chemoradiotherapy
Stage 2b+= Chemoradiotherapy
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14
Q

PCOS Tx

A

Maintain low weight
COCP (if not trying to get preg. w/3-4 bleeds pa)
Clomifene (if trying to get pregnant)
Metformin (insulin + Clomifene sensitiser)
Lap + Dye

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15
Q

Brenner tumours

A

Small benign + rare epithelial Ovarian tumours

Urothelium-like

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16
Q

Granulosa cell tumour

A

Secrete oestrogen

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17
Q

Thecoma

A

Secrete oestrogen + androgen

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18
Q

Krukenberg tumours

A

Mets to ovary from gastric primary Ca

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19
Q

Hydatidiform mole Histo+ USS

A

Mixture of large + small villi w/ scalloped outline + trophoblastic hyperplasia
Snowstorm appearance on USS

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20
Q

ChorioCa Histo

A

Closely related syncytiotrophoblasts + cytotrophoblasts w/ eosinophils

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21
Q

Dysgerminoma

A

Lobular cells w/ fibrous stromal cells w/ lymphocytic invasion

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22
Q

Combined test

A

Nuchal translucency (11-13+6/40 scan)
BhCG
PPA
>1 in 150= high risk -> amnio or CVS

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23
Q

Triple test

A

15-20/40
Unconj estriol
AFP
BhCG

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24
Q

Quad test

A 
15-20/40
Unconj estriol
AFP
BhCG
Inhibin A
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25
Amniocentesis
Only after 15/40 | Less chance of miscarriage + can analyse infection
26
CVS
After 11/40 | 1% chance of miscarriage
27
ToP Law
1. Risk of death of mother > termination 2. Prevent grave permanent injury to physical or mental health of mother 3. Not >24/40 + risk of physical + mental harm to mother or existing children > continuing 4. Substantial risk of mental or physical disability to unborn
28
PIH
BP> 140/90 after 20/40
29
Pre-eclampsia
PIH + Proteinuria >0.3g/24h after 20/40
30
HELLP
Haemolysis Elevated Liver Ezs Low Platelets Indication for emergency delivery
31
Mx of Pre-eclampsia/HELLP
Mild: Admit for observation + monitoring, induce after 34/40 Severe (>160/110 on 2 occasions 6h apart, proteinuria 3+ on 2 dips, HELLP, IUGR): Induce after 34/40, Hydrazine, Nifedipine, Labetolol + careful fluid Mx
32
Gest DM Dx
Fasting Glu >5.6 | GTT >7.8
33
Gest DM Targets
Fasting less than 5.3 1hr post prandial less than 7.8 OR 2hr post prandial less than 6.4
34
Gest DM Mx
Fasting less than 7: Lifestyle then Metformin if no improvement in 2/52 Fasting >7: Insulin +/- Metformin
35
Gest DM ANC
Fortnightly visit up to 34/40 Weekly visits thereafter Elective induction at 37-38+6/40 Aspirin 75mg from 12/40
36
SFD
Weight less than 10th centile (2.7kg at term)
37
IUGR
Falling off centiles
38
Rate of dilatation
>1cm/h in nullip, >1.5cm/h in multip
39
Perineal tears
``` 1st degree: minor damage to forchette 2nd degree: Perineal muscle involved 3rd degree: anal sphincter involved 3a: less than 50%EAS 3b: >50% EAS 3c: EAS + IAS 4th degree: anal mucosa involved ```
40
Bishop's score
``` Position (0-2) Consistency (0-2) Effacement (0-3) Dilatation (0-3) Foetal station (0-3) ```
41
Primary PPH def
>500ml blood loss | Prevent at risk w/ Syntometrine IM (CI if HTN)
42
Primary PPH Mx
IV fluid, Oxytocin + uterine massage 2nd line: ergometrine + bimanual compression 3rd line: IU balloon + intramyometrial uterotonics
43
Secondary PPH
Excessive blood loss 24h-6wks post partum
44
Booking infection screen
Syphilis, HIV, Hep B, Rubella
45
Placenta accreta
Firm adhesion of placenta to uterine wall w/o invasion through myometrium
46
Placenta increta
Invasion through full myometrium
47
Placenta percreta
Invasion beyond myometrium e.g. bladder
48
Mx of PPROM
Admit 10 ABx prophylaxis Steroids if
49
Warfarin syndrome
Nasal hypoplasia, vertebral calcinosis, brachydactyly
50
Preferred anticoag in pregnancy
Enoxaparin
51
Placental abruption
Painful vaginal bleed
52
Placenta praevia
Painless vaginal bleed
53
APH Mx
``` Admit unless only spotting (ceased) + prevue excluded Steroids if 24-34+6/40 Tocolysis NOT indicated Anti D if Rh-ve X match 4 units if ongoing bleed Foetal compromise -> C section ```
54
HSV primary infection
C section if w/i 6 weeks of term
55
Obstetric cholestasis Mx
Induce at 37-38/40 due to risk of stillbirth
56
PUPP
Rash on abdo + spreading w/ periumbilical sparing | After 34/40
57
Prurigo gestationis
Rash of limbs + trunk, sparing abdo
58
ToP types
Surgical after 7 weeks | Medical up to 9 weeks (Methotrexate)
59
Methotrexate for ectopic criteria
Small ectopic No foetal pulse No clinical compromise No free fluid in pouch
60
Foetal heart beat 1st appears at
5-6/40
61
Foetal heat 1st heard on doppler at
8-9/40
62
PID Tx
IM Ceftriaxone, Oral Doxycyline + Metronidazole Severe or Septic: IC Cef+ Doxy Pregnant: IV Oflox + Met
63
HRT risks
Stroke Breast + Ovarian Ca Endometrial Ca (give constant or cyclical progestogen) VTE (highest in 1st year, stops after stopping)
64
Elleste solo
Estradiol
65
Elleste duet + Evorel
Estradiol + Norethisterone
66
Vagifem
Topical oestrogen for vagina
67
C section risk
``` Damage to bladder 1 in 1000 VTE 4-16 in 10000 Haemorrhage 5 in 100 Hysterectomy 8 in 1000 Death 1 in 12000 ```
68
Triptorelin
GnRH agonist used in endometriosis
69
Danazol
Antieostrogen + anti progesterone used in endometriosis
70
Endometriosis Tx
``` Mefenamic acid (NSAID) for pain COCP (if not trying to conceive) for 3-6/12 If doesn't want contraception give Oral progestogen Failure: GnRH agonists + add back HRT (if >6/12), Androgens (rare), Surgery ```
71
HMB Tx
1st line: Mirena 2nd line: Tranexamic acid +/or Mefenamic Failure: Hysterectomy
72
PMS Tx:
SSRIs Vit B6, improved diet + exercise CBT Yasmin or Cileste
73
Non reassuring CTG
BR 161-180 or 100-109 Variability less than 5bpm for 40-90min Decels w/ over 50% of contractions for 90mins or single prolonged less than 3mins
74
Pathological CTG
BR> 180 or less than 100 Variability less than 5bpm for >90 mins Late decels or single prolonged decel > 3mins
75
Cord Prolapse Mx
Elevate presenting part | Deliver immediately: Assisted or C section
76
Induction
Vaginal PGE2 NOT oral/IV | CCTG monitoring
77
Augmentation
Oxytocin
78
Induction for IU death
Mifepristone for cervical ripening | Misoprostol to initiate contractions
79
Toxo infection
Chorioretinitis, hydrocephalus + convulsions
80
CMV infection
Chorioretinitis, Microcephaly + Hearing+visual loss
81
Cord Prolapse Mx
Elevate presenting part | Deliver immediately: Assisted or C section
82
Induction
Vaginal PGE2 NOT oral/IV | CCTG monitoring
83
Augmentation
Oxytocin
84
Induction for IU death
Mifepristone for cervical ripening | Misoprostol to initiate contractions
85
Subfertility Ix
``` Day 1-3 FSH+LH Mid luteal phase progesterone USS HSG Semen analysis ```
86
CMV infection
Chorioretinitis, Microcephaly + Hearing+visual loss
87
COCP risks
``` Cervical Ca (w/ prolonged use >8 years) Lowers risk of Breast, Bowel + Ovarian Ca Overall 12% Ca reduction ```
88
IVF risks
``` LBW Congenital abnormalities Ectopic Multiple pregnancy + therefore pre-eclampsia SGA PIH (if donor egg) ```
89
Emergency Contraception
CU IUD up to 5 days post UPSI Ulipristal up to 5 days post UPSI Levonorgesterol 1.5mg w/i 72 hours of UPSI
90
Asherman's syndrome
IU scar tissue after surgery causing subfertility
91
Subfertility Ix
``` Day 1-3 FSH+LH Mid luteal phase progesterone USS HSG Semen analysis ```
92
Semen analysis
``` >50% normal motility >4% normal morpholoy Volume >1.5ml pH 7.2-8 >15million/ml ```
93
Rokitansky's
Mullerian agenesis causes lack of uterus + fallopian tubes but normal ovaries and function
94
C section categories
Cat 1: immediate threat to life Cat 2: Distress/prolonged Cat 3: No foetal-maternal compromise but need for early delivery Cat 4: Elective

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