O & G Flashcards

Question

**Menorrhagia / Abnormal Bleeding** **Hx** **Dx** **Management**

Answer 1

**Hx:** Cycle length How long do you bleed for, Clots/Flooding How many pads When did it start Pain Discharge Screen for anaemia Screen for STI risk Psychosocial impact Contraception Pregnant? Smears? PCB, IMB, Dyspareunia, **PMB** **DDx:** Dysfunctional Uterine Bleeding, Fibroids, Platelet Dysfunction, Infection, Malignancy, Polyps (older women) **Examinations:** Abdominal (Enlarged uterus, tenderness), Pelvic Examinations (Bimanual and speculum) , Swabs **Investigations:** Urine Dip, Pregnancy Test, Temperature, FBC, CRP, ESR, Rapid antigen tests for organisms, USS?, Laproscopic with fimbrial biopsy for treatment resistant PID Testing for bleeding/ platelet disorders **in primary menorrhagia** **Mx:** Dysfunctional Uterine Bleeding - Fertility sparing - Tranexamic Aid, NSAIDS. Non- fertilty sparing - **LNG-IUS** (with endometrial biopsy first), COCP, GnRH, Injectable progesterones, **surgical -** hysterectomy, uterine artery emboliation, ablation Fibroids - See fibroid card. STI - See STI Card Malignancy - see malignancy card. **USS and** **Hysteroscopy + Endometrial Biopsy**

Answer 2

**Hx** \>50 Bloating, early satiety, pelvic pain, urinary symptoms, bowel sx, weight loss, recent UTIs (obstructioN) RFs: FH (BRCA1, BRCA2), Oestrogen Exposure (nulliparity, early menarche, late menopause, HRT, tamoxifen)], not breastfeeding **Dx:** Examination: abdominal, bimanual Investigations: **CA125 (\>35)** (epithelial), (CEA (mucinous)) **If \<40** - **bHCG** (embryonal, choriocarcinoma), **AFP**( endodermal sinus, embryonal), **Inhibin** ( granulosa cell), **LDH** (dysgerminoma), FBC, ESR, U&Es, LFTs (metastatic spread) USS **RMI -** post menopausal = 3 x Worrying features x CA-125 **Staging:** **1: a) One ovary - capsule intact b) Both ovaries - capsule intact c) capsule not intact** **2: a) uterus/ fallopian tubes. b) other pelvic tissues c) a or b + in peritoneal fluid** **3: to peritoneum + lymph nodes** **4: outside of pelvis and abdomen** **Mx:** **Stage 1:** Surgical management: oopherectomy/ excision. If high grade = carboplatin six cycles **Stage 2-4:** Surgical management: resection of all cancerous tissue + **paclitaxel**

Answer 3

**Questions for antenatal consultation:** Gravida and parity Gestational Age/ LMP (Nagle's Rule) Fetal Movements Discharge, bleeding, pain, hyperemesis, ROM (bloody show) Booking Visits? BP? Urine Dip? GDM Risk? **Screen for psych** PMH,PSH, DH (folic acid, penicillin allergy, latex allergy), FH (pre-term, pre eclampsia, HTN, DM, miscarriage) SH (Domestic abuse, alcohol, smoking, drug use) **Examination:** Pregnant Abdo exam + Doppler/ Pinnard BP, Urine Dip, USS if indicated Speculum + swabs if indicated

Answer 4

**Hx** Abdominal pain, severe, peritonism, shoulder tip pain, diorrhae, Amenorrhoea (LMP) RFs- Coil, uterine abnormalities, smoking, Previous gynae surgery, Previous history of ectopic, PID, STIs, Assisted Conception **Dx -** Avoid abdo exam due to rupture risk ABCDE. Observations. Pregnancy Test **If worried about rupture** - Fast Scan, ABG and cross match **TVUS, FBC, CRP, ESR, B-HCG (serial B-HCG to make sure it decreases)** Most commonly in the ampula of the fallopian tube **Mx** **Surgical Indications:** \>35mm, pain, haemodynamically unstable, Beta HCG \>1500, fluid in the pouch **Medical Indications:** Serial HCG monitoring, 15% require second dose and some people require surgery. Make sure they can come back to hospital for another pregnancy test. 70% go onto have another successful pregnancy Complications: Immediate - risks of surgery, perforation, loss of fallopian tube, infection Long term - adhesions, damage to abdominal organs, incontinence, subfertility, risk of ectopic pregnancy

Answer 5

**Pathological** \>3 minutes bradycardia Reduced variability for more 90 minutes Late decelerations \>30 minutes **Suspicious** Baseline rate high (160-180) Baseline variability \<5 (30-90 minutes) Variable decelerations or late decelerations for less than 30 minutes

Answer 6

PC: Hx, Screen for non-consensual, for risk, for abuse, Previous TOPs, clotting disorders, IUD in place, endocrine problems **Before (medical and surgical) :** Scan to assess pregnancy- Rule out miscarriage and ectopic Counsellor involved because can be long term traumatic effects Contraception -Can be inserteid while doing termination Bloods - RhD Negative given anti-D Prophylactic antibiotics **During:** **Medical: \<13 weeks** Mifipristine and Misoprostol. **Surgical: \>13weeks** Dilatation and vacuum/suction (before 14 weeks) Dilation and evacuation (after 15 weeks) **If \>22 weeks:** Fetacide (potassium chloride) **Complications:** Common - bleeding (safety net for severe bleeding) , infection Rare - **failure**, prolonged bleeding, uterine perforation, miscarriage, **Contraindications:** Chronic Adrenal Failure Clotting Disorders IUD in place - must be taken out before TOP Ectopic **Abortion act:** \<24 weeks: harm to **mother**, harm to **fetus** (physical, psychological harm to mother, fetus or any **existing** **children**) \>24 weeks: grave danger or injury to the **fetus** or the **mother**

Answer 7

**Fraser:** Do you understand why im talking about contraception? Cannot be persuaded to inform parents? Likely to continue having intercourse? Physical/mental health liely to suffer? **Extra:** Talk about boyfriend, age and consensual. \<13 with someone \>16 is crime. Currently on contraception? **Ovulation Inhibitors (95%)** **Ulipristal Acetate -** can only be used once in a cycle. **120 hours.** Progresterone receptor modulator. Breast pain, N&V **Levonorgestel -** N&V, Breast Pain. Can take another one if vomited out within 3 hours. **72 hours** **Fetacidal (thickens cervical mucus)** **Copper COil (99%)** **- contraindicated in ectopic history, current PID,** -**120 hours** **Four extra things** safety net - for fever, bleeding, abdominal pain Offer long term contraception screen for STIs Test of pregnancy - 2 weeks time

Answer 8

**On Anti - D antibody testing at booking and at 28 weeks:** **\>4 iu/ml = moderate risk** **\>15 iu/ ml = severe risk** **If deteted before 28 weeks testing should occur every 4 weeks until 28 weeks and then every 2 weeks thereafter** **Cord blood taken at birth to assess for anti-D antibodies.** **Cell saver - 1500 iu anti-D** Sensitising Events: Give anti -D within 72 hours 250 iu 12-20 weeks 500iu \>20 weeks + kleihauher test medical interventions (chorionic villus sampling, amniocentesis or external cephalic version) terminations late miscarriages antepartum haemorrhage abdominal trauma

Answer 9

**DDx -** Physiological - menopause, breastfeeding, pregnancy Hypothalamic - low weight, exercise Pituitary - hyperprolactinaemia (can be secondary to hypothyroidisM), pituitary failure, sheehan's Adrenal - CAH, virilising tumours Ovarian - PCOS, premature menopause, virilising tumours Outflow - Asherman's, Cervical stenosis , endometrial surgery **Dx:** 21 Day Progesterone ( 7 days before start of new cycle) - If \<30 then consider anovulation FSH/ LH - Day 3 - if low then pituitary failure, if high then ovarian failure TFTs Pituitary Function testing Testosterone - if high PCOS Oestrogen - If low suggests premature ovarian failure

Answer 10

Hypothalamic - Low weight, exercise , consitutional delay Adrenal - CAH Congenital - Turner's, Kallman's (GnRH deficiency) Outflow - Imperforate hymen, Transverse Vaginal Septum, Rokitansky's syndrome (failure of mullerian duct development resulting in missing uterus and variable degrees of vaginal hypoplasia )

O & G Flashcards

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