O&G Flashcards
(137 cards)
1
Q
At what week does gonadal differentiation occur?
A
Week 7
2
Q
The mesonephric duct is also known as _____ duct, and forms the (male/ female) reproductive system
A
Wolffian; male
3
Q
The Mullerian duct is also known as ____ duct, and forms the (male/ female) reproductive system. In the other, it degenerates into the ____
A
Paramesonephric; female; appendix testis
4
Q
What are the risk factors for endometrial hyperplasia?
A
Obesity, PCOS, chronic anovulation, unopposed oestrogen (HRT), tamoxifen, oestrogen-secreting tumours (granulosa cell ovarian Ca), prolonged oestrogen exposure (early menarche, late menopause, nulliparity), genetics (PTEN mutn)
5
Q
What category of endometrial hyperplasia has the highest risk of progression to endometrial carcinoma?
A
Complex type with nuclear atypia (30% risk)
6
Q
True or false: oophorectomy cannot be performed in a vaginal hysterectomy?
A
True
7
Q
From where does the uterine artery arise, and describe its course through the pelvis?
A
It arises from the ant division of the internal iliac artery. It passes medially in the broad ligament to the lateral edge of the uterus, and sends branches in all directions, often forming anastomoses with the ovarian and vaginal arteries
8
Q
In order to avoid ureteric/ bladder injury, the bladder is reflected (up/down)wards in abdominal hysterectomy and (up/down)wards in vaginal hysterectomy?
A
Downwards; upwards
9
Q
List 2 pros & 2 cons of a transverse Pfannenstiel incision
A
Pros
1) Cosmetically attractive
2) Strong, low risk of herniation
Cons
1) Difficult to extend
2) Access limited to pelvic organs
10
Q
Thyroid-binding globulin (TBG) levels naturally (increase/ decrease) during pregnancy?
A
Increase ~2-fold due to increased production (stimulated by oestrogen) & decreased clearance
11
Q
Oestrogen stimulates hyperplasia of ____ cells in the pituitary
A
Lactotropic
12
Q
True or false: during early pregnancy, women can have results consistent with hypothyroidism?
A
True
ßhCG cross-reacts with TSH-Rs; if hypoTH persists, consider starting low-dose thyroxine
13
Q
What are the complications of hypothyroidism during pregnancy?
A
Premature birth, low birth weight, miscarriage, impaired fetal neurocognitive development
14
Q
For treatment of hyperthyroidism, (PTU/carbimazole) is preferred in the first trimester and (PTU/ carbimazole) should be used thereafter
A
PTU; carbimazole
15
Q
For women with a thyroid disorder during pregnancy, TFTs should be checked how many weeks post-partum?
A
6 weeks
16
Q
True or false: Cushing’s syndrome in pregnancy is more likely caused by a pituitary adenoma whereas in non-pregnant patients it is more likely an adrenal adenoma
A
False - the opposite is true
adrenal adenoma 40-50% pregnancy; pit adenoma 30%
17
Q
List 4 intrapartum complications of obesity:
A
Any of:
- requirement for IOL & failure of IOL
- C/S
- Complicated or operative vaginal birth
- Shoulder dystocia
- Obstructed labour
- Peripartum death
18
Q
Provide 3 reasons for why breast feeding is less common in obese mothers
A
1) Mechanical difficulties
2) Reduced PRL response to suckling
3) Psychological issues
19
Q
What dose of folate is recommended for obese women?
A
5mg/d (high-dose)
20
Q
For a women with healthy pre-pregnancy BMI (18.5-24.9), what is the recommended total weight gain?
A
11.5-16kg
21
Q
Definitive diagnosis of nephrotic syndrome during pregnancy requires a ____
A
24 hour urinary protein excretion
22
Q
Asymptomatic bacteriuria affects ___% of pregnant women
A
4-7%
23
Q
What are the cut-offs for HTN & severe HTN in pregnancy?
A
BP ≥140/90
Severe if ≥170/110
24
Q
A diagnosis of pre-eclampsia requires hypertension + one or more of the following:
A
Proteinuria (urine PCR >0.3mg protein/1mg Cr)
Plasma Cr ≥1.1mg/dL (aka renal impairment)
Liver disease: AST ≥50 IU/L and/or severe epigastric or RUQ pain
Neuro problems: convulsions (eclampsia), hyperreflexia + clonus, severe headaches
Haematologic disturbances: thrombocytopaenia, haemolysis, IUGR
25
What are the most common causes of post-menopausal bleeding?
Atrophic vaginitis/ endometritis is most common (60-80%)
Endometrial carcinoma in ~10%
Other causes: endometrial hyperplasia, polyps (endometrial/ cervical), cervical cancer, vaginal trauma, exogenous oestrogens
26
What are the 5-year survival rates of stage I versus stage V endometrial carcinoma?
Stage I: >85%
| Stage V: 10-20%
27
What is the most urgent management required for HELLP syndrome, AFLP and pre-eclampsia?
Urgent delivery of the baby
| Usually + ICU admission with supportive care (BP control, blood products/ IV fluid, ± dialysis)
28
True or false: spider naevi, palmar erythema and peripheral oedema are signs of liver disease in pregnancy?
False - these are all common & normal for pregnancy due to increased oestrogen
29
(HBV/HCV) is the most common cause of chronic viral hepatitis in pregnancy and has a vertical transmission rate of up to 95%
HBV
30
Which liver enzyme is produced by the placenta?
ALP
31
What should be avoided during the intrapartum period/ delivery to reduce the risk of transmission of HBV/ HCV from mother to baby?
Instrumental delivery (e.g. forceps) & fetal scalp clip
32
True or false: breast feeding is considered to be safe for mothers with HBV or HCV hepatitis?
True
33
For biliary disease in pregnant women, surgery is preferred in which trimester?
2nd trimester
34
The most common presentation of Intrahepatic cholestasis of pregnancy (ICP) is a) _______. This is treated with ________.
a) severe pruritus
b) ursodeoxycholic acid (UDCA)
ICP classically presents with severe pruritus of the palms and soles, in the 2nd or 3rd trimester.
UDCA is a secondary bile acid and reduces the itch and risk of preterm delivery.
Oral vitamin K may also be given to reduce the risk of bleeding due to vit K deficiency in ICP
35
Which of the following is NOT a content of amniotic fluid? Urea, lecithin, fatty acids, alpha fetoprotein, sodium, water, protein
Fatty acids
36
What are the 4 key functions of the amniotic fluid sac?
1) Mechanical protection
2) Pressure equalisation during uterine contractions
3) Immune protection (amniotic fluid has bactericidal activity)
4) Accommodates fetal growth
37
What percentage of live births are multiple pregnancies?
3%
38
Which type of twin pregnancy is higher risk - monozygosity or dizygosity?
Monozygosity
39
Uncomplicated MCDA twins should be delivered from ___ weeks gestation and uncomplicated DCDA from ____ weeks. Antenatal steroids are given to (MCDA/ DCDA)?
MCDA - 36wks onwards + steroids
| DCDA - 37wks onwards
40
List 3 key ways to differentiate between the different types of miscarriage
1) Clinical signs & symptoms e.g. presence of PV bleeding, abdo pain, early pregnancy symptoms (N&V, breast tenderness)
2) USS findings
3) Cervical dilation
41
The risk of venous thromboembolism (VTE) increases 8 -fold during pregnancy
8X risk due to
Increased coagulability
Venous stasis
Reduced venous outflow due to compression of IVC or pelvic vein by gravid uterus
42
What is included in a thrombophilia screen during pregnancy to assess for VTE risk?
```
Protein C/S/ATIII deficiency
Factor V Leiden
Activated Protein C resistance
Anti-phospholipid antibodies (lupus anticoagulant, anti-cardiolipin Ab, ß2GP1)
Prothrombin mutation
```
43
What are the VTE risk factors (4) considered to be high risk?
1. Prev history of DVT/ VTE
2. Family history of VTE
3. Thrombophilia
4. Antenatal LMWH prophylaxis
44
True or false: enoxaparin (LMWH) crosses the placenta
False - it does not cross the placenta, and has no evidence suggesting it is teratogenic
45
What are the risk factors for Pre-eclampsia?
```
Advanced maternal age
High BMI
Multiple pregnancy
1st pregnancy; new partner; >10yr interval since last pregnancy
Prev pre-eclampsia
Pre-existing HTN
FHx
DM, SLE, Anti-PL syndrome
GTD, fetal triploidy
```
46
```
For each of the following medication pairs, select which is contraindicated/ should be avoided during pregnancy:
Warfarin/ heparin
Paracetamol/ NSAID
ß-blocker/ ACEi
Sertraline/ Sodium valproate
Tetracyclines/ penicillins
```
Warfarin (category D)
NSAIDs (category C: inhibit PG synthesis, may cause premature closure of ductus arteriosus, fetal renal impairment, inhibit platelet aggregation)
ACEi (category D: in 2nd & 3rd trimester cause renal dysfunction, oligohydramnios, IUFD)
Sodium valproate (category D, contraindicated: causes congenital malformations incl NTD)
Tetracyclines (category D; cause teeth discolouration)
The other drugs in each pair are generally considered safe to use during pregnancy, however as always risk benefit must be calculated
47
What are the routine tests ordered at the booking-in antenatal visit?
FBC, blood group & maternal antibodies
Serology: HIV, HBV, HCV, syphilis, rubella
Urine MCS
48
What does the combined first trimester screen (CFTS) involve?
```
Blood test (PAPP-A and ßhCG)
Nuchal translucency on ultrasound
```
49
Asymptomatic bacteriuria must be treated during pregnancy because ____ go on to develop symptomatic UTI, which increases the risk of ______
20-30%
preterm labour, low birth weight and perinatal mortality
50
Acute cystitis in pregnancy is treated with ___ or ____
nitrofurantoin or cefalexin
51
A pregnant woman presents with fever, tachycardia, a tender uterus and offensive purulent PV discharge, and her membranes have been ruptured for >18 hours. The likely diagnosis is ___
chorioamnionitis
52
The treatment for chorioamnionitis is _____
IV ampicillin/ amoxicillin + gentamicin + metronidazole
53
______ is the most common cause of early onset neonatal sepsis
Group B streptococcus (Strep agalactiae)
54
List the risk factors for early-onset GBS disease (EOGBSD)
```
GBS colonisation/ bacteriuria in the current pregnancy
Prev EOGBSD
Maternal temp ≥38 degrees intrapartum
Preterm labour
ROM>18hrs
```
55
Intrapartum antibiotic prophylaxis is considered adequate when it is given at least ___ before the birth, but ideally ___ prior
2 hours
| 4 hours
56
What is the dosing regime for intra-partum antibiotic prophylaxis (IAP) to reduce the risk of early-onset GBS disease?
IV benzylpenicillin: 3g loading dose then 1.8g q4h maintenance (4hrs after loading) until delivery
Commence IAP after onset of labour and aim for at least 4 hours prior to birth
57
The most common bacterial cause of postpartum wound infections is ____
Staph aureus.
58
Mastitis can be sub-categorised as _____. Women should be encouraged to (stop/continue) breastfeeding.
Infective or congestive
Infective: inflammation ± purulent discharge and fever approx 1 week postpartum, most commonly due to S. aureus
Congestive: breast engorgement ~ day 2-3
If already breastfeeding, women should continue. Emptying the breast is one of the key treatments, plus antibiotics if infective
59
List risk factors for SGA
```
in utero infection (TORCH/ syphilis)
Genetic syndromes (Trisomy 21, Turner's)
Multiple pregnancy
Maternal genetics (low BMI/ low birth weight)
Maternal comorbidities
Maternal smoking/ drugs
Placental insufficiency and hypoxia
Teratogen exposure
```
60
An LGA/ macrosomic baby is at increased risk of ____
birth injuries (e.g. shoulder dystocia, clavicular fracture, brachial plexus damage), hypoglycaemia, respiratory distress and long-term metabolic disease
61
Where an instrumental delivery is required ____ are considered first line treatment in a baby with caput succedaneum
Forceps
| Forceps are preferred to vacuum extraction, as the vacuum may not maintain its suction if there is marked caput
62
A lambda (twin peak) sign on ultrasound indicates what type of pregnancy?
DCDA twin pregnancy
63
In asymmetrical IUGR the (measurement) ____ is preserved
head circumference
64
What are the 3 functional shunts in the fetal circulation?
1. Ductus venosus: shunts oxygenated blood from umbilical vein to IV, bypassing the immature liver
2. Foramen Ovale: shunts mixed blood (oxygenated from placenta + deoxygenated from rest of body) from right atrium (higher pressure d/t pulmonary vascular resistance) into left atrium (lower pressure), bypassing the immature lungs
3. Ductus arteriosus: shunts mixed blood (as above) from the pulmonary trunk into aorta, bypassing the immature lungs
65
At what gestation do pregnant mother's tend to first feel fetal movements ('quickening')?
Between 16-20 weeks
66
The most common causes of antepartum haemorrhage are a) _____, which is usually painless, and b) ____, which is usually painful.
a) Placenta praevia - occurs in 2% of pregnancies
Presents as recurrent, painless PV bleeding
May be mild (near the os), marginal (reaching the edge of the os), partial (partly covering the os) or complete (full coverage of the os)
b) Placental abruption - occurs in 4% of pregnancies
Presents as acute onset, painful PV bleeding with constant abdominal pain
Group 1 (no retroplacental haemorrhage, <50-100mL blood loss), group 2 (retroplacental bleeding <1.5L) or severe (retroplacental blood loss >1.5L)
67
What are the 4 T's of postpartum haemorrhage (PPH)?
1. Tone (70%): uterine atony due to exhaustion, over-distension of structural anomaly
2. Trauma (20%): uterine, cervical, perineal damage
3. Tissue (10%): retained products of conception
4. Thrombin (<1%): inherited (vWD) or acquired (PET, DIC, ITP, AFE) coagulopathy
68
Non-pharmacological management of PPH includes a) _____.
Pharmacological management is b) _____
Surgical management includes c) ______
a) fundal rub/ pressure, bimanual compression, controlled-cord traction, balloon tamponade
b) tranexamic acid 1g IV ± oxytocin/ ergometrine/ misoprostol.
c) B-Lynch compression sutures/ repair trauma/ packing/ remove retained POC).
Oxytocin, ergometrine and misoprostol can be given if the underlying issue is uterine atony
Also consider the need for blood transfusion
69
During the menstrual cycle, the dominant hormone in the follicular phase is a) ____ and in the luteal phase is b) ____.
a) oestrogen
b) progesterone
Follicular phase: week 1-2, selection of dominant follicle, secondary oocyte formation & rupture
Luteal phase: week 3-4, follicle degeneration (corpus lute --> corpus albicans)
70
Premature menopause is cessation of periods under 40 years old. It is caused by _______ (4)
ovarian insult (e.g. cytotoxic meds or radiotherapy), autoimmune or infective oophoritis, genetic (Turner's, Downs Syndrome, Fragile X, hormone deficiency) or idiopathic
71
The average age of menopause is _____.
51 years old
The average range is 45-55 years old
72
The key symptoms of peri-menopause are _____
Menstrual irregularities: long/ short cycles, abrupt cessation, breakthrough bleeding
Vasomotor Sx: hot flushes, sweating
Mood/ sleep change: depression, poor memory/ concentration, sleep problems
Urogenital Sx: vaginal dryness, sexual dysfunction & dyspareunia, recurrent UTI
73
The primary purpose of hormone-replacement therapy during [peri]menopause is for _____
relief of vasomotor symptoms (hot flushes).
74
What are the contraindications for hormone replacement therapy?
Previous cardiovascular or cerebrovascular disease (MI, stroke)
Venous thromboembolism (VTE)
Breast cancer (hormone-sensitive)
PV bleeding
Caution with: treated endometrial cancer, active SLE, high cardiovascular risk, abnormal LFTs or un-investigation abnormal uterine bleeding
75
Chronic hepatitis ____ has up to 95% risk of vertical transmission. Chronic hepatitis ___ only has a 3-5% risk.
B
| C
76
The key investigations for diagnosing intrahepatic cholestasis of pregnancy are (2)
Liver enzymes and fasting bile acids.
The classic profile is transaminitis with increased fasting bile acids. There may also be a vit K deficiency, due to impaired absorption of fat-soluble vitamins with cholestasis.
77
What are the complications of HELLP syndrome?
```
Placental abruption
DIC
Eclampsia
Subcapsular liver haematoma/ hepatic rupture
Pulmonary oedema
AKI
Retinal detachment
Fetal demise
IUGR
Preterm delivery
```
78
Acute Fatty Liver of Pregnancy (AFLP) usually manifests during the ___ trimester and has a (high/low) risk of recurrence.
3rd
| High
79
Anti-D is routinely given as prophylaxis to ____ pregnant women at _____ weeks.
Rh negative
| 28 and 34 weeks
80
Which of the following is NOT an indication for anti-D administration?
1) Abortion (medical or surgical)
2) Invasive fetal intervention including CVS or amniocentesis
3) Threatened miscarriage <12 weeks
4) Antepartum haemorrhage
5) Miscarriage
6) External cephalic version for breech presentation
3 - threatened miscarriage <12 weeks. According to the RANZCOG guidelines, there is insufficient evidence to suggest that threatened miscarriage <12 weeks gestation necessitates anti-D. https://ranzcog.edu.au/RANZCOG_SITE/media/RANZCOG-MEDIA/Women%27s%20Health/Statement%20and%20guidelines/Clinical-Obstetrics/Use-of-Rh(D)-Isoimmunisation-(C-Obs-6).pdf?ext=.pdf
81
The typical dosing for anti-D is ___ IU in the first trimester and ___ IU in the 2nd or 3rd trimester.
250
| 625
82
What are the risk factors for breech presentation?
Maternal
- Older age
- Primip
- Prev breech/ FHx
- Uterine structural anomalies: bicornuate/ septate uterus, fibroids
- Anticonvulsant meds
Pregnancy/ fetal
- Placenta praevia
- Oligo-/ polyhydramnios
- Short umbilical cord
- Female
- Multiple pregnancy
- Preterm gestation
- IUGR, fetal asphyxia
- Anencephaly, hydrocephaly
83
The most important and urgent risk factor for a breech presentation in labour/ attempting vaginal delivery is ___
cord prolapse.
84
What are contraindications for external cephalic version (ECV)?
```
Footling breech
Previous C/S with uterine scar
Multiple pregnancy
Active labour/ SROM
PV bleeding, APH, placenta praevia
Uterine structural anomaly
PET
Fetal compromise, oligohydramnios
```
85
Define stages 1-3 of labour
Stage 1 of labour is from the onset of true labour contractions until full cervical dilation (10cm).
Stage 2 is from full cervical dilation until expulsion of the fetus.
Stage 3 is from fetal delivery until placental delivery.
86
The active phase of stage 1 of labour refers to when the cervical dilation is ____ cm, and there are intense, regular uterine contractions
6-10cm
87
A risk of controlled cord traction in stage 3 of labour (delivery of placenta) is ____
uterine inversion
88
Stage 2 of labour is considered prolonged once it is a) ___ in a primip or b) _____ in a multip. (Note: add 1 hour extra allowance if an epidural has been given)
a) ≥3hrs pushing
| b) ≥2hrs pushing
89
Approximately__ % of shoulder dystocia cases have no identifiable risk factors.
50%
90
The key risk factors for shoulder dystocia are ____ (5)
macrosomia, maternal diabetes, maternal high BMI and/or excess gestational weight gain, previous shoulder dystocia and post-term delivery.
The majority of risk factors are also associated independently with increased fetal weight/ macrosomia (maternal diabetes, obesity, post-term delivery). There is an association between shoulder dystocia and prolonged labour (stage 1 or 2) and instrumental assisted vaginal delivery, however it is unclear if these are direct risk factors, or consequences of the same underlying problems.
91
What is McRobert's manoeuvre?
a) In which situation is it used
b) Describe the process
c) What is the outcome
a) Used for shoulder dystocia
b) Flexion and abduction of maternal hips
c) This tilts Mum's pelvis, straightening the lumbosacral angle and increasing the AP diameter of her pelvis to open up the birth canal
92
What does the acronym 'HELPERR' stand for with regards to management of shoulder dystocia?
```
H = call for help
E = Evaluate need for episiotomy
L = legs positioned as per McRobert's manoeuvre
P = apply suprapubic pressure
E = enter the vagina to perform internal manipulation
R = remove the post fetal arm
R = roll mum onto her hands & feet
```
93
List the complications of shoulder dystocia:
a) fetal: ____
b) maternal ____
a) Fetal: brachial plexus injury, clavicular or humerus fracture and fetal asphyxia/ hypoxic ischaemic encephalopathy (HIE)
b) maternal: PPH and perineal tears (especially 3rd-4th degree)
94
Cord prolapse usually occurs when _____ or _____
the presenting part doesn't adequately fill the pelvis
OR
obstetric interventions dislodge the presenting part.
Presenting part doesn't fit:
SGA, preterm, polyhydramnios
Malpresentation: breech (esp footling), transverse/ oblique/ unstable lie
Twin 2
Low-lying placenta, long umbilical cord
Cephalo-pelvic disproportion
Uterine malformations or external fetal anomalies
Obstetric interventions:
IOL: balloon catheter, ARM
Intrapartum monitoring: Fetal scalp electrode, intrauterine P catheter
External (ECV) or internal fetal manipulation
Forceps/ vacuum-assisted delivery
95
Infertility is defined as the failure to conceive after _____
12 months of regular, unprotected sex.
96
Female infertility accounts for approx 1/3rd of cases of infertility. The causes are _____ (5)
Oligo/anovulation 25%: PCOS, hypothalamic, 1o ovarian failure, hyperPRL
Endometriosis 15%
Pelvic adhesions 12%
Tubal occlusion 11%: surgery, PID, endometriosis
Uterine anomalies: septate, bicornuate, fibroids, polyps, Asherman's syndrome
97
Clomiphene citrate is an _____ (MOA) used for _____.
Anti-oestrogen used for ovulation induction
| It stimulates a surge in LH/FSH
98
What does PALM-COEIN stand for?
```
PALM-COEIN is an acronym for DDx of abnormal uterine bleeding (AUB)
P = Pregnancy, ectopic
A = Adenomyosis
L = Leiomyoma
M = Malignancy
C = Coagulopathy
O = Ovulatory dysfunction (PCOS, thyroid/ pituitary disorder)
E = Endometrial
I = Iatrogenic
N = Not yet classified
```
99
The gold standard diagnosis of endometrial hyperplasia/ carcinoma is ____
hysteroscopy, dilation and curettage (HD&C) + endometrial biopsy
100
In post-menopausal women, endometrial thickness should be ____
<4mm
101
Secondary amenorrhoea is defined as cessation of regular menses after ___ or previously irregular menses after ___
3 months
| 6 months
102
The first line treatment of endometrial hyperplasia without atypia is a) ____, and with atypia is b) .
a) Levonorgestrel IUD (Mirena)
| b) total hysterectomy ± BSO
103
What is the Rotterdam criteria?
The Rotterdam criteria is used to diagnose PCOS. It states that 2 or more of the following are required for a diagnosis:
1. Hyperandrogenism: clinical (hirsutism, acne, virilization) or biochemical (increased free androgen index [FAI] or testosterone)
2. Ovulatory dysfunction: irregular or anovulatory cycles; oligo-/amenorrhoea
3. Polycystic ovaries: on USS
104
The complications of PCOS are ____
metabolic (T2DM, dyslipidaemia, obesity, NAFLD), OSA, cardiovascular disease, mood disorders (depression/ anxiety), endometrial hyperplasia/ carcinoma, infertility and pregnancy-related (PET, GDM, miscarriage, spina bifida)
105
The first line treatments for infertility in PCOS are ____
Clomiphene citrate and Letrozole. Both are agents used for ovulation induction
Clomiphene citrate: anti-oestrogen -> stimulates pituitary LH/FSH secretion -> stimulates ovarian follicle development
Letrozole: aromatase inhibitor -> prevent conversion of androgen to oestrogens -> increase LH/FSH as above
106
The 3 types of fibroids (based on location) are ___
subserosal, intramural and submucosal
107
Fibroids typically present as ____
abnormal uterine bleeding (AUB), pelvic pain/ pressure or subfertility (including recurrence miscarriage)
108
In women with irregular periods, the ___ phase is always constant
Secretory.
The secretory phase is always constant at 14 days (after ovulation)
The follicular phase may be variable, causing irregular menstrual cycles
109
Clue cells on microscopy of vaginal smear are indicative of ____
bacterial vaginosis.
110
The most common strains of genital warts are HPV ____
6 and 11
111
```
List the treatment (medication name, no doses required) for each of the following gynaecological infections
Bacterial vaginosis
Candidal vulvovaginitis
Chlamydia trachomatis
Neisseria gonorrhoea
Trichomonas vaginalis
Genital herpes (HSV)
Syphilis
Genital warts (HPV)
```
Bacterial vaginosis: metronidazole + clindamycin PO/ PV
Candidal vulvovaginitis: oral fluconazole (or PV clotrimazole, miconazole, nystatin)
Chlamydia trachomatis: azithromycin (OR doxycycline)
Gonorrhoea: ceftriaxone IM + azithromycin
Trichomonas vaginalis: metronidazole PO
Genital herpes (HSV): acyclovir or valaciclovir
Syphilis: benzathine penicillin
Genital warts (HPV): cryotherapy, podophyllotoxin, imiquimod, surgical (excision, laser, diathermy)
112
Chlamydia and gonorrhoea are tested for via a(n) ____
endocervical swab + PCR
If this is not possible, a first pass urine sample can be collected and tested
113
Acute PID is a a)____ diagnosis. Treatment b) (should/should not) be commenced before receiving results of swab tests.
a) clinical
| b) should
114
70% of acute PID is ___
polymicrobial
115
The empirical antibiotics for acute PID are ____
ceftriaxone + metronidazole + azithromycin
This is delivered orally in an outpatient setting for non-severe infection, or IV as inpatient if severe (different dosage)
116
The long-term complications of PID are ____ (6)
chronic pelvic pain, sub/infertility, ectopic pregnancy, tubal scarring, pelvic adhesions and tubal-ovarian mass or abscess.
117
The majority of cervical cancers are ___ carcinoma
squamous cell
80-90% are SCC
15-20% are AC (adenocarcinoma)
118
Smoking (increases/ decreases) the risk of cervical cancer.
increases
```
Other risk factors are
Early sexual activity, multiple partners, lack of barrier protection and previous STI
Lack of or irregular CST
Immunosuppression
Poor nutrition or low SES
```
119
CIN I (cervical intraepithelial neoplasia type I) is also known as a) ____ and has a regression rate of b)____
a) LGSIL (low-grade squamous intraepithelial lesion)
| b) 70%
120
What is the FIGO/ TNM staging 0-4 for cervical cancer?
0: carcinoma in-situ (HGSIL)
1: cancer is contained to cervix (N0M0)
2: cancer spreads beyond cervix, but does not involve pelvic wall or lower 1/3rd of the vagina (N0M0)
3: cancer involves the pelvic walls or lower 1/3rd of the vaginal; may involve LNs (M0)
4: cancer has spread beyond the pelvis and involves bladder or rectal mucosa, or has distant metastases
121
The National Cervical Screening Test (CST) is offered to asymptomatic women aged ____
25-74 years old.
122
According to the National CST guidelines, if the test comes back as positive for HPV non-16/18 types with low-grade cellular changes (LGSIL), the woman should ____
have a repeat test in 12 months.
CST results & actions
Low-risk (no HPV detected) -> re-screen in 5 years
Intermediate risk (HPV non-16/18 detected ± LGSIL i.e. situation above): repeat test in 12 months. If negative, return to regular screening; if positive again, refer for colposcopy
High-risk (HPV type 16/18 or any HGSIL): refer for colposcopy ± biopsy
123
Describe the 4 degrees of vaginal prolapse
1st degree: prolapse descends into vaginal cavity but does not reach introitus
2nd degree: prolapse reaches, but does not protrude past, the introitus
3rd degree: prolapse protrudes beyond introitus
4th degree: prolapse protrudes beyond introitus and remains outside of vaginal cavity (procidentia)
124
Ovarian preserving surgery can be considered for ovarian torsion for up to ___ days.
3 days
125
The most common position of the fetus at delivery is ___
left occipito-anterior (LOA)
126
In an ectopic pregnancy, serum ßhCG should be low or falling
<1500mIU/L
Tubal mass >3cm, free peritoneal fluid or haemodynamic instability
127
Ectopic pregnancies can be treated medically using ____. Women must not get pregnant for at least ___ after receiving treatment.
methotrexate
| 4 months
128
After surgical treatment of an ectopic pregnancy, ßhCG should be checked on ______ if a salpingotomy was performed, or after ____ in a urine test for post-salpingectomy.
day 1 and then weekly until negative
| 3 weeks
129
After one ectopic pregnancy, women have a ___ % chance of a successful intrauterine pregnancy, and a ___ % chance of a recurrent ectopic.
60%
| 10-20%
130
Miscarriage is defined as pregnancy loss before ___ weeks gestation or fetal weight
20 weeks
<400g
'Early pregnancy loss' is miscarriage during the first trimester i.e. before 12+6 weeks
131
The possible maternal causes of miscarriage can be remembered by the mnemonic MISCAREE (self-made). What does this stand for?
```
M = Medications (anti-convulsants, warfarin, vit A)
I = Infection (TORCH: Toxoplasmosis, syphilis, rubella, CMV, HSV; Listeria)
S = Structural abnormalities (septate/ bicornuate uterus, fibroids, polyps, cervical insufficiency)
C = Coagulation defect
A = Autoimmune (SLE), Anti-phospholipid syndrome
R = Recreational drugs
E = EtOH, smoking
E = Endocrine: luteal phase defect, uncontrolled DM, thyroid disease
```
132
The USS criteria for non-viability of a fetus are ___ PLUS crown rump length CRL >___, mean sac diameter MSD ≥___
no fetal heart activity
>7mm
≥25mm
133
In gynaecology, methotrexate is a DHFR inhibitor (antifolate) used for a) ____, misoprostol is a PG analogue used for b) ____ and mifepristone is a steroidal anti-progesterone used for c) ___
a) ectopic pregnancy
b) miscarriage or termination of pregnancy
c) termination of pregnancy.
134
Cervical shock occurs when products of conception are trapped in the cervical os, and presents as ____ and ____
hypotension and bradycardia
135
What are the 4 theories of endometriosis?
1. Retrograde menstruation
2. Metaplasia of coelomic epithelium
3. Haematogenous or lymphatic spread of endometrial cells
4. Direct transplantation of endometrial cells during procedure
136
What are the absolute contraindications for the COCP? (11 total)
Breastfeeding, <6wks post-partum
>35yo + smoking ≥15 cigs
Migraines + aura
Hx of VTE, CVA, complicated IE, AF or pulm HTN
HTN ≥160/100, 3+ CV risk factors
SLE + anti-PL Ab +ve
Current breast cancer
Liver cirrhosis or tumour
Surgery w prolonged immobilisation
DM for ≥20yrs OR microvascular complications
Undiagnosed PV bleed
137
Maternal deaths are any death that occurs up to 42 days after delivery. In relation to this, define the terms direct, indirect and incidental.
```
Direct = resulting from obstetric complications or their management
Indirect = resulting from pre-existing conditions that were aggravated by the physiological effects of pregnancy
Incidental = unrelated to the pregnancy
```
