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Week 2 paces cases > O&G > Flashcards

O&G Flashcards

(108 cards)

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1
Q

Components and counselling of a medical abortion

A

Oral mifepristine taken at the clinic
Vaginal misoprostol taken at home
Follow up
Give supportive advice about what might happen (passage of clots/blood)

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2
Q

Types of surgical abortion

A 
Vacuum aspiration (<14w) (gentle suction)
Dilation and evacuation (later) = suction and cutterage to remove any remaining tissue
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3
Q

Rules around abortions

A

<24w unless risk to mothers life

The reasoning behind = damage to mothers life/mental health/other children

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4
Q

Aspects of O&G Hx

A

PC
Basic pregnancy questions if relevant
HPC

Previous pregnancies
Any terminations or miscarriages

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5
Q

What is gravidity?

A

Number of pregnancies

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6
Q

What is parity?

A

Number of pregnancies past 24w

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7
Q

Key obstetrics questions regarding Sx

A 
Any vaginal bleeding?
Any nausea and vomiting?
Any itching?
Any abdominal pain?
Any headache?
Reduced foetal movements?
Chest pain/SOB ?PE
Leg swelling (ruling out DVT)
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8
Q

Types of miscarriage

A 
Complete = passed tissue and os now closed, USS shows no retained tissue
Threatened = some bleeding/pain, Os is closed 
Incomplete = passed some tissue and now pain and os closed 
Inevitable = os open
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9
Q

Mx of miscarriage

A 
Expectant = wait 7-14 days
Medical = Vaginal misoprostol 
Surgical = Vacuum aspiration if evidence of infection or very painful (risk of haemorrhage)
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10
Q

Stages of labour

A

1= latent (0-3cm)
1 active = 3-10cm
2 = delivery of the foetus
3 = delivery of the placenta

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11
Q

RF for pre-eclampsia

A

DIABETES
Previous pre-eclampsia
Multiple pregnancy
Pre-existing renal disease

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12
Q

What does vaginal misoprostol do?

A

Stimulates uterine contractions

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13
Q

How do you confirm a miscarriage?

A

TVUSS to look for uterine pregnancy

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14
Q

Features of endometriosis

A

Abdominal pains
Dysparenuria
Irregular periods

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15
Q

Mx of endometriosis

A

Analgesia
COCP
GnRH agonists
Endometrial ablation

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16
Q

Symptoms of PID

A

Unusual discharge
Abdominal pains
RUQP (Fitz-Hugh-Curtis)

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17
Q

Mx of PID

A

NAAT
IV antibiotics
Analgesia

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18
Q

Features of anti-phospholipid syndrome

A

Recurrent miscarriages
Recurrent VTE
Lichen planus (webbed rash)

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19
Q

Mx of anti-phospholipid syndrome

A

Aspirin

Warfarin if still getting recurrent Sx

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20
Q

Ix for anti-phospholipid syndrome

A

Coagulation Ix
Anti-cardiolipin
Lupus antibodies

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21
Q

Features of pre-eclampsia

A

Oedema
Headache
High blood pressure
Proteinuria

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22
Q

Mx of pre-eclampsia

A

Labetalol or if asthmatic -> nifedipine

CTG during labour

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23
Q

Cut off for labetalol in pregnancy

A

160/110

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24
Q

Risks of pre-eclampsia

A

Foetal prematurity
Growth retardation
Eclampsia
Haemorrhage

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25
What is eclampsia?
The development of seizures in association with pre-eclampsia Its caused by cerebral oedema
26
Mx of eclampsia
Magnesium sulphate | Can cause resp depression in which case give calcium gluconate
27
Amount of proteinuria to Dx pre-eclampsia
0.3g protein / 24hr
28
Symptoms of STI
``` Dysparaenuia Offensive discharge Itching Lesions PID Infertility ```
29
Mx of STI
STI screen and referral to STI clinic NAAT testing Antibiotics IM or ?course Azithromycin
30
Symptoms of ovarian cancer
``` Abdominal bloating Abdominal pain Urinary symptoms (from pressure) ```
31
Ix for ovarian cancer
CA125 (also raised in endometriosis, cysts and PID) TVUSS Abdominal ultrasound
32
Mx of ovarian cancer
Chemotherapy | Surgery
33
How does the COCP affect cancer rates?
Reduces ovarian and endometrial cancer | Increases breast and cervical cancer
34
Most common ovarian cancer
Serousadenoma (epithelial)
35
RF for ovarian cancer
More oestrogen exposure (earlier menarche, tamoxifen, lynch syndrome, BRCA)
36
Treatment for bacterial vaginosis and trichomonas
Oral metronidazole
37
Dx of PCOS
12+ cysts in ovary Hirsuitism Anovulation/irregular periods
38
What do you give during labour for GBS
Benpen
39
Sx and Dx of endometrial cancer
``` Often post-menopausal vaginal bleeding TVUSS shows thickened endometrium (>5mm) Endometrial biopsy (pipelle biopsy) ```
40
Mx of endometrial cancer
Hysterectomy +/- bilateral salpingectomy
41
Things to measure in amenorrhoea
``` Brings Oars To Paddle B-HCG Oestrogen Thyroid Prolactin ```
42
Cut off in size for ovarian cysts before you do a laparoscopy?
5cm
43
Mx of post-partum haemorrhage
ABC Uterine massage IV syntocinon IV carboprost (contraindicated in HTN)
44
Which hormone surges to induce ovulation?
LH
45
What score on Bishops indicates the need to induce
<5
46
Which hormone prepares the endometrium?
Progesterone
47
Mx for PPROM
Inspect the abdomen CTG Sterile speculum examination (look at the fluid as well) If its amniotic, give erythromycin for 10 days or up until labour! Because risk of amniocentesis
48
At what age range do you give corticosteroids to the mother if premature?
24w-34w
49
Sx of acute fatty liver of pregnancy
3rd trimester Systemically unwell N+V Anorexia
50
Mx of acute fatty liver of pregnancy
IV fluids | Dextrose
51
Mx of gestational diabetes
5mg folic acid at the start then at 12w start aspirin Refer to gestational diabetes clinic Mx depends on glucose levels <7 can give lifestyle and exercise advice for 2w If doesn't improve then start insulin
52
Indications for C-section
Breech 2x previous C-section Foetal distress Eclampsia
53
Things that increase the risk of an ectopic pregnancy
PID Endometriosis Previous ectopic Previous surgery e.g. for cyst removal
54
What is adenomyosis and what are the symptoms?
Endometrium penetrates the myometrium Results in abdominal cramps Bloating before periods Heavy periods
55
Mx for adenomyosis
Pain killers GnRH agonists Hysterecomy
56
Gonorrhoea Mx
Ceftriaxone
57
Chlamydia Mx
Azithromycin and doxy
58
FIGO staging
``` 1 = confined to cervix 2 = confined to pelvis 3 = invaded nearby tissues 4 = distance invasion ```
59
Sx of polyps
Light, intermenstual bleeding -> endometrial | Cervical -> post-coital bleeding
60
Sx of PUPP
``` Rash of pregnancy Spares the umbilicus In stretch marks Light pink Hives like rash ```
61
Components of APGAR?
``` How Ready Is This Child? HR RR Irritable Tone Colour ```
62
Mx of hyperesmesis gravidarum
Pabrinex IV hydration Promethazine Admit if any electrolyte abnormalities or can't tolerate fluid/lost a lot of weight
63
Features of HELLP syndrome
Haemolysis Elevated liver enzymes Low platelets
64
Sx of HELLP syndrome
Fatigue DIC RUQP
65
Features of menopause
Hot flushes Vaginal dryness Irritable
66
Mx of menopause
A natural part of ageing | In the interim as the body adjusts you can give HRT, SSRI, new generation COCP and lubricant
67
How long without a period until it counts as menopause?
1 year
68
premature ovarian failure?
40
69
Ix for premature ovarian failure
All the amenorrhoea Ix (BOTP) | FSH levels
70
What causes the symptoms in menopause?
Reducing oestrogen levels
71
Mx of PCOS
COCP | Fertility assistance = clomifene and metformin
72
Emergency contraception options
Most effective = IUD Levonorgestrol = < 3 days EllaOne = < 5 days
73
Features of implantable contraceptives
Slowly releases progesterone Lasts for 3 years Irregular bleeding is a common side effect
74
Mx of ectopic pregnancy
Methotrexate Follow up scans If large or high B-HCG levels need surgical salpinectomy or otomy
75
Ix for ectopic pregnancy
Pregnancy test | TVUSS
76
Features of premature labour
Weak contractions Dilated cervix Too early along, say 27w
77
Mx of premature labour
Admit and administer tocolytic drugs such as nifedipine | Give steroids
78
Risks of prematurity
Necrotising enterocolitis Increased mortality Jaundice
79
Indications for induction of labour
``` Prolonged pregnancy (41w) PROM Diabetic mother (38w because macrosomia) ```
80
Method for induction of labour
Membrane sweep Intravaginal prostaglandins Syntocinon (CTG if you are inducing with oxytocin) Artificial rupture
81
RF for gestational diabetes
BMI >30 | Previous macrosomic baby
82
Screening for gestational diabetes
If RF -> OGTT
83
Mx of cervical cancer
Hysterectomy + lymph node clearance Cone biopsy (increased risk of miscarriage) Radiotherapy and chemotherapy
84
HPV risk factors
SMOKING HIV High parity
85
Causes of menorhagia
Fibroids PID Dysfunctional uterine bleeding Hypothyroidism
86
Symptoms of gonorrhoea
Thin, purulent discharge Dysuria Dyspareunia Intermenstrual bleeding
87
Sx of herpes
Tingling/burning Blisters Dysuria
88
Mx of herpes
Aciclovir
89
Symptoms of syphilis
Painless ulcers
90
Cottage cheese discharge Low pH Dx and Mx
Thrush (vaginal candiadis) | Clotrimazole cream
91
Features of placenta previa
Low lying placenta Painless, bright red blood loss in the 3rd trimester Confirm with TVUSS
92
Features of trichomonas
Green discharge Frothy Strawberry cervix
93
Mx of fibroids
Myomectomy
94
Ix for fibroids
Examination and USS
95
Aspects of an infertility Hx
``` LMP Regular periods Regular sex Partner any issues Testing Previous STI? Structural issues ```
96
What is Sheehan's syndrome?
A complication of severe PPH The pituitary gland can be damaged leading to necrosis The patient will present with lack of milk production (due to inadequate prolactin)
97
Advice for breastfeeding
Ensure a good latch Feed regularly Allow the baby to drain the breast (feels soft and empty), this will prevent milk stasis If blocked duct, keep feeding, this will help to clear it and reduce tenderness
98
What is the premalignant stage of cervical cancer?
Cervical intraepithelial neoplasia (CIN)
99
How do HPV 16 and 18 induce cervical cancer?
Inactivate tumour suppressors
100
At what year are patients invited for a cervical smear?
25yo
101
Causes of primary amenorrhoea
Turners | CAH
102
Causes of secondary amenorrhoea
``` Pregnancy Hypothalamic (stress) Menopause POF Anorexia ```
103
Causes of vaginal bleeding
``` Endometrial cancer Submucosal fibroid Endometrial polyp Endometriosis Adenomyosis ``` Cervical polp, ectropion or cancer
104
Management of bleeding from things like fibroids
Mirena coil
105
Types of urogenital prolapse
Cystocele Rectocele Uterine prolapse
106
Mx of intrahepatic cholestasis of pregnancy
3rd trimester Itchy Raised bilirubin Treat with ursodeoxycholic acid
107
Clinical features of placental abruption
Shock out of keeping with visible loss Severe constant pain Absent foetal heart beat Tender, tense uterus
108
Treatment of atrophic vaginitis
Topical oestrogen cream | Vaginal lubricants and moisturisers

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