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OSCE Y5 > OBGYN > Flashcards

OBGYN Flashcards

1
Q

Ectopic pregnancy typical hx.

A

6-8 weeks amenorrhoea
Lower abdominal pain (unilateral)
Vaginal bleeding - dark brown
Peritoneal bleeding may cause shoulder tip pain on defecation/urination

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2
Q

Placental abruption fx.

A

Shock out of keeping with visible blood loss
Pain, constant
tender, tense uterus
Normal lie
foetal heart absent
coagulation problems
Beware pre-eclampsia, DIC, anuria

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3
Q

Antenatal care - nausea and vomiting

A

‘P6’ point acupuncture and ginger are recommended by NICE
Antihistamines - PROMETHAZINE

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4
Q

Conditions NOT screened for in pregnancy

A

Chlamydia
Cytomegalovirus
Fragile X
Hepatitis C
Group B streptococcus
Toxoplasmosis

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5
Q

Antepartum haemorrhage definition

A

Bleeding from the genital tract after 24 weeks of pregnancy prior to delivery of foetus

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6
Q

How to distinguish placenta praevia from abruption. Shock? Pain? Coagulation problems?

A

Abruption = shock out of keeping with visible blood loss
Praevia = shock in proportion
No pain in praevia, pain in abruption
Uterus is tense and tender in abruption, not in praevia
Coagulation problems are RARE in praevia, common in abruption

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7
Q

Mastitis tx.

A

Treat if systemically unwell, if nipple fissure present or if symptoms do not improve after 24 hours of effective milk removal or if future indicated infection
FLUCLOXACILLIN FOR 10-14 DAYS

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8
Q

Antibiotics contraindicated in BREAST FEEDING

A

Ciprofloxacin, tetracycline, chloramphenicol

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9
Q

Endocrine drugs contraindicated in BREAST FEEDING

A

Carbimazole

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10
Q

Psychiatrc drugs contraindicated in BREAST FEEDING

A

Lithium, BZPs

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11
Q

Anticoagulants SAFE in BREAST FEEDING

A

HEPARIN AND WARFARIN

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12
Q

When is hyperemesis gravidarum most common

A

between 8 and 12 weeks - may persist up to 20 weeks

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13
Q

Referral criteria for nausea and vomiting assoc. w/ pregnancy

A

Continued N&V and is unable to keep down liquids
Continued N&V with ketonuria and or weight loss (greater than 5% of body weight)
Confirmed or suspected co-morbidity e.g unable to tolerate oral antibiotics)

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14
Q

Hyperemesis gradvidarum

A

5% pre-pregnancy weight loss
Dehydration
Electrolyte imbalance

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15
Q

Hyperemesis scoring system:

A

PUQE score

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16
Q

Hyperemesis first-line medications

A

ORAL cyclizine or ORAL PROMETHAZINE
Phenothiazines: prochlorperazine, chlorpromazine

Second line: Oral ONDANSETRON
Meoclopramide or domperidone - not to be used for > 5 days due to risk of EPSEs

IV if acute vomiting but oral if possible

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17
Q

Definition of pre-eclampsia

A

New-onset blood pressure > 140/90 at later than 20 weeks of pregnancy plus ONE of

proteinuria
other organ involvement - e.g. renal insufficiency (creatinine ≥ 90 umol/L), liver, neurological, haematological, uteroplacental dysfunction

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18
Q

Potential consequences of pre-eclampsia

A

Eclampsia
Prematurity
IUGR
Liver failure
haemorrhage
cardiac failure

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19
Q

Features of severe pre-eclampsia

A

BP >160/110
Proteinuria +++
Visual disturbance
headache
Papilloedema
Hyperreflexia
Platelet count decreased

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20
Q

Mx. to reduce risk of hypertension in pregnancy

A

ASPIRIN 75-150 mg
if one major risk factor or two mild/moderate risk factors present

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21
Q

Pre-eclampsia management: when to refer to secondary care

A

Every woman should be referred to secondary care for assessment
Pts. w/ BP > 160/110 are likely to be admitted and observed

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22
Q

Pre-eclampsia treatment

A

Labetalol
Nifedipine if asthmatic

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23
Q

4T causes of postpartum haemorrhage

A

Tone
Tissue
Thrombin
Trauma

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24
Q

Mx. of PPH (Outline)

A

ABCDE - Seniors involved immediately
Mechanical ->
Medical ->
Surgical ->

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25
Q

Mx. of PPH (Mechanical)

A

Uterine massage to simulate contractions

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26
Q

Mx. of PPH (medical)

A

IV oxytocin (slow IV)
IV ergometrine (if no hx. of hypertension)
IM carboprost
Sublingual misoprostol

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27
Q

Mx. of PPH (Surgical)

A

IF medical/mechanical measures fail
1) intrauterine balloon tamponade
2) B-lynch suture -> ligation of arteries
3) Hysterectomy

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28
Q

When does secondary PPH occur and what is the usual cause

A

24 hours -> 6 weeks post partum
Retained placental tissue or endometritis

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29
Q

Post menopausal bleeding: most common cause

Other causes:

A

Vaginal atrophy

HRT (spotting)
Endometrial cancer (MUST BE RULED OUT)
Vaginal cancer
Endometrial hyperplasia (precursor for carcinoma)
cervical and ovarian cancer

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30
Q

Ix. for post-menopausal bleeding:

A

All women >55 years with PMB MUST BE seen within 2 weeks for TRANSVAGINAL USS to rule out endometrial cancer

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31
Q

Vaginal atrophy tx.

A

Topical oestrogens

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32
Q

Endometrial hyperplasia tx.

A

Dillatiation and curettage

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33
Q

Fibroids Ix.

A

Trans-vaginal US

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34
Q

Features of fibroids

A

If symptomatic
Menorrhagia
Sub-fertility
Bulk symptoms: Lower abdominal pain, bloating

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35
Q

Mx. of menorrhagia 2ry to fibroids

A

IUS (if uterus not distorted)
NSAIDs - MEFENAMIC acid
Tranexamic acid
oral progestogen

36
Q

medical tx. to shrink fibroids

A

GnRH analogues (short term)

37
Q

Surgical tx. for fibroids

A

myomectomy: this may be performed abdominally, laparoscopically or hysteroscopically

hysteroscopic endometrial ablation

hysterectomy

38
Q

GnRH side effects

A

Menopause symptoms - flushing, vaginal dryness)
Reason why these are considered a short term measure

39
Q

Rare feature of Fibroids

A

Polycythaemia due to autonomous production of EPO

40
Q

Eclampsia: Tx. to prevent and/or treat seizures

A

Magnesium sulphate

tx. to continue for 24 hours after last seizure

41
Q

What else should be monitored during eclampsia?

A

urine output
reflexes
respiratory rate
oxygen saturations

42
Q

Treatment for magnesium sulphate induced respiratory depression

A

Calcium gluconate

43
Q

Anaemia in pregnancy when should women receive IRON

A

1TM: 110 g/l
3TM: 105 g/l
Post partum: 100 g/l

Oral FERROUS SULPHATE should be continued for 3 months post-correction

44
Q

When should aspirin be continued to for pre-eclampsia prophylaxis

A

till 12 weeks before the scheduled birth of the baby

45
Q

Endometriosis Px.

A

Chronic pelvic pain
Secondary dysmenorrhoea - usually days preceding normal period
Subfertility
Deep dyspareunia

46
Q

Endometriosis Ix.

A

Laparoscopy is gold standard

47
Q

Endometriosis Tx.

A

NSAIDs and paracetamol are first line
COCP if these fail to control symptoms

48
Q

Endometriosis if conventional mx. fails

A

GnRH analogues
Surgery

49
Q

Causes of gynae pelvic pain

A

Ectopic pregnancy
Ovarian cyst/torsion/rupture
Endometriosis
PID

50
Q

Primary dysmenorrhoea: definition and management

A

No underlying pelvic pathology - appears 1-2 years of menarche
Mx. NSAIDs - Mefenamic acid and/or ibuprofen
2) COCP

51
Q

Secondary dysmenorrhoea definition and Mx.

A

Develops many years after the menarche due to underlying pathology
Refer all patients to gynaecology for investigation

52
Q

Causes of secondary dysmenorrhoea

A

Endometriosis
Adenomyosis - (EM tissue in the MUSCLE of uterus)
PID
IUDs (IUS may actually help dysmenorrhoea)
Fibroids

53
Q

examination findings in ectopic pregnancy

A

Abdominal tenderness
Cervical excitation
adnexal mass

54
Q

In the case of pregnancy of unknown location, which bHCG level points towards diagnosis of ectopic pregnancy

A

> 1500

55
Q

Ix. of choice in suspected ectopic pregnancy:

A

TransVAGINAL US

56
Q

Ectopic pregnancy
Expectant management:
Medical management:
Surgical management:

A

Expectant management: Monitor bHCG
Medical management: Methotrexate
Surgical management: Salpingectomy or salpingotomy if contralateral tube damage or other risk factor for infertility

57
Q

EM cancer definitive management

A

Localised disease = TAHBSO
Pts. with high risk disease may have follow up radiotherapy
Progestogen therapy for elderly pts. too frail for surgery

58
Q

EM hyperplasia Mx.
Simple
Atypical

A

Simple: High dose progestogen w/ repeat sampling in 3-4 months
Atypial: hysterectomy advised

59
Q

Gynaecological causes of abdominal pain->
All women should receive

A

Bimanual vaginal examination
urine pregnancy test
consideration of abdominal/pelvic US

60
Q

Menorrhagia Ix.

A

FBC - anaemia? de-compensating
Trans-vaginal US if symptoms suggest structural cause

61
Q

Menorrhagia Mx.
Does not Require contraception

A

Does NOT require contraception
Mefenamic acid 500 mg TDS (particularly if dysmenorrhoea)
Tranexamic acid 1g TDS

If no improvement then try other drug whilst awaiting referral

62
Q

Menorrhagia Mx.
Requires contraception

A

1) Intrauterine system (mirena)
2) COCP
3) Long acting progestogens

63
Q

Which medication may be used as a short term option to RAPIDLY control heavy bleeding in periods

A

Norethisterone 5 mg

64
Q

HRT oestrogen Increases risk of which cancers

A

Breast (increased further by addition of progestogen) and endometrial cancer

65
Q

HRT: Method of delivery to avoid increase in risk of VTE

A

Transdermal delivery

66
Q

Menopause: when should contraception be used until

A

12 months after LAST PERIOD in women > 50 years
24 months after LAST PERIOD in women < 50 years

67
Q

HRT contraindications

A

Current or past breast cancer
Any oestrogen-senstive cancer
Undiagnosed vaginal bleeding
Untreated endometrial hyperplasia

68
Q

non-HRT Mx. of post-menopausal vasomotor symptoms

A

FLUOEXETINE, CITALOPRAM, VENLAFAXINE

69
Q

Dysfunctional uterine bleeding meaning

A

Menorrhagia in the absence of underlying pathology (50% of patients w/ bleeding)

70
Q

Miscarriage: medical management

A

Vaginal MISOPROSTOL

addition of mifepristone is NOT recommended

71
Q

Miscarriage: surgical management

A

Vacuum aspiration (suction curettage)
surgical mangement under GA

72
Q

Ovarian cancer Ix.

A

CA125
US
Diagnosis is difficult and usually involves diagnostic laparotomy

73
Q

Aside from ovarian cancer, which conditions may also increase CA125

A

endometriosis
menstruation
benign ovarian cysts

74
Q

Ovarian torsion Mx.

A

Laparoscopy is usually diagnostic and therapeutic

75
Q

PID Ix.

A

Pregnancy test (exclude ectopic)
High vaginal swab (often negative)
Screen for chlamydia and Gonorrhoea

76
Q

Complications of PID

A

Perihepatitis -> Fitz-hugh Curtis syndrome
Infertility
Chronic pelvic pain
Ectopic pregnancy

77
Q

PCOS suggested Ix.

A

Pelvic US
FSH
LH
Prolactin
TSH
Testosterone
SHBG
Check for impaired glucose tolerance

78
Q

Causes of post-coital bleeding

A

Cervical ectropion (50%)
Cervicitis -> 2ry to chlamydia
Cervical cancer
Polyps
Trauma

79
Q

PMB action

A

Every woman over the age of 55 with PMB should be investigated within 2 weeks by ultrasound for endometrial cancer

80
Q

Commonest cause of PMB

A

Vaginal atrophy -> reduction of oestrogen causes thinning,drying and inflammation of the walls of the vagina

81
Q

Urinary incontinence initial Ix.

A

Bladder diaries for 3 days
Vaginal examination to exclude pelvic organ prolapse and ability to initiate voluntary contraction of pelvic floor muscles
Urine dipstick and culture
Urodynamic studies

82
Q

Mx URGE incontinence

A

Bladder retraining - 6 weeks

1) Oxybutynin, tolterodine, derifenacin
2) Mirabegron (B3 agonist) if there is concern about anticholinergic side effects in FRAIL elderly pts.

83
Q

Mx. STRESS incontinence

A

Pelvic floor training -> 3 months
Surgical procedures - retropubic mid-urethral tape
Duloxetine offered to women if they DECLINE surgical procedures

84
Q

Fibroids - diagnosed with which investigation

A

Transvaginal US

85
Q

Vaginal candidiasis diagnosis

A

Clinical -> high vaginal swab NOT indicated unless diagnostic uncertainty

86
Q

Vaginal candidiasis mx.

A

1) ORAL fluconazole 150 mg
2) Clotrimazole 500 mg PESSARY as single dose if oral therapy contraindicated

If pregnancy ONLY topical anti-fungals are to be used

87
Q

Recurrent vaginal candidiasis Ix.

A

High vaginal swab for microscopy and culture
Blood glucose test to exclude DIABETES (glycosuria)

OSCE Y5 (7 decks)

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