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OSCE Y5 > OBGYN > Flashcards

OBGYN Flashcards

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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
Mx. of PPH (Mechanical)
Uterine massage to simulate contractions
26
Mx. of PPH (medical)
IV oxytocin (slow IV) IV ergometrine (if no hx. of hypertension) IM carboprost Sublingual misoprostol
27
Mx. of PPH (Surgical)
IF medical/mechanical measures fail 1) intrauterine balloon tamponade 2) B-lynch suture -> ligation of arteries 3) Hysterectomy
28
When does secondary PPH occur and what is the usual cause
24 hours -> 6 weeks post partum Retained placental tissue or endometritis
29
Post menopausal bleeding: most common cause Other causes:
Vaginal atrophy HRT (spotting) Endometrial cancer (MUST BE RULED OUT) Vaginal cancer Endometrial hyperplasia (precursor for carcinoma) cervical and ovarian cancer
30
Ix. for post-menopausal bleeding:
All women >55 years with PMB MUST BE seen within 2 weeks for TRANSVAGINAL USS to rule out endometrial cancer
31
Vaginal atrophy tx.
Topical oestrogens
32
Endometrial hyperplasia tx.
Dillatiation and curettage
33
Fibroids Ix.
Trans-vaginal US
34
Features of fibroids
If symptomatic Menorrhagia Sub-fertility Bulk symptoms: Lower abdominal pain, bloating
35
Mx. of menorrhagia 2ry to fibroids
IUS (if uterus not distorted) NSAIDs - MEFENAMIC acid Tranexamic acid oral progestogen
36
medical tx. to shrink fibroids
GnRH analogues (short term)
37
Surgical tx. for fibroids
myomectomy: this may be performed abdominally, laparoscopically or hysteroscopically hysteroscopic endometrial ablation hysterectomy
38
GnRH side effects
Menopause symptoms - flushing, vaginal dryness) Reason why these are considered a short term measure
39
Rare feature of Fibroids
Polycythaemia due to autonomous production of EPO
40
Eclampsia: Tx. to prevent and/or treat seizures
Magnesium sulphate tx. to continue for 24 hours after last seizure
41
What else should be monitored during eclampsia?
urine output reflexes respiratory rate oxygen saturations
42
Treatment for magnesium sulphate induced respiratory depression
Calcium gluconate
43
Anaemia in pregnancy when should women receive IRON
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
When should aspirin be continued to for pre-eclampsia prophylaxis
till 12 weeks before the scheduled birth of the baby
45
Endometriosis Px.
Chronic pelvic pain Secondary dysmenorrhoea - usually days preceding normal period Subfertility Deep dyspareunia
46
Endometriosis Ix.
Laparoscopy is gold standard
47
Endometriosis Tx.
NSAIDs and paracetamol are first line COCP if these fail to control symptoms
48
Endometriosis if conventional mx. fails
GnRH analogues Surgery
49
Causes of gynae pelvic pain
Ectopic pregnancy Ovarian cyst/torsion/rupture Endometriosis PID
50
Primary dysmenorrhoea: definition and management
No underlying pelvic pathology - appears 1-2 years of menarche Mx. NSAIDs - Mefenamic acid and/or ibuprofen 2) COCP
51
Secondary dysmenorrhoea definition and Mx.
Develops many years after the menarche due to underlying pathology Refer all patients to gynaecology for investigation
52
Causes of secondary dysmenorrhoea
Endometriosis Adenomyosis - (EM tissue in the MUSCLE of uterus) PID IUDs (IUS may actually help dysmenorrhoea) Fibroids
53
examination findings in ectopic pregnancy
Abdominal tenderness Cervical excitation adnexal mass
54
In the case of pregnancy of unknown location, which bHCG level points towards diagnosis of ectopic pregnancy
>1500
55
Ix. of choice in suspected ectopic pregnancy:
TransVAGINAL US
56
Ectopic pregnancy Expectant management: Medical management: Surgical management:
Expectant management: Monitor bHCG Medical management: Methotrexate Surgical management: Salpingectomy or salpingotomy if contralateral tube damage or other risk factor for infertility
57
EM cancer definitive management
Localised disease = TAHBSO Pts. with high risk disease may have follow up radiotherapy Progestogen therapy for elderly pts. too frail for surgery
58
EM hyperplasia Mx. Simple Atypical
Simple: High dose progestogen w/ repeat sampling in 3-4 months Atypial: hysterectomy advised
59
Gynaecological causes of abdominal pain-> All women should receive
Bimanual vaginal examination urine pregnancy test consideration of abdominal/pelvic US
60
Menorrhagia Ix.
FBC - anaemia? de-compensating Trans-vaginal US if symptoms suggest structural cause
61
Menorrhagia Mx. Does not Require contraception
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
Menorrhagia Mx. Requires contraception
1) Intrauterine system (mirena) 2) COCP 3) Long acting progestogens
63
Which medication may be used as a short term option to RAPIDLY control heavy bleeding in periods
Norethisterone 5 mg
64
HRT oestrogen Increases risk of which cancers
Breast (increased further by addition of progestogen) and endometrial cancer
65
HRT: Method of delivery to avoid increase in risk of VTE
Transdermal delivery
66
Menopause: when should contraception be used until
12 months after LAST PERIOD in women > 50 years 24 months after LAST PERIOD in women < 50 years
67
HRT contraindications
Current or past breast cancer Any oestrogen-senstive cancer Undiagnosed vaginal bleeding Untreated endometrial hyperplasia
68
non-HRT Mx. of post-menopausal vasomotor symptoms
FLUOEXETINE, CITALOPRAM, VENLAFAXINE
69
Dysfunctional uterine bleeding meaning
Menorrhagia in the absence of underlying pathology (50% of patients w/ bleeding)
70
Miscarriage: medical management
Vaginal MISOPROSTOL addition of mifepristone is NOT recommended
71
Miscarriage: surgical management
Vacuum aspiration (suction curettage) surgical mangement under GA
72
Ovarian cancer Ix.
CA125 US Diagnosis is difficult and usually involves diagnostic laparotomy
73
Aside from ovarian cancer, which conditions may also increase CA125
endometriosis menstruation benign ovarian cysts
74
Ovarian torsion Mx.
Laparoscopy is usually diagnostic and therapeutic
75
PID Ix.
Pregnancy test (exclude ectopic) High vaginal swab (often negative) Screen for chlamydia and Gonorrhoea
76
Complications of PID
Perihepatitis -> Fitz-hugh Curtis syndrome Infertility Chronic pelvic pain Ectopic pregnancy
77
PCOS suggested Ix.
Pelvic US FSH LH Prolactin TSH Testosterone SHBG Check for impaired glucose tolerance
78
Causes of post-coital bleeding
Cervical ectropion (50%) Cervicitis -> 2ry to chlamydia Cervical cancer Polyps Trauma
79
PMB action
Every woman over the age of 55 with PMB should be investigated within 2 weeks by ultrasound for endometrial cancer
80
Commonest cause of PMB
Vaginal atrophy -> reduction of oestrogen causes thinning,drying and inflammation of the walls of the vagina
81
Urinary incontinence initial Ix.
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
Mx URGE incontinence
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
Mx. STRESS incontinence
Pelvic floor training -> 3 months Surgical procedures - retropubic mid-urethral tape Duloxetine offered to women if they DECLINE surgical procedures
84
Fibroids - diagnosed with which investigation
Transvaginal US
85
Vaginal candidiasis diagnosis
Clinical -> high vaginal swab NOT indicated unless diagnostic uncertainty
86
Vaginal candidiasis mx.
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
Recurrent vaginal candidiasis Ix.
High vaginal swab for microscopy and culture Blood glucose test to exclude DIABETES (glycosuria)

OSCE Y5 (7 decks)

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