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ccfp > obgyn FM learner FP notebook > Flashcards

obgyn FM learner FP notebook Flashcards

1
Q

name 6 contraindications to combined OCPS

A

<4 weeks postpartum & breastfeeding
-Smoker >15cigs/day and >35 yo
-thrombophilia
-CAD
-acute VTE
-hx VTE and not anticoagulated
-current breast ca
-severe cirhosis
-migraine with aura

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2
Q

how many days post coitus is the copper IUD effective as an emergency contraception?

A

7 days

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3
Q

Which emergency contraceptives are less effective in patients with elevated BMI?

A

hormonal emergency contraceptives

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4
Q

what is the first choice emergency contraception for women with BMI > 30?

A

copper IUD

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5
Q

what is the first hormonal emergnecy contraception choice for women with BMI over 30?

A

ulipristal acetate

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6
Q

what are the general IUD contraindications?

A

PID
Unexplained bleeding
Abnormal uterine anatomy
Pregnancy
Cervical Cancer

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7
Q

contraindications specific to the LNG IUD?

A

severe liver disease (ca, tumour, cirhosis), breast ca

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8
Q

contraindications specific to the copper IUD?

A

wilsons disease
copper allergy
anemia
menorhagia

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9
Q

what are some non-contraceptive indications for the LNG-IUS?

A

On label - AUB, heavy menstrual bleeding
Off label - dysmenorhia, endometriosis, adenomyosis, endometrial protection (HRT, hyperplasia, polyps)

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10
Q

how does the copper IUS effect rates of uterine cancer?

A

reduces risk of endometrial cancer

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11
Q

what are some IUD side effects?

A

Both - prolonged bleeding, irregular bleeding, postcoital bleeding, dyspareunia

LNG IUS - hair loss, acne, headache, bloating, functional ovarian cysts

Copper - excessive bleeding, dysmenorrhia

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12
Q

which type of IUD is immediately protective against pregnancy?

A

copper
(LNG-IUS takes 7 days)

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13
Q

what are the contraindications for the subdermal implant?

A

-pregnancy
-undiagnosed vaginal bleeding
-breast ca
-liver tumour
-lupus +antibodies

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14
Q

what is the ON LABEL uses for the DMPA (progesterone shot) other than contraception?

A

endometriosis

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15
Q

risks of DMPA?

A

-delayed return to fertiliy (50% at one year, 90% at two years)
-BMD reduction

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16
Q

what are some DMPA side effects?

A

-irregular bleeding/amenorhea
-weight gain (10-25%) of patients
-hormonal SE - headache, acne, breast tenderness

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17
Q

what is your differential diagnosis for dysmenorrhea?

A

-primary dysmenorhhea
-secondary dysmenorrhea: endometriosis, adenomyosis, uterine myoma, PID, pelvic adhesions, IBS, IBD, interstitial cystitis

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18
Q

non-pharm options for management of dysmenorrhea?

A

-regular exercise
-heated pads
-ginger during the first 3-4 days of menses

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19
Q

pharm management of dysmenorrhea?

A

-tylenol
-NSAIDS
-cOCPs
-progestin regimes (IUS)

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20
Q

risk factors for uterine leiomyomas (fibroid)?

A

-nulliparity
-obesity
-family hx
-HTN

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21
Q

complications associated with uterine fibroids?

A

-IDA
-infertility
-slight risk of miscarriage, preterm labour, abruption, IUGR
-fibroids in lower uterus can increase risk of fetal malpresentation, C/S, post partum hemorrhage

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22
Q

what risks increase with maternal age in pregnancy?

A

-spontaneous pregnancy loss
-chromosomal abnormalities

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23
Q

what risks increase with paternal age in pregnancy?

A

-spontaneouos pregnancy loss, AD conditiions, autism spectrum disorder, schihzophrenia

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24
Q

what is the most common reversible cause of male infertility?

A

a varicoceole

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25
Q

what age is considered premature menopause?

A

<40

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26
Q

which group can be safely started on menopause hormonal therapy?

A

women <60, with menopause < 10 years ago

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26
Q

name non-hormonal medications for menopausal symptoms

A

-SSRIs
-SNRIs
-gabapentin
-clonidine

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26
Q

define menopause

A

1 year of amenorrhea caused by declining ovarian reserve, or as the onset of vasomotor symptoms in people with iatrogenic amenorrhea.

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26
Q

which route of hormone therapy for menopause is associated with lower risk of VTE?

A

transdermal

27
Q

In a patient with CIs to HT, list three lifestyle treatments for urogenitary symptoms

A

-kegels
-regular sexual activity (increases blood flow)
-lubricant
-vaginal moisturizers

28
Q

what is the standard dose of rhogam? and the time frame in which it is given?

A

300 mcg
within 72 hours of bleed

29
Q

uterine bleeding with a live IUP & closed cervix =

A

threatened abortion

29
Q

Which pregnancies get rhogam with a bleeding exposure?

A

PV bleeding in a woman who is RH neg and >= 12 weeks gestation

30
Q

bleeding + open cervix + no products passed =

A

inevitable abortion

30
Q

management of a threatened abortion

A

expectant

31
Q

bleeding + open cervix + some tissue passed =

A

incomplete abortion

32
Q

bleeding + complete sac passed + open cervix =

A

complete abortion

33
Q

management of threatened abortion =

A

expectant - FU with OB in 3-4 days

34
Q

management of inevitable abortion

A

-expectant, misoprostal, or D+C, +/- oxytocin

35
Q

at how many weeks gestation can you see a heart beat on transvaginal US?

A

6 weeks

36
Q

when is the GBS screening in pregnancy?

A

at 35-37 weeks

37
Q

what is the name of the score that predics cervical favourability for delivery?

A

Bishop score (>6)

38
Q

After a c-section, how long should someone wait until their next conception?

A

18 mo

39
Q

conception during active IBD episode increases which risks…

A

miscarriage, premature delivery, still birth, low birth weight

40
Q

what should women on thyroid supplementation do once pregnant?

A

increase their dose by 30%

41
Q

what extra supplement shoulder smokers take during pregnancy?

A

extra 35 mcg vit C daily

42
Q

what is a normal amount of fetal movements in someone over 26 w gestation?

A

6 movements/2 hour period

43
Q

what is considered a decreased cervical length?

A

<25 mm at 16-24 weeks

44
Q

how is a decreased cervical length managed?

A

vaginal progesterone

45
Q

how is the prenatal OGTT performed?

A

-at 24-28 weeks, non fasting 50g OGCT given

46
Q

what is an abnormal result with the 1 hr 50g OGTT

A

7.8 mmol/L or above

47
Q

If a patient has a OGTT with a result of <7.8mmol/L what is the next step?

A

negative, no further workup

48
Q

If a patient has an OGTT with a result of 11.1 mmol/L or above, what does this mean?

A

diagnostic of GDM

49
Q

If a patient has a 1hr OGTT with a result from 7.8-11, what is the next step?

A

order a 75 g OGTT

50
Q

When should a mom who had GDM be rescreened for diabetes?

A

Between 6 weeks - 6 months, with 75g OGGT

51
Q

what extra monitoring do patients with GDM need during pregnancy?

A

Fetal growth evaluations every 3-4 weeks, then weekly NST at 36 weeks (+more if other risks)

52
Q

what is a normal endometrial stripe thickness?

A

<5mm

53
Q

what colour is the discharge commonly seen in BV?

A

thin off white with fishy odour

54
Q

what what pH does BV or trichomonas occur?

A

pH > 4.5

55
Q

what colour is the discharge with trichomonas?

A

thin, yellow-green, frothy, malodorous

56
Q

what is the discharge like in candida vaginitis?

A

thick cottage cheese

57
Q

at what pH does a candida vaginitis occur?

A

Normal pH - 3.8-4.5

58
Q

which type of vaginitis requires treatment of the sexual partner?

A

trichomonas

59
Q

treatment of BV

A

-metronidazole or clindamycin

60
Q

treatment of trichomonas

A

-metronidazole PO (intravaginal is not enough) and treat partner

61
Q

treatment of BV

A

oral or vaginal metronidazole

62
Q

what is considered recurrent vulvovaginitis?

A

4 or more episodes a year

63
Q

Diagnostic criteria for PCOS?

A

AT least TWO of the THREE:
-menstrual cycle irregularities
-hyperandrogenism (clinic or biochemical)
-polycystic ovaries on US

64
Q

how many years from menarche should you ideally wait before diagnosing PCOS?

A

8 years, due to initial menstrual irregularities which may settle

65
Q
A

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