Obs and gynae Flashcards

Question

VTE in pregnancy - rf, prophylaxis and treatment

Answer 1

RF: smoking, parity 3<, 35yo, BMI 30, immobility, twins, PET, varicosity, FH, IVF if 3 RF: LMWH from 28 weeks if 4 RF: LMWH from 1st trimester Paused during labour DVT/PE treated with M=LMWH for pregnancy + 3 months

Answer 2

Screening for asymptomatic bacteriuria (due to increased risk of preterm) If +ve: treat with either nitrofurantoin (should be avoided near term), amoxicillin or cefalexin for a 7-day course Cefuroxime if symptomatic

Answer 3

CPR with 15 degree tilt to the left hand side (avoid aortocaval compression) Immediate C section if no response after 4 minutes

Answer 4

urticarial papules, wheals and plaques on the abdomen; Umbilical sparing 3rd trimester Improves as preg. ends; steroids, emollients as needed

Answer 5

Eczema flares in 1st or 2nd trimester E type - eczematous skin. F type Prurigo, itchy papules Improves as preg. ends; steroids, emollients as needed

Answer 6

Increased pigmentation to the face Due to increased oestrogen in preg. Also seen with COCP and HRT

Answer 7

Benign rapidly growing tumour of capillaries Resolves after pregnancy ends

Answer 8

Autoimmune condition in pregnancy; 2nd and 3rd trimester auto-Ab to connections between dermis and epidermis itchy papular rash around umbilicus, which progresses to large fluid filled blisters emollients, steroids, immunosuppression, Abx

Answer 9

Congenital form -> intracranial calcification, hydrocephalus, chorioretinitis Asymptomatic in woman

Answer 10

virus causes congenital rubella syndrome in first 20 weeks: Congenital deafness, cataracts, heart disease (PDA and pulmonary stenosis), Learning disability Women planning to become pregnant should ensure they have had the MMR vaccine; they can be vaccinated with two doses of the MMR, three months apart.

Answer 11

Fetal growth restriction Microcephaly Hearing loss Vision loss Learning disability Seizures

Answer 12

HSV-2 can pass to neonate during delivery => 1/3 skin lesions, 1/3 CNS infection, 1/3 sepsis Treat with aciclovir Prophylactic for mother from 36 weeks if primary infection, prophylactic treatment immediately if after 28 weeks

Answer 13

gram +ve bacteria from unpasteurised milk flu-like illness in mother; rarely pneumonia, meningoencephalitis increased risk of miscarriage, stillborn, severe neonatal infection

Answer 14

newborns should receive IgG HBV and vaccine within 24 hours

Answer 15

increased risk of miscarriage, severe fetal anaemia -> hydrops fetalis (Oedema in 2+ compartments/HF), Maternal pre-eclampsia-like syndrome (mirror syndrome - triad of hydrops fetalis, placental oedema and oedema in the mother. It also features hypertension and proteinuria.) Fetal anaemia- infection of the erythroid progenitor cells in the fetal bone marrow and liver. This anaemia leads to heart failure, referred to as hydrops fetalis. IgM, IgG and rubella antibody testing Supportive management

Answer 16

Transmitted by mosquitos in pregnancy -> microcephaly, FGR, ventriculomegaly, cerebellar atrophy viral PCR and Ab for diagnosis Supportive management

Answer 17

Mother: pneumonitis, hepatitis, encephalitis Baby: severe neonatal infection, varicella zoster syndrome: If in first 28 weeks: FGR, microcephaly, hydrocephalus, dermatomal scars, limb hypoplasia, chorioretinitis Exposure: previous infection - safe unsure - test VZV IgG Not immune - oral aciclovir for 7 days, 1 week after exposure Infection: if >20 weeks and within 24 hours; oral aciclovir

Answer 18

i.v. benzypenicillin prophylaxis during labour if PMH of infection

Answer 19

Chorioamnionitis and UTI main causes Septic symptoms (BP late sign in pregnancy) Pain, tenderness, discharge in Chorioamnionitis SEPSIS 6 Abx to cover gram +ve, -ve, anaerobes

Answer 20

Dichorionic Diamniotic - lambda sign on USS Monochorionic Diamniotic - T sign on USS Monochorionic Monoamniotic Maternal - anaemia, polyhydramnios, HTN, PET, preterm labour, instrumental delivery, C section, PPH, hyperemesis gravidarum Fetal - miscarriage, stillbirth, FGR, prematurity, congenital diseases, twin anaemia polycythaemia sequence, twin-twin transfusion syndrome: Twin A receives majority of blood supply and nutrients - HF & polyhydramnios B - FGR, oligohydramnios Increased risk in MCDA twins FBC at booking, 20, 28 2 weekly scans for monochorionic from week 16 4 weekly scans for dichorionic from week 20 Planned delivery: MCMA; elective C section at 32-24 MCDA; elective c section if A is not cephalic at 36-37 DCDA; NVD

Answer 21

Over the internal os. RF: c section, PMH, age, smoking, fibroids, IVF presents on 20 week anomaly scan or painless vaginal bleeding - diagnosed acutely with transvaginal USS Repeat scans at 32 and 36 steroids at 34-36 (risk of preterm) Planned delivery at 36-37 by C section

Answer 22

Type I velamentous umbilical cord - cord inserts into membranes and travels unprotected to the placenta Type II accessory/ succenturiate lobe - vessels travel unprotected between lobes APH: fetal distress and dark red bleeding followed by rupture of membranes. Steroids given from 32 weeks elective C section 34-36

Answer 23

RF: PET, trauma, twins, FGR, multigravida, age, smoking, cocaine/meth Continuous abdominal pain, bleeding, decreased BP, Increased HR, fetal distress woody abdomen Can be concealed if os is closed 2x grey cannula FBC, U+E, LFT,coag crossmatch 4 units resus CTG Maternal monitoring If stable, steroids 24-35 weeks, anti-D prophylaxis

Answer 24

Placenta embedded into the myometrium increta - deeply percreta - through the perimetrium rf: curettage, c section, multigravida, age, low lying placenta Presents on USS or difficult 3rd stage of labour with PPH MRI for detailed anatomy Planned C section 35-37 weeks + steroids with hysterectomy advised Can be left to be absorbed but high chance of PPH

Answer 25

intrauterine fetal death >24 weeks PET, abruption, vasa praevia, cord prolapse, obstetric cholestasis, DM, thyroid, infection, genetic RF: FGR, smoking, alcohol, age, obesity, twins, sleeping on back Presents with reduced fetal movements, abdo pain and vaginal bleeding Diagnosed with USS; fetal heartbeat NVD induced with oral mifepristone and misoprostol Dopamine agonists used to suppress lactation

Answer 26

Complete - legs fully flexed at hip and knees Incomplete - one leg fully flexed at hip but extended at the knee Extended (frank) - both legs extended at the knee Footling - foot presenting through the cervix with leg extended <36 weeks - often resolves spontaneously >36 weeks - external cephalic version with SC terbutaline (B agonist) to relax the myometrium. Kleinhauer +- anti-D after

Answer 27

First stage: true contractions -> 10cm dilation latent phase - 0cm -> 3cm - 0.5cm/hour active phase 3cm -> 7cm - 1cm/hour transition phase 7cm -> 10cm - 1cm/hour Delayed if less than 2cm in 4 hours or slowing of progress in multiparous women Second stage: 10cm -> delivery of the baby Delay if pushing for more than 2 hours in nulliparous, 1 hour if multiparous Third stage: Delivery of the placenta Delayed if more than 30 minutes with active management, 60 minutes if physiological

Answer 28

First stage: Delayed if less than 2cm in 4 hours or slowing of progress in multiparous women Second stage: Delayed if pushing for more than 2 hours in nulliparous, 1 hour if multiparous Third stage: Delayed if more than 30 minutes with active management, 60 minutes if physiological

Answer 29

If cervix is more than >25mm on 24w USS Vaginal progesterone is used Cervical cerclage offered if as above, PMH, trauma e.g. colposcopy

Answer 30

Rupture of the amniotic sac Diagnosed with speculum examination + insulin like growth factor binding protein/placental alpha microglobulin PAMG: +ve if amniotic fluid prophylactic erythromycin 250mg QDS for 10 days consider induction at 34 weeks

Answer 31

Regular painful contractions and cervical dilation Diagnosis <30 weeks clinical >30 weeks transvaginal USS: if cervix <15mm = preterm labour Fibronectin >50ng/ml can be used for dx Management Tocolysis; nifedipine* or Atosiban used 24-34 weeks - short term use only to buy time Antenatal steroids: IM betamethasone, 2 doses 24 hours apart for foetal lung development IV magnesium sulfate if <34 weeks to decrease chance of cerebral palsy Monitor mother for Mg Toxicity: Low BP, RR and decreased reflexes

Answer 32

Offered beyond 40 weeks, PROM, FGR, PET, Obstetric cholestasis, DM, IUFD Bishop score <5 : unlikely to start labour without induction >8 increased chance of spontaneous labour/response to interventions <5 = vaginal prostaglandins >8 = amniotomy + oxytocin infusion Other options: membrane sweep, cervical ripening balloon (if previous C section, multiparous), oral mifeprisone -> misoprostol for IUFD Oxytocin => Uterine hyperstimulation : Individual contractions for >2 minutes, contractions 5 in 10 --> fetal compromise: hypoxia and acidosis Emergency C section Uterine rupture Tocolysis with terbutaline

Answer 33

Baseline rate: Reassuring 110-160bpm Non reassuring 100-109, 161-180 Abnormal <100, >180 Variability: Reassuring: 5 – 25 bpm Non-reassuring: less than 5 bpm for between 30-50 minutes more than 25 bpm for 15-25 minutes Abnormal: less than 5 bpm for more than 50 minutes more than 25 bpm for more than 25 minutes sinusoidal Accelerations are an abrupt increase in the baseline fetal heart rate of greater than 15 bpm for greater than 15 seconds. Accelerations occurring alongside uterine contractions is a sign of a healthy fetus. Decelerations: Early - gradual dips in HR corresponding with peak of contraction - normal physiology (head compresses vagus nerve) Late - gradual dips in HR that start after the start of the contraction, and lowest HR is after peak of contraction - caused by hypoxia; reduced blood flow to uterus and placenta Variable - abrupt dips in HR not related to contractions Brief accelerations before and after dip (shoulders) indicate fetus is coping Prolonged - A deceleration that lasts more than 2 minutes fetal hypoxia Sinusoidal - severe fetal anaemia/hypoxia

Answer 34

Paracetamol; not NSAIDS (closes ductus arteriosus) Entonox; 50:50 Oxygen and NO Pethidine/Diamophine IM (risk of resp depression in neonate) epidural - bupivicaine (increases risk of instrumental delivery)

Answer 35

Visually and fetal distress Emergency C section; gather appropriate staff SOAPS: Senior midwife, Obstetrician, Anaesthetist, Paediatrician, and Scribe Presenting part can be pushed back up with knee-chest position on all fours Tocolytics to buy time Cord should be kept warm, wet and not handled

Answer 36

Anterior shoulder stuck behind pubic symphysis; failure of restitution (head should turn sideways after it is delivered) McRoberts' manoeuvre should be performed: flexion and abduction of the maternal hips, bringing the mother's thighs towards her abdomen. Other options; episiotomy Rubins manoeuvre involves reaching into the vagina to put pressure on the posterior aspect of the baby’s anterior shoulder to help it move under the pubic symphysis. Wood’s screw manoeuvre is performed during a Rubins manoeuvre. The other hand is used to reach in the vagina and put pressure on the anterior aspect of the posterior shoulder. The top shoulder is pushed forwards, and the bottom shoulder is pushed backwards, rotating the baby and helping delivery. If this does not work, the reverse motion can be tried, pushing the top shoulder backwards and the bottom shoulder forwards. Zavanelli manoeuver involves pushing the baby’s head back into the vagina so that the baby can be delivered by emergency caesarean section.

Answer 37

Ventouse - suction cup to baby head -> cephalohaematoma and caput succedneum (localised oedema) Forceps - facial nerve palsy Risks to mother: femoral and obturator nerve injury lateral cutaneous, lumbosacral plexus, common peroneal compressed in lithotomy (foot drop),

Answer 38

First degree - skin Second degree - perineal muscles Third degree; A: <50% external sphincter B: >50% external sphincter C: Internal and external sphincter Fourth degree - rectal mucosa => pain, infection, dehiscence. Incontinence. Fistula. Dyspareunia. Psychosocial Mediolateral episiotomy and perineal massage decrease chance in high risk cases

Answer 39

IM oxytocin with careful traction of umbilical cord Massage uterus afterwards and ensure none is retained

Answer 40

500ml after vaginal, 1000ml after C section Uterine atony (most common), trauma, retained placenta, bleeding disorders RF: previous PPH, BMI, large baby, failure to progress, PET, placental abnormalities, instrumentation Prevent: treat anaemia prior, empty bladder, active 3rd stage, iv tranexamic acid if high risk in c section Management: ABCDE resus 2 large bore cannulas FBC, U+E, Clotting Group and crossmatch 4 units O2 FFP if clotting abnormalities Stop the bleeding; oxytocin, carboprost, mosiprostol, balloon catheter Uterine artery ligation, hysterectomy

Answer 41

Likely RPOC or endometritis USS, Swabs Surgical evaluation and abx if indicated

Answer 42

1 - immediate danger - <30 minutes 2 - compromised - <75 minutes 3 - required, but stable 4 elective; symptomatic perineal tear, praevias, breech, twins, HIV, cervical cancer Procedure Incision; Joel-cohen preferred straight incision slightly higher than pfannenstiel (2 fingers above pubic symphysis) Followed by blunt dissection Layers dissected; skin, subcut, fascia/rectus sheath, rectus abdominus, peritoneum, vesicouterine peritoneum, uterus, amniotic sac Spinal anaethetic in subarachnoid space risks: anaphylaxis, hypotension, headache, urinary retention, nerve damage, haematoma C section risks: aspiration pneumonitis; give PPI before Bleeding, pain, infection, VTE PPH Damage to ureters, bladder, bowel, vessels Ileus, adhesions, hernias Risk of future C sections, rupture, PP, stillbirth Transient tachpnoea of the newborn

Answer 43

Uterine rupture, classical cesarean scar, anything that indicates C section required

Answer 44

Fetal tissue passes into maternal blood stream => anaphylaxis like symptoms: SOB, 02 sats down, hypotension, coagulopathy, haemorrhage, tachycardia, confusion, seizures, cardiac arrest supportive management; A-E assessment

Answer 45

Acutely unwell mother and abnormal CTG pain, bleeding, zero uterine contractions, low BP, High HR, collapse Emergency C section with hysterectomy

Answer 46

Life threatening emergency Large PPH +- shock; fundus drops through the cervix Johnson manoeuvre - push fundus back into place and give oxytocin infusion hydrostatic methods laparotomy

Answer 47

Lochia - endometrial breakdown over 6 weeks; dark red-> brown and lighter flow over time Breast feeding -> oxytocin -> increased bleeding during feeding If breastfeeding, lactational amenorrhoea for up to 6 months Bottle feeding, menstrual periods from 3 weeks

Answer 48

Required from 21 days if not breast feeding POP or implant - safe in BF and started at any time COCP - Not safe in BF or in first 21 days due to VTE risk Copper coil/IUS - insertion within 48hr of birth or after 4 weeks

Answer 49

foul smelling discharge, increase in bleeding, pain, fever, sepsis swabs, urine culture USS to rule out RPOC Broad spectrum abx e.g. co-amoxiclav i.v. clindamycin + gentamicin if ?sepsis

Answer 50

vaginal bleeding, pelvic pain, fever if infection USS evacuation under GA -> endometritis Asherman's syndrome - adhesions within the uterus => infertility, secondary amenorrhorea

Answer 51

FBC 24hours after birth if PPH, C section, antenatal anaemia, symptomatic 100g/L - oral iron 90g/L - iron infusion (if no infections ongoing) 70gL - blood transfusion

Answer 52

topical miconazole after each breastfeed

Answer 53

antibiotics: ciprofloxacin, tetracycline, chloramphenicol, sulphonamides psychiatric drugs: lithium, benzodiazepines aspirin carbimazole methotrexate sulfonylureas cytotoxic drugs amiodarone

Answer 54

Thyrotoxicosis (first 3 months) - TFTs at 6-8 weeks if symptomatic -> Beta blockers e.g. propranolol Hypothyroid (months 3-6) - levothyroxine Euthyroid - annual monitoring for hypothyroidism

Answer 55

Rare PPH complication; low BP in hypothalamo-hypophyseal portal system -> avascular necrosis of the anterior pituitary gland ↓ prolactin -> ↓ lactation ↓LH/FSH -> amenorrhoea <-Oestrogen and prog ↓ACTH -> adrenal crisis <- hydrocortisone ↓TSH -> hypothyroid <- levothyroxine ↓GH <- GH

Answer 56

Ampulla of fallopian tube most common, most likely to rupture if in isthmus Missed period, constant iliac fossa pain, pv bleeding, tenderness, cervical motion tenderness Syncope, shoulder tip pain, N+V Diagnosis +ve Beta hCG Transvaginal USS If pregnancy of unknown location: serum hCG baseline taken and repeated after 48 hours; ↑ 63%< intrauterine pregnancy ↑ 63%> ectopic; monitor ↓ 50% miscarriage; urine hCG in 2 weeks management Expectant if: unruptured, <35mm, no heartbeat, no pain, hCG <1500 Medical - IM Methotrexate hCG <5000, confirmed absence of intrauterine pregnancy Avoid pregnancy for 3 months. ADRs: PV bleeding, N+V, pain, stomatitis Avoid if eGFR <30 Surgical (Salpingectomy*) If pain, >35mm, visible heartbeat, hCG >5000 Salpingotomy if contralateral tube is not functional (to retain fertility)

Answer 57

management Expectant if: unruptured, <35mm, no heartbeat, no pain, hCG <1500 Medical - IM Methotrexate hCG <5000, confirmed absence of intrauterine pregnancy Avoid pregnancy for 3 months. ADRs: PV bleeding, N+V, pain, stomatitis Avoid if eGFR <30 Surgical (Salpingectomy*) If pain, >35mm, visible heartbeat, hCG >5000 Salpingotomy if contralateral tube is not functional (to retain fertility)

Answer 58

Late = 12-24 PV bleeding +- pain Missed - foetus not alive but no symptoms threatened - bleeding with closed cervix and alive fetus inevitable - bleeding with open cervix incomplete - RPOC complete Anembryonic pregnancy - gestation sac with no fetus Transvaginal USS: fetal heartbeat, pregnancy is considered viable. A fetal heartbeat is expected once the crown-rump length is 7mm or more. When the crown-rump length is less than 7mm, without a fetal heartbeat, the scan is repeated after at least one week to ensure a heartbeat develops. When there is a crown-rump length of 7mm or more, without a fetal heartbeat, the scan is repeated after one week before confirming a non-viable pregnancy. A fetal pole is expected once the mean gestational sac diameter is 25mm or more. When there is a mean gestational sac diameter of 25mm or more, without a fetal pole, the scan is repeated after one week before confirming an anembryonic pregnancy. Management <6 weeks; expectant >6 weeks; expectant: if no RF for bleeding/infection. Pregnancy test in 3 weeks Medical: Misoprostol Surgical: vacuum aspiration

Answer 59

<6 weeks; expectant >6 weeks; expectant: if no RF for bleeding/infection. Pregnancy test in 3 weeks Medical: Misoprostol Surgical: vacuum aspiration

Answer 60

3< first trimester miscarriages, 1< second Age Antiphospholipid syndrome; hypercoagulable state -> thrombosis and miscarriage. Primary or SLE. Managed with low dose aspirin & LMWH in pregnancy. Hereditary thrombophilia: factor v leiden*, factor II mutation, protein S deficiency Uterine abnormalities: Septum, unicornuate, bicornuate, didelphic, cervical insufficiency, fibroids chronic histiocytic intervillosis Investigate for above causes Pelvic USS genetics on products of conception and mother

Answer 61

Up to 24 weeks; via GP, BPAS referral, SH Medical Mifepristone then misoprostol anti-D prophylaxis if 10 weeks< Surgical Suction <14 weeks Evacuation >14 weeks Confirm both with multi level pregnancy test after 2 weeks

Answer 62

N+V - start 4-7 weeks, worse at 12 weeks, resolved by 20 5% weight loss, dehydration, electrolyte imbalance PUQE score <7 mild, 7-12 moderate, 12< severe Manage with anti emetics: prochlorperazine/promethazine*, cyclizine, ondansetron (increase risk of nasal cleft), metoclopramide (only for 5 days - extrapyrimidal)/domperidone (cardiac issues - 7 days) + PPI Admission if: zero oral intake 5% weight loss ketones for: iv fluids U+Es Thiamine supplementation Thromboprophylaxis

Answer 63

Admission if: zero oral intake 5% weight loss ketones for: iv fluids U+Es Thiamine supplementation Thromboprophylaxis

Answer 64

Hydatiform mole Complete - 2 sperm fertilise ovum with no genetic material, divide into a tumour with no fetal material Incomplete - 2 sperm fertilise normal ovum; 3 sets of chromosomes with some fetal material Presents as pregnancy +- morning sickness severe, really raised hCG, which can mimic TSH -> thyrotoxicosis, PV bleeding, and large for dates uterus Diagnosis with USS and histology - snowstorm appearance Managed with surgical evacuation, systemic chemo if mets, specialist follow up

Answer 65

Not starting menstruation by: 13 if no other characteristics, 15 if other signs of puberty Hypogonadotrophic Hypogonadism: Hypopituitarism, significant chronic disease (IBD, CF), excessive exercise, GH deficiency, cushings, hypothyroid, hypoprolactinaemia, kallman syndrome (genetic + anosmia) Hypergonadotrophic Hypogonadism: Damage to gonads, congenital absence of ovaries, Turner's syndrome (X chromosome only) Congenital adrenal hyperplasia: congenital deficiency of the 21-hydroxylase enzyme. This causes underproduction of cortisol and aldosterone, and overproduction of androgens from birth. autosomal recessive pattern. In severe cases, the neonate is unwell shortly after birth, with electrolyte disturbances and hypoglycaemia. In mild cases, female patients can present later in childhood or at puberty with typical features: Tall for their age ,Facial hair, Absent periods (primary amenorrhoea), Deep voice, Early puberty Androgen Insensitivity Syndrome: genetically and internally male, externally female Structural: imperforate hymen etc.

Answer 66

FBC, Ferritin U&E for CKD Anti-TTG/EMA FSH/LH TFTs Insuline like GF prolactin Testosterone Genetic screen X ray of wrist to assess bone age for constitutional delay MRI brain Pelvic USS Management: Pulsatile GnRH if hypogonadotrophic COCP if no wish for pregnancy or hypergonadotrophic

Answer 67

3 months< amenorrhoea pregnancy, menopause, hormonal contraception HPG axis pathology, PCOS, Asherman's syndrome, thyroid, prolactin up hCG LH,FSH (↑ LH:FSH think PCOS, ↑FSH think premature ovarian failure) Prolactin TFTs Testosterone Management: replace hormones (If PCOS, withdrawal bleed required) Vit D and Ca HRT/COCP

Answer 68

Symptoms in the luteal phase (before menses); low mood, irritability, anxiety, bloating, headaches, breast pain "premenstrual dysphoric disorder" if affects QoL Symptom diary if needed, GnRH analogues to induce menopause to check Management: COCP: Drospirenone SSRIs in luteal phase CBT Donaxole for breast pain

Answer 69

Dysfunctional uterine bleeding (no cause), fibroids, endometriosis, CTD, endometrial Ca, PCOS, PID, copper coil, anti-coags, bleeding disorders (von willebrand) Investigations: FBC Outpatient hysteroscopy: ?submucosal fibroids, ?endometrial pathology, persistent intermenstrual bleeding Transvaginal USS if: ? large fibroids, ?adenomyosis, obesity, hysteroscopy declined Swabs coag screen ferritin TFTs ManagementL No contraception required: Tranexamic acid if no pain, Mefenamic acid if pain Mirnea coil, COCP, cyclical progestogens Endometrial ablation, hysterectomy if resistant to treatment and QoL

Answer 70

Benign tumours of smooth muscle - oestrogen sensitive Intramural, submucosal, subserosal, pedunculated Often asymptomatic; menorrhagia, prolonged menstruation, pain, bleeding, urinary or bowel sx, deep dyspareunia, decreased fertility hysteroscopy, pelvic USS, MRI for detailed anatomy Management <3cm : mirena coil, COCP +- NSAIDs, Txa >3cm : refer to gynae + uterine artery embolisation, myomectomy, hysterectomy Complications: menorrhagia, decreased fertility, pregnancy complications Constipation, UTIs Red degeneration of fibroids; necrosis of fibriod in 2nd/3rd trimester due to increase in size outgrowing supply. Severe pain, low fever, increased HR (supportive management)

Answer 71

Cyclical pain, deep dyspareunia, dysmenorrhea, infertility, cyclical bleeds from other sites Laparoscopy with biopsy* NSAIDs, paracetamol COCP*, POP, mirena coil, GnRH Excision, hysterectomy

Answer 72

Endometrial tissue in the myometrium Dysmenorrhoea, menorrhagia, dyspareunia with enlarged tender uterus Transvaginal USS Treat as per menorrhagia

Answer 73

Anovulation, hyperandrogenism, multiple cysts on USS 2/3 needed for diagnosis amenorrhoea, infertility, obesity, hirsutism, acne, hair loss, insulin resistance -> acanthosis nigricans, CVD, endometrial hyperplasia Investigations ↑ Testosterone, ↓ sex hormone binding globulin, ↑ LH, ↑ LH:FSH, ↑ prolactin, TSH - Transvaginal USS - String of pearls, 12< follicles (2mm<), or 10cm ovarian volume OGTT Management Wt loss, diabetes control, exercise ↓ endometrial Ca risk: No prog from corpus luteum; mirena coil, cocp, progestogens USS if 3< without period for thickness (10mm< => biopsy) Hirsutism: co-cyprindiol COCP (3 months at a time) Topical eflornithine Infertility: wt loss*, clomifene, ovarian drilling

Answer 74

Often asymptomatic; pain, bloating, abdo fullness, palpable mass Functional (related to fluctuating hormones) Follicular cysts* Corpus luteum cysts Other: Mucinous cystadenoma - benign tumour endometrioma - pain and disrupt ovulation dermoid cysts - benign teratomas; increased risk of torsion, raised a-FP & hCG Sex cord stromal tumours e.g. leydig; can be malignant Investigations USS If 5cm< : CA125 LDH, aFP, hCG, if complex mass and <40yo Management: <5cm no follow up 5-7 -> gynae + yearly USS 7cm< gynae + ?MRI ?Ca -> 2WW ?dermoid -> gynae Complications: Torsion, haemorrhage, rupture Meig's syndrome: Ovarian fibroma, pleural effusion, ascites

Answer 75

Sudden onset severe unilateral pain, N+V Pelvic USS: Whirlpool sign, free fluid, ovary oedema Emergency laparoscopic surgery for detorsion or oophorectomy -> abscess & sepsis

Answer 76

Columnar epithelium of the endocervix extend out into the ectocervix Often asymptomatic; discharge, post coital bleeding, dyspareunia Management only required if problematic bleeding: cauterisation

Answer 77

vault prolapse

Answer 78

Sensation of prolapse, urinary and bowel sx 0 normal, 1 1cm above introitus, 2 within 1cm, 3 1cm below, 4 external to the vagina Management physio, wt loss, symptomatic treatment e.g. anticholinergics for stress incontinence, vaginal oestrogen cream Pessary Surgery

Answer 79

Lifestyle: caffeine, alcohol, medications, BMI Severity : frequency, nocturia, pads/clothing Pelvic tone - 0 no contraction, 5 strong diary, urine dip, bladder scan, urodynamics

Answer 80

Overactive bladder -> sudden urgency *Bladder retraining for 6 weeks to increase time between voids Anticholinergics e.g. oxybutynin, tolterodine, solifenacin Mirabegron (beta3 agonist) if dementia^; but contraindicated in uncontrolled hypertension Botulinum toxin A injection*, sacral nerve stimulation, cystoplasty

Answer 81

Weakness of pelvic floor Avoid caffeine, diuretics, high intake wt loss supervised pelvic floor exercise for 3 months< Duloxetine Surgery: taping, colposuspension, urethral bulking

Answer 82

Decreased oestrogen -> itching, dryness, dyspareunia, bleeding UTIs, prolapse, stress incontinence Pale mucosa, thin skin, decreased skin folds, inflamm Oestrogen cream

Answer 83

X linked recessive condition; mutation to androgen receptor Genetically male, female phenotype externally Abdominal testes - anti-mullerian hormone -I development of female internal organs. Presents with inguinal hernias with testes, primary amenorrhoea: ↑ LH, ↑-FSH, ↑ Oestrogen Management: Bilateral orchidectomy (testicular cancer) Oestrogen therapy Vaginoplasty

Answer 84

Chronic inflammatory condition -? porcelain white skin 45-60yo with vulval itching & skin changes; shiny, tight, thin skin Potent topical steroids: clobetasol propionate (dermovate)

Answer 85

Fluid filled cyst in blocked mucous gland at posterior introitus Abscess: hot, tender, draining pus Management: Simple cyst - hygiene, analgesia, warm compress If abscess: Abx (e.coli inf. most likely) -> surgical: word catheter (LA) or Marsupialisation (GA)

Obs and gynae Flashcards

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