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Passmed questions > Obs and gynae quesmed > Flashcards

Obs and gynae quesmed Flashcards

1
Q

What is most sensitive test for pre-eclamsia?

A

-Urine protein:creatinine ratio (PCR)
-A PCR >30mg/mmol

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2
Q

When to repeat smear test if HPV + but no dyskaryosis?

A

12 months (if HPV still + then repeat at 24 months, if positive at 24 months colposcopy)

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3
Q

What are the two main associations of obstetric cholestasis?

A

-Fetal death
-Maternal haemorrhage

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4
Q

When should you plan to deliver baby in mother with obstetric cholestasis?

A

37-38 weeks

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5
Q

What is the action of clomifene and what re the side effects?

A

-Selective oestrogen receptor modulator
-Side effects include ovarian hyperstimulation syndrome

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6
Q

Post menopausal bleeding in women is what until proven otherwise?

A

Endometrial cancer

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7
Q

What are the most common causes of post menopausal bleeding?

A

-Atrophic vaginitis (inflammation and thinning)
-Endometrial atrophy
-Cervical/endometrial polyps
-Endomterial hypertrophy

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8
Q

What is the HRT of choice in a women with regular periods?

A

Monthly, cyclical HRT

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9
Q

What is the HRT of choice in a women with irregular periods?

A

3 monthly, cyclical HRT

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10
Q

What is the HRT of choice in post-menopausal women ?

A

Continuous combined HRT

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11
Q

What can VWD disease cause?

A

-Menorrhagia (heavy periods)
-Will have prolonged APTT

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12
Q

What is first line to induce labour?

A

Prostaglandin pessary

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13
Q

What does PCOS do to risk of endometrial and ovarian cancer?

A

Increases the risk by 2-3 times

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14
Q

What symptoms can risperidone cause?

A

-Reduced libido, galactorrhoae and amenorrhoea

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15
Q

What is the treatment for lichen sclerosus?

A

-Topical corticosteroids (potent steroids such as dermovate) to reduce inflammation and itching
-Avoid soaps
-Emollients to relieve dryness and soothe itching

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16
Q

Describe first degree perineal tear

A

Tear limited to the superficial perineal skin or vaginal mucosa only
-Heal quickly, no muscle involvement and heal quickly superficial

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17
Q

Describe second degree perineal tear

A

Tear extends to perineal muscles and fascia, but the anal sphincter is intact (episiotomy is anatomically classified as second degree)

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18
Q

Describe third degree perineal tear

A

3a: less than 50% of the thickness of the external anal sphincter is torn
3b: more than 50% of the thickness of the external anal sphincter is torn, but the internal anal sphincter is intact
3c: external and internal anal sphincters are torn, but anal mucosa is intact

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19
Q

Describe fourth degree perineal tear

A

Perineal skin, muscle, anal sphincter and anal mucosa are torn

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20
Q

What can cause an enlarged, irregular and firm non tender uterus?

A

Fibroids

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20
Q

When does uterus return to non-pregnant size?

A

4 week post party

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21
Q

When is the anomaly scan performed?

A

18-20 + 6 weeks

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22
Q

What can you give women prior to fibroid surgery to mange bleeding?

A

Goserelin

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23
Q

What is the triad of hyperemesis gravidarum?

A

weight loss, dehydration and electrolyte disturbance
A key finding is ketonuria

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24
Q

What age group do germ cell ovarian tumours normally affect?

A

younger women

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25
Q

What is the Kleihauer test used for?

A

Used to assess the number of foetal cells within the maternal circulation

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26
Q

If cervial ectropion that is bothersome?

A

Non-urgent colpscopy

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27
Q

Why is diabetes mellitus a risk factor for developing endometrial cancer?

A

There are several possible mechanisms linking diabetes and endometrial cancer, one of which is the proliferation of endometrial stromal cells in response to high insulin levels.

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28
Q

What are the infection routinely screened for in pregnancy?

A

-Syphilis
-Hep B
-HIV
-Rubella

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29
Q

What is choice of medication for GBS prophylaxis?

A

IV intrapartum benzylpenicillin

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30
Q

What is the cut off Hb for high dose folic acid?

A

110

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31
Q

What is a risk factor for hyperemesis gravidarum?

A

Trophoblastic disease due to raised beta-HCG

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32
Q

What is diagnostic of a miscarriage with crown-length rump >7mm?

A

A transvaginal ultrasound demonstrating a crown-rump length greater than 7mm with no cardiac activity is diagnostic

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33
Q

What is Human chorionic gonadotropin (hCG)?

A

-A hormone first produced by the embryo and later by the placental trophoblast
-Main role is to stop degeneration of corpus luteum
-

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34
Q

Contraceptives - time until effective (if not first day period)?

A

instant: IUD
2 days: POP
7 days: COC, injection, implant, IUS

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35
Q

Treatment for vaginal vault prolapse?

A

Sacrocolpopexy - this suspends the vaginal apex to the sacral promontory. This support is usually afforded by the uterosacral ligaments.

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36
Q

What are the normal laboratory findings during pregnancy?

A

Reduced urea, reduced creatinine, increased urinary protein loss (look out for pre-eclampsia)

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37
Q

What is most common cause of postmenopausal bleeding?

A

vagianal atrophy

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38
Q

Methotrexate when conceiving?

A

6 months before stop in male and female

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39
Q

How long does urine pregnancy remain positive for following termination?

A

4 weeks - if beyond this then indicates incomplete abortion or persistent trophoblasts

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40
Q

How does the COCP work?

A

-Inhibiting ovulation to reduce LH and FSH
-Also thought to alter the cervical mucus

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41
Q

What type of contraception isn entogestrel (implantable contraceptive)?

A

-Long acting reversible method of contraception
-Prevents ovulation
-Also prevent sperm implantation by altering cervical music and preventing implantation but thinning endometrium

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42
Q

How does the copper intrauterine device work?

A

Decreases sperm motility and survival

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43
Q

How does intrauterine system (levonorgestrel) work?

A

Prevents endometrial proliferation
Also thickens cervical mucus

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44
Q

How does Progestogen-only pill (excluding desogestrel) work?

A

Thicken cervical mucus
-this is the pill that you must take within 3 hour time frame

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45
Q

How does the desogestrel only pill work?

A

-Inhibits ovulation
-Thickens cervial mucus
-Take within 12 hours

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46
Q

How does Injectable contraceptive (medroxyprogesterone acetate) work?

A

-Inhibits ovulation
-Thickens cervical mucus

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47
Q

If 1st repeat smear at 12 months is hrHPV positive then when do you repeat the smear? (cytology normal cells)

A

repeat in 12 months

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48
Q

Why should COCP not be used in 1st 21 days?

A

Increased venous thromboebolsim risk

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49
Q

What are the classic symptoms of endometriosis?

A

pelvic pain, dysmenorrhoea, dyspareunia and subfertility

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50
Q

When should referral be made to maternal fetal medicine unit if no metal movements are felt?

A

24 weeks

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51
Q

How does acute fatty liver disease of pregnancy present?

A

jaundice, mild pyrexia, hepatitic LFTs, raised WBC, coagulopathy and steatosis on imaging

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52
Q

Why is it normal for ALP to be raised in pregnancy?

A

Due to placental ALP

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53
Q

Management of PPH in order

A

1.Bimanual uterine compression to manually stimulate contraction
2.Intravenous oxytocin and/or ergometrine
3.Intramuscular carboprost
4. Intramyometrial carboprost
5.Rectal misoprostol
6.Surgical intervention such as balloon tamponade

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54
Q

What is salpingectomy?

A

Removal of fallopian tube

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55
Q

What score can be used to assess severity of symptoms for vomiting?

A

-Pregnancy unique quantification of emesis (PUQE) score

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56
Q

When does patient have smear test ever 5 years instead of eery 3 years?

A

Once over 50

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57
Q

How should women be managed who are bleeding <6 weeks gestation? (with no pain or risk factor for ectopic pregnancy?)

A

-These women can be managed expectantly
-Return if bleeding continues or pain develops
-Advise to repeat urine pregnancy test after 7-10 days
-A negative pregnancy test means the pregnancy has miscarried

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58
Q

Progesterone only pill and antibiotics?

A

-No need for extra precautions

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59
Q

What antibiotics can affect the pill?

A

-Enzyme inducing antibiotics, such as rifampicin

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60
Q

What is gestational trophoblastic disease?

A

-Abnormal cells or tumours that start in the uterus from cells that would normally develop in the placenta

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61
Q

What is hyperemesis gravidarum?

A

The extreme form of vomiting and nausea
-occurs in 1% pregnancy and is thought to be associated with raised beta hCG levels

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62
Q

When is hyepermesis gravidarum most common?

A

-Between 8-12 weeks but may persist put to 20 weeks

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63
Q

What are the risk factor for hyperemesis gravidarum?

A

-Increased levels of beta hCG (multiple pregnancy and trophoblastic disease)
-Nulliparity
-Obesity
-Family or personal history of NVP

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64
Q

Relationship with smoking and hyperemesis?

A

-Associated with decreased incidence of hyperemesis

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65
Q

What is the NICE criteria for referral of nausea and committing in pregnancy?

A
  1. Continued nausea and dominating and unable to keep down liquids and oral antiemetics
  2. Continued nausea and committing with ketonuria and/or weight loss (greater 5% of body weight), despite treatment with oral antiemetics
  3. A confirmed or suspected cormorbitiy e.g. unable to tolerate oral ABx for infection due to vomiting
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66
Q

When do NICE recommended to lower the threshold for admission to hospital?

A

If has co-existing condition (e.g. diabetes) that many be adversely affected by N and V

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67
Q

What is the triad of hyperemesis gravidarum?

A

-5% pre pregnancy weight loss
-Dehydration
-Electrolyte imbalance

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68
Q

What are the simple measures that can be taken for hyperemesis gravidarum?

A

-Rest and av oid triggers
-Bland, plain food
-Ginger

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69
Q

What are the first line medications for hypermedia gravidarum?

A

-Antihistamine: oral cyclizine or premethazine

-Phenothiazines: oral prochlorperazine or chlorpromazine

-Combination drug doxylamine/pyridoxine: pyridoxine (vitamin B6) monotherapy is actually used commonly outside of the UK as a first-line treatment for NVP. However, pyridoxine monotherapy is specifically not recommended in the RCOG guidelines

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70
Q

What are second line medications for hyperemesisgravidarum?

A

-Oral ondansetron (discuss risk of cleft palate with woman)
-Oral metocloprmid for domperiodone - metoclopramide may cause extrapyramidal side effects so do not use more than 5 days

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71
Q

What is used to hydrate patients with hyperemesis gravidarum?

A

-Normal saline with added potassium

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72
Q

Aside from weight loss, electrolyte imbalance what are the other complications of hyperemesis gravidarum?

A

-AKI
-Wernicke’s encephalopathy
-Oesophagitis, Mallory-Weiss tear
-Venous thromboembolism

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73
Q

How does hyperemesis gravidarum impact the foetus ?

A

-Studies show little evidence of adverse outcomes for birth weight/other markers for mild-moderate symptoms
-Severe NVP resulting in multiple admissions and failure to ‘catch up’ may be linked to small increase in preterm birth and low birth weight

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74
Q

What are the types ovarian cysts?

A

-Can get simple and complex
-Physiological cysts
-Benign germ cell tumours
-Benign epithelial tumours
-Benign sex cord stromal tumours

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75
Q

What is a complex cyst?

A

Cysts containing a solid mass, or those which are multi-loculated - should be treated as malignant until proven otherwise.

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76
Q

What are the tests recommended for premenopausal women with a complex cyst?

A

Serum CA-125, αFP and βHCG

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77
Q

What are the two types of physiological (functional cysts)?

A

-Follicular cyst
-Corpus letup cyst

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78
Q

What is a follicular cyst?

A

-Commonest type of ovarian cyst
-Due to a non-rupture of the dominant follicle or failure of atresia in a non-domain follicle
-Commonly regress after several menstrual cycles

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79
Q

How does a corpus lute cyst occur?

A

-During menstrual cycle if pregnancy doesn’t occur the corpus lutes may fill with blood or fluid and form a corpus luteal cyst
-These are more likely to present with intraperitoneal bleeding than follicular cyst

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80
Q

Give an example of a benign germ cell tumour?

A

-Dermoid cyst also called mature cystic teratoma

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81
Q

What is a dermoid cyst?

A

-A cyst lined with epithelial tissue, may contain skin appendages, hair and teeth

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82
Q

What is the median age of diagnosis with a dermoid cyst?

A

-30 years old
-This sis the ,out common benign ovarian tumour in woman under age 30 yrs

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83
Q

What percent of dermoid cysts are bilateral?

A

10-20%

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84
Q

What is the presentation of dermoid cyst?

A

-Usually asymptomatic
-More likely than with other ovarian tumours

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85
Q

Where of benign epithelial tumours arise?

A

-Arise form the ovarian surface epithelium

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86
Q

What are two types of benign epithelial ovarian tumours ?

A

-Serous cystadenoma
-Mucinous cystadenoma

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87
Q

What is serous cystadenoma?

A
  • Most common benign epithelial tumour - bears resemblance to most common type of ovarian cancer (serous carcinoma)
    -It is bilateral in around 20%
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88
Q

What is a mucinous cystadenoma?

A

-Second most common benign epithelial tumour
-They are typically large and become massive
-If rupture may cause psuedomyxoma peritonei (which can be fatal)

89
Q

What is adenomyosis?

A

-Presence of endometrial tissue within the myometrium
-More common in multiparous women towards end of reproductive years

90
Q

What are the feature of adenomyosis?

A

-Dysmenorrhoae
-Menorrhagia
-Enlarged, boggy uterus

91
Q

What are the investigation for suspected adenomyosis?

A

-NICE recommend transvaginal ultrasound as first line
-MRI is an alterative

92
Q

How do GnRH agonist work?

A

Act on pituitary gland to suppress ovulation and production of ovarian hormones

93
Q

What are prescribed along GnRH agonists?

A

-Combined hormonal contraception or combined HRT

94
Q

Why should GnRH only be used for 6 months?

A

-Risk of osteoporosis
-If taken for long term need DEXA scans every 12-18 months

95
Q

Give examples of GnRH agonists

A

Leuprolide, goserelin, triptorelin and histrelin

96
Q

What is the management of adenomyosis?

A

-Symptomatic treatment (tranexamic acid to manage menorrhagia)
-GnRH agonists
-Uterine artery embolisation
-Hysterecotmy (considered definitive treatment)

97
Q

what are then main key points of nexplanon?

A

-Highly effective: failure rate 0.07/100 women-years - it is the most effective form of contraception
-Long-acting: lasts 3 years
-Doesn’t contain oestrogen so can be used if past history of thromboembolism, migraine etc
-Can be inserted immediately following a termination of pregnancy

97
Q

What is the implantable contraception that is used?

A

-Nexplanon - releases progesterone hormone etonogestrel
-This prevents ovulation and thickens the cervical mucus

98
Q

What is needed to nexplanon is not inserted on day 1 to 5 of woman’s menstrual cycle?

A

Additional contraceptive methods are needed for first 7 days

99
Q

What are the adverse effects of implantable?

A

-Irregualr/heavy bleeding
-Progesteron effects which include nausea, breast pain and headache

100
Q

What are contraindications for implantable?

A

-Ischaemic heart disease/stroke
-Unexplained vaginal bleeding
-Past breast cancer
-Severe liver cirrhosis, liver cancer
-Current great cancer - this is an absolute contraindication

101
Q

When should magnesium sulphate infusion be stopped in women with eclampsia?

A

Continue for 24 hours after last seizure or delivry

102
Q

Why is magnesium sulphate used in preeclampsia and eclampsia?

A

-Used in serve pre-eclampsia to prevent seizures
-Used in eclampsia to treat seizures

103
Q

What are the guidelines for giving magnesium sulphate?

A

-Should be given once decision to deliver has been made
-In eclampsia an IV bolus of 4g over 5-10 minutes should be given followed by infusion 1g/hour
-Urine output/reflexes, RR and oxygen stats should be monitored during treatment

104
Q

What is first line treatment for magnesium sulphate induced respiratory depression?

A

-Calcium gluconate

105
Q

Why is fluid restriction important when using magnesium sulphate?

A

To avoid potentially serious consequences of fluid overload

106
Q

What are the risk factors for gestational diabetes ?

A

-BMI >30
-Previous macrocosmic baby weighing 4.5 kg or above
-Previous gestational diabetes
-First degree relative with diabetes
-Family origin with high prevalence of diabetes

107
Q

What is the test of choice for GD?

A

Oral glucose tolerance test

108
Q

When should OGTT be performed in patient with previous gestational diabetes?

A

-As soon as possible after booking and at 24-28 weeks if the test is normal

109
Q

What can be used as a alternative to oral glucose tolerance test?

A

-Self monitoring of blood glucose

110
Q

When should women with risk factors be offered a OGTT?

A

24-28 weeks

111
Q

What are the risk factors for urinary incontinence?

A

-Advancing age
-Previous child brith or pregnancy
-High BMI
-Hysterectomy
-Family hisotry

112
Q

How can urinary incontinence be classified?

A

-Urge incontinence
-Stress incontinence
-Mixed incontinence
-Overflow incontinence
-Functional incontinence

113
Q

What is urge incontinence?

A

-Overactive bladder
-Due to detrusor overactivity
-The urge to urinate is quickly followed by uncontrollable leakage ranging from a few drops to complete bladder emptying

114
Q

What is stress incontinence?

A

-Leaking small amounts when coughing or laughing

115
Q

What is mixed incontinenece?

A

both urge and stress incontinence

116
Q

What is overflow incontinence?

A

Due to bladder outlet obstruction e.g. due to prostate enlargement

117
Q

What is fucntional incontinenece?

A

-Co-morbid physical conditions that impair the patients ability to get to bathroom in time
-Causes include dementia, sedating medication dn injury/illness resulting in decreased ambulation

118
Q

What is the management If urge is predominant?

A
  1. Bladder retraining (gradually increase intervals between voiding, should last for minimum 6 weeks)
  2. Bladder stabilising drugs - antimuscarinics are first-line
  3. Mirabegron may be useful if there is concern about anticholinergic side effects in frail elderly patients
119
Q

Give examples of antimuscarinics used in urge incontinence

A

-Oxybutynin (immediate release)
-Tolterodine (immediate release)
-Darifenacin (once daily preparation)
NOTE: oxybutynin should be avoided in frail older women

120
Q

What is the management if stress incontinence is predominant?

A
  1. Pelvic floor muscle training
    (Nice Recommend at least 8 contractions 3 times per day for a minimum of 3 months)
  2. Surgical procedures e.g. retropubic mid-urethral rape procedures
  3. Duloxetine may be offered to women if they decline surgical procedures
121
Q

How does duloxetine work?

A

-It is a combined noradrenaline and serotonin reuptake inhibitor
-It increases synaptic concentration of serotonin and NA within the pudenal nerve → increased stimulation of urethral striated muscles within the sphincter → enhanced

122
Q

How long is IUS effective for?

A

5 years

123
Q

What is the investigation of choice for patients with suspected deep vein thrombosis in pregnancy?

A

-Compression duplex ultrasound should be undertaken where there is clinical suspicion of DVT

124
Q

What is the procedure in a women with confirmed DVT on duplex doppler and symptoms of PE?

A

Initiate treatment dose of low molecular weight heparin

125
Q

What are the investigations in women with a suspected PE?

A

-ECG and chest X-ray in all patients

-If DVT is confirmed no further investigation is necessary and treatment for VTE can continue

-Decision to perform V/Q or CTPA should be taken at a local level discussions with patient and radiologist

126
Q

Why does D-dimer have limited use?

A

Often already raised in pregnancy

127
Q

What is a contraindication for epidural anaesthesia during labour?

A

Coagulopathy

128
Q

When to commence insulin?

A

Fasting glucose > 7 mol

129
Q

What is vasa praaevia?

A

-A complication in which fatal blood vessels cross or run near the orifice of the uterus
-The vessels can be easily compromised when supporting membranes rupture leading to bleeding

130
Q

What is the classic triad of symptoms in vasa praaevia?

A

-Rupture membranes
-Painless vaginal bleeding
-Fetal bradycardia

131
Q

What is the risk of vasa praaevia?

A

-Unlike placenta preavia vasa preavia carries no major maternal risk but fetal mortality rates are high

132
Q

How can you differentiate between placenta praaevia and vasa praveia?

A

-Difficult to distinguish in acute clinical situations but in examination purposes a preceding rupture of membranes will usually be emphasised
-Ulrasound scans can detect vasa preavia, ,many cases are undetectable antenatally

133
Q

What are the risk factors of ovarian cancer?

A

-Family history: mutation of BRCA1 or BRCA2 gene
-Many ovulations: early menarche, late menopause, multiparty (these increase number of ovulations)

134
Q

What blood pressure reading would make you admit the patient?

A

> 160/110 mmHg

135
Q

What are the risk factors for endometrial cancer?

A

-Excess oestrogen (nulliparity late menopause, early menarche, unopposed oestrogen)
-Metabolic syndrome (obesity, DM, PCOS)
-Tamoxifen
-Hereditary non-polyposis colorectal carcinoma

136
Q

What are protective factors against endometrial cancer?

A

-Multiparty
-COCP
-Smoking

137
Q

What is the classic symptom of endometrial cancer?

A

-Post menopausal bleeding
-This is normal slight and intermittent initially before becoming heavier
NOTE: pain is not common and signifies extensive disease

138
Q

What do women who are premenopausal present with in endometrial cancer?

A

-Menorrhagia or intermenstrual bleeding

139
Q

What are the investigation in women with suspected cancer?

A

-1st line is trans-vaginal ultrasound - a normal endometrial thickness (<4mm) has a high negative predictive value
-Hysteroscopy with endometrial biopsy

140
Q

What is a galactocele?

A

-Occurs in women who have recently stopped breastfeeding and is due to occlusion of a lactiferous duct
-A build up of milk creates a cystic lesion in the breast

141
Q

How can you differentiate an abscess from galactocele ?

A

-Usually painless, with no local or systemic signs of infection

142
Q

When do you give iron supplementation in pregnancy?

A

Cut off
1st trimester - 110g/L
2nd/3rd trimester - 105g/L
Postpartum <100g/L

143
Q

What is the treatment given for oral iron therapy?

A

oral ferrous sulfate or ferrous fumarate

144
Q

What is the medical management for abortion?

A

-Mifepristone (anti-progesterone) followed by misoprostol (prostaglandin)

145
Q

How is the medication for abortion taken?

A

-Mifepristone followed by misoprotol 48 hours later
-Misoprostol stimulates uterine contractions
-Pregnancy test in 2 weeks to confirm the pregnancy has ended
-This should be a multi-level pregnancy test that detects the level of hCG

146
Q

Wheelchair users and COCP?

A

Risk increase risk VTE

147
Q

What are red flags to consider am urgent psychiatric evolution in puerperal psychosis ?

A

-Poor interaction with baby
-Talking in incoherent fashion about the future
-Stating baby has been bought into “very bad world” is odd and worrying

148
Q

Why is dextrose not given in patients with hyperemesis gravidarum?

A

Thiamine deficiency is common in patient with hyperemesis gravidarum and dextrose increases body need for thiamine

149
Q

Medical protocol for PPH?

A

-IV injection syntocinon 5 units followed by syntocinon infusion

150
Q

What is the most common type of ovarian pathology associated with Meigs’ syndrome?

A

Fibroma

151
Q

What is the most common benign ovarian tumour in women under 25 years?

A

Dermoid cyst (teratoma)

152
Q

What is the most common cause of ovarian enlargement in women of reproductive age?

A

Follicular cyst

153
Q

How is PCOS diagnosis according to Rotterdam cirteria?

A

-2 out of 3 must be present
1. Infrequent or no ovulation (usually manifested as infrequent or no menstruation)

  1. Clinical and/or biochemical signs of hyperandrogenism (such as hirsutism, acne, or elevated levels of total free testosterone)
  2. Polycystic ovaries on ultrasound (presence of >12 follicles in one or both ovaries)
154
Q

What investigation should you perform if suspect PCOS?

A

-Pelvic ultrasound
-NICE recommend - FSH, LH, prolactin, SHBG, testosterone
-Check for impaired glucose levels

155
Q

What should you be aware of when testing LH:FSH ratio in PCOS?

A

Raised ratio was a classic feature but is no longer considered useful

155
Q

What should the results of prolactin, testosterone and SHBG in women with PCOS?

A

-Prolcatin may be normal or mildly elevated
-Testosterone normal or mildly elevated - if markedly raised consider other causes
-SHGB is normal to low in women with PCOS

156
Q

If the results of FSH, LH , prolactin, TSH, testosterone and SHBG are often normal in PCOS then why are they useful?

A

Can be used to exclude other causes

157
Q

When should surgical management ectopic occur?

A

All ectopic pregnancies >35 mm in size or with a serum B-hCG >5,000IU/L should be managed surgically

157
Q

Cocaine abuse?

A

Hypereflexia and dilated pupils

158
Q

What is the mode of action of levonorgestrel?

A

-Not fully understood - acts to stop ovulation and inhibit implantation

159
Q

When should levonorgestrel be taken?

A

-As soon as possible the efficacy decreases with time
-Must be taken within 72 hours of UPSI

160
Q

What is the dose of levonorgestrel (progesterone) given?

A

-Single dose 1.5mg
-Dose doubled for those with BMI>26 or weight over 70kg

161
Q

How effective is levonorgestrel?

A

-84% if used within 72 hours

162
Q

When can hormonal contraception be started after using levonorgestrel?

A

Started immediately

163
Q

What is the mode of action of Ellaone (Ulipristal)?

A

Inhibition of ovulation

164
Q

What is the dose of Ella one (Ulipristal) and when should you take it?

A

-30mg oral dose ASAP
-No more than 12hours after intercourse

165
Q

What contraception to women on sequential HRT?

A

All progesterone only methods of contraception are safe to use as contraception alongside HRT

166
Q

When shouldnt progesterone injectable be used?

A

over the age of 50

166
Q

Trans male contraception?

A

-Avoid COC
-Copper IUD
-POP/Implant/Injection

166
Q

Trans female contracpetion?

A

-Advise use of condoms
-Hormonal treatments

166
Q

What is metoclopramide use associated with?

A

Extrapyramidal effects - shoudld not use more than 5 days

167
Q

How long does it take for POP to become effective?

A

48 hours

167
Q

UKMEC 3?

A

-More than 35 AND smoking >15 cigs daily
-FHx of thromboembolicm in 1st degree relative<45
-BMI>35
-Controlled hypertension
-Immobility e.g. wheelchair
-BRAC gene
-Gallbladder disease

167
Q

Ovarain cyst in early pregnancy?

A

These are usually physiological known as the corpus luteum

168
Q

Dribbling incontinence after prolonged labour?

A

Vesicovaginal fistulae

169
Q

What is a vesicovagibal fistula?

A

An abnormal opening between bladder an dvagina resulting in continuous and unremitting urinary incontinence

169
Q

Investigation for vesicovagianbl fistula?

A

urinary dye studies can identify the presence of a fistula

169
Q

How is vesicovaginal fistula treated?

A

-Catheter
-Surgery

170
Q

What is vulval intraepithelial neoplasia?

A

VIN is a pre cancerous skin lesion of vulva, if left untreated may result in squamous skin cancer

170
Q

What is the age range for women being affected by VIN?

A

50 years

171
Q

What are the risk factors for vulvar intraepithelial neiplasia?

A

-HPV 16 and 18
-Smoking
-Herpes simplex virus 2
-Lichen planus

172
Q

What are the features of vulval intraepithelial neoplasia?

A

-Itching and burning
-Rasiedm well defined skin lesions

173
Q

2 week wait referral - persistent vulval skin lesions?

A

An unexplained vaginal lump, ulceration or bleeding prompt a 2 week wait referral to investigate possible cancer

174
Q

RF for ectopic?

A

-Damage to tubes
-Previous ectopic
-Endometrioses
-IUCD
-Progesterone only pillm
-IVF

175
Q

If secondary sexual characteristics but no period?

A

More likely to be an obstructive cause of amenorrhoea rather than endocrine

176
Q

What is atrophic vaginitis?

A

-Occurs in post-menopausal women
-Presents with vaginal dryness, dyspareunia and occaisional spotting

177
Q

What will you find on examination in a patient with atrophic vaginitis?

A

Vagina appears pale and dry

178
Q

What is the management for atrophic vaginitis?

A

Vaginal lubricants and moisturisers, if these do not help then topical oestrogen cream can be used

179
Q

Hyperemesis gravidarum - ketonuria/weight loss despite antiemtics

A

Admission to hospital - this is due to risk to mother

180
Q

First investigation in post menopausal bleeding?

A

TVUS - this is because it gives the clearest image of endometrial thickness which is a key factor in establishing whether bleed could be caused by endometrial cancer

181
Q

What is Asherman’s syndrome?

A

-Occurs when there is scar tissue in the uterus (intrauterine adhesions)
-This can cause the endometrium to stop responding to oestrogen as it normally would
-It can occur following dilation and curettage

182
Q

What condition is a strong risk factor for for endometrial cancer?

A

-HNPCC/lynch syndrome
-HNPCC - herediatry non-polyposuis colorectal carcinoma

183
Q

What is a cervical ectropian?

A
  • On the ectrocervic there is a transformation zone where the stratified squamous epithelium meets the columnar epithelium on the cervical canal

-When oestrogen levels are elevated it results in larger area of columnar epithelium being present on ectocervix

184
Q

What can cause an increase in oestrogen levels and therefore cause a cervical ectropion?

A

-Ovulatory phase, pregnancy, COCP

185
Q

What are the features of cervical ectropion?

A

-Vaginal discharge
-Post-coital bleeding

186
Q

What is management of cervical ectropion?

A

Albative treatment - only used for troublesome symptoms

187
Q

Secondary dysmenorrhoea?

A

Refer to gynae

188
Q

What is the diagnostic triad for hyperemesis gravidarum?

A

-5% pre-pregnancy weight loss
-Dehydration
-Electrolyte imbalance

189
Q

What is the first line treatment for primary dysmenorrhoea?

A

Mefenamic acid (NSAID)

190
Q

Ataxia and diplopia in patient with hyperemesis gravidarum?

A

Wernicke’s encephalopathy -supplement with thiamine (vit B1) and vit B and C complex (parbrinex)

191
Q

What can be used to assess ovarian cysts that are incidentally found on ultrasound?

A

IOTA criteria - help classify cysts as benign “b rules” or malignant “M rules”

192
Q

What does IOTA stand for?

A

International ovarian tumour analysis

193
Q

What are M rules?

A

-Irregular solid tumour
-Ascites
-4 papillary structures
-Irrregualr multlocular solid tumour with largesrt diameter >100mm
-Very strong blood flow

194
Q

How does Trichomonas vaginalius present?

A

-Offensive, yellow/green, frothy discharge
Vulvovaginitis
-Strawberry cervix

195
Q

What is strawberry cervix?

A

-Sign of trichomoniasis
-Erythematous cervix with pinpoint areas of exudation

196
Q

What is the management for bacterial vaginosis ?

A

oral metronidazole

197
Q

What is the management for trichomonas vaginalis?

A

Oral metrondiazole

198
Q

What is the Amsel criteria for bacterial vaginosis?

A

3 of 4 points should be present:
-Thin, white homogenous discharge
-Clue cells on microscopy: stippled vaginal epithelial cells
-Vaginal pH > 4.5
-Positive whiff test (addition of potassium hydroxide results in fishy odour)

199
Q

What would swab show in gonorrhoea?

A

-Gram negative doplococcus

200
Q

What is management for gonorrhoea?

A

IM ceftriaxone

201
Q

What is the risk of using ondansetron in pregnancy?

A

-Smll risk of celft lip/palate - advised to discuss this with pregnant women

202
Q

When is ondansetron used in pregnancy?

A

used in hyperemesis gravidarum

203
Q

What is a side effect of GnRH agonists ?

A

Loss of mineral bone density

204
Q

Why are GnRH agonists useful?

A

Shrink size of fibroid

205
Q

What is a smear testing for?

A

High risk HPV (types 16 and 18 cause 4 out of 5 )

206
Q

What do you give for incomoplete miscarriage?

A

single does of misoprostol (usually vaginal)

207
Q

How are NSAID effective for dysmenorrheoa?

A

Ibhibit prostglandin synthesis which is a main cuase of dysmenorrheoea

208
Q

Satge IA cervical cancer and maintain feritlty ?

A

cone biposy

209
Q

Bladder palpable after urination ?

A

Urinary overflow incontinence

210
Q
A

Passmed questions (11 decks)

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