obs + gynae high yield Flashcards
(124 cards)
1
Q
what does COC do
A
suppresses ovulation
2
Q
what is miscarriage defined as
A
loss of pregnancy less than 24 weeks
3
Q
who should get a medical or surgical miscarriage over expectant management
A
- Increased risk of haemorrhage (late first trimester or coagulopathies or unable to have blood transfusion)
- Previous adverse/traumatic experience
- Evidence of infection
- expectant management was unsuccessful
4
Q
what does mifepristone do
A
- weakens attachment to endometrial wall
- softens and dilates cervix
- induces uterine contractions
progesterone receptor antagonist
5
Q
what does misoprostol do
A
- strong myometrial contractions
- expells products out
prostoglandin analogue, binds to myometrial cells
6
Q
management of a missed miscarriage
A
1) oral mifepristone
after 48 hours - misoprostol
(unless gestational sac has already passed)
7
Q
management of an incomplete miscarriage
A
misoprostol
8
Q
what test needs to be done after medical managment of a miscarriage
A
pregnancy test at 3 weeks
9
Q
management of ectopic pregnancy
A
surgical (acutely unwell, heartbeat):
1) salpingectomy
2) salpingotomy if damage to other tube
Medical if:
-stable, hCG below 5000, ectopic is <35 mm and unruptured
-methotrexare
10
Q
when can expectant management be done for ecotpic
A
-unruptured
-hCG < 1000
-asymptomatic
-size < 35 mm
11
Q
complete mole vs partial mole
A
complete
-egg without DNA
-2 sperms fertilise
-only paternal genes
-choriocarcinoma!
partial
- 2 sperm fertilise a normal egg
-cell has three sets of chromosomes
12
Q
ultrasound shows a snowstorm appearance
A
molar pregnancy
13
Q
what indicates molar preggers
A
-more severe morning sickness
-vaginal bleeding
-huge uterus
-abnormally high hCG
-thyrotoxicosis (hCG can mimic TSH)
14
Q
if b-hCG fail to drop 1 year after molar preggers
A
MALIGNANT CHORIOCARCINOMA
15
Q
how long should pregnancy be avoided for after molar pregnancy
A
1 year
16
Q
what mums need anti-D immunoglobulin in a sensitising event
A
RhD- mums (negative)
17
Q
first line medication for hyperemesis gravidum
A
antihistamines: oral cyclizine or promethazine
phenothiazines: oral prochlorperazine or chlorpromazine
18
Q
odansetron in first trimester of pregnancy
A
NO
-cleft lip
19
Q
how long can metoclopramide be used for in hyperemesis
A
5 days
-causes extra pyramidal side effects
20
Q
whirlpool sign on USS
A
ovarian torsion
21
Q
which cyst most associated with ovarian torsion
A
dermoid
22
Q
treatment of pelvic inflammatory disease
A
1) IM ceftriaxone + 14 days of doxycycline and metronidazole
2) oral olfloxacin and oral metronidazole
23
Q
treatment of gonorrhoea
A
1) IM ceftriaxone or single dose of oral ciprofloxacin
2) cefixime oral plus azithromycin
24
Q
treatment of syphillis
A
early (primary and secondary/within 2 years)
- IM benzathine penicillin
late latent (after 2 years)
-benzathine penicillin weekly x3 weeks
25
name some AIDs defining conditions
-pneumocystis pneumonia
-TB
-cerebral toxoplasmosis
-cytomegalovirus
-HIV associated neurocognitive impairment
-skin infections
26
what are some AIDs related cancers
kaposi's sarcoma
non-hodgkin's lymphoma
cervical cancer
27
clue cells on microscopy
BV
28
BV vaginal pH
above 4.5
29
treatment of BV
asymptomatic - nothing (unless undergoing TOP)
symptomatic
-oral metronidazole for 5-7 days (single dose 2g stat if adherence issue)
pregnant
-oral metronidazole 5-7 days, can't give the stat dose
30
frothy, yellow-green discharge, strawberry cervis and vulvovaginitis
trichomonas
-treat with metronidazole
31
primary attack of herpes in pregnancy
elective c-section at term
32
what cancer can unopposed oestrogen cause
endometrial
33
which contraception is not recommended for patients undergoing testosterone therapy (transgender patients)
COC
34
kallmann syndrome
genetic disorder that causes hypogonadotrophic hypogonadism
35
how quickly can hormonal contraception be started after taking emergency contraception
immediately
36
management of PPH
- ABC
- rub the fundus
- catheterise
- IV oxytocin (syntocinon)
-ergometrine (unless history of hypertension)
- carboprost IM (unless history of asthma)
- misoprostol
-then surgical: balloon tamponade then B-lynch
37
most common cause of PPH
uterine atony
38
if low lying placenta at 20 week scan
re-scan at 32 weeks
-still present? rescan every 2 weeks
-final USS at 36-37 weeks to determine mode of delivery
-elective c-section for grades 3-4 between 37-38 weeks
39
placenta praevia with bleeding Mx
admit
not stable - emergency c-section
if in labour or term reached - emergency c-section
40
2 missed pills of COCP what to do? had sex
take last pill but not any earlier (even if it means taking two in one day)
if in week 1: emergency contraception if had sex in pill-free interval
if in week 2: after 7 days of taking pill consecutively no need for emergency contraception
41
management of thrush
1) oral fluconazole single dose
2) clotrimazole pessary
if vulval symptoms - add topical imidazole
42
which HPV for cervical cancer
16 and 18
43
HRT for people who have a uterus
must give progesterone aswell, can't give unopposed yet
44
who gets FSH levels checked for menopause
women > 45 with atypical symptoms
women between 40 and 45 with menopausal symptoms and/or iatrogenic amenorrhoea
45
koebner phenomenon
when signs and symptoms are made worse by friction to the skin
- lichen sclerosus
46
symptoms of fibroids
-pressure symptoms
-abdo distension
-heavy bleeding
-subfertility
-post coital bleeding
47
investigation of fibroids
transvag USS
48
options for managing fibroids
for menorrhagia:
- IUS
- NSAIDs
- tranexamic acid
-other contraceptions
to shrink/remove firboids:
- GnRH agonists short term (get loss of bone mineral density)
- surgery: myomectomy
| fibroids generally regress after the menopause
49
S+S of adenomyosis
menorrhagia
dysmenorrhoea
deep dyspareunia
irregular bleeding
BOGGY UTERUS
symmetrically enlarged and tender
50
Ix of adenomyosis
trans vag USS
51
mx of adenomyosis
hysterectomy only option
symptom management with contracpetion
uterine artery embolisation for short term management
52
CA-125 raised? what next
ULTRASOUND SCAN of abdomen and pelvis
53
risk factors for ovarian cancer
family history: mutations of the BRCA1 or the BRCA2 gene
many ovulations*: early menarche, late menopause, nulliparity
54
which ovarian cancer is hCG raised in
choriocarcinoma
55
which ovarian cancer is LDH raised in
dysgerminoma
56
staging of ovarian cancer
figo
57
gold standard Ix for endometriosis
laparoscopy
58
first line endometriosis
NSAIDs/paracetamol
then..
hormonal treatment like COC or progestogens
59
risk factors for endometrial cancer
excess ostrogen
- nulliparity
- early menarche
- late menopause
- unopposed oestrogen
metabolic syndrome
- obesity
- diabetes mellitus
- polycystic ovarian syndrome
tamoxifen
hereditary non-polyposis colorectal carcinoma
60
Ix for endometrial cancer
transvag US
61
who gets a biopsy after trans vag US for endometrial cancer
* if endometrial thickness of >4mm in postmenopausal woman
* >12mm in premenopausal women
62
management of endometrial hyperplasia
- Simple endometrial hyperplasia without atypia: high dose progestogens with repeat sampling in 3-4 months, levonorgestrel IUS may be used
- Atypia: hysterectomy is usually advised
63
when do people get screened for cervical cancer/HPV
25-49 years: 3-yearly screening
50-64 years: 5-yearly screening
in scotland it's 5 yearly
64
HPV positive but cytology normal test in repeated in 12 months then...
- if the repeat test is now hrHPV -ve → return to normal recall
- if the repeat test is still hrHPV +ve and cytology still normal → further repeat test 12 months later:
- If hrHPV -ve at 24 months → return to normal recall
- if hrHPV +ve at 24 months → colposcopy
65
treatment of bartholians cyst
if small and asymptomatic - no treatment
if treatment:
- word catheter
- marsupialisation
66
Ix of PCOS
transvag USS
- string of pearls appearance
67
treatment of PCOS
lose weight
1) COCP
2) topical eflronithine (slows hair growth)
68
what is premature ovarian insufficency
menopause before 40
hypergonadotrophic hypogonadism
69
diagnosis of premature ovarian insufficiency
women younger than 40 with symptoms and elevated FSH
-FSH levels need to be persistently raised on two occasions spearated by 4 weeks
70
define pre-eclampsia
new-onset blood pressure ≥ 140/90 mmHg after 20 weeks of pregnancy, AND 1 or more of the following:
proteinuria
other organ involvement e.g. renal insufficiency, liver, neurological, haematological, uteroplacental dysfunction
71
who should take aspririn for prevention of pre-eclampsia and when
women with the following should take aspirin 75-150mg daily from 12 weeks gestation until the birth
≥ 1 high risk factors
≥ 2 moderate factors
72
pregnant women with BP ≥ 160/110 mmHg
admit and observe
73
what should you do if you suspect pre-eclampsia
admit to secondary care for assessment
74
medical management of pre-eclampsia
oral labetalol
nifedipine if asthmatic
75
management of eclampsia
IV labetalol, IV hydralazine
IV magnesium sulphate
- calcium gluconate if this causes resp depression
treatment should be continued to 24 hours after last seizure or delivery
| monitor urine output, sats, reflexes and RR
76
what does oxytocin do
triggers uterine contractions and breat milk production
77
Mx of shoulder dystocia
H- call for Help
Evaluate for episiotomy
Legs - McRoberts maneouver
P- suprapubic pressure
E- enter - roational maneouvers
R- roll patient onto her hands and knees
78
Mx of mastitis
keep breast feeding
warm compress and NSAIDs
-fluclox if not improving
-clindamycin is penicillin allergic
79
symptoms of placental abruption
-abdo pain
-bleeding
-woody hard uterus
-uterus contracts hardens and rises
80
antiphospholipid syndrome in pregnancy
LMWH
81
Rupture of membranes followed immediately by vaginal bleeding.
vasa praevia
82
what's urge incontinence/OAB
due to detrusor overactivity
the urge to urinate is quickly followed by uncontrollable leakage ranging from a few drops to complete bladder emptying
83
what is stress incontince
peeing when laughing or coughing
84
overflow incontinece
bladder outlet obstruction
85
management of urge incontinence
-bladder retraining
-antimuscarinics: oxybutynin (immediate release), tolterodine (immediate release) or darifenacin (once daily preparation)
-frail old women: mirabegron
-desmopressin if nocturia
last line: botox
86
management of stress incontinence
pelvic floor training
surgery or duloxetine
87
management if fasting glucose < 7
trial of diet and exercise
-if not met within 1-2 weeks then metformin
-if still not met then insulin - short acting
88
fasting glucose over 7
insulin +/- metformin
89
Mx of cord prolapse
* Presenting part of foetus may be pushed back into the uterus to avoid compression
* If the cord is visible - minimal handling and keep it warm and moist to avoid vasospasm
* Patient goes on all fours until c section
* C section is first line delivery method
* Tocolytics may be used to reduce uterine contractions
Retrofilling the bladder with saline may be helpful
90
genotype of androgen insensitivity syndrome
46 XY
91
presentation of androgen insensitivity syndrome
genotypically male children have female phenotype
- testes in abdomen
- absence of uterus, upper vagina, cervis
raised LH
92
which medication for cord prolapse to reduce uterine contractions
terbutaline
- tocolytics
93
absolute contraindication for injectable contraception (progesterone)
current or previous breast cancer
94
when do post partum women require contraception
21 days after pregnancy
95
management of infertility in PCOS
clomifene
96
which placental abnormality in IVF
placenta praevia
97
is metformin safe in breastfeeding
yes
98
adverse effects of implant
irregular/heavy bleeding
progestogen effects - headaches, nausea, breast pain
99
what contraception if breastfeeding and < 6 weeks
POP
- POP can be given at any time post partum
100
when can women take COCP post partum
after 6 weeks breastfeeding - 6 months post partum
should not be used in first 21 days as can increase risk of VTE
101
when can an IUS or IUD be inserted after childbirth
either within 48 hours or after 4 weeks
102
bishop score < 6, management
vaginal prostaglandins or oral misoprostol
103
bishop score > 6 management
amniotomy and an IV oxytocin infusion
104
hyperemesis diagnostic criteria
- 5% pre-pregnancy weight loss
- dehydration
- electrolyte imbalance
105
if a pregnant women is exposed to chicken pox, management?
1) check for varicella antibodies
2) oral aciclovir given day 7 to day 14 after exposure (not immediately) as PEP
106
management of chickenpox in pregnanct
oral aciclovir if:
- women >=20 weeks
- presents within 24 hours
if under 20 weeks then should be considered with caution
107
when should progesterone levels be checked to confirm ovulation
7 days prior to expected period
108
pre menopausal women hormonal breast cancer Mx
tamoxifen
TAMoXifen
= TAMpaX
109
what drugs for post menopausal women breast cancer
anastrazole
A = Ancient
110
what medication for stopping lactation, when a women has stopped breast feeding
| and the MoA
cabergoline
- dopamine receptor agonist
111
when do pregnant women need to avoid air travel
over 32 weeks if multiple pregnancy
over 37 weeks if singleton pregnancy
112
COCP and relation to cancer
increased risk of breast and cervical cancer
protective against ovarian and endometrial cancer
113
cervical smear inadequate?
repeat in 3 months
- if two consecutive inadequate samples then colposcopy
114
pregnant women with BMI > 30, when are they tested for diabetes and how
OGTT at 24-28 weeks
115
what are the stages of ovarian cancer
stage 1 - confined to ovary
stage 2 - outside ovary but within pelvis
stage 3 - tumour outside pelvis but within abdomen
stage 4 - distant metastasis
116
quadruple test results for down's syndrome
↓ AFP
↓ oestriol
↑ hCG
↑ inhibin A
| if it has a h its high
117
what are the hepatic enzyme inducing drugs
CRAP GP
Carbamazepine
Rifampicins
Alcohol - chronic consumption
Phenytoin
Griseofulvin
Phenobarbitone
Sulfonylureas
118
which contracpetives do hepatic enzyme induce decrease the efficacy of
COCP and POP
119
so which contraceptives can women take when taking a hepatic enzyme inducer
depo
copper IUD
IUS
120
Mx of HELLP
urgent delivery
magnesium sulphate if assoc eclampisa
121
HRT for peri menopausal and post menopausal
peri - cyclical combined
post - continuous combined
122
ciprofloxacin in pregnancy?
No
123
presentation of chorioamnionitisis
- tachycardia
- suprapubic tenderness
- purlulent vaginal discharge
after a PPROM
124
