Passmed obs and gynae Flashcards by Yorck Newrick

What does cyclical mastalgia vary with?

Phases of the menstrual cycle - tends to be worse 1-2 weeks before menstruation

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What is blood stained discharge most associated with?

Papilloma

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What are the main risks of axillary node clearance?

Lymphoedema and functional arm impairment

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What is used in the management of ER positive breast cancer patients in pre and peri menopausal women?

Tamoxifen (selective oestrogen receptor modulator)

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What is a histological feature of carcinoma-in-situ?

Comedo necrosis

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What is used in post-menopausal ER positive breast cancer patients?

Aromatase inhibitors - anastrozole

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When does perimenopausal change to post-menopausal?

12 months after last period

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What is indicated in breast cancer patients with palpable axillary lymphadenopathy?

Axillary node clearance indicated at primary surgery

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How do aromatase inhibitors work?

Inhibition of peripheral oestrogen synthesis

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When are breast fibroadenomas indicated for excision?

If >3cm

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How is lactational mastitis treated in breastfeeding women?

Continue breastfeeding - if effective milk removal hasn’t improved symptoms in 12-24h then 10 days flucloxacillin

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What is the pathway for a woman who is 28 and has a breast lump?

Non-urgent referral - woman under 30y with painful/painless breast lump

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What is the chance of a woman who is BRCA1/2 positive to pass it on to her children?

50% - as they’re almost always heterozygous and is autosomal dominant

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What is the main complication of aromatase inhibitors?

Osteoporosis and osteoporotic fractures

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What is recommended in women after wide local excision?

Whole breast radiotherapy

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What is green and brown nipple discharge associated with?

Duct ectasia

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What is a very loose rule for wide local excision vs mastectomy?

Tumour size more than 4cm - very loose rule

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Describe the pathway when a woman with breast cancer with no palpable axillary lymphadenopathy.

Ultrasound
If negative then sentinel node biopsy is indicated

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What is a snowstorm sign indicative of on breast ultrasound?

Implant rupture

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Who is periductal mastitis more common in and how does it present? Treatment?

Smokers - presents with recurrent infections
Tx- co-amoxiclav

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What is Mondor’s disease?

Localised thrombophlebitis of a breast vein

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Which type of chemotherapy is used in breast cancer patients who are node positive?

FEC-D chemotherapy1

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What is neo-adjuvant chemotherapy used for in breast cancer?

To downsize primary tumour so breast conserving surgery can be used rather than a mastectomy
(reducing perioperative risks and cosmetically favoured)

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How does a breast abscess typically present?

Breastfeeding women presenting with very painful, red swelling above areola

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What is fibroadenosis?

'Lumpy' breasts in middle aged women Symptoms may worsen prior to menstruation

What is fat necrosis of the breast?

Benign lump of degeneration and scarring of adipose tissue Usually trauma causes it Can mimic breast cancer

What is given to rhesus negative pregnant women?

Anti-D at 28 and 34 weeks

What is the first step when you're exposed to chickenpox in pregnancy?

Test for VZV antibodies

What is the most common cause of postpartum haemorrhage?

Uterine atony - inadequate uterine contractions (effective contractions required for haemostasis)

Which food do pregnant women need to avoid eating and why?

Liver - contains high level of vitamin A which may cause birth defects

What are the choice of SSRIs in breastfeeding?

Sertraline or paroxetine

What is the management of a pregnant woman with a blood pressure over 160/110?

Arrange obstetric assessment in hospital

Explain blood pressure medications during pregnancy?

If on ACEi or ARBs for pre-existing hypertension - stopped and offered labetalol or nifedipine. (Nifedipine if asthmatic)

What is the correct positioning for women with cord prolapse?

On all fours - knees and elbows

When is the screen for gestational diabetes done and how?

OGTT - 24 to 28 weeks

When should a referral be made to maternal unit when no maternal movement is felt?

By 24 weeks

What Bishop score indicates a cervix is ripe?

Above 8 - high chance of spontaneous labour/response to interventions that will induce labour

What is the normal fetal heart rate?

110/120 - 160

Describe the categories of C-sections

1 - immediate threat to life of baby or mother 2 - maternal/fetal compromise not immediately life threatening 3 - stable mother and baby but c-section required 4 - elective c section

Management if baby loses more than 10% of birth weight in the first week?

Refer to midwife-led breastfeeding clinc

What is given to mothers at risk of pre-eclampsia?

Low dose aspirin to be prescribed from week 12 to birth

What are the medical treatment for PPH secondary to uterine atony?

Oxytocin, ergometrine, carboprost, misoprostol

Management for baby blues?

Reassure, support and follow up

What is the medication of choice to suppress lactation and why is it done?

Cabergoline - dopamine agonists - suppresses prolactin and thus lactation Lactation is suppressed as this may be uncomfortable for the mother and mastitis/breast abscess may occur

Mnemonic for medications to cease in pregnancies?

LAMBAST CCC Lithium Amiodarone Methotrexate Benzodiazepines Aspirin Sulphonamide Tetracyclines carbimazole, ciprofloxacin, chloramphenicol

How is postpartum thyroiditis managed?

Propranolol - no thyroid medications used

Mnemonic for placental abruption risk factors?

ABRUPTION Abruption previously Blood pressure (htn, pre-ecl) Ruptured membranes Uterine injury Polyhydramnios Twins/multiple gestation Infection of uterus Older age Narcotic use

Results of trisomy disorders in quadruple testing?

Similar between trisomy 13, 18 and 21 hCG is lower in Edward's and Patau but raised in Down's

What is the symphysis-fundal height and how big should it be?

Top of pubic bone to top of uterus Should match gestational age in weeks to within 2 cm etc 24cm (22-26)

Describe the management of gestational diabetes?

FPG <7 diet/exercise, 2w no improvement - metformin FPG >7 insulin

How does intrahepatic cholestasis affect childbirth?

Plan to induce labour at 37 weeks as it increases the chance of stillbirth

MMR and pregnancy?

Avoid during pregnancy and before attempting to get pregnant. Wait for 28d after MMR

Most important investigation for first trimester bleeding?

Transvaginal ultrasound

What is placenta accreta?

Attachment of placenta to the myometrium due to a defective decidua basalis - doesn't properly separate during labour - increased risk of PPH

How does chorioamnionitis present?

Maternal pyrexia, maternal tachycardia and fetal tachycardia

Which dose of folic acid should obese women have?

High dose - 5mg

What are the indications for higher dose folic acid?

MORE: Metabolic - t1dm, coeliacs Obesity - >30 bmi Relative (PMHx) Epileptic medications (and haem conditions)

What delivery method should be recommended for grade III/IV placenta praevia?

Elective C section at 37-38 weeks

What is the tern used to describe the position of the head in relation to the ischial spine?

Station

What is a main contraindication for epidural anaethesia during labour?

Coagulopathy

Can you breastfeed while on amiodarone?

What is the main complication of labour induction?

Uterine hyperstimulation - high contraction frequency and duration

What is the most common ovarian cancer?

Serous carcinoma

What is the most common cause of postcoital bleeding?

Cervical ectropion

What is a potential side effect of ovulation induction?

Ovarian hyperstimulation syndrome - GI symptoms

What is the drug of choice for medical management of ectopic pregnancy?

Methotrexate

What else should be offered to women having medical management of ectopic pregnancy?

Antiemetics and analgesia

What is a common cause of secondary amenorrhoea in athletes?

Hypothalamic hypogonadism - low levels of fat means less GnRH - hypogonadism

What is used first line for hyperemesis gravidarum?

Antiemetics - antihistamines (promethazine/cyclizine)

What is given to women in hospital with hyperemesis gravidarum?

IV saline 0.9% with potassium

What management is needed for ectopic pregnancy if there's abdominal pain?

Surgical management

What are the medical abortion tablets?

Mifepristone then prostaglandins (misoprostol)

What is the first line management for menorrhagia?

Mirena coil (intrauterine system)

When isn't expectant management suitable in a miscarriage?

Evidence of infection or increased bleeding risk

What are the classic symptoms of endometriosis?

Pelvic pain, dysmenorrhoea, dyspareunia and subfertility

How long will a urine pregnancy test remain positive after termination?

Up to 4 weeks

What is the most common cause of postmenopausal bleeding?

Vaginal atrophy

When is contraception needed after menopause?

>50 is 12 months after last period <50 is 24 months after last period

What needs to be ruled out in women with recurrent vaginal candidiasis?

Diabetes - Hba1c

How does pelvic inflammatory disease cause RUQ pain?

Causes perihepatitis (Fitz-Hugh Curtis syndrome)

What is the gold standard investigation for endometriosis?

Laparoscopy

What is the risk malignancy index (RMI) based on in ovarian cancer?

CA-125 levels, US findings and menopausal status

What does whirlpool sign on imaging suggest?

Ovarian torsion

What should be tried if NSAIDs/paracetamol doesn't help endometriosis?

COCP or POP

What is the first line treatment for urinary incontinence?

Urge - bladder retraining Stress - pelvic floor muscle training

What is stress incontinence?

Incontinence when laughing or coughing

What is the treatment for vaginal vault prolapse?

Sacrocolpoplexy

What is used in stress incontinence when pelvic floor muscle exercises don't work?

Duloxetine

What is the first line treatment for primary dysmenorrhoea?

NSAIDs such as mefenamic acid

What is the investigation of choice for ectopic pregnancy?`

Transvaginal ultrasound

What is contraindicated in medical management of ectopic pregnancy and indicates for surgical management?

Presence of foetal heartbeat

What is the medical management of an incomplete miscarriage?

Only vaginal misorpostol

What is the hyperemesis gravidarum diagnostic triad?

5% pre-pregnancy weight loss dehydration electrolyte imbalance

When you add progesterone to HRT which cancer does it increase the risk of?

Breast

What is required to classify miscarriages?

Fetal heartbeat, cervical os open/closed, size of uterus

How does an imperforate hymen present?

Cyclical pain without menstrual bleeding

How does adenomyosis present?

>30, dysmenorrhoea, menorrhagia, enlarged and boggy uterus

What is the first line treatment for menorrhagia?

Insertion of IUS

What is the most common cause of pelvic inflammatory disease?

Chlamydia

What is the first line management in an older woman with new onset non-specific abdo pain/bloating?

Measure CA-125 levels

What is the next step for cervical screening after two repeat inadequate samples?

Colposcopy

Which medication is used to shrink uterine fibroids and what is their side effect?

GnRH agonists and loss of bone mineral density

How does fibroid degeneration present in pregnancy?

Low grade fever, pain and vomiting

Is ondansetron safe in pregnancy?

Associated with a small increased risk of cleft palate/lip if used in first trimester

What is the most appropriate investigation to diagnose premature ovarian failure?

FSH level

How do you properly diagnose primary ovarian insufficiency?

Not based off one FSH -If normal, repeat FSH at 4-6 weeks

When are ectopic pregnancies managed surgically?

bHCG over 5000 More than 35mm in size

Which HRT option doesn't appear to increase the risk of VTE?

Transdermal HRT

What are the typical blood results for PCOS?

Raised LH:FSH level Normal/raised testosterone SHBG is normal/low

What is the first investigation in patients with urinary incontinence?

Urinalysis

If a sperm sample is abnormal, when should the test be repeated?

In 3 months

How does complete hydatidiform mole present?

Uterus size greater than expected for gestational age and abnormally high bHCG

What is endometrial hyperplasia caused by?

Oestrogen unopposed by progesterone

What is the definition of premature ovarian failure?

Onset of menopausal symptoms and elevated gonadotrophin levels before the age of 40

Passmed obs and gynae Flashcards

(115 cards)