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year 3 > Repro > Flashcards

Repro Flashcards

1
Q

Mx for ovulation supression

A

1st line: yasmine and eloine COC
-GnRH agonists
- Danazol (gnrh inhibitor)
-Oestrogen
- bilateral oopherectomy and hysterectomy with add back oestrogen only

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2
Q

Cervical shock tx

A

Removing product from cervix

(Sometimes IV and uterotonics required)
(complication of miscarriage)

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3
Q

Threatened miscarriage tx

A

Micronised progesterone
(to try and prevent a true miscarriage)

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4
Q

Molar pregnancy management
how long must pregnancy be avoided afterwards

A

Surgical-(uterine evacuation) and tissues sent for histology to ascertain type

pregnancy should be avoided for 1 year after

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5
Q

Bacterial vaginosis tx
(and avoid…)

A

Metronidazole oral/gel

Avoid alcohol

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6
Q

Chlamydia
and If pregnant

A

doxycycline is first line

if pregnant: azithromycin/erythromycin/ amoxicillin

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7
Q

Hyperemesis gravidarum management

A

saline + potassim chloride (fluid replacement)
IV or IM antiemetics
thiamine + folic acid
TED stocking and LMWH

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8
Q

what anti-emetics are used for nausea and vomiting in pregnancy (& for hyperemesis gravidarum)

and their side effects

A

first line: antihistamines- oraal cylizine or promethazine-
end in zine

2nd: oral ondansetron (SE 1st trim, cleft palate)
oral metoclopramide or domperidone:
(meto SE- extrapyramidal, do not use for longer than 5 days)

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9
Q

Lifestyle advice for infertility

A

Stop smoking (and don’t replace with other nicotine products)
Bmi 18.5-30
Reduce/stop alcohol
Moderate caffeine
Stop recreation drugs/methadone for at least 12 months
Folic acid

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10
Q

Pcos infertility tx

A

1st line: clomifene citrate / tamoxifen +/- metformin
Alternatively lenotraxin +/- metformin

2nd: gonadotrophin injections (risks multiple pregnancy, overstimulation)
Needs supervision

3rd : laproscopic ovarian diathermy

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11
Q

Clomifene resistence

A

Add metformin

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12
Q

Male infertility treatment

A

Ivf
…

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13
Q

Blocked fallopian thbes tx

A

IVF

Sometimes if it is a very small blockage u can cannulate and open it

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14
Q

Pregnancy of unkown location

A

Expectant management (will resolve itself)
Medical- methotrexate

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15
Q

How long should a women wait to conceive after methotrexate management

A

6 months

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16
Q

Ruptured cyst

A

premenopausal: conservative unless hypovolaemic shock

postmenopausal: laparoscopy

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17
Q

Pelvic inflammatory disease management

A

oral ofloxacin + oral metronidazole
or
IM ceftriaxone + oral doxy + oral metronidazole

Advice she use barrier contraception as IUD removal should be considered

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18
Q

Bartholins abscess/cyst

A

Conservative if small cyst

Antibiotics broad spectrum- if infected and systemically unwell

usually treated with:
-Word catheter
-Marsupialization

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19
Q

TOP missed miscarriage medical tx

A

Mifepristone orally + bucall/sublingual/ vaginal misoprostol 24-48 hrs later

all women should be offered antiemetic and pain relief
Dose/frequency dependant on gestation

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20
Q

incomplete miscarriage medical tx

A

single dose of misoprostol (vaginal, oral or sublingual)

all women should be offered anti-emetics and pain relief

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21
Q

choosing type of TOP (termination of pregnancy)

A

medical or surgical offered up to and including 23+6 weeks

after 9 weeks medical abortions become less common (as inc risk of seeing products of conception pass and dec success rate)

<10 weeks medical abortions usually done at home

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22
Q

What is screening must all women undergo for TOP

A

STI screening,
VTE risk screening- if high risk give LMWH after abortion. if v high risk give before +/- continue

Contraception consultation and offered contraception

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23
Q

who receives antibiotic prophylaxis at time of abortion and regimen

A

those undergoing surgical TOP (STOP)

those undergoing MTOP with an increased risk of STI (if screening not performed/results unavailable)

regimen= 7 days doxcy

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24
Q

rhesus isoimmunisation who to treat at time of abortion

A

if rhesus d negative and at risk, higher gestation and surgical procedure increases risk

anti D is the tx

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25
Q

Diagnosing gonnococcal urethritis on microscopy

A

Gram negative intracellular diplococci- gonnococcal urethritis (gonnorhea)

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26
Q

Primary genital hsv tx
When to admit

A

Aciclovir tx 400mg 3x a day 5 days
+ supportive tx

Admit if urinary retention/ cant swallow

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27
Q

Syphillis tx

A

Benzathene penicillin

No sex
…

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28
Q

Lichen schlerosus tx

A

1- genital skin care: gentle wash (dermovate(, avoid tight clothing, irritabts etc
- apply emollient

2- super potent topical steroid- 12 week regimen (30g tube) then on an as required basis

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29
Q

When would a cystectomy be carried out

A

If cyst is >5cm
(As there is risk of torsion)

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30
Q

PMS tx mild

A

regular frequent balanced meals rich in complex carbohydrates

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31
Q

pms moderate symptoms

A

COCP

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32
Q

severe PMS tx

A

SSRI- continuously or just during the luteal phase

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33
Q

mx of gestational diabetes: fasting glucose >5.6 & <7

A

1st: trial of diet and exercise,
2nd: if targets not met within 1-2 weeks + metformin
3rd: ADD (not switch) short acting insulin if targets not met after a further 1-2 weeks

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34
Q

what are the blood glucose targets for women with gestational diabetes

A

fasting: </= 5.3mmol
1hr postprandial 7.8 mmol/L or
2 hours postprandial: 6.4 mmol/L

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35
Q

gestational diabetes tx: >7mmol

A

1st; start insulin immediately

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36
Q

Atypical endometrial hyperplasia tx

A

hysterectomy - if post menopausal then bilateral salphingo-oopherectomy adivsed as well

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37
Q

simple endometrial hyperplasia- w/o atypia tx

A

high dose progestogens with repeat sampling in 3-4 months. The levonorgestrel intra-uterine system may be advised

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38
Q

neiserria gonorrhoeae 1: what agar, type of bacteria

A

requires chocolate agar to grow

gram negative diplococci

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39
Q

neisseria gonorrhoeae II antibiotic tx

A

Ceftriaxone
NOT ciprofloxacin unless sensitivity known
Azithromycin

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40
Q

chlamydia trachomatis II tx

A

doxcy or azithromycin

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41
Q

women with vulva-vaginal atrophy (from menopause) tx

A

vaginal oestrogen.
can be used in combination with HRT or be the alternative to HRT for women who it is contraindicated in

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42
Q

women with premature ovarian insufficiency tx (<40)

A
  • give HRT till the average age of menopause (51)
  • CHC (continuously) could be considered as alternative unless CI
  • HRT does not add risks compared to women without POI
  • continue with contraception
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43
Q

Women with early menopause (40- 44):

A
  • consider strongly giving HRT till the average age of menopause (51)
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44
Q

when can contraception be stopped in women aged 40-49

A

-2 years after last “natural” menstrual period or
- 2 years after 2 results of FSH of ≥ 30 IU/l, taken at least 4-6 weeks apart

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45
Q

when can contraception be stopped in women >/=50

A

-1 year after last “natural” menstrual period or
-1 year after 1 result of FSH of ≥ 30 IU/l

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46
Q

when can contraception be stopped >/=55

A

Age ≥ 55: contraception can be stopped even if still having periods

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47
Q

when would you give transdermal HRT over oral HRT

A

increased VTE risk or BMI >30

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48
Q

management of menorrhagia secondary to fibroids
(1st, second and third line)

A

1: levonorgestrel intrauterine system (LNG-IUS) (mirena coil)
- useful if the woman also requires contraception
- cannot be used if there is distortion of the uterine cavity

2nd: NSAIDs e.g. mefenamic acid

3rd: tranexamic acid

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49
Q

surgical management of ectopic pregnancy

A

salpingectomy

2nd: salpingotomy (rf for infertility eg contralateral tube damage)

50
Q

hirsutism and acne in PCOS tx

A

1st: third generation COC / co-cyprindol

2nd: topical elfornithine

51
Q

Pregnant women with epilepsy: principles of management

A

pregnant women should continue anti-epileptics
Folic acid, 5mg daily

avoid valproate,
if taking phenytoin + vit k
carbamezapine considered least teratogenic

52
Q

Hypertension tx for pregnant women
(and what to avoid)

A

1st line: labetolol
2nd: methyldopa/nifedpine

Avoid ace/arb
Beta blockers MAY inhibit foetal growth

If >160/110bp then ADMIT and OBSERVE

(Bp falls during 2nd trimester)

53
Q

Nausea and vomiting preganant women tx
(first line only)

A

Cyclizine first line

54
Q

UTI pregnant women tx

A

1st line: nitrofurantoin
2nd: amox/ cefelaxin

55
Q

1st line treatment for pain in pregnant women

A

paracetomol

56
Q

What are the criteria that have to be met for prophylaxis for DVT in pregnancy

when is prophylaxis and what is the treatment

A

2 or more risk factors:
obesity, age >35yrs, smoking, para>3

prophylaxis tx: LMWH at delivery and up to 7 days post partum

57
Q

Tx of venous thromboembolism in pregnancy
and what to avoid

A

therapeutic dose of low molecular weight heparin

avoid warfarin (teratogenic early, risk of haemorraghe late)

58
Q

Who gets pre eclampsia prophylaxis and what is the treatement

A

75-100mg aspirin daily

Women with one high risk or 2 moderate risk factors (eg. Over 40)

59
Q

active management of third stage of labour

A

prophylactic administration of syntometerine

1ml ampoule: 500micrograms ergometrine maleate & 5IU oxytocin

cord claming and cutting
controlled cord traction
bladder emptying

60
Q

plan for delivery placenta praevia

A

C/section : If placenta covers os or <2cm from cervical os
Vaginal delivery if placenta>2cm from os and no malpresentation

61
Q

antepartum haemorraghe tx

A

Kleihauer test (check if there has been blood transfusion)( only if rhesus negative), if test is += Anti-D & Steroids

give corticosteroids if risk of preterm birth and <34 weeks

rescus if necessary,
admit for obs etc

Antepartum haemorrhage= bleeding from the genital tract >24 weeks pregnancy, prior to delivery of the fetus

62
Q

antibiotic management of suspected sepsis
and if penicillin allergic pregnant woman

A

IV co-amoxiclav within “golden hour” +/- gentamicin depending on severity and clindamycin if sore throat (GAS)

Clindamycin + gent if penicillin allergic

63
Q

antibiotic management of septic shock in pregnant woman

A

Tazocin , clindamycin + gentamicin

64
Q

GBS risk (previous baby infected with GBS)/detected in pregnancy management; management

A

antibiotic prophylaxis

1st: Benzylpenicillin

2: Clindamycin

65
Q

post partum endometritis tx (not penillin allergic)

A

Treatment with co-amoxiclav +/- surgical evacuation of uterus if significant RPOC (retained products of pregnancy)

66
Q

post partum endometritis tx if penicillin alergic

A

Co-trimoxazole +metronidazole

+/- surgical evacuation of uterus if sig.fig. RPOC

67
Q

epidural abscess tx

A

Vancomycin, metronidazole and cefotaxime +/- surgical decompression (if no response or neurological concerns)
drain abscess

68
Q

placental abruption tx

A

Fetus alive and < 36 weeks
fetal distress: immediate caesarean
no fetal distress: observe closely, steroids, no tocolysis, threshold to deliver depends on gestation

Fetus alive and > 36 weeks
fetal distress: immediate caesarean
no fetal distress: deliver vaginally

69
Q

1st line tx for magnesium sulfate induced respiratory depression

A

calcium gluconate

70
Q

varicella zoster virus management

A

oral aciclovir 7 days after exposure for 7 days

if <20 weeks aciclovir should be considered with caution

71
Q

treatment for Persistent Pulmonary Hypertension of the newborn

A

Ventilation, O2, nitric oxide, sedation inotropes

if above fails: ECLS machine (mechanical lung)

72
Q

ectopic pregnancy:
criteria for expectant management

A

size <35mm
hcg <1000IUL
asymptomatic

73
Q

ectopic pregnancy:
criteria for medical management

A

size<35mm
hcg <1500IUL
no significant pain

not suitable if there is another intrauterine pregnancy

74
Q

ectopic pregnancy:
surgical management criteria

A

if its ruptured or
size >35mm/
pain/
foetal heartbeat/
hcg>5,000IUL

75
Q

post partum haemorraghe tx (overview)

A

1st: ABCE and IV warmed crystalloid
2nd: (mechanical) rub uterine fundus and catheterise
3rd:medical uterotonics etc
4th line: intrauterine tamponade

76
Q

post partum haemorrhage- medical management

A

IV oxytocin
ergomotine IV
carboprost IM
misoprotol subingual

77
Q

fibrocystic change management

A

exclude malignancy
reassure
excise if necessary (unusual)

78
Q

fibroadenoma mx

A

if greater than 3xm excise

79
Q

radial scar tx

A

excise or vacuum biopsy

80
Q

duct ectasia management

A

stop smoking
excise ducts- michrodochectomy if young or total duct excision if older

(Duct ectasia is a dilatation and shortening of the terminal breast ducts within 3cm of the nipple. It is common and the incidence increases with age. It typically presents with nipple retraction and occasionally creamy nipple discharge. )

81
Q

1st line tx for uterine fibroids

A

<3cm- IUS for menorrhagia and gnRH analogues to reduce size
>3cm- surgical management eg myomectomy

82
Q

thrush tx (and contraindication) (candidias)
(4)

A

1st line: oral fluconazole single dose
2nd: clotrimazole intravaginal single dose if oral contraindicated
if vulval symptoms too- topical imidazole + oral/intravaginal antifungal

if pregnant oral tx contraindicated

83
Q

how long should magnesium sulfate be continued for seizure pregnancy

A

24 hours after delivery or last seizure- whichever is later

84
Q

intrahepatic cholestasis of pregnancy management

A

ursodeoxycholic acid

INDUCTION OF LABOUR AT 37-38 WEEKS ( as inc risk of still birth)

vit k supplementation

85
Q

Preterm prelabour rupture of the membranes

A

(preterm- before 37 weeks)

oral erythromycin should be given for 10 days

antenatal corticosteroids should be administered to reduce the risk of respiratory distress syndrome

delivery should be considered at 34 weeks of gestation - there is a trade-off between an increased risk of maternal chorioamnionitis with a decreased risk of respiratory distress syndrome as the pregnancy progresses

86
Q

current breast cancer is a contrindication for which contraceptives

A

all hormonal contraceptives

87
Q

rhesus negative woneb- when should she recieve anti D

A

at 28 weeks and 2nd dose at 34 weeks

88
Q

Treatment to shrink/remove fibroids

A

medical- gnrh agonists

surgical- myomectomy, hysteroscopic endo ablation, hysterectomy
uterine atery embolisation

89
Q

what advice should be given, regarding folate supplementation, to women hoping to concieve

A

Women should be encouraged to take folic acid 400mcg OD 3 months before conception up to 12 weeks gestation

90
Q

stress incontinence tx (3 lines of management)

A

1st: pelvic floor muscle training

2nd: surg procedures

3rd: duloxetine

91
Q

urge incontinence tx
include if frail/elderly

A
  1. bladder retraining
    antimuscarinics: oxybutnin
    mirabegron- if frail/elderly
92
Q

non HRT menapause vasomotor symptoms tx

A

SSRIs
fluoxetine/citalopram or venlafaxine (SNRI)

93
Q

mode of delivery, labour in women with HIV

A

vaginal delivery is recommended if viral load is less than 50 copies/ml at 36 weeks, otherwise caesarian section is recommended
a zidovudine infusion should be started four hours before beginning the caesarean section

94
Q

neonatal antiretroviral therapy

A

zidovudine orally to the neonate if maternal viral load is <50 copies/ml.

Otherwise triple ART for 4-6 weeks.

95
Q

what are the haemoglobin cut offs for tx- non preg, early preg, late preg, after childbirth

A

115 for non-pregnant women, 110 in early pregnancy, 105 in later pregnancy, and 100 after childbirth

96
Q

when can COC be given after labour

A

never before day 21 post partum due to risk of vte

if breast feeding: 6 weeks - 6 months postpartum

if inc risk of VTE then not in the first 6 weeks

97
Q

what contraception can be given immedietely after labour

A
  • progesterone only pill
  • implant
  • injection
  • condoms
98
Q

when can IUD/IUS be given post partum

A

within 48 hours after labour
or
4 weeks later

99
Q

what type of drug is cabergoline

A

long acting dopamine agonist

100
Q

ucfetal transverse lie management

A

<36 weeks- no management

> 36 weeks- external cephalic version of foetus- offered in all cases of vag delivery
or
elective caesarean

cant do ECV if membranes have ruptured

101
Q

when is induction of labour offered to women with intrahepatic cholestasis

A

37-38 weeks

102
Q

when do postpartum women require contraceptives

A

not required before day 21 postpartym. earliest date of ovulation is day 28

103
Q

when must levonogestrel be taken regarding emergency contraception

A

within 72 hours of unprotected sexual intercourse

104
Q

emergency contraception: ulipristal (progesterone receptor modulator)- when can it be taken

A

no later than 120 hours after intercourse (5 days)
*caution with those with severe asthma

105
Q

if bishop score is 6 management

A

vaginal prostoglandins/ oral misprostol

balloon catheter if higher risk of hyperstimulation/previous caesarean

106
Q

if bishop score is greater than 6 management

A

amniotomy and IV oxytocin infusion

107
Q

> 37 weeks women with pre-eclampsia + mild/moderate hypertension tx

A

delivery within 24-48 hours

consider magnesium sulphate if birth is planned within 24 hours or if there is a concern that the woman may develop eclampsia

108
Q

primary dysmenorrhoea tx

A

(painful periods)

1st line: NSAIDs eg mefenamic acid/ibuprofen.

2nd line:COCP

109
Q

Pregnant women uti tx

A

1st line: niturofurantoin
2nd- amox or cefalexin

7 day course!!! (3 in non pregnant)

110
Q

perineal tears tx

A

1st degree- no repair required

2nd degree- suture on ward by midwife or clinician

3rd: repair in theatre by clinicial

4th: same^

111
Q

what is the only fibroid treatment which maintains fertility

A

myomectomy

112
Q

what ovarian cysts, found on imaging, require referral to gynaecology (5)

A

-irregular solid tumour
-ascites
-at least 4 papillary structures
- irregular multilocular sold tumour growth with largest diameter >/= 100mm
- very strong blood flow

113
Q

which medication can be used to supress lacation

A

cabergoline- dopamine agonist

114
Q

what is category 1 caesarean

A

caesarean for mother where there is an immediate threat to the life of the mother or baby

delvery wtihin 30 mins of making decision

115
Q

what is category 2 caesarean

A

maternal or fetal compromise which is not immediately life-threatening
delivery of the baby should occur within 75 minutes of making the decision

116
Q

prophylaxis for anti -D, who gets it and when

A

all women who are rhesus negative whether sensitised or not get anti- d prophylaxis at
-28 weeks
&
-34 weeks

117
Q

endometriosis tx

A

first line: NSAIDs and/or paracetamol
second: COCP or POP
3rd: GnRH analogues

(^all symptomatic relief)

118
Q

endometriosis: tx for women trying to concieve

A

laparoscopic excision or ablation of endometriosis plus adhesiolysis as this has been shown to improve the chances of conception. Ovarian cystectomy (for endometriomas) is also recommended

119
Q

cord prolapse tx

A
  • presenting part of fetus may be pushed back into uterus to avoid compression
  • if cord is past level of intoitus- minimal handling, keep warm and moist- to prevent vasospasm
    -get patient to go on all fours
    -tocolytics (reduce contractinos)
    -retrofill bladder

cesarean- unless cervix fully filated and head is low- instrumental delivery.

120
Q

surgical abortion management

A

(under anaesthesia)

misoprostol/osmotic dilators given before

up to 13+6 weeks:
-Electric vacuum aspiration
-Manual vacuum aspiration

> 14wks
-Dilatation and evacuation

year 3 (5 decks)

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