Reproductive Health Flashcards
(98 cards)
1
Q
Menorrhagia Differentials
A
2
Q
Dysmenorrhea Differentials
A
3
Q
Dyspareunia Differentials
A
4
Q
Abnormal Vaginal Bleeding Differentials
A
5
Q
Irregular Periods Differentials
A
6
Q
Vaginal Discharge Differentials
A
7
Q
At what intervals after exposure should testing be repeated?
A
Chlamydia and gonorrhoea tests:
2 weeks
HIV tests:
4-8 weeks
Syphilis and Hepatitis B tests:
12 weeks
8
Q
What vaccines should MSM have?
A
Hep A
Hep B
HPV
9
Q
What infections should you test for when someone attends GUM Clinic?
A
Chlamydia (NAAT first catch)
Gonorrhoea (NAAT first catch)
Syphilis (TP-EIA)
Hep B/C (Blood)
HIV (P24 4th gen test and HIV Antibodies blood test)
10
Q
Why is it relevant at what time a pregnant women gets infected with HSV?
A
Earlier:
Maternal antibodies grown
Only C section if ulcer at delivery
Last trimester:
Baby born w/out maternal antibodies
Disseminated HSV in neonates
High rates of morbidity
11
Q
What are the 6 C’s of sexual health history taking?
A
Contraception?
Cycle - last period?
Children - obstetric/gynae hx?
Cytology - smear?
Chlamydia - STI risk assessment?
C - Hep C and HIV?
12
Q
How does PCOS appear on hormone blood tests?
A
Raised LH:FSH ratio
Testorone may be normal or elevated
Low sex hormone binding globulin
13
Q
A post-menopausal women comes to you with bleeding. What is the cause?
A
Endometrial Cancer until proven otherwise
14
Q
How do we define menorrhagia?
A
An amount that a women consideres to be excessive
15
Q
What do we do if we find an under 18 year old with FGM?
A
Report to police immediately
16
Q
What is the first line for infertility in PCOS?
A
Clomifene
17
Q
What is the most common cause of postmenopausal bleeding?
A
Vaginal atrophy
18
Q
A urodynamics study finds:
High voiding detrusor pressure
Low peak flow rate
What is the cause?
A
Overflow Incontinence
19
Q
What is the treatment for candidiasis in pregnant women?
A
Clotrimazole pessary
20
Q
What condition does a boggy uterus appear in?
A
Adenomyosis
21
Q
How does mittelschmerz present?
A
2 weeks since LMP/Mid cycle
Supra pubic pain
(conservative management)
22
Q
What are differentials for pelvic pain?
A
Endometriosis
Adenomyosis
Fibroids
PID
Ovarian Cyst (and rupture)
Ovarian Torsion
Ectopic pregnancy rupture
Ovarian cancer
UTI/Cystitis
IBS
IBD
Appendicitis
Gastroenteritis
23
Q
What investigation should you complete in pelvic pain?
A
Pregnancy test (uHCG)
CRP/ESR
FBC
Urine dip
Vaginal swabs/STI Screen
Transvaginal USS
24
Q
What does each level of UKMEC mean for contraception?
A
UKMEC1: No restriction
UKMEC2: Benefits generally outweigh the risks
UKMEC3: Risks generally outweigh the benefits
UKMEC4: Unacceptable risk (contradiction)
25
What are the effectiveness of the different types of contraception?
Natural family planning - 76%
Condoms - 82% (98%)
COCP/POP - 91% (>99%)
Progestogen injection - 94% (>99%)
Progestogen implant - >99%
Coils - >99%
Surgery - >99%
Typical Use
(Perfect Use)
26
What contraceptions can you use in breast cancer?
Copper coil or condom
(Avoid hormonal)
27
What contraceptions should you abide in cervical or endometrial cancer?
IUS (Mirena coil)
28
What contraception should you avoid in Wilson's disease?
Copper coil
29
What are the UKMEC 4 risk factors for COCP?
Uncontrolled HTN
Migraine w/ aura
Hx of VTE
35yrs+ and smoke 15+ a day
Post major surgery
Vascular disease/stroke
IHD/AF/Cardiomyopathy
Liver cirrhosis/tumour
SLE
Antiphospholipid syndrome
30
What should you inform to women around the menopause with regards to contraception? (x4)
After LMP: contraception is needed for 2yrs in 50yrs below and 1yr in 50yrs and above
HRT is not a form of contraception
COCP can be used up until 50, may be useful for perimenopausal
Progestogen injection (depo-provera) should be stopped before 50 (osteoporosis risk)
31
What should women post childbirth know about contraception?
Fertility returns at day 21 after birth
Lactational amenorrhoea is 98% effective up to 6 months after birth (if amenorrhoeic)
COCP should be avoided in breastfeeding until 6 weeks after (POP or implant)
IUD/IUS can be inserted 4 weeks post birth
32
What 3 ways does the COCP prevent pregnancy?
1) Prevent ovulation
Thickens cervical mucus
Inhibits proliferation of endometrium
(both progesterone)
33
What regimes are available for the COCP?
1) 21 days on and 7 days off
2) 63 days on and 7 days off (tricycling)
3) Continuous use
34
What are the side effects/ADRs of COCP?
Unscheduled bleeding
Breast pain/tenderness
Mood change
VTE (lower then pregnancy)
Hypertension
Small increase risk of breast/cervical cancer
Small increase risk of MI/stroke
35
At what points during the cycle when starting the COCP do you need extra contraception?
Day 1-5 = no extra contraception needed
Day 5 onwards = 7 days of condoms
(if switching from POP then 7 days of condoms also needed)
36
What is the missed pill rule?
The pill is more then 24 hours late (48 hrs since the last pill was taken)
Less than 72 hrs since last pill:
Take missed pill with 'todays pill'
More than 72 hrs since last pill:
Take missed pill
Additional contraception for 7 days
(day 1-7 of pack will need emergency contraception)
37
When should you stop the COCP pre surgery?
4 weeks before
38
What are the benefits of the POP when compared to the COCP?
It's only UKMEC4 is active breast cancer
It's taken continuously
39
What are the 2 types of POP? What is the difference way they both work?
Tradition POP (Norgeston) - thickens cervical mucus, reduces ciliary action in Fallopian tubes
Desogestrel only pill - Inhibits ovulation (secondary actions are same as above)
40
What is the difference in missed pill between traditional POP and desogestrel?
POP - 3 hours late is missed pill
Desogestrel - 12 hours late is missed pill
41
What other protections should you put in place with the POP when starting the pill at different times of the cycle?
Days 1-5 = insane protection
Day 5+ = 48hrs of condoms
42
What are the ADRs/risks of the POP?
Unscheduled bleeding:
20% amenorrhoea
40% regular
40% irregular
Breast tenderness
Acne
Headache
Small increase risk of ectopic or breast cancer
43
What is important when switching from COCP to POP?
Can start POP immediately if:
Have taken COCP for 7 days+
Are on day 1-2 of pack
If day 1-7 of COCP they can swap but need 48 hrs of condoms
If UPSI since day 3 then take COCP for 7 days and then swap
44
How and when do you give the progestogen-only injection (depot medroxyprogesterone)?
12-13 week intervals
Depo-provera - IM
Sayana Press - SC
45
What are the contraindications for the Depo-provera injection?
UKMEC 4 - active breast cancer
UKMEC 3 -
IHD/stroke
Unexplained vaginal bleeding
Liver cirrosis/cancer
46
What are the ADRs and risks for the depo-provero injection?
Unscheduled bleeding
Weight gain
Acne
Reduced libido
Mood changes
Headaches
Flushes
Alopecia
Osteoporosis increased risk (UK MEC 2 in 45yrs+, should change to 50)
Small increase risk of breast and cervical cancer
47
How could you manage initial irregular bleeding with the depo-provero injection?
Take the COCP for 3 months
Or mefenamic acid
48
What are the benefits of the DP injection?
Improves dysmenorrhoea
Improves endometriosis
Reduces the risk of ovarian and endometrial Cancer
49
How long does the progestogen only implant last?
3 years
Upper medial arm
50
What benefits are the for the implant over the injection?
Lasts longer (3 yrs)
Not user dependant
Doesn't cause weight gain
No effect on bone mineral density
51
What are the drawbacks of the implant?
Minor operation and local anaesthetic
Worsens acne
No STI protection
Implant can be bent
Implants can be deeply implanted e.g. in the lungs
Problematic bleeding
52
What are the contraindications to the coils?
PID/Infection/STIs
Immunosuppression
Pregnancy
Unexplained bleeding
Pelvic cancer
Uterine cavity distortion by fibroids
53
What are the risks when inserting a coil?
Bleeding
Pain on insertion
Vasovagal reaction
Increases risk of STI/PID
Expulsion
Uterine perforation
54
What is the process when inserting a coil?
1) bimanual exam to check uterus size and position
2) Speculum is inserted and coil inserted
See pt 3-6wks post insertion to check the threads
If removing coil abstain from sex for 7 days prior
55
What could cause non-visible threads in coil insertion? How do we investigate this?
Expulsion
Pregnancy
Uterine perforation
Pelvic USS
56
What other scenario can an IUS be used?
As endometrial protection in HRT
Licensed for 4 yrs as HRT
5 yrs for contraception
57
What are the benefits to the IUD?
Effective
Can be used 5 days post UPSI as emergency contraception
No risk of VTE/hormone related cancer
58
What are the benefits to the IUS?
Helpful for mennorhagia or dysmenorrhoea
No VTE risk
59
What are drawbacks to coils?
Procedural risks
Pelvic pain
Infection risk
Increased ectopic risk
Expulsion
60
How does the IUS and IUD work?
IUS: Thickens cervical mucus
IUD: Copper is toxic to sperm and ovum
61
When do ALO (Actinomyces-Like Organsims) appear on smears?
Women with IUD
Can remove IUD if symptomatic but if not no tx required
62
What are the options for emergency contraception?
Copper coil (gold standard) - 5 days post UPSI
Ulipristal Acetate (EllaOne) - 120 hrs post UPSI
Levonorgestrel - 72 hrs post UPSI
63
What do you do if a 12 year old comes to you for contraception?
Escalate to safeguarding
Children under 13 cannot consent to sexual activity
64
What are the Frazer guidelines?
They are mature and intelligent enough to understand the treatment
They can’t be persuaded to discuss it with their parents or let the health professional discuss it
They are likely to have intercourse regardless of treatment
Their physical or mental health is likely to suffer without treatment
Treatment is in their best interest
65
At what gestation age is the uterus palpable on abdominal examination. What reason could their be for an oversized uterus?
12 weeks - just above pubic symphysis
16 weeks - midpoint between the umbilicus and the pubic symphysis.
36 weeks - xiphisternum
(Molar Pregnancy)
66
How can you estimate the fundal height?
gestational age in weeks (+/- 2 cm)
67
Why should a pregnant women avoid sleeping on her right side?
Pressure on the liver and kidney which can increase swelling
68
Why should a pregnant women avoid sleeping on her back?
Avoid in 3rd trimester
Increases risk of stillbirth as compresses IVC so less blood flow to fetus
69
What is the best position to sleep when pregnant?
Left Side
70
Best option for atypical endometrial hyperplasia in a post menopausal women?
Total hysterectomy with bilateral salpingo-oophorectomy
71
A hepatitis B serology positive woman gives birth to a healthy baby girl. The mother is surface antigen positive. What treatment should be given to the baby?
HBIG (Hep B Immunoglobulins as well as HEP B vaccine after birth)
72
What contraception options are open to trans men who have a uterus and are on testosterone therapy?
Condoms
IUD
POP
Oestrogen interferes with their testosterone therapy
Testosterone therapy alone is not contraceptive and would be teratogenic
73
What is antepartum haemorrhage and what are the main causes?
Vaginal bleeding from week 24 of gestation until delivery
Placenta praevia
Placental abruption
Vasa praevia
74
How soon should the COCP be stopped before surgery?
4 weeks
75
What's the first line for primary dysmenorrhoea?
mefenamic acid
76
Hypertension and proteinuria before 20 weeks?
Chronic hypertension (pre-eclampsia starts 20 weeks later)
77
What to do if 2nd repeat smear is still hrHPV +ve but cytology is normal?
Refer for colposcopy
78
How does Down's syndrome present on combined test?
↑ HCG, ↓ PAPP-A, thickened nuchal translucency
79
When do you do the oral glucose tolerance test for GDM?
24-28 WEEKS
80
8 week pregnancy presents with bleeding
Transvaginal ultrasound is performed, which fails to detect an intrauterine pregnancy.
B-HCG is 3,000
what is diagnosis?
Ectopic
In the case of pregnancy of unknown location, serum bHCG levels >1,500 points toward a diagnosis of an ectopic pregnancy
81
Roughly what is the chance of survival with different levels of prematurity?
Less than 22 weeks is close to zero chance of survival
22 weeks is around 10%
24 weeks is around 60%
27 weeks is around 89%
31 weeks is around 95%
34 weeks is equivalent to a baby born at full term.
82
What extra scans are needed for twins?
2 weekly scans from 16 weeks for monochorionic twins
4 weekly scans from 20 weeks for dichorionic twins
83
What type of anaesthesia should you use if a women has sepsis?
General over spinal
84
What should you do if a pregnant women gets sepsis?
Continuous maternal and fatal monitoring
Emergency CS if fetal distress
Sepsis 6
85
What are the sources of sepsis in pregnant women?
Chorioamnionitis
UTI
86
What is uterine inversion?
The funds of the uterus drops down through the cervix turning the uterus inside out
Large PPH
Maternal shock/collapse
87
How do you manage uterine inversion?
Johnson manoeuvre:
push fundus back up into abdomen, hold in place for several mins and give oxytocin to contract and remain in place
Fill vagina with fluid to inflate uterus back to normal position
Laparotomy
88
When do you do a pregnancy test after miscarriage?
3 weeks
89
How long after childbirth do you have to wait for the implant?
Immediately
90
Which non-hormonal drug can be given for hot flushes in menopause?
fluoxetine (SSRIs)
91
What blood test confirms ovulation?
Day 21 progesterone
92
What is the relevance of AFP in pregnancy?
Low in Down's
High in Neural Tube defects
93
What should you do if a pregnant women's fasting glucose comes back at 6.1?
Trial diet and exercise for 2 weeks if less then 7
94
How long does the common contraceptives take to work?
instant: IUD
2 days: POP
7 days: COCP, injection, implant, IUS
95
How do you treat group B strep in pregnancy?
intrapartum intravenous benzylpenicillin only
96
How do you confirm diagnosis of placenta praevia?
TRANSVAGINAL uss
97
The Fraser guidelines state the following should be fulfilled before consent can be accepted:
The minor understands the professional's advice
The minor cannot be persuaded to inform their parents
The minor is likely to begin, or to continue having, sexual intercourse with or without contraceptive treatment
Unless the minor receives contraceptive treatment, their physical or mental health, or both, are likely to suffer
The minors best interests require them to receive contraceptive advice or treatment with or without parental consent
98
