21/06 Flashcards
which cancers does COCP protect against
endometrial
ovarian
colorectal
which cancers does COCP increase risk of
breast
cervical
positive antiphospholipid antibodies (e.g. in SLE)
UKMEC 4 for cocp
when does cocp need to be taken for no extra precautions
first 5 days of cycle (otherwise 7 days condoms)
POP MOA
thickens cervical mucous
IUS MOA
prevents endometrial proliferation
restrating hormonal contraception after emergency contraception
levenorgestrel - straight away
ullipristal - 5 days
inter-pregnancy interval of less than 12 months
increased risk of preterm birth, low birth weight and small for gestational age babies
enlarged, boggy uterus
adenomyosis
adnomyosis invx
transvaginal USS
when is cervical screening delayed until if pregnant
3 months post partum
cervical intraepithelial neoplasia
Large loop excision of transformation zone (LLETZ)
primary dysmenorrhea tx
NSAIDs eg mefanemic acid and ibuprofen
COCP
2ndary dysmenorrhea
refer to gynae
medical mx of ectopic
methotrexate
most dangerous ectopic site
isthmus
cervical cancer tx
surgery
radiotherapy
endometrial cancer tx
surgery
post op radiotherapy if high risk
endometrial cancer if frail elderly women not suitable for surgery
progestogen
tx of simple endometrial hyperplasia without atypia
high dose progestogens with repeat sampling in 3-4 months. The levonorgestrel intra-uterine system may be used
tx of endometrial hyperplasia with atypia
hysterectomy
low-grade fever, pain and vomiting during pregnancy
?fibroid degeneration
menorrhagia tx does not require contraception
mefanemic acid or tranexamic acid
menorrhagia tx does require contraception
IUS first-line
combined oral contraceptive pill
long-acting progestogens
short-term option to rapidly stop heavy menstrual bleeding
Norethisterone 5 mg tds
HRT cancer risk
inc risk of breast and endometrial cancer
CXR aortic dissection
widened mediastinum
hyperemesis gravidarum diagnosis
5% pre-pregnancy weight loss
dehydration
electrolyte imbalance
hyperemesis gravidarum tx
antihistamines: oral cyclizine or promethazine
phenothiazines: oral prochlorperazine or chlorpromazine
complications of vaginal hysterectomy with antero-posterior repair
enterocele
vaginal vault prolapse
invx of infertility
semen analysis
serum progesterone 7 days prior to expected next period (>30 indicates ovulation)
hrt inc cancer risk
breast ovarian and endometrial
mx of vasomotor symptoms
fluoxetine, citalopram or venlafaxine
medical mx of miscarriage
vaginal misoprostol
ovarian cancer most common cause
epithelial - serous carcinoma
whirlpool sign
ovarian torsion
first line ovulation induction in PCOS
Letrozole
PID mx
oral ofloxacin + oral metronidazole or intramuscular ceftriaxone + oral doxycycline + oral metronidazole
first line hirsutism in PCOS
COCP
most common cause of postcoital bleeding
cervical ectropion
most common cause of post meno bleeding
vaginal atrophy
diagnosis of premature ovarianinsufficiency
elevated FSH levels should be demonstrated on 2 blood samples taken 4–6 weeks apart
when should anti-d be given in abortion
women who are rhesus D negative and after 10+0 weeks’ gestation
medical abortion
oral mifepristone
48 hrs later - vaginal prostaglandins
when is abortion legal
up to 24 weeks
urge incontinence
bladder-retraining
anti-muscarinics eg oxybutynin
mirabegron in elderly
stress incontince
pelvic floor muscle training
surgical procedures: e.g. retropubic mid-urethral tape procedures
duloxetine
thrush mx
oral fluconazole 150 mg as a single dose first-line
clotrimazole 500 mg intravaginal pessary as a single dose
vulval symptoms - topical imidazole
Offensive, thin, white/grey, ‘fishy’ discharge
BV
Offensive, yellow/green, frothy discharge
trichomonad
AST:ALT ratio 2:1
alcoholic hepatitis
venous ulceration is most commonly seen above the
medial malleolus
ejection systolic murmur, louder on performing Valsalva and quieter on squatting
HOCM
poor response to fluid challenge
acute tubular necrosis
partial seizures when child is asleep
benign rolandic epilepsy
myoclonic and generalised tonic-clonic seizures, typically occurring when the child is sleep-deprived and not during sleep itself
juvenile myoclonic epilepsy
A large hyperechoic lesion in the presence of normal AFP
haemangioma
Diabetic ketoacidosis: once blood glucose is < 14 mmol/
an infusion of 10% dextrose should be started at 125 mls/hr in addition to the saline regime
organophosphate poisoning
atropine
colles fracture nerve injury
median
unilateral undescended testicle
review at 3 months - if persistent refer
LMWH
factor Xa
exuberant callus formation
steroid induced osteoporosis
where do the testes drain
para-aortic nodes
placental abruption
separation of a normally sited placenta from the uterine wall, resulting in maternal haemorrhage into the intervening space
Pain over the pubic symphysis with radiation to the groins and the medial aspects of the thighs. A waddling gait may be seen
symphysis pubis dysfunction
inc AFP
Neural tube defects
Abdominal wall defects
Multiple pregnancy
dec AFP
Down’s syndrome
Trisomy 18
Maternal diabetes mellitus
shock out of keeping with visible loss
placental abruption
shock in proportion to visible loss
placenta praevia
tx of nipple thrush
miconazole cream for the mother
nystatin suspension for the baby
if med is required for suppressing lactation
cabergoline
rarer breech that carries higher mortality
footling
most common breech
frank - hips flexed and knees fully extended
when should ECV be offered
36 weeks in nulliparous women and from 37 weeks in multiparous women
loss of baseline variability
Prematurity, hypoxia
Early deceleration
usually an innocuous feature and indicates head compression
late deceleration
Indicates fetal distress e.g. asphyxia or placental insufficiency
variable decelerations
May indicate cord compression
skin scarring
eye defects (microphthalmia)
limb hypoplasia
microcephaly and learning disabilities
foetal varicella syndrome
chorioamnionitis RF
PROM
chorioamnionitis tx
Prompt delivery of the foetus
IV abx
what is combined test and when is it offered
nuchal translucency measurement
serum B-HCG
pregnancy-associated plasma protein A (PAPP-A)
11-13+6 weeks
what is offered instead of combined test if women book later
quadruple test 15-20 weeks
alpha-fetoprotein, unconjugated oestriol, human chorionic gonadotrophin and inhibin A
downs syndrome results
increased HCG and inhibin A
decreased PAPPA, AFP and unconjugated oestradiol
increased nuchal translucency
edwards syndrome (trisomy 18) results
everything decreased
neural tube defects results
increased AFP
what will a women be offered if she has a higher chance
NIPT, CVS or amniocentesis
reducing risk of hypertensive disorders in preg
high risk women - aspirin 75-150mg daily from 12 weeks gestation until the birth
what should be monitored during magnesium sulphate delivery
urine output
reflexes
respiratory rate
oxygen saturations
tx of mag sulphate induced resp depression
calcium gluconate
sodium valproate defect
neural tube defects
phenytoin defect
cleft palate
safest anti epileptics
lamotrigine and carbamazepine
diseases meaning 5mg of folic acid is needed
coeliac disease, diabetes, or thalassaemia trait
galactocele
occlusion of a lactiferous duct -> cystic lesion
painless and usually occurs when recently stopped breast feeding
women who have prev had GDM
OGTT @ booking and at 24-28 wks if first test is normal
women with risk factors for GDM
OGTT @ 24-28 wks
fasting plasma glucose level is < 7 mmol/l
trial of diet and exercise
what insulin is GDM treated with
short acting
if at the time of diagnosis the fasting glucose level is >= 7 mmol/l
insulin
gestational thrombocytopenia > ITP
if the platelet count continues to fall as pregnancy progresses
women whove had GBS in prev preg
offered intrapartum antibiotic prophylaxis (IAP) OR testing in late pregnancy and then antibiotics if still positive
when should swabs for GBS be done
35-37 weeks or 3-5 weeks prior to the anticipated delivery date
when should IAP be offered to women regardless of status
preterm labour
pyrexia >38 during labour
GBS prophylaxis
benzylpenicillin
HELLP
Hemolysis
Elevated Liver enzymes
Low Platelet
babies born to mothers who are chronically infected with hepatitis B or to mothers who’ve had acute hepatitis B during pregnancy
complete course of vaccination + hepatitis B immunoglobulin
which electrolyte abnormality predisposes to digoxin toxicity
hypokalaemia
If after 28/40 weeks, if a woman reports reduced fetal movements and no heart is detected with handheld Dopple
ultrasound scan
reducing vertical transmission of HIV
maternal antiretroviral therapy
mode of delivery (caesarean section)
neonatal antiretroviral therapy
infant feeding (bottle feeding)
when can PLWH deliver vaginally
viral load less than 50 copies/ml at 36 weeks
BP physiological changes in preg
falls in first trim -> 20-24 wks
then returns to pre-preg levels by term
if the Bishop score is ≤ 6
vaginal prostaglandins or oral misoprostol
if the Bishop score is > 6
amniotomy and an intravenous oxytocin infusion
monitoring in labour
FHR monitored every 15min (or continuously via CTG)
Contractions assessed every 30min
Maternal pulse rate assessed every 60min
Maternal BP and temp should be checked every 4 hours
VE should be offered every 4 hours to check progression of labour
Maternal urine should be checked for ketones and protein every 4 hours
stage 1 labour timeframe
latent phase = 0-3 cm dilation, normally takes 6 hours
active phase = 3-10 cm dilation, normally 1cm/hr
stage 2 time frame
1 hour
how long is lochia normal for
6 weeks after childbirth
placenta accreta risk
PPH
placenta praevia diagnosis
TVUS
placenta praevia mx
final ultrasound at 36-37 weeks to determine the method of delivery
elective caesarean section for grades III/IV between 37-38 weeks
if grade I then a trial of vaginal delivery may be offered
placenta abruption
fetus alive and <36w
fetal distress: immediate caesarean
no fetal distress: observe closely, steroids, no tocolysis, threshold to deliver depends on gestation
placenta abruption
fetus alive and >36w
fetal distress: immediate caesarean
no fetal distress: deliver vaginally
surgical mx PPH first line
intrauterine balloon tamponade
first trim anaemia
<110
second trim anaemia
<105
post partum anaemia
<100
raised bilirubin
intrahepatic cholestasis of preg
raised ALT
acute fatty liver of preg
PPROM invx
speculum exam
testing the fluid for placental alpha microglobulin-1 protein (PAMG-1) (e.g. AmniSure®) or insulin-like growth factor binding protein‑1
PPROM mx
admission
regular obs
oral erythromycin should be given for 10 days
antenatal corticosteroids
delivery should be considered at 34 weeks
most common cause of puerperal pyrexia
endometritis - iv abx till apyrexial for 24hrs
when do nulliparous women experience fetal movements from
18-20 wks
when do multiparous women experience fetal movements from
16-18 wks
when to refer if not felt fetal movements
24 weeks
cause of hyperechogenic bowel
cystic fibrosis
Down’s syndrome
cytomegalovirus infection
extremely high serum PTH with moderately raised serum calcium
tertiary hyperparathyroidism
halo appearance on mammography
breast cyst
cheese like/green nipple discharge and slit like retraction of the nipple
duct ectasia
breast cyst tx
aspiration
those which are blood stained or persistently refill should be biopsied or excised
blood stained nipple discharge
duct papilloma
Indication of breast cancer survival
nottingham prognostic index
breast disorder assoc with smoking
periductal mastitis
lateral epicondylitis
supination
medial epicondylitis
pronation
which pts are sensitive to non-depolarising agents
those with myaesthenia gravis
subclinical hyperthyroidism
atrial fibrillation
osteoporosis
dementia
fever, neuro signs, thrombocytopenia, haemolytic anaemia and renal failure
thrombotic thrombocytonpenic purpura
what diabetes drug is contraindicated in heart failure
pioglitazone
