Conditions summary Flashcards by Jay Slater

medical induction of TOP

mifepristone and vaginal prostaglandins

metronidazole prophylactic antibiotic

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surgical induction of TOP

vaginal prostaglandins
+ vacuum aspiration
metronidazole prophylactic antibiotic

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pregnant lady
hypertension
proteinuria
oedema

pre-eclampsia

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<24w pregnant lady
bleeding and period like cramps
cervical os closed on speculum examination

threatened miscarriage (threatened bc cervical os still closed)

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<24w pregnant lady
bleeding and period like cramps
can see fetus in vagina with cervical os open on speculum examination

complete miscarriage

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eclampsia treatment

delivery of baby asap
IV labetalol
IV magnesium sulfate (to stop seizures)

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v bad morning sickness
decreased QoL
electrolyte imbalance
emotional instability

hyperemesis gravidarum

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hyperemesis gravidarum treatment

IV fluids
electrolyte replacement
steroids if recurrent

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recurrent miscarriages

anti cardiolipin antibody positive

antiphospholipid syndrome

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PMH chlamydia 
shoulder tip pain 
pain>bleeding 
hCG positive 
US - empty uterus

ectopic pregnancy

chlamydia = PID = narrows tubes

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treatment of ectopic pregnancy (if stable, stable but far along and unstable)

stable - methotrexate
stable but far along - laparoscopy
unstable eg sepsis - laparotomy (remove tube and ectopic)

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treatment of ectopic pregnancy (if stable, stable but far along and unstable)

stable - methotrexate
stable but far along - laparoscopy
unstable eg sepsis - laparotomy (remove tube and ectopic)

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hyperemesis
vaginal bleeding with tissue discharge
hCG v v high
US snowstorm appearance

molar pregnancy

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molar pregnancy treatment

surgical removal of mole

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molar pregnancy treatment

surgical removal of mole

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pregnant >24w

painless bleeding

placenta praevia until proven otherwise

need to do US (NOT speculum/vaginal exam)

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placenta praevia treatment (2)

c section unless >2cm of cervical os , not emergency

fluid resus if blood loss

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pregnant >24w 
painful bleeding 
tender/woody abdo 
antiphospholipid syndrome 
hCG v high

placental abruption

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treatment of placental abruption

emergency c section

fluid resus mum

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sudden bleeding and fetal tachycardia

vasa praevia

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vasa praevia management

emergency c section

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fetus in distress
full cervical dilatation 10cm
2/5 engagement

what type of delivery

operative vaginal delivery - forceps or ventouse

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fetus in distress
cervical dilatation 9cm
3/5 engagement

what type of delivery

c section

bc not fully dilated and not 2/5 engagement

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vaginal bleeding >500ml <24h after birth

primary post partum haemorrhage (PPH)

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vaginal bleeding >500ml 48 hours after birth | fever

secondary post partum haemorrhage (PPH) caused by infection

management of primary PPH (4)

uterine massage syntocin (synthetic oxytocin) surgery fluid resus

management of secondary PPH (2)

antibiotics - bc infectious cause | fluid resus

PPH after birth of last child | now infertile

sheehans syndrome

puerperium | red hot swollen leg

DVT

DVT treatment

LMWH | mobility

low mood 3-10 days after birth of baby

baby blues

baby blues treatment

reassurance

low mood 2 weeks after birth of baby | PMH depression

post natal depression

post natal depression management

mild - counselling moderate - CBT and antidepressants severe - admission to mother baby unit

``` PMH bipolar perinatal death acute onset confusion 2 weeks after birth decreased sleep hallucinations and irrational ideas ```

puerperal psychosis

puerperal psychosis management

admission to mother baby unit

excess amniotic fluid | shiny tense abdo during pregnancy

polyhydramnios

treatment of female infertility from pituitary/hypothalamus problem

HRT - GnRH if hypothalamus problem, LH and FSH if pituitary problem

``` 50yo mood swings hot flushes night sweats menorrhagia ```

menopause

menopause treatment

vasomotor symptoms - HRT (COCP or oestrogen only pill), clonidine menorrhagia - mefenamic acid and tranexamic acid, or mirena coil vaginal dryness - oestrogen cream mood swings - SSRI increase Ca in diet

menorrhagia US normal pregnancy test negative

dysfunctional uterine bleeding (no pathological cause)

dysfunctional uterine bleeding treatment

first line - mirena coil second line - mefenamic acid + tranexamic acid third line - COCP

>16yo never had a period

primary amenorrhoea eg kallmans, turners

cessation of periods for >6 months in someone previously with a period

secondary amenorrhoea eg anorexia, POF, PCOS, hyperprolactinaemia, hypopituitarism

dragging sensation and back pain

uterine prolapse

dragging sensation | urinary/bowel incontinence

prolapse (dk what kind until investigations)

management of prolapse

conservative - pelvic floor exercises, lose weight pessaries surgery

koilocytosis on cytology after cervical smear unusual discharge, painful sex irregular bleeding what investigation do you do to confirm

cervical cancer biopsy - to see if squamous cell carcinoma or adenocarcinoma (glandular)

CIN 1 management

conservative

CIN 2/3/CGIN management

loop excision

squamous cell carcinoma of cervix, or adenocarcinoma of cervix management

loop excision cervical excision hysterectomy chemo

lump in uterus with glands and stroma presents with bleeding do US

endocervical polyp

lump in uterus with smooth muscle presents with bleeding and pelvic mass do US

fibroid (leiomyoma)

``` abnormal bleeding bloating weight loss fatigue Fx bowel cancer ```

endometrial cancer associated with lynch syndrome

endometrial cancer management

hysterectomy and salphinoectomy

``` amenorrhoea infertility overweight acne, hirsutism diabetes PMH pearl necklace on laparoscopy ```

PCOS

PCOS management

1 - weight loss and clomifene citrate | 2 - metformin, gonadotrophin therapy, COCP, laparoscopic ovarian diathermy (drilling)

amenorrhoea <40yo prev cancer treated with chemo infertility osteoporosis

POF

POF management

HRT (COCP) | vit D and Ca and bisphosphonates - for osteoporosis

menorrhagia chronic pelvic pain infertility chocolate cysts on laparoscopy

endometriosis

endometriosis management

NSAIDs for pain COCP - will probs do! ablation/excision/hysterectomy

ovarian cancer secondary mets where is most likely primary cancer

stomach

ovarian cancer | psammoma bodies

serous ovarian tumour (type of epithelial)

ovarian cancer | epithelium looks like bladder

brenner ovarian tumour (aka transitional cell carcinoma) | type of epithelial ovarian tumour

ovarian cancer with teeth, skin and hair inside it

dermoid cyst (aka teratoma) type of germ cell ovarian tumour

ovarian cancer | secretes AFP

yolk sac tumour | type of germ cell ovarian tumour

ovarian cancer secretes hCG prev molar pregnancy

choriocarcinoma | type of germ cell ovarian tumour

ovarian benign tumour ascites pulmonary oedema

meigs syndrome associated with fibroma type of sex cord/stromal ovarian tumour

ovarian tumour | presents with precocious puberty <9yo

granulosa-theca cell tumour type of sex cord/stromal ovarian tumour secretes oestrogen = precocious puberty or abnormal bleeding

ovarian tumour | presents with hirsutism and acne

Leydig-Sertoli cell tumour type of sex cord/stromal ovarian tumour secretes androgens = hirsutism

management of ovarian tumours

chemo and surgery

watery urethral discharge most common STI dysuria

chlamydia

chlamydia treatment

first line - doxycycline BD 7 days | second line - azithromycin PO once

chlamydia in past | now infertile

PID

pus urethral discharge dysuria irritation

gonorrhea

gonorrhea treatment

ceftriaxone IM, test of cute 5w later

painless penile ulcer

primary syphilis

syphilis treatment

long acting penicillin IM

painful penile ulcer | recurrent

genital herpes (caused by HSV)

strawberry vagina | recurrent

genital herpes (caused by HSV)

genital herpes treatment

acyclovir | symptomatic - topical lidocaine cream, saline bath

painless cauliflower warts

genital warts (caused by HPV 6+11)

genital warts treatment

nothing

intense vaginal itch white vaginal discharge uncontrolled diabetes

vaginal thrush (caused by candidia albicans)

vaginal thrush treatment

topical clotrimazole cream OTC (anti fungal)

fishy discharge frothy bubbles no pain 'clue cells' on microscopy

bacterial vaginalis

bacterial vaginalis treatment

Po metronidazole 7 days

``` fishy discharge frothy bubbles painful red 'strawberry cervix' ```

trichomonas vaginalis

trichomonas vaginalis treatment

Po metronidazole 7 days

MSM presents with viral symptoms what should you suspect

HIV!

HIV treatment

HAART - 3 drugs from 2 classes until undetectable viral load PrEP/PEP for partner

emergency contraception (3)

levonorgestrel (LNG-EC) - <3 days EllaOne (UPA-EC) - <5 days copper coil (IUD) <5days

painless lump in breast 25yo

probs fibroadenoma

bloody nipple discharge | 'cauliflower' like extension of duct

papilloma of breast

minor car accident 3 weeks ago | lump in upper outer quadrant of breast

fat necrosis

``` smoker green nipple discharge sub areolar (under areola) lump ```

duct ectasia

red inflamed breasts when breast feeding | not painful

mastitis

painful swelling of breasts when breast feeding

engorgement

scaly eczematous nipple | discharge

pagets disease of nipple - type of DCIS

most common type of breast cancer

invasive ductal carcinoma

dimpled skin lump in breast nipple change and discharge

breast cancer

management of breast cancer

``` wide local excision + radiotherapy OR mastectomy (entire breast removal) ```

adjuvant therapy for oestrogen receptor pos breast cancer

tamoxifen (anti oestrogen)

adjuvant therapy for triple negative breast cancer

chemo

adjuvant therapy for HER2 receptor pos breast cancer

trastuzumab (Herceptin)

prev radiotherapy on breast | new lump on same breast

breast angiosarcoma