extra Flashcards
A 42-year-old Caucasian lady is referred to the gynaecology clinic as she has not had any periods in 8 months. She also complains of joint pains for the last 2 years as well as lethargy. Her past medical history is significant for diabetes diagnosed 4 months ago and early-stage liver fibrosis diagnosed 6 months ago. She has no other past medical history and has never consumed alcohol.
A hormone profile requested by the gynaecologist reveals low levels of FSH and LH.
Which of the following investigations should be performed next?
Iron studies
This patient has secondary amenorrhoea which is the cessation of menstruation for at least 6 months in a patient who had periods before. The symptoms of lethargy and history of recent diabetes together with liver fibrosis point towards a diagnosis of hereditary haemochromatosis. This is a primary disorder of iron overload and can cause amenorrhoea due to deposition of iron in the hypothalamus and ovaries. Iron studies would reveal elevated levels of serum iron, raised ferritin and raised transferrin saturation. Transferrin levels and total iron-binding capacity (TIBC) would be reduced
AMH is hormone that serves as a marker of ovarian reserve.
decreased in what women
POI
what is ashermans syndrome
Asherman’s syndrome is characterised by intrauterine adhesions commonly as a result of previous uterine surgery such as dilation and curettage. It can lead to obstruction to the menstrual outflow tract which presents as secondary amenorrhoea.
in this case, the cyclical abdominal pain may be a sign that menstruation is occurring.
what is sheehan syndrome
Sheehan syndrome is hypopituitarism caused by ischaemic necrosis of the pituitary gland following excessive peri-partum blood loss. However, it is very rare in the developed world and the history is not consistent with this diagnosis
most common type of vulvar cancer
squamous cell carcinomas.
sx of vulvar cancer
Lump with or without lymphadenopathy
Itching
Non-healing ulcer
Vulval pain
Skin changes
Bleeding
how long do you not need contraception for in postnatal period
first 3 weeks
if you had a classic vertical. section can you have NVD after
no only if had LSCS
A 76 year old man comes into the GP clinic with a complaint of erectile dysfunction. He is prescribed Viagra (sildenafil). Which of the following medications is contraindicated with concurrent use?
Sildenafil is a PDE5 inhibitor and leads to vasodilation of the peripheral vasculature leading to a drop in the blood pressure in a similar way to how nitrates work - cannot be taken together
on examination of cervix in preg
a halo of red tissue around external os
blue ish tinge - increased blood flow
slit like apparance - pinpoint
is all nromal what is abnromal
odourless clear white watery fluid in posteriro vaginal vault - PPROm
recognised complication of epidural
Maternal and foetal distress secondary to hypotension are a recognised complication
This is correct. Maternal hypotension can be a distressing complication from epidural anaesthesia. It can be treated with 1L Hartmann’s solution over 20 minutes
how can maternal hypotension be treated in a distressing complication from epidural anaethesia
1L Hartmann’s solution over 20 minutes
A 32 year old patient with a history of depression presents with four episodes of severe shooting pain on her right cheek. Cranial nerve examination is normal, but the patient complains of worsening pain on light touch in the same area.
trigmeninal neuralgia
treated with carbamazepine
symptoms of local anaesthetic toxicity
Symptoms include the tinnitus, tremor, dizziness and paraesthesia seen in this patient
diabetic neuropathy first line
duloxetine
suxamethonium apnoea occurs in individuals who have a defect in
the enzymes (plasma cholinesterase) to metabolise suxamethonium leading to sustained action of the drug on the post-synaptic membrane of the neuromuscular junction
prolonged paralysis
uterine rupture common is sudden onset abdo pain and loss of contractions especially in context of previous c section
emergence lapratomy
cardiac disease - maternal, hypertension, pre-eclampsia or pre-existing renal disease can cause what in the baby
Due to the later onset of growth restriction, and the head circumference being reduced less than the abdominal circumference, this can be classed as asymmetrical IUGR. This is most commonly caused by maternal conditions such as hypertension, pre-eclampsia or pre-existing renal or cardiac disease. This can also be caused by maternal substance abuse.
can a HIV positive patient have a normal vaginal delivery
If a patient has a viral load of <50 copies/ml and is taking multiple antiretroviral medications, they can be offered a vaginal delivery
can a HIV positive patient have a normal vaginal delivery
If a patient has a viral load of <50 copies/ml and is taking multiple antiretroviral medications, they can be offered a vaginal delivery
Intrahepatic cholestasis generally seen in third trimester. There is accumulation of bile salts in the serum. As a result it often involves pruritus in the palms and soles. Liver enzymes rarely rise above 250 u/l along with elevated bilirubin
Acute fatty liver of pregnancy is a rare complication of pregnancy but important to be aware of. It commonly occurs in the third trimester or immediately following delivery and is thought to be more common in nulliparous women as in the case of this patient. A typical patient will present with a few days history of general malaise, anorexia, vomiting, and jaundice. Pain in the right upper quadrant may sometimes be present. Blood results would show marked elevation of liver enzymes, prolonged PT, raised and bilirubin. Low platelets will be seen due to consumptive coagulopathy
nulliparous
follows delivery
RUQ
and raised LFTs
iron deficiency anaemia no symtpoms what shoudl you be given
oral ferrosu sulpahte fumarate 200mg TDS
and checked HB in 2 weeks
remain on for at least 3 months
B12 deficiency
IM cyanocobalamin 12mg
what if fitz hugh curtis syndrome
Fitz–Hugh–Curtis syndrome is a complication of pelvic inflammatory disease where the liver capsule becomes inflamed, leading to the development of adhesions between the capsule and the surrounding peritoneum. This causes right upper quadrant pain, which can radiate up to the shoulder, alongside symptoms of pelvic inflammatory disease such as vaginal discharge and fever.
The risk of malignancy (RMI) index is used to determine the risk category in a woman with suspected ovarian malignancy.
The RMI is a product of
ultrasound scan score, menopausal status and the serum CA125 level (IU/ml)
The ultrasound result is scored 1 point for each of the following characteristics: multilocular cysts, solid areas, metastases, ascites and bilateral lesions. U = 0 (for an ultrasound score of 0), U = 1 (for an ultrasound score of 1), U = 3 (for an ultrasound score of 2–5).
kallmann syndrome main feature
no smell
lack of all secondary sex - so no breasts
what is androgen-insensitivity syndrome
Androgen-insensitivity syndrome occurs when an individual has XY chromosomes (male sex), but their body does not respond to the androgen hormones that drive the development of the male body.
Hence, they have externally female characteristics but no female reproductive organs.
features - primary amenorrhoea, lack of secondary sexual characteristics (except for breast development), absence of female reproductive organs and a short vagina (sometimes described as ‘blind ending’).
Breast development still occurs because testosterone can be converted to oestrogen in the periphery to drive breast development, but it is not present in the reproductive system.
bhcg readings
molar massive over 10000
When a pregnancy is not seen on an early scan, a β-hCG should be performed. If it is more than 1500 mIU/ml, the pregnancy should be treated as ectopic. If it is lower than this, the test will be repeated in 48 h and the two numbers compared. If the second reading is less than half of the first reading, it is most likely a miscarriage. If the second reading is more than double the first reading, it is most likely a viable pregnancy. If the second reading is between half and double the first reading, it should be treated as an ectopic pregnancy - which is the case for this woman.
what contraceptive measure reduces pelvic pain in endometriosis
POP