General Gynae Flashcards
PMS management for: mild, moderate and severe symptoms
Mild: lifestyle (complex carbs)
Moderate: COOP
Severe: sertraline
3 red flags for menorrhagia that would indicate TV USS
IMB, postcoital bleeding, pelvic pain/ discomfort
All women with menorrhagia require
FBC
First line treatment in women with menorrhagia that do not need contraception
TXA/ mefenamic acid
First, second and third line treatment in women with menorrhagia that need contraception
1: IUS
2: COOP
3: long acting progesterone (DEPO)
Mullerian agenesis presentation
Teenagers presenting with amenorrhoea and no pain
From lack of uterus
Clomifine
Anti-oestrogen used to treat fertility issues in PCOS
Metformin second line
What do women with PCOS undergoing IVF, are particularly at risk of it:
Ovarian hyperstimulation syndorme
Common pattern of endometriosis pain
With period/ cyclical
First line investigation in infertile women after 1 year
Day 21 progesterone
CA125 used to measure
Ovarian cancer
3 components to risk malignancy index and for what cancer
Ovarian
Ca125, US findings, menopausal status
How long after termination will HCG test be positive
Upto 4 weeks
In molar pregnancy high levels of HCG can imitate what hormone
TSH
Management for all cases of secondary dysmenorrhoea
Referral to gynaecologist
Management of ectopic pregnancy with heart beat
Surgical
Turners syndrome chromosomes
45X
Cord prolapse management
Hand into vagina to elevate the presenting part
Treatment given to all HIV patients with CD4 < 200 to prevent ?
Pneumocystis jirovceii pneumonia
Co-trimoxazole (septrin)
Changes to smear testing in women with HIV
Every year as high risk HPV
When is zidovudine used in labour
C section in women with viral load >10000 (very high)
Drug given to children of HIV mother
Zidovudine for 4 weeks if low viral load
Zidovudine, lamivudine and nevirapine for 4 weeks if high viral load
Can HIV be passed on in breast feeding
Yes - even if undetectable
What is Fitz Hugh Curtis syndrome
Complication of PID
Inflammation and infection of liver cavity causing adhesions
Hypermesis gravidarum diagnostic criteria
5% weight loss
Dehydration
Electrolyte imbalance
First line pregnancy anti-emetic
Prochlorperazine
Ginger and acupressure on PC6 wrist
FSH levels in menopause
Very high (>40)
How to determine if pregnancy of unknown location is viable
Monitor HCG over 48 hours. Should double. (>63% acceptable)
Ectopic will be less
Medical management of pregnancy termination drug
Methotrexate (cannot conceive for a further 3 months)
Missed miscarriage
Fetus no longer alive - no symptoms
Threatened miscarriage
Vaginal bleeding, CLOSED CERVIX, fetus alive
Inevitable miscarriage
Vaginal bleeding, OPEN CERVIX
Investigation to diagnose miscarriage
TV USS
Difference between triple and quad testing for Downs
Quad includes Inhibin A which makes it slightly more sensitive
Low AFP likely to indicate
Downs
AFP, estriol and HCG readings in Downs
AFP low
Estriol low
HCG high
AFP, estriol and HCG readings in Edwards
All low
HCG high in Downs
Edwards karyotype
trisomy 18
Can COOP be prescribed while breast feeding
UKMEC 4 up to 6 weeks the UKMEC 2
SSRI choice in pregnancy
Sertraline
1st and 2nd line mx of endometriosis
Paracetamol/ NSAIDS
COOP
3: POP/ depo/ implant
4: GnRH analogues
Methotrexate use before pregnancy - management
MAN AND WOMEN must stop using it 6 months before
Rokitansky’s protuberance is associated with
Teratoma
Likely diagnosis in pregnancy women with low grade fever and severe abdominal pain
Red degeneration of fibroids
Cancers associated with BRACA1/2
Breast and ovarian
Main risks for COOP
VTE, CV conditions, breast and cervical cancer
Ovarian cancer - 2 main risk factors
Many ovulations (nuliparity, early menache, late menopause) FH - BRACA 1/2
FSH and LH in menopause
High
Low oestrogen which would normally provide negative feedback as less ovarian follicles developing -> less granulosa cells
Endomertial cancer risk factors
Many ovulations (nuliparity, early menache, late menopause) High oestrogen (obesity, HRT, PCOS) DM, tamoxifen
Endometrial cancer classic symptom
Post menopausal bleeding
Percentage weight loss after birth that is pathogenic and management
10%
Referral to midwife led breastfeeding clinic
Continuous dribbling incontinence after childbirth
Vesicovaginal fistula
Medical advantage of transdermal HRT
Reduces VTE risk
Cancers associated with HRT
Breast (risk normal 5 years after stopping)
Endometrial (reduced by progesterone)
Cabergoline
Stops lactation
Drug of choice to stop lactation
Cabergoline
Why do males not develop a uterus or other female sex organs
Anti-Mullerian hormone
Vaginal agenesis cause
Failure of the Mullerian ducts to properly develop
clomifine use
Infertility in women who do not ovulate
COOP increases risk of which cancers
Breast and cervix
HRT: adding a progesterone increases the risk of ?? and ?? UNLESS ??
Breast Ca VTE unless transdermal
Medical management of miscarriage
Vaginal misoprostol alone
Ulipristal contraindication
Severe asthma
Polycythemia is associated with which GOSH condition
Uterine fibroids secondary to autonomous EPO production
How long until IUS is effective
7 days (same as implant, IUD and Depo)
All women in pre-term labour should be offered ABX?
True - benzyl penicillin
What week before should consider IV steroids
24-34 - offer
34-36 - consider
Key monitoring of women on MgSO4
Deep reflexes every 4 hours
When should mgso4 be given for neuroprotection
24-30 - offer
30-34 - consider
Size of fibroids after menopause
Decrease (more LH and FSH)
Everyone should get 2 USS - at around what weeks
12 and 20
