General Gynae Flashcards
What are the first line treatment drugs to enable fertility with PCOS? (As long as weight is normal)
Clomifene and Letrozole
What type of cell from vaginal swab suggests BV?
Clue cells
What is the first line treatment of GN?
Ceftriaxone 1 mg stat
What is the 1st and 2nd line treatment for CT?
1st line: Azithromycin 1mg stat
2nd line: Erythromycin 500mg QDS for 7 days
What strains are covered in the HPV vaccine?
16 and 18
What are the classifications of CIN?
CIN ==> Cervical intraepithelial neoplasia
CIN I- mild only lower 1/3 of epithelium
CIN II- Moderate- lower 2/3 of epithelium
CIN III- Severe- whole thickness of epithelium (carcinoma in situ)
When do you start cervical smears?
25 (or first intercourse)
How often are the performed?
Every 3 years up until the age of
Which 2 proteins produced by HPV affect which 2 tumour suppressor genes in cervical carcinogenesis?
E6 inhibits p53
E7 inhibits pRb
Lichen sclerosis
White flat itchy plaques, caused by autoimmune response, treat with high strength steroid cream and emollient treatment. (5% ==> vulval carcinoma)
What causes a hydatidifrom mole?
A fertilised ovum (either a non fertile one or a fertile one fertilised by 2 sperm)
Management of hydatidiform mole?
ERPC (evacuation of retained products of contraception) also referred to gestational trophoblastic disease centre and follow up serum hCG checks
What is the average age of menopause?
51
How long should women be on contraception after menopause?
Under 50 for 2 years
Over 50 for 1 year
What are the two progesterone hormones given in HRT?
• Levogorgestrel/ norethisterone
By what age will menarche usually have occurred? What is the average age?
16, 13
What is considered the normal for menstrual cycle length
23-35 days
normal amount of blood loss in each menstrual cycle?
<80 ml
Uterine Procidentia
A prolapse extending past the introitus
What is a common complication of hysterectomy to treat apical prolapse?
40% experience a vault prolapse
Patients main symptoms with prolapse what treatment may be best and aid relieving symptoms (after kegel)?
Burch colposuspension
How would you measure pelvic floor strength?
Modified Oxford grading system
Patient has fever and is on AP, what sinister diagnosis should you rule out?
NMS
What class of drugs are used to treat OAB?
Anti muscarinic (M3) Oxybutynin, tolterodine, solifenacin
How long should patients have performed pelvic floor muscle training for before other treatment in stress incontinence?
3 months
What drug can you use if surgery is CI in stress incontinence?
Duloxetine (SNRI)
What other drug (other than M3 antagonists) can be used in the management of OAB?- why not always used?
Mirabegron (B3 receptor agonist)- can lead to hypertensive crisis raised risk of TIA and stroke (sympathetic stimulator)
Which two surgical treatments can be used for stress incontinence?
Tension-free Vaginal tape (TVT) or trans-obturator tape (TOT)
Risk factors for thrush
- Increased oestrogen (higher in pregnancy, lower pre-puberty and post-menopause)
- Poorly controlled diabetes
- Immunosuppression
- Broad spectrum Abx
What is the treatment for thrush?
o Antifungal cream (i.e. clotrimazole) inserted into the vagina with an applicator
o Antifungal pessary (i.e. clotrimazole)
o Oral antifungal tablets (i.e. fluconazole)
Which swab type picks up thrush?
Charcoal
How many women have asymptomatic chlamydia?
75%
What is the medium on the end of the Charcoal?
Amies transport medium
Nucleic Acid Amplification tests (NAAT)
Chlamydia and gonorrhoea
What do you do if a NAAT shows potential gonorrhoea infection?
Do a charcoal swab- for microscopy, culture and sensitivity
What is the first line treatment for CT?
100mg Doxycycline BD for 7 days
What would you give a pregnant woman with CT?
Any of the below- not doxycycline- CI!
Azithromycin 1g stat then 500mg once a day for 2 days
Erythromycin 500mg QDS 7 days- 2nd line for normal too
Erythromycin 500mg BD for 14 days
Amoxicillin 500mg TDS for 7 days
Why should all patients with an STI be referred to GUM?
For contact tracing!
What are 3 complications of CT infection?
- PID
- Chronic pelvic pain
- Infertility
- Ectopic pregnancy
- Conjunctivitis
- Lymphogranuloma venereum
- Reactive arthritis
What are 3 pregnancy related complications of CT?
Pregnancy related complications: • Preterm delivery • Premature rupture of membranes • Low birth weight • Postpartum endometritis • Neonatal infection (conjunctivitis and pneumonia)
How would you treat a NG infection without MSC?
1g IM Ceftriaxone
How would you treat a NG infection with MSC?
oral ciprofloxacin 500mg One dose
Follow up for NG to check treatment?
o 72 hrs post for culture
o 7 days for RNA NAAT
o 14 days for DNA NAAT
Trichomonas vaginalis vaginal discharge?
o Frothy yellow and green (may have a fishy smell)
What sign could be seen on the cervix of a patient with Trichomonas? What would the pH be?
Strawberry cervix
pH >4.5
Treatment of Trichomonas vaginalis?
Metronidazole
What maintains the vaginal acidity at <4.5?
Lactobacillus bacterial flora
Treatment of BV?
Metronidazole
HSV-1? HSV-2?
Type of HSV most common associated with cold years- under 5. Remains in trigeminal ganglion then spreads back down to give cold sores.
HSV-2 is almost exclusively an STI
Why is it key to know if a woman is in first episode genital herpes (HSV) breakout?
Primary genital herpes contracted after 28 weeks gestation is treated with acyclovir during the initial infection and then immediately followed with regular prophylactic acyclovir. C-Section is recommended in all cases to reduce the chance of neonatal infection.
Recurrent genital herpes in pregnancy when known to have herpes pre pregnancy is low risk (0-3%) of neonatal herpes infection. Regular prophylactic acyclovir is considered from 36 weeks gestation to reduce the risk of symptoms at time of delivery.
(due to maternal Abx being passed to the babies)
What is the name of the painless ulcer formed in primary infection of syphilis?
Chancre
Latent syphilis
Occurs after the secondary stage of syphilis, where symptoms disappear and the patient becomes asymptomatic, despite still being infected. Early latent syphilis occurs within 2 years of the initial infection, late latent syphilis occurs from two years after the initial infection onwards.
Secondary syphilis
Systemic symptoms- skin and mucous membranes in particular. Resolve after 3-12 weeks and patients can then enter a latent stage
Syphilis causative organism?
Treponema pallidum
What finding is specific to neurosyphilis?
Argyll- Roberston pupil
Fixed pinpoint “accommodating but not reactive”
What 2 tests for syphilis can show active infection?
• Rapid plasma reagin (RPR) and venereal disease research laboratory
Syphilis treatment?
IM benz-penicillins (second line- Doxycycline)
What type of virus is HIV?
RNA retrovirus- most common is HIV-1
Which cells are affected in HIV?
CD-4 T-helper cells
What is involved in ART?
ART involves at least 3 medications, typically 2 NRTI’s (nucleoside reverse transcriptase inhibitors) and either a protease inhibitor (PI) or a Non-nucleoside reverse transcriptase inhibitor (NNRTI)
What are 3 AIDS defining conditions?
Kaposi’s sarcoma Pneumocystis jirovecii pneumonia (PCP) Cytomegalovirus infection Candidiasis (oesophageal or bronchial) Lymphomas Tuberculosis
What group of cells develop into the placenta?
chorion frondosum
What forms the umbilical cord?
The connecting stalk
What SE can hCG have during pregnancy?
It can cause N+V (morning sickness in early pregnancy)
Actions of oestrogen during pregnancy?
- Stimulates growth of the myometrium
2. Stimulates mammary growth and lactation
Functions of the placenta in pregnancy?
- Respiration
- Nutrition
- Excretion (filter like a kidney)
- Endocrine
- Immunity
What happens to hCG levels during pregnancy?
hCG levels rise, roughly doubling every 24 hrs, until they plateau at weeks 8-12 then gradually fall.
Why is ALP raised in pregnancy?
Serum alkaline phosphatase activity increases in late pregnancy, due both to the production of the placental isoenzyme and to the increase in bone isoenzyme. Consequently, measurement of serum alkaline phosphatase levels is not a suitable test for the diagnosis of cholestasis during pregnancy.
