GOSH 3 Flashcards
How soon before urodynamic tests should patients stop taking any anticholinergic and bladder related medications?
5 days before
What investigation measures the detrusor muscle contraction and pressure?
Cystometry
I.e. cystometry measures the contractile force of the bladder when voiding
What outcome measures are taken in urodynamic tests?
(4)
1) Cystometry –> detrusor muscle contraction
2) Uroflowmetry –> flow rate
3) Post-voidal bladder volume –> incomplete emptying (w/ bladder scan)
4) Leak point pressure
What happens in urodynamic tests?
A thin catheter is inserted into the bladder, and another into the rectum. These two catheters can measure the pressures in the bladder and rectum for comparison.
The bladder is filled with liquid, and various outcome measures are taken.
How long must pelvic floor exercises be done before considering surgery in stress incontinence?
3 months (and must be supervised)
Stepwise management of urge incontinence (and overactive bladder)?
1) Bladder retraining
2) Anticholinergics e.g. oxybutynin, solfenacin
3) Mirabegron
4) Surgery e.g. botulinum toxin injection
What is an alternative to anticholinergic medications used in urge incontinence?
Mirabegron
What must be monitired regularly during treatment with mirabegron?
BP (can cause HTN)
What type of incontinence can Botulinum injection be used in?
Urge incontinence
What is leak point pressure?
The point at which the bladder pressure results in leakage of urine. The patient is asked to cough, move or jump when the bladder is filled to various capacities.
This assesses for stress incontinence.
How are the strength of the pelvic muscle contractions graded?
Oxford grading system
What system is used to grade uterine prolapses?
Pelvic organ prolapse quantification (POP-Q)
What is the most important investigation in bleeding in the 1st trimester?
TV US
Describe the 4 stages of ovarian cancer
Stage 1 Tumour confined to ovary
Stage 2 Tumour outside ovary but within pelvis
Stage 3 Tumour outside pelvic but within abdomen
Stage 4 Distant metastasis
What is the treatment of choice for stage I and II endometrial carcinoma?
Total abdominal hysterectomy with bilateral salpingo-oophorectomy
What is the cut off for Hb levels for for oral iron therapy in pregnancy:
a) 1st trimester
b) 2nd/3rd trimester
c) postpartum
a) <110 g/L
b) <105 g/L
cc) <100 g/L
How long should treatment of anaemia with oral ferrous sulphate be continued for after iron deficiency is corrected?
3 months, to allow iron stores to be replenished
When can a miscarriage be confirmed on an US? (2)
No cardiac activity PLUS:
1) Crown rump length is >7mm
OR
2) Gestational sac is >25mm
What is hCG secreted by in pregnancy?
The syncytiotrophoblasts
Is cervical screening indicated for lesbians/bisexual women?
Yes - as HPV can be transmitted during genital contact or oral sex.
What is the treatment for vaginal vault prolapse?
Sacrocolpoplexy –> this procedure suspends the vaginal apex to the sacral promontory.
How long does the implant take to become effective?
7 days (unless inserted on day 1-5 of cycle)
How long does the IUS take to become effective?
7 days
Why should cooked liver or pate be avoided in pregnancy?
Due to vitamin A
When should women with uncomplicated, multiple pregnancies avoid flying?
Once >32 weeks
How many years from start of puberty do menstrual periods typically begin?
2 years
At what age is 1ary amenorrhoea defined where there are other signs of puberty, such as breast bud development?
15 y/o
Inheritance of congenital adrenal hyperplasia?
Autosomal recessive
At what age is 1ary amenorrhoea defined when there is NO other evidence of pubertal development?
13 y/o
Which hormones are OVERPRODUCED in congenital adrenal hyperplasia?
Androgen
What 2 features are seen in Kallman syndrome?
1) delayed puberty
2) anosmia
What hormonal blood tests can be done in 1ary amenorrhoea?
1) FSH/LH
2) Testosterone
3) IGF-1
4) prolactin
5) TFTs
Is Kallman syndrome associated with hypo- or hypergonadotrophic hypogonadism?
Hypo
In milder cases, when will congenital adrenal hyperplasia present?
What symptoms?
Female patients can present later in childhood or at puberty with typical features:
- tall for age
- deep voice
- hirsutism
- 1ary amenorrhoea
- early puberty
How does hyperprolactinaemia cause amenorrhoea?
Raised prolactin PREVENTS release of GnRH which prevents the release of LH/FSH.
define 2ary amenorrhoea
no menstruation for more than 3 months after previous regular menstrual periods
What does a raised testosterone in amenorhoea indicate?
(3)
1) PCOS
2) Androgen insensitivity syndrome
3) Congenital adrenal hyperplasia
Tests in 2ary amenorrhoea?
1) hCG (rule out pregnancy)
2) LH:FSH ratio
3) TFTs
4) Prolactin level
5) Testosterone
What can be used to stimulate a withdrawal bleed in women with PCOS?
(2)
1) Regular use of COCP
2) Medroxyprogesterone for 14 days
In severe cases of congenital adrenal hyperplasia, how will the neonate present?
Neonate is unwell shortly after birth, with electrolyte disturbances and hypoglycaemia.
When do women with amenorrhoea require management to reduce risk of osteoporosis?
> 12 months
What is premenstrual dysphoric disorder
Severe PMS –> impact on quality of life
What type of fibroids require a hysteroscopy to look at?
Submucosal
COCPs containing what are recommended 1st line in PMS?
Drosperinone (antimineralocorticoid)
How much blood do women lose (on average) during menstruation?
40ml
What can be used to treat the physical symptoms of PMS, such as breast swelling, water retention and bloating?
Spironolactone
Imaging in possible Kallman syndrome?
MRI –> assess for olfactory bulbs
What ml is defined as exessive menstrual blood loss?
> 80ml
What can be given for cyclical breast pain in PMS?
(2)
1) Danazole
2) Tamoxifen
These will be given under specialist guidance.
What dose of folic acid is required in pregnancy in pre-existing diabetes?
folic acid 5 mg/day from pre-conception to 12 weeks gestation
Mx of a suspected PE in a pregnant woman with a confirmed DVT?
Treat with LMWH immediately
Then get a CTPA to rule in/out
When should absent foetal movements be referred?
If fetal movements have not yet been felt by 24 weeks, referral should be made to a maternal fetal medicine unit
What is acute fatty liver of pregnancy?
A rare complication which may occur in the 3rd trimester or the period immediately following delivery.
Features of acute fatty liver of pregnancy?
- abdominal pain
- nausea & vomiting
- headache
- jaundice
- hypoglycaemia
- severe disease may result in pre-eclampsia
Mx of ovarian tumours which are stage 2-4?
Treated primarily by surgical excision of the tumour.
Mx of pregnant women who are <6 weeks gestation and present with vaginal bleeding and no pain?
Manage expectantly, advise to repeat pregnancy test in 7 days.
If negative - confirm miscarriage
If positive, or continued or worsening symptoms - refer to early pregnancy assessment unit.
What type of anaemia can phenytoin cause?
Macrocytic, megaloblastic (due to folic acid deficiency)
Mx of all patients with 2ary dysmenorrhoea?
All patients with 2ary dysmenorrhoea need to be referred to gynaecology for investigation
When should a category 2 c-section occur?
Within 75 minutes of making the decision
What is the most important investigation in bleeding in the 1st trimester?
TV US
When should you only expect the fundal height to increase by 1cm a week?
After 24 weeks gestation
The ABSENCE of what on a swab from the vagina or endocervix EXCLUDES a diagnosis of PID?
Pus cells
The rupture of what type of cyst can cause pseudomyxoma peritonei?
Mucinous cystadenoma