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