Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Finals Revision > Gynae > Flashcards

Gynae Flashcards

1
Q

Benign ovarian tumours:

  • when should they be biopsied?
  • 2 physiological?
  • 1 germ cell?
  • 2 epithelial?
A

If complex/multi-loculated on USS

Physiological:

  • Follicular: commonest, non-rupture of dominant follicle or failure of atresia, regress after several cycles
  • Corpus luteum: failure to breakdown of corpus luteum, may fill with fluid/blood, more likely to cause intraperitoneal bleeding than follicular

Germ cell:
- Dermoid (mature): lined with epithelium, may contain hair and teeth. Most common ovarian tumour <30, usually asymptomatic but may cause torsion

Epithelial:

  • Serous cystadenoma: commonest benign epithelial tumour, bilateral in 20%
  • Mucinous cyst adenoma: second commonest, typically large and may become massive, can rupture to cause pseudomyxoma peritonei
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

How long after TOP can pregnancy tests remain positive?

A

4 weeks

If still positive at this point it suggests incomplete abortion or persistent trophoblast

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Investigations for heavy menstrual bleeding?

A

FBC in all women

If intermenstrual/postcoital bleeding, pain/pressure symptoms, or exam findings (e.g. bulky tender uterus suggesting adenomyosis), refer for routine TVUSS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Management of menorrhagia if requires contraception?

If doesn’t require contraception?

A

Requires contraception:

  1. Mirena
  2. COCP
  3. Long-acting progestogen (Depo-provera)

Doesn’t:
- Tranexamic acid or mefanamic acid (NSAID)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Subfertility primary care Ix?

A

Primary care:

  • chlamydia screen
  • Day 2-5 FSH/LH
  • TSH, PRL, testosterone and rubella Ig (vaccinate if not immune)
  • Mid-luteal progesterone (luteal phase always 14 days so 7 days before period due)
  • semen analysis: repeat in 3 months if abnormal - make lifestyle changes, start taking zinc, selenium and VitC supplements
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Subfertility secondary care Ix?

A

TVUSS - rule out masses, fibroids or polyps

Hyspetosalpingogram - dye injected and XR - confirm tubal patency (dye can cause tubal spasm -> false positive)

Laparoscopy and dye test gold standard - do if HSPG abnormal - pelvic pathology can be treated at the same time

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Semen analysis - what to look for?

A

Must be 3-5 days since last ejaculation and be at lab within an hour

Volume >1.5ml
pH >7.2
Conc >15 million/ml
>4% normal morphology
>32% motile
>58% live
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Key counselling points if couple struggling to conceive but <1 year?

A

Folic acid
BMI 20-25
Regular intercourse every 2-3 days
Smoking/drinking

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Management of endometriosis?

A

1st line - NSAIDs and/or paracetamol
2nd line - add in COCP

Secondary care:

  • GnRH analogues (lower oestrogen, induce ‘pseudomenopause’)
  • Surgery - laparoscopic excision and laser treatment of endometriotic ovarian cysts

(unfortunately drug treatment has very little impact on fertility)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Complications of hysterectomy with antero-posterior repair?

A
  • enterocoele
  • vaginal vault prolapse

Urinary retention may occur acutely following operation but not usually a chronic complication

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What happens during follicular phase?

A
  • Initial fall in oestrogen and progesterone triggering menstruation
  • steady increase in FSH and LH, and steady increase in oestrogen

FSH and LH complete first meiotic division to form secondary follicle

Oestrogen thins cervical mucus and stimulates endometrial thickening

As it nears completion, control of FSH/LH by oestrogen switches to positive feedback and there is a surge

  • LH - greatest and stimulates ovulation
  • FSH - occurs 12-36 huours after LH surge
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What happens during luteal phase?

A

Always 14 days
Fall in FSH, LH and oestrogen, increase in progesterone which increases endometrial glandular secretions and vascularity (preparing it for implantation)

If fertilisation doesn’t occur, corpus luteum degenerates and progesterone decreases

If fertilisation occurs, embrue produces hCG which maintains corpus luteum, which maintains endometrium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Causes of menorrhagia?

A

Obesity
Non-organic: DUB, contraception
Pregnancy (miscarriage, ectopic etc)
Systemic: hypothyroid, diabetes, adrenal disease, ITP, von Willebrand, renal, liver disease

Local:
PID, trauma, fibroids, IUD/IUS, cervical ectropion/polyps, cervical/endometrial malignancy, endometrial: hyperplaisia, endometriosis, adenomyosis, polyp

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is DUB?
Anovulatory?
Ovulatory?

A

Abnormal bleeding in the absence of any underlying pathology

Anovulatory:
Seen at extremes of fertility, assoc w irregular cycles - endometrium not being regularly shed so when bleeds happen they tend to be heavy

Ovulatory:
Poor quality egg and follicle which fails to produce enough progesterone, causing failure to fully shed endometrium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Ix DUB?

A

It is a diagnosis of exclusion

PV exam
FBC, TFT, LFT, coag
USS, hysteroscopy or endometrial sampling if Hx suggests

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Management of DUB?

A

Symptoms:

  • tranexamic acid - bleeding
  • mefanamic acid - pain
Periods:
1st - mirena
2nd - COCP
3rd - IM progestogens
4th - GnRH analogues/Danazol - dampen HPA axis and induce menopause

Surgical:
endometrial ablation
hysterectomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Primary/secondary amenorrhoea?

Causes of each?

A

Prim: no period by 15, or by 13 in girls with no secondary sex characteristics

  • imperforate hymen (normal developement)
  • Turner’s (short stature 45XO)
  • Testicular feminisation (female phenotype, male genotype)
  • anorexia, exercise etc

Secondary: cessation of periods for 3-6 months when previously normal, no pregnancy

  • Pregnancy, menopause
  • PCOS
  • drugs: withdrawal from COCP, recreational, steroids
  • stress, weight loss, over exercising, obesity
  • Kallman, Turner, Prader Willi
  • THYROID, renal, pituitary, haemochromatosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Causes of oligomenorrhoea?

A

PCOS
Menopause
Withdrawal from contraception, recreational, steroids
Stress, weight loss, exercise, obesity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Ix a/oligo-menorrhoea?

A

PREGNANCY
FSH, LH, oestrogen, progesterone, prolactin, TFT, U&E, coeliac

Low FSH/LH = pituitary cause
High = ovarian cause

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Rotterdam criteria?

A

Oligomenorrhoea and/or anovulation

Hyperandrogenism (acne, hirsutism, acanthosis nigricans)

Ovaries:
- 12+ follicles in each ovary (2-9mm diameter) or ovarian volume >10ml

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Tests to do for PCOS?

A

Normal amenorrhoea tests

Plus:

  • fasting glucose/OGTT
  • fasting lipids
  • pelvic USS
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Menegement PCOS hirsutism?

PCOS infertility?

A

General: Lifestyle & monitor for diabetes, HTN, hyperlipidaemia

Hirsutism:

  • COCP
  • topical eflornithine

Infertility:

  • weight reduction
  • Letrozole or Clomifene (stimulates ovulation)
  • Metformin
  • gonadotrophins
  • IVF
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Causes of intermenstrual bleeding?

A

Pregnancy
Hormonal contraception
Infection (chlamydia/PID)
Cervical (ectropion, polyps, carcinoma)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Causes of post-coital bleeding?

A

Vaginitis (any cause)
Infection (chlamydia)
Endometrial (carcinoma)
Cervical (ectropion, polyp, malignancy)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Causes of postmenopausal bleeding?

A 
Oestrogen withdrawal
Vaginal (atrophy, malignancy)
Cervical (polyp, malignancy)
Uterine (hyperplasia, malignancy, polyp, fibroid)
Ovarian (malignancy - theca cells)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Depot:

  • MOA? Length of cover?
  • Pearl?
  • CI?
  • Risks?
  • initiating?
A

Inhibits ovulation - provides cover for 12-14 weeks
Pearl index 0.3%

CI:

  • BREAST CANCER
  • cardiac disease
  • undiagnosed vaginal bleeding

Risks:

  • osteoporosis (avoid in young if possible)
  • weight gain
  • delay in return of fertility (10 months)
  • irregular bleeding (settles with time)

Cover with condoms unless <5 days of cycle or TOP, and <21 days post partum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Copper coil:

  • MOA? Length of cover?
  • Pearl?
  • CI?
  • Risks?
  • initiating?
A

Prevents fertilisation - can leave in for 5-10 years
Pearl 0.5%

CI:

  • peptic ulcer disease
  • PID
  • Abnormal uterine anatomy
  • endometrial/cervical cancer
  • Pregnancy - risk of ectopic

SE:

  • prolonged, heavy periods
  • pain, infection, uterine perforation

Initiating:

  • within first 7 days of period or up to 5 days after UPSI/ovulation
  • immediately after TOP
  • <2 days or >4 weeks post-partum
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Mirena:

  • MOA? Length of cover?
  • Pearl?
  • CI?
  • Risks?
  • initiating?
A

Prevents implantation
Can stay in for 5 years
Pear 0.2%

CI:
- same as IUD

Risks:
- irregular menstrual bleeding (usually becomes lighter with most becoming amenorrhoeic)

Initiating:

  • any time if not pregnant needs 7 days cover
  • <2 days or >4 weeks post-partum
  • Immediately after TOP
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Implant:

  • MOA? Length of cover?
  • Pearl?
  • CI?
  • interactions?
  • Risks?
  • initiating?
A

Inhibits ovulation
3 years
0.07

CI:

  • Breast cancer
  • IHD
  • unexplained vaginal bleeding
  • liver cirrhosis

Interactions:
Enzyme inducers like rifampicin, phenytoin; and obesity - need to change earlier

Problems:

  • Irregular bleeding
  • Headache, nausea, brest pain (progestogen effect)

Initiating:

  • No cover if <5 days of cycle, <21 days post-partum, <5 days post TOP
  • otherwise 7 days cover
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Transdermal patch:

  • regimen?
  • how many days off before efficacy lost?
  • Problems?
A

Patch applied for 1 week, 3 weeks in a row, then a week off (can be worn for 9 days max)

2 days

Obesity - reduced efficacy
Breast pain, nausea, painful periods
Thrombosis risk

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Vaginal ring:

- regimen?

A

Ring inserted for 21 days followed by 7 day ring free period

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

COCP

  • MOA?
  • initiating?
  • after emergency contraception?
  • Benefits?
A

inhibits ovulation

Starting:

  • <5 days no cover
  • > 5 days, 7 days cover
  • Can be started immediately after TOP, or 3 weeks post-partum if not breast feeding (CI in breast feeding)

Immediately after levonelle
5 days after EllaOne

Benefits:

  • improves acne
  • improves premenstrual symptoms
  • protects against ovarian, endometrial and colorectal cancer
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

SE of COCP?

A

Minor:
- increased BP, mood swings, N&V

Major:

  • Increased VTE risk (>35, smoking, immobility, long haul, puerperium, high altitude >1 week)
  • Increased CVD risk
  • Increased risk of breast and cervical cancer
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

What are the absolute CI for COCP?

A 
>35 smoking 15 a day
Migraine with aura
Hx VTE or IHD/stroke
Breastfeeding 
<6 weeks puerperium
HTN >160/110
Current breast cancer
Major surgery with prolonged immobilisation
Antiphospholipid syndrome
Liver cirrhosis/cancer
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

COCP missed pills?

Illness?

A

1 missed, <48 hours - take the missed pill and carry on (even if it means 2 in a day)

2+ missed - take the most recent pill (even if it means 2 in a day), disregard other previous ones, continue with pack

If missed in:

  • day 1-7: 7 days cover and emergency contraception
  • day 8-14: if pills are missed after 7 consecutive days of contraception then no EC needed*
  • day 15-21: finish pills in current pack and omit pill free interval

*(theoretically could take 7 days on 7 days off with no issue)

illness:

  • vomiting <2 hours - take again
  • Take again it more than 24 hours of diarrhoea
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

POP:

  • MOA?
  • Initiation?
  • CI?
  • SE?
  • when is it generally used?
A

Inhibits ovulation and thickens cervical mucus

Initiating:

  • immediate protection if <5 days
  • 2 days protection if >5 days
  • immediate protection if going straight on from day 21 of COCP

CI:
- breast cancer

SE:
- irregular bleeding, headaches

Generally used when COCP CI (e.g. breast feeding, >35 and smoking)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

POP:

  • missed pills?
  • illness?
  • interactions?
A

Take at same time every day - no pill free break

If <3 hours late, no cover
If >3 hours late, take missed pill ASAP and cover for 2 days

P450 inducers reduce effectiveness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Levonelle:

  • what is it? MOA?
  • timing and how many times per cycle?
  • vomiting?
  • Efficacy?
  • Cautions?
  • starting hormonal contraceptives afterwards?
A

Levonorgestrel - high dose progesterone - inhibits ovulation and stops implantation

Up to 3 days after UPSI, many times per cycle

Take again if vomit within 2 hours

84% effective in 72 hours

Obesity, enzyme inducers

Can start contraceptives immediately

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Why is injection contraceptive contraindicated 50+ y/o?

A

Osteoporosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Are progestogen-only contraceptives safe alongside HRT?

A

yes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

What contraceptive is the only one capable of being part of HRT?

A

Mirena

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

Male patient on anti androgen treatment such as GnRH analogues (goserilin), oestradiol, finasteride, cyproterone - does he need contraception?

A

Yes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

Unexplained vaginal bleeding is a CI for what contraceptives?

A

IUS and IUD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

How long are Kyleena and Jaydess effective for?

A

Jaydess - 3 years

Kyleena - 5 years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

Is age a CI for any contraceptive?

A

Usually no - apart from

> 35 and smoking 15/day CI for COCP

> 40 UKMEC 2 for COCP

> 45 UKMEC 2 for depo

STOP injectable contraceptive 50+, osteoporosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

Why might COCP be used in perimenopausal women?

A

Contraceptive, helps maintain bone mineral density, may help reduce menopausal symptoms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

What contraceptives are preferred in epilepsy?

A

Depo, IUD or IUS

Lamotrigine:
- all bar COCP

48
Q

POP post-partum?

A

Start from 21 days, barrier for 2 days

49
Q

COCP post-partum?

A

NOT <6 weeks if breastfeeding

CAN give >6 weeks, even if breastfeeding (UKMEC 2), although it can reduce breast milk production

If not breastfeeding, can start from day 21

If on day 21, immediate contraception

If after day 21, barrier for 7 days

50
Q

When can IUS/IUD be inserted post-partum?

A

<2 days or >4 weeks

51
Q

Lactational amenorrhoea as contraception?

A

98% effective in first 6 months providing fully breastfeeding with no supplementation and remains amenorrhoeic

52
Q

Contraception for a woman taking testosterone to become a man?

A

Cu IUD, condoms, or any progesterone-only contraception

53
Q

IUD/IUS and ectopics?

A

The proportion of penalties that are ectopic is increased

BUT the absolute number of ectopics is reduced compared to a woman not using contraception

54
Q

If breastfeeding - hormonal emergency contraceptive?

A

Levonelle preferred as ullipristal requires you to take a break from breastfeeding for a week

55
Q

Levonelle in obesity?

A

Double dose

56
Q

If vomiting within 3 hours of taking emergency contraceptive?

A

Repeat dose

57
Q

If a POP contains desorgestrel - missed pill?

A

12 hour window instead of 3 hour

58
Q

How long after stopping COCP are women amenorrhoeic?

A

Up to 3 months

59
Q

COCP and surgery?

A

Stop 4 weeks before, restart 2 weeks after

POP may be used

60
Q

EllaOne:

  • what is it? MOA?
  • When can it be used?
  • How many times per cycle?
  • CI?
  • starting contraceptives?
  • breastfeeding?
A

Ullipristal acetate - progesterone receptor modulator, inhibits ovulation

Up to 5 days post intercourse

> 1 time

Asthma

Restart contraceptives 5 days after

Take a 1 week break in breastfeeding

61
Q

Cu-IUD as an emergency contraceptive:

  • when?
  • what may be given at the same time?
A

up to 5 days post-UPSI
OR
>5 days if <5 days post expected ovulation

Prophylactic abx if at risk of STI

62
Q

Changes in circulating oestrogen post-menopause?

A

E2 levels reduced as mainly made from theca cells in ovaries

E1 proportion increases, produced by adipose/adrenals

63
Q

Long term complications of menopause?

A

Osteoporosis

Increased risk of cardiovascular and cerebrovascular disease

64
Q

What is adenomyosis?
Features?
Ix?
Management?

A

Presence of endometrium in myometrium

Dysmenorrhoea
Menorrhagia
enlarged, boggy uterus

Ix: MRI

Rx:

  • GnRH analogues
  • Hysterectomy
65
Q 
General advice for menopause?
Non-HRT symptomatic relief options for:
- vasomotor symptoms?
- vaginal dryness?
- psychological?
A

Weight loss, smoking cessation, complementary therapies

Vasomotor: fluoxetine, citalopram, velafaxine, clonidine

Vaginal dryness:

  • topical oestrogen (can be used alongside HRT)
  • vaginal lubricant or moisturiser

Psych: CBT, antidepressants, self-help

66
Q

When should perimenopausal women be referred to secondary care?

A

Inability to control symptoms

ongoing side effects

Unexplained vaginal bleeding

67
Q

Contraindications for HRT?

A
  • current/past breast cancer
  • any oestrogen-sensitive cancer
  • undiagnosed vaginal bleeding
  • untreated endometrial hyperplasia
68
Q

Sequential HRT: who, regimen and time limit?

A

Used in perimenopausal women with a uterus

Give oestrogen for 28 days and progesterone for last 14

Used for a maximum of 2 years

69
Q

Continuous HRT: who?

A

Used in postmenopausal women with a womb, or peri- who have used sequential for 2 years already

70
Q

First line for perimenopausal women who want a bleed free HRT regimen?

A

Oestrogen only + mirena

71
Q

Risks of HRT:

  • VTE?
  • Stroke?
  • Endometrial Ca?
  • Ovarian Ca?
  • CVD?
  • Dementia?
A

VTE: higher risk in all but highest in combined and in first year of treatment. Lowered with exercise and transdermal application

Stroke: higher is in all, no difference between regimens

Endometrial: Only in women with uterus, higher in sequential but eliminated by continuous

Ovarian: Small increased risk with all, eliminated when stopped

CVD: increased risk of combined started >10 years after menopause

Dementia: Increased risk of alzheimers if started over the age of 50

72
Q 
What is premature ovarian failure?
Most common cause?
Causes of primary ovarian failure:
- autoimmune?
- chromosomal?
- other?
A

Menopause <45 years old

Idiopathic - most common, often familial

Primary ovarian failure:
- autoimmune - hypothyroidism, addisons, diabetes, SLE, RA

  • chromosomal - turners, down’s
  • other - resistant ovary syndrome (FSH resistance)
73
Q

Causes of secondary ovarian failure:

  • drug-induced?
  • surgical?
  • infective?
A

Chemo/Radiotherapy

Bilateral oophorectomy

TB/Mumps

74
Q

Features of premature ovarian failure?
Tests?
Management?

A

Same as menopause - hot flushes, night sweats, infertility

Tests:

  • FSH and LH >40 on 2 occasions 6 weeks apart
  • Oestradiol <100

Management:
<52: HRT or COCP
>52: HRT
Hormone replacement essential to reduce risk of long term complications

75
Q

If IUD in situ whilst pregnant?

A

Remove after 12 weeks

76
Q 
Presentation of ectopic?
Findings on exam?
What not to do?
Where are they usually?
Potential natural histories?
A

Pelvic/abdo pain, bleeding, shoulder tip pain or pain on urination/defaecation (if peritoneal bleeding)

Abdo tenderness
Cervical excitation

DO NOT feel for adnexal mass if suspecting ectopic - risk of rupture

Most common in ampulla
Highest risk of rupture in isthmus
3% in ovary, cervix or peritoneum

Tubal abortion
Tubal absorption
Tubal rupture

77
Q

Ix for ectopic?

A

PREGNANCY TEST

TVUSS

78
Q

Criteria for management of ectopics:

  • expectant?
  • medical?
  • surgical?
A

Expectant:

  • size <35mm, asymptomatic, no heart beat
  • hCG <1000
  • if another intrauterine pregnancy
  • measure bHCG 48 hours later, and if rise or symptoms manifest then intervention performed

Medical:

  • size <35mm, no heart beat, no significant pain
  • hCG <1500
  • NOT if another intrauterine pregnancy
  • give the patient methotrexate, and must be willing to attend follow up

Surgical:

  • if above conditions not met
  • hCG >1500
  • If another intrauterine pregnancy
  • salpingectomy or salpingotomy
79
Q

Complete and partial mole?
Management?
How long before getting pregnant?

A

Complete: sperm duplicates in an empty egg - diploid but no foetal parts

Partial: haploid egg fertilised by 2 sperm, or 1 sperm which duplicates - triploid, has foetal parts

Surgical evacuation of uterus and follow up hCG testing

DO NOT get pregnant for 12 months

80
Q

Bleeding in first trimester if:

  • <6 weeks?
  • 6+ weeks or uncertain gestation?
A

If NO PAIN, then manage expectantly and repeat pregnancy test in 7-10 days. Return if pain and if pregnancy test still positive
If negative, miscarriage.

If 6+ weeks or uncertain gestation, refer to EPAU

81
Q

What is primary and secondary dysmenorrhoea?

Management of each?

A

Primary:
- pain begins hours before of after bleeding with period. Suprapubic cramping which can radiate to thighs
- usually begins within 1-2 years of menarche
Rx:
1. Ibuprofen/mefanamic acid
2. COCP

Secondary:

  • develops many years after menarche
  • pain starts 3-4 days before bleeding
  • causes: adenomyosis, endometriosis, PID, Cu-IUD, fibroids
  • Refer to gynae
82
Q

FSH/LH in turner’s syndrome?

A

Raised

Primary gonadal dysgenesis

83
Q

What happens in ovarian hyper stimulation syndrome?

A

Multiple cysts form, causes systemic leaky capillaries with fluid shifting into extravascular space. This results in vomiting, diarrhoea, ascites etc

Comps: hypovolaemic shock, AKI, venous/arterial thrombosis

Management:

  • fluid and electrolyte replacement
  • anticoagulation
  • ascites paracentesis
  • TOP to prevent further hormonal imbalance
84
Q

How often should HIV+ women have cervical smears?

A

Annually

85
Q

Woman who gets bloating, spasmodic iliac fossa pain and some constipation around periods?

A

IBS

Abdo pain, bloating, change in bowel habits

86
Q

5 female factors which warrant early referral to infertility clinic?
5 male factors?

A

Female:

  • age >35
  • amenorrhoea
  • previous pelvic surgery
  • previous STI
  • abnormal genital examination

Male:

  • previous surgery on genitalia
  • previous STI
  • varicocele
  • significant systemic illness
  • abnormal genital exam
87
Q

When should you not do expectant management for miscarriage?

A
  • Increased risk of haemorrhage (e.g. coagulopathy, unable to have transfusion)
  • Previous adverse/traumatic experience with it
  • Infection
88
Q

3 components of RMI for ovarian cancer?

A

Menopausal status
CA125
USS findings

89
Q

How do clomifene and metformin work in PCOS in helping fertility?

A

Clomifene - SERM that causes GnRH release from hypothalamus thus increasing LH/FSH

Metforming - insulin resistance causes hyperinsulinaemia thus hyperandrogenism which arrests antral follicular development. Treats insulin resistance

90
Q

Woman due a smear when pregnant?

A

Reschedule until at least 3 months post-delivery

91
Q

Initial investigations for urinary incontinence?
If they have post-void symptoms (feeling of incomplete emptying)?
If unsure what type of incontinence?

A
  • bladder diary 3 days
  • pelvic exam to exclude prolapse and pelvic floor muscle weakness
    (remember neuro exam S2-S4!!!)
  • Urinalysis

Post-void:
- post-void residual

If unsure what type:
- urodynamic studies

Cystoscopy may also be used

92
Q

Management when urge incontinence is predominant?

A
  1. bladder retraining at least 6 weeks
  2. Antimuscarinics (oxybutinin, darifenacin, tolterodine)
  3. Mirabegron
  4. Botox

(desmopressin for nocturia)

93
Q

Management when stress incontinence is predominant?

A
  1. Pelvic floor exercises for at least 3 months, incontinence ring
  2. vaginal oestrogen (if post-menopausal)
  3. Surgical - colposuspension/fascial sling
  4. duloxetine - if deny surgery
94
Q

If someone has treatment for CIN when should their next smear be?

A

6 months later

95
Q

52 y/o woman has been amenorrhoeic for 3.5 years (since 3 months after her Mirena coil insertion) and presents with 3 days vaginal bleeding and 2 episodes of postcoital bleeding. Management?

A

Refer to PMB clinic for USS/endometrial biopsy

96
Q

Woman shows up for cervical screening but has symptoms of intermenstrual bleeding and postcoital bleeding for the past 2 months - what should you do?

A

Don’t do smear, refer straight to gynae (not colposcopy)

Screening is for asymptomatic patients

97
Q

Causes of overflow incontinence in women?

A

Nerve damage (diabetes, alcoholism, surgery)

Neoplasm

98
Q

Why does PCOS increase risk of endometrial cancer?

A

oligo/a-menorrhoea with pre-menopausal levels of oestrogen promotes hyperplasia

99
Q

Diagnostic criteria for hyperemesis?

A
  • 5% pre-pregnancy weight loss
  • dehydration
  • electrolyte disturbance
100
Q

Chlamydia type of bacteria?
Ix?
Rx?

A

Gm -ve intracellular

M: MSSU
F: swab
for PCR/NAAT

Rx: Doxy 1 week
or Azith 1g 1 dose if pregnant

101
Q

Gonorrhoea bacteria type?
Ix?
Rx?

A

Gv -ve diplococci

M: MSSU
F: swab
for PCR/NAAT

Rx: 1g Ceftriaxone IM

102
Q

Genital herpes Ix?
Rx?
If pregnant/labour?

A

Swab base of ulcer for PCR (50% HSV1 and HSV2)

Rx: analgesia and aciclovir

Pregnant - risk of 1st trimester miscarriage
Labour - C section

103
Q

Trichomonas features?

Rx?

A

Frothy green discharge
Itch
Strawberry cervix

Metronidazole

104
Q

Cause of genital warts?

Management?

A

HPV 6-11

Raised, pale, roughened lesions

If solitary and keritanised - cryotherapy
If multiple or non-keratinised - topical podophyllum

105
Q

Crabs - features?

Rx?

A

Parasitic infection
Itch, visible eggs

Malathion

106
Q

Features of thrush?

Rx?

A

M: spotty white balanitis
F: thick white discharge, intense itch, white spots on cervix

M & F - swab

Rx: clotrimazole

107
Q

Bacterial vaginosis features?

Rx?

A

Fishy discharge
Clue cells

Metronidazole

108
Q

Syphilis tests?

What stays positive and what stays negative?

A

Cardiolipin tests - RPR or VLDR
Test for non-specific antibody to cardiolipin
(false positive in APS, pregnancy etc)

Treponema specific antibody - TPHA

After treatment:
VLDR/RPR - are negative
TPHA - remain positive

109
Q

Pt gets penicillin for syphillis and comes out in a rash a few hours later with fever and tachycardia?

A

Jarish-Herxheimer reaction
No wheeze or hypotension

Rx: paracetamol

Due to release of endotoxins from dying bacteria

110
Q

Management if initial infertility investigations reveal mild endometriosis, mild male factor infertility or unexplained?

A

Try for another year

111
Q

Ix for suspected vesicovaginal fistula?

A

Urinary dye studies

112
Q

Premenstrual syndrome:

  • what is it?
  • how is it managed (mild, mod severe)?
A

Anxiety, stress, fatigue, mood swings, bloating and breast pain - comes on in luteal phase of cycle and stops just before menstruation

Mild - lifestyle with frequent small meals with complex carbs

Mod - COCP continuously

Severe - SSRI taken continuously or just during luteal phase

113
Q

Management of endometrial hyperplasia if simple without nuclear atypic?
If any other type?

A

High dose progestogens with repeat sampling in 3-4 months, IUS may be used

Any others - Hysterectomy with BSO

114
Q

Most common complications of TOP?

A

Infection - 10%

Haemorrhage (1%), most likely >20 weeks gestation

Retained tissue (1%)

Failure (1%)

Cervical injury (1%)

115
Q

At what CD4+ level should people receive Co-trimoxazole for pneumocystis prophylaxis in HIV?

A

200

Finals Revision (29 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions