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Finals Revision - Last Min > Gynae > Flashcards

Gynae Flashcards

1
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)

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2
Q

If semen analysis abnormal?

A

Repeat in 3 months

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3
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)

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4
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

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5
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
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6
Q

CI and risks of depot?

A

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)
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7
Q

CI IUD?

A

CI:

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

IUS same but not peptic ulcer

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8
Q

Implant CI and interactions?

A

CI:

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

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

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9
Q

Why is injection contraceptive contraindicated 50+ y/o?

A

Osteoporosis

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10
Q

Unexplained vaginal bleeding is a CI for what contraceptives?

A

IUD/IUS

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11
Q

What contraceptives are preferred in epilepsy?

A

Depo, IUD or IUS

Lamotrigine:
- all bar COCP

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12
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

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13
Q

If a POP contains desorgestrel - missed pill?

A

12 hour window instead of 3 hour

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14
Q

How long after stopping COCP may women be amenorrhoeic?

A

3 months

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15
Q

CI for EllaOne (ullipristal)?

A

Asthma

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16
Q

Rx adenomyosis?

A

GnRH anologues

Hysterectomy

17
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

18
Q

CI for HRT?

A
  • current/past breast cancer
  • any oestrogen-sensitive cancer
  • undiagnosed vaginal bleeding
  • untreated endometrial hyperplasia
19
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

20
Q

FSH/LH in turner’s syndrome?

A

Raised

Primary gonadal dysgenesis

21
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
22
Q

3 components of RMI for ovarian cancer?

A

Menopausal status
CA125
USS findings

23
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

24
Q

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

A

6 months

25
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

26
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

27
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

Finals Revision - Last Min (12 decks)

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