Gynae Flashcards
1
Q
Risk factors for ovarian cancer
A
all related to an increase in ovulation: old clomifene early menarche late menopause no/low pregnancy
2
Q
red degeneration of fibroid summary
A
most common in second and third trimester due to fibroid rapidly outgrowing blood supply and uterus changing shape. fibroids grown under oestrogen
3
Q
red degeneration of fibroid presentation
A
pregnant, severe abdo pain, fever, tachycardia, vomiting. History of menorrhagia/diffuclty conceiving (fibroids)
4
Q
during which trimester is placental abruption most common
A
third
5
Q
when is the first trimester
A
1-12 weeks
6
Q
when is the second trimester
A
13-27 weeks
7
Q
when is the thrid trimester
A
28-end
8
Q
management of PID
A
start antibiotics immediately (doxycycline, metronidazole and IM ceftriaxone)
In mild PID IUD can be left it.
9
Q
risks of PID
A
Fitz-Hugh Curtis syndrome (perihepatitis) infertility chronic pelvic pain (not dysparunia) ectopic pregnancy hydrosalpinx (fluid in fallopian tubes) tubo-ovarian abscesses
10
Q
When should nitrofuratonin be avoided in pregnancy
A
3rd trimester as risk of haemolytic anaemia in neonate with G6PD deficiency
11
Q
When should trimethoprim be avoided in prenancy
A
1st trimester as it is a folate antagonist
12
Q
when should sulfonamides be avoided in pregnancy
A
3rd trimester associated with kernicterus
13
Q
how long should pelvic floor exercises for stress incontenence be used
A
3 months
14
Q
what drug for stress incontinence
A
duloxetine (SNRI)
15
Q
What can cause raised CA125
A
loads breast cancer ovarian cancer ovarian torsion endometrial cancer liver disease metastatic lung cancer adenomyosis ascites endometriosis menstruation
16
Q
what is adenomyosis
A
presence of endometrial tissue within the myometrium, it is more common in multiparous women towards the end of their reproductive years
17
Q
features of adenomyosis
A
dysmenorrhoea menorrhagia enlarged uterus Management: GnRH agonists hysterectomy
18
Q
GnRH agonist functions
A
decrease LH, FSH release and hence lower sex hormones
GnRH is usually released in PULSATILE fashion hence why this works
19
Q
Treatment for fibroids
A
Reduce oestrogen to reduce mirena coil first line for <3cm OCP for les than 3cm endometrial ablation <3cm GnRH given to shrink before surgery (myomectomy) uterine artery embolisation for large
20
Q
What would indicate admission for a patient with PID
A
temp >38 as indicates severe infection
21
Q
How long should endometriosis pain be present to diagnose
A
over 6 months (can be continous pain not always cyclical)
Chronic pelvic pain has to be 6 months!
22
Q
Treatment of endometriosis
A
NSAIDs/paracetamol first line
OCP (unless contraindicated)
progesterone only contraception
late can try GnRH analouges
23
Q
Risk factors for ectopic pregnancy
A
smoking multiple sexual partners use of IUD prior fallopian surgery infertility and using IVF age <18 first sexual intercourse black race age >35 PID
24
Q
How is haemorrhagic ovarian cyst managed
A
Admit to hospital, they will have marked tenderness
25
What would indicate ovarian torsion
low abdo pain, tenderness, vomiting, peritonism, fever
26
Risk factors for IUGR
maternal age <16 or >35
low BMI
high BMI
interpregnancy interval <6 or >120 months
27
when should antibiotics be given form PPROM
10 days following or until woman is in labour
28
Causes of recurrent miscarriage
```
antiphospholipid syndrome
endocrine disorders: poorly controlled diabetes mellitus/thyroid disorders.
Polycystic ovarian syndrome
uterine abnormality: e.g. uterine septum
parental chromosomal abnormalities
smoking
```
29
What is the role of HCG
Prevent the breakdown of the corpus luteum
30
How often do HCG levels double during pregnancy
every 48 hours for the first few weeks
31
When do HCG levels peak
8-10 weeks
32
Signs of hydatiform mole
vaginal bleeding
uterus size greater than expected for gestational age
abnormally high hCG
snow storm appearance on ultrasound
33
What would point towards an ectopic in pregnancy of unknown location
bHCG>1500
34
Should you examine for an adnexal mass for ectopic
NO you might rupture it.
| A pelvic examination for cervical excitation is recommended as this indicates ectopic
35
How many weeks does an ectopic pregnancy present
6-8 weeks, if >10 weeks likely another cause e.g. inevitable abortion
36
Placental abruption presentation
mild or no vaginal bleeding PAIN, woody uterus
37
RF ffor placental abruption
hypertension IUGR, cocaine, multiparity, increasing age
38
presentation of praevia
red profuse blood, painless, shock consistent with loss
39
rf for vte in pregnancy
factor v leiden deficiency/thrombophilia
multiple pregnancy
pre-eclampsia
40
When are heart pulsations visible
six weeks
41
what is the fetal pole
a thick area alongside the yolk sac
42
when is the insertion of the placenta visivle
12 weeks
43
what is the gold standard test for endometriosis
laproscopy
44
Risk factors for GBS infection
maternal pyrexia
prematurity
previous sibling GBS
prolonged rupture of membranes
45
signs/symptoms of cervical cancer
```
postcoital bleeding
purulent discharge
red brown discharge
age 45-49
smoker
multiple sexual partners
```
46
features of BV
fishy odour
| grey-white discharge
47
what colour is the discharge from trichomonas
green
48
what colour would chlamydia discharge be if present
yellow
49
rf for placenta praevia
```
>40 yrs
multiple pregnancy
high parity
previous praevia
previous uterine surgery
```
50
presentation of vasa praevia
presents at rupture of membranes
painless bleeding
acute foetal compromise
51
what is contraindicated in vasa praevia and placenta praevia
digital vaginal examination (risk rupturing)
52
which hormonn initially produced by the corpus luteum causes stromal hypertrophy and increased blood supply to the endometrium
progesterone
53
Causes of polyhydraminos
```
idiopathic (most common)
macrosomia
maternal diabetes
structural deformities of foetus
viral infection
```
54
what is first-line treatment for symptomatic uterine fibroids
levonorgestral IUD
second line - tranexamic acid, OCP
myomectomy
55
What are the Rotterdam criteria for PCOS
1. 12 or more follicles or increased ovarian volume >10
2. oligo-ovulation or anovulation
3. clinical signs of hyperandrogenism
56
How metformin help in PCOS
appetite reduction
decreased androgen production
decreases LH from the anterior pituitary
decreases sex-hormone binding globulin in the liver
57
Fluid choice for correcting dehydration in DKA
saline with 20mmol potassium chloride
58
Clinical features of pre-eclampsia
```
epigastric pain
facial oedema
hypertension
proteinurea
papilloedema
hyperreflexia (due to raised ICP)
```
59
what test detects feto-maternal haemorrhage is suspected sensitising event
Kleinhauer test
60
what is a normal fetal baseline rate
110-160
61
what should variability be
5-25
62
how long should contraception be used for after menopause
2 years after last period if under 50
| 1 year after period if over 50
63
when can HRT with unopposed oestrogen be used
when had hysterectomy
64
what age would you be sent for mammogram
over 35, if under then USS
65
what is the most common type of breast cancer
invasive ductal carcinoma in situ.
| begins in milk ducts - fixed in position, hard and irregular
66
causes of fetal hydrops
(abnormal accumulation of serous fluid in 2+ fetal compartments) (fetal anaemia)
IMMUNE - blood group incompatibility causing fetal anaemia
NON-IMMUNE:
congenital parvovirus B19
alpha thalassaemia
cardiac abnormalities
trisomy 13, 18, 21 or turners
infection (toxoplasmosis, rubella, CMV, varicella)
twin-twin transfusion
chorioangioma
67
commonest cause of anaemia in pregnancy
iron deficiency
68
risk factors for developing pre-eclampsia
```
High BMI
maternal antiphospholipid syndrome
multiple pregnancy
pre-eclampsia in previous pregnancy
>10 years between births
```
69
first line treatment for heavy menstrual bleeding
intrauterine system
then COCP
progesterone only/tranexamic acid
endometrial ablation
70
risk factors for obstetric cholestasis
hep C infection
multiple preganncy
obstetric cholestasis in previous pregnancy
gallstones
71
when is external cephalic version offered
36 weeks if nulliparous
| 37 weeks if multiparous
72
first line management for seizure control in pregnancy
magnesium sulphate
| diazepam second line
73
risk factors for placenta accreta
```
IVF
>35 years
previous C section
previous uterine surgery
(think any surgical cause)
```
74
severity of placental adhesion
placenta accreta - attach to myometrium
placenta increta - deep into myometrium
placenta percreta - into peritoneum
75
what blood results see in premature ovarian failure
high FSH and LH as there is no negative feedback from ovaries
76
what is first degree tear
skin only
77
what is second degree tear
fascia and muscles of perineum
78
what is third degree tear A
fascia muscles and <50% of external anal sphincter
79
what is third degree tear B
fascia and muscles and >50% of external anal sphincter
80
what is third degree tear C
fascia and muscles and internal and external sphincter
81
which nerve roots are affected in Erb's palsy
C5 and C6
82
what is the treatment of choice for TOP <9 weeks
mifepristone and misoprostol
83
what is the treatment of choice for TOP >9 weeks
surigcal dilation and suction
| If >15 weeks induce mini labour
84
why is lactic dehydrogenase raise in HELLP
haemolysis
85
rf for placenta praevia
increased age
ivf
maternal smoking
previous c section
86
features of ovarian neoplasms
```
hirsutism due to testosterone secretion
acute abdomen due to torsion
rupture or haemorrhage
thyrotoxicosis
amenorrhoea
```
87
what is haematocolpos
accumulation of blood in the vagina e.g. imperforate hymen
88
what is ovarian hyperthecosis
accounts for most cases of hyperandrogenaemia in postmenopausal women.
Presence of leutenised theca cells in ovarian stroma
testosterone levels are much higher than in PCOS
89
indications/management of peurperal psychosis
poor interaction with baby (very unusual even in post natal depression)
talking in an incoherent fashion
saying baby has been brought into a bad world
psychotic delusions
URGENT HOSPITAL ADMISSION
90
how long after sex can take levonogestrel emergency contraceptive
72 hours
91
how long to take ulipristal acetate after sex
120 hours
92
how long to take copper coil after sex
5-7 days
93
complications of c section
increased abdo pain
hysteractomy
bladder/ureteric injury
VTE
94
decreased complications of c section
perineal pain
urinary incontinence
uterovaginal prolapse
95
blood results in hyperemesis gravidum
raised haematocrit FBC
raised transaminases and low albumin LFT
low potassium and sodium and metabolic hypochloremic alkalosis in U&Es
ketones in urine
96
what defect is sodium valproate most associated with in pregnancy
hypospadiasis
| also: spina bifida, ASD, cleft palate and polydactyly
97
marfans mode of inheritance
autosomal dominant
98
antibiotic for PPROM
oral erythromycin 10 days
99
group B strep treatment
iv benpen in labour
100
rf for ectopic preganncy
think anything that could slow passage of ovum (scarring etc)
POP (slows passage of ovum)
endometriosis
101
investigation for ovarian cancer
CA125
abdominal US
then CT
