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Finals > Gynae > Flashcards

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
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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

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3
Q

red degeneration of fibroid presentation

A

pregnant, severe abdo pain, fever, tachycardia, vomiting. History of menorrhagia/diffuclty conceiving (fibroids)

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4
Q

during which trimester is placental abruption most common

A

third

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5
Q

when is the first trimester

A

1-12 weeks

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6
Q

when is the second trimester

A

13-27 weeks

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7
Q

when is the thrid trimester

A

28-end

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8
Q

management of PID

A

start antibiotics immediately (doxycycline, metronidazole and IM ceftriaxone)
In mild PID IUD can be left it.

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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
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10
Q

When should nitrofuratonin be avoided in pregnancy

A

3rd trimester as risk of haemolytic anaemia in neonate with G6PD deficiency

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11
Q

When should trimethoprim be avoided in prenancy

A

1st trimester as it is a folate antagonist

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12
Q

when should sulfonamides be avoided in pregnancy

A

3rd trimester associated with kernicterus

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13
Q

how long should pelvic floor exercises for stress incontenence be used

A

3 months

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14
Q

what drug for stress incontinence

A

duloxetine (SNRI)

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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
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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

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17
Q

features of adenomyosis

A 
dysmenorrhoea
menorrhagia
enlarged uterus
Management:
GnRH agonists
hysterectomy
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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

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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
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20
Q

What would indicate admission for a patient with PID

A

temp >38 as indicates severe infection

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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!

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22
Q

Treatment of endometriosis

A

NSAIDs/paracetamol first line
OCP (unless contraindicated)
progesterone only contraception
late can try GnRH analouges

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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
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24
Q

How is haemorrhagic ovarian cyst managed

A

Admit to hospital, they will have marked tenderness

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25
Q

What would indicate ovarian torsion

A

low abdo pain, tenderness, vomiting, peritonism, fever

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26
Q

Risk factors for IUGR

A

maternal age <16 or >35
low BMI
high BMI
interpregnancy interval <6 or >120 months

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27
Q

when should antibiotics be given form PPROM

A

10 days following or until woman is in labour

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28
Q

Causes of recurrent miscarriage

A 
antiphospholipid syndrome
endocrine disorders: poorly controlled diabetes mellitus/thyroid disorders. 
Polycystic ovarian syndrome
uterine abnormality: e.g. uterine septum
parental chromosomal abnormalities
smoking
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29
Q

What is the role of HCG

A

Prevent the breakdown of the corpus luteum

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30
Q

How often do HCG levels double during pregnancy

A

every 48 hours for the first few weeks

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31
Q

When do HCG levels peak

A

8-10 weeks

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32
Q

Signs of hydatiform mole

A

vaginal bleeding
uterus size greater than expected for gestational age
abnormally high hCG
snow storm appearance on ultrasound

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33
Q

What would point towards an ectopic in pregnancy of unknown location

A

bHCG>1500

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34
Q

Should you examine for an adnexal mass for ectopic

A

NO you might rupture it.

A pelvic examination for cervical excitation is recommended as this indicates ectopic

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35
Q

How many weeks does an ectopic pregnancy present

A

6-8 weeks, if >10 weeks likely another cause e.g. inevitable abortion

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36
Q

Placental abruption presentation

A

mild or no vaginal bleeding PAIN, woody uterus

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37
Q

RF ffor placental abruption

A

hypertension IUGR, cocaine, multiparity, increasing age

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38
Q

presentation of praevia

A

red profuse blood, painless, shock consistent with loss

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39
Q

rf for vte in pregnancy

A

factor v leiden deficiency/thrombophilia
multiple pregnancy
pre-eclampsia

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40
Q

When are heart pulsations visible

A

six weeks

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41
Q

what is the fetal pole

A

a thick area alongside the yolk sac

42
Q

when is the insertion of the placenta visivle

A

12 weeks

43
Q

what is the gold standard test for endometriosis

A

laproscopy

44
Q

Risk factors for GBS infection

A

maternal pyrexia
prematurity
previous sibling GBS
prolonged rupture of membranes

45
Q

signs/symptoms of cervical cancer

A 
postcoital bleeding
purulent discharge
red brown discharge
age 45-49
smoker
multiple sexual partners
46
Q

features of BV

A

fishy odour

grey-white discharge

47
Q

what colour is the discharge from trichomonas

A

green

48
Q

what colour would chlamydia discharge be if present

A

yellow

49
Q

rf for placenta praevia

A 
>40 yrs
multiple pregnancy
high parity
previous praevia
previous uterine surgery
50
Q

presentation of vasa praevia

A

presents at rupture of membranes
painless bleeding
acute foetal compromise

51
Q

what is contraindicated in vasa praevia and placenta praevia

A

digital vaginal examination (risk rupturing)

52
Q

which hormonn initially produced by the corpus luteum causes stromal hypertrophy and increased blood supply to the endometrium

A

progesterone

53
Q

Causes of polyhydraminos

A 
idiopathic (most common)
macrosomia
maternal diabetes
structural deformities of foetus
viral infection
54
Q

what is first-line treatment for symptomatic uterine fibroids

A

levonorgestral IUD
second line - tranexamic acid, OCP
myomectomy

55
Q

What are the Rotterdam criteria for PCOS

A
  1. 12 or more follicles or increased ovarian volume >10
  2. oligo-ovulation or anovulation
  3. clinical signs of hyperandrogenism
56
Q

How metformin help in PCOS

A

appetite reduction
decreased androgen production
decreases LH from the anterior pituitary
decreases sex-hormone binding globulin in the liver

57
Q

Fluid choice for correcting dehydration in DKA

A

saline with 20mmol potassium chloride

58
Q

Clinical features of pre-eclampsia

A 
epigastric pain
facial oedema
hypertension
proteinurea
papilloedema
hyperreflexia (due to raised ICP)
59
Q

what test detects feto-maternal haemorrhage is suspected sensitising event

A

Kleinhauer test

60
Q

what is a normal fetal baseline rate

A

110-160

61
Q

what should variability be

A

5-25

62
Q

how long should contraception be used for after menopause

A

2 years after last period if under 50

1 year after period if over 50

63
Q

when can HRT with unopposed oestrogen be used

A

when had hysterectomy

64
Q

what age would you be sent for mammogram

A

over 35, if under then USS

65
Q

what is the most common type of breast cancer

A

invasive ductal carcinoma in situ.

begins in milk ducts - fixed in position, hard and irregular

66
Q

causes of fetal hydrops

A

(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
Q

commonest cause of anaemia in pregnancy

A

iron deficiency

68
Q

risk factors for developing pre-eclampsia

A 
High BMI
maternal antiphospholipid syndrome
multiple pregnancy
pre-eclampsia in previous pregnancy
>10 years between births
69
Q

first line treatment for heavy menstrual bleeding

A

intrauterine system
then COCP
progesterone only/tranexamic acid
endometrial ablation

70
Q

risk factors for obstetric cholestasis

A

hep C infection
multiple preganncy
obstetric cholestasis in previous pregnancy
gallstones

71
Q

when is external cephalic version offered

A

36 weeks if nulliparous

37 weeks if multiparous

72
Q

first line management for seizure control in pregnancy

A

magnesium sulphate

diazepam second line

73
Q

risk factors for placenta accreta

A 
IVF
>35 years
previous C section
previous uterine surgery
(think any surgical cause)
74
Q

severity of placental adhesion

A

placenta accreta - attach to myometrium
placenta increta - deep into myometrium
placenta percreta - into peritoneum

75
Q

what blood results see in premature ovarian failure

A

high FSH and LH as there is no negative feedback from ovaries

76
Q

what is first degree tear

A

skin only

77
Q

what is second degree tear

A

fascia and muscles of perineum

78
Q

what is third degree tear A

A

fascia muscles and <50% of external anal sphincter

79
Q

what is third degree tear B

A

fascia and muscles and >50% of external anal sphincter

80
Q

what is third degree tear C

A

fascia and muscles and internal and external sphincter

81
Q

which nerve roots are affected in Erb’s palsy

A

C5 and C6

82
Q

what is the treatment of choice for TOP <9 weeks

A

mifepristone and misoprostol

83
Q

what is the treatment of choice for TOP >9 weeks

A

surigcal dilation and suction

If >15 weeks induce mini labour

84
Q

why is lactic dehydrogenase raise in HELLP

A

haemolysis

85
Q

rf for placenta praevia

A

increased age
ivf
maternal smoking
previous c section

86
Q

features of ovarian neoplasms

A 
hirsutism due to testosterone secretion
acute abdomen due to torsion
rupture or haemorrhage
thyrotoxicosis
amenorrhoea
87
Q

what is haematocolpos

A

accumulation of blood in the vagina e.g. imperforate hymen

88
Q

what is ovarian hyperthecosis

A

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
Q

indications/management of peurperal psychosis

A

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
Q

how long after sex can take levonogestrel emergency contraceptive

A

72 hours

91
Q

how long to take ulipristal acetate after sex

A

120 hours

92
Q

how long to take copper coil after sex

A

5-7 days

93
Q

complications of c section

A

increased abdo pain
hysteractomy
bladder/ureteric injury
VTE

94
Q

decreased complications of c section

A

perineal pain
urinary incontinence
uterovaginal prolapse

95
Q

blood results in hyperemesis gravidum

A

raised haematocrit FBC
raised transaminases and low albumin LFT
low potassium and sodium and metabolic hypochloremic alkalosis in U&Es
ketones in urine

96
Q

what defect is sodium valproate most associated with in pregnancy

A

hypospadiasis

also: spina bifida, ASD, cleft palate and polydactyly

97
Q

marfans mode of inheritance

A

autosomal dominant

98
Q

antibiotic for PPROM

A

oral erythromycin 10 days

99
Q

group B strep treatment

A

iv benpen in labour

100
Q

rf for ectopic preganncy

A

think anything that could slow passage of ovum (scarring etc)
POP (slows passage of ovum)
endometriosis

101
Q

investigation for ovarian cancer

A

CA125
abdominal US
then CT

Finals (15 decks)

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