Gynae Flashcards
What is the typical treatment for dysfunctional uterine bleeding?
TXA 1gm TDS
Medroxyprogesterone 10mg TDS
Norethisterone 5mg TDS
What are the factors on H/E suggestive of PID?
- Prior PID
- Unprotected sex
- Multiple partners
- Sex work
- Recent instrumentation
- Vaginal discharge
- Dyspareunia
What are the complications of PID?
- Acute sepsis
- Tubo-ovarian abscess
- Chronic pain
- Transmission to partners
- Scarring with fertility complications (infertile, higher risk of ectopic etc)
What is the most common cause of bacterial vaginosis? What is the treatment?
Gardnerella vaginalis
Treatment is Clindamycin PO 300mg BD for 7 days
What are the typical exam findings of Trichomonas Vaginitis? What is the treatment?
- “Strawberry cervix”
- Diffuse vaginal erythema
- frothy grey white discharge
Metronidazole 2gm oral
If pregnant use clotrimazole 2% vaginal cream for 6 days instead (Metronidazole B2)
What are the statistics around the HPV vaccine?
- Usually 3 doses over 6 months around puberty (12-13yrs old)
- Peak incidence of HPV infection is within 1st 5yrs of sexual activity
- Subtypes 16 and 18 are the most common cancer causing strains
- Subtypes 6 and 11 are the most common types overall
What is the discriminatory level for BHCG when using ultrasound?
Transvaginal - can detect pregnencies as low as 1000-1500 BHCG
Transabdominal - Can detect as low as 6500
What is the sensitivity and specificity of ultrasound for ectopic pregnancy?
Absent intrauterine pregnancy
+
Adnexal mass on TV U/S
= 88% sens, 99% spec
What are the stats around ovarian torsion?
- More likely to occur on the R) (rigid rectosigmoid protective on the L)
- more likely if cyst >4cm
- More likely if patient <30yrs old
What are the general features of ovarian cysts?
- More common in women with irregualr menses (up to 50%)
- Multilocular cysts with septations <2mm and no solid areas or papillary projections are very low risk for malignancy
What is the typical treatment for women post sexual assault?
- All cases get 1gm PO Azithromycin and Hep B vaccine update
- Higher risk cases get IM ceftriaxone 250mg and Hep B immunoglobulin
- HIV prophlyaxis should be considered
What are the high risk criteria for HIV transmission in sexual assault?
- Assailant +ve (1:500 - 1:1000)
- Assailant has risk factors
- Multiple assailants
- Anal rape (2-10x higher risk)
- significant trauma/bleeding
- RASP score for risk determination
- If no risk factors the risk is approx 1:5,000,000 for transmission
- HIV prophylaxis should be given within 72hrs to be effective
- About 80% reduction in transmission
What is the maximum time frame that the morning after pill will work?
- 72hrs, beyond this much less effective
- Most effective in the 1st 24hrs
- Levonorgestrel 1.5mg one dose PO is the usual method
- Copper IUD insertion within 5 days can prevent 99.9% of pregnancies
What is the definition of sexual assault?
- Penetration of the vulva beyond the labia majora and/or anus by a penis or any other object, and/or penetration of the mouth by a penis
- Without the persons consent
Lifetime incidence is 5-10%
What are the causes of cervicitis?
STI
- Gonorrhoea/Chlamycia
- Trichomonas vaginalis
Non-STI
- Candida albicans
- Gardnerella vaginalis
- Mycoplasma hominis
- Ureaplasma urealyticum
How should uncomplicated Cervicitis be managed in the emergency department?
How is B-HCG level and ultrasound combined in risk stratifying a suspected ectopic pregnancy?
