gynae Flashcards
what is a krunkenburg tumour
development of mets to the ovary
what to do when having surgery if on the pill
stop 4 wks before
first line for urge incontinence
bladder retraining for a min of 6 wks (gradually increasing the time between voiding)
first line for stress incontinence
pelvic floor muscle training
8 contractions 3x/day for at least 3 mths
first-line in the management of nausea & vomiting in pregnancy/hyperemesis gravidarum
antihistamines - oral cyclizine or promethazine
ondansetron is second line
RFs of Hyperemesis gravidarum
increased levels of beta-hCG
- multiple pregnancies
- trophoblastic disease
nulliparity
obesity
family or personal history of NVP
Referral criteria for nausea and vomiting in pregnancy
Continued nausea and vomiting and is unable to keep down liquids or oral antiemetics
Continued nausea and vomiting with ketonuria and/or weight loss (greater than 5% of body weight), despite treatment with oral antiemetics
A confirmed or suspected comorbidity (for example she is unable to tolerate oral antibiotics for a urinary tract infection)
dx of Hyperemesis gravidarum
5% pre-pregnancy weight loss
dehydration
electrolyte imbalance
cervical smear: what to do if the sample is Positive hrHPV
samples are examined cytologically
cervical smear: what to do if the sample is Positive hrHPV and abnormal cytology
colposcopy
cervical smear: what to do if the sample is Positive hrHPV and normal cytology
repeat test at 12 months
if the repeat test is now hrHPV -ve → return to normal recall
if the repeat test is still hrHPV +ve and cytology still normal → further repeat test 12 months later:
If hrHPV -ve at 24 months → return to normal recall
if hrHPV +ve at 24 months → colposcopy
(ie test HPV 3x b4 colposcopy)
what to do if cervical smear sample is inadequate
repeat the sample within 3 months
if two consecutive inadequate samples then → colposcopy
medical mx of abortion
mifepristone (an anti-progestogen)
followed by misoprostol (a prostaglandin) 48 hrs later
take a multi-level preg test after 2 wks to check (Quantitative hCG measurement )
causes of primary amenorrhoea
gonadal dysgenesis (e.g. Turner’s syndrome) - the most common causes
testicular feminisation
congenital malformations of the genital tract
functional hypothalamic amenorrhoea (e.g. secondary to anorexia)
congenital adrenal hyperplasia
imperforate hymen
causes of secondary amenorrhoea (after excluding pregnancy)
hypothalamic amenorrhoea (e.g. secondary stress, excessive exercise)
polycystic ovarian syndrome (PCOS)
hyperprolactinaemia
premature ovarian failure
thyrotoxicosis*
Sheehan’s syndrome
Asherman’s syndrome (intrauterine adhesions)
what is gonadal dysgenesis + what might be the examination findings
congenital condition in which the gonads are atypically developed, and may be functionless
e.g. turners syndrome
Due to the abnormal gonads, androgens are not produced in response to FSH and LH from the anterior pituitary gland. -> absent 2ndary sex characteristics
FSH + LH remain high as no -ve feedback
ix for ectopic preg
transvaginal ultrasound
when to do expectant mx for ectopic
size < 35mm
unruptured
asx
no fetal heartbeat
hCG <1,000IU/L
Compatible if another intrauterine pregnancy
what does expectant mx for ectopic involve
closely monitoring the px over 48 hours and if B-hCG levels rise again or symptoms manifest intervention is performed
when to do medical mx for ectopic
Size <35mm
unruptured
no signif pain
no fetal heartbeat
hCG <1,500IU/L
Not suitable if intrauterine pregnancy
what does medical mx for ectopic involve
methotrexate
needs to attend follow up
when to do surgical mx for ectopic
Size >35mm
can be ruptured
pain
visible fetal heartbeat
hCG >5,000IU/L
Compatible with another intrauterine pregnancy
what does surgical mx for ectopic involve
Salpingectomy is first-line for women with no other risk factors for infertility (full fallopian tube out)
Salpingotomy (tube not acc removed, opening made) should be considered for women with risk factors for infertility such as contralateral tube damage
PCOS test results
raised LH:FSH ratio
testosterone may be normal or mildly elevated
SHBG is normal to low