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gynae Flashcards

1
Q

Diagnostic thresholds for gestational diabetes:
Fasting glucose
2-hour glucose

A

Fasting glucose > 5.6mmol/L
2-hour glucose >7.8mmol/L

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2
Q

Targets for self monitoring of pregnant women (pre-existing and gestational diabetes):
(a) fasting
(b) 1 hour after meals
(c) 2 hours after meals

A

(a) fasting = 5.3
(b) 1 hour after meals = 7.8
(c) 2 hours after meals = 6.4

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3
Q

Hand foot and mouth disease
What pathogen causes it

A

Coxsackie A16

Rx = symptomatic only
Do not need to be off school with this

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4
Q

If cyclical mastitis (breast pain before period) pain has not responded to conservative measures, and is affecting the quality of life or sleep, then referral should be considered after what length of time?

And what 2 medications may help?

A

3 months

Bromocriptine and danazol

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5
Q

if guttate psoriasis covers greater than 10% of the body surface area then the patient should have what management

A

urgent referral for phototherapy consideration

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6
Q

Pregnancy induced HTN with proteinuria (>0.3g/day) = pre-eclampsia. What are the treatment options for gestational hypertension + pre-eclampsia prior to birth?

A
  • If previously HTN - stop ACEi/ARB
  • Start labetalol (first-line)
  • Or nifedipine (if asthmatic) and hydralazine
  • Pre-eclampsia - have aspirin 75mg OD from 12 weeks until birth of baby
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7
Q

Jaydess IUS coil is licensed for how many years

A

3 years

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8
Q

Mirena IUS coil is licensed for how many years

A

5 years

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9
Q

Kyleena IUS coil is licensed for how many years

A

5 years

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10
Q

Copper IUD coil is licensed for how many years

A

5-10 years

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11
Q

First line anti-emetic for hyper-emesis gravidarum

A

Oral cyclizine or promethazine

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12
Q

Hyperemesis gravidum is most common between what weeks

A

8-12 weeks
But may persist up to 20 weeks

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13
Q

What are 4 risk factors of hyperemesis gravidum

A
  1. Increased b-hCG levels - multiple pregnancies or molar pregnancy
  2. Nulliparity
  3. Obesity
  4. Family or personal history
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14
Q

What is associated with a decreased incidence of hyperemesis

A

Smoking

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15
Q

3 criteria for admission for nausea + vomiting in pregnancy

A
  1. Unable to keep down liquids/ oral antiemetics
  2. Ketonuria or >5% weight loss
  3. Comorbidity
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16
Q

What triad is present before the diagnosis of hyperemesis gravidarum

A
  1. 5% pre pregnancy weight loss
  2. Dehydration
  3. Electrolyte imbalance
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17
Q

ondansetron during the first trimester is associated with

A

small increased risk of baby having a cleft lip/palate

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18
Q

primary amenorrhoea age cut offs

A

failure to start period by 15 (with normal secondary sexual characteristics) or by 13 (with no secondary sexual characteristics)

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19
Q

secondary amenorrhoea is the cessation of menstruation for what timeframe

A

3-6 months with previously normal/regular periods

or 6-12 months in women with previous oligomenorrhoea

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20
Q

What is the most common cause of primary amenorrhoea

A

Gonadal dysgenesis

i.e. Turner’s syndrome

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21
Q

Gonadotrophins (LH/FSH) are raised in which primary amenorrhoea disease

A

Gonadal dysgenesis
i.e. Turner’s syndrome

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22
Q

gold standard investigation for endometriosis

A

laparoscopy

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23
Q

Management of endometriosis

A
  1. NSAIDs/paracetamol
  2. COCP or progestogens (Depo Provera)
  3. Secondary care can start GnRH analogues - which can induce psuedomenopause due to low oestrogen
  4. Surgery - laparoscopic excision
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24
Q

Management of menorrhagia if does not need contraception

A

Mefanamic acid 500mg TDS
Or Tranexamic acid 1g TDS

Or Norethisterone 5mg TDS short-term to rapidly stop menstrual bleeding

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25
Q

First-line for painful periods

A

NSAIDs
- inhibit prostaglandin synthesis

Second line = COCP

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25
Q

1st swab = HPV positive with normal cytology

When should the sample next be repeated?

A

In 12 months time

If on the repeat smear, there is HPV infection and normal cytology again, then repeat again in 12 months time.

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25
Q

Following a first inadequate cervical screen sample, when should another sample be taken

A

Within 3 months

If the repeat sample is also inadequate, the patient should be referred for colposcopy

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25
Q

Management of menorrhagia - requires contraception

A

1st line - Mirena coil
2. COCP
3. Long acting progesterones

Or Norethisterone 5mg TDS short-term to rapidly stop menstrual bleeding

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25
Q

Which patients with dysmenorrhoea should be referred to Gynae for investigation

A

ALL patients with SECONDARY dysmenorrhoea

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26
Q

Negative HPV smear tests return to normal recall unless what 4 things

A
  1. Test of cure pathway - if treated for CIN, they should have repeat smear in 6 months
  2. Untreated CIN1
  3. Follow-up for incompletely excised CGIN or SMILE or cervical cancer
  4. Follow up for borderline changes in endocervical cells
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27
Q

If cervical smear is HPV positive but cytology is normal, when is the test repeated?

A

12 months

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27
Q

If cervical smear is HPV positive but cytology is normal, and is repeated then in 12 months with HPV negative, when is it repeated

A

Return to normal recall

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28
Q

If cervical smear is HPV positive and normal cytology, and is repeated then in 12 months with HPV positive and normal cytology, when is it repeated?

A

12 months
- if HPV is positive here, then to colposcopy
- if HPV is negative here, then return to normal recall

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29
Q

Cervical smear shows positive HPV with abnormal cytology
What is the next step?

A

Refer to colposcopy

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30
Q

When shouod individuals who’ve been treated for CIN1, CIN2, or CIN3 should be invited back after treatment for a test of cure repeat cervical sample in the community

A

6 months after treatment

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31
Q

What is the most common treatment for CIN?

A

Large loop excision of transformation zone

Can be done during initial colposcopy visit
Or at later date

Alternative techniques = cryotherapy

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32
Q

Cervical cancer can be divided into which 2 types

A

Squamous cell carcinoma - 80%
Adenocarcinoma - 20%

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33
Q

Highest risk human papillomavirus HPV strains

A

16, 18, 33

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34
Q

6 risk factors for development of cervical cancer |(other than HPV 16, 18, 33)

A
  1. smoking
  2. HIV
  3. ++ sexual partners, early first intercourse
  4. high parity
  5. low socioeconomic status
  6. COCP
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35
Q

mechanism of HPV 16 and 18 causing cervical cancer

A

HPV 16 produces oncogene E6 - which inhibits p53 tumour suppressor gene

HPV 18 produces oncogene E7 which inhibits RB suppressor gene

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36
Q

Female Genital Mutation over 18s - what to do

A

local safeguarding
refer to mental health services

police not needed over 18

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37
Q

Female Genital Mutation under 18s - what to do

A

call police + safeguarding

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38
Q

Definitive treatment of Bartholin’s abscess

A

marsupialisation

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39
Q

3 main differentials of bleeding in the first trimester

A
  1. Miscarriage
  2. Ectopic pregnancy
  3. Implantation bleeding
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40
Q

For immediate referral to early pregnancy unit to rule out ectopic, a woman will have a positive pregnancy test and has any 3 of which criteria

A

Tenderness/pain in:
Abdomen
Pelvis
Cervical motion

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41
Q

If a pregnant woman, >6 weeks gestation has bleeding, what is the next steps

A

Refer to early pregnancy assessment service
TV USS to identify foetal pole and heartbeat

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42
Q

If a pregnant woman, <6 weeks gestation has bleeding (and no pain, no ectopic), what is the next steps

A

Manage expectantly for miscarriage
Advise to return if bleeding continues or pain starts
Repeat urine pregnancy test after 7-10 days - return if positive
Negative pregnancy means miscarriage

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43
Q

When smear shows HPV +ve and abnormal high-grade cytology (moderate or severe dyskaryosis)
- how fast should colposcopy be offered

A

Within 2 weeks

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44
Q

When smear shows HPV +ve and abnormal borderline or LOW-grade cytology - how fast should colposcopy be offered

A

6 weeks

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45
Q

When smear results are inadequate twice (within 3 months), how fast should colposcopy be offered

A

6 weeks

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46
Q

HRT increases the risk of which two cancers

A

Breast cancer - reduces after 5 years of stoppingP
Endometrial cancer - reduces when given progesterone if there is a womb

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47
Q

Women requesting HRT who are high risk for VTE - what is appropriate management

A

Refer to haematology before starting any treatment!

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48
Q

Primary ovarian insufficiency (premature ovarian failure) shows what in:
FSH
LH
Oestradiol

A

FSH - raised
LH - raised
Oestradiol - low

49
Q

ANY ovarian mass in a post-menopausal woman needs what type of referral?

A

2ww gynae

50
Q

Ovarian cysts
<35 year olds
What is the management

A

If <5cm (small) - likely benign
Repeat ultrasound for 8-12 weeks - and referral considered if it persists

51
Q

What size is considered as a ‘small’ ovarian cyst

A

<5cm

52
Q

Ovarian hyperstimulation syndrome increases your risk of

A

ovarian torsion

53
Q

when ovarian torsion involves fallopian tube too, what is it called

A

adnexal torsion

54
Q

what does ultrasound show in ovarian torsion

A

free fluid or whirlpool sign

55
Q

what investigation is both diagnostic and therapeutic in ovarian torsion

A

laparoscopy

56
Q

ovarian torsion 4 risk factiors

A
  1. ovarian mass
  2. reproductive age
  3. pregnancy
  4. ovarian hyperstimulation syndrome
57
Q

Around 90% of ovarian cancers are epithelial in origin. What type of epithelial ovarian cancer are they?

A

Serous carcinomas - 70-80%

58
Q

Which 2 gene mutations are seen with ovarian cancer

A

BRCA1
BRCA2

59
Q

Risk factors for ovarian cancer include many ovulations. This includes what in terms of menarche, menopause and number of pregnancies

A

Early menarche
Late menopause
Nulliparity (never pregnant) - so can continue having periods + ovulating

60
Q

What is the initial test suggested by NICE to investigate ovarian cancer

A

CA125

61
Q

If Ca125 is raised in ovarian cancer, urgent ultrasound scan abdo pelvis should be ordered.
Above what level does it need to be raised above?

A

> 35

62
Q

Management of ovarian cancer

A

Surgery and platinum based chemotherapy

63
Q

which type of incontinence is worse with laughing/coughing

A

stress incontinence

64
Q

which incontinence is due to detrusor overactivity - the urge to urinate is followed by leakage

A

overactive bladder (OAB) /urge incontinence

65
Q

which urine incontinence is due to bladder outlet obstruction e.g. prostate

A

overflow incontinence

66
Q

functional incontinence is secondary to

A

comorbid physical conditions so a patient cannot get to a bathroom

e.g. dementia, decreased mobility

67
Q

initial investigation for urine incontinence includes bladder diary to be kept for at least how many days

A

3 days

68
Q

management of urge incontinence (overactive bladder)

A
  1. bladder retraining - at least 6 weeks
  2. bladder stabilising drugs:
    - antimuscarinics 1st line e.g. IR oxybutynin, IR tolterodine, or darifenacin (once daily)
    - 2nd line = mirabegron. this is used in older frail patients to avoid falls/side effects
69
Q

management of stress incontinence

A
  1. pelvic floor muscle training - at least 8 contractions done 3 times a day for at least 3 months
  2. surgery - retropubic urethral tape
  3. duloxetine if surgery declined
70
Q

what is the role and mechanism of duloxetine in stress incontinence

A
  • combined NA and serotonin reuptake inhibitor
  • given if surgery declined
  • increases NA and serotonin in the pudendal nerve, stimulates urethral muscles in the sphincter to contract more
71
Q

Women need to use contraception up until what ages with regards to the menopause

A

Women <50 years - 24 months after last period
Women >50 years - 12 months after last period

72
Q

Who has the rights to child - surrogate vs genetic parents

A

surrogate!!

73
Q

What are the routine recall ages and timeframes for cervical smear

A

25-49 = every 3 years
50-65 = every 5 years

74
Q

what are uterine fibroids

A

benign smooth muscle tumours of the uterus

75
Q

treatment of fibroids

A

Medical: GnRH agonists (reduce size)
Surgical: myomectomy, ablation, hysterectomy or uterine artery embolisation

76
Q

What do NICE recommend for initial primary care investigations for males with infertility

A

Semen analysis
Chlamydia testing

77
Q

What is tested for in women to assess for infertility

A

Serum progesterone - 7 days before next period

e.g. for 28 day cycle, day 21 prog is tested

78
Q

Interpretation of serum progesterone levels (take 7 days prior to next expected period) in female infertility:
<16
16-30
>30

A

<16 - refer to specialist
16-30 - repeat
>30 - normal, ovulation

79
Q

Four key counselling points on infertility

A
  1. folic acid
  2. aim for BMI 20-25
  3. advise regular intercourse every 2-3 days
  4. smoking/drinking advice
80
Q

Endometrial cancer risk is increased by…

A
  1. Excess oestrogen (nulliparity, early menarche, late menopause, unopposed oestrogen)
  2. Metabolic syndrome - obesity, DM, PCOS
  3. Tamoxifen
  4. HNPCC
81
Q

Investigations that occur for suspected endometrial cancer

A
  1. First line TV USS - normal endometrial thickness <4mm has a high negative predictive value
  2. Hysteroscopy with endometrial biopsy
82
Q

First line investigation for suspected endometrial cancer is TVUSS. What is the threshold for endometrial thickness size

A

<4mm

this has high negative predictive value

83
Q

What is the age criteria for women who have postmenopausal bleeding for 2ww gynae

A

> 55 years with post-menopausal bleeding

84
Q

what is the commonest type of ovarian cyst

A

follicular cyst

85
Q

dermoid cysts are also called

A

mature cystic teratomas

86
Q

What are the three main types of categories of ovarian cysts and subtypes

A
  1. Physiological (functional) cysts - follicular cysts, corpus luteum cyst
  2. Benign germ cell tumours - dermoid cyst (teratomas)
  3. Benign epithelial tumours - serous cystadenoma, mucinous cystadenoma
87
Q

What ovarian cyst if ruptures may cause pseudomyxoma peritonei

A

Mucinous cystadenoma - this is a type of benign epithelial tumour

88
Q

What type of HRT has the highest risk of VTE

A

COMBINED oestrogen + progesterone tablets

89
Q

Management of PMS - mild symptoms

A

Lifestyle advice
Regular and frequent (2-3 hourly) small, balanced meals rich in complex carbohydrates

90
Q

Management of PMS - moderate and severe symptoms

A

Moderate - COCP
Severe - SSRI continuous or during LUTEAL phase

91
Q

for severe PMS symptoms, it is advised to try low dose SSRI at what time frame?

A

Continuous
Or LUTEAL phase (days 15-28 of cycle)

92
Q

PCOS diagnosis needs 2 out of 3 features which are:

A
  1. Oligomenorrhoea
  2. Clinical or biochem signs of hyperandrogenism
  3. Polycystic ovaries on USS (>12 follicles over 9mm or increased ovarian volume >10cm3)
93
Q

How may the hormone profile be with someone who has PCOS?

  • LH:FSH ratio
  • Prolactin
  • Testosterone
  • SHBG
A

LH:FSH ratio - high
Prolactin - normal/mildly high
Testosterone - normal/mildly high
SHBG - normal to low

94
Q

Infertility in PCOS - what is used first line

A

Clomifene

95
Q

Cervical screening in pregnancy is delayed until when

A

3 months post-partum unless missed screening or previous abnormal smears

96
Q

BASHH define recurrent vaginal candidiasis as how many episodes or more per year

A

4 or more per year

97
Q

What is the most common benign ovarian tumour in a woman under tha age of 30 years old

A

Dermoid cyst (teratoma)

98
Q

What is the most common type of ovarian pathology associated with Meigs’ syndrome

A

Fibroma

  • associated with ascites and pleural effusion
99
Q

What is the most common cause of ovarian enlargement in women of a reproductive age

A

Follicular cyst

100
Q

For ectopic pregnancy, what do NICE advise NOT TO EXAMINE FOR?

A

Adnexal mass
Due to risk of rupturing pregnancy

They do recommend cervical excitation (i.e. cervical motion tenderness) examination

101
Q

What % of infertility in couples is due to male infertility

A

30%

102
Q

What is the most common cause of RECURRENT first trimester spontaneous miscarriage?

A

antiphospholipid syndrome

103
Q

is migraine with aura a contraindication for HRT

A

no

104
Q

Most women with VIN present with

A

burning
itching
or vulval skin lesions

105
Q

Vulval intraepithelial neoplasia (VIN) is a pre-cancerous skin lesion of the vulva, and may result in what if it is left untreated

A

Squamous skin cancer

106
Q

What are 4 risk factors for vulval intraepithelial neoplasia

A
  1. HPV 16 and 18
  2. Smoking
  3. HSV 2
  4. Lichen planus
107
Q

What is the most common ovarian cancer

A

Serous carcinoma

108
Q

What are sometimes referred to as chocolate cysts due to their external appearance

A

Endometriotic cyst

109
Q

Treatment of pelvic inflammatory disease

A

Oral oflaxacin + oral metronidazole OR
IM ceftriaxone + oral doxycycline + oral metronidazole

110
Q

Threatened miscarriage
- bleeding?
- cervical os?
- pain?

A
  • bleeding - yes but small
  • cervical os - closed
  • pain - painless bleeding
111
Q

Missed (delayed) miscarriage
- bleeding?
- cervical os?
- pain?
- scan findings?

A
  • bleeding - light
  • cervical os - closed
  • pain - painless
  • scan findings - no fetal pole. when gestational sac is >25mm and no fetal part, it can be called blighted ovum or anembryonic pregnancy
112
Q

Inevitable miscarriage
- bleeding?
- cervical os?
- pain?
- scan findings?

A
  • bleeding - heavy, clots
  • cervical os - open
  • pain present
113
Q

Incomplete miscarriage

A
  • bleeding ++ with pain
  • cervical os - open
    NOT ALL PRODUCTS OF CONCEPTION HAVE BEEN EXPELLED
114
Q

In women with PCOS, intervals between menstruation of more than 3 months (or fewer than 4 per year) increase the risk of

A

Endometrial hyperplasia and carcinoma

therefore inducing a bleed every 3-4 months is recommended - this prevents proliferation of endometrium

115
Q

How often should a withdrawal bleed be induced in patients with PCOS

A

every 3-4 months
- this prevents proliferation of endometrium and decreases risk of endometrial hyperplasia or carcinoma

116
Q

What is the most appropriate advice to give regarding semen collection

A

abstain for 3-5 days before giving sample and then deliver sample to lab within 1 hour

117
Q

Which HRT is unsuitable for use within 12 months of last menstrual period as it can cause irregular bleeding

A

Tibolone

118
Q

clonidine can be used in the menopause to decrease hot flushes and night sweat vasomotor symptoms. what are two side effects that are common

A

dry mouth
dizziness

119
Q

Premature ovarian insufficiency should not be diagnosed on the basis of one raised FSH level - when should a further sample be taken?

A

In 4-6 weeks

120
Q

HRT: adding a progestogen increases the risk of what cancer

A

breast cancer

121
Q

what is the relationship between the menstrual cycle and body temperature

A

body temp rises following ovulation

122
Q

If a semen test is abnormal, when should it be repeated

A

3 months

123
Q

Older woman with labial lump and inguinal lymphadenopathy. What should be ruled out?

A

Vulval carcinoma

124
Q

The most common cause of puritus vulvae is

A

contact dermatitis

125
Q

What hormone surge causes ovulation

A

LH surge

126
Q

How can the menstrual cycle be divided into phases

A

Menstruation - day 1-4
Follicular (proliferative) phase - day 5-13
Ovulation - day 14
Luteal (secretory) phase - 15-28

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