Gynae Flashcards
What is needed following a medical termination of pregnancy?
Multiple level pregnancy test in 2 weeks
Management of vaginal thrush?
Oral fluconazole
Enlarged boggy uterus?
Adenomyosis
What is a C/I to injectable progesterone contraceptives?
Current breast cancer
Management of pregnant women who are<6 weeks gestation with painless bleeding?
Expectant management - repeat test in 7 days
Imaging of choice for adenomyosis?
Transvaginal US
How long should women wait before starting regular hormonal contraception after taking ulipristal?
5 days
Management of 2 missed pills in week 3?
Take an active pill and omit the pill-free interval
What is acceptable with nearly all anti epileptic drugs?
Breastfeeding
Risks of HRT?
- Increased risk of breast cancer
- Increased risk of endometrial cancer(if no progresterone)
- Increased risk of VTE
Unopposed oestrogen increases the risk of?
Endometrial cancer
If one pill missed, what is the next steps?
Take the next pill ASAP then continue as normal
If 2 pills are missed in week 2, what is the next steps?
No emergency contraception needed if previous 7 days have been taken correctly
What is the drug of choice for reversing respiratory depression caused by mag sulphate?
Calcium Gluconate
When should anti-D prophylaxis be given to women who are having an abortion?
If rhesus negative and after 10 weeks gestation
Management of switching from IUD to COCP
No additional contraception needed if removed on day 1-5
If later, barrier contraception needed for 7 days
When should oestrogen containing contraceptives be discontinued before surgery requiring immobilisation?
4 weeks before
COCP protects against which cancers?
Ovarian and endometrial
Presence of heartbeat on US of ectopic suggests what?
Surgical management needed
When do women require contraception post partum?
After 21 days
First line for menorrhagia?
Mirena IUS
Risk factors for premature ovarian failure?
positive family history, exposure to chemotherapy/radiation and autoimmune disease.
Which contraceptives are not affected by enzyme inducing drugs?
- Copper IUD
- Injection
- Mirena
When is anti-D given?
28 and 34 weeks
What are the normal blood test results for PCOS?
- Raised LH:FSH ratio
- Normal/Raised testosterone
- SHBG is normal/low
Most common ovarian cancer type?
Epithelial cell tumour
Most common type of fibroid?
Intramural fibroid
Vulval itching with white atrophic patches of skin?
Lichen sclerosis
What can be precipitated by antibiotic exposure?
Fungal infection
Current breast cancer is a C/I to what?
All hormonal contraceptives
Management of all postmenopausal women with atypical endometrial hyperplasia
Hysterectomy with bilateral salpingo-oophorectomy
Itching and vaginal burning with latex condoms?
Irritant contact dermatitis
blue and bulging membrane with a mass protruding from behind
Imperforate hymen
Failure of the corpus luteum to regress can lead to what?
Corpus luteal cyst
Why is a urine dip done when patients have hyperemesis gravidarum?
Assess for ketones as these would suggest ketosis/starvation
What vitamin can be given to patients with hyperemesis?
Thiamine to prevent Wernickes
What are causes of recurrent spontaneous miscarriages?
- Antiphospholipid
- Infection
- Uterine/Cervical abnormalities
What is CIN and how do you differ between CIN1/2/3?
CIN - premalignant condition where abnormally diving cells have now invaded below the basement membrane
1 - 1/3 of epithelium 2 - 2/3 of epithelium, 3 - 3/3 of epithelium
What are types of cervical cancer?
Squamous cell and adenocarcinoma
What is the investigation of choice to look for local and distant spread of invasive cervical carcinoma?
CT
What is an ectropion?
growth of endocervical columnar epithelium outside of the external os
Side effects of GnRH agonists?
Menopausal symptoms
Loss of bone mineral density
What causes ovarian torsion?
Small cyst ruptures on a free pedicle, restricting its blood supply causing potential ovarian necrosis
How do dermoid cysts arise?
Derived from primitive germ cells which can differentiate into any body tissue
What are signs of endometriosis on examination?
- Fixed, retroverted uterus
- Tender uterus
- Enlarged ovaries
- Uterosacral ligament nodules
- Visible lesions
Primary vs secondary infertility
Primary - couple have never been able to conceive
Secondary - couple have achieved conception in the past
Management of infertility in PCOS?
- Metformin
- Clomiphene
- Gonadotrophins
What is the classic PCOS triad?
- Hyperandrogenism
- Ovulatory dysfunction
- Polycystic ovaries
What bloods would you measure for ovulatory function?
- Day 21 progesterone
- FSH/LH
- Oestradiol
What are C/I to IUD insertion?
- STI/PID
- Ovarian/Endometrial/Cervical cancer
Why can women sometimes feel faint and become bradycardic during IUD insertion?
Cervical shock leads to vasovagal which causes reflex bradycardia
Where does endometrial cancer metastasize?
- Inguinal lymph nodes
- Lung
- Bone
- Liver
- Peritoneum
What are non contraceptive ways to manage menorrhagia?
- Tranexamic acid
- Aspirin
- Indomethacin
- Mefenamic acid
What are common places for endometrial tissue to grow?
- Ovaries
- Pouch of Douglas
- Uterosacral ligaments
What markers should be done in suspected ovarian cancer?
- CA125
- AFP
- BHCG
What are risk factors for uterovaginal prolapse?
- Multiparity
- Raised intrabdominal pressure
- Menopause
- Hysterectomy
What can be done to prevent prolapse?
- Pelvic floor excercises
- Support the vaginal vault during hysterectomy
What is management of prolapse?
- Pessaries
- Physio
- Surgical repair
What can cause oligohydramnios?
- PROM, renal agenesis, foetal abnormalities, IUGR
What complications can occur with oligohydramnios?
- Resp difficulties
- Skull deformities
- IUGR
- Pulmonary hypoplasia
- Cord compression
- Shoulder dystocia
- Foetal hypoxia
What is the management of oligohydramnios?
- Encourage maternal hydration
- Oligoinfusion
When should serum progesterone levels be taken to check ovulation?
7 days before next expected period
Missed pill rules
- If 1 missed (any time in cycle): take it and continue as normal
- If 2 or more missed: take it and use condoms for 7 days
- If 2 or more missed in week 1 and she has had sex this week or previous pill-free interval: + emergency contraception
- If 2 or more missed in week 3: start next pack as soon as she finishes current pack
Management of stage 1 cervical cancer to maintain fertility?
Cone biopsy
Which should be measured when thinking about premature ovarian insufficiency?
FSH - will be raised
What is the first line management for prolapse?
- If asymptomatic: nothing
- Conservative: weight loss and pelvic floor excercises
- Pessary
- Surgery: colporrhaphy
Which hormone surges just before ovulation?
LH
What is a fibroid?
Benign smooth muscle tumour originating from the myometrium
Most common tumour in young women?
Germ cell tumour
Lichen sclerosus needs what to be treated?
Potent topical steroid
Woman recently stopped breastfeeding with lump?
Galactocele
PCOS increases the risk of what?
Endometrial and ovarian cancer
What should be given to induce a withdrawal bleed when thinking about cancer in someone with PCOS?
Oral cyclical progestogen
When should a follow up smear after LLETZ be done?
6 months
Premenstrual syndrome management
COCP
SSRI
Before sterilisation, how long must women have been on effective contraception for?
1 month
