GYNAE Flashcards
1
Q
Whats Meig’s syndrome
A
Older women with
1. Ovarian tumor (fibroma which is benign)
2. Ascites
3. Pleural effusion
2
Q
Bladder retraining
A
urge incontinence
3
Q
Oxybutynin
A
urge incontinence
4
Q
Pelvic floor exercises
A
stress incontinence
5
Q
Duloxetine
A
stress incontinence
6
Q
gonorrhoea abx coverage
A
ceftriaxone 1mg IM stat
7
Q
chlamydia abx coverage
A
doxycycline 100mg TDS 14 days
8
Q
ovarian cancer metastasises to which lymph nodes
A
para aortic
9
Q
endometrial cancer metastasises to which lymph nodes
A
para aortic
10
Q
cervical cancer metastasises to which lymph nodes
A
inguinal
11
Q
most common type of cervical cancer
A
squamous cell
12
Q
PCOS increases risk of developing what condition
A
diabetes
13
Q
PCOS what test done at diagnosis
A
OGTT
14
Q
impaired glucose tolerance on OGTT
A
fasting glucose <7
2 hr glucose >7.8 but <11.1
15
Q
if a women is having a threatened miscarriage she should return when
A
bleeding persists beyond 14 days
bleeding gets worse
16
Q
first line mx for a confirmed miscarriage is
A
expectant
for 7-14 days
17
Q
contraindications for expectant management for miscarriage
A
evidence of infection
last first trimester
previous traumatic events
18
Q
take pregnancy test how long after expectant mx
A
3 weeks
19
Q
concerned if bleeding has not started in how many hrs in medical mx of miscarriage
A
24
20
Q
medical mx of miscarriage medication
A
misoprostol
with analgesia and antiemetics
21
Q
is asked about cause of miscarriage
A
explain most of the time there is no cause
one miscarriage will not affect future pregnancies
22
Q
refer to what charity for miscarriage mx
A
miscarriage association
23
Q
serial hcg measurements in ectopic pregnancy until
A
levels undetectable
24
Q
hcg level for expectant management of an ectopic
A
<1000
25
hcg level for medical management of an ectopic
<1500
26
serial hcg is done on
presentation, day 2, 4, 7 then weekly
27
advice for after medical mx of ectopic
dont have sex during treatment
dont conceive for 3 months
avoid alcohol and prolonged exposure to sunlight
28
hcg level for surgical management of an ectopic
>5000
29
follow up for salpingotomy ectopic mx
serum hcg at 1 week
then weekly till undetectable
30
follow up for salpingectomy ectopic mx
urine pregnancy test after 3 days
31
what to say when explaining why ectopic needs to be removed
it will not be able to develop
will put the mother at significant risk if not removed
32
diagnosis of ectopic explanation
implantation of a pregnancy outside the uterus which means it is not viable
33
first line mx for molar pregnancies
suction curettage
34
follow up for molar pregnancy
depends on hcg at day 56 of pregnancy event
normal= follow up in 6 months
abnormal= follow up in 6 months from date hcg normalises
35
contraception advice for molar pregnancy
barrier contraception until hcg normalises
COCP can be started when hcg is normal
36
vomitting rules for levonelle and ullipristal
levonelle= repeat dose if vomit in 2 hrs
ulipristal= repeat dose if vomit in 3 hrs
37
when should hormonal contraception be restarted after taking ulirpistal
5 days
use barrier contraception for 2-9 days
38
levonelle moa
inhibit ovulation for 5 days
39
ulipristal moa
inhibit fertilisation until sperm isn't viable
40
emergency contraception rule for women >70kg or BMI >26
ellaone is recommended
if levonelle taken double the dose
41
side effects of copper coil
expulsion
heavy, painful periods
infection
perforation
ectopic
42
side effects of IUS
acne
breast tenderness
mood disturbance
headaches
43
jaydess is used for
contraception but not heavy periods
lasts 3 years
44
how does IUS affect periods
makes them lighter, less painful or no period at all
intially might increase bleeding
45
how does the implant work
thickens mucus
thins endometrium
prevents ovulation
46
how long does the implant last
3 years
47
what is the most effective form of contraception
progesterone implant
48
what drugs may reduce efficacy of the implant
anti epileptics and rifampicin
49
what are progestogenic side effects of contraception
irregular bleeding
mood changes
breast tenderness
headaches
50
what contraception should you avoid in those with osteoporosis
progestrone implant
51
what are the long acting reversible contraceptives
uterine devices
implant
injection
52
if cocp has been missed over 72 hrs what rules apply
2 pills missed rules
53
POP is effective when
immediately if first 5 days of cycle or switching from COCP
in 2 days otherwise
54
COCP is effective when
immediately if first 5 days of cycle
otherwise 7 days
55
disadv of POP
take at same time everyday
irregular bleeding
ovarian cysts
56
POP missed in how many hrs doesnt make a difference
< 3 hrs (just take)
<12 hrs if cezarette
57
POP missed >3hrs rule
take and barrier contraception for 48 hrs
58
transdermal patch delayed change rules
<48hrs change and continue
>48hrs change and barrier contraception for 7 days
>48hrs in week 3 take off and continue
delayed at end of patch free week= barrier contraception for 7 days
59
contraceptive ring worn for how long
21 days then 7 days hormone free period
60
rotterdam criteria
2/3:
oligoamenorrhoea for 2 years
clinical/biochemical features of hyperandrogensim
polycystic ovaries on US (over 12 in one/both measuring 2-9mm or volume over 10 cm3)
61
oligo/amenorrhoea in rotterdam criteria for how long
over 2 years
62
polycystic ovaries on US in rotterdam criteria qualifies as
>12 in one/both ovaries measuring 2-9mm
or ovarian volume 10cm3
63
screen for what in PCOS
diabetes and cardiac disease
64
1st line mx PCOS
lifestyle mx (diet and weight reduction)
65
what pill is given in PCOS for androgenism sx
co cyprindiol (dianette)
66
when is metformin added to clomiphene for infertility in PCOS
after 3 failed cycles
67
mx of subfertility in PCOS
weight reduction
clomiphene
gonadotrophins
lap ovarian drilling
68
top timeline
4-24 weeks
69
when is medical mx for TOP possible
anytime between the 4-24 weeks
70
medical mx for TOP at home when
<9 weeks GA
71
medical mx for TOP in hospital when
after 9 weeks GA
72
special consideration in medical mx for TOP when
after 21 weeks GA
give KCL as a feticide so expelled contents dont show signs of life
73
anti D prophylaxis in TOP when
after 10 weeks GA
74
surgical mx of TOP options
vacuum aspiration <14 weeks (under LA or GA)
dilatation and evacuation 13-24 weeks
75
risks of surgical mx of TOP
failure to end pregnancy
bleeding
infection
perforation
76
how many doctors needed for TOP approval
2, they dont both need to see patient
77
discuss what with all TOP patients
LARCs
78
mifepristone dose for TOP
20mcg
79
risk assess for what in TOP
STIs
80
bleeding can last for how long after medical mx in TOP
2 weeks
81
pregnancy test after medical mx of TOP when
in 3 weeks
82
subfertility LH/FSH/oestrogen measured when?
early in the cycle- days 2/3
83
AMH produced by what
granulosa cells
84
what bloods are done in subfertility
LH/FSH/oestrogen- day 2,3
progesterone- mid luteal
TFTs
prolactin
testosterone
85
what STIs are screened for if assistive reproduction is being considered
hep c
hep b
HIV
86
antral follicle count measures
ovarian reserve
87
what antral follicle count is a poor vs good response
poor= <4
good= >16
88
what tests are done for semen analysis
2 tests 3 months apart
89
how is tubal patency assessed
hysterosalpingography (HSG)
lap and dye
90
subfertility initial ix
bloods
STI screen
TVUS
tubal assessment if rf
semen analysis
91
conservative mx for subfertility
address stress, caffeine, drug use
smoking cessation
no alcohol
obesity or low body weight
92
medical mx of subfertility
ovulation induction (clomiphene or FSH)
intrauterine insemination
donor insemination
IVF
donor egg IVF
93
surgical mx of subfertility
lap to treat disease (adhesions, endometriosis, cysts)
myomectomy
tubal surgery
laparoscopic ovarian drilling
94
statistics for getting pregnanct subfertility
80% in first year of trying
50% in second year of trying
95
advice about sex in subfertility
at least every other day
96
oestrogen only HRT in BMI >30
as transdermal patch only
97
benefits of HRT
improved vasmotor sx, sleep, performance
prevention of osteoporosis
reduced dryness, dyspareunia
98
when does HRT increase risk of endometrial cancer
no progestogens
99
what cancers does HRT increase risk of
breast
endometrial if no progesterone
100
risks of HRT
breast cancer
cardiovascular disease
VTE
101
oestrogenic side effects
breast tenderness
nausea
headaches
102
progestogenic side effects
fluid retention
mood swings
depression
think PMS
103
contraindications for HRT
pregnancy
current/previous breast or endometrial cancer
uncontrolled HTN
current VTE
current thrombophilia
undiagnosed vaginal bleeding
104
contraception is needed after amenorrhoea
for 1 yr if >50
for 2 yrs if <50
105
BV abx
metronidazole 400mg BD 5-7 days
106
vulvovaginal candidiasis medical mx
150mg fluconazole PO stat
clotrimazole pessary or cream if pregnant
topical clotrimazole if 12-15 yrs or if vulval sx (alongside oral medication)
107
vulvovaginal candidiasis advice
return if sx not resolved in 7-14 days
simple soap substitute to wash vulval area not more than once a day, do not overwash
wear tight fitting clothing, wash underwear not with biological washing powder/detergent
consider probiotics
108
PID partners in what time frame should be screened
current and within past 6 months
109
follow up for outpatient PID when
within 72 hrs to assess response
2-4 to ensure resolution
110
overactive bladder syndrome vs incontinence
OBS= increased frequency and nocturia but not incontinent
if incontinent= urge incontinence
111
stress incontinence mx 1/2/3 line
1= pelvic floor training for 3 months
2= surgery
3= duloxetine
112
urge incontinence mx 1/2/3/4 line
1= bladder retraining 6 weeks
2= oxybutynin
3= mirabegron
4= surgery
113
rf stress incontinence
age
traumatic delivery
obesity
previous pelvic surgery
114
rf urge incontinence
age, obesity, smoking, family hx, diabetes mellitus
115
how long is bladder retraining trialled for
6 weeks
116
how long are pelvic floor exercises trialled for
3 months
117
asherman syndrome mx
surgery to remove adhesions
foley cathter or IUD to prevent reformation
2 cycles oestrogen to promote endometrial hyperplasia
118
what must you exclude in someone you think has atrophic vaginitis
malignancy
endometrial cancer
118
what catheter is used for bartholins cyst
word catheter
118
marsupialisation for bartholins cyst
suture inside of cyst to outside of cyst to prevent reformation
119
GnRH agonists side effect
osteoporosis
120
what is given 3 months prior to surgery in someone with endometriosis
GnRH agonists
121
prevelance of endometriosis
10%
122
contraceptives may be not useful in fibroids if
submucosal fibroids
enlarged uterus
123
uterine artery embolisation can only be used in fibroid mx if
not desiring fertility
124
radiological mx for fibroids
uterine artery embolisation
125
fibroids rf
increasing age until menopause
early puberty
obesity
afro caribbean
family hx
126
fibroids prevelance
20-50% of women over 30
127
contraception is used when someone has fibroids for
menorrhagia
128
biopsy in lichen sclerosus when
if it doesnt resolve with treatments
129
small ovarian cyst diameter
<50 mm
130
yearly follow up for ovarian cyst of what size
50-70mm
131
cysts bigger than what size require further imaging
>70mm
132
risk of malignancy index includes
menopausal status
US features of cyst
ca125
133
post menopausal with complex or solid cyst mx
do TVUS and calculate RMI as suspicious of malignancy
134
which COCP is best for PMS
yasmin
135
what type of COCP use os best for PMS
continuous
136
SSRI for PMS is given for
3 month trial
monitor closely especially regarding self harm
137
cervical cancer 1a1 mx
conservative
LLETZ or cone biopsy
138
complication of LLETZ
midtrimester miscarriage
preterm delivery
139
CIN1a2-b2 mx
if <4cm radical hysterectomy with bilateral salpingoopherectory
if >4cm chemoradiation
140
radical hysterectomy risks
bladder dysfunction (atony)
sexual dysfunction
lymphoedema
141
CIN/cervical cancer hysterectomy vs chemoradiation 1st lune
hysterectomy= CIN 1a2-b2, <4cm
chemoradiation= >CIN 1b2 or >4cm
142
chemoradiation is
radiotherapy plus chemotherapy
143
radiotherapy for cervical cancer given how
external beam
intracavity
144
risks/se of chemoradiotherapy for cervical cancer
fibrosis
lethargy
bowel/bladder urgency
cystitis sx
early menopause
akin erythema (external beam radiotherapy)
145
chemotherapy agent for cervical cancer
cisplatin
146
grade IVb cervical cancer mx
systemic chemo (alternate between single agent therapy and palliative care)
147
repeat smear for CIN
6 months after mx
148
CIN mx
repeat smear in one year
take biopsy at colposcopy
moderate/severe abnormality seen do LLETZ or cone
149
what stage of cervical cancer is metastatic
IVb
150
what stage of cervical cancer is locally invasive
Ib2-IVa
151
endometrial hyperplasia without atypia mx
consider observing
LNG IUS
discuss rf: obesity, HRT, tamoxifen
biopsy at 6 months
152
endometrial hyperplasia with atypia mx
non fertility preserving= total hysterectomy + BSO
fertility preserving= LNG IUS or continuous progesterone and rebiopsy at 3 months
153
FIGO 1 endometrial cancer mx
total hysterectomy + BSO
154
FIGO 2 endometrial cancer mx
radical hysterectomy, lymph node assessment and maybe adjuvant radiotherapy
155
FIGO 3 endometrial cancer mx
max debulking surgery, chemo and radio
156
FIGO 4 endometrial cancer mx
max debuling surgery, maybe palliative approach (low dose radio, high dose progestrone)
157
in endometrial cancer whats the purpose of adjuvant treatment
reduces local recurrence but doesnt improve survival rates
158
risk of malignancy index is used for what cancer
ovarian
159
RMI interpretation
>250= refer to gynae
159
RMI scores
menopausal status= 1 for pre, 2 for post
US= features inc solid, multilocular, mets, ascites, bilateral lesions. 1 for 1 feature, 2 for 2 or more
ca125= in units/ml
160
ovarian cancer stage 1 mx
total hysterectomy + BSO plus adj systemic chemo
if stage 1a and fertility preserving, remove only the affected ovary
161
ovarian cancer stage 2 mx
debulking surgery
chemo neo adj or adj
162
ovarian cancer stage 3 mx
debulking surgery
chemo neo adj or adj
targeted bevacizumab
163
bevacizumab targets
VEGF-A
164
chem for ovarian cancer mx is what agents
platinum compound (carboplatin) with paclitaxel
165
how does carboplatin work
cross links dna and causes cell cycle arrest
166
how does paclitaxel work
causes microtubular damage and prevents replication/division
167
risk factors for ovarian cancer
age
fhx
obesity
HRT
enodmetriosis
smoking
diabetes
168
ovarian cancer protective factors
COCP
pregnancy and breastfeeding
hysterectomy
169
vulval cancer excision margin
15mm
170
vulval cancer mx
excision of lesion with a 15mm margin
full inguinofemoral lymphadenectomy for all tumors with depth >1mm
171
radiotherapy is used in vulval cancer when
excision margins are close
2 or more groin node mets
172
