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Aaska's specialities > GYNAE > Flashcards

GYNAE Flashcards

1
Q

Whats Meig’s syndrome

A

Older women with
1. Ovarian tumor (fibroma which is benign)
2. Ascites
3. Pleural effusion

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2
Q

Bladder retraining

A

urge incontinence

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3
Q

Oxybutynin

A

urge incontinence

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4
Q

Pelvic floor exercises

A

stress incontinence

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5
Q

Duloxetine

A

stress incontinence

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6
Q

gonorrhoea abx coverage

A

ceftriaxone 1mg IM stat

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7
Q

chlamydia abx coverage

A

doxycycline 100mg TDS 14 days

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8
Q

ovarian cancer metastasises to which lymph nodes

A

para aortic

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9
Q

endometrial cancer metastasises to which lymph nodes

A

para aortic

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10
Q

cervical cancer metastasises to which lymph nodes

A

inguinal

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11
Q

most common type of cervical cancer

A

squamous cell

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12
Q

PCOS increases risk of developing what condition

A

diabetes

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13
Q

PCOS what test done at diagnosis

A

OGTT

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14
Q

impaired glucose tolerance on OGTT

A

fasting glucose <7
2 hr glucose >7.8 but <11.1

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15
Q

if a women is having a threatened miscarriage she should return when

A

bleeding persists beyond 14 days
bleeding gets worse

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16
Q

first line mx for a confirmed miscarriage is

A

expectant
for 7-14 days

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17
Q

contraindications for expectant management for miscarriage

A

evidence of infection
last first trimester
previous traumatic events

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18
Q

take pregnancy test how long after expectant mx

A

3 weeks

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19
Q

concerned if bleeding has not started in how many hrs in medical mx of miscarriage

A

24

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20
Q

medical mx of miscarriage medication

A

misoprostol
with analgesia and antiemetics

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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

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22
Q

refer to what charity for miscarriage mx

A

miscarriage association

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23
Q

serial hcg measurements in ectopic pregnancy until

A

levels undetectable

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24
Q

hcg level for expectant management of an ectopic

A

<1000

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25
Q

hcg level for medical management of an ectopic

A

<1500

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26
Q

serial hcg is done on

A

presentation, day 2, 4, 7 then weekly

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27
Q

advice for after medical mx of ectopic

A

dont have sex during treatment
dont conceive for 3 months
avoid alcohol and prolonged exposure to sunlight

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28
Q

hcg level for surgical management of an ectopic

A

> 5000

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29
Q

follow up for salpingotomy ectopic mx

A

serum hcg at 1 week
then weekly till undetectable

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30
Q

follow up for salpingectomy ectopic mx

A

urine pregnancy test after 3 days

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31
Q

what to say when explaining why ectopic needs to be removed

A

it will not be able to develop
will put the mother at significant risk if not removed

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32
Q

diagnosis of ectopic explanation

A

implantation of a pregnancy outside the uterus which means it is not viable

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33
Q

first line mx for molar pregnancies

A

suction curettage

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34
Q

follow up for molar pregnancy

A

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

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35
Q

contraception advice for molar pregnancy

A

barrier contraception until hcg normalises
COCP can be started when hcg is normal

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36
Q

vomitting rules for levonelle and ullipristal

A

levonelle= repeat dose if vomit in 2 hrs
ulipristal= repeat dose if vomit in 3 hrs

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37
Q

when should hormonal contraception be restarted after taking ulirpistal

A

5 days
use barrier contraception for 2-9 days

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38
Q

levonelle moa

A

inhibit ovulation for 5 days

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39
Q

ulipristal moa

A

inhibit fertilisation until sperm isn’t viable

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40
Q

emergency contraception rule for women >70kg or BMI >26

A

ellaone is recommended
if levonelle taken double the dose

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41
Q

side effects of copper coil

A

expulsion
heavy, painful periods
infection
perforation
ectopic

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42
Q

side effects of IUS

A

acne
breast tenderness
mood disturbance
headaches

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43
Q

jaydess is used for

A

contraception but not heavy periods
lasts 3 years

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44
Q

how does IUS affect periods

A

makes them lighter, less painful or no period at all

intially might increase bleeding

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45
Q

how does the implant work

A

thickens mucus
thins endometrium
prevents ovulation

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46
Q

how long does the implant last

A

3 years

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47
Q

what is the most effective form of contraception

A

progesterone implant

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48
Q

what drugs may reduce efficacy of the implant

A

anti epileptics and rifampicin

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49
Q

what are progestogenic side effects of contraception

A

irregular bleeding
mood changes
breast tenderness
headaches

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50
Q

what contraception should you avoid in those with osteoporosis

A

progestrone implant

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51
Q

what are the long acting reversible contraceptives

A

uterine devices
implant
injection

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52
Q

if cocp has been missed over 72 hrs what rules apply

A

2 pills missed rules

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53
Q

POP is effective when

A

immediately if first 5 days of cycle or switching from COCP
in 2 days otherwise

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54
Q

COCP is effective when

A

immediately if first 5 days of cycle
otherwise 7 days

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55
Q

disadv of POP

A

take at same time everyday
irregular bleeding
ovarian cysts

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56
Q

POP missed in how many hrs doesnt make a difference

A

< 3 hrs (just take)
<12 hrs if cezarette

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57
Q

POP missed >3hrs rule

A

take and barrier contraception for 48 hrs

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58
Q

transdermal patch delayed change rules

A

<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

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59
Q

contraceptive ring worn for how long

A

21 days then 7 days hormone free period

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60
Q

rotterdam criteria

A

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)

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61
Q

oligo/amenorrhoea in rotterdam criteria for how long

A

over 2 years

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62
Q

polycystic ovaries on US in rotterdam criteria qualifies as

A

> 12 in one/both ovaries measuring 2-9mm
or ovarian volume 10cm3

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63
Q

screen for what in PCOS

A

diabetes and cardiac disease

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64
Q

1st line mx PCOS

A

lifestyle mx (diet and weight reduction)

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65
Q

what pill is given in PCOS for androgenism sx

A

co cyprindiol (dianette)

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66
Q

when is metformin added to clomiphene for infertility in PCOS

A

after 3 failed cycles

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67
Q

mx of subfertility in PCOS

A

weight reduction
clomiphene
gonadotrophins
lap ovarian drilling

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68
Q

top timeline

A

4-24 weeks

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69
Q

when is medical mx for TOP possible

A

anytime between the 4-24 weeks

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70
Q

medical mx for TOP at home when

A

<9 weeks GA

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71
Q

medical mx for TOP in hospital when

A

after 9 weeks GA

72
Q

special consideration in medical mx for TOP when

A

after 21 weeks GA
give KCL as a feticide so expelled contents dont show signs of life

73
Q

anti D prophylaxis in TOP when

A

after 10 weeks GA

74
Q

surgical mx of TOP options

A

vacuum aspiration <14 weeks (under LA or GA)

dilatation and evacuation 13-24 weeks

75
Q

risks of surgical mx of TOP

A

failure to end pregnancy
bleeding
infection
perforation

76
Q

how many doctors needed for TOP approval

A

2, they dont both need to see patient

77
Q

discuss what with all TOP patients

78
Q

mifepristone dose for TOP

79
Q

risk assess for what in TOP

80
Q

bleeding can last for how long after medical mx in TOP

81
Q

pregnancy test after medical mx of TOP when

A

in 3 weeks

82
Q

subfertility LH/FSH/oestrogen measured when?

A

early in the cycle- days 2/3

83
Q

AMH produced by what

A

granulosa cells

84
Q

what bloods are done in subfertility

A

LH/FSH/oestrogen- day 2,3
progesterone- mid luteal
TFTs
prolactin
testosterone

85
Q

what STIs are screened for if assistive reproduction is being considered

A

hep c
hep b
HIV

86
Q

antral follicle count measures

A

ovarian reserve

87
Q

what antral follicle count is a poor vs good response

A

poor= <4
good= >16

88
Q

what tests are done for semen analysis

A

2 tests 3 months apart

89
Q

how is tubal patency assessed

A

hysterosalpingography (HSG)
lap and dye

90
Q

subfertility initial ix

A

bloods
STI screen
TVUS
tubal assessment if rf
semen analysis

91
Q

conservative mx for subfertility

A

address stress, caffeine, drug use
smoking cessation
no alcohol
obesity or low body weight

92
Q

medical mx of subfertility

A

ovulation induction (clomiphene or FSH)
intrauterine insemination
donor insemination
IVF
donor egg IVF

93
Q

surgical mx of subfertility

A

lap to treat disease (adhesions, endometriosis, cysts)
myomectomy
tubal surgery
laparoscopic ovarian drilling

94
Q

statistics for getting pregnanct subfertility

A

80% in first year of trying
50% in second year of trying

95
Q

advice about sex in subfertility

A

at least every other day

96
Q

oestrogen only HRT in BMI >30

A

as transdermal patch only

97
Q

benefits of HRT

A

improved vasmotor sx, sleep, performance
prevention of osteoporosis
reduced dryness, dyspareunia

98
Q

when does HRT increase risk of endometrial cancer

A

no progestogens

99
Q

what cancers does HRT increase risk of

A

breast
endometrial if no progesterone

100
Q

risks of HRT

A

breast cancer
cardiovascular disease
VTE

101
Q

oestrogenic side effects

A

breast tenderness
nausea
headaches

102
Q

progestogenic side effects

A

fluid retention
mood swings
depression

think PMS

103
Q

contraindications for HRT

A

pregnancy
current/previous breast or endometrial cancer
uncontrolled HTN
current VTE
current thrombophilia
undiagnosed vaginal bleeding

104
Q

contraception is needed after amenorrhoea

A

for 1 yr if >50
for 2 yrs if <50

105
Q

BV abx

A

metronidazole 400mg BD 5-7 days

106
Q

vulvovaginal candidiasis medical mx

A

150mg fluconazole PO stat

clotrimazole pessary or cream if pregnant

topical clotrimazole if 12-15 yrs or if vulval sx (alongside oral medication)

107
Q

vulvovaginal candidiasis advice

A

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
Q

PID partners in what time frame should be screened

A

current and within past 6 months

109
Q

follow up for outpatient PID when

A

within 72 hrs to assess response
2-4 to ensure resolution

110
Q

overactive bladder syndrome vs incontinence

A

OBS= increased frequency and nocturia but not incontinent

if incontinent= urge incontinence

111
Q

stress incontinence mx 1/2/3 line

A

1= pelvic floor training for 3 months
2= surgery
3= duloxetine

112
Q

urge incontinence mx 1/2/3/4 line

A

1= bladder retraining 6 weeks
2= oxybutynin
3= mirabegron
4= surgery

113
Q

rf stress incontinence

A

age
traumatic delivery
obesity
previous pelvic surgery

114
Q

rf urge incontinence

A

age, obesity, smoking, family hx, diabetes mellitus

115
Q

how long is bladder retraining trialled for

116
Q

how long are pelvic floor exercises trialled for

117
Q

asherman syndrome mx

A

surgery to remove adhesions

foley cathter or IUD to prevent reformation

2 cycles oestrogen to promote endometrial hyperplasia

118
Q

what must you exclude in someone you think has atrophic vaginitis

A

malignancy
endometrial cancer

118
Q

what catheter is used for bartholins cyst

A

word catheter

118
Q

marsupialisation for bartholins cyst

A

suture inside of cyst to outside of cyst to prevent reformation

119
Q

GnRH agonists side effect

A

osteoporosis

120
Q

what is given 3 months prior to surgery in someone with endometriosis

A

GnRH agonists

121
Q

prevelance of endometriosis

122
Q

contraceptives may be not useful in fibroids if

A

submucosal fibroids
enlarged uterus

123
Q

uterine artery embolisation can only be used in fibroid mx if

A

not desiring fertility

124
Q

radiological mx for fibroids

A

uterine artery embolisation

125
Q

fibroids rf

A

increasing age until menopause
early puberty
obesity
afro caribbean
family hx

126
Q

fibroids prevelance

A

20-50% of women over 30

127
Q

contraception is used when someone has fibroids for

A

menorrhagia

128
Q

biopsy in lichen sclerosus when

A

if it doesnt resolve with treatments

129
Q

small ovarian cyst diameter

130
Q

yearly follow up for ovarian cyst of what size

131
Q

cysts bigger than what size require further imaging

132
Q

risk of malignancy index includes

A

menopausal status
US features of cyst
ca125

133
Q

post menopausal with complex or solid cyst mx

A

do TVUS and calculate RMI as suspicious of malignancy

134
Q

which COCP is best for PMS

135
Q

what type of COCP use os best for PMS

A

continuous

136
Q

SSRI for PMS is given for

A

3 month trial
monitor closely especially regarding self harm

137
Q

cervical cancer 1a1 mx

A

conservative
LLETZ or cone biopsy

138
Q

complication of LLETZ

A

midtrimester miscarriage
preterm delivery

139
Q

CIN1a2-b2 mx

A

if <4cm radical hysterectomy with bilateral salpingoopherectory

if >4cm chemoradiation

140
Q

radical hysterectomy risks

A

bladder dysfunction (atony)
sexual dysfunction
lymphoedema

141
Q

CIN/cervical cancer hysterectomy vs chemoradiation 1st lune

A

hysterectomy= CIN 1a2-b2, <4cm

chemoradiation= >CIN 1b2 or >4cm

142
Q

chemoradiation is

A

radiotherapy plus chemotherapy

143
Q

radiotherapy for cervical cancer given how

A

external beam
intracavity

144
Q

risks/se of chemoradiotherapy for cervical cancer

A

fibrosis
lethargy
bowel/bladder urgency
cystitis sx
early menopause
akin erythema (external beam radiotherapy)

145
Q

chemotherapy agent for cervical cancer

146
Q

grade IVb cervical cancer mx

A

systemic chemo (alternate between single agent therapy and palliative care)

147
Q

repeat smear for CIN

A

6 months after mx

148
Q

CIN mx

A

repeat smear in one year
take biopsy at colposcopy
moderate/severe abnormality seen do LLETZ or cone

149
Q

what stage of cervical cancer is metastatic

150
Q

what stage of cervical cancer is locally invasive

151
Q

endometrial hyperplasia without atypia mx

A

consider observing
LNG IUS
discuss rf: obesity, HRT, tamoxifen
biopsy at 6 months

152
Q

endometrial hyperplasia with atypia mx

A

non fertility preserving= total hysterectomy + BSO
fertility preserving= LNG IUS or continuous progesterone and rebiopsy at 3 months

153
Q

FIGO 1 endometrial cancer mx

A

total hysterectomy + BSO

154
Q

FIGO 2 endometrial cancer mx

A

radical hysterectomy, lymph node assessment and maybe adjuvant radiotherapy

155
Q

FIGO 3 endometrial cancer mx

A

max debulking surgery, chemo and radio

156
Q

FIGO 4 endometrial cancer mx

A

max debuling surgery, maybe palliative approach (low dose radio, high dose progestrone)

157
Q

in endometrial cancer whats the purpose of adjuvant treatment

A

reduces local recurrence but doesnt improve survival rates

158
Q

risk of malignancy index is used for what cancer

159
Q

RMI interpretation

A

> 250= refer to gynae

159
Q

RMI scores

A

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
Q

ovarian cancer stage 1 mx

A

total hysterectomy + BSO plus adj systemic chemo

if stage 1a and fertility preserving, remove only the affected ovary

161
Q

ovarian cancer stage 2 mx

A

debulking surgery
chemo neo adj or adj

162
Q

ovarian cancer stage 3 mx

A

debulking surgery
chemo neo adj or adj
targeted bevacizumab

163
Q

bevacizumab targets

164
Q

chem for ovarian cancer mx is what agents

A

platinum compound (carboplatin) with paclitaxel

165
Q

how does carboplatin work

A

cross links dna and causes cell cycle arrest

166
Q

how does paclitaxel work

A

causes microtubular damage and prevents replication/division

167
Q

risk factors for ovarian cancer

A

age
fhx
obesity
HRT
enodmetriosis
smoking
diabetes

168
Q

ovarian cancer protective factors

A

COCP
pregnancy and breastfeeding
hysterectomy

169
Q

vulval cancer excision margin

170
Q

vulval cancer mx

A

excision of lesion with a 15mm margin
full inguinofemoral lymphadenectomy for all tumors with depth >1mm

171
Q

radiotherapy is used in vulval cancer when

A

excision margins are close
2 or more groin node mets

Aaska's specialities (7 decks)

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