Gynae Flashcards
Mechanism of POP
Thickens cervical mucus
Mechanism of injection
Prevents ovulation
Thickens mucus
Mechanism of IUD
Decreases sperm motility and survival
Mechanism of IUS
Prevents endometrial proliferation
COCP missed pill
Take ASAP even with next one
Miss two - take as soon as remember but use condoms for 1 week
7-day condom rule for d/v
Emergency contraception if two missed from first 7
Contraindications to COCP
Smoker over 35 Migraine with aura Current cancer History of VTE Stroke and TIA HCC Major surgery with prolonged immobilisation BP 160/95 Breastfeeding
POP Window
3 hours
Cerazette - 12 hours
Time until effective
If not first day of period
Instant: IUD
2 days : POP
7 days: COC, injection, implants, IUS
Emergency contraception things to ask
- Details of unprotected sex
- Current contraception?
- Menstrual history
- Any chance that they could already be pregnant?
Discuss reasons Future contraception Risk of STIs Leaflet 3 week follow up and pregnancy test Next period may be early or late Seek attention for lower abdominal pain
Levonelle
1.5mg levonorgesterol
Prevents ovulation and disrupts implantation
Within 3 days
EllaOne
30mg ulipristal acetate
Inhibits ovulation and thins endometrium
Contra indicated in under 18 year olds
Gynae history aspects
Menstrual history Vaginal bleeding Pain Discharge Sexual history Obstetric history
Mechanism of action of COCP
Inhibits ovulation
Increases cervical mucus
Thins endothelium
Vaginal discharge differentials
Physiological discharge STI Non-STI - candida/thrush and BV PID Foreign body Genital tract malignancy
Bacterial vaginosis diagnosis
KOH whiff test
pH >4.5
Saline wet-mount
Clue cells and absent leukocytes
Gardenerella
Bacteria vaginosis treatment
Metronidazole
400-500mg BD 5-7 days
Or 2g one dose
Vaginal gel
Normal pH of vagina
3.8 - 4.2
Candidiasis diagnosis
PH
Candidiasis treatment
Topical clotrimazole
Oral fluconazole
Pregnant - only use topicals
Resistant try topical nystatin
May need prophylaxis
Treatment of genital warts
Podophyllia paint Podophyllotoxin cream Cryocauterisation Surgery Laser therapy
HPV strands
6/11 - warts
16/18 - cervical cancer
Order of swabs
- High vaginal charcoal - BV, TV, Candida, group b strep
- Endocervical gonorrhoea - charcoal
- Endometrial chlamydia
Long term complications of pelvic inflammatory disease
Infertility
Chronic pid
Ruptured TOAs
Ectopics
Causes of post coital bleeding
Cervical polyp
Cervical ectropion
Cervical cancer
STIs
Causes of post menopausal bleeding
Endometrial cancer
Atrophic vaginitis
Endometrial hyperplasia
Intermenstrual bleeding differentials
Ectopic
Spontaneous abortion
Sexually transmitted infections
Management of stress incontinence
Conservative
Pelvic floor muscle training - for at least 3 months
Surgical - tapes/colposuspension
Management of urge incontinence
Bladder retraining
Antimuscarinics
Sacral nerve stimulation
Amenorrhoea differentials
Primary Pregnancy Drug-induced PCOS hyper/hypothyroid Hypogonadotropic hypogonadism (hypothalamic) Menopause Hypperprolactinaemia Premature ovarian failure Sheehans Ashermans
Fibroid symptoms
May be asymptomatic Menorrhagia Lower abdominal pain Bloating Urinary symptoms Sub fertility
Ectopic pregnancy management
Small and unruptured - methotrexate IM. (Serial b-hcg measurements)
Surgical - for haemodynamically unstable. Salpingectomy vs conservative. Can be laparoscopic,
Risk factors for ectopic pregnancy
Previous ectopic pregnancies Pelvic inflammatory disease Prior tubal surgery IUD Increasing age Smoking
Causes of cervical excitation
PID
Ectopic
Cervical cancer screening ages
25 - 49 every 3 years
50 -64 smear every 5 years
Cervical ectropion
Squamocolumnar Junction extends under hormonal influence
COCP, pregnancy, puberty
Incontinence history taking
Onset frequency nocturnal amount urge stress pads access
Urological hx for men - start middle and end of urination
Obstetric - prolapse, parity and delivery, menopause
Red flags: haemturia, pain, fever, bone pain, weakness, constipation
Ice
Sh - fluid type and intake, effect on life
Causes of stress incontinence
Management
Cause - weak, damaged pelvic floor
Management - pelvic floor muscle training (atleast 3 months)
Surgical - tapes
Causes of urge incontinence
Management
Detrusor over activity, BPH, prostate cancer, autonomic neuropathy, infection, stool impaction
Management - bladder retraining
Antimuscarinics
Sacral nerve stimulation
Conservative methods - lifestyle
Meigs syndrome
Benign ovarian tumour and ascites and pleural effusion (transudate)
PCOS features
Hyperandrogenic chronic anovulation
Hirsutism Obesity Acanthosis nigricans Sub/infertility Menstrual disturbance
PCOS investigations
FSH LH prolactin TSH testosterone
Glucose tolerance
LH:FSH ratio raised:
Prolactin normal or mildly raised
Testosterone - normal or mildly raised
Premature ovarian failure definition
Cessation of menses for 1 year, onset of menopausal symptoms and elevated gonadotropin levels before 40
Causes \: Idiopathic Radiation Chemotherapy Autoimmune
Suspected ovarian cancer investigation
Ascites or a palpable mass - 2 weeks
No mass/ascites - measure ca-125
If >35 then do ultrasound abdo/pelvis and refer within 2 weeks
Sub fertility investigations
Semen analysis
Mid-luteal progesterone in female
Male causes of sub/infertility
Testicular torsion Testicular trauma Bilateral undescended testes Chemo Mumps and orchitis STIs Retrograde ejaculation post TURP
Female causes of subfertility
Age Overweight Iatrogenic - pelvic surgery Ovulatary problems - PCOS thyroid Hyperprolactinaemia Premature menopause Hypothalamic Tubal pathology Uterine pathology
Male causes of sub fertility
Bilateral undescended Mumps STIs Retrograde ejaculation post TURP Testicular torsion Trauma
