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MFSRH > Gynae > Flashcards

Gynae Flashcards

1
Q

Lichen sclerosis risk of scc

A

<5%

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2
Q

Amenorrhoea
Primary
Secondary

A

Primary nil Menses by age 16 in presence of secondary sex characteristics

Or nil menses or secondary sex characteristics by age 14

Secondary amenorrhoea - absent periods for at least 6/12 if prev regular periods or 12 months if okigoamenorrhoea

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3
Q

Type 1 amenorrhoea

A

Low estrogen, low fsh and no hypothalamic pituitary pathology leading to hypogonadotrophic hypogonadism

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4
Q

Type 2 amenorrhoea

A

Normal estrogen normal fsh normal prolactin - pcos

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5
Q

Gondal failure hormone levels

A

Low estrogen

High fsh

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6
Q

Tanner stages

A

Stage 1 prepubertal
Stage 2 breast bud few hairs
Stage 3 larger breast bud, central hair growth
Stage 4 mound formed, triangular hair growth
Stage 5 fully formed breast, adult pubic hair

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7
Q

Causes only of primary amenorrhoea

A

Hydrocephalus
Empty sella syndrome
Constitutional delay
Genetic disorders - androgen insensitivity syndrome, turners, rokintansky syndrome

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8
Q

Causes only of secondary amenorrhoea

A 
Fragile x syndrome 
Sheehans
Head injury
Ashermans
PCOS
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9
Q

Primary ovarian failure under what age and what blood tests?

A

Under 40
Two fsh >20 on two occasions
Screen for mumps, autoimmune, hiv, karyotype and baseline dexa

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10
Q

Turner syndrome chromosomes

A

45X0

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11
Q 
Amenorrhoea with 
Normal low fsh
Normal low LH
High prolactin
Testosterone normal
A

Hyperprolactinaemia

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12
Q 
Fsh normal
LH normal or slightly raised
Prolactin normal or slightly increased
Testosterone slightly increased 
LH:FSH ratio raised
A

PCOS

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13
Q

Secondary amenorrhoea with low normal FSH and LH with normal testosterone, prolactin and oestrogen

A

Hypothalamic stress weight loss

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14
Q

Turners syndrome

A 
High FSH high LH
Low estrogen 
Short stature 
Short 4th metacarpal
Horseshoe kidney
Streak like gonads

Remove testes
Induce with CHC

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15
Q

Constitutional delay of menses Rx

A

Induce puberty with 2mcg ee daily
Increase in 5mcg increments every 6/12 until 20mcg
Then go for CHC

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16
Q

Kallmans syndrome

A

Anosmia
Colour blind
Amenorrhoea primary

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17
Q

Rotterdam criteria for PCOS

A

Amenorrhoea

Hyperandrogenism or polycystic ovary (over 10 in each ovary)

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18
Q

Mx of PCOS

A

Weight loss
Induce regular bleeds
Mpa 10mg OD for 5 days every 3/12 or give CHC dianette

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19
Q

Rokitansky syndrome

A 
Mullerain agenesis
Vagina absent
Uterus usually absent
Check kidneys
Normal ovaries 
Can do IVF with surrogate
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20
Q

Androgen insensitivity syndrome

A 
46XY
Gonads are testes
Minimal Vulval or pubic hair development 
Short vagina 
Do get breasts

Remove testes
Can’t conceive

Testosterone >5

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21
Q

Risk factors for endometrial hyperplasia

A

Obesity
Anovulation
Estrogen secreting Tumors
Drugs eg tamoxifen HRT

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22
Q

Mx of endometrial hyperplasia without Atypia

A

Reverse RF - can observe but prefer to
Rx with progestogen IUS
TVUSS to check ovaries
2nd line Rx mpa 10mg daily

Review at 6/12 for pipelle

If persists >12/12 despite RX - hysterectomy

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23
Q

Atypical hyperplasia Mx

A

Total hyst

BSO for all

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24
Q

Wishing to preserve fertility and atypical hyperplasia

A

Ius
Exclude invasive ca with mri and Timor markers
Then TAH when no longer need fertility

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25
Q

Describe types of FGM

A

Type 1 - partial or total removal of clitoris
Type 2 partial or total removal of clitoris and labia minora
Type 3 narrowing of vagina opening by cutting and stitching labia togethe
Type 4 piercing, pricking

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26
Q

Mx of FGM medicolegally

A

If > 18 discuss with safeguarding. If children at risk then discuss with child protection or if pregnant

If under 18 - report to police by end of working day. Strategy meeting within 45 days

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27
Q

In early pregnancy if crl <7mm and no FH what the MX plan?

A

Second scan in a week

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28
Q

If crl >7mm and no FH what plan?

A

Can rescan in a week or second sonographer to confirm

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29
Q

If GS over 25mm and nil pole

A

Second sonographer to confirm

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30
Q

Rfs for ectopic

A 
Smoking
Prev ectopic
Tubal surgery
PID
>35
IVF
IUD
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31
Q

PUL Mx of 48hours hcgs

A

If >63% increase then likely intrauterine. Rescan when hcg >1500

If descrease over 50% likely failing pregnancy and do PT

If between the two - potential ectopic

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32
Q

Mx of miscarriage

A

Expectant mx first line for 2 weeks
Medical mx vaginal miso 800mcg
Surgical Mx

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33
Q

Ectopic mx for expectant

A 
If clinical stable
Pain free
Tubal ectopic not over 35mm
No FH
Hcg less than 1000

Hcg on d2, 4 and 7 and should drop by 15%

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34
Q

Ectopic medical mx

A 
No significant pain
Unruptured 
Less than 35mm
No FH
Hcg less than 1500

Hcg d4 and d7

Can consider up to 5000 but chance of intervention increased

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35
Q

When surgical mx of ectopic 1st line

A

Significant pain
Mass over 35mm
FH
Hcg >5000

36
Q

How to calculate % change

A

New number minus old number
Divided by old number
X100

37
Q

Dose of methotrexate

A

50mg/m2

Transient pain 3-10 days post

38
Q

Complete mole

A

Empty egg fertilised by one sperm

46XX androgenetic

Snow storm on USS with nil embryo

39
Q

Partial mole

A

Two sperm fertilise one egg

Most triploid

69XXY or 69 XYY

Uss- embryo but looks like m/c with cysts
Thecal luteal cysts

40
Q

Follow up for molar

A

If hcg normal within 8 weeks of evac - 6/12 from evac

If not normal at 8 weeks then 6/12 from when normal

41
Q

Ix of HMB

A

If low risk start medical mx

Is suspect fibroids etc or Sx imb- OP hyst and pipelle

42
Q

Mx of HMB if nil pathology

Fibroids less than 3cm

A

IUS
If declines then txa, nsaids, CHC
GNRHa

If declines medical

Surgical - ablation or hysterectomy

43
Q

Mx of fibroids >3cm

A

Medical - txa, nsaids, esmeya, ius, CHC zoladex

Surgical - myomectomy, uae hysterectomy

44
Q

Esmya side effects and monitoring

A

Can cause liver damage
LFTs for first 2 courses

Dose 5mg OD for up to 3/12
Max 4 courses

Should be fibroids >3cm and hb less than 102

45
Q

Palm coein for causes of AUB

A 
Polyp
Adenomyosis
Leiomyoma 
Malignancy
Coag 
Ovulating disorder
Endometrial 
Iatrogenic
Not yet classified
46
Q

Ablation

A

Up to 14cm cavity length
Not fibroids >3cm
No cavity distortion
Myometrium at least 10mm

Pipelle and hyst pre procedure

47
Q

When to offer risk reducing bso

A

Brca 1 or 2
15-60% risk of ovarian ca
Risk reducing bso after family complete

48
Q

Rx of LS

A

Dermovate 0.05%

49
Q

Cin by grades

A

Cin 1 basal third
CIN 2 basal 2/3rds
CIN 3 entire epithelium

50
Q

Cervical screening per age

A

25-49 every 3 years

50-64 every 5 years

51
Q

When to screen women over 65 for cervical screen

A

If recent smear abnormal

Nil test since 50

52
Q

If inadequate sample or postnatal when to perform smear?

A

3/12

53
Q

When no longer near a smear?

A

Total hysterectomy
Congenital abcense
Radical trachelectomy

54
Q

Pathway through colp and outcome

A

If borderline or mild dyskaryosis and hpv neg then normal recall
If hpv positive and colp normal - smear and colp 1 year
If low grade disease and punch biopsy shows cin 1 - smear in one year
Cin2/3 lletz and smear in 6/12
If severe mod and high grade disease - lletz 6/12 toc and if hpv neg - routine recall

55
Q

Dose of folic acid and which conditions to give higher dose in!

A

0.4mg for low risk
5mg for high risk

Prev neural tube defect
Diabetic
On antiepileptics
BMI>30

56
Q

Type 1 ovulating disorders and fertility

A

Low LH and FSH
Signs of low estrogen
Nil progestogen withdrawal bleed

Rx underlying cause
Will need gnrh ovulation induction

57
Q

Rx for fertility in PCOS

A

Optimise health
Then induce ovulation with clomifene
Monitor with uss and progesterone to avoid over recruitment
If clomifene resistant then ovarian drilling

Can induce with gnrh

58
Q

Define oligospermia
Asthenospermia
Teratozoospermia
Azoospermia

A

Oligo- reduces concentration <15 million
Astheno- reduces motility <32%
Tertato- reduce normal shape <4%
Azoo- no sperm

59
Q

Causes of male factor problems

A 
Unknown
Tumors
Steroids for beef caking
Chronic illness
Obesity

Kallmans, caricocoele, infection, drugs, smoking

60
Q 
Normal semen analysis
Volume
Sperm number
Concentration
Total motility
Progressive motility
Normal sperm
A 
Volume 1.5ml
Total sperm no 39million
Concentration 15million
Total motility 40%
Progressive motility 32%
Normal speed 4%
61
Q

Ovarian reserve

A

Amh > 25 good low if under 5.5

Total antral follicle count 4-16

62
Q

Indications of assisted reproduction

A

Tubal damage if severe and nil conceive 6/12 post tubal surgery
Endometriosis I’d mod to severe and 12/12 post ablative surgery
Male factor if significant
Pcos failed with clomifene
Unexplained fertility if over 2 years and lifestyle not worked

63
Q

Cycles offered on nhs of ivf

A

3 cycles to women under 40 who have tried for 2 years

Can offer investigations after 1 year of trying

64
Q

Fertility Rx and 40-42 yers old

A

1 cycle ivf as long as nil previous. Not low ovarian reserve

65
Q

Mx of overactive bladder, urgency symptoms

A 
Lifestyle change
Bladder diary and void chart
Restrict fluid intake
Bladder train for 6 weeks
If urogenital atrophy add oestrogen pessary
Give solifenacin

If still Sx then urodynamics
If destructor overactivity then do Botox

If not then detrusor myectomy

66
Q

Mx of stress incontinence

A

Physio exercises 3/12
Weight loss

Can trial duloxetine
Or offer surgery
TVT
Burch colposuspension

67
Q

Grading a prolapse

A

Grade 1 half way down vagina
Grade 2 to hymenal ring
Grade 3 not max decent
Grade 4 maximal decent

68
Q

HRT regime

A

Sequential combined - estrogen daily then 14/7 progestogen every cycle to induce bleed

Continuous combined continual regime

69
Q

Preparations of HRT

A

Transdermal or tablet micronised estradiol

Progestogen micronised pessary or capsule
Or mpa tablet as less androgenic

70
Q

Risks of HRT

A

Breast ca - increases risk. Not in first 3 years. After this 8 extra cases per 1000.

VTE - increases by oral, not increased by transdermal . Two fold increase

CV risk- between 50-59 protective role but over 60 estrogen increases stroke risk

71
Q

Diagnosing PMS

A

Diary for 2 cycles

Gnrh analogues for 3/12 if diary inconclusive

72
Q

Complimentary therapies in PMS

A

Saffron
Calcium and vit D
Vitex agnus
B6

73
Q

Rx algorithm for PMS

A

1st line exercise CBT vit b6
CHC Yasmin or SSRI 10mg cotalopram

2nd line - estradiol patches (100mcg) plus micronised progestogen 100mg for 10/7 or mirena
Higher dose SSRI 20-40

3rd line - GNRH analogues plus add back HRT 100mcg estradiol patch plus micronised progestogen 100mg/day

4th line surgery and then HRT

74
Q

Pre top what needs to be tested

A 
Rhesus
Hb 
VTE risk
Smear check
Uss
Abx
Medical Hx 
Sti screen
Contraception
75
Q

When to give fetecide for TOP

A

Over 21+6

76
Q

Surgical TOP and method depending on gestation

A

<14 weeks vacuum aspiration
14-16 weeks vacuum aspiration with large bore cannula
Over 14 weeks dilataion and evacuation under uss

77
Q

Miso pre stop regime

A

400mcg 3 hours pre op

> 14 weeks oncogenic dilators better but miso ok up to 18/40

78
Q

Medical TOP regime

A

Early medical up to 9 weeks- mifepristone 200mg then miso 800mcg. If nil give one further dose 400mcg

9-13 weeks mife 200mg then miso 800mcg. Max 4 further doses of 400 at 3 hourly intervals

13-24 weeks mife 200mg then 800mcg then miso 400 3 hourly for max 4 further doses. If nil then repeat mife 3hours post last miso and restart miso 12 hours later

79
Q

Advice post top

A 
Leaflet
Sx ongoing pregnancy
What to expect with bleeding
When to present
24hours phone number 
Nil pt post surgical
Pt post medical
80
Q

What is the hsa1?

A

Form needing two docs and circling reason for top

Must be kept for 3 years

81
Q

Hsa4 what is it?

A

Form saying place and details of
TOp
Must send to chief medical officer within 14/7
Only doctors terminating pregnancy can complete

82
Q

Abortion grounds letters

A

A- risk to life of pregnant woman
B- permenant grave injury of physical of mental health to woman
C- not over 24 weeks and continuing would risk physical or mental health of woman
D- not over 24 weeks and risk health of existing children
e - risk to unborn child of physical or mental abnomalitie
F- save life of preggers woman
G - prevent permanat grave injury to preggers woman in an emergency

83
Q

Fraser criteria

A 
Under 16 year old understand the advice
Can’t be persuaded to tell parents
Likely to keep having sex
Mental or physical health may suffer without it
Best interests to give
84
Q

Forensic timescales

A 
Digital penetration 12hours
Kissing licking 48hours
Oral penetration 48hours
Anal penetration 3 days
Vaginal penetration 7 days
Blood within 3 days and urine within 4 days

Hair analysis up to 6/12

85
Q

Crl and weeks approx

A 
6/40 5
7/40 10mm
8/40 15mm
9/40 20mm
10/40 30mm
11/40 40mm
12/40 55mm

> 13/40 head circumferenxe

MFSRH (8 decks)

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