Gynae Corrections Flashcards
Management of lichen sclerosis?
Potent topical corticosteroid e.g. dermovate
Purpose of treatment of lichen sclerosis?
Prevent complications e.g. scarring and narrowing of vaginal opening
Reduces risk of vulval cancer
Ovarian cancer can present with symptoms of a bowel obstruction.
What are some symptoms?
- Abdo pain
- Constipation
- Nausea
- Bilious vomiting
What vomiting occurs with a bowel obstruction?
Bilious vomiting
1st line investigation in suspected ovarian cancer?
Ca-125
Management option for advanced ovarian cancer?
Surgery aiming to remove all macroscopic disease - can be done before or after chemotherapy.
Most common type of ovarian cancer?
Serous cystadenocarcinoma
What is management for cervical cancers that are still contained within the cervix with aim of sparing fertility?
Radical trachelectomy - removal of cervix, upper vagina and pelvic lymph nodes
If missed two COCP pills in week 3 of the pack, what should you do?
Finish the pills in the current pack and start the new pack the next day (i.e. omit the pill-free interval)
Can levonorgestrel and ulipristal (emergency contraception) be used more than once in the same cycle?
Yes
How long before major surgery or surgery to the legs or surgery which involves prolonged immobilisation to the lower limb should the COCP be stopped?
4 weeks
What happens if two COCP pills are missed between days 8-14 of the cycle?
a) is emergency contraception required?
b) is barrier contraception required?
As long as the previous 7 days of COCP have been taken correctly, no emergency contraception is needed
BUT barrier contraception required for the next 7 days
What is the main method of action of the implant?
Inhibits ovulation
Is ciprofloxacin a P450 inducer or inhibitor?
Inhibitor
How is POP affected by P450 enzyme inducers or inhibitors?
Inducers –> should use barrier contraception during and for 4 weeks after cessation of treatment as can reduce levels of POP
Inhibitors –> do NOT affect effectiveness of oral POPs
When can non-hormonal methods of contraception be stopped;
a) in woman <50
b) in women >=50
a) Stop contraception after 2 years of amenorrhoea
b) Stop contraception after 1 year of amenorrhoea
At what age should the COCP be stopped?
At 50 - swap to non-hormonal or progestogen-only method
At what age should the Depo-Provera (injection) be stopped?
Can be continued to 50 years
After 50 - switch to either a non-hormonal method and stop after 2 years of amenorrhoea OR switch to a progestogen-only method
At what age should the implant, POP and IUS (i.e. Mirena) be stopped?
Can be continued beyond 50 years
Which type of contraception can be continued >50 y/o?
Implant, POP and IUS (i.e. Mirena)
If a patient vomits within 3 hours of taking levonorgestrel as emergency contraception, what should you do?
Take another dose ASAP
What is the most effective method of emergency contraception?
Copper IUD
If a woman presents >5 days after unprotected sex, when may an IUD still be fitted?
Up to 5 days after the likely ovulation date (whatever is later)
Is the copper coil affected by BMI?
No
At what BMI should the standard dose of levonorgestrel (1.5mg) be doubled?
BMI >26 (or weight >70kg)
Before trying for a baby, how long should methotrexate be stopped?
At least 6 months (and use effective contraception in this time)
Both men AND women using methotrexate need to use effective contraception for at least 6 months after treatment
Which gynaecological condition is a risk factor for ecoptic pregnancy?
Endometriosis - as slows ovum’s passage to uterus
If not breastfeeding, how soon after birth can the COCP be prescribed?
3 weeks due to increased VTE risk post-partum
With the COCP, if one pill is missed at any time in the cycle, what should you do?
1) take the last pill even if it means taking two pills in one day and then continue taking pills daily, one each day
2) no additional contraceptive protection needed
When taking the COCP, if 2 or more pills are missed, what should you do?
Take the last pill even if it means taking two pills in one day, leave any earlier missed pills and then continue taking pills daily, one each day
The women should use condoms or abstain from sex until she has taken pills for 7 days in a row.
When taking the COCP, if 2 or more pills are missed in week 1, what should you do?
emergency contraception should be considered if she had unprotected sex in the pill-free interval or in week 1
When taking the COCP, if 2 or more pills are missed in week 2 (days 8-14), what should you do?
after seven consecutive days of taking the COC there is no need for emergency contraception
When taking the COCP, if 2 or more pills are missed in week 3 (days 15-121), what should you do?
Should finish the pills in her current pack and start a new pack the next day; thus omitting the pill free interval
When can the COCP be given during breastfeeding?
If 6 weeks postpartum
Which POP has a 12 hour missed pill window?
Desogestrel
How does ulipristal affect hormonal contraception?
Ulipristal may reduce the effectiveness of hormonal contraception. Contraception with the pill, patch or ring should be started, or restarted, 5 days after having ulipristal. Barrier methods should be used during this period
When switching from an IUD to COCP, when is no additional contraception needed?
if removed day 1-5 of cycle
For patients assigned female at birth receiving testosterone therapy, which contraceptive methods are not recommended?
contraceptives containing oestrogen as they can antagonize the effect of testosterone therapy
Is the nexplanon implant affected by enzyme inducers?
Yes
Is the Depo-Provera injection affected by enzyme inducers?
no
What lobe does HSV encephalitis typically affect?
Temporal lobes
Note - questions may give the result of imaging or describe temporal lobe signs e.g. aphasia, rising feeling in stomach (aura) before seizure.
Features of HSV encephalitis?
- fever
- headache
- seizures
- vomiting
- psychiatric symptoms
- focal symptoms e.g. aphasia