Gynae - Early Pregnancy + Menstruation

Question 1

what is premenstrual syndrome?

Answer 1

occurs in the luteal phase and resolves by menstruation

Question 2

what causes premenstrual syndrome?

Answer 2

decreased progesterone

increased PRL/oestrogens

Question 3

features of premenstrual syndrome?

Answer 3

emotional lability
bloating 
wt gain
mastalgia
fatigue
headache
cravings
cyclical

Question 4

features of a molar pregnancy?

Answer 4

missed period
vaginal bleeding
large for dates

Question 5

what causes a molar pregnancy?

Answer 5

non viable fertilised egg implants into the uterus/fallopian tube

Question 6

what is a partial mole?

Answer 6

egg fertilised by one/two sperm (triploidy)

Question 7

what is a complete mole? what are these at risk of?

Answer 7

egg with no DNA fertilised by sperm (diploidy)

choriocarcinoma

more common (snowstorm etc..)

Question 8

Ix for molar pregnancy?

Answer 8

BhCG elevated
pelvic US (snowstorm)
CXR (metastatic disease)

Question 9

Tx for molar pregnancy? how long should pregnancy be avoided?

Answer 9

D+removal / hysterectomy
anti D

avoid pregnancy for 1 year

Question 10

what is the menopause?

Answer 10

amenorrhoea for 12 months

Question 11

when is the menopause premature?

Answer 11

<45yrs

Question 12

features of the menopause?

Answer 12

hot flush
night sweats
joint pain
dry sin 
hair thin
vaginal dryness
osteoporosis
poor memory
loss of libido
labile mood/concentration

Question 13

what happens to cause the menopause?

Answer 13

decline in follicles
reduced oestrogen (which is produced by these)
no negative feedback on LH/FSH production
anovulation occurs

Question 14

what does lack of oestrogen increase risk of?

Answer 14

CVS
osteoporosis
incontinence
prolapse

Question 15

Ix for menopause?

Answer 15

FSH (high)

Question 16

how long should women use contraception for after the menopause?

Answer 16

<50 2 years after LMP

>50 1 year after LMP

Question 17

benefits vs risks of HRT?

Answer 17

decrease # risk
decrease CVD (<65yrs)

VTE
stroke/CVD
breast Ca
ovarian if >5yrs

Question 18

what do those with no uterus get for HRT?

Answer 18

oestrogen

Question 19

what do those with a uterus get for HRT?

Answer 19

combined (oestrogen everyday, prog for 12/14 days monthly)

cyclical if perimenopausal

Question 20

contraindications for HRT?

Answer 20

undiagnosed PV bleed
liver disease
uncontrolled HT
Hx VTE
Hx CVD/Stroke
Hx of benign breast disease

Question 21

oestrogen side effects of HRT?

Answer 21

breast enlargement
leg cramps
fluid retention
nausea
headache

Question 22

progesterone side effects of HRT?

Answer 22

PMS
headache
acne
mood swings
depression
irritable
constipated
increased appetite

Question 23

what is amenorrhoea? what is primary?

Answer 23

absence of menstruation for at least 6 months

primary is failure by 16yrs

Question 24

causes of primary amenorrhoea?

Answer 24

imperforate hymen 
premature ovarian failure
turners (XO)
Kallman's
hypothyroid
PCOS
CAH
prolactinoma
sarcoid

Question 25

causes of secondary amenorrhoea?

Answer 25

``` wt loss exercise sheehan's high PRL thyroid PCOS ashermann's pregnancy breastfeeding ```

Question 26

Ix for amenorrhoea?

Answer 26

``` BMI PV bHCG FSH/LH (low hypogonad, high ovarian failure) TFTs genetic tests imaging ```

Question 27

what is mittelschemerz? Tx?

Answer 27

mid cyclical pain | analgesia

Question 28

where do bartholin's cysts occur? Tx?

Answer 28

5/7 oclock position at introitus marsupulisation and Abx

Question 29

when is abortion legal up until?

Answer 29

24wks

Question 30

when is abortion legal past 24 wks?

Answer 30

life at danger | fetal anomoly

Question 31

what is given for a medical abortion?

Answer 31

mifepristone | 48hrs later misoprostol (up to 5 doses)

Question 32

risks of medical abortion?

Answer 32

bleeding incomplete procedure pain infection

Question 33

what happens after a medical abortion?

Answer 33

complete pregnancy test at home 2wks later

Question 34

when can a medical abortion be completed?

Answer 34

up to 24wks

Question 35

what surgical abortion is done up to 12+6 wks?

Answer 35

vacuum aspiration

Question 36

what surgical abortion is done after 14 wks?

Answer 36

D+evacuation (not done in scotland) misoprotolol softens cervix azithro + met given

Question 37

what Ix should be done pre abortion?

Answer 37

``` rhesus FBC swabs US bHCG ```

Question 38

who gets anti D prophylaxis after an abortion?

Answer 38

rhesus -ve after 9+6 wks ALL surgical

Question 39

Tx for DUB?

Answer 39

mirena coil tranxemic (antifibrinolytic) mefanamic acid (NSAID)

Question 40

surgical complications 0-24hrs?

Answer 40

haemorrhage | UTI

Question 41

surgical complications 24hrs - 5days?

Answer 41

infection DVT/PE bladder/bowel/ureter injury

Question 42

surgical complications 7-14 days?

Answer 42

infection DVT/PE AVN secondary to diathermy