Gynaecology Flashcards by Bethany Norman

What is the whirlpool sign a sign of?

Ovarian torsion

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Pharmacological treatment for PCOS infertility

Clomifene

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How often do women aged 25-49 attend for a cervical smear

every 3 years

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what site of ectopic pregnancy increases the risk of rupture

isthmus

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What is the most common ovarian cancer

serous carcinoma

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medical treatments for endometroosis

NSAIDs
COCP
GnRH analogues

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4 classic symptoms of endometriosis

pelvic pain
dysmenorrhoea
dyspareunia
subfertility

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first line treatment for primary dysmenorrhoea

NSAIDs e.g. mefenamic acid

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diagnosis of mild pain in pregnancy

threatened miscarriage

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most common identifiable cause of postcoital bleeding

cervical ectropion

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When do you measure mid luteal progesterone when fertility testing

7 days before the end of the cycle (day 21)

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pharmacological management of stress incontinence

duloxetine

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pharmacological treatment for ovulation induction to treat fertility

letrozole

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if a semen sample is abnormal then when should a repeat test be arranged?

3 months later

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Diagnosis in patients with continuous dribbling incontinence after prolonged labour from an area with limited obstetric services

Vesicovaginal fistulae

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Medical management of miscarriage

Give vaginal misoprostol alone

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Cause of post menopausal bleeding

Granulosa cell tumours

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What is the best measure of ovulation

Progesterone 7 days before

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What are women with PCOS at increased risk of?

Ovarian hyperstimulation syndrome

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What does PCOS increase the risk of?

Endometrial cancer

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Patient with secondary dysmenorrhoea

Refer to gynae for invesitgation

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Pharmacological management and clinical diagnosis of bacterial vaginosis

Strawberry cervic

Oral metronidazole

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Pharmacological management of gram negative gonorrhoea

IM ceftriaxone

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What can smoking help with in pregnancy (but obvs don’t do it lol)

Sickness

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Investigation for adenomyosis

MRI

Investigation for recurrent thrush

Diabetes

Medical abortion at any gestation

Mifepristone followed by at least one episode of prostaglandins

Pharmacological management of PMS

SSRI during the luteal phase

Downside of adding a progesterone to HRT

Increases the risk of breast cancer

What is Rokitansky’s protuberance

Dermoid cyst (teratoma)

What does endometriosis increase the risk of?

Ectopic pregnancy

Pharmacological management to reduce the size of uterine fibroids

GnRH agonists e.g. triptorelin

Strong risk factor for endometrial cancer

HNPCC/Lynch Syndrome

What would you do if a cervical smear sample was inadequate

Repeat the smear in 3 months

What would you do if HPV was abnormal but the cells were normal

Repeat the test in 12 months then: - if normal HPV then discharge to regular screening - If abnormal HPV then repeat again 12 months later and if still abnormal then colposcopy

What would you do if the HPV and cells were abnormal on a smear?

Refer to colposcopy

First line for non pregnant women with vaginal thrush | how does it present?

Single dose oral fluconazole | creamy white odourless discharge

When can you give an IUS for heavy periods in a female with a fibroid?

If the fibroid is less than 3cm

Multi-loculated ovarian cyst with strong blood flow - management

Refer for biopsy, high suspicion of malignancy

Known cause of fertility (e.g. PCOS) when would you refer to fertility services? What treatment would they recieve?

Immediately | Clomifene or metformin 1st line then laparoscopic ovarian drilling or gonadotrophins

Widely spaced nipples, systolic murmur and primary amenorrhoea - diagnosis and 1st line investigation to prove it

Turners Syndrome | Increased FSH/LH

Cervical ectopion

Post coital bleeding, excessive discharge, pregnant and previously took the COCP

Cervical ectropion | Increased columnar epithelium

Mechanism of action of oxybutynin and what is it used for

Anti muscarinic for overactive bladder

Most common type of ovarian pathology associated with Meigs' syndrome What 2 things is it associated with?

Fibroma | Associated with ascites and pleural effusion

Most common benign ovarian tumour in women under the age of 25 years

Dermoid cyst (teratoma)

Most common cause of ovarian enlargement in women of a reproductive age

Follicular cyst

Is migraine with aura a contraindication for HRT?

Patient with LMP over 12 months ago with some recent vaginal bleeding, HRT?

Contraindicated, needs further investigation

Menopausal lady with hot flushes who does not want HRT

Fluoxetine for vasomotor Sx

Older lady with labial lump and inguinal lymphadenopathy

Vulval carcinoma

Unilateral labial swelling with pain whilst walking and dysparapeunia in a woman of childbearing age

Bartholians Cyst

Treatment for vaginal vault prolapse

Sacrocolpopexy

Chronic pelvic and sacral pain with menstruation, tender posterior vaginal fornix with uterine motion tenderness

Endometriosis

Gold standard investigation for endometriosis

Laparoscopy

How does ovarian cancer initially spread?

Local spread within the pelvic region | then to the abdomen

Investigation for continuous dribbling incontinence

Urinary dye studies

Diagnosis of PCOS

2/3 of the following: Infrequent or no ovulation Clinical or biochemical signs of hyperandrogenism or elevated levels of total or free testosterone Polycystic ovaries on ultrasonography or increased ovarian volume

Snow storm appearance on ultrasound

Complete hyadtidiform mole

MOA of metformin in PCOS

Increases peripheral insulin sensitivity

Women who are HIV positive, how often should they attend a cervical smear?

Annual cervical cytology

Management of patient with secondary amenorrhoea

All patients with secondary dysmenorrhoea need to be referred to gynaecology for investigation

What are the three components of the RMI for ovarian cancer?

US findings, menopausal status and CA125 levels

Ovarian cyst that if ruptures may cause pseudomyxoma peritonei

Mucinous cystadenoma

The most common type of epithelial cell tumour

Serous cystadenoma

Ovarian cyst that may contain skin appendages, hair and teeth

Dermoid cyst (teratoma)

What increases the risk of hyperemesis gravidarum

Multiple pregnancy

For how many weeks after terination is the HCG positive

4 weeks

First line pharmacological management of nausea and vomiting in pregnancy

Prochlorperazine

How long after pregnancy do you have to wait until you have a smear test

3 months post-partum unless missed screening or previous abnormal smears