Gynaecology Flashcards
expectant management of miscarriage
less than 6w, bleeding and no pain with no haemorrhage of infection
management of incomplete miscarriage
vaginal misoprostal
diagnosis of miscarriage
transvaginal ultrasound showing no cardiac activity
os closed no cardiac activity
missed miscarriage
no retained products of conception
complete miscarriage
open os and heavy bleeding
inevitable miscarriage
vaginal bleeding but viable pregnancy with cardiac activity
threatened miscarriage
risk factor for 2nd trimester miscarriage
large cervical cone biopsy
medical management of TOP
mifepristone and prostaglandin
how long after TOP can the pregnancy test remain positive for
4 weeks
most common site of ectopic pregnancy
ampulla
most dangerous site of ectopic pregnancy
isthmus
endometriosis, PID and current IUS are risk factors for what
ectopic
increasing age, smoking, drugs, alcohol, caffiene, obesity, infection, unusual uterus, cervical incompetence, DM, HTN, thyroid, ibuprofen, methotrexate and retinoids are risk factors for what
miscarriage
5 indications for expectant management of ectopic
unruptured embryo less than 35mm with no cardiac activity, asymptomatic mum and declining hcg below 1000
medical management of ectopic
methotrexate
surgical management of ectopic
all cases larger than 35mm with hcg above 5000
salpingectomy 1st line
salpingotomy if infertility RF
risk of ondansetron in pregnancy
cleft lip/cleft palate
when do you refer for infertility
after 12m unless PMHx surgery/STI/mum over 35 or other abnormalities
3 criteria for hyperemesis gravidarum
5% pre-pregnancy weight loss
dehydration
electrolyte imbalance
snowstorm apperance and increased hcg
molar pregnancy
management of hyperemesis
cyclizine/promethazine
can you use metoclopramide in pregnancy
if necessary but max 5 days
management of an abnormal semen sample
repeat in 3m
what condition can present with wernicke’s encephalopathy
hyperemesis gravidarum (diplopia and ataxia)
how can you assess emesis in pregnancy
PUQE
medical management of PMS
SSRI continuous or in luteal phase
define menorrhagia
heavy bleeding (SUBJECTIVE)
when would you ultrasound for menorrhagia
if abnormal exam, pain or abnormal bleeding
management of menorrhagia
1st: IUS (mirena)
2nd: Tranexamic acid
define dysmenorrhoea
pain during periods
management of primary and secondary dysmenorrhoea
Primary: NSAID e.g. mefenamic acid
Secondary: gynae referral
PC of fibroids
Menorrhagia and dysmenorrhea
Diagnosis of fibroids
usss
Management of fibroids
less than 3cm and no distortion: IUS, COCP, Tranexamic acid
GnRH agonists reduce size short term (triptorelin)
Management of fibroids causing fertility issues
myomectomy
What is carenous degeneration
fibroids increase in size due to oestrogen in pregnancy faster than the blood can supply them
presents with pain, pyrexia and nausea
supportive
criteria to diagnose PCOS
2 of:
1. oligomenorrhoea
2. hyperanddrogenism
3. cysts on USS
role of metformin in PCOS
increases peripheral insulin sensitivity
treatment of infertility in PCOS
clomifene
how to reduce endometrial cancer risk in PCOS
induce a withdrawal bleed
type of cysts in endometriosis
chocolate
management of endometriosis
1st: NSAID/paracetamol
2nd: COCP/progestogen
sudden and intense pain with hx endometriosis
ruptured endometrioma
secondary amenorrhea with increased FSH/LH
Premature ovarian insufficiency
management of premature ovarian insufficiency
HRT/COCP until 50
primary amenorrhoea with increased FSH/LH
Turners
diagnosis of adenomyosis
MRI
whirlpool sign
ovarian torsion
most common cause of postcoital bleeding and RF
cervical ectropion (increased with COCP)
sudden onset unilateral pelvic pain after exercise/sex
ruptured ovarian cyst
most common benign ovarian cyst in under 25
Teratoma (dermoid cyst)
Rokitansky’s proterberance
Teratoma (dermoid cyst)
cause of pseudomyxoma peritoni
mucinous cystadenoma rupture
most common ovarian cancer
serous carcinoma (cystadenoma epilthelial cell tumour)
Staging of ovarian cancer
- confined to ovary
- outside ovary within pelvis
- outside pelvis in abdomen
- mets
3 markers to measure in ovarian cancer
CA125, alpha feroprotein, beta hCG
prognosis of ovarian cancer is based off
US, menopausal status, CA125
older lady with labial lump and inguinal lymphadenopathy
vulval cancer
RF for endometrial cancer
increased unopposed oestrogen
obesity, nulliparity, early menarche, late menopause, DM, Tamoxifen, PCOS, HNPCC
Which strains of HPV increase cervical cancer risk
16, 18 and 33
Inadequate smear
repeat in 3m
2 inadequate refer for colposcopy
HPV abnormal, cells normal
repeat in 12 m
- normal then discharge
- abnormal HPV then repeat again in 12m and still abnormal then colopscopy
HPV positive
annual cystology
HPV abnormal and cells abnormal
refer for colposcopy
which treatment of cervical cancer maintains fertility
stage 1a cone biopsy
smear postpartum
delay 3m unless previous abnormal smear
what gene is BRCA1
tumour suppressor (increased breast and ovarian)
Cottage cheese discharge
thrush
treatment of thrush (non-pregnant and pregnant)
Not pregnant: single oral flucanazole (recurrent = more)
Pregnant: clotrimazole pessary
Most common cause of PID
chlamydia
thin purulent odourless discharge with dysuria, IM bleeding and dysparapeunia
gonorrhoea
gram negative diplococci
gonorrhoea
treatment of gonorrhoea
IM ceftriaxone
offensive musty, frothy green PV discharge with a strawberry cervix
trichomonas vaginalis
treatment of trichomonas vaginalis and bacterial vaginosis
oral metronidazole
thin white discharge with clue cells, fishy smell and pH 4.5
Bacterial vaginosis (need 3 of 4)
1st line investigation for incontinence
dipstick (DM)) and culture (UTI)
management of urge incontinence
- bladder retraining
- oxybutynin (antimuscarinic for detrusor overactivity)
who should you avoid prescribing oxybutynin to
elderly as increased falls
management of stress incontinence
pelvic floor exercises
duloxetine
treatment of vaginal vault prolapse
sacrocolpoplexy
continuous dribbling incontinence after long labour in poor area
vesicovaginal fistulae
investigation for vesicovaginal fistulae
urinary dye studies
management of atrophic vaginitis
lubricants, moisturisers, topical oestrogen
bladder palpable after urination would indicate what
retention and overflow
treatment of vasomotor sx in menopause
SSRI e.g. fluoxetine
does transdermal HRT increase VTE risk
no
how long is mirena licensed for progesterone in HRT
4 years
benefit and risk of adding progesterone to HRT
increases breast cancer
decreases endometrial cancer
what causes ovarian hyperstimulation syndrome
fertility treatment
define sheehan syndrome
hypopituitaism due to ischaemic necrosis from hypovolemic shock (blood loss)
what is asherrman’s syndrome
intrauterine adhesions caused by D+C
reduces endometrium response to oestrogen
2 conditions cervical excitation is found in
PID and ectopic
