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Ob/gyn > Gynaecology > Flashcards

Gynaecology Flashcards

1
Q

Follicular phase = FSH stimulates follicular development
Oestrogen and inhibin produced by dominant follicle inhibits FSH production
Due to declining FSH levels, only the dominant follicle survives

A

LH surge occurs 36 hours before ovulation
Dominant follicle ruptures, releasing oocyte

In the luteal phase the corpus luteum is formed and progesterone is released
Luteolysis occurs 14 days post-ovulation

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2
Q

What is metrorrhagia?

A

Regular IMB

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3
Q

Duration of a normal menstrual cycle

A

21 - 35 days

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4
Q

What is oligomenorrhoea?

A

Menses at duration >35 days

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5
Q

What is adenomyosis?

A

A cause of painful/ heavy periods
It is similar to endometriosis but the endometrium breaks through the normal myometrium

An important cause of chronic pelvic pain

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6
Q

List some causes of menorrgahia?

A

Local:

  • fibroids
  • polyps (endometrial )
  • endometriosis
  • adenomyosis
  • endometrial hyperplasia
  • PID

Systemic;

  • DM
  • Thyroid
  • Clotting disorder e.g. VWD
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7
Q

Dysfunctional uterine bleeding is a diagnosis of exclusion. It is more common in obese women and at the extremes of reproductive age. What investigations should be done prior to this diagnosis?

A
  • FBC
  • smear
  • Clotting
  • TFT
  • TVUS
  • Endometrial biopsy
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8
Q

Define menorrhagia?

A

Menstrual loss >80ml/ cycle

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9
Q

1st line for a lady wanting contraception who has menorrhagia?

A

Mirena

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10
Q

What is androgen insensitivity syndrome?

A

Also call testicular feminisation
X-linked recessive - patients have male karyoptype (46XY)

Testes develop but do not descend - androgen response does not occur so patients have undescended testes with female genitalia
Presents at puberty with amenorrhoea and lack of pubic hair

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11
Q

An adult is found to have an undescended testes. What should be considered?

A

Orchidopexy = cancer risk is x6

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12
Q

What secretes testosterone?

A

Leydig cells

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13
Q

What do Sertoli cells do?

A

Loads of actions:

  • blood-testes barrier
  • provide nutrients
  • phagocytosis
  • release androgen binding globulin
  • secrete seminiferous tubule fluid
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14
Q

LH acts on Leydig cells to regulate testosterone secretion

A

FSH acts on Sertoli cells to enhance spermatogenesis

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15
Q

Don’t forget to ask about steroid abuse in male patients with infertility

A

Don’t forget to ask about steroid abuse in male patients with infertility

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16
Q

What is the normal scrotal volume?

A

12-25ml

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17
Q

In male ?infertility what examinations would you perform?

A

1) Look for secondary sexual characteristics e.g. body hair, gynaecomastia
2) Scrotal and penile exam e.g. vas deferense, urethral orifice

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18
Q

What investigations would you like to do for ?male infertility

A

1) Bloods: LH, FSH, TSH, PRL, testosterone
2) Chromosomal analysis
3) semen analysis - 6 weeks apart
4) ? Biopsy/ US

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19
Q

What are the endocrine features of Klinefelters?

A

Low testosterone

High LH and FSH

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20
Q

In a standard 28 day cycle - which are the most fertile days?

A

Days 8 to 18

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21
Q

Lactational amenorrhoea is 98% effective. What are the 3 criteria?

A

1) Exclusive breastfeeding
2) Less the 6/12 post-natal
3) Amenorrhoea

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22
Q

What is the mode of action of combined hormonal contraception?

A

1) Mainly inhibits ovulation

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23
Q

What is the mode of action of the POP?

A

Primarily inhibits ovulation

E.g. desogestrel

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24
Q

What is the mode of action of the implant?

A

Primary inhibits ovulation

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25
Q

What is the mode of action of the depo provera?

A

Primarily inhibit ovulation for 14 weeks (given every 12)

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26
Q

What is the mode of action of the mirena?

A

It effects implantation by making the endometrium unfavourable

(failure rate is 1 in 500)

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27
Q

What is the mode of action of the IUD?

A

Prevents fertilisation due to inflammatory response

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28
Q

BP and BMI measures before giving depo, CHC or POP

A

Do a PV to check uterine position/ size before IUD

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29
Q

Don’t forget to ask about FH of breast cancer if you are prescribing the pill

A

If yes, enquire about BRACA gene - this may make it too high risk

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30
Q

Which cancers does the pil protect against?

A

1) Protect = ovarian and endometrial

2) Increase risk = cervical and breast

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31
Q

What is the main risk factor of the depo provera?

A

Low bone mineral density e.g. smoking, very low BMI etc

32
Q

Give some absolute CI to using the COC?

A
  • Smoking >15/day if >35
  • migraine with aura
  • personal history of VTE
  • BP > 160/95 etc
33
Q

When does the pill become effective

A

1) Day 1-5 of cycle/ day of TOP = immediately

2) After day 5 = condoms for 1 week

34
Q

What are missed pills rules/

A

1) 2 or more pills missed = take next pill and use condoms for 7 days
2) 2 pills of 1st 7 days missed = emergency contraception

35
Q

POP missed pills rule

A

If 1 or more pill missed or late (>12 hours if cerazette) then need emergency contraception if UPSI has occurred in 2 days after this

36
Q

If someone is anxious about having an STI screen done. What could you say to reassure them about the confidentiality?

A

GP does not have to be told

Samples are given a number not a name

37
Q

What STIs are partner notification not required?

A

BV
Thrush
Herpes
Warts

38
Q

Which vaccines are given to protect people against STIs?

A

Hep B

HPV

39
Q

A MSM is at risk of contracting HIV after UPSI with a high risk partner. What can you tell him about PEPSE?

A

1) has to be taken within 72 hours
2) 28 days total
3) reduces risk of hIV by 80%

Could also consider the Hep B vaccine, must be given within 72 hours

40
Q

What are the 2 situations in which an emergency abortion can be performed?

A

1) Save the life of the women

2) Prevent grave permanent harm to the physical or mental health of the women

41
Q

Remember conscientious objection is not allowed if it is an emergency

A

Would have to abort if it was to save ladies life

42
Q

In GP, patient wants a TOP. What actions do you take?

A

Refer to TOP clinic
Nurse led
Chat, scan and options

Blood taken - FBC, G+S
? STI screen

43
Q

What are the time cut offs for TOP in Tayside?

A 
Surgical = up to 12 weeks
Medical = up to 18 weeks, 6 days

(Elsewhere it is 24 weeks max and any if fetal abnormal)

44
Q

An early medical abortion is at <9 weeks. How is it done?

A

1) Oral mifepristone 200mg (anti-progesterone)
2) vaginal or oral misoprostol (prostaglandin) - can be taken at home

For later abortions, multiple doses of misoprostol will be needed

45
Q

Surgical TOP is Scotland?

A

Vacuum aspiration from 6-12 weeks

Done under GA as day case
Vaginal prostaglandin used to ‘prime’
LARC fitted

46
Q

Levonorgestrel and ulipristal acetate are emergency contraeption. How do they work?

A

Delay ovulation

47
Q

Ulipristal acetate is more effective and can be taken up to 120 hours after UPSI. What is a major CI?

A

Severe asthma controlled by steroids

48
Q

IUD is best EC as has pre- and post- implantation effects e.g. toxic to ovum

A

All women must be screened (+ treated) prior to insertion

49
Q

When does an embryo implant?

A

Dat 8-10 post fertilisation

50
Q

What is the incubation period for common STI?

A

Chlamydia/ Gonorrhoea = up to 1 weeks
Hep B = 6 weeks
HIV/ Hep C = up to 3 months

51
Q

HIV targets CD4 cells. What is the normal level? What puts patients at risk of opportunistic infection?

A

Normal = 500-1600 cells/mm

At risk = <200

52
Q

What is the treatment for PCP?

A

High dose co-trimoxazole

53
Q

Remember is anyone has HIV think - do they have TB too?

A

Remember is anyone has HIV think - do they have TB too?

54
Q

CMV presents in HIV with reduced visual acuity and floaters

What CD4 level puts people at risk?

A

CD4 <50

Opthalmoplegia screening is offered to all patients with this CD4 level

55
Q

Kaposi sarcoma is a vascular tumour seen in HIV. What causes it?

A

Human herpes virus 8

EBV will also predispose to Burkitt’s lymphoma

56
Q

What is the risk of mother to child transmission if viral load is undetectable?

A

<0.1%

57
Q

Wha examination and investigations are done at the booking scan?

A 
Height and weight
BP, CVS and abdo exam
US
FBC - Hb, ABP, rhesus
HIV, HBV, HCV, syphillus 
US 
Urinalysis - MSSU, C&amp;S
58
Q

What investigations/ examinations do you do in ALL pregnant women at every visit?

A 
BP
Urinalysis
Symphysis-fundal heigh
Lie 
Auscultation for heart

Ask about mood and anxiety

59
Q

When you do an ultrasound at the booking scan - what are you looking for?

A

Intravascular-uterine pregnancy
Obvious anomalies
Placental site

60
Q

When is the nuchal thickness measured?

A

Between 11 and 13+6 weeks (e.g. in the first trimester)

Combined with HCG and PAPP-A (pregnancy associated plasma protein A) and maternal age

61
Q

In the 2nd trimester, a blood sample can be taken at 15-20 weeks which measures HCG and AFP. UE3 and inhibin A What is the cut off for ‘high risk’ downs and therefore requires further investigation?

A

> 1 in 250

62
Q

When is CVS performed?

A

After 12 weeks

Miscarriage rate = 2%

63
Q

When is amniocentesis performed?

A

After 15 weeks

Miscarriage rate = 1%

64
Q

What are the 2 main haematological disorders to be aware of in pregnancy?

A

Sickle cell
Thalassaemia

60% of all women are anaemia in pregnancy

65
Q

RF for gestational DM?

A 
BMI >30
Previous macrosomic baby (>4.5 kg)
Previous GDM
FH of DM (1st degree)
High risk ethnicity
66
Q

Where should the bump be at what stage?

A

Pubic symphysis = 12 weeks
Umbilicus = 20 weeks
Xiphoid pricess = 36 weeks

67
Q

If SFH measurement is <10th centile or growth is static/ slowing then…

A

Refer for US do fetal size

68
Q

RF for ‘high risk’ pre-eclampsia

A

Chronic HT or previous gestational HT
CKD
Lupus or similar
Type 1 or 2 DM

69
Q

How do you treat primary, secondary and tertiary syphilis of duration <12 months?

A

Benzylpenicillin 2.4 mega units IM

doxycycline is used as the alternative in penicillin allergic

70
Q

How do you treat latent syphilis e.g. 3 years previously?

A

Benzylpenicillin 2.4 units IM weekly for 3 weeks

71
Q

Common cause of diarrhoea in HIV positive person?

A

Cryptosporidium

72
Q

Patient with profuse watery diarrhoea +blood/ mucus and hypokalaemia?

A

Rectal villous adenoma

they secrete large amounts of mucus which can cause hypokalaemia - also risk of malignant transformation

73
Q

Anchovy sauce pus in a liver abscess?

A

Infecting organism is most likely to be ameoibic causing an abscess

74
Q

Papillary thyroid cancer derived from iodine rich cells

A

Medullary thryoid derived from C cells in the thyroid

75
Q

Patient with small papule ulcer on genital region. This breaks down to form a painless ulcer. Lymph node involvement with matted inguinal lymph nodes, abscess and sinus formation

A

Lymphogranuloma venerum

L1 -L3

76
Q

Severe bleeding from placenta praevia necessitates resusucation and C-section

A

Vaginal delivery is CI if there has been major bleeding

Normally placenta praevia is managed with a section from 38 weeks

77
Q

Sudden onset SOB and pleuritic pain after amniocentesis?

A

Amniotic fluid embolism

this can be complicated by DIC as shown by development of a rash

Ob/gyn (4 decks)

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