Gynaecology and Sexual Health Flashcards
What might gram staining identify in BV
Klew Cells
What may MC+S identify in thrush
Mycelia
Spores
Yeast sensitivities
Signs of dissseminated Gonorrhoea
Petechial/ pustular rash Arthralgia Fever Septic Arthritis Tenosynovitis
Infective organism in syphilis
Treponema pallidum
Spirochete
What is the Jarisch-Herxheimer Reaction to syphilis treatment
Affects up to 50% of pregnant women
Causes significant pregnancy problems
Features of the primary phase of syphilis infection
Incubation of 2-3 weeks
- Formation of a single chancre (anogenital ulcer)
- Painless, indurated, smooth clean base
- Regional lymphadenopathy
Features of the secondary phase of syphilis infection
Incubation of 6-12 weeks
25% of patients who had untreated primary disease
- Chancre develops into condylomata lata
- Mucocutaneous rash, systemic signs, hepatitis, spenomegaly, neurological complications
Features of the latent phase of syphilis infection
May be:
- Early latent (< 2years)
- Late latent (2+ years, can be up to 20-40 years later)
Features of the Late Symptomatic (Tertiary) phase of syphilis infection
Gummatous disease (inflammatory fibrous nodules/ plaques on the skin or bone)
Cardiovascular disease (vasculitis, aortic regurgitation)
Neurosyphilis (stroke, meningitis, optic neuritis risk)
Skin symptoms of Symptomatic phase of HIV
Folliculitis
Herpes zoster at multiple sites
Seborrhoeic dermatitis
Oral symptoms of Symptomatic phase of HIV
Candidiasis
Hairy leukoplakia
Respiratory symptoms of Symptomatic phase of HIV
Pneumocystis jiroveci pneumonia
TB
GI symptoms of Symptomatic phase of HIV
Hepatomegaly
Perianal warts
Opportunistic GI infection
Ophthalmic symptoms of Symptomatic phase of HIV
CMV retinitis
CNS symptoms of Symptomatic phase of HIV
Toxoplasma gondii infection
Lymphoma
HIV-Associated Neurocognitive Disorder (HAND)
Transient meningoencephalitis
CD4 count in HIV
Significant if under 350 cells/ microlitre
Drugs that may interact with HAART
Steroids Statins Benzodiazepines/ Z Drugs Anticoagulants Chemotherapy Anti TB Recreational drugs Antacids Multivitamins
PEP: when it must be given, duration of treatment
Ideally within 24 but must be within 72 hours
Taken for 28 days
What does UKMEC 1 represent?
No restriction on contraceptive usage
What does UKMEC 2 represent?
Advantages outweigh disadvantages
What does UKMEC 3 represent?
Disadvantages outweigh the advantages
What does UKMEC4 represent?
An unacceptable risk
UKMEC 4 criteria for Combined Hormonal Contraception
Migraine with aura Aged 35+, smoking 15 a day or more Current breast cancer Previous VTE AF, IHD, Stroke or Cardiomyopathy Liver Cirrhosis Hypertension >160/100 Under 6 week post-partum
UKMEC 3 criteria for combined hormonal contraception
Controlled hypertension <160/100 VTE family history Migraine 35 years + BMI 35+ Enzyme inducing drugs Aged 35+ smoking less than 15 a day
UKMEC 4 for progesterone only contraception (including Pill, Implant
Current breast cancer
UKMEC 3 for progesterone only contraception (including Pill, Implant, Injectables
Recent stroke
Liver disease
Use of enzyme-inducing medication (pill only)
+ Vascular disease for the Injectables
When should two doses of Levonogestrel be taken?
Vomiting previous 2 hours
BMI 26+/ 70KG
Using enzyme inducers
When is EllaOne/ Ullipristal Acetate less effective?
When hormonal contraception is used 7 days before, or 5 days afterwards
SEs of vasectomy
Swollen scrotum
Sperm granuloma formation
Chronic pain
What is the follow up after a vasectomy
Semen analysis at 8-12 weeks, to check its all used up
Most common site of oocyte fertilisation
Ampulla (the expanded bit)
What is the pouch of douglas
Recto-Uterine pouch
Indications to consider a Hysteroscopy ± Biopsy in HMB/ Menorrhagia
Persistent
Obese
PCOS suspicion
Taking Tamoxifen
How effective is the Mirena Coil for reducing HMB
Reduces bleeding in 85% by 3 months
Which ethnicity most at risk of developing Fibroids?
Afro-Caribbean
Contra-indications to HRT
Breast cancer
Undiagnosed vaginal bleeding
Untreated endometrial hyperplasia
Any oestrogen-sensitive cancer
Rotterdam criteria for PCOS
2/3 from:
- Evidence of Polycystic Ovaries (12+ follicles/ volume 10cm3+ on USS)
- Oligo/ anovulation
- Clinical and biochemical signs of Hyperandrogenism
Biochemical Signs of Hyperandrogenism in PCOS
Raised LH
Raised LH:FSH ratio
Normal/ elevated Testosterone
Normal/ low sex hormone binding globulin
Most common organisms in Pelvic inflammatory disease
Chlamydia (20-30%) Gonorrhoea (15%) Mycoplasma (15%) Flora Aerobic streptococci BV associated organisms
Outpatient treatment for mild-moderate Pelvic Inflammatory Disease (PID):
Single IM dose of Ceftriaxone 500mg
Doxycycline + Metronidazole PO
Inpatient treatment for Pelvic Inflammatory Disease:
Ceftriaxone + Doxycycline iV
then oral switch to Doxycycline + Metronidazole PO for 14 days
Additional antibiotic if gonorrhoea suspected in PID
Azithromycin 1g
Additional antibiotic if mycoplasma genitalium suspected in PID
Moxifloxacin
What is Meig’s Syndrome
- Right-sided Fibroma
- Pleural Effusion
- Ascites
Indications for Medical management of an Ectopic pregnancy
- Beta HCG between 1500 and 5000 IU
- No significant pain
- Unruptured ectopic
- No visible heartbeat
- Foetal pole <35mm
- No intrauterine pregnancy
Indications for surgical management of an ectopic pregnancy
- Beta HCG greater than 5000IU
- Pain
- Foetal Heartbeat
- Adnexal mass 35mm+
- Outside uterus (abdominal)
What is a complete Hydatidiform mole
Sperm fertilises an empty oocyte
Forms only swollen chorionic villi
What is a partial Hydatidiform mole
Two sperm fertilise one oocyte
Triploid foetus formed
What is the most important advice to give after Medical management of Ectopic pregnancy
Use contraception for 3 months
SEs of Methotrexate: Abdo pain, nausea, conjunctivitis, impaired liver function
Which type of gestational trophoblastic disease develops around 3 years after the pregnancy?
Placental Site Trophoblastic Tumour
Why does molar pregnancy/ GTD cause hyperthyroidism?
hCG resembles TSH and may lead to a thyrotoxic storm.
Factors to consider before termination of pregnancy
Screen for HIV and STIs
Determine Rhesus status and prophylaxis if appropriate
VTE risk assessment
Contraception discussion
Antibiotic prophylaxis (Azithromycin and Metronidazole)
Need pregnancy test 2-3 weeks later to confirm
When can the COCP be started after a ToP
Same day
Which type of surgical termination is performed before 14 weeks
Vacuum aspiration
Requires an aspirate examination if before 7 weeks
Which type of surgical termination is performed after 14 weeks
Dilation and Evacuation
Requires USS guidance
After what gestation is a feticide Medical ToP performed
21+6 weeks
Indications for 5mg folic acid pre-conception
Previous child with NTD or family history
Diabetes
Coeliac disease
Epilepsy
BMI 30+
Inherited haemoglobinpathies/ carrier states (thalassaemia)
Using anti-folate medications e.g. sulpha drugs
Criteria for diagnosing premature ovarian failure
Aged under 40
Oligomenorrhoea/ Amenorrhoea for 4+ months
Elevated FSH level (25IU+) on two occasions, 4 weeks apart
Side effects of clomifene
Breast tenderness Hot flushing Nausea Headache Abnormal bleeding Blurredd bision Ovarian hyperstimulation Multiple pregnancy risk (10%)
Why can clomifene only be offered for 6 months
Increased ovarian cancer risk
Features of mild-moderate OHSS
Abdominal pain ± bloating
Nausea and vomiting
Ascites
Ovarian swelling
Features of severe/critical OHSS
Oliguria Raised haematocrit Hyponatraemia Hypo-osmolality Hyperkalaemia Hypo-proteinaemia Raised WCC Thromboembolism ARDS
Oligozoospermia
Less than 15 million sperm per ml
Teratozoospermia
Normal morphology sperm less than 4%
Asthenozoospermia
Progressive motility sperm less than 32%
Medical management of Stress Incontinence
Duloxetine (SNRI)
Side Effects: Dyspepsia, dry mouth, dizziness, insomnia, drowsiness
Surgical management of Stress Incontinence
Tension-free Vaginal Tapes
Peri-urethral injections (bulking agents)
Colposuspension
Medical management of Urge Incontinence
Anticholinergics e.g. Tolterodine, Oxybutynin, Darifenacin
- Avoid oxybutynin in elderly patients- falls risk
Mirabegron (when anticholinergics ineffective, but assc. with Hypertension)
Type of epithelium of the cervix
Columnar
Type of epithelium of the vagina
Squamous
Staining in Colposcopy
5% acetic acid is taken up by neoplastic cells in the transformational zone
Lugol’s Iodine solution stains the rest of the cervix
Which type of cervical cancer is detected on the smear, and is also the most common?
Squamous Cell Carcinoma
Metastatic spread of cervical cancer
Direct (vagina, bladder, parametrium, bowel)
Lymphatic (parametrial nodes, lungs, liver)
Cervical cancer staging
Stage 1: Confined to cervix
Stage 2: Cervix + local extension
Stage 3: Cervix + pelvic wall or lower 1/3 vagina
Stage 4: Invades bladder, rectum or has mets
Metastasis of endometrial cancer
Vagina, ovaries, pelvic lymph nodes
Utility of CA-125 in ovarian cancer
Raised in 80% of epithelial cancers
BUT is only raised in early disease in 50%
Staging on ovarian cancer
Stage 1: limited to ovaries
Stage 2: Limited to pelvis
Stage 3: Limited to abdomen including LN mets
Stage 4: Distant mets outside of abdomen
Contra-indications to Ullipristal Acetate use
Breast/ ovarian/ uterine/ cervical cancer
Severe asthma
Enzyme inducers
