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4th Year > Gynaecology and Sexual Health > Flashcards

Gynaecology and Sexual Health Flashcards

1
Q

What might gram staining identify in BV

A

Klew Cells

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2
Q

What may MC+S identify in thrush

A

Mycelia
Spores
Yeast sensitivities

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3
Q

Signs of dissseminated Gonorrhoea

A 
Petechial/ pustular rash
Arthralgia
Fever
Septic Arthritis
Tenosynovitis
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4
Q

Infective organism in syphilis

A

Treponema pallidum

Spirochete

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5
Q

What is the Jarisch-Herxheimer Reaction to syphilis treatment

A

Affects up to 50% of pregnant women

Causes significant pregnancy problems

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6
Q

Features of the primary phase of syphilis infection

A

Incubation of 2-3 weeks

  • Formation of a single chancre (anogenital ulcer)
  • Painless, indurated, smooth clean base
  • Regional lymphadenopathy
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7
Q

Features of the secondary phase of syphilis infection

A

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

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8
Q

Features of the latent phase of syphilis infection

A

May be:

  • Early latent (< 2years)
  • Late latent (2+ years, can be up to 20-40 years later)
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9
Q

Features of the Late Symptomatic (Tertiary) phase of syphilis infection

A

Gummatous disease (inflammatory fibrous nodules/ plaques on the skin or bone)

Cardiovascular disease (vasculitis, aortic regurgitation)

Neurosyphilis (stroke, meningitis, optic neuritis risk)

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10
Q

Skin symptoms of Symptomatic phase of HIV

A

Folliculitis
Herpes zoster at multiple sites
Seborrhoeic dermatitis

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11
Q

Oral symptoms of Symptomatic phase of HIV

A

Candidiasis

Hairy leukoplakia

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12
Q

Respiratory symptoms of Symptomatic phase of HIV

A

Pneumocystis jiroveci pneumonia

TB

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13
Q

GI symptoms of Symptomatic phase of HIV

A

Hepatomegaly
Perianal warts
Opportunistic GI infection

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14
Q

Ophthalmic symptoms of Symptomatic phase of HIV

A

CMV retinitis

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15
Q

CNS symptoms of Symptomatic phase of HIV

A

Toxoplasma gondii infection
Lymphoma
HIV-Associated Neurocognitive Disorder (HAND)
Transient meningoencephalitis

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16
Q

CD4 count in HIV

A

Significant if under 350 cells/ microlitre

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17
Q

Drugs that may interact with HAART

A 
Steroids
Statins
Benzodiazepines/ Z Drugs
Anticoagulants
Chemotherapy
Anti TB
Recreational drugs
Antacids
Multivitamins
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18
Q

PEP: when it must be given, duration of treatment

A

Ideally within 24 but must be within 72 hours

Taken for 28 days

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19
Q

What does UKMEC 1 represent?

A

No restriction on contraceptive usage

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20
Q

What does UKMEC 2 represent?

A

Advantages outweigh disadvantages

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21
Q

What does UKMEC 3 represent?

A

Disadvantages outweigh the advantages

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22
Q

What does UKMEC4 represent?

A

An unacceptable risk

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23
Q

UKMEC 4 criteria for Combined Hormonal Contraception

A 
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
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24
Q

UKMEC 3 criteria for combined hormonal contraception

A 
Controlled hypertension <160/100
VTE family history
Migraine 35 years +
BMI 35+
Enzyme inducing drugs
Aged 35+ smoking less than 15 a day
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25
Q

UKMEC 4 for progesterone only contraception (including Pill, Implant

A

Current breast cancer

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26
Q

UKMEC 3 for progesterone only contraception (including Pill, Implant, Injectables

A

Recent stroke
Liver disease
Use of enzyme-inducing medication (pill only)

+ Vascular disease for the Injectables

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27
Q

When should two doses of Levonogestrel be taken?

A

Vomiting previous 2 hours
BMI 26+/ 70KG
Using enzyme inducers

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28
Q

When is EllaOne/ Ullipristal Acetate less effective?

A

When hormonal contraception is used 7 days before, or 5 days afterwards

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29
Q

SEs of vasectomy

A

Swollen scrotum
Sperm granuloma formation
Chronic pain

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30
Q

What is the follow up after a vasectomy

A

Semen analysis at 8-12 weeks, to check its all used up

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31
Q

Most common site of oocyte fertilisation

A

Ampulla (the expanded bit)

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32
Q

What is the pouch of douglas

A

Recto-Uterine pouch

33
Q

Indications to consider a Hysteroscopy ± Biopsy in HMB/ Menorrhagia

A

Persistent
Obese
PCOS suspicion
Taking Tamoxifen

34
Q

How effective is the Mirena Coil for reducing HMB

A

Reduces bleeding in 85% by 3 months

35
Q

Which ethnicity most at risk of developing Fibroids?

A

Afro-Caribbean

36
Q

Contra-indications to HRT

A

Breast cancer
Undiagnosed vaginal bleeding
Untreated endometrial hyperplasia
Any oestrogen-sensitive cancer

37
Q

Rotterdam criteria for PCOS

A

2/3 from:

  • Evidence of Polycystic Ovaries (12+ follicles/ volume 10cm3+ on USS)
  • Oligo/ anovulation
  • Clinical and biochemical signs of Hyperandrogenism
38
Q

Biochemical Signs of Hyperandrogenism in PCOS

A

Raised LH
Raised LH:FSH ratio
Normal/ elevated Testosterone
Normal/ low sex hormone binding globulin

39
Q

Most common organisms in Pelvic inflammatory disease

A 
Chlamydia (20-30%)
Gonorrhoea (15%)
Mycoplasma (15%)
Flora
Aerobic streptococci
BV associated organisms
40
Q

Outpatient treatment for mild-moderate Pelvic Inflammatory Disease (PID):

A

Single IM dose of Ceftriaxone 500mg

Doxycycline + Metronidazole PO

41
Q

Inpatient treatment for Pelvic Inflammatory Disease:

A

Ceftriaxone + Doxycycline iV

then oral switch to Doxycycline + Metronidazole PO for 14 days

42
Q

Additional antibiotic if gonorrhoea suspected in PID

A

Azithromycin 1g

43
Q

Additional antibiotic if mycoplasma genitalium suspected in PID

A

Moxifloxacin

44
Q

What is Meig’s Syndrome

A
  • Right-sided Fibroma
  • Pleural Effusion
  • Ascites
45
Q

Indications for Medical management of an Ectopic pregnancy

A
  • Beta HCG between 1500 and 5000 IU
  • No significant pain
  • Unruptured ectopic
  • No visible heartbeat
  • Foetal pole <35mm
  • No intrauterine pregnancy
46
Q

Indications for surgical management of an ectopic pregnancy

A
  • Beta HCG greater than 5000IU
  • Pain
  • Foetal Heartbeat
  • Adnexal mass 35mm+
  • Outside uterus (abdominal)
47
Q

What is a complete Hydatidiform mole

A

Sperm fertilises an empty oocyte

Forms only swollen chorionic villi

48
Q

What is a partial Hydatidiform mole

A

Two sperm fertilise one oocyte

Triploid foetus formed

49
Q

What is the most important advice to give after Medical management of Ectopic pregnancy

A

Use contraception for 3 months

SEs of Methotrexate: Abdo pain, nausea, conjunctivitis, impaired liver function

50
Q

Which type of gestational trophoblastic disease develops around 3 years after the pregnancy?

A

Placental Site Trophoblastic Tumour

51
Q

Why does molar pregnancy/ GTD cause hyperthyroidism?

A

hCG resembles TSH and may lead to a thyrotoxic storm.

52
Q

Factors to consider before termination of pregnancy

A

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

53
Q

When can the COCP be started after a ToP

A

Same day

54
Q

Which type of surgical termination is performed before 14 weeks

A

Vacuum aspiration

Requires an aspirate examination if before 7 weeks

55
Q

Which type of surgical termination is performed after 14 weeks

A

Dilation and Evacuation

Requires USS guidance

56
Q

After what gestation is a feticide Medical ToP performed

A

21+6 weeks

57
Q

Indications for 5mg folic acid pre-conception

A

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

58
Q

Criteria for diagnosing premature ovarian failure

A

Aged under 40
Oligomenorrhoea/ Amenorrhoea for 4+ months
Elevated FSH level (25IU+) on two occasions, 4 weeks apart

59
Q

Side effects of clomifene

A 
Breast tenderness
Hot flushing
Nausea
Headache
Abnormal bleeding
Blurredd bision
Ovarian hyperstimulation
Multiple pregnancy risk (10%)
60
Q

Why can clomifene only be offered for 6 months

A

Increased ovarian cancer risk

61
Q

Features of mild-moderate OHSS

A

Abdominal pain ± bloating
Nausea and vomiting
Ascites
Ovarian swelling

62
Q

Features of severe/critical OHSS

A 
Oliguria
Raised haematocrit
Hyponatraemia
Hypo-osmolality
Hyperkalaemia
Hypo-proteinaemia
Raised WCC
Thromboembolism
ARDS
63
Q

Oligozoospermia

A

Less than 15 million sperm per ml

64
Q

Teratozoospermia

A

Normal morphology sperm less than 4%

65
Q

Asthenozoospermia

A

Progressive motility sperm less than 32%

66
Q

Medical management of Stress Incontinence

A

Duloxetine (SNRI)

Side Effects: Dyspepsia, dry mouth, dizziness, insomnia, drowsiness

67
Q

Surgical management of Stress Incontinence

A

Tension-free Vaginal Tapes
Peri-urethral injections (bulking agents)
Colposuspension

68
Q

Medical management of Urge Incontinence

A

Anticholinergics e.g. Tolterodine, Oxybutynin, Darifenacin
- Avoid oxybutynin in elderly patients- falls risk

Mirabegron (when anticholinergics ineffective, but assc. with Hypertension)

69
Q

Type of epithelium of the cervix

A

Columnar

70
Q

Type of epithelium of the vagina

A

Squamous

71
Q

Staining in Colposcopy

A

5% acetic acid is taken up by neoplastic cells in the transformational zone

Lugol’s Iodine solution stains the rest of the cervix

72
Q

Which type of cervical cancer is detected on the smear, and is also the most common?

A

Squamous Cell Carcinoma

73
Q

Metastatic spread of cervical cancer

A

Direct (vagina, bladder, parametrium, bowel)

Lymphatic (parametrial nodes, lungs, liver)

74
Q

Cervical cancer staging

A

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

75
Q

Metastasis of endometrial cancer

A

Vagina, ovaries, pelvic lymph nodes

76
Q

Utility of CA-125 in ovarian cancer

A

Raised in 80% of epithelial cancers

BUT is only raised in early disease in 50%

77
Q

Staging on ovarian cancer

A

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

78
Q

Contra-indications to Ullipristal Acetate use

A

Breast/ ovarian/ uterine/ cervical cancer
Severe asthma
Enzyme inducers

4th Year (7 decks)

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