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ED checkpoints > Gyne > Flashcards

Gyne Flashcards

1
Q

Emergency Contraception options

A

Levenorgestrel 1.5mg
Ullipristal acetate
IUD

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2
Q

Enzyme inducing drugs that may cause OCP to fail

A

Rifampicin, Carbmazepine, Phenytoin, Topiramate, Griseofulvin, Phenobarbital, Primadone

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3
Q

Common causes for PID

A

Chlamydia trachomatis, Neisseria gonnorhea, mycoplasma hominis, ureaplasma urealyticum

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4
Q

Tx or PID

A
  1. STABLE: ofloxacin 400mg BD PO + metronidazole 400mg BD for 14 days + DISCHARGE and GP F/U
  2. UNSTABLE: resus+ ceftriaxone 2g IV+ metronidazole 500mg TDS IV + doxycycine 100mg BD PO + TVUS + GYNE referral
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5
Q

Menorrhagia management in ED

A

1g TXA QDS + mefenamic acid 500mg PO TDS AFTER food + GP/Gyne folllow up

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6
Q

Causes for menorrhagia

A
  1. early menarche
  2. PCOS
  3. hypothyroidism
  4. anticoagulation
  5. blood clotting issues like VWD
  6. PID
  7. IUD/IUS
  8. Endometriosis
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7
Q

Cervical cancer causes

A

HPV 16 and 18

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8
Q

Cervical cancer symptoms

A

post coital or IMB, abnormal smear tests in past,
on examination: cervix has nodules, ulcers, erosions, bleed when touched,
ADVANCE: retrovaginal fistula, ureteric obstruction, pyometra

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9
Q

Uterine carcinoma facts

A
  1. adenocarcinmoa
  2. 50+
  3. RF: no babies, obese, late menopause
  4. symps: bleeding after menopause, age,
  5. dx: TVUS and pipelle biopsy
  6. refer to GYNE
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10
Q

gravidity

A

total number of pregnancies
first pregnancy–> primigravida

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11
Q

Parity

A

number of pregnancies after 24 weeks + Number before

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12
Q

miscarriage

A

fetal death BEFORE 24 weeks

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13
Q

stillbirth

A

fetal death AFTER 24 weeks

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14
Q

Physiological changes in pregnancy based on systems

A

Cardio: increased cardiac output, systolic flow murmur, diastolic pressure drops by 10mmHg
Resp: tidal volume increases but NOT RR
Heme: increase clotting fibrinogen, ESR, platelets,
gastro: low and slow –> heart burn, constipation,
GU: increased kidney size and marked dilation of the renal pelvis
skin: melasma (due to increased progesterone and estrogen)

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15
Q

Important scans in pregnancy

A

8-12 weeks: DATING SCAN
20 week: ANOMALY SCAN

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16
Q

SAFE meds in pregnancy

A
  1. penicillin
  2. Cephalosporins
  3. nystatin
  4. paracetamol
  5. Chlorphenamine
  6. Cimetidine
17
Q

UNSAFE meds in pregnancy I.E: avoid these badboys

A
  1. Trimethoprim
  2. Tetracyclines e.g. doxycyline
  3. Streptomycin
  4. Warfarin
  5. Thiazides
  6. Sodium Valproate
18
Q

Hyperemesis Gradvidarum tx

A
  1. IV line and fluid replacement
  2. IV/IM anti-emetics: cyclzine/ promethazine OR metaclopromide
  3. Refer to gyne for consideration of IV hydrocortisone +/- thiamine

Ix: pregnancy test, FBC, U+E, LFTS, BHCG, LFTS and TVS

19
Q

Complications of Hyperemesis gravidarum

A
  1. Dehydration
  2. Liver and kidney failure
  3. Electrolytes wonky: low Na, HIGH K+
  4. Wernicke encephalopathy due to low thiamine
  5. Risk to fetus: IUGR
20
Q

Causes of bleeding in first trimester

A
  1. Miscarriage
  2. Placental implantation
  3. Ectopic pregnancy
  4. Trophoblastic disease
  5. Chorionic hematoma
21
Q

Causes of PV bleed in second trimester

A
  1. Placenta previa
  2. Miscarriage
  3. Trophoblastic disease
  4. Placental abruption
22
Q

Causes of PV bleed in 3rd trimester

A
  1. Placental abruption
  2. Placenta previa
  3. Vasa previa
  4. Vasa previa
23
Q

Causes of PV bleed in 3rd trimester

A
  1. Placental abruption
  2. Placenta previa
  3. Vasa previa
  4. Vasa previa
24
Q

Anti D IG

A

indication: given to Rh-ve woman with ectopic pregnancy, spontaneous abortion, antepatrum hemorrage, labour and delivery
Ix: Group and save and Kleihauer tests for Feto-maternal hemorrhage
Tx
- <12 weeks and PROVEN Rh-ve status– > 250U IM anti- D
- >12-20 weeks –> 250U
- >20 weeks–> 500U
REFER to GYNE

25
Q

Cervical shock sx and tx

A

Cause: products of conception passing through cervical OS but gets STUCK
sx: hypotension and reflex bradycardia (low BP and LOW HR) + PV bleed
tx: speculum exam, visualise cervical OS, use sterile gauze and sponge holding forceps
TAKEAWAY MESSAGE: suspect cervical shock—> DO SPECULUM EXAM

26
Q

Miscarriage tx (<24 weeks of gestation )

A

Only tx needed if significant pain or hemorrhage
1. exclude cervical shock (low bp/hr + PV bleed, AMS)
2. pain management
3. FBC, G+S, Rh satuys, BHC and FBC
4. fluids + blood products if needed
5. SEVERE bleeding- ergometrine 500mcg IM
6. Anti D IG if indicated 250U or 500U IM
7. Refer to GAU for review in 2 days

27
Q

Causes of septic miscarriage

A

E.Coli, Staph aureus, Clostridium wellchi, bacteroids, streptococci, clostridium sordelli

28
Q

Sx and Tx of Septic Miscarriage

A

SX
1. Signs of shock (low bp, high hr, temp)
2. foul PV discharge
3. PV bleed
4. cervical excitation, uterine tenderness, peritonitis

IX: FBC, G+S, Clotting, cultures, lactate, Rh, erect CXR to look for free gas

tx: resus, IV co-amox 1.2, monitor PU, refer to gyne

29
Q

Missed miscarriage

A

Miscarriage occurs but some products of conception are retained
Causes risk of DIC
HIGHLY DANGEROUS
RESUS + refer to obs and heme

30
Q

Types of miscarriage

A
  1. spontaneous
  2. threatened: PV bleed but closed cervical OS
  3. Inevitable miscarriage: PV bleed and cervical OS OPEN
  4. complete miscarriage: PV bleed and open cervical OS leading to all products of conception passed which is CONFIRMED by TVUS
  5. Incomplete miscarriage: retained products of conception
  6. Septic miscarriage: retained products of conception causing shock due to infection
  7. Missed miscarriage: retained products of conception causing DIC
31
Q

RPOC- retained products of conception

A

sx: PV bleed >3 weeks which is smelly with a temp, low BP, uterine tenderness and cervical excitation
dx: TVUS
tx: surgical evacuation + abx if concerned about sepsis

32
Q

Ectopic Pregnancy sx

A

Abdominal pain, PV bleed, N+V, syncope
hx of amenorrhea
shoulder tip pain

33
Q

Tx for Ectopic pregnancy

A

Dx with pregnancy test, TVUS
Tx: o2, fluids, analgesia, keep NBM, refer to gyne, OR mtx

ED checkpoints (1 decks)

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