Gynecology Flashcards
UKMEC 1 for pregnant 6 weeks to 6 months breastfeeding mom
Progestogen-Only Pill
UKMEC 2 for pregnant 6 weeks to 6 months breastfeeding mom
COCP
FLOP of PCOS
FSH - normal
LH - increased (LH:FSH > 2)
Oestradiol - normal to mildly increased
Prolactin - normal to mildly increased
FLOP of Premature Ovarian Insuffiency
FSH - increased (Diagnostic Criteria: An elevated FSH > 25 on two occasions, 4 weeks apart)
LH - increased
Ostradiol - decreased
Prolactin - no information
FLOP of Prolactinoma
FSH - decreased
LH - decreased
Oestradiol - decreased
Prolactin - extremley increased (<5000 mU/L)
What are the differences among
- Premature Ovarian Failure
- Premature Menopause
- Early Menopause
- Menopause
- Perimenopause
Premature Ovarian Failure - onset of menopausal symptoms before age of 40; diagnosed with elevated FSH 4 wks apart for 2 occasions; can still have periods but irreg; can still get pregnant but difficult
Premature Menopause - 12 mos amenorrhea before 40; no periods; cannot get pregnant
Early Menopause - 12 mos amenorrhea 40-45
Perimenopause - irreg mens PLUS vasomotor symptoms
Early Menopause -
Best management for stress incontinence
Pelvic floor exercises
Vasomotor symptoms described in menopause
Vaginal dryness Irrritability Dyspareunia Hot flashes Night sweats
How do you manage lost IUD
- Exclude pregnancy
2a. If pregnant, Refer to Early Pregnancy Unit, IUD is seen in utero
2b. If not pregnant, arrange for an ultrasound
Not seen in UTZ? Request for an Xray
- Not seen in abdominal X-ray? Assume expulsion AND offer replacement
- Seen in the abdominal cavity? Laparoscopy
INCONTINENCE:
“when I have to go to the toilet, I really have to go”
Urge Incontinence
INCONTINENCE:
“I have the desire to pass urine and sometimes urine leaks before I have time to get to the toilet”
Urge incontinence
Also known as overactive bladder
Urge incontinence
Pathophysiology of urge incontinence
Detrusor overactivity
Differentiate between urge and stress incontinence
In urge incontinence, there is overactivity of detrusor while in stress incontinence, there is weakness of pelvic floor muscles.
INCONTINENCE:
With history of many vaginal deliveries
STRESS INCONTINENCE
INCONTINENCE:
Happens during coughing or laughing
Stress Incontinence
INCONTINENCE:
There is an involuntary release of urine from an overfull UB, in the absence of an urge to urinate.
Overflow Incontinence
NICE recommendation on pelvic floor exercises for stress incontinence
8 contractions TID x 3 mos
Which drug for urge incontinence should be avoided in frail older women?
Oxybutynin
Outpatient therapy for PID
Ceftriaxone 500mg IM single dose
Followed by:
1. Doxycycline 100mg PO BD x 14 days
2. Metronidazole 400mg PO BD x 14 days
Outpatient therapy for Chlamydia cervicitis
Doxycycline 100mg PO BD x 7 days
Azithromycin 1g PO single dose then 500mg OD x 2 more days
Outpatient therapy for N gonorrhoeae cervicitis
unknown antimicrobial susceptibility - Ceftriaxone 1g IM single dose
Known susceptible to ciprofloxacin - ciprofloxacin 500mg PO single dose
Complications of pelvic inflammatory disease
ICE
Infertility
Chronic pelvic pain
UKMEC2 in patients who suffer from migraine with aura
MIrena IUD
POP
DMPA
Progestogen-only implant
UKMEC1 for patients with migraine with aura
Copper IUD
In cervical ectropion, _ epithelium of the ectocervix is replaced by _ epithelium of the endocervix.
Squamous
Columnar
Risk Factor for Cervical ectropion
Pregnancy
Puberty
COCP
What are the common features of a patient who present with chorioamnionitis?
Maternal tachycardia - precedes pyrexia Uterine tenderness Abdominal pain Fetal tachycardia = fetal distress Foul-smelling amniotic fluid Uterus small for dates
Labs:
Leukocytosis
Increased inflammatory markers
Management for chorioamnionitis
IV ampicillin and Gentamicin
If a patient tests negative for HR-HPV, how will routine recall be done?
Every 3 years for age 25-49
Every 5 years for age >50
A patient tests positive for HR-HPV, what is the next step?
Cytology triage
If normal cytology, rescreen in 12mos
If abnormal, Colposcopy referral
Contraception Clincher:
Sexually active woman requiring contraception with sickle cell disease and menorrhagia
Depo-Provera IM (injectable progesterone, DMPA)
What parameters are increased in PCOS?
Serum DHEAS
Total serum testosterone
(Serum prolactin can be normal to mildly increased)
Why is ultrasound superior to CT scan in diagnosing PCOS?
Ultrasound is part of the Rotterdam consensus criteria in diagnosing PCOS
You have to fulfill 2 out of 3, that which is comprised of:
- UTZ finding of polycystic ovaries (12 or more)
- Oligo-ovulation or anovulation
- Clinical and/or biochemical signs of hyperandrogenism
How is hyperandrogenism in PCOS diagnosed?
FAI>5
*free androgen index
What are the biochemical abnormalities found in PCOS?
Hyperandrogenism - FAI>5
Hyperinsulinemia
Increase in serum LH (LH:FSH of 2:1 or 3:1)
UTZ findings of complete mole
Snowstorm appearance (mixed echogenicity, representing hydropic villi and intrauterine hemorrhage)
After a diagnosis of molar pregnancy, when is a woman advised to try to conceive again?
6 mos after hCG levels have been normal
OR
12mos after COMPLETING chemotherapy
Treatment of post-menopausal symptoms if woman is a smoker
HRT is given as transdermal patch as oral route has a higher risk for VTE
Treatment of postmenopausal symptoms if woman has no uterus or if there is IUS in place
Estrogen-only HRT
- because progesterone is usually added to estrogen to protect against EM carcinoma
Endometrial ablation as a surgical management for fibroids is only indicated for fibroids of this size
Less than 3cm in diameter
What symptoms should alarm you to check for CA-125 in a woman aged 50 and above?
Bloatedness
Early satiety
Abdominal pain
Increased urinary urgency or frequency
Diagnostic imaging method of choice for acute pelvic pain in gynecology
UTZ
For tubo-ovarian abscess: TVS
Management for premature ovarian failure
HRT until age 51
Why is UTZ preferred over swabs in the diagnosis of PID in acute care setting?
For the reason that swabs would take days to return with results
Fibroid without uterine distortion PLUS menorrhagia
MIrena coil (LNG-releasing IUS)
Contraceptive for a woman with fibroid which does not distort uterine cavity
All methods can be used BUT LNG-IUS is the most effective (provides contraception and decrease menstrual bleeds)
WHich contraceptive should you AVOID in a patient with fibroids but distorts the uterine cavity?
IUS and IUD
Cervical smear shows inflammatory changes without dyskaryosis. PE: normal cervix and vaginal mucosa. No discharge. Next action?
Repeat after 6 mos - to ensure that inflammation has resolved after 6 mos
Which type of HRT should be given in a pregnant woman with hysterectomy and has an IUS? (***pregnant talaga???)
Oestrogen-only HRT
Cyclical combined HRT is intended for this population
Peri-menopausal woman
Which type of HRT should be given to menopausal women?
Continuous combined HRT
- also those women who have been taking cyclical combined HRT for 1 year
Young woman + not sexually active + does not require contraception + menorrhagia
IUS
Sexually active woman who requires contraception + menorrhagia/dysmenorrhoea OR with fibroids that do not distort the uterine cavity
IUS Mirena
Sexually active woman who requires contraception + menorrhagia/dysmenorrhoea OR with fibroids that do not distort the uterine cavity + younger than 20 y/o
UKMEC 1?
COCP, POP, Nexplanon (etonogestrel implant)
Sexually active woman who requires contraception + menorrhagia/dysmenorrhoea OR with fibroids that do not distort the uterine cavity + younger than 20 y/o
UKMEC 2?
IUS Mirena (LNG-releasing IUS)
Sexually active woman who requires contraception + afflicted with sickle cell disease + presents with menorrhagia
DMPA (Depo-Provera) injection
Emergency contraception within 72 hours of unprotected sex
Levonelle pill (LNG)
Emergency contraception within 120 hours of unprotected sex
IUCD
Or
ellaOne pill (Ullipristal acetate)
