Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Royal College > Gynecology Guidelines > Flashcards

Gynecology Guidelines Flashcards

1
Q

Tests for vonWillebrand disease

A

Factor VIII
vWF antigen
vWF functional assay

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Most common inherited bleeding disorders?

How are they inherited and what tests would be abnormal?

A

Hemophilia A - X-linked recessive - low factor VIII - prolonged PTT
Hemophilia B - X-linked recessive - low factor IX - prolonged PTT
vWB - autosomal dominant - low factor VIII, vWF antigen and assay - prolonged PTT and bleeding time

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

First line treatment for menorrhagia in women with inherited bleeding disorders?
Other hormonal options?
Non-hormonal options?

A

OCP (50% decrease)
causes increase in plasma levels of factor VIII and vWF
Can consider Depo (if bleeding not severe), Mirena, Danazol, GnRH agonist
Non-hormonal: TXA, desmopressin, NSAIDs (*only COX2 inhibitors), blood, ablation or hysterectomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Define Allodynia

A

Pain from stimuli that are not normally painful

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Incidence of endo in women having lap for CPP

A

30%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Best imaging test to assess adenomyosis?

A

MRI (sens + spec 86-100%)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Medication to treat interstitial cystitis?

A

Pentosan polysulfate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Risk factors for endometriosis?

A 
Family history (3-10x)
anomalous reproductive tracts
nulliparity
subfertility
prolonged intervals since pregnancy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Classes of medications used to treat endometriosis

A 
CHC
Progestins (PO, IM, IUD)
Danazol
GnRH agonist
?Aromatase inhibitors
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Indications for surgical management of endometriosis

A
  1. not responding to medical tx
  2. acute adnexal event
  3. severe invasive disease
  4. endometrioma >3cm and pelvic pain
  5. endometrioma and infertility
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

GnRH agonists are contraindicated in girls <18yo (T/F)

A

False. Can use if 16-18yo and endo confirmed by laparoscopy and persistent pelvic pain after trial of NSAIDs, OCP etc.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q 
VTE risks:
baseline @ reproductive age?
on OCP?
pregnancy?
immediate PP?
A

Baseline: 4-5/10,000
on OCP: 9-10/10,000
Pregnancy: 30/10,000
Imm PP: 300-400/10,000!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Non-contraceptive benefits of OCP?

A

Regulates cycles
Improves dysmenorrhea
improves PMS, hirsutism, acne
Decreased risk of ovarian, endometrial, colorectal ca

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Define: Hypoactive sexual desire

A

Persistent/recurrent deficiency of sexual fantasies/desire for sexual activity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Define: sexual aversion disorder

A

Persistent/recurrent extreme aversion/avoidance of genital sexual contact with a sexual partner

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Define: sexual arousal disorder

A

Persistent/recurrent inability to attain/maintain adequate lubrication/excitement

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Define: orgasmic disorder

A

inability to achieve orgasm with adequate excitement

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Define: dysparunea

A

Persistent/recurrent genital pain associated with sexual intercourse

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Define: Vaginismus

A

Persistent/recurrent involuntary contraction of the perineal muscles surrounding outer 1/3 of vagina with penetration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Which of the following have been shown NOT to negatively impact sexual function?

a) Alcohol
b) Cannabis
c) Opioids
d) Cocaine

A

b) Cannabis (improves sexual function)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Stages of vaginismus

A

Stage 1: perineal spasm, not maintain t/o exam
Stage 2: perineal spasm, maintained t/o exam
Stage 3: levator spasm and elevation of buttocks
Stage 4: perineal and levator spasm, elevation, adduction and retreat

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Absolute C/I to IUD insertion

A 
Current PID
Purulent cervicitis
Current G/C
Undiagnosed vaginal bleeding
unresolved GTN
Patient refusal
Allergy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Two reasons to remove IUD in women who develop mild/mod PID

A

Patient request

Failure of symptoms to improve after 72h of treatment with appropriate antibiotics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Lifetime risk of endometrial ca in woman with Lynch?

Ovarian ca?

A

40-60% endo

10-12% ovarian

25
Which would NOT be a good first-line medication for treatment of HMB? a) Micronor (POP) b) depoprovera c) Mirena IUD d) Mefenemic acid
a) micronor | Good for contraception, not studied for treatment of menorrhagia
26
Risks of endometrial ablation
``` Bleeding Infection Perforation Injury to bowel/bladder/cervix/vessels Fluid overload Hematometria (post-ablation syndrome) ```
27
Differential diagnosis (causes) of AUB?
``` PALM-COIEN P - polyps A - adenosine L - leiomyoma M - malignancy/hyperplasia C - coagulopathy O - ovulatory dysfuntion I - iatrogenic E - endometrial N - NYD ```
28
Risk factors for development of fibroids
``` Nulliparity Early menarche Family hx Obesity African descent Age (peak 40-50) Diabetes HTN ```
29
Most common symptom of fibroids: a) pelvic pain b) AUB c) infertility
AUB (30%) | Pain is rare, due to degeneration/torsion
30
Majority of fibroid growth is during the proliferative phase of the menstrual cycle? (T/F)
False. Secretory
31
Required investigations prior to EA
Pregnancy test Endometrial biopsy Pap w/in 2 years (+/- swabs) Cavity assessment
32
3 methods to reduce fluid absorption during EA
``` Pretreat endometrium Distension pressure < MAP Intracervical pressors (vasopressin, epinephrine) ```
33
Advantages of NR EA vs. Resectoscopic
Shorter surgical time Can be done under local anesthetic (not in OR) Fewer uterine perforations Lower risk of fluid overload Less hematometria Fewer cervical lacerations BUT increased cramping, post-procedure N/V
34
Techniques to reduce risk of capacitative coupling injury during R EA
``` Use "cut" more than "coag" (lower voltage) Avoid over-dilating cervix Ensure loop is touching tissue Weighted spec in vagina Ensure insulation intact over device Avoid prolonged/uninterrupted activation ```
35
At a glycerine deficit of 500cc, the surgeon and anesthetist should be made aware. How would your management change at a deficit of 1000cc? 1500cc? What if you were using NS (bipolar)?
1000cc - finish procedure ASAP Consider placing foley to monitor ins/outs, IV TKVO and IV furosemide 1500cc - stop immediately Lytes in PACU, observe for signs of fluid overload + encephalopathy (change in LOC, seizure, pulm edema, tachypnea), consider admission if using NS, finish procedure asap at 2000cc and immediately at 2500
36
Contraindications to NR EA
Previous classical or transmural myomectomy
37
What is the dose for the mife/miso medical abortion regimen?
Mifepristone 200mg PO, then 24-48h later, miso 800mcg buccal/SL/vaginal (can be used up to 70d)
38
Absolute C/I to medical abortion with mife/miso? Relative?
``` Chronic adrenal failure Ectopic pregnancy Ambivalence Inherited porphyria Uncontrolled asthma Allergy/hypersensitivity ``` ``` Relative: Unknown GA IUD in place Long-term systemic glucocorticoids Hemorrhagic d/o or anticoagulation therapy ```
39
Dose for the MTX/miso medical abortion regimen?
MTX 50mg PO/IM, 3-5d later Misoprostal 800mcg PV (can be used up to 63d)
40
Contraindications to MTX MA therapy
``` Ectopic Anemia IUD IBD Acute liver/renal disease Hemorrhagic d/o or anticoagulation therapy Allergy ```
41
Criteria on U/S to confirm pregnancy failure
1. CRL >7mm with no FHR 2. MSD >25mm with no embryo 3. No embryo >2weeks after u/s with GS but no YS 4. No embryo >11d after u/s with GS and YS
42
Ca requirements are higher in adolescents than in post-menopausal women?
True 9-18yo: 1300mg/d 19-50: 1000mg/d >50: 1200mg/d
43
Which is NOT a risk factor for PONV? a) female sex b) hx of PONV, motion sickness c) smoker d) use of post-op opioids
c) smoker | NON-smokers are at higher risk of PONV
44
Describe the minimum acceptable preoperative evaluation for a women wishing surgery for SUI (6 points)
1. focused hx 2. pelvic exam (r/o masses, assess prolapse, r/o latent sui) 3. demonstrate UVJ hypermobility (q-tip test, observation) 4. objective evidence of SUI (including assessment for latent) - cough test while supine or stress test (fill bladder and cough while standing over towel) 5. PVR (<100cc N) 6. Urine R&M, C&S
45
List four indications for Urodynamic testing
1. Diagnosis uncertain after initial H&P 2. Objective findings do not correlate with patients symptoms 3. Patient fails to improve after treatment 4. Clinical trial setting
46
Which regimen would not be appropriate for treatment if an uncomplicated UTI? a) Septra DS i tab PO BID x 3d b) Macrobid 100mg PO BID x 3d c) Ciprofloxacin 250mg PO BID x 3d 4) Fosfomycin 1 dose PO x 1
b) microbid should be given for at least 7 days
47
Elements of Chronic Pain Syndrome? (4)
1. duration 6mo or longer 2. incomplete relief with most treatments 3. impaired function at home or work, altered family roles 4. signs of depression
48
38yo G2P2 with 4cm ovarian endometrioma seen on U/S. Management?
Excise if symptoms or wishing fertility, otherwise expectant management
49
Most common cause of secondary dysmenorrhea in adolescents?
Endometriosis
50
Classic triad of endometriosis clinical symptoms
dysmenorrhea, dyschezia, dysparunia
51
Which women MUST have an endometrial biopsy?
1. PMB 2. >35 with AUB, anovulation 3. Pyometria 4. >45yo with endometrial cells on pap 5. Bleeding on Tamoxifen 6. Yearly HNPCC 7. Perimenopausal with AUB
52
In women with dysparunea and chronic vulvar pain, it is reasonable to start a 3-6mo course of anti fungal/anti viral if no cause of her symptoms can be found (T/F)
True....
53
What is the mechanism of action of TXA?
anti-fibrinolytic, reversibly binds to plasminogen and prevents its activation
54
What effect does TXA have on coagulation factors?
None
55
Options for reducing blood loss at the time of myomectomy?
``` Vasopressin Epinephrine Bupivicaine Misoprostal Pericervical tourniquet gelatin-thrombin matrix TXA UA occlusion ```
56
Most fibroids grow during pregnancy (T/F)
False, usually don't change in size or get smaller
57
Describe Post-Embolization Syndrome
Fever, nausea, vomiting, pain
58
In which patients would lactational amenorrhea be a reasonable option for contraception?
1. <6mo PP AND 2. EBF AND 3. not resumed menses (amenorrheic)
59
How long do you need to use backup contraception after a lap tubal? Essure? Vasectomy?
1 week 3 months 2-3 months (1 fresh sample must show azoospermia or <100,000)

Royal College (8 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions