Lectures : O&G Flashcards
When does the anomaly scan take place:
20 WEEKS
Consequences of diaphragmatic hernia
- lung hypoplasia
- altered pulmonary vascular development
Infections that could affect pregnancy
- Toxoplasmosis
- Other: Syphilis, parvovirus b19, varicella zoster, listeria
- Rubella
- Cytomegalovirus
- Herpes simplex 2
Describe screening for trisomy 21
Quad test–> 14+0 to 20+0 weeks
Serum biomarkers (AFP, hCG, oestriol, inhibin A)
Combined test –>10+0 to 13+6 weeks
- Nuchal thickness
- Serum biomarkers (hCG, PAPP-A)
NIPT –> From 9 weeks
- Small fragments of foetal cells within maternal blood.
- not NHS
99% sensitivity
State two other diagnostic tests done in pregnancy :
Chorionic villous sampling: up to 15 weeks
–> placental villous fragments
Amniocentesis: 16 weeks onwards
–> foetal skin cells in amniotic fluid
Key investigation for endometrial cancer
- US endometrial thickness and biopsy for diagnosis
- MRI pelvis and/or CT chest, abdomen and pelvis staging
Vaccination protects against which subtypes of HPV
16 and 18
Treatment options for cervical cancer
- Local excision (loop or knife cone)
- Radical trachelectomy / hysterectomy with pelvic node dissection
- Radical chemoradiotherapy
- Palliative chemo and or radiotherapy
NOTES
- trachelectomy involves removal of cervix and upper part of vagina
Risk factors for vulval cancer
-
Vulval dermatosis
a. Lichen sclerosis (white appearance, resorption of labia minora, figure of 8 pattern, atrophic) autoimmune.
b. Lichen planus (Affect inside of vagina) -
HPV
- Types 16, 32, 18
- Relatively normal looking vulva
Chlamydia symptoms male vs female
Male
- urethral discharge (clear, watery or sticky)
- dysuria
- ureteral discomfort
- testicular pain
Female
- change in vaginal discharge
- dysuria
- lower abdominal pain
- intermenstrual bleeding
- dyspareunia
EXTRA-GENITAL
- rectal discharge
- conjunctivitis
Important complications of Chlamydia:
- Pelvic inflammatory disease
- Epididymo-orchitis
- Sexually acquired reactive arthritis (SARA)
- Peri-hepatitis (Fitz-hugh-curtis syndrome)
Mainstay for diagnosis of Chlamydia:
Nucleic acid amplification swab (NAAT)
- note: chlamydia difficult to culture - may see evidence of pus cells
Male –> first pass urine
Female –> vulvo-vaginal NAAT
Management of Chlamydia?
1st Line 🡪 DOXYCYCLINE 100mg BD for 7 days
2nd line 🡪 AZITHROMYCIN 1g stat followed by 500mg OD for 2 days. (first line in pregnancy & breast feeding)
For asymptomatic males and females, how far back do you need to do partner notification?
All partners in last 6 months
- or last month if male patient has symptoms
What are the 3 serovars of chlamydia trachomatis?
Serovar/serotype
group of microorganisms or viruses based on their cell surface antigens
- A-C: trachoma (blindness)
- D-K: chlamydia in genital tract
- L1-L3: LGV (lymphogranuloma venereum)
- more common in men vs men sex
Stages of LGV infection
- Classical
a. PRIMARY —> small painless papule which ulcerated
b. SECONDARY —> gross lymphadenopathy, buboes, necrose to form abscesses
c. TERTIARY —> scaring, fibrosis, rectal strictures and fistulae - Primary Rectal LGV
a. direct transmission to rectal mucosa
b. haemorrhagic prostatitis
c. often mistaken for IBD
Management of LGV infection
-
DOXYCYCLINE 100mg BD for 3 weeks
- test of cure !
What type of organism is Neisseria Gonorrhoea:
GRAM NEGATIVE INTRACELLULAR DIPLOCOCCI
How do you diagnose Gonorrhoea?
- Microscopy
- NAAT –> culture everyone and all contacts and sites of sex
Complications of Gonorrhoea:
- PID
- Epididymo-orchitis
- SARA
- disseminated gonococcal infection
Treatment regime for Gonorrhoea:
1st Line = ceftriaxone 1g IM stat
- or Ciprofloxacin 500mg if sensitive
2nd Line
- Gentamicin 240mg IM stat + 2g Azithromycin
- Cefixime 400mg PO + 2g Azithromycin
- Azithromycin 2g PO alone
TEST OF CURE –> after 2 weeks
Name of the smallest known self-replicating bacteria
- mycoplasma genitalium
- non-specific urethritis
Management of mycoplasma genitalium infection:
UNCOMPLICATED
-
Doxycycline 100mg BD for 7 days
- followed by Azithromycin 1g stat then 500mg OD for 2 days
COMPLICATED (if PID, EO, or failure of 1st line)
- Moxifloxacin 400mg OD for 14 days
- test of cure at 5 weeks
Syphilis caused by what bacteria:
Treponema Pallidum
- more common among men vs men sex
What is condylomata lata?
fleshy wart like lesions
will go away with penicillin treatment
associated with secondary syphilis
Common sites of infection of tertiary syphilis:
- ascending aorta
- dilatation? aortic regurgitation?
3 types of neurosyphilis
Tabes Dorsalis (15-25 years)
Slow degeneration of nerves carrying sensory information to the brain.
- lightening pain
- sensory ataxia
- argylle-robertson pupil
General Paresis (10-25 years)
- progressive severe dementia with seizures
Meningo-vascular (2-7 years)
- commonly affects younger patients
- MCA most commonly affected arteritis
- ischaemic stroke
What is an argyll robertson pupil?
- AR pupils do not constrict when exposed to light
- will constrict when focusing on a near object
If a chancre is present how might you investigate syphilis?
dark ground microscopy
Management of Syphilis summarised
Primary, secondary and early latent
–> 2.4MU benzathine penicillin IM stat
Late latent
–> 2.4MU benzathine penicillin IM stat weekly for 3 weeks
Neurosyphilis
–> 1.8-2.4 MU procaine penicillin IM OD for 14 days
Incubation period of Herpes Simplex virus
Acquisition (skin to skin contact)
Incubation (2-20 days)
1/3rd clinical symptoms (last 5-10 days)
2/3rds asymptomatic or symptoms not recognised
LATENT in sensory ganglia
Then either
–> recurrent infection
–> asymptomatic shedding
Initial episodes of HSV can be primary or non-primary, what does this mean:
- Primary: no antibodies to either HSV1 or HSV 2
- Non-primary: prior antibodies to HSV1 or HSV 2
Symptoms of herpes
- painful ulceration
- dysuria
- vaginal or urethral discharge
- prodrome (flu like illness before) and systemic symptoms
- asymptomatic or minor symptoms (itch)
Important extra-genital manifestations of Herpes
- Meningitis
- Encephalitis
- Herpetic eye disease: dendritic ulcers
- Skin lesions: dermatitis herpetiformis
Diagnosis of herpes
-
viral PCR of skin lesions
- open ulcer
- pop vesicles to get serous fluid
-
serology
- ask for type specific IgG
Management of herpes
- avoid sex
- Pharmacological
- start within 5-7 days
- ACICLOVIR 400mg TDS for 5-10 days
After how many episodes may recurrent episodes be treated with suppressive treatment?
more than 6 episodes a year
If a mother has herpes at what point in the pregnancy is HSV suppression advised?
- from 36 weeks
- to reduce risk of neonatal herpes
Example of low risk HPV strains which cause benign warts
6 and 11
Management of genital warts (low risk HPV)
- Cryotherapy
- Topical agent (Imiquimod, Podophyllotoxin)
- Imiquimod can be given in BCC
- Electro-cautery
- Surgery
- nothing? 30% will disappear with no treatment
What is the main protein in the blood responsible for drug binding?
albumin
By how much roughly is cardiac output increased by in pregnancy?
30-50%
Which CYP enzyme is responsible for metabolism of over 50% of all drugs and is affected during pregnancy
CYP3A4
- enzymes are affected in pregnancy
Other important enzyme = CYP2D6
What classification is used for abnormal uterine bleeding:
FIGO classification of abnormal uterine bleeding
PALM COEIN
- polyps
- adenomyosis
- leiomyoma
- malignancy and hyperplasia
- coagulopathy
- ovulatory dysfunction
- endometrial
- iatrogenic
- not yet classified
Name a cancer drug which may lead to abnormal uterine bleeding:
TAMOXIFEN (selective oestrogen regulator)
- treats certain types of breast cancer
- however stimulates uterine lining proliferation —> HMB
Surgical management of heavy menstrual bleeding
- Endometrial ablation
- Uterine artery embolisation
Medical management of heavy menstrual bleeding
- IUS
- COCP
- POP
Tranexamic acid
Mefenamic acid
What features are associated with disseminated gonococcal disease:
- Tenosynovitis
- Migratory polyarthritis
- Dermatitis
