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MEDICINE NEW > Minimal Gynaecology > Flashcards

Minimal Gynaecology Flashcards

1
Q

What is the definition of secondary amenorrhoea?

A

Periods stop for 6 months, not due to pregnancy

- were occurring before

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2
Q

Rx for primary dysmenorrhoea?

A

Cramping without organ pathology due to uterine cramping causing ischaemia

NSAIDs- mefanamic acid (inhibits prostaglandins)
Combined Pill

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3
Q

Causes of secondary dysmenorrhoea + questions to ask:

A

More constant throughout period, may be associated with dyspareunia:

Adenomyosis
Endometriosis
Chronic sepsis- chlamydia infection (PID)
Fibroids

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4
Q

Tests to do if a woman has secondary amenorrhoea (no periods for 6 months):

A 
Urinary bHCG- pregnant
FSH- high in menopause, low in exercise
Prolactin level
TFTs
Testosterone levels- androgen secreting tumour
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5
Q

3 features of polycystic ovarian syndrome:

A
  1. Hyperandrogenism- pattern baldness, hirsuitism, acne
  2. Oligo-ovulation- subfertility
  3. Polycystic ovaries- 12 follicles or >10cm ovarian volume

Insulin resistance- ancanthosis nigricans

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6
Q

Who needs investigating for primary amenorrhoea?

A

Failure to start menstruating by age 15

Or age 14 if no breast development

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7
Q

Rx of menorrhagia?

A

Heavy menstrual blood loss

  1. Progesterone containing IUCDs- Mirena
  2. Antifibrinolytics (tranexamic acid), NSAID (mefanamic acid), combined pill

Surgical: endometrial ablation- if family complete
Uterine artery embolization or myomectomy- for fibroids, family incomplete

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8
Q

At how many weeks is a pregnancy loss a miscarriage?

A

24 weeks

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9
Q

How may an ectopic pregnancy present:

A 
Abdo pain
Vaginal Bleeding
Fainting
D+V
Amenorrhoea for 8 weeks

Peritonism + shock if rupture
Shoulder-tip pain, pain on defication + urination = pelvic blood

EHx: enlarged uterus 30%, cervical excitation 50%, adnexal mass 60%

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10
Q

Tests for ectopic pregnancy:

A

Urinary bHCG
Blood bHCG
Transvaginal USS- intrauterine gestational sac

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11
Q

Management of ectopic pregnancy:

A

Shock- emergency laparotomy + fluids
May require salpingotomy or salpingectomy

Small early ectopic- Methotrexate

No acute Sx + bHCG falling- Expectant, monitor bHCG levels + USS

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12
Q

5 conditions for termination of pregnancy:

A

2 doctors agree:

  1. Risk to mother’s life of continuing pregnancy
  2. Prevent permanent grave injury to physical/mental health of woman
  3. Risks injury to the physical or mental health of woman greater than if terminated
  4. Risks injury to health of existing children if not terminated
  5. Risk of seriously handicapped fetus
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13
Q

Aside from abortion procedure what other therapies does a woman require in a termination of pregnancy?

A

Antibiotics: reduce post-op infection rates
Anti-D antibodies if rhesus -ve
Discussion of contraception and STI screen

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14
Q

Mechanism of medical and surgical abortions:

A

Mifepristone- disimplants fetus
Prostaglandin- triggers evacuation

Vacuum aspiration + dilatation or surgical forceps used

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15
Q

Difference between the discharge found in trichomoniasis and bacterial vaginosis:

A

Trichomoniasis- frothy yellow/green fish smelling discharge

Bacterial vaginosis- thin white discharge + fishy smell

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16
Q

Lab findings in vaginal discharge suggest which diagnosis:
A. Mycelia + spores on microscopy
B. Stippled vaginal ‘clue’ cells
C. Motile flagellates on wet films

A

Rx: clotrimazole or fluconazole
A. Candida (thrush)

Rx: metronidazole
B. Bacterial vaginosis- also overgrowth of bacterial flora
C. Trichomoniasis

17
Q

Which vaginal infections require a high vaginal swab?

A

High vaginal swab = posterior fornix
Trichomonas
Candida
Bacterial vaginosis

Endocervical canal is for NAAT- chlamydia + gonorrhoea

18
Q

Rx for chlamydia + gonorrhoea + syphilis?

A

Chlamydia: azithromycin once off, doxycycline 7ds

Gonorrhoea: azithromycin PO + ceftriaxone IM

Syphilis: benzylpenicillin

19
Q

Which GI condition can endometriosis be mistaken for?

A

IBS- causes pain on defication
May be associated with deep dyspareunia or secondary dysmenorrhoea
Cyclical pelvic pain or constant (adhesions)

20
Q

How is endometriosis diagnosed?

A

EHx: endometriosis
Fixed retroverted uterus (adhesions)
Generalised tenderness

Adenomyosis:
Boggy enlarged tender uterus

Laparoscopy: cysts, adhesions, peritoneal deposits

21
Q

At what point can you offer investigation for subfertility?

A

After 1 year of trying

Earlier if female is <35 years, not having periods or has had PID or cancer treatments or undescended testes in the past

22
Q

Rx of stress and urge incontinence:

A

Stress:

  1. Pelvic floor exercises 3 months
  2. Duloxetine SNRI
  3. Surgery, mid-urethral slings + tapes, urethral bulking

Urge:

  1. Bladder training 6 weeks
  2. Oxybutinin, Tolterodine
  3. Botox, sacral nerve stimulation

Mixed:
Treat urge first before stress

23
Q

Which drugs cause voiding difficulties in women?

A

Anticholinergics- atropine, chlorpromazine
Tricyclic antidepressants
Anaesthetics

24
Q

CI to oral contraceptive pill

A

CVS RFs: obesity, diabetes, HTN, dyslipidaemia, smoking

VTE: FHx +ve <46 years, major surgery due

Migrane + aura

Breast or liver CA

Post-natal

25
Q

Which form of oral contraception do you not take breaks with?

A

Progesterone oral contraceptive

26
Q

When can the different emergency contraception be given?

A

Levonorgestrel- 3 days
Ulipristal- 5 days
Intrauterine device- within 5 days of UPSI or earliest ovulation

Earliest ovulation is shortest cycle length based on most recent period -14 days

27
Q

What do you say to women after prescribing emergency contraception?

A
  1. Repeat dose if vomiting within 2/3 hours
  2. May have irregular bleeding or late period
  3. Pregnancy test in 3 weeks
  4. Ongoing contraception
28
Q

Features of menopause:

A

Menstrual irregularity
Vasomotor disturbance- sweats, palpitations, flushes
Atrophy of vagina, breasts + skin
Osteoporosis

29
Q

For how long does a woman need contraception during the menopause:

A

For 1 year from becoming amenorrhoeic if over 50, 2 years if under 50

30
Q

CI to HRT:

A 
Oestrogen dependent cancer- breast
Past PE or phlebitis
Undiagnosed PV bleeding
Pregnancy + breastfeeding
LFTs abnormal
31
Q

Which US features are suggestive of a malignant ovarian mass:

A 
Multi-loculated cyst
Solid areas
Ascites
Intra-abdominal mets
Bilateral lesion
32
Q

Which types of cancer does BRCA 1 + 2 genes predispose patients to?

A

Breast + ovarian cancer

33
Q

Aside from colorectal cancer, what other cancers are patients with hereditary non-polyposis colorectal cancer predisposed to?

A

Ovarian + endometrial cancer

34
Q

Difference between placenta praevia + abruption?

A

Placenta praevia: not much pain, uterus non-tender
Avoid PV exam as can trigger further bleeding
-due to placenta lying in lower uterine segment

Abruption: shock out of keeping with visible blood loss, pain constant, tense tender uterus, fetal heart absent or distressed
- due to placenta detaching from uterus

35
Q

Definition of pre-eclampsia:

A

Pregnancy induced hypertension with proteinuria
± oedema

Due to failed trophoblastic invasion of the spiral arteries leaving them vasoactive
PC: headache, chest/epigastric pain, vomiting, tachycardic
Visual disturbance, shaking, hyperreflexia, irritable

36
Q

What constitutes severe pre-eclampsia and how is it managed?

A

> 160/110 + proteinuria

Or >140/90 + proteinuria +
seziures/visual disturbance/ headache/ clonus/ papilloedema / low platelets/ ALT high/ liver tenderness

Rx: MgS04 IV
Labetalol IV (or hydralazine)
Fluid restrict
Expedite labour

MEDICINE NEW (22 decks)

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