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DRCOG > Module 1 : Fertility and sexual health > Flashcards

Module 1 : Fertility and sexual health Flashcards

1
Q

Trichomonas

Signs (4)

A

Offensive, yellow/green, frothy discharge
Vulvovaginitis
Strawberry Cervix
pH >4.5
Asymptomatic usually in men, may cause urethritis

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2
Q

Trichomonas
Ix
Treatment

A

Ix - microscopy shows motile trophozoites

Tx - Oral metronidazole 5-7 days or 2g STAT

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3
Q 
Bacterial Vaginosis
Amsels Criteria (4)
A 
3 of 4 for diagnosis
Thin white homogenous discharge
Clue cells on microscopy
pH >4.5
Positive wiff test - fishy with potassium hydroxide
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4
Q

BV - Organism

A

Garderella Vaginalis overgrowth - leads to fall in lactic acid producing aerobic lactobacilli

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5
Q

BV
Tx
Cure rate, Relapse rate

A

Oral metronidazole 5-7 days

70-80% cure, >50% relapse in 3 months

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6
Q

BV risks in pregnancy

A 
Increased risk of..
Preterm labour
Low birth weight
Late miscarriage
Chorioamnionitis
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7
Q

Candida

Signs (4)

A

Cottage cheese, non offensive
Itch
Vulvitis - superficial dyspareunia, dysuria
Vulval erythema, fissuring, satellite lesions

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8
Q

Risk factors for Candida

A

DM, steroids, Abx, pregnancy, immunosuppression

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9
Q

Treatment for Candida

A

Local - clotrimazole pessary 500mg PV
Oral - Itraconzaole, Fluconazole
Pregnancy - oral CONTRAINDICATED

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10
Q

Recurrent Candida

Definition and Management

A

4 or more episodes per year
Do HVS to confirm, bloods ? DM, exclude lichen sclerosus
Induction: Fluconazole every 3 days for 3 doses
Maintenance: Fluconazole weekly 6 months

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11
Q

HPV strains
Genital Warts
Cervical Ca

A

Genital Warts 6,11

Cervical Ca 16,18

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12
Q

Cervical screening ages

A

25-49 3 yearly
50-64 5 yearly
Can be delayed 3 months post partum

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13
Q

HPV negative screen

A

Return to recall unless on treat till cure, untreated CIN1 or follow up

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14
Q

HPV positive and cytology normal

A

Repeat at 12 months

  • if -ve routine
  • if +ve repeat again in 12 months and if + again COLPOSCOPY
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15
Q

HPV positive cytology abnormal

A

Colposcopy

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16
Q

Cervical smear inadequate sample

A

Repeat in 3 months

2x inadequate go to COLPOSCOPY

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17
Q

Risk factors for Cervical Ca

A 
HPV 16,18,33
Smoking
HIV
Many sexual partners
High parity
COCP
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18
Q

How do HPV 16 and 18 work

A

16 - produces E6 oncogene which inhibits p53 tumour suppressor
18 - produces E7 oncogene which inhibits RB suppressor

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19
Q

FIGO Cervical Ca

1A

A

Confined to cervix
Less than 7mm wide
A1 = <3mm deep
A2 = 3-5mm deep

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20
Q

FIGO Cervical Ca

1B

A

Confined to cervix
Visible or larger than 7mm
B1 = <4cm diameter
B2 = >4cm diameter

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21
Q

FIGO Cervical Ca

II

A

Beyond cervix but not to pelvic wall
A = upper 2/3 vagina
B = parametrial involvement

22
Q

FIGO Cervical Ca

III

A

Extension of tumour beyond cervix and to pelvic wall
A = lower 1/3 vagina
B = pelvic side wall
Any tumour causing hydronephrosis or non functioning kidney

23
Q

FIGO Cervical Ca

IV

A

Extension of tumour beyond pelvis or involvement of bladder or rectum
A = bladder/rectum
B = distal sites to pelvis

24
Q

How long after birth before women require contraception?

A

21 days

25
Q

Lactational Amenorrhoea Method

A

Lactational amenorrhoea method (LAM)
is 98% effective providing the woman is fully breast-feeding (no supplementary feeds), amenorrhoeic and < 6 months post-partum

26
Q

Risks of pregnancy again within 12 months of birth

A

An inter-pregnancy interval of less than 12 months between childbirth and conceiving again is associated with an increased risk of preterm birth, low birthweight and small for gestational age babies

27
Q

Breastfeeding: POP

A

Progestogen only pill (POP)
the FSRH advise ‘postpartum women (breastfeeding and non-breastfeeding) can start the POP at any time postpartum.’
after day 21 additional contraception should be used for the first 2 days
a small amount of progestogen enters breast milk but this is not harmful to the infant

28
Q

Breastfeeding: COCP

A

Combined oral contraceptive pill (COC)
absolutely contraindicated - UKMEC 4 - if breast feeding < 6 weeks post-partum
UKMEC 2 - if breast feeding 6 weeks - 6 months postpartum*
the COC may reduce breast milk production in lactating mothers
may be started from day 21 - this will provide immediate contraception
after day 21 additional contraception should be used for the first 7 days

29
Q

Postpartum insertion of coils

A

The intrauterine device or intrauterine system can be inserted within 48 hours of childbirth or after 4 weeks.

30
Q

Smoking cessation in pregnant women

A

Nicotine replacement patches

CONTRAINDICATED - varenicline and bupropion

31
Q

How long after female sterilisation do you need to use contraception?

A

Until next period

32
Q

First line contraception for women taking phenytoin,carbamazepine, barbiturates, primidone, topiramate, oxcarbazepine….

A

IUD, IUS, Depo Provera - UKMEC 1

Implant, UKMEC 2 and COCP/POP UKMEC 3

33
Q

First line contraception for lamotrigine:

A

UKMEC 1: POP, implant, Depo-Provera, IUD, IUS

UKMEC 3: the COCP

34
Q

Causes of acute liver failure

A

paracetamol overdose
alcohol
viral hepatitis (usually A or B)
acute fatty liver of pregnancy

35
Q

Acute fatty liver of pregnancy - when to think of this

A

Jaundice following abdominal pain and pruritus during pregnancy think acute fatty liver of pregnancy

36
Q

Syphilis in pregnancy - complications (7)

A 
saddle nose
sensorineural deafness
encephalopathy
 limb abnormalities
It can also result in miscarriages, stillbirths and early neonatal death.
37
Q

Management of syphilis

A

intramuscular benzathine penicillin is the first-line management
alternatives: doxycycline

38
Q

Reaction to syphilis management

A

Jarisch-Herxheimer reaction is sometimes seen following treatment
fever, rash, tachycardia after the first dose of antibiotic
in contrast to anaphylaxis, there is no wheeze or hypotension
it is thought to be due to the release of endotoxins following bacterial death and typically occurs within a few hours of treatment
No treatment is needed other than antipyretics if required

39
Q

Return to fertility: IUS

A

No delay

40
Q

Return to fertility: Implant

A

Within 2 weeks

41
Q

Return to fertility: Depo Provera

A

3-6months

42
Q

Features of AntiPhospholipid Sydrome

A 
venous/arterial thrombosis
recurrent fetal loss
livedo reticularis
thrombocytopenia
prolonged APTT
other features: pre-eclampsia, pulmonary hypertension
43
Q

Test for Anti Phospholipid Syndrome

A

Anti-cardiolipin syndrome

44
Q

Primary and Secondary Management of Antiphosphoipid Syndrome

A

Management - based on EULAR guidelines
primary thromboprophylaxis
low-dose aspirin
secondary thromboprophylaxis
initial venous thromboembolic events: lifelong warfarin with a target INR of 2-3
recurrent venous thromboembolic events: lifelong warfarin; if occurred whilst taking warfarin then consider adding low-dose aspirin, increase target INR to 3-4
arterial thrombosis should be treated with lifelong warfarin with target INR 2-3

45
Q

Time till effective (if not 1st day of period): IUD

A

instant

46
Q

Time till effective (if not 1st day of period): COCP

A

7 days

47
Q

Time till effective (if not 1st day of period): POP

A

2 days

48
Q

Time till effective (if not 1st day of period): Depo

A

7 days

49
Q

Time till effective (if not 1st day of period): IUS

A

7 days

50
Q

Time till effective (if not 1st day of period): Implant

A

7 days

DRCOG (7 decks)

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