O&G Flashcards
30 y/o
- increasingly painful periods
- ibuprofen useless
- worsened on intercourse
- adnexal tenderness
diagnosis:
first line IX:
endometriosis
IX: transvaginal USS
turners syndrome is associated with what genotype:
45 XO
- primary & secondary amenorrhoea due to premature ovarian failure
- failure to develop secondary sexual characteristics
Fragile X syndrome is what type of disorder:
X-linked dominant
Which condition is associated with the following features:
- narrow face
- large ears
- large testicles
- significant mental retardation
- developmental delay
- men affected more
Fragile X syndrome
which hormone increases greater than the others during pregnancy:
- LH
- FSH
- oestrone
- oestradiol
- oestriol
oestriol
- increases 1000 fold
- least potent of three oestrogens
oestrogen needed to control LH and FSH
- stimulate & control placental growth
classical marker of colorectal cancer
CEA
POP is associated with increased risk of ectopic pregnancy.
what other method of contraception is also associated with this:
depo-provera
- progesterone only injectable contraceptive
side effects
- weight gain
- irregular bleeding
- amenorrhoea
most common type of vulval malignancy:
squamous cell carcinoma
- peak age of incidence 60 years
- vulval discomfort and itching
classical triad of pre-eclampsia
proteinuria
hypertension
oedema
recap symptoms of pre-eclampsia
frontal headache
blurring, flashing in vision
epigastric / upper abdo pain
vomiting
oedema : face hands and feet
what is HELLP
- haemolysis
- elevated liver enzymes
- low platelet count
first line for pre-eclapmsia
labetalol
complications of pre-eclampsia
DR COG
D- disseminated intravascular coagulation –> HELLP
R- renal failure
C- cerebral haemorrhage
O- oligohydraminos
G- growth restriction (intrauterine growth restriction)
most common cause of bacterial vaginosis
gardnerella vaginalis
Pelvic inflammatory disease is usually due to:
chlamydia or gonorrhoea infection
signs
- bilateral lower abdo pain
- deep dyspareunia
- abnormal bleeding or discharge
treatment for a patient with PID who is otherwise wel:
stat IM ceftriaxone
then 2 week course of doxycycline and metronidazole
treatment for patient with PID who has severe disease, including pyrexia >38c
IV therapy
54 y/o
pc: 3 day hx increased urinary frequency + urgency , urinary incontinence
pmh: T2DM, heavy drinker
obs: 104bpm, lower abdo discomfort , perineal sensation and anal tone are normal
likely cause of incontinence:
urinary tract infection
urge incontinence!
- overactive detrusor muscle
- acute onset, mildly t.cardic, generalised lower abdo pain –> UTI most likely cause
high risk factors for pre-eclampsia
- personal history of pre-eclampsia
- essential HTN
- T1DM / T2DM
- CKD
- AUTOIMMUNE: antiphospholipid syndrome and SLE
moderate risk factor for pre-eclampsia:
BMI > 35kg/m
FH of pre-eclampsia
> 40 in 1st -pregnancy
multiple pregnancy
interpregnancy interval of > 10 years
Fluoxetine has licensed use in treatment of:
- hot flushes
- severe menopausal symptoms
- in patients with breast cancer
CONTRAINDICATED
- if patient with history of breast cancer is receiving tamoxifen therapy
- fluoxetine reduces efficacy of tamoxifen
patient with hx breast cancer.
dh: tamoxifen therapy
low mood, sleep disturbance secondary to hot flush
best management:
cognitive behaviour therapy
accompanied by lifestyle modifications
- regular exercise
- weight loss if applicable
- relaxation exercises
- good sleep hygiene
urinary incontinence differential diagnoses:
UTI
bladder carcinoma
pharmalogical treatment of urge incontinence
antimuscarinics
- oxybutinin
pharamological treatment in stress incontinence
duloxetine
- SSRI
- 2nd line when conservative measures fail
duloxetine is contraindicated in patients with:
uncontrolled hypertension
17 y/o female
- primary amenorrhoea
- phenotypically female
- absent uterus
likely to have:
androgen insensitivity syndrome
karyotype of 46 XY
first line treatment for lichen sclerosis:
high potency steroids such as clobestasol proprionate.
3 month trial of topical steroid then review.
if patient with lichen sclerosis fails to respond to first line tx of high potency steroid, what might be given next?
topical calcineurin inhibitors such as tacrolimus
- immunosuppressant
- inhibits secretion of IL-2 (so T cell proliferation inhibited)
- reduces inflammation
first line tx for UTI in pregnancy
nitrofurantoin
safe to use in pregnancy, should be avoided near term, don’t use in breast feeding
note:
- trimethoprim contraindicated.
- interferes with folate metabolism in first trimester
what causes microcytic anaemia:
iron deficiency anaemia
what would give rise to macrocytic anaemia?
- folic acid or b12 deficiency
- raised MCV
in a fit and well 39 week pregnant lady, the following findings are consistent with:
- low Hb
- normal MCV
- normal platelets
- normal WCC
dilutional anaemia of pregnancy
- disproportional rise in plasma volume for RBC are diluted out
difference between urge and stress incontinence:
stress incontinence
- weakening or damage of pelvic floor muscles
urge incontinence
- overactivity of detrusor muscle
- anti-muscarinics: oxybutinin
ectopic pregnancies most common in:
ampulla
HOWEVER
- rupture more likely in isthmus because its narrower
what is placenta accreta?
- placenta grows into the myometrium rather than in decidua
40 y/o female
- hot flushes
- nausea
- palpitations
- sweatiness
which is a recognised cause of premature menopause:
a) addisons disease
b) PCOS
c) mutliparity
d) recurrent miscarriage
e) hyperthyroidism
addisons disease
associated with premature ovarian failure
PCOS clinical presentation
PCOS PAL
P-polycystic ovaries on USS
C- cycles erratic
O- obesity and hirustism
S- subfertility
P- prolactin
A- androgens elevated
L - LH elevated
3 weeks post partum, 31 y/o female requests contraception. breastfeeding.
which method is most practical?
progesterone implant
4-6 weeks
- barrier method
- POP
- progesterone implant
- copper coil, IUS
COCP contraindicated
- risk of thromboembolism
sheehans syndrome is
- ishcaemic necrosis of anterior pituitary
difference between laparoscopic salpinectomy or laparocopic salingotomy
salpingectomy
- removal of fallopian tube
salpingotomy
- removes only ectopic pregnancy
- leaves fallopian tube in place
- in attempt to preserve fertility
what is recommended for patients as prophylaxis for pre-eclampsia
aspirin 75mg daily
which is the earliest possible diagnostic test for downs syndrome?
11 weeks onwards
- Chorionic villus sampling for karyotyping
15 weeks onwards
- amniocentesis if baby high risk for downs
18-21 weeks
- anomaly scan
screening tests
- nuchal translucency test
- quadruple blood test (15-22 weeks)
bacterial vaginosis treatment
metronidazole 400mg twice a day for week
treatment of severe pre-eclampsia
proteinuria with ongoing headache
magnesium sulphate
55 y/o obese post menopausal
- voice deepened
- severe hirsutism and clitoral enlargement
- elevated testosterone
- bilaterally enlarged, solid appearing ovaries
- simple endometrial hyperplasia
likely diagnosis
ovarian stromal hyperthecosis
peripheral adipose tissue
- conversion of androgen to oestrogen
–> hyperoestrogenic state
—> endometrial hyperplasia
most common cause of cervical cancer:
human papillomavirus
which virus caused slapped cheek syndrome?
parovirus b19
commonly affects paeds
general malaise + erythematous rash on cheeks
which hormone regulates development of male structures in womb
anti-mullerian hormone
suppresses development of female structures
causes and risk factors of infertility
INFERTILE
Idiopathic
No ovulation, PCOS, menopause…
Fibroids
Endometriosis
Regular bleeding pattern disrupted - oligo/amenorrhoea
Tubal disease
Increasing age > 35
Large size
Excessive weight loss - anorexia nervosa
first line management for prolactinoma:
dopamine receptor agonist
- cabergoline
if conservative management fails then surgical excision
