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o&g Flashcards

1
Q

How long does Nexplanon progesterone contraceptive implant last for?

A

3 years

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2
Q

What is the timing of use of the drugs in pregnancy:

(a) trimethoprim
(b) nitrofurantoin

A

(a) AVOID trimethoprim in early pregnancy

(b) AVOID nitrofurantoin in late pregnancy

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3
Q

When is trimethoprim teratogenic in pregnancy

A

First trimester

- avoid during early pregnancy

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4
Q

When should nitrofurantoin be avoided in pregnancy

A

Near term (late pregnancy)

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5
Q

If trimethoprim and nitrofurantoin cannot be used in pregnancy, what can treat the UTI

A

cefalexin

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6
Q

Aromatase inhibitors (e.g. anastrozole) may cause what major side effect

A

osteoporosis

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7
Q

Selective oestrogen receptor modulators (SERMs) e.g. tamoxifen increase the risk of what cancer

A

Endometrial cancer

  • also increases risk of VTE, vaginal bleeding, amenorrhoea
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8
Q

all pregnant and breastfeeding women should take a daily supplement of what vitamin

A

Vitamin D

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9
Q

Women trying to conceive through to 12 weeks gestation should take what dose of folic acid

A

400mcg

5mg if epilepsy, neural tube defects, or diabetes

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10
Q

The symphysis-fundal height (SFH) is measured from the …. to the … in centimetres

It should match the gestational age in weeks to within 2 cm after 20 weeks, e.g. if 24 weeks then the a normal SFH = 22 to 26 cm

A

From the top of the pubic bone to the top of the uterus

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11
Q

The symphysis-fundal height (SFH) is from the top of the pubic bone to the top of the uterus in centimetres.

After how long should the SFH match the number of weeks?

A

After 20 weeks gestational age

The SFH should then match GA in weeks plus/minus 2cm, e.g. at 20 weeks = 18-22cm

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12
Q

first line medication for hypertension in pregnancy

A

labetalol

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13
Q

women who are at high risk of developing pre-eclampsia should take what medicine from 12 weeks until baby is born

A

aspirin 75mg OD

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14
Q

Combined oral contraceptive pill increases the risk of which 2 cancers and decreases the risk of which 2 cancers

A
  1. Increases the risk of breast and cervical cancer

2. Decreases the risk of ovarian and endometrial cancer

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15
Q

What is the treatment for group B streptococcus (GBS) found in vaginal swabs and urine during pregnancy?

A

Intrapartum IV benzylpenicillin

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16
Q

Women who have had a previous baby infected with GBS are offered what in future pregnancies

A

Intrapartum IV benzylpenicillin in future pregnancies

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17
Q

Which HPV are most commonly associated with cervical cancer

A

16, 18, 33

6 and 11 develop genital warts

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18
Q

tamoxifen can be used in oestrogen receptor positive, HER negative breast cancers in pre and peri-menopausal women. what is used if the woman is post-menopausal?

A

Anastrozole

for oestrogen receptor positive breast cancer in POST menopausal women

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19
Q

what treatment is used for HER positive, oestrogen receptor negative breast cancer?

A

Trastuzumab (herceptin)

20
Q

8 absolute contraindications (UKMEC4) to COCP

A
  1. > 35 years and >15cigs/day
  2. Migraine with aura
  3. History of VTE/genes
  4. History of stroke/IHD
  5. Breast feeding <6 weeks post-partum; or 21 days if not breastfeeding
  6. Uncontrolled HTN
  7. Breast cancer
  8. Major surgery
21
Q

When is the COCP stopped before major surgery, and restarted after

A

Stopped 4 weeks before surgery

Restarted 2 weeks after

22
Q
  • vaginal discharge - offensive, green
  • vulvovaginitis
  • strawberry cervix
  • pH >4.5
  • can cause urethritis in men

What is the pathogen

A

Trichomonas vaginalis

highly motile flagellated parasite STI. Micro shows motile trophozoites.

23
Q

What is the treatment for trichomonas vaginalis STI

A

Oral metronidazole

24
Q

What is the pH in bacterial vaginosis and trichomonas

A

> 4.5

25
Q

What daily supplements does the NHS currently advise all women take during pregnancy (in the absence of additional risk factors)?

A

folic acid 400mcg for the first 12 weeks, and vitamin D 10mcg throughout pregnancy

26
Q

Contraceptives - time until effective (if not on first day of period):

  1. Copper IUD
  2. POP
  3. COCP, implants, injection, Mirena IUS
A
  1. IUD - immediately
  2. POP - 2 days
  3. COCP, implants, IUS - 7 days
27
Q

treatment for vaginal candidiasis

A

clotrimazole cream/pessary if they are pregnant. Thrush cannot be treated with oral fluclonazole if they are pregnant.

28
Q

Routine recall for cervical smear if recent smear was negative for

(a) ages 25-49
(b) ages 50- 65

A

(a) Every 3 years

(b) Every 5 years

29
Q

2 cervical smears that are inadequate samples 3 months apart requires..

A

colposcopy

30
Q

women who are at high risk of developing pre-eclampsia should take 75mg aspirin OD from 12 weeks until baby is born. what are the 4 high risk groups?

A
  1. previous pregnancy induced HTN
  2. Autoimmune disorders e.g. SLE or antiphospholipid disorder
  3. Diabetes
  4. Chronic kidney disease
31
Q

When do you need to refer painful periods (dysmenorrhoea) to gynae

A

Secondary dysmenorrhoea i.e. develops after many years after menarche to look for cause

32
Q

Secondary dysmenorrhoea typically develops many years after the menarche and is the result of an underlying pathology. What are 4 causes

A
  1. endometriosis
  2. PID
  3. adenomyosis
  4. fibroids
33
Q

what breast cancer drug increases the risk of endometrial cancer

A

tamoxifen

34
Q

what is the classic symptom of endometrial cancer

A

post menopausal bleeding

35
Q

Many ovulations will increase the risk of ovarian cancer as it increases oestrogen levels. Therefore what 3 risk factors will increase ovulations

A
  1. Early menarche
  2. Late menopause
  3. No children
    n. b. these are same for endometrial cancer.

also BRCA1/BRCA2

36
Q

Pregnant women with gestational DM should be advised to maintain their blood glucose below the following target levels:

A

fasting: 5.3mmol/L

AND

1 hour postprandial: 7.8 mmol/L or
2 hours postprandial: 6.4 mmol/L

37
Q

combined HRT is used in patients with a uterus (no history of hysterectomy) because systemic oestrogen only HRT increases risk of…

A

endometrial cancer

also ovarian cancer risk increases with number of ovulations

38
Q

perimenopausal (<12 months since last period) HRT treatment

A

combined cyclical HRT

combined continuous HRT is used in women >12 months since last period, and with uterus

39
Q

menopause is defined as what time frame after last menstrual period

A

12 months

40
Q

If the contraceptive patch change is delayed greater than 48 hours, what should be done?

A

Change patch immediately

Barrier method needs to be used for 7 days

41
Q

Combined test for chromosomal disorders is is done between 11-13+6 weeks. The triple/quad test is done 15-20 weeks. What results in Down’s syndrome would be shown?

A
  • Thickened nuchal transulency
  • High serum b-hCG
  • Low PAPP-A
  • Low AFP
  • Low oestriol
42
Q

It is advised that pregnant women taking phenytoin are given what to prevent clotting disorders in the newborn

A

vitamin K

43
Q

urinary incontinence which occurs when laughing/coughing is called stress incontinence.

Initial investigations are bladder diary for min 3 days,
vaginal examination, Kegel exercises, urine dip MC&S, urodynamic studies

what is the treatment for stress incontinence?

A
  1. pelvic floor muscle training
  2. surgery - retropubic mid urethral tape procedures
  3. if do not want surgery, duloxetine
44
Q

what is the treatment for overactive bladder/urge incontinence (i.e. detrusor overactivity)

A
  1. bladder retraining for at least 6 weeks - to increase interval between weeing
  2. medication - antimuscarinics e.g. oxybutynin (IR), tolterodine (IR) or once daily darifenacin
  3. If old lady and frail and unable to tolerate antimuscarinics, try mirabegron (b3 agonist)
45
Q

Hormone replacement therapy for menopause is contraindicated in what 4 criteria

A
  1. Current/past breast cancer
  2. Any oestrogen dependent cancer
  3. Undiagnosed vaginal bleeding
  4. Untreated endometrial hyperplasia

msra (5 decks)

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