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O&G Flashcards

1
Q

At how many weeks gestation should should anti-D prophylaxis be given if needed?

A

28 weeks

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2
Q

How long should women take folic acid for?

A

From the moment of trying until 12 weeks (400mcg) standard dose. 5mg if have risk factors

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3
Q

Define primary amenorrhoea

A

Not starting menstruation by the age of 13 with no other evidence of pubertal development
or
Age of 15 with other signs of puberty

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4
Q

Age what age are boys and girls considered to have precocious puberty?

A

Signs of puberty before 8 in girls and 9 in boys

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5
Q

What is Kallman syndrome?

A

Hypogonadotrophic hypogonadism and failure to start puberty. Associated with reduced/absent sense of smell

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6
Q

What is hypogonadism?

A

Lack of oestrogen and testosterone

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7
Q

What are the 2 types of hypogonadism?

A

Hypogonadotropic - deficiency of LH and FSH
And
Hypergonadotropic - testes and ovaries do not respond to LH and FSH

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8
Q

What can cause hypogonadotropic hypogonadism?

A
  • Abnormal functioning of hypothalamus or pituitary gland
  • Chronic conditions such as CF and IBD
  • Endocrine disorders such as GH deficiency, hypothyroidism, Cushing, hyperprolactinaemia
  • Kallman syndrome
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9
Q

What can cause hypergonadotrophic hypogonadism?

A
  • Abnormal functioning of gonads (torsion, cancer, infection)
  • Congenital absence of ovaries
  • Turner syndrome
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10
Q

Which enzyme is deficient in congenital adrenal hyperplasia?

A

21 hydroxylase enzyme

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11
Q

What is the pathophysiology of amenorrhoea in congenital adrenal hyperplasia?

A

21 hydroxylase enzyme deficiency = no cortisol = increased ACTH from pituitary = increased production of adrenal androgens = primary amenorrhoea

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12
Q

Features of congenital adrenal hyperplasia?

A

Girls are:

  • Tall for age
  • Facial hair
  • Deep voice
  • Early puberty
  • Primary amenorrhoea
  • Ambiguous genitalia
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13
Q

What is androgen insensitivity syndrome?

A

Tissues are unable to respond to testosterone, so typical male characteristics do not develop. Results in female phenotype in males

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14
Q

Features of androgen insensitivity syndrome?

A

Female external genitalia

  • Breast tissue
  • Testes in abdomen
  • Absent uterus, upper vagina, fallopian tubes, ovaries
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15
Q

What are the 3 components of the Rotterdam criteria? How many are needed for a diagnosis?

A

1) oligomenorrhoea
2) symptoms of hyperandrogenism (hirsutism, acne)
3) polycystic ovaries on US

At least 2/3 is needed for PCOS

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16
Q

Presentation of PCOS?

A
  • Oligomenorrhoea/amenorrhoea
  • Hirsutism and acne
  • Male pattern hair loss
  • Obesity
  • Infertility
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17
Q

What drug can be given to aid infertility in PCOS?

A

Clomifene

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18
Q

What other features and complications are seen in PCOS?

A
  • Diabetes
  • Acanthosis nigricans
  • CVD
  • Hypercholesterolaemia
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19
Q

What can be given to help symptoms of acne and hirsutism?

A

COCP

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20
Q

How long is Levonorgestrel licensed for use as emergency contraception?

A

Up to 72hrs after UPSI

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21
Q

How long is EllaOne licensed for use as emergency contraception?

A

Up to 5days after UPSI

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22
Q

How long do you have to wait before returning to normal contraception after taking levonorgestrel?

A

Restart within 12 hours

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23
Q

How long do you have to wait before returning to normal contraception after taking EllaOne

A

Wait 5 days before returning to normal contraception

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24
Q

What is the mode of action of the POP?

A

Inhibits implantation, thickens cervical mucus, inhibits ovulation

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25
Q

What is the mode of action of the IUS?

A

Inhibits implantation, thickens cervical mucus

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26
Q

What is the mode of action of the IUD?

A

Inhibits fertilisation, inhibits implantation

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27
Q

What is the mode of action of the implant?

A

Inhibits implantation, inhibits ovulation, thickens cervical mucus

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28
Q

What is the mode of action of the injection?

A

Inhibits implantation, inhibits ovulation, thickens cervical mucus

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29
Q

How long is the IUS licensed for?

A

5 years

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30
Q

How long is the IUD licensed for?

A

10 years

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31
Q

What contraindications for use of IUD are there?

A

PID, heavy menstrual bleeding, distortion of uterine cavity/fibroids

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32
Q

Which age group should attend smear tests every 3 years?

A

25-49

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33
Q

Which age group should attend smear tests every 5 years?

A

50-65

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34
Q

Which types of HPV are associated with cervical cancer?

A

16, 18, 33

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35
Q

Which types of HPV are associated with genital warts?

36
Q

What does a smear test look for?

A

Identifies presence of high-risk strains of HPV only (cytological testing is only done if HPV positive)

37
Q

What happens next if a cervical smear comes back negative for hrHPV (high risk HPV)?

A

Return to normal recall (3 or 5 years)

38
Q

What happens next if a cervical smear comes back positive for hrHPV but cytology is normal ?

A

Repeat test in 12 months. If hrHPV negative then normal recall.
If cytology normal again then repeat again at 12 months

39
Q

What happens next if a cervical smear comes back positive for hrHPV, normal cytology, and the same results again 12 months later?

A

Repeat again in 12 months (24 months since original test).

If hrHPV negative then return to normal recall.

If hrHPV +ive then colposcopy regardless if cytology is normal at 24 months

40
Q

What happens next if a cervical smear comes back positive for hrHPV and has abnormal cytology?

A

Colposcopy

41
Q

What happens if a cervical smear sample is inadequate?

A

Repeat in 3 months

42
Q

What happens if a cervical smear sample is inadequate and then 3 months later is inadequate again?

A

Colposcopy

43
Q

What is the most common treatment for cervical intraepithelial neoplasia?

A

LLETZ procedure (large loop excision of transformation zone)

44
Q

What are advantages of COCP?

A
  • Highly effective if taken correctly (>99%)
  • Doesn’t interfere with sex
  • Contraceptive effects are reversible upon stopping
  • Makes periods lighter, regular, less painful
  • Protective against ovarian and endometrial cancer
45
Q

What are disadvantages of COCP?

A
  • Relies on you to remember to take it
  • No protection against STIs
  • Increased risk of VTE
  • Increased risk of breast and cervical cancer
  • Increased risk of stroke and ischaemic heart disease (especially in smokers)
46
Q

How many weeks gestation should the booking visit take place?

A

8-12 weeks

47
Q

How many weeks gestation should dating scan take place?

A

10-14 weeks

48
Q

How many weeks gestation should Down syndrome screening take place?

A

11-14 weeks

49
Q

How many weeks gestation should anomaly scan take place?

A

18-21 weeks

50
Q

Which tests does the combined scan consist of and when should this be done?

A

nuchal translucency/thickness measurement

serum bHCG

PAPP-A

Done between 11-14weeks

51
Q

What results of the combined test indicate increased risk of Down Syndrome?

A
  • increased nuchal translucency
  • increased bHCG
  • decreased PAPP-A
52
Q

What results of the triple (and quadruple) test indicate Down syndrome?

A
  • increased bHCG
  • decreased AFP
  • decreased oestriol
  • (increased inhibin A)
53
Q

When is the triple/quadruple test done?

A

If women book later in pregnancy at 15-20 weeks

54
Q

If there is a risk greater than 1 in __ then amniocentesis/chorionic villus sampling is done

55
Q

When would amniocentesis be done and when would CVS be done?

A

amniocentesis if >15 weeks gestation because there would be enough amniotic fluid to do so

CVS is done between 11-14 weeks. Before 11 weeks can lead to fetal limb abnormality

56
Q

What is the criteria for expectant management of ectopic pregnancies?

A
  • No fetal heartbeat
  • HCG level <1500IU/L
  • Adnexal mass <35mm
  • No significant pain and no rupture
  • Ensure follow up is possible
57
Q

What is the criteria for medical management for ectopic pregnancy?

A

Same as for expectant but

  • HCG level <5000IU/L
  • Confirmation of absent intrauterine pregnancy on US
58
Q

Criteria for surgical management of ectopic pregnancy?

A
  • Pain
  • Adnexal mass >35mm
  • Visible heartbeat
  • HCG level >5000IU/L
59
Q

What is the triad of pre-eclampsia?

A

NEW ONSET Hypertension (>20 weeks gestation)
Oedema
Proteinuria

60
Q

Other features of pre-eclampsia?

A

Headache
Visual disturbance
N&V
Brisk reflexes

61
Q

Management of pre-eclampsia?

A

Labetalol 1st line (contraindicated in asthmatics)

62
Q

What do you give asthmatics with pre-eclampsia?

A

Nifedipine

63
Q

What do you give in severe pre-eclampsia?

A

IV hydralazine/IV magnesium sulphate

64
Q

What is HELLP syndrome?

A

Features that occur as a complication of pre-eclampsia and eclampsia:
Haemolysis
Elevated Liver enzymes
Low Platelets

65
Q

Presentation of placenta praevia?

A

Painless, bright red vaginal bleeding

66
Q

Management of placenta praevia?

A

Corticosteroids at 34-36 weeks due to risk of preterm delivery

Planned C section at 36/37 weeks

Emergency C section if premature labour or haemorrhaging

67
Q

Suitable and unsuitable investigations of placenta praevia?

A

Suitable: transvaginal US
Unsuitable: digital vaginal exam (provokes haemorrhage)

68
Q

Presentation of placental abruption?

A

Sudden onset, severe abdominal pain and vaginal bleeding

Tense, hard, woody uterus on palpation

Shock

CTG abnormality

69
Q

Risk factors for placenta accreta/increta?

A 
Previous placenta accreta/increta
Previous C-Section
Placenta praevia 
Increased maternal age
Multigravida
70
Q

Management of placenta accreta/increta?

A
  • Corticosteroids given
  • Planned C-section35-37 weeks to reduce risk of spontaneous labour and delivery

At C-section, hysterectomy is recommended, however patients can choose to have some myometrium resected with placenta to preserve uterus

71
Q

Definition of postpartum haemorrhage?

A

Loss of >500ml blood after delivery of baby

72
Q

Most common cause of PPH?

A

uterine atony

73
Q

Contraindications to COCP?

A

Breastfeeding, migraine with aura, smoker >35yo, history of VTE, breast cancer

74
Q

What should be prescribed after the fixation of a perineal tear?

A

Laxatives to prevent constipation and comprisation of the tear

75
Q

Difference between 3a, 3b and 3c perineal tears?

A

3a: <50% external sphincter torn
3b: >50% external sphincter torn
3c: internal sphincter torn

76
Q

Women with gestational diabetes have a significantly increased risk of what?

A

Still birth

77
Q

Women with gestational diabetes should give birth by when?

A

40+6 weeks

78
Q

What is the management if a pregnant mother tests positive for GBS?

A

Give antibiotics intrapartum (during labour and delivery) to prevent transmission to fetus.
Giving antibiotics antenatally does not have effect

79
Q

What hormone imbalances are seen in PCOS?

A
  • Increased testosterone
  • Increased LH
  • Normal FSH
80
Q

Indications for assisted delivery?

A
  • Fetal distress in 2nd stage labour
  • Fetus stuck in birth canal (birth not progressing)
  • Exhaustion
81
Q

Complications and risks of assisted delivery?

A
  • Vaginal tears +/- episiotomy
  • Urinary/anal incontinence
  • VTE risk post birth
  • Cephalohaematoma in baby
82
Q

When used in pregnancy, SSRIs can cause what birth defect?

A
  • Gastroschisis, omphalocele

- Skull defects (craniosynostosis, anencephaly)

83
Q

When used in pregnancy, TCAs can cause what birth defect?

A

-Neonatal irritability and convulsions

84
Q

When used in pregnancy, lithium can cause what birth defect?

A

-Cardiac abnormalities (Ebsteins anomaly)

85
Q

When used in pregnancy, benzodiazepines can cause what birth defect?

A

cleft lip and palate, neonatal withdrawal

86
Q

Treatment for infertility in endometriosis?

87
Q

Treatment for endometriosis?

A
  • Analgesia
    1. COCP or progesterone injection or IUS
    2. Goserelin (GnRH analogue) to induce a medical menopause
    3. Surgery to remove adhesions and endometrial tissue
    4. Hysterectomy and bilateral salpingo-oophorectomy

Revision all topics (11 decks)

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