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Difficult Passmed- MLA > O&G > Flashcards

O&G Flashcards

1
Q

First line surgery for women needing surgery for ectopic pregnancy and no other RFs for infertility

A

Salpingectomy
(Salpingotomy - option but 20% chance failing and needing more mx so if they have no factors affecting fertility of their other tube then complete removal)

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2
Q

First line Ix for endometrial cancer

A

Transvaginal US
(If abnormal then endometrial biopsy)

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3
Q

Women who have had a salpingostomy for ectopic pregnancy but following procedure still has discomfort and high HCG - what is the mx

A

Methotrexate (and/or salpingectomy)

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4
Q

1st line treatment primary dysmenorrhoea

A

NSAID - mefanamic acid

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5
Q

Premenstrual symptom management

A

Mild - lifestyle
Mod - COCP (Yasmin)
Severe - SSRI continuous or during luteal phase

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6
Q

Pregnant woman presents with painful vaginal bleeding, foetal heart often absent and might move less
Diagnosis?

A

Placental abruption (hard, woody uterus)

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7
Q

A 31-year-old woman complains of intermittent pain in the left iliac fossa for the past 3 months. The pain is often worse during intercourse. She also reports urinary frequency and feeling bloated. There is no dysuria or change in her menstrual bleeding

Dx

A

Ovarian cyst

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8
Q

Rfs endometrial cancer

A

Nulliparity, early menarche, late menopause, unopposed oestrogen (HRT not progesterone), obesity, DM, POS, tamoxifen, HNPCC

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9
Q

Which ovarian tumour is ass with development of endometrial hyperplasia

A

Granulosa cell tumours

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10
Q

Abnormal vaginal bleeding, discharge, pelvic pain, dyspareunia.

Possible malignancy, pathology and Tx

A

Cervical Cancer

Tx - Hysterectomy + LNs or if fertile then cone biopsy

HPV 16&18

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11
Q

Normal cytology but HPV positive:

After 12m repeat = neg =
If still + after 12m =
If +ve at 24m then =

A

Normal cytology - test repeated at 12m:
If now neg = normal recall
If still +ve then further repeat in 12m
If then finally neg at 24m = normal recall
But if +ve at 24m still then colposcopy

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12
Q

Inadequate sample from Smear - how many to colposcopy

A

Inadequate - repeat within 3m. If this (2 samples) inadequate then colposcopy

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13
Q

Inadequate sample from Smear - how many to colposcopy

A

Inadequate - repeat within 3m. If this (2 samples) inadequate then colposcopy

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14
Q

Endometrial cancer - what are the risk factors

A

DM, obesity, unopp oestrogen

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15
Q

Symptoms of ovarian cancer

A

bloating, early satiety, loss appetite, pelvic pain, mass

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16
Q

What does the risk of malignant index include in ovarian cancer

A

US findings, menopausal status, Ca125

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17
Q

Primary amenorrhoea - CAH vs AIS symptoms

A

primary:CAH ( increase androgens)- Female with facial hair/deep voiceAIS - F phenotype, mal genotype (testis in abdo)

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18
Q

Secondary amenorrhea - when to refer and the Ix results for Primary ovarian failure vs PCOS

A

3-6m or 6-12m (if irreg cycles).
↑FSH = primary ovarian failure
↑LH/↑LH:FSH = PCOS (dx is TV US-string of pearls)

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19
Q

PMS - how to diagnose and how to treat

A

Dx by GnRH to see if it helps. COCP- Yasmin

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20
Q

Stres sincontinence tx

A

When cough / sneeze

  1. Pelvic floor exercises
  2. Surgery/duloxetine
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21
Q

Urge incontinence

A

1.Bladder retraining
2.Oxybutynin

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22
Q

45-60 year old with vulval itch/skin changes

dx and mx

A

Lichen sclerosus
No cure
topical steroid and emollients

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23
Q

Heavy bleeding mx

A

Tranexamic acid (B), Mefanamic acid (Pain + B)
Or Mirena coil -> COCP -> cyclical progesterone
If secondary then refer gynae first

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24
Q

Fibroids Ix and Mx

A

Hysteroscopy or Pelvic US if larger
<3cm - same mx as heavy bleeding
If larger then GnRH/gynae referral

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25
Q

Contraception in Menopause

A

Post M= 12m after LMP
Contraception needed 2 years after LMP if <50 or 1Y if >50
Not the depot as >45 is weight gain and ↓BMD (osteoporosis)

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26
Q

HRT contraindications

A

current/past Breast Ca, any oestrogen sensitive Cancer, undiagnosed vaginal bleeding, untreated endometrial hyperplasia, ↑ risk stroke/VTE (oral HRT), CHD/Bca/ovarianCa

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27
Q

Diagnosis

Ovarian fibroma (benign), pleural effusion, ascites

A

Meig’s syndrome

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28
Q

What will a pelvic US show for ovarian torsion

A

Whirlpool sign

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29
Q

Unilateral Unilateral dull ache (intermittent/in intercourse).
If large may see abdo swelling
Ruptured - sudden onset unilateral pelvic pain precipitated by intercourse or strenuous activity

Diagnosis

A

Ovarian cyst

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30
Q

Endometriosis Tx

A

If not controlled by NSAIDs/COCP then GnRH analogues
surgery

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31
Q

When to ix infertility

A

Investigations/referral after 12m or 6m if >35
If semen sample is abnormal repeat in 3m

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32
Q

Clue cells, fishy, ph>4.5

dx/mx

A

BV
Metronidazole

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33
Q

Tx candidiasis

A

1st lien for non pregnant is oral fluconazole
If preg then crema or pessaries only

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34
Q

chlamydia ix and mx

A

Gram -ve
NAAT Dx
Doxycycline 100mg BD 7d (not in preg)

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35
Q

Gonorrhoea ix and Mx

A

Gram -ve diplococci
NAAT Dx
IM Ceftriaxone or if sensitivities known then PO Ciprofloxacin
Test of cure

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36
Q

Syphilis - organism, Mx

A

Treponema Pallidum - spirochete
Painless ulcers
Argyll Robertson pupil (accommodates but does not react to light) in neurosyphilis
Deep IM benzathine benzylpenicillin

Can have Jarish Herxheimer reaction to tx - fever/rash/tachy after 1st dose. Needs antipyretic’s like paracetamol, no tx

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37
Q

Mycoplasma genitalium mx

A

Swab/ 1st urine sample
Doxy then azizthromycin
Test of cure

38
Q

Cervical excitation, bilateral lower abdo pain associated with vaginal discharge, Dysuria
Peri-hepatic inflammation secondary to chlamydia (fitz Hugh Curtis) is RUQ discomfort and fever 38+

diagnosis

A

PID

39
Q

Fishy, alkaline, strawberry cervix

Dx, ix, mx

A

Trichomoniasis
Charcoal swab + microscopy
Metronidazole

40
Q

Ulcers/blisters, neuropathic type pain, flu like symptoms, dysuria, inguinal LNs

dx, mx

A

genital herpes

Viral PCR
Aciclovir

41
Q

After childbirth - the rules of fertility returning, breast feeding as contraception

A

Fertility returns >21 days.
Lactational amenorrhoea up to 6m if BF + amenorrhoeic

42
Q

What are the rules with IUS/IUD and cocp after birth

A

IUS/IUD - within 48hrs or >4weeks
COCP >6weeks if BF but do prgenancy test if uPSI from day 21 post partum

43
Q

MOA of COCP, the risks and contraindications

A

Inhibits ovulation
Increased risk breast Ca
Protective for endometrial and ovarian cancer
MEC3= BMI>35
MEC4-Migraine with aura, uncontrolled HTN + VTE

44
Q

When starting the COCP - when to have extra contraception

A

Start day 5+ or swapping from POP then extra contraception for 7 days except with desogestrel (no extra needed)

45
Q

Missing COCP and emergency contraception

A

If uPSI in delay time…
Missed pill = >24 hours. If missed over 72hrs and NOT taken 7d before straight then emergency contraception
If taken 7days prior then no emergency but barrier 7d after

46
Q

MOA POP, and the one UKMEC4 CI

A

thickens mucus (+ desogestrel inhibits ovulation)
UKMEC4 = breast cancer

47
Q

Delay times for POP

A

Traditional can delay 3hrs
Desogestrel can delay 12 hrs

48
Q

When to start POP and add contraception

A

When start - if not day 1-5 then add 48hrs

49
Q

emergency contraception and POP

A

If >3 />12 (as above) and had UPSI within that time of lateness

50
Q

Depo injection:
How often, MOA
UKMEC3s
S/E

A

Every 12-13 weeks
Inhibits ovulation and thickens mucus
UKMEC3 - IHD, UE vaginal bleeding, liver Ca
Ass with weight gain, and ↑ risk osteoporosis (so not to >45)
delays fertility

51
Q

depo injection - when to start and if extra contraception needed

A

If start after day 5 then need 7d extra contraception

52
Q

Contraceptive patch - hormones, when to change, when its delayed and if emergency needed

A

Combined
Change every week for 3 weeks then 1 week off
If >48hrs late swapping then extra contraception 7d and emergency contraception if >48 and UPSI in last 5d

53
Q

3 types emergency contraception

A

Levonorgestrel - <72hrs. 1.5mg single dose. Multiple in cycle. Start hormonal contraception immediately after
Ulipristal - <120hrs (Ella one) = Start hormonal C after 5d (use barrier), multiple in 1 cycle fine. Not in severe asthma
Copper IUD <5d or up to 5d after weekly ovulation date

54
Q

Implant MOA

A

Inhibits ovulation and thickens

55
Q

IUD MOA

A

↓ sperm motility and survival

56
Q

IUS MOA

A

Prevents endometrium proliferation and thickens mucus

57
Q

What happens to HCG every 48hrs in Ectopic pregnancy

A

Doubles every 48hours

58
Q

Management of Ectopic pregnancy and when each can be done

A

Expectant Mx if unruptured/no heartbeat/no pain. HCG<1000

Medicine with methotrexate (don’t get pregnant 3m after) - can have pain but not significant, unruptured, no heartbeat but allowed up to 35mm length. HCG <1500

Surgery - salpingectomy (pain/heart beat)

59
Q

Pt is pregnant but bleeding 1st/2nd Trimester, with exaggerated symptoms (hyperemesis, large dates)

What is the dx, what might happen to HCG, and IX findings

A

↑ HCG, ‘snow storm’ pelvic US
( ↓TSH, ↑ thyroxine)

60
Q

Dx miscarriage and Management

A

TV US

If recurrent - check antiphospholipid syndrome

Expectant + test 1-2w after
Medical - misoprostol (in Von Willebrand disease)
Surgery (aspiration)

61
Q

Dx N&V in pregnancy and first line medications

A

5% pre-pregnancy weight loss, dehydration, electrolyte imbalance
Prochlorperazine

62
Q

Abortion mx

A

Mifepristone
Misoprostol
Suction <14w/ evac (14-24 wk)

63
Q

Pregnant + COnstant lower abdo pain, may be more shocked than appears
Tender, tense uterus with Normal lie and presentation
Fetal heart may be distressed

Placental abruption

A

Placental abruption

Emergency steroids 24-35 weeks

64
Q

Pregnant + Vaginal bleeding, no pain
Non tender uterus but lie and presentation may be abnormal

Dx, Mx

A

Placenta Praevia

65
Q

Rupture membranes then immediate bleeding
Possible fetal bradycardia

Dx, Mx

A

If asymptomatic then elective 34-36 weeks
If symptoms then urgent C section

66
Q

Mx umbilical cord prolapse

A

Emergency
Can push presenting part fetus back into uterus
If cord is past introitus then minimal handling and keep warm and moist to avoid vasopasm
Pt on all fours or left lateral
Tocolytic can be used to reduce contractions
Retrofill bladder poss
C section usually first line but instrumental vaginal is poss if cervix fully dilated and head is low.

67
Q

When is anaemia screened in pregnancy and what are the thresholds for starting oral iron in 1st/2nd/3rd trimester

A

1st trimester start PO iron when <110
2nd T is <105
3rd trimester is <100

68
Q

When is booking apt

A

8-12 weeks

69
Q

AT how many weeks (apt) are dates confirmed in pregnancy

A

10 - 13+6

70
Q

When is the DS screening + translucency scan

A

11- 13+6

71
Q

When is anomaly scan

A

18-20+6

72
Q

Tx of UTI in pregnancy

A

7d Abx even if asymptomatic
Avoid nitrofurantoin 3rd trimester
(Amoxicillin after snesitivities)
Cefalexin

73
Q

The triad of Pre-Eclampsia and Mx

A

HTN, Proteinuria, Oedema
Aspirin 12+ weeks + Labetolol then after delivery - enalapril

74
Q

Dx Eclampsia, Mx and what to monitor with mx

A

Seizures >20 weeks
IV Mg SO4 - continue until >24hrs after last seizure or delivery
(monitor urine output, reflexes, RR, 02 sats
-> HELLP syndrome

75
Q

Folic acid def - what is the risk of this and what are the folic supplement doses in pregnancy

A

400 mcg till 12 weeks or
5mg if high risk (AED, BMI>30, history of NTD)

76
Q

When to screen for OGTT, the thresholds and management

A

Screen OGTT
If prev had then immediate OGTT and one at 24-28 weeks
If just have RFs then one at 24-28 weeks

FG>5.6
2 hours glucose >7.8

FG>7 = insulin started
FG <7 = diet + exercise-> metformin

77
Q

Jaundice in pregnancy - Intraheptic cholestasis pregnancy (features, Mx)

A

3rd Trimester, pruritis, no rash, -> bilirubin
Ursodeoxycholic acid, weekly LFTs + induced 37weeks as risk still birth

78
Q

Jaundice in pregnancy - Acute fatty liver - features, mx

A

Acute fatty liver = Abdo pain, N&V, headache, jaundice, hypoglycaemia, Severe-> eclampsia
↑ ALT, supportive care.
-> HELLP

79
Q

CPR rules whilst pregnant

A

15 deg tilt LHS and deliver <4m

80
Q

Shoulder dystocia caused…
Adduction and internal rotation arm - waiters tip

Dx?

A

Erbs palsy - damage to upper brachial plexus

81
Q

PPH Mx

ABCDE
Bimanual uterine compression
IV oxytocin +/- ergometrine
IM Carboprost
Intramyometrial carboprost
Surg - balloon catheter

A
82
Q

Cord prolapse mx

A

ABCDE
Bimanual uterine compression
IV oxytocin +/- ergometrine
IM Carboprost
Intramyometrial carboprost
Surg - balloon catheter

83
Q

Uterine rupture mx

A

Push back, hold + oxytocin
If fail - fill vagina with fluid and surgery if that fails

84
Q

Bishop score - what is this representing

A

Prior to induce labour
<5 = likely to need induction

85
Q

Placenta accreta - what is it

A

Placenta attach to myometrium and doesn’t properly separate in labour - PPH risk

accreta: chorionic villi attach to the myometrium, rather than being restricted within the decidua basalisincreta: chorionic villi invade into the myometriumpercreta: chorionic villi invade through the perimetrium

86
Q

GBS props

A

If history infection in prev baby etc
Benzyl penicillin in labour

87
Q

Proph and Mx of preterm labour

A

Prophylaxis = Vaginal progesterone (can get hyperstim) 16-24 weeks, cervical cerclage 16-28 (where dilation)

Tococlysis can stop contractions
Betamethasone if <36 wks (lung) + MgSO4 (<34wks) - brain

88
Q

Induction of labour options

A

41-42 weeks
Membrane sweep from 40 weeks
Vaginal PGE2 or cervical ripening balloon
Artificial rupture with oxytocin
IUFD - mifepristone + misoprotsol

89
Q

Carboprost MOA

A

Stimulate uterine contractions
PG analogues

90
Q

Oxytocin MOA

A

Stimulate ripening cervix, contract uterus and lactation role

91
Q

Nifedipine MOA

A

CCB to decrease smooth muscle contractions

92
Q

Terbutaline

A

B2 agonist - suppress ocntractions

Difficult Passmed- MLA (26 decks)

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