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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
Contraception in Menopause
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)
26
HRT contraindications
current/past Breast Ca, any oestrogen sensitive Cancer, undiagnosed vaginal bleeding, untreated endometrial hyperplasia, ↑ risk stroke/VTE (oral HRT), CHD/Bca/ovarianCa
27
Diagnosis Ovarian fibroma (benign), pleural effusion, ascites
Meig's syndrome
28
What will a pelvic US show for ovarian torsion
Whirlpool sign
29
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
Ovarian cyst
30
Endometriosis Tx
If not controlled by NSAIDs/COCP then GnRH analogues surgery
31
When to ix infertility
Investigations/referral after 12m or 6m if >35 If semen sample is abnormal repeat in 3m
32
Clue cells, fishy, ph>4.5 dx/mx
BV Metronidazole
33
Tx candidiasis
1st lien for non pregnant is oral fluconazole If preg then crema or pessaries only
34
chlamydia ix and mx
Gram -ve NAAT Dx Doxycycline 100mg BD 7d (not in preg)
35
Gonorrhoea ix and Mx
Gram -ve diplococci NAAT Dx IM Ceftriaxone or if sensitivities known then PO Ciprofloxacin Test of cure
36
Syphilis - organism, Mx
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
37
Mycoplasma genitalium mx
Swab/ 1st urine sample Doxy then azizthromycin Test of cure
38
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
PID
39
Fishy, alkaline, strawberry cervix Dx, ix, mx
Trichomoniasis Charcoal swab + microscopy Metronidazole
40
Ulcers/blisters, neuropathic type pain, flu like symptoms, dysuria, inguinal LNs dx, mx
genital herpes Viral PCR Aciclovir
41
After childbirth - the rules of fertility returning, breast feeding as contraception
Fertility returns >21 days. Lactational amenorrhoea up to 6m if BF + amenorrhoeic
42
What are the rules with IUS/IUD and cocp after birth
IUS/IUD - within 48hrs or >4weeks COCP >6weeks if BF but do prgenancy test if uPSI from day 21 post partum
43
MOA of COCP, the risks and contraindications
Inhibits ovulation Increased risk breast Ca Protective for endometrial and ovarian cancer MEC3= BMI>35 MEC4-Migraine with aura, uncontrolled HTN + VTE
44
When starting the COCP - when to have extra contraception
Start day 5+ or swapping from POP then extra contraception for 7 days except with desogestrel (no extra needed)
45
Missing COCP and emergency contraception
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
MOA POP, and the one UKMEC4 CI
thickens mucus (+ desogestrel inhibits ovulation) UKMEC4 = breast cancer
47
Delay times for POP
Traditional can delay 3hrs Desogestrel can delay 12 hrs
48
When to start POP and add contraception
When start - if not day 1-5 then add 48hrs
49
emergency contraception and POP
If >3 />12 (as above) and had UPSI within that time of lateness
50
Depo injection: How often, MOA UKMEC3s S/E
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
depo injection - when to start and if extra contraception needed
If start after day 5 then need 7d extra contraception
52
Contraceptive patch - hormones, when to change, when its delayed and if emergency needed
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
3 types emergency contraception
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
Implant MOA
Inhibits ovulation and thickens
55
IUD MOA
↓ sperm motility and survival
56
IUS MOA
Prevents endometrium proliferation and thickens mucus
57
What happens to HCG every 48hrs in Ectopic pregnancy
Doubles every 48hours
58
Management of Ectopic pregnancy and when each can be done
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
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
↑ HCG, ‘snow storm’ pelvic US ( ↓TSH, ↑ thyroxine)
60
Dx miscarriage and Management
TV US If recurrent - check antiphospholipid syndrome Expectant + test 1-2w after Medical - misoprostol (in Von Willebrand disease) Surgery (aspiration)
61
Dx N&V in pregnancy and first line medications
5% pre-pregnancy weight loss, dehydration, electrolyte imbalance Prochlorperazine
62
Abortion mx
Mifepristone Misoprostol Suction <14w/ evac (14-24 wk)
63
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
Placental abruption Emergency steroids 24-35 weeks
64
Pregnant + Vaginal bleeding, no pain Non tender uterus but lie and presentation may be abnormal Dx, Mx
Placenta Praevia
65
Rupture membranes then immediate bleeding Possible fetal bradycardia Dx, Mx
If asymptomatic then elective 34-36 weeks If symptoms then urgent C section
66
Mx umbilical cord prolapse
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
When is anaemia screened in pregnancy and what are the thresholds for starting oral iron in 1st/2nd/3rd trimester
1st trimester start PO iron when <110 2nd T is <105 3rd trimester is <100
68
When is booking apt
8-12 weeks
69
AT how many weeks (apt) are dates confirmed in pregnancy
10 - 13+6
70
When is the DS screening + translucency scan
11- 13+6
71
When is anomaly scan
18-20+6
72
Tx of UTI in pregnancy
7d Abx even if asymptomatic Avoid nitrofurantoin 3rd trimester (Amoxicillin after snesitivities) Cefalexin
73
The triad of Pre-Eclampsia and Mx
HTN, Proteinuria, Oedema Aspirin 12+ weeks + Labetolol then after delivery - enalapril
74
Dx Eclampsia, Mx and what to monitor with mx
Seizures >20 weeks IV Mg SO4 - continue until >24hrs after last seizure or delivery (monitor urine output, reflexes, RR, 02 sats -> HELLP syndrome
75
Folic acid def - what is the risk of this and what are the folic supplement doses in pregnancy
400 mcg till 12 weeks or 5mg if high risk (AED, BMI>30, history of NTD)
76
When to screen for OGTT, the thresholds and management
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
Jaundice in pregnancy - Intraheptic cholestasis pregnancy (features, Mx)
3rd Trimester, pruritis, no rash, -> bilirubin Ursodeoxycholic acid, weekly LFTs + induced 37weeks as risk still birth
78
Jaundice in pregnancy - Acute fatty liver - features, mx
Acute fatty liver = Abdo pain, N&V, headache, jaundice, hypoglycaemia, Severe-> eclampsia ↑ ALT, supportive care. -> HELLP
79
CPR rules whilst pregnant
15 deg tilt LHS and deliver <4m
80
Shoulder dystocia caused... Adduction and internal rotation arm - waiters tip Dx?
Erbs palsy - damage to upper brachial plexus
81
PPH Mx ABCDE Bimanual uterine compression IV oxytocin +/- ergometrine IM Carboprost Intramyometrial carboprost Surg - balloon catheter
82
Cord prolapse mx
ABCDE Bimanual uterine compression IV oxytocin +/- ergometrine IM Carboprost Intramyometrial carboprost Surg - balloon catheter
83
Uterine rupture mx
Push back, hold + oxytocin If fail - fill vagina with fluid and surgery if that fails
84
Bishop score - what is this representing
Prior to induce labour <5 = likely to need induction
85
Placenta accreta - what is it
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
GBS props
If history infection in prev baby etc Benzyl penicillin in labour
87
Proph and Mx of preterm labour
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
Induction of labour options
41-42 weeks Membrane sweep from 40 weeks Vaginal PGE2 or cervical ripening balloon Artificial rupture with oxytocin IUFD - mifepristone + misoprotsol
89
Carboprost MOA
Stimulate uterine contractions PG analogues
90
Oxytocin MOA
Stimulate ripening cervix, contract uterus and lactation role
91
Nifedipine MOA
CCB to decrease smooth muscle contractions
92
Terbutaline
B2 agonist - suppress ocntractions

Difficult Passmed- MLA (26 decks)

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