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UCPEX > O+G > Flashcards

O+G Flashcards

1
Q

Endometriosis risk factors

A

Nulliparty/late childbearing
Early menarche
Delayed menopause
Hydrocolpos
First degree relative with endo
White
Smoking
Low BMI

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2
Q

Endometriosis symptoms and signs

A

Dysmenorrhoea
Dysparaeunia
Subfertility
Chronic or cyclical pelvic pain
Bloating
Lethargy
Dyschezia
Constipation
Low back pain
Dysuria (2/3 have interstitial cystitis)

Exam likely normal but also:
Tenderness or nodules/masses in adnexae/posterior fornix
Bluish haemorrhagic nodules in the posterior fornix
Decreased uterine mobility - may be fixed and/or retroverted
Uterine enlargement

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3
Q

Endometriosis management

A

TXA for heavy bleeding
Suppression of ovulation for at least 6/12 via:
-POP (1st line)
-COCP (2nd line)
-IUD
-GnRH agonist (gosrelin)
Laparoscopic surgical Tx

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4
Q

Endometriosis complications

A

Sub-fertility/infertility
Adhesions
Inflammatory bowel disease
Ectopic pregnancy risk is greater
?Ovarian cancer

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5
Q

Ectopic pregnancy risk factors/at risk groups

A

Previous ectopic pregnancy
Previous tubal surgery or pathology
PID
Smoking
Current or previous IUD use
IVF

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6
Q

Indication for USS or endometrial biopsy in anovulatory bleeding. (Risk of cancer or hyperplasia)

A

<35yo and at least one of:
-chronic anovulation for 2-3 years
-diabetes
-FHx colon cancer
-infertility
-nulliparity
-obesity
-tamoxifen
Adolescent, obese, years of anov bleeding
>35, esp if obese
Not responding to medical therapy

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7
Q

Causes of chronic anovulation

A

Thyroid disorders
DM
PCOS (6-10)
Hyperprolactinaemia
Eating disorders
Some antipsychotics or antiepileptics (they cause raised prolactin)

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8
Q

Menorrhagia causes

A

50% unknown
Coagulopathy (von Willebrands #1)
Thyroid dysfunction (hypo)
Fibroids
Endometrial polyps
Liver disease

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9
Q

Menorrhagia treatment

A

POP
NSAIDs
TXA
Mirena
Endometrial ablation/polypectomy/ embolization/fibroidectomy

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10
Q

Menorrhagia investigation indications

A

HCG, CBC, TSH
Coag screen if:
-flooding
->7 days of bleeding
-FHx bleeding disorder
-hx tx for anaemia
-hx of excessive bleeding
USS to assess for structural abnormality
Endometrial biopsy if not responding to treatment or risk factors for cancer and >35yo

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11
Q

Excessive menstrual bleeding definition

A

Changing pads every 1-2 hours
Clots bigger than 1 inch
“very heavy” bleeding reported by patient

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12
Q

Anovulatory bleeding - treatment

A

COCP
POP

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12
Q

Early pregnancy bleeding causes

A

Miscarriage - 10-20%
Ectopic pregnancy - 1-2%
Endometrial implantation
Gestational trophoblastic disease (rare)
Cervical and vaginal lesions (rare)

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12
Q

Anovulatory bleeding definition

A

Irregular or infrequent periods
Flow ranging from low to heavy
Includes:
-amenorrhoea (no periods for 3 cycles or more)
-oligomenorrhoea (occurs at periods of >35 days)
-metroragghia (irregular intervals and periods lasting >7 days)

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12
Q

Late pregnancy bleeding causes

A

Placental previa. Incidental finding in 2nd trimester, resolves in 90%
Placental abruption - 1% of pregnancies. #1 cause of serious PV bleeding in pregnancy. Fatal mortality 10-30%. 50% <36 weeks
Vasa previa - rare but up to 100% mortality as can cause foetal exsanguination

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12
Q

Normal HCG rise

A

66% every 48 hours
(ectopic can mimic this in up to 20% of cases)

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12
Q

Late pregnancy bleeding management

A

Placenta previa - avoid PV digital exam as may exacerbate bleeding. Speculum is ok. Bedrest from 3rd trimester if sig bleed. Steroids. Avoid sex and tampons
Abruption - may require prompt delivery

13
Q

Risk factors for placenta previa

A

Multiparty
Tobacco smoking
Uterine curettage
Previous caesarian
Multiple gestations
Older age
Chronic HTN

14
Q

Risk factors for placental abruption

A

Pre-eclampsia
Chronic HTN
Multiparty
Maternal cocaine, tobacco or methamphetamine use
Previous abruption
Trauma/sudden deceleration injury
Uterine fibroids
Thrombophilias
Short umbilical cord

15
Q

Vasa previa risk factors

A

Low-lying and 2nd trimester placenta previa
IVF
Multiple gestation
Marginal cord insertion

16
Q

Abruption - presentation

A

Vaginal bleeding
Uterine/fundal pain
Back pain
Foetal distress
IUGR/pretem labour/feotal death may occur
DIC (10%)

17
Q

PPH definition and management

A

Minor = 500-1000ml <24 hrs post delivery
Major = >1000ml

IVL x2 large bore
Examine vagina looking for lacerations (more likely in absence of atony) or uterine inversion
Assess for uterine atony - if present give 10 units oxytocin IV and perform bimanual massage

If major PPH commence warmed IVF
-up to 3.5L then move to blood
-after 4 units blood give FFP
-keep fibrinogen >2g/L by use of cryoprecipitate
-TXA
-platelets if <75

18
Q

Hyperemesis gravidarum facts

A

1% of pregnancies
Starts week 4
Peaks week 9
90% resolved by 16-20 weeks
Unlikely if begins after 12 weeks
More likely in Pacific women (?H. pylori ?thyroid)

19
Q

Hyperemesis gravidarum treatment

A

Small meals, low in fat, high in carbs
Acupressure
Lie down for nausea
Frequent small volumes fluid PO
Avoid getting hungry
Check ketones
Metoclopramide
Cyclizine
Prochloperazine
Promethazine
Ondansetron last-line
If severe consider thiamine and omeprazole and referral
Consider underlying H. pylori infection and hyperthyroidism

20
Q

Pre-eclampsia definition

A

3-8% of pregnancies in NZ
New HTN after 20 weeks AND:
-proteinuria (+/- oedema)
-LFT dysfunction
-renal impairment
-haematological dysfunction eg low platelets, haemolysis
-neurological dysfunction eg headaches, flashing lights, clonus
-maternal organ dysfunction

21
Q

Pre-eclampsia risk factors

A

Major:
Existing HTN
Diabetes
Personal history of pre-eclampsia
FHx pre-eclampsia
SLE or antiphospholipid syndrome
Oocyte donation

Minor:
BMI >35
Age >40
African, Indian, Maori or PI
Primip
Multiple pregnancy
Change in partner
Sperm donation
FHx PET on fathers side

22
Q

PET features (hx, exam)

A

Pregnancy >20 weeks AND any of:
-new oedema
-severe headache
-visual sx eg scotoma
-chest pain
-SOB
-vomiting
-upper abdominal pain esp RUQ
-reduced urine output
-reduced foetal movements

Exam
-HTN - 140/90, severe if 160/110
-hyperreflexia
-abdominal tenderness
-oedema

23
Q

PET treatment

A

Refer to hospital, do not do bloods
Control BP with nifedipine, labetalol, hydralazine
Magnesium sulphate

24
Q

Emergency contraception: how to

A

Check date of LMP and calculate date of likely ovulation
Check timing of UPSI
Consider possibility of non-consensual sexual activity
Consider pregnancy test
Consider STI test
Consider whether ECP or IUCD (copper only)
ECP:
1.5mg levonorgestrel single dose
Check no contraindications eg VTE hx, active breast cancer
Higher risk of failure in:
-UPSI close to ovulation
-subsequent UPSI in same cycle
-missed first week of COCP
-weight >70kgv(consider double dose)
-increased time since UPSI (12 hours ideal, 72-96 is limit
IUCD can be used up to 120 hours post UPSI, is most effective. Use ECP while organising

25
Q

Urethral discharge treatment

A

Azithromycin 1g stat or doxy 1/52
If purulent add ceftriaxone

26
Q

Patient advice and FU post PID

A

Use condoms for 14 days post treatment and 7 days post partner treatment
3/12 partner tracing
Repeat bimanual in 3/7 - if still sore refer to O&G
Repeat STI check in 3/12

27
Q

HSV facts

A

20% of carriers will have no lesions
Transfer can occur without lesions but 100-1000x more likely with lesions
Fomite transfer highly unlikely as virus
does not survive at room temperature
Lesions last 4-15 days
Recurrences can be triggered by:
-sunlight
-stress
-minor trauma
-pre-menstrual

Complications include:
-urethritis
-proctitis
-neurogenic -leg and thigh pain
-meningitis
-widespread if immunocompromised

28
Q

HSV treatment

A

Initial presentation:
-7-10/7 valaciclovir
Recurrence can be either episodic if not severe symptoms or suppressive if severe or frequent symptoms
Refer if herpes proctitis or pregnant

29
Q

HSV patient advice

A

Partner infection does not necessarily indicate infidelity
Use salt washes
Dilute urine by drinking more
Pee in bath/shower
Topical anaesthetic - may sting initially
No cancer risk
Avoid sex until lesions healed
Printed information

30
Q

HPV facts

A

Long latency
75% of population affected
Pain, bleeding and itch common sx
Self-treatment with podophyllotoxin or imiquimod.
Clinic treatment with cryotherapy

31
Q

HPV need for referral

A

Pregnant
Extensive
Cervical
Immunosuppressed/HIV
Diabetes
Intra-urethral
Treatment failure

32
Q

Primary syphilis features

A

50% asymptomatic
Incubation 10-90 days
Chancre, not always painless, not always solitary
30% multiple lesions
Inguinal LN

33
Q

Secondary syphilis features

A

2-24 weeks latency
90% involve skin changes
-usually trunk but can be palms and soles
-can be confused with guttate psoriasis or pityriasis rosea
-alopecia
-condylomata lata
-neurological signs
Some constitutional sx

34
Q

Tertiary syphilis

A

Gumma
Aortitis
Neuro sx: paraesthesia, ataxia, dementia, deafness, visual impairment

35
Q

Chlamydia treatment

A

Doxycycline first line as better at treating rectal chlamydia (which is asymptomatic in 90% of women)
Azithromycin second line for those unlikely to take full course. Also contributes to resistance

UCPEX (28 decks)

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