O&G Flashcards
STI with gram -ve diplococcus
Treatment?
Gonorrhoea!
Ceftriaxone IM (Hollie)
Thin frothy yellow/green vaginal discharge
‘Strawberry cervix’
Dx ?
Tx ?
Trichomonas vaginalis
Metronidazole
Pregnancy scans - when and what for? (X2)
11-14 weeks - dating
18-21weeks - anomaly scan
Test to detect neural tube defects if USS unable?
Amniocentesis for amniotic fluid a-protein (1% risk of foetus loss)
What tests are done for Down’s syndrome screening in pregnancy?
Combined test (11-13 weeks)
-nuchal translucency
-free B-hcg
-pregnancy associated plasma protein
If risk of baby with Down’s syndrome is >1:200, women is offered what:
If <13 weeks gestation?
>15 weeks gestation
<13 = chorionic villus sampling
>15 = amniocentesis
What is released in the
-anterior pituitary
-posterior pituitary?
-anterior -LH, FSH, GH, TSH, ACTH, prolactin (sexy stuff at the front!)
-posterior: oxytocin & ADH
Medication that can be started for hot flushes in menopause (other than HRT?)
SSRIs
Tender breast lump that varies in size with menstrual cycle - Dx?
Breast CYST
Pregnancy test becomes positive when?
9 days post conception
Absolute contraindications to COCP?
->35 years AND smoke >15 cigarettes/day
-migraine with aura
-Hx VTE or THROMBOGENIC MUTATION
-breast feeding <6 weeks postpartum
-uncontrolled HTN
-current breast cancer
-major surgery with prolonged immobilisation
-Positive antiphospholipid antibodies ie SLE
Painful blistering rash in 2-3rd trimester pregnancy - Dx?
Tx?
Pemphigoid gestationis
Oral steroids
Itchy red rash during 3rd trimester pregnancy that started in abdominal striae?
Polymorphic eruption of pregnancy
Acute haemolytic transfusion reaction - what are the symptoms
abdominal pain, hypotension, fever/chills, dark urine
How does Cubital tunnel syndrome present?
What is it caused by?
Numbness and tingling in 4th and 5th finger. Worse when leans on elbow
(Compression of ulnar nerve)
Young lady confirmed to have breast cyst. What is appropriate management?
Aspirate breast cyst
How do these breast lumps differ in presentation:
-fibroadenomas
-fat necrosis
-breast cysts
-breast cancer
Fibroadenomas - (women 2-3rd decade) discrete, firm, non-tender and highly mobile nodule
Fat necrosis - (large fatty breasts in obese women, usually after trauma) painless, skin around may look red/bruised/dimples
Breast cysts (peri-menopausal) - smooth discrete lumps, increase in size before period, decrease after it, and disappear after menopause
Breast cancer: hard, painless, irregular, fixed to chest wall, skin dimpling, discharge (may be bloody), nipple retraction
Risk factors for breast cancer?
Previous history / family history
Increasing age
Nulliparity/first child after 30
Not having breast-fed
Early menarche/late menopause
HRT
Chest radiation
Overweight after menopause
High ETOH
Management of acute fatty liver of pregnancy?
Rare life-threatening complication
PROMPT DELIVERY!
When does most nausea/vomiting of pregnancy generally resolve?
Most resolve spontaneously within 16-20 weeks gestation
Which are the 2 high-risk subtypes of HPV that account for the majority of cervical cancer?
HPV 16 and 18
Treatment of syphilis?
Penicillin
Treatment for listeria?
Amoxicillin plus gentamicin
Treatment for toxoplasmosis?
Spiramycin
How often is cervical screening and what ages?
Age 25-49: every 3 years
Age 50-64: every 5 years
What organism causes ‘chancroid’ - painful genital ulcers and tender initial lymphadenopathy (STI)?
Haemophilus ducreyi
(I DO CRY about my genital ulcers!)
What is best general advice to give to couples trying to conceive?
If they follow this advice, what are the statistics for likelihood to conceive?
Regular sexual intercourse (2-3x/week) throughout the woman’s cycle
84% will conceive within 1 year
92% will conceive within 2 years
How often and what ages for the UK breast screening programme?
3 yearly mammograms ages 50-70
What is the UK bowel screening programme?
-One off flexible sigmoidoscopy at 55 years
-home testing kit every 2 years for men and women ages 60-74
(People >74 can request one)
Who is targeted lung cancer screening for?
People aged 55-74 at high risk of lung cancer (ie smoking) - invited for low dose computed tomography scan
-reinvited for further scans every 2 years
What is adenomyosis?
Examination findings?
Treatment?
-Ectopic endometrial tissue within uterine myometrium
-‘boggy’ enlarged uterus, may be tender
-Definitive tx is hysterectomy (if family completed) otherwise NSAIDs, hormonal therapies, uterine artery embolisation
Causes of secondary amenorrhea (no Menses for consecutive 6 months)
-pregnancy / contraception!
-primary ovarian failure
-weight loss
-pituitary disease and hyperprolactinaemia
-cervical stenosis & intrauterine adhesions (ie Asherman’s syndrome)
-Sheehan’s syndrome (damaged pituitary ie from trauma/tumours etc)
Blood tests to investigate secondary amenorrhea?
-hCG
-LH, FSH, gonadotrophin
-TFTs
-Prolactin, oestradiol, testosterone
-pelvic USS
In secondary amenorrhoea :
What does low oestrogen, but increased FSH and LH suggest?
What does low oestrogen but DECREASED FSH and LH suggest?
-Primary ovarian problem
-Problem at hypothalamic or pituitary level
When to advise to take folic acid in normal pregnancy and how much?
400 micrograms OD before conception for first 12 weeks
What is the most common hormone-secreting pituitary tumour?
How do they present?
Prolactinoma
-oligomenorrhoea/amenorrhoea
-infertility
-galactorrhoea
Risks of smoking (pre-pregnancy counselling)?
Reduction in ovulations
Abnormal sperm production
2x rates of miscarriage
Preterm labour
Light-for-dates babies
Reduced reading ability up to 11 y/o
Initial investigations in women struggling to conceive (after 1 year)?
-Mid-luteal cycle progesterone (ONE WEEK BEFORE PERIOD EXPECTED - READ QUESTION CAREFULLY AS DEPENDS ON LENGTH OF CYCLE - ie day 21 if 28 day cycle, but day 28 of 35 day cycle!)
-FSH and LH
-TFTs
-Prolactin
-Check for chlamydia
First like Tx for stress incontinence?
Pelvic floor muscle training
How does COCP work?
Prevention of ovulation (acts on hypothalamo-pituitary-ovarian axis to suppress LH and FSH)
(Also changes to cervical mucous, endometrium and tubal motility)
How do POPs work?
-increase volume and viscosity of cervical mucous
-Suppress ovulation
-Endometrial changes
-Reduction in cilia activity -slow passage of ovum
How does copper IUD work? When does it start working?
Effective immediately following insertion
TOXIC effect of copper on ovum/sperm
Changes to cervical mucous
(For emergency contraception) - endometrial inflammatory reaction has anti-implantation effect
How do intrauterine levonorgestrel-releasing intrauterine systems ie Mirena work?
Changes to cervical mucous
Endometrial changes (atrophy)
(Foreign body effect)
How does emergency contraception Ulipristal acetate work?
Delays ovulation for at least 5 days (until sperm no longer viable)
How does levonorgestrel as emergency contraception work?
Delays ovulation - prevents follicular rupture and causes luteal dysfunction
Etonogestrel implant - how does it work?
Prevention of ovulation
Progestogen-only injectable - how does it work?
Inhibiting ovulation
Effects on cervical mucous
Endometrial changes
Pharmacological Treatment for fibroids?
-NSAIDs
-Antifibronolytic agents ie TXA
-Combined hormone contraception
-LNG-IUS (Mirena)
-GnRH agonists
-Ryeqo (relugolix with Estrada and norethisterone)
-Ullipristal acetate (only for severe, due to risk of liver failure!)
If taking phenytoin for epilepsy, which contraceptives to avoid?
COCP (interferes with oestrogen)
POP (however progesterone only injection is ok!)
Cardio respiratory changes in pregnancy?
-Increased cardiac output (increased stroke volume and heart rate)
-Blood pressure LOWERS in first 2 trimesters then returns to normal
-Bounding/collapsing pulse
-3rd HS from mid pregnancy (systolic murmurs are common)
Resp:
-Increased tidal volume
-increased oxygen consumption
(NB no increase in Resp rate!)
Morning after pill - up to what period following UPSI is levonorgestrel licensed for use?
72 hours
