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O+G Flashcards

1
Q

Primary amenorrhoea

A

No periods by age 16

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2
Q

Secondary amenorrhoea

A

Periods stop for 6 moths or more

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3
Q

Precocious puberty

A

Menstruation before age 10 or Secondary sex characteristics before age 8

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4
Q

McCune-Albright

A

Precocious puberty, cafe-au-lait spots and bone+ovarian cysts (fibrous dysplasia)

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5
Q

Endometrial Ca staging

A

Stage 1= Confined to uterus (A=less than 50%, B=>50%)
Stage 2= Cervical invasion
Stage 3= Invasion through uterus
Stage 4= Distant spread (A= bowel or bladder, B=further)

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6
Q

Nabothian follicle

A

Squamous epithelium (metaplasia) over columnar endocervix -> cysts (i.e reverse ectropion)

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7
Q

Ectropion

A

Metaplasia of squamous to columnar

Sx: contact bleed, PCB + cervical excitation

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8
Q

CIN staging

A 
CIN1= mild dyskaryosis - lower 1/3 of epithelium
CIN2= Mod dyskaryosis - 2/3 epithelium
CIN3= Dyskaryosis throughout epithelium= Ca in situ
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9
Q

UK smear programme dates

A

Age 25-49: every 3 years
Age 50-64: every 5 years
Age 65+: only if recent abnormal or no smear since 50

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10
Q

UK smear programme triage

A

Inadequate: repeat w/i 3 months + Tx any infection
Borderline + Mild: HPV triage, +ve colposcopy, -ve routine recall
Moderate+ Severe: Colposcopy

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11
Q

Colposcopy results

A

CIN1: 6 monthly f/u
CIN2: LLETZ + HPV test of cure
CIN3: LLETZ + HPV test of cure

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12
Q

Cervical Ca Staging

A 
1= confined to cervix
2= Invasion into vagina but not pelvic side wall
3= Invasion of lower vagina or pelvic side wall -> ureteric obstruction
4= Invasion into bladder or rectal mucosa or beyond true pelvis
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13
Q

Cervcial Ca Tx

A 
Stage 1a(i)= Cone Bx
Stage 1 (other)= Surgery vs chemoradiotherapy
Stage 2b+= Chemoradiotherapy
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14
Q

PCOS Tx

A

Maintain low weight
COCP (if not trying to get preg. w/3-4 bleeds pa)
Clomifene (if trying to get pregnant)
Metformin (insulin + Clomifene sensitiser)
Lap + Dye

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15
Q

Brenner tumours

A

Small benign + rare epithelial Ovarian tumours

Urothelium-like

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16
Q

Granulosa cell tumour

A

Secrete oestrogen

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17
Q

Thecoma

A

Secrete oestrogen + androgen

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18
Q

Krukenberg tumours

A

Mets to ovary from gastric primary Ca

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19
Q

Hydatidiform mole Histo+ USS

A

Mixture of large + small villi w/ scalloped outline + trophoblastic hyperplasia
Snowstorm appearance on USS

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20
Q

ChorioCa Histo

A

Closely related syncytiotrophoblasts + cytotrophoblasts w/ eosinophils

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21
Q

Dysgerminoma

A

Lobular cells w/ fibrous stromal cells w/ lymphocytic invasion

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22
Q

Combined test

A

Nuchal translucency (11-13+6/40 scan)
BhCG
PPA
>1 in 150= high risk -> amnio or CVS

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23
Q

Triple test

A

15-20/40
Unconj estriol
AFP
BhCG

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24
Q

Quad test

A 
15-20/40
Unconj estriol
AFP
BhCG
Inhibin A
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25
Q

Amniocentesis

A

Only after 15/40

Less chance of miscarriage + can analyse infection

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26
Q

CVS

A

After 11/40

1% chance of miscarriage

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27
Q

ToP Law

A
  1. Risk of death of mother > termination
  2. Prevent grave permanent injury to physical or mental health of mother
  3. Not >24/40 + risk of physical + mental harm to mother or existing children > continuing
  4. Substantial risk of mental or physical disability to unborn
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28
Q

PIH

A

BP> 140/90 after 20/40

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29
Q

Pre-eclampsia

A

PIH + Proteinuria >0.3g/24h after 20/40

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30
Q

HELLP

A

Haemolysis
Elevated Liver Ezs
Low Platelets
Indication for emergency delivery

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31
Q

Mx of Pre-eclampsia/HELLP

A

Mild: Admit for observation + monitoring, induce after 34/40
Severe (>160/110 on 2 occasions 6h apart, proteinuria 3+ on 2 dips, HELLP, IUGR): Induce after 34/40, Hydrazine, Nifedipine, Labetolol + careful fluid Mx

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32
Q

Gest DM Dx

A

Fasting Glu >5.6

GTT >7.8

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33
Q

Gest DM Targets

A

Fasting less than 5.3
1hr post prandial less than 7.8 OR
2hr post prandial less than 6.4

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34
Q

Gest DM Mx

A

Fasting less than 7: Lifestyle then Metformin if no improvement in 2/52
Fasting >7: Insulin +/- Metformin

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35
Q

Gest DM ANC

A

Fortnightly visit up to 34/40
Weekly visits thereafter
Elective induction at 37-38+6/40
Aspirin 75mg from 12/40

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36
Q

SFD

A

Weight less than 10th centile (2.7kg at term)

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37
Q

IUGR

A

Falling off centiles

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38
Q

Rate of dilatation

A

> 1cm/h in nullip, >1.5cm/h in multip

39
Q

Perineal tears

A 
1st degree: minor damage to forchette
2nd degree: Perineal muscle involved
3rd degree: anal sphincter involved
3a: less than 50%EAS
3b: >50% EAS
3c: EAS + IAS
4th degree: anal mucosa involved
40
Q

Bishop’s score

A 
Position (0-2)
Consistency (0-2)
Effacement (0-3)
Dilatation (0-3)
Foetal station (0-3)
41
Q

Primary PPH def

A

> 500ml blood loss

Prevent at risk w/ Syntometrine IM (CI if HTN)

42
Q

Primary PPH Mx

A

IV fluid, Oxytocin + uterine massage
2nd line: ergometrine + bimanual compression
3rd line: IU balloon + intramyometrial uterotonics

43
Q

Secondary PPH

A

Excessive blood loss 24h-6wks post partum

44
Q

Booking infection screen

A

Syphilis, HIV, Hep B, Rubella

45
Q

Placenta accreta

A

Firm adhesion of placenta to uterine wall w/o invasion through myometrium

46
Q

Placenta increta

A

Invasion through full myometrium

47
Q

Placenta percreta

A

Invasion beyond myometrium e.g. bladder

48
Q

Mx of PPROM

A

Admit
10 ABx prophylaxis
Steroids if

49
Q

Warfarin syndrome

A

Nasal hypoplasia, vertebral calcinosis, brachydactyly

50
Q

Preferred anticoag in pregnancy

A

Enoxaparin

51
Q

Placental abruption

A

Painful vaginal bleed

52
Q

Placenta praevia

A

Painless vaginal bleed

53
Q

APH Mx

A 
Admit unless only spotting (ceased) + prevue excluded
Steroids if 24-34+6/40
Tocolysis NOT indicated
Anti D if Rh-ve
X match 4 units if ongoing bleed
Foetal compromise -> C section
54
Q

HSV primary infection

A

C section if w/i 6 weeks of term

55
Q

Obstetric cholestasis Mx

A

Induce at 37-38/40 due to risk of stillbirth

56
Q

PUPP

A

Rash on abdo + spreading w/ periumbilical sparing

After 34/40

57
Q

Prurigo gestationis

A

Rash of limbs + trunk, sparing abdo

58
Q

ToP types

A

Surgical after 7 weeks

Medical up to 9 weeks (Methotrexate)

59
Q

Methotrexate for ectopic criteria

A

Small ectopic
No foetal pulse
No clinical compromise
No free fluid in pouch

60
Q

Foetal heart beat 1st appears at

A

5-6/40

61
Q

Foetal heat 1st heard on doppler at

A

8-9/40

62
Q

PID Tx

A

IM Ceftriaxone, Oral Doxycyline + Metronidazole
Severe or Septic: IC Cef+ Doxy
Pregnant: IV Oflox + Met

63
Q

HRT risks

A

Stroke
Breast + Ovarian Ca
Endometrial Ca (give constant or cyclical progestogen)
VTE (highest in 1st year, stops after stopping)

64
Q

Elleste solo

A

Estradiol

65
Q

Elleste duet + Evorel

A

Estradiol + Norethisterone

66
Q

Vagifem

A

Topical oestrogen for vagina

67
Q

C section risk

A 
Damage to bladder 1 in 1000
VTE 4-16 in 10000
Haemorrhage 5 in 100
Hysterectomy 8 in 1000
Death 1 in 12000
68
Q

Triptorelin

A

GnRH agonist used in endometriosis

69
Q

Danazol

A

Antieostrogen + anti progesterone used in endometriosis

70
Q

Endometriosis Tx

A 
Mefenamic acid (NSAID) for pain
COCP (if not trying to conceive) for 3-6/12
If doesn't want contraception give Oral progestogen
Failure: GnRH agonists + add back HRT (if >6/12), Androgens (rare), Surgery
71
Q

HMB Tx

A

1st line: Mirena
2nd line: Tranexamic acid +/or Mefenamic
Failure: Hysterectomy

72
Q

PMS Tx:

A

SSRIs
Vit B6, improved diet + exercise
CBT
Yasmin or Cileste

73
Q

Non reassuring CTG

A

BR 161-180 or 100-109
Variability less than 5bpm for 40-90min
Decels w/ over 50% of contractions for 90mins or single prolonged less than 3mins

74
Q

Pathological CTG

A

BR> 180 or less than 100
Variability less than 5bpm for >90 mins
Late decels or single prolonged decel > 3mins

75
Q

Cord Prolapse Mx

A

Elevate presenting part

Deliver immediately: Assisted or C section

76
Q

Induction

A

Vaginal PGE2 NOT oral/IV

CCTG monitoring

77
Q

Augmentation

A

Oxytocin

78
Q

Induction for IU death

A

Mifepristone for cervical ripening

Misoprostol to initiate contractions

79
Q

Toxo infection

A

Chorioretinitis, hydrocephalus + convulsions

80
Q

CMV infection

A

Chorioretinitis, Microcephaly + Hearing+visual loss

81
Q

Cord Prolapse Mx

A

Elevate presenting part

Deliver immediately: Assisted or C section

82
Q

Induction

A

Vaginal PGE2 NOT oral/IV

CCTG monitoring

83
Q

Augmentation

A

Oxytocin

84
Q

Induction for IU death

A

Mifepristone for cervical ripening

Misoprostol to initiate contractions

85
Q

Subfertility Ix

A 
Day 1-3 FSH+LH
Mid luteal phase progesterone
USS
HSG
Semen analysis
86
Q

CMV infection

A

Chorioretinitis, Microcephaly + Hearing+visual loss

87
Q

COCP risks

A 
Cervical Ca (w/ prolonged use >8 years)
Lowers risk of Breast, Bowel + Ovarian Ca
Overall 12% Ca reduction
88
Q

IVF risks

A 
LBW
Congenital abnormalities
Ectopic
Multiple pregnancy + therefore pre-eclampsia
SGA
PIH (if donor egg)
89
Q

Emergency Contraception

A

CU IUD up to 5 days post UPSI
Ulipristal up to 5 days post UPSI
Levonorgesterol 1.5mg w/i 72 hours of UPSI

90
Q

Asherman’s syndrome

A

IU scar tissue after surgery causing subfertility

91
Q

Subfertility Ix

A 
Day 1-3 FSH+LH
Mid luteal phase progesterone
USS
HSG
Semen analysis
92
Q

Semen analysis

A 
>50% normal motility
>4% normal morpholoy
Volume >1.5ml
pH 7.2-8
>15million/ml
93
Q

Rokitansky’s

A

Mullerian agenesis causes lack of uterus + fallopian tubes but normal ovaries and function

94
Q

C section categories

A

Cat 1: immediate threat to life
Cat 2: Distress/prolonged
Cat 3: No foetal-maternal compromise but need for early delivery
Cat 4: Elective

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