O&G Flashcards
Hirsitiusm, oligo/amenorrheoa, raised androgens - what would be DDx?
PCOS** (Rotterdam criteria)
Late onset congenital adrenal hyperplasia (lack of cotisol and aldosterone but lots of androgens giving PCOS like symptoms due to lack of 21–hydroxylase deficiency - check serum 17-hydroxyprogesterone levels to see if raised)
What is an absolute contraindication of COCP and what does it increase the risk of?
Name six other absolute contraindications
Migraine with aura - increases risk of haemorragic stroke
Previous DVTs
Previous Breast Cancer (current or within 5 years)
Ischaemic heart disease
Uncontrolled HTN (>160 systolic, >110 diastolic)
Major surgery with prolonged immobilisation (especially ortho/genera - COCP should be stopped 4-6 weeks before surgery)
Levonorgestrel Intrauterine System - how does it work, how long for?
Thins endometrial lining - ovum unable to implant
Thickens cervical mucus - sperm unable to enter
3-5 years for
Risks of IUS and its insertion
Small risk of uterine rupture
increased risk of ectopic pregnancy
increased risk of pelvic inflammatory disease
icreased risk of infection with Actinomyces organisms
Benefits of IUS
Lighter bleeding (may take up to 6 months for this to settle) - good for patients with menorragia Long term contraception (3-5 years) with immediate reversal of its effects
What is inhibin and where is it secretes
Hormone produced by Sertoli cells in men and Granulosa cells in women that blocks the seretion of FSH
Mastitis treatment recommendation
Analgesia, continue to breast feed, if there is infection/fissure in nipple treat with fluclox
Gestational trophoblastic disease is likely to metastatise/have complications where?
Metastatise to lung and cause thryoid dysfunction
What dose gestational trophoblastic disease look like on US?
Snow-storm appearance (no feotal forms can be identified)
Miscarriage definition WHO and UK
WHO - before 20 weeks
UK - before 24 weeks
When is GDM likely to manifest? Why are pregnant women more vulnerable to DM in pregnancy?
After 20 weeks
hPL produced from the placenta opposes maternal insulin action to allow more glucose in the blood to be available for the feotus. Also increased levels of cortisol and growth hormone in pregnancy - which have anti-insulin effects
What are the fasting glucose and OGTT levels needed to diagnosis GDM
Fasting >5.6
OGTT >7.8
(note if fasting >7.0 then start the mum on insulin straight away)
Treatment of GDM for mother with fasting glucose <6.2
Fasting glucose <6.2 so lifestyle advice with two weeks to implement changes, if control still poor, add metformin, follow up in two weeks, if still poor, combined therapy with metformin and insulin. Follow up in joint diabetes clinic every two weeks throughout pregnancy.
> 7.0 fasting - straight on the insulin
BMI encouraged to get below 27
Three signs of hyperandrogenism
Acne
Hirstitism
Acanthosis nigricas (thickened, hyperpigmented areas in axillae/intertrogial regions)
ACEi in pregnancy associated with what
Oligohydroamnios
Recommended HbA1C in pregnancy
<48mmol/mol
What gestation should women with GDM/DM be advised to induce labour by and what are the risks if not?
37 - 38+6 weeks
Stillbirth,
BASHH guidelines for treatment of PID in a patient with temperature <38
Outpatient treatment with IM ceftriaxone and 14 day course of doxycycline and metronidazole
Phenytoin teratogenic effects
Fetal hydrantoin syndrome
- hypolastic fingernails
- IUGR
- Microcephaly
- CLEFT LIP/PALATE
- distal limb deformities
- mental retardation
Meningiomyloceole - what is it and what’s it associated with?
Type of spina bifida/neural tube defect that has neural tissue as well as meninges in the outpouchhing (as opposed to spina bifida occulta and meningioceole)
Associated with anti-folate medications e.g. methotrexate and sodium valproate
Also folate deficient pregnancies - alcohol/poor diet/ceoliac/DM?obesity
Contra indications to LMWH
Active bleeding, peptic ulcer, allergy, recent cerebral heamorrage
If pregnant women CI to LMWH and needs VTE treatment or prophylaxis warafarin treatment can be considered after consulting about the individual case with haematology
Pregnant woman with suspected PE - what test would you do?
VQ scan as opposed to CTPA to minimise radiation to the feotus
Pelvic organ prolapse quantification grading for uterine prolapse grading
first degree - descent but above level of introitus
second - at level of introitus
third - below introitus i.e. outside
fourth - outside plus ulceration
