O+G Flashcards
Initial investigations in urinary incontinence?
- bladder diaries min 3 days
- vaginal exam to exclude pelvic organ prolapse
- urine dip + MSU
- urodynamic studies
Mx of stress incontinence?
- pelvic floor muscle training
- 2nd line: surgical procedures
Mx of urge incontinence?
- bladder retraining for min 6 wks
- anti-muscarinics: oxybutynin (immediate release), tolterodine (IR) or darifenacin (OD)
*Avoid oxybutynin IR in frail older women
Mx of urge incontinence if there are concerns about anticholinergic side effects in frail elderly patients?
mirabegron (beta-3 agonist)
Which varieties of HPV are assoc with genital warts?
HPV Types 6 & 11
Which varieties of HPV are associated with cervical cancer?
HPV Types 16, 18 and 33
Mx of genital warts
1st line: topical podophyllum (if multiple, non-keratinised warts) or cryotherapy (if single, keratinised wart)
2nd line: imiquimod cream
Risks of COCP?
clots, MI/ stroke, Br and cervical cancer
Risks of smoking in pregnancy?
- includes cannabis
increased risk of miscarriage, preterm labour, stillbirth, IUGR, sudden unexpected death in infancy
Risks of Alcohol in pregnancy?
Fetal alcohol syndrome: learning difficulties, characteristic facies (smooth philtrum, thin vermilion, small palpebral fissures, epicanthic folds, microcephaly), IUGR & postnatal restricted growth.
*binge drinking is major risk factor
Risks of heroin in pregnancy?
risk of neonatal abstinence syndrome
Risks of cocaine in pregnancy?
Maternal risks: HTN, pre-eclampsia
Fetal risks: prematurity, neonatal abstinence syndrome
Management of breech presentation at 36 weeks?
Recommend External cephalic version.
If multiparous -> offer ECV from 37 wks
Absolute contraindications to external cephalic version?
- where caesarean delivery is required
- antepartum haemorrhage within last 7 days
- abnormal cardiotocography
- major uterine anomly
- ruptured membranes
- multiple pregnancy
failure rate of sterilisation in females?
1 in 200
Mx of labial adhesions?
Conservative mx in the majority. If recurrent UTIs, oestrogen cream. If this fails, may warrant surgical intervention
Treatment for nipple candidiasis in breast feeding mother?
treat mother and child: miconazole cream applied to the nipple post feed and the oral mucosa of the infant + nystatin suspension for baby. continue breastfeeding during tx.
Mx of acute mastitis during breastfeeding?
Flucloxacillin for 10-14 days. treat ‘if systemically unwell, if nipple fissure present, if symptoms do not improve after 12-24 hours of effective milk removal of if culture indicates infection’. continue breastfeeding
management of exposure to chickenpox in non immune lady <20 wks gestation?
VZIG Asap (effective up to 10 days post exposure)
management of exposure to chickenpox in non immune lady >20 wks gestation?
either VZIG or antivirals (aciclovir or valaciclovir) should be given days 7 to 14 after exposure
mx of chickenpox in pregnancy?
oral aciclovir if the pregnant women is ≥ 20 weeks and she presents within 24 hours of onset of the rash.
if <20 wks, consider oral acyclovir with caution
Features of L3 nerve root compression?
Sensory loss over anterior thigh
Weak quadriceps
Reduced knee reflex
Positive femoral stretch test
Features of L4 nerve root compression?
Sensory loss anterior aspect of knee
Weak quadriceps
Reduced knee reflex
Positive femoral stretch test
Features of L5 nerve root compression?
Sensory loss dorsum of foot
Weakness in foot and big toe dorsiflexion
Reflexes intact
Positive sciatic nerve stretch test
