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Week 2 paces cases > O&G > Flashcards

O&G Flashcards

1
Q

Components and counselling of a medical abortion

A

Oral mifepristine taken at the clinic
Vaginal misoprostol taken at home
Follow up
Give supportive advice about what might happen (passage of clots/blood)

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2
Q

Types of surgical abortion

A 
Vacuum aspiration (<14w) (gentle suction)
Dilation and evacuation (later) = suction and cutterage to remove any remaining tissue
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3
Q

Rules around abortions

A

<24w unless risk to mothers life

The reasoning behind = damage to mothers life/mental health/other children

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4
Q

Aspects of O&G Hx

A

PC
Basic pregnancy questions if relevant
HPC

Previous pregnancies
Any terminations or miscarriages

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5
Q

What is gravidity?

A

Number of pregnancies

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6
Q

What is parity?

A

Number of pregnancies past 24w

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7
Q

Key obstetrics questions regarding Sx

A 
Any vaginal bleeding?
Any nausea and vomiting?
Any itching?
Any abdominal pain?
Any headache?
Reduced foetal movements?
Chest pain/SOB ?PE
Leg swelling (ruling out DVT)
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8
Q

Types of miscarriage

A 
Complete = passed tissue and os now closed, USS shows no retained tissue
Threatened = some bleeding/pain, Os is closed 
Incomplete = passed some tissue and now pain and os closed 
Inevitable = os open
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9
Q

Mx of miscarriage

A 
Expectant = wait 7-14 days
Medical = Vaginal misoprostol 
Surgical = Vacuum aspiration if evidence of infection or very painful (risk of haemorrhage)
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10
Q

Stages of labour

A

1= latent (0-3cm)
1 active = 3-10cm
2 = delivery of the foetus
3 = delivery of the placenta

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11
Q

RF for pre-eclampsia

A

DIABETES
Previous pre-eclampsia
Multiple pregnancy
Pre-existing renal disease

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12
Q

What does vaginal misoprostol do?

A

Stimulates uterine contractions

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13
Q

How do you confirm a miscarriage?

A

TVUSS to look for uterine pregnancy

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14
Q

Features of endometriosis

A

Abdominal pains
Dysparenuria
Irregular periods

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15
Q

Mx of endometriosis

A

Analgesia
COCP
GnRH agonists
Endometrial ablation

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16
Q

Symptoms of PID

A

Unusual discharge
Abdominal pains
RUQP (Fitz-Hugh-Curtis)

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17
Q

Mx of PID

A

NAAT
IV antibiotics
Analgesia

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18
Q

Features of anti-phospholipid syndrome

A

Recurrent miscarriages
Recurrent VTE
Lichen planus (webbed rash)

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19
Q

Mx of anti-phospholipid syndrome

A

Aspirin

Warfarin if still getting recurrent Sx

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20
Q

Ix for anti-phospholipid syndrome

A

Coagulation Ix
Anti-cardiolipin
Lupus antibodies

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21
Q

Features of pre-eclampsia

A

Oedema
Headache
High blood pressure
Proteinuria

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22
Q

Mx of pre-eclampsia

A

Labetalol or if asthmatic -> nifedipine

CTG during labour

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23
Q

Cut off for labetalol in pregnancy

A

160/110

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24
Q

Risks of pre-eclampsia

A

Foetal prematurity
Growth retardation
Eclampsia
Haemorrhage

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25
Q

What is eclampsia?

A

The development of seizures in association with pre-eclampsia
Its caused by cerebral oedema

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26
Q

Mx of eclampsia

A

Magnesium sulphate

Can cause resp depression in which case give calcium gluconate

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27
Q

Amount of proteinuria to Dx pre-eclampsia

A

0.3g protein / 24hr

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28
Q

Symptoms of STI

A 
Dysparaenuia 
Offensive discharge 
Itching 
Lesions
PID 
Infertility
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29
Q

Mx of STI

A

STI screen and referral to STI clinic
NAAT testing
Antibiotics IM or ?course
Azithromycin

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30
Q

Symptoms of ovarian cancer

A 
Abdominal bloating 
Abdominal pain 
Urinary symptoms (from pressure)
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31
Q

Ix for ovarian cancer

A

CA125 (also raised in endometriosis, cysts and PID)
TVUSS
Abdominal ultrasound

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32
Q

Mx of ovarian cancer

A

Chemotherapy

Surgery

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33
Q

How does the COCP affect cancer rates?

A

Reduces ovarian and endometrial cancer

Increases breast and cervical cancer

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34
Q

Most common ovarian cancer

A

Serousadenoma (epithelial)

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35
Q

RF for ovarian cancer

A

More oestrogen exposure (earlier menarche, tamoxifen, lynch syndrome, BRCA)

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36
Q

Treatment for bacterial vaginosis and trichomonas

A

Oral metronidazole

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37
Q

Dx of PCOS

A

12+ cysts in ovary
Hirsuitism
Anovulation/irregular periods

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38
Q

What do you give during labour for GBS

A

Benpen

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39
Q

Sx and Dx of endometrial cancer

A 
Often post-menopausal vaginal bleeding 
TVUSS shows thickened endometrium (>5mm)
Endometrial biopsy (pipelle biopsy)
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40
Q

Mx of endometrial cancer

A

Hysterectomy +/- bilateral salpingectomy

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41
Q

Things to measure in amenorrhoea

A 
Brings Oars To Paddle 
B-HCG
Oestrogen 
Thyroid
Prolactin
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42
Q

Cut off in size for ovarian cysts before you do a laparoscopy?

A

5cm

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43
Q

Mx of post-partum haemorrhage

A

ABC
Uterine massage
IV syntocinon
IV carboprost (contraindicated in HTN)

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44
Q

Which hormone surges to induce ovulation?

A

LH

45
Q

What score on Bishops indicates the need to induce

A

<5

46
Q

Which hormone prepares the endometrium?

A

Progesterone

47
Q

Mx for PPROM

A

Inspect the abdomen
CTG
Sterile speculum examination (look at the fluid as well)
If its amniotic, give erythromycin for 10 days or up until labour! Because risk of amniocentesis

48
Q

At what age range do you give corticosteroids to the mother if premature?

A

24w-34w

49
Q

Sx of acute fatty liver of pregnancy

A

3rd trimester
Systemically unwell
N+V
Anorexia

50
Q

Mx of acute fatty liver of pregnancy

A

IV fluids

Dextrose

51
Q

Mx of gestational diabetes

A

5mg folic acid at the start then at 12w start aspirin
Refer to gestational diabetes clinic
Mx depends on glucose levels
<7 can give lifestyle and exercise advice for 2w
If doesn’t improve then start insulin

52
Q

Indications for C-section

A

Breech
2x previous C-section
Foetal distress
Eclampsia

53
Q

Things that increase the risk of an ectopic pregnancy

A

PID
Endometriosis
Previous ectopic
Previous surgery e.g. for cyst removal

54
Q

What is adenomyosis and what are the symptoms?

A

Endometrium penetrates the myometrium
Results in abdominal cramps
Bloating before periods
Heavy periods

55
Q

Mx for adenomyosis

A

Pain killers
GnRH agonists
Hysterecomy

56
Q

Gonorrhoea Mx

A

Ceftriaxone

57
Q

Chlamydia Mx

A

Azithromycin and doxy

58
Q

FIGO staging

A 
1 = confined to cervix 
2 = confined to pelvis 
3 = invaded nearby tissues
4 = distance invasion
59
Q

Sx of polyps

A

Light, intermenstual bleeding -> endometrial

Cervical -> post-coital bleeding

60
Q

Sx of PUPP

A 
Rash of pregnancy 
Spares the umbilicus 
In stretch marks 
Light pink
Hives like rash
61
Q

Components of APGAR?

A 
How Ready Is This Child?
HR
RR
Irritable
Tone
Colour
62
Q

Mx of hyperesmesis gravidarum

A

Pabrinex
IV hydration
Promethazine
Admit if any electrolyte abnormalities or can’t tolerate fluid/lost a lot of weight

63
Q

Features of HELLP syndrome

A

Haemolysis
Elevated liver enzymes
Low platelets

64
Q

Sx of HELLP syndrome

A

Fatigue
DIC
RUQP

65
Q

Features of menopause

A

Hot flushes
Vaginal dryness
Irritable

66
Q

Mx of menopause

A

A natural part of ageing

In the interim as the body adjusts you can give HRT, SSRI, new generation COCP and lubricant

67
Q

How long without a period until it counts as menopause?

A

1 year

68
Q

premature ovarian failure?

A

40

69
Q

Ix for premature ovarian failure

A

All the amenorrhoea Ix (BOTP)

FSH levels

70
Q

What causes the symptoms in menopause?

A

Reducing oestrogen levels

71
Q

Mx of PCOS

A

COCP

Fertility assistance = clomifene and metformin

72
Q

Emergency contraception options

A

Most effective = IUD
Levonorgestrol = < 3 days
EllaOne = < 5 days

73
Q

Features of implantable contraceptives

A

Slowly releases progesterone
Lasts for 3 years
Irregular bleeding is a common side effect

74
Q

Mx of ectopic pregnancy

A

Methotrexate
Follow up scans
If large or high B-HCG levels need surgical salpinectomy or otomy

75
Q

Ix for ectopic pregnancy

A

Pregnancy test

TVUSS

76
Q

Features of premature labour

A

Weak contractions
Dilated cervix
Too early along, say 27w

77
Q

Mx of premature labour

A

Admit and administer tocolytic drugs such as nifedipine

Give steroids

78
Q

Risks of prematurity

A

Necrotising enterocolitis
Increased mortality
Jaundice

79
Q

Indications for induction of labour

A 
Prolonged pregnancy (41w)
PROM 
Diabetic mother (38w because macrosomia)
80
Q

Method for induction of labour

A

Membrane sweep
Intravaginal prostaglandins
Syntocinon (CTG if you are inducing with oxytocin)
Artificial rupture

81
Q

RF for gestational diabetes

A

BMI >30

Previous macrosomic baby

82
Q

Screening for gestational diabetes

A

If RF -> OGTT

83
Q

Mx of cervical cancer

A

Hysterectomy + lymph node clearance
Cone biopsy (increased risk of miscarriage)
Radiotherapy and chemotherapy

84
Q

HPV risk factors

A

SMOKING
HIV
High parity

85
Q

Causes of menorhagia

A

Fibroids
PID
Dysfunctional uterine bleeding
Hypothyroidism

86
Q

Symptoms of gonorrhoea

A

Thin, purulent discharge
Dysuria
Dyspareunia
Intermenstrual bleeding

87
Q

Sx of herpes

A

Tingling/burning
Blisters
Dysuria

88
Q

Mx of herpes

A

Aciclovir

89
Q

Symptoms of syphilis

A

Painless ulcers

90
Q

Cottage cheese discharge
Low pH
Dx and Mx

A

Thrush (vaginal candiadis)

Clotrimazole cream

91
Q

Features of placenta previa

A

Low lying placenta
Painless, bright red blood loss in the 3rd trimester
Confirm with TVUSS

92
Q

Features of trichomonas

A

Green discharge
Frothy
Strawberry cervix

93
Q

Mx of fibroids

A

Myomectomy

94
Q

Ix for fibroids

A

Examination and USS

95
Q

Aspects of an infertility Hx

A 
LMP 
Regular periods 
Regular sex 
Partner any issues 
Testing 
Previous STI?
Structural issues
96
Q

What is Sheehan’s syndrome?

A

A complication of severe PPH
The pituitary gland can be damaged leading to necrosis

The patient will present with lack of milk production (due to inadequate prolactin)

97
Q

Advice for breastfeeding

A

Ensure a good latch
Feed regularly
Allow the baby to drain the breast (feels soft and empty), this will prevent milk stasis
If blocked duct, keep feeding, this will help to clear it and reduce tenderness

98
Q

What is the premalignant stage of cervical cancer?

A

Cervical intraepithelial neoplasia (CIN)

99
Q

How do HPV 16 and 18 induce cervical cancer?

A

Inactivate tumour suppressors

100
Q

At what year are patients invited for a cervical smear?

A

25yo

101
Q

Causes of primary amenorrhoea

A

Turners

CAH

102
Q

Causes of secondary amenorrhoea

A 
Pregnancy
Hypothalamic (stress)
Menopause 
POF 
Anorexia
103
Q

Causes of vaginal bleeding

A 
Endometrial cancer
Submucosal fibroid 
Endometrial polyp
Endometriosis
Adenomyosis

Cervical polp, ectropion or cancer

104
Q

Management of bleeding from things like fibroids

A

Mirena coil

105
Q

Types of urogenital prolapse

A

Cystocele
Rectocele
Uterine prolapse

106
Q

Mx of intrahepatic cholestasis of pregnancy

A

3rd trimester
Itchy
Raised bilirubin
Treat with ursodeoxycholic acid

107
Q

Clinical features of placental abruption

A

Shock out of keeping with visible loss
Severe constant pain
Absent foetal heart beat
Tender, tense uterus

108
Q

Treatment of atrophic vaginitis

A

Topical oestrogen cream

Vaginal lubricants and moisturisers

Week 2 paces cases (3 decks)

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