O&G/ Sexual Health Flashcards
What are the risk factors that require higher doses of Folic Acid in pregnancy?
BMI >30, Sickle cell, thallesemia, coeliac, hx of neural tube defect/ anti epileptic meds
Management of chickenpox (varicella) exposure in less than 20 weeks
Check immunoglobulins and if non immune start on IV varicella zoster immunoglobulin
Mangement of chickenpox (varicella) EXPOSURE if over 20 weeks
Check immunoglobulins and if non immune start on IV varicella zoster immunoglobulin OR acyclovir 7 to 14 days post exposure
What phase of the mensutrual cycle is Progesterone highest?
Luteal phase- secreted from corpus luteum
What drug is first line for infertility in PCOS?
Clomifene (Metformin used in combination if increased BMI)
What is the first line tx for Gonorrhoea?
IM Ceftriaxone
What type of bacteria is a Gonorrhoea (eg what would be seen in microscopy??)
Gram neg diplocci
First line treatment of chalymdia? (Uncomplicated)
Doxycycline 7 day course.
When should test of cure be performed for Chylamidia infections?
After 5 weeks in pregnant woman. TOC is not routinely in men or non pregnant females
Whooping cough (Pertussis) vaccine- when is it given during pregnancy?
between 16-32 weeks
TOPs can be carried out until what gestation in the UK Abortion Act?
23+6
When would you refer to colposcopy in a patient with HPV pos cervical smear but normal cytology?
at 24 months. eg if initial smear was HPV pos, then 12 month FU was still HPV pos and then 3rd smear at 24 months also pos.
What is the emergency contraception up to 5 days?
Ella one- Uliprisate up to 120 hours
What is the emergency contraception up to 3 days?
Levongesterol (1.5mg) progesterone
Treatment of premature ovarian failure
Combined HRT until aged 51
How long does the COCP need to be stopped prior to surgery?
4 weeks!
Chancres are due to which organism?
Haemophilus ducreyi.
Screening for downs syndrome- what is offered?
Combined test (nuchal and bloods) between 11- 13+6
Triple or quadruple screening 15-20
What fetal abnormalities would be seen in Varicella (chickenpox) infection intrapartum?
Scarring of the skin, limb hypoplasia, microcephaly and eye defects
What drugs are inducers of the PY450 system? and why is this relevant?
Carbamazapine, Phenytoin, Rifamicin, St Johns work and therefore they will reduce the efficacy of the COCP.
SICKFACES
St John’s Wort
isonidiazid
carbamazepine
Ketconazole
Fluconazole
Alchohol
Chloramphenicol
Erythromycin
Smoking
What age and regime is used for cervical ca screening in UK?
Aged 25-64.
25-50 every 3 years
50-65 every 5 years
When to start infertility testing? How many months of trying to concieve
12 months if under 35
6 months if over 35
Management of fibroadenoma?
Depends on size! 3cm or above= surgery
under 3cm= reassurance and monitoring
Management of GDM
If fasting BM >7 = Insulin
If fasting BM under 7= trial of diet+lifestyle.
Trichomonas is treated with?
Oral metronidazole
What are the risk factors for breast cancer?
HRT, early menarche, late menopause and COCP
Is Aspirin allowed in breastfeeding?
NO!
What are the rules around COCP and breastfeeding
UKMEC 2 between 6 weeks and 6 months
GDM. What fasting glucose on the OGTT should insulin be started?
If fasting glucose is over 7 = start Insulin
Or if fasting 6-6.9 but with complications such as macrosomia = consider Insulin
Secondary dysmenorrhagia management in GP
Refer to Gynae
How many days from starting the POP is it effective?
2 days
What age does cervical screening go to 5 yearly?
50-65 years old - 5 yearly screening
What is the treatment if a pregnant woman HAS chickenpox eg presents with the rash?
Aciclovir if over 20 weeks and Aciclovir can be considered if less than 20 weeks
Presentation of Lymphogranuloma venereum
Stage 1: painless genital ulcer
Stage 2: Painful lymphadenopathy
What are some contraindications to POP?
Acute porphyria/ current breast ca.
What are the features of congenital rubella syndrome?
Cataracts, cardiac lesions, splenomegaly, cerebral palsy
How do you define Perinatal Mortality Rate?
Number of stillbirths and early neonatal deaths (7 days) by number of livebirths and stillbirths PER 1000
What is HELLP syndrome?
Haemolysis
Elevated liver enzymes
Low platelets
Diagnostic criteria need raised LFTs (twice upper limit of normal) and low platelets
What are the risk factors for endometrial ca.
Nulliparious
High BMI
Unopposed oestrogen PCOS HRT
Tamoxifen
What are the neonatal effects of maternal toxoplasmosis infection?
CNS and eyes!
Neonatal seizures, hydrocephalus, chorioretinitis, cerebral calcification, cataracts
When can the copper IUD be fitted as emergency contraception?
5 days or 120 hours of USPI OR within 5 days of the earliest estimated date of ovulation.
Copper IUD should be offered to everyone first line!
When can Ullipristate vs Levongestrol be used for emergency contraception?
Levongestrol - 72 hours
Ullipristate- 5 days/ 120 hours (shouldn’t be used in severe Asthma)
Risk factors for HE?
Non smokers, twin pregnancies, molar pregnancies, eating disorders, N+v outside of pregnancy.
PID Antibiotics?
Ceftriaxone 1 g as a single intramuscular (IM) dose, doxycycline 100 mg twice daily
metronidazole 400 mg twice daily for 14 days.
Gonorrhoea in a man- presentation and Abx?
Discharge and dysuria
Mx: IM Cef + Azithromycin
Chlamydia in a man- presentation and Abx?
Itchiness and urethritis but no discharge
Mx: Azithromycin
Management of Pre menstrual tension
- Lifestyle
- COCP
- SSRI if severe and can be discontinued when pregnant
When can a copper IUD be fitted?
Within 5 days after the first UPSI in a cycle
OR
within 5 days of the earliest estimated date of ovulation.
What are some of the contraindications to copper IUD?
Unexplained bleeding
Current chlaymida/ gonorrhoea
Post TOP/ Post postpartum sepsis
Cervical CA
Molar pregnancies
PID
Treatment of Gonorrhoea? and how would it be prescribed under the microscope?
IM CEF!!!
Gram neg diplococci
What do these terms mean?
Azoospermia
Oligospermia
Hypospermia
Tetartospermia
Asthenzoospermia
Azoospermia- no sperm
Oligospermia- reduced sperm
Hypospermia- reduced semen volume
Tetartospermia- poor sperm morphology
Asthenzoospermia - reduced sperm motility
Treatment of epidiymo-orchitis?
IM Cef (STAT) + Doxy for 10-14 days
What would a high FSH indicate in the investigations of secondary amenorrhoea?
Primary Ovarian Failure
Placental abruption presents with which examination finding?
Tender woody uterus
Pain
PV bleeding
Which rash spares the umbilicus in pregnancy?
Polymorphic eruption of pregnancy
What are the missed pill rules for POP?
Missed pill occurs if >3 hours late.
If this happens- take next pill and extra precautions for 48 HOURS!
EC only required if UPSI occurred between missed pill and 48 hour window
What are the TORCH infections?
Toxoplasmosis
Other (syphillis)
Rubella
Cytomegalovirsus
H erpes simplex
What gestation does ECV take place?
Nulliparous 36/40
Multiparous 37/40
What gestation is routine anti D given?
28 weeks and 34 weeks
What gestation is presentation palpated for
36 weeks
Indications for high dose folic acid (5)
Sickle cell/ Thalassemia
Diabetes
Epileptic medication
BMI >30
Fhx of neural tube defects
What drugs for medical TOP?
Mifepristone
Followed by Misoprostol 48 hours later
Missed pill rules COCP
1 pill- fine - take next one and carry on
2 pills- 7 days extra precautions.
If at beginning of pack will need EC
How to start COCP
If between D1-D5 quick start and no additional contraception required
If after D5 of period need 7 additional condom days!
Lipid modification drugs in pregnancy?
All lipid modification drugs are contraindicated in pregnancy.
And should stop 3 months prior to pregnancy
Risk factors for endometrial ca
Obesity
Nulliparity
Late menopause
Tamoxifen
Treatment of listeria infection in pregnancy
Amoxicillin
Treatment of Toxoplasmosis in pregnancy
Spiramycin
What is a UK MEC 4 (unacceptable risk) for progesterone implant and injectables?
Current breast ca (within 5 years)
What are the causes of painless genital ulcer (3)
- Syphillis
- Chancroid (haemophyllis ducreyi)
- Lymphogranuloma venereum (chlaymidia trichomatosis)
