OBGYN Flashcards
1
Q
duration until effective contraception
IUD
A
INSTANT
2
Q
duration until effective contraception POP
A
2days
Levonorgestrelm norethisterone, ethynodiol diacetate , desogetrel
3
Q
duration until effective contraception IUS
A
7 days
4
Q
duration until effective contraception COC
A
7 days
5
Q
duration until effective contraception injection + implant
A
7 days
depo provera- medroxyprogesterone acetate 150mg im every 12-14 wks
6
Q
What type of contraception Nexplanon + duration until effective contraception achieved
A
IUS + 7days
7
Q
youngest age for consent- contraception
A
13yrs
8
Q
Choice of contraception in young pts
A
Progesterone only implant Neplanon
9
Q
Increase risk/ SE of COCP
A
VTE, increased risk breast and cervical cancer
small risk MI + strokes
10
Q
What risk decreased using COCP
A
ovarian cancer
11
Q
which drug decreases efficacy of COCP
A
St John’s Wart
Rifampicin
CYP450 inducers
12
Q
which contraceptive method in pt with migraine
A
Copper IUD
13
Q
UKMEC 4 COCP
A
> 35 yrs old + smoking >15 cig
migraine with Aura
Hx VTE/ thombogenic mutation
Hx stroke or IHD
breast feeding <6wks postpartum
uncontrolled HTN
current breast cancer
SLE
14
Q
when to discontinue COCP before surgery
A
Before maj sugery 4wks
Progestogen only contraceptive may be offered
15
Q
Emergency Contraception, when to take it
A
(POP) Levonorgestrel within 72hr
Ulipristal within 120hrs
IUD within 5day OR if after 5d-> after 5d likely ovulation date
16
Q
CI depo provera + SE ass
A
Breast cancer
weight gain
17
Q
When can you start postpartum contraception
A
after 21d
18
Q
Which contraception CI postpartum
A
COCP-> if breast feeding <6 wks
19
Q
Most common ovarian cyst
A
follicular cyst
20
Q
which cyst aka chocolate cyst
A
endometriotic cyst
21
Q
most common ovarian cancer
A
serous carcinoma
22
Q
most common Benign ovarian tumour + what risk it increases
A
Dermoid cyst + increases risk of torsion
23
Q
most common benign epithelial ovarian tumour
A
serous cystadenoma
The mucinous cystadenoma
24
Q
HTN in pregnancy
A
HTN after 20GW
SBP >140 or dBP >90 or increase above booking reading of >30SBP, >15 DBP
25
Mx HTN in pregnancy- 1st and 2nd line
po labetalol FIRST line
2nd line: Nifedipine + hydralazine if asthmatic
Aspirin low dose 12-14GW till delivery reduce risk of pre-eclampsia
26
Definition of pre-clampsia
1. new onset HTN 140/90 after 20GW AND one of
2a. proteinuria 0.3g/24hr= 300mg or protein: creatinine ratio 30mg/mmol
2b. renal insufficiciency Cr >90umol/L, liver, neuro, haematological, uteroplacental dysfunction
27
When to admit pt with pre-clampsia
BP >160/110
28
Eclampsia
preclampsia
1. BP >140/90 + 2. proteinuria or end stage organ dysfunction
3. seizure
29
Mx elcampsia
1. MgSO4
iv bolus 4g 5-10min follow by infusion 1g/hour
2. emergency C-section
30
MgSO4 induced resp depression mx
iv Ca-gluconate
31
most common cause of post-coital bleeding
cervical ectropion
32
which contraceptive method ass with weight gain?
depo provera (medroxyprogesterone acetate)
33
Which HPV strain-> cervical ca
HPV 16,18/, 33
34
Cervical cancer screening age + freq
25-49 every 3 yrs
50-64 every 5 yrs
NOT offered >64yrs
35
(-)hr HPV Cervical ca screening result
return to normal recall unless test of cure pathway (CIN)
25-49 3 yrly
50-64 5 yrly
36
(+) hr HPV Cervical ca screening result
1. CYTOLOGY
2. CYTOLOGY NORMAL: repeat test 12 months
- if HPV (-): normal recall 25-49 3 yrly; 50-64 5yrly
- if HPV (+) + cytology still normal: repeat after 12 months
- if hrHPV (-) at 24 months- return to normal recall
- if hrHPV (+)==> colposcopy
3. CYTOLOGY ABNORMAL: COLPOSCOPY
37
inadequate sample- cervical ca screening
repeat sample w/in 3month
2 inadequate sample==> COLPOSCOPY
38
CIN mx
LLETZ: large loop excision of transformation zone
alternative cryotx
39
Epidemio endometrial cancer + cervical cancer
endometrial: postmenopausal
cervical: 25-29 yrs
40
Risk factors for endometrial cancer
excess oestrogen: nulliparity, early menarche, late menopause, unopposed oestrogen
Metabolic sy: obesity, PCOS, DM
Tamoxifen
Hereditary Non-poliposis CRC
41
Protective factors for endometrial cancer
multiparity, COCP, smoking
42
Asx uterine fibroid Mx
1) asymptomatic NIL mx
43
Uterine fibroid Mx
1) menorrhagia: Levnogetrel IUS, NSAIDS- mefenamic acid, tranexamic acid/ COCP or po/ sc progestogen
2) pre-op: GbRH AG eg. leuprolide- dec size of fibroids
44
Breast feeding CI abx
ciprofloxacin: arthropathy
Tetracycline: bdins to Ca2+ in infants system-> dental staining, enamel hypoplasia, inhibits bone growth, photosensitivitiy
chloramphenicol: grey baby syndrome CV collapse, cyanosis
sulphonamides
Aspirin
45
Mx vasomotor sx menopause
fluoxetine, cialopram, velafaxine
46
Mode of action: COCP
inhibit ovulation
47
Mode of action:: POP
thickens cervical mucous
48
Mode of action: desogestrel-only pill
Pri inhibit ovulation
also thickens cervical mucous
48
implantable contraceptive
pri: inhibits ovulation
also thickens cervical mucous
49
IUD
decreases sperm motility and survival
50
IUS
pri prevents endmetrial proliferation
also thickens cervical mucous
51
Mode of action: Levonorgestrel
inhibit ovulationu
52
Mode of action: Ulipristal
inhibits ovulation
53
IUD Mode of action:
pri toxic to pserm and ovum
inhibit implantation
54
Mx of primary & sec dysmenorrhoea
Primary: NSAIDS + ibuprofen, if not effective then COCP 2nd line
Secondary: ALL pt with secondary needs to be referred to OBGYN
55
When to check for 1st and 2nd rhesus status red cell autoAb
8-12 weeks & 28 weeks
56
When to check for BP, urine dipstick and urine culture for asx bacterium is in preg
8-12 weeks
57
When to check hep b and syphilis in pregnancy
8-12 weeks
58
Early scan to confirm dates, excl multiple preg
10-13 weeks
59
When to check down sy, nuchal scan
11-13 weeks
60
When is anomaly scan in pregnancy
18-20 weeks
61
When do you give anti-D prophylaxis for rhesus negative pregnancy
Week 28 and week 34
62
When do you check presentation & offer cephalon version week 36
63
Define obesity in pregnancy and mx
BMI >30kg/m2 at 1st antenatal visit
Folic acid 5mg and vit D 10mcg (400units) OD
64
Foetal alcohol syndrome FAS
Learning difficulties
Face: smooth philtrum, thin vermilion, small palpebral fissure, epicanthic folds, microcephaly
IUGR & postnatal restricted growth
65
Which scale do you use for depression postnatal
Edinburgh postnatal depression scale
66
Induction of labour- which score do you use and the score indication
Bishop score: assess whether incision of labour required
<5 unlikely to start without induction.
>-8 cervix ripe or favourable for induction.
<-6 vag PG/ po misoprostal, mech methods balloon catheter can be considered if high risk of hyperstimulation/ prev c-section.
>6 amniotomy + iv oxytocin infusion
67
Causes of postpartum haemorrhage
Trauma, tone, tissues, thrombin
68
Mx of postpartum haemorrhage
1. Mechanical: palpate uterine fungus + rub stimulate contraction, catheterisation prevent bladder distension
2. Medical: failed mechanical mx. If oxytocin slow iv injection followed by infusion. Ergometrine slow iv.im unless he of HTN, carboprost unless he of asthma, misoprotol suvlingual
3. Surgical: failed med mx- intra-uterine balloon tampon are 1st line where uterine stony main/ only cause
B-lynch suture, ligation of uterine arteries/ internal iliac arteries.
69
Secondary postpartum haemorrhage definition and causes
24 hours - 6weeks
Causes: due to retained placenta/ endometritis
70
Perineal tears classification
1st degree: superficial
2nd: perineal muscle but not involving anal sphincter
3rd: injury to perineum involving anal sphincter complex
4th: injury to EAS+ IAS and rectal mucosa
71
Puerperal pyrexia definition, causes, mx
Fever .38 first 14day postpartum
Causes: endometritis, uti, wound infection
Mx: iv abx- clindamycin + gentamicin until a febrile >24hrs
72
Postpartum haemorrhage definition
Blood loss .500ml after vaginal delivery
73
Mx of breech position and classification of breech position
Complete
Frank: flexed hip, extended knee most common
Footling
Mx: <36GW may turn spontaneously
>36GW- attempt external cephalon version
If still breech- c-section/ vag delivery
74
Folate deficiency in preg mx and when to give folic acid
ALL preg F should take folic acid 400mcg unto 12 GW
High risk patient should take 5mg folic acid before conception up to 12 Gw
High risk: either partner NTD or prev affected by NTD. fmhx of NTD. Anti-epileptic, DM, coeliac disease, Thalassaemia. Obese BMI 30kg.m2
75
Vit D replacement in preg
ALL preg + breastfeeding patients 10mg Od which is 400units of colecalciferol
76
Exposure of VZV in pregnancy
1st step check Antibody for VZ whether vaccinated or not.
2. If <-20GW with NO immunisation: start VZIg up to 10days after exposure
>20GW with no immunity: NO VZIg
If rash >-20GW give po aciclovir if <20Gw consider with precaution
77
Meig’s syndrome
Benign ovarian tumour ass with pleural effusion and ascites
78
Mx of ovarian cyst
Premenopausal: conservative esp if <35years. If small <5cm + simple cyst- repeat US in 8-12 weeks.
It postmenopausal: any cyst regardless of nature and size- referral
79
Risks of ovarian cancer
BRCA1 AND BRCA 2
early menarche, late menopause, nulliparity
80
Protective factors of endometrial cancer
Multiparty
Smoking
COCP- needs progesterone if on HrT
81
Mx of endometrial cancer especially frail pt
Surgery: total abdominal hysterectomy with bilateral saplings-oophrectomy
Frail pt: progrstogen tx
82
Medications used for emergency contraception, timing and mechanism of action
1. Levonogestrel (progesterone): inhibits ovulation and prevention of implantation. Take within 72 hours.
2. Ulipristal: selective progesterone receptor modulator. Inhibits ovulation. Can take up to 120 hours.cI asthma severe
3. iUD: most effective. Within 5 days. Inhibits fertilisation or implantation.
83
Side effects of POP and how long does it take to be effective
2 days
SE: irregular vag. Bleeding
84
Injectable contraception mech of action, SE and Contraindication
Inhibits ovulation, secondary mech inhibit cervical mucous thickening and endometrial thinning.
SE: weight gain, irregular bleeding, increased risk of osteoporosis, not quickly reversed
CI: breast cancer
85
Which contraception can be used in patient with migraine
Implantable contraception
86
Mech of action of implantable contraception, advantages, SE, CI
Contains etonogestrel inhibits ovulation
High effective, long lasting 3 years, can be used in migraine
No oestrogen therefore can be used in patient with VTE he, migraine
SE: irregular bleeding
CI: IHD, unexpected or suspicious vag bleeding post breast cancer
Current breast cancer
87
Can you used COCP post partum
No absolute contraindication if breast feeding <6weeks post partum
88
Which contraceptive methods can be used postpartum
Progestogen only pill: can start POP at any time
ISD/IUD: 48 hours or after 4 weeks
89
Definition of premature ovarian insufficiency, lab findings
Onset of menopause sx and increased gonadotropins level before age 40 years
Labs: low estradio <100pmol/L with raised FSH and LH.
FSH>40 is/L, high FSH demonstrated x2 samples taken 4-6 weeks apart
90
Contraindications of HRt
Current. Post breast cancer
Any oestrogen sensitive cancer
Undo caginal bleeding
Unix endometrial hyperplasia
91
Atrophic vaginitis mx
1st line: vaginal lubricants + moisturiser
2nd line if x work then try topical oestrogen cream
92
Congenital rubella syndrome sx esp cardiac abonormalities
Sensorineural hearing loss, congenital cataracts, congenital heart disease PDA/ pulmonstenosis, hepatosplenimegaly, cerebral palsy.
Mx: if female patient has no immunity stay away from contact, offer MMR post natally, not offered during pregnancy or attempting to become pregnant
93
Which rheumatoid arthritis drugs are safe to be used during pregnancy
Silfasalazine, hydroxychloroquine
Low dose steroid
NSAIDS can be used til 32GW but stopped due to increased risk of early closure of PDA
94
Intrahepatic cholestasis in pregnancy mx
Induction of labour 37-38GW
Ursodeoxycholic acid, weekly LFT checkup
Vit K supplementation
95
When to consider surgical mx for ectopic pregnancy
Size >35mm
Foetal heart present
Significant pain
HCG >5000U/L
96
Salpingectomy vs salpingotomy im ectopic pregnancy
1st line salpingectomy for F with no other risk factors for infertility
Slapingotomy- considered for F with risk factors for infertility eg PID or contrast damage
97
When to consider medical mx for ectopic pregnancy and what do you use
Size <35mm, no foetal heart
HCG <100-1500U/L
MTX
98
Dx gestational diabetes and when do you test
1st line OGTT.
offered 24-28GW, if prev GDM offer within first trimester if normal repeat test 24-28GW.
Fasting glucose >5.6mmol/l
After 2 hours >7.8mmol/l
99
Mx of gestational DM
If fasting glucose doesn’t;t decrease <7mmol/l with life style in 1-2 weeks= add metformin.
If glucose target not met with metformin=> insulin!!!
Plus add aspirin and folic acid 5mg from preconception - 12GW
100
What can you give preg pt can’t tolerate metformin
Glibenclamide
101
Mx of hyperemesis in pregnancy 1st and 2nd line
1st line: po cyclising, promethazine. Po prochloperazine
2nd line: po odansetron, metoclopramide/ deomperidone
102
Medical mx of miscarriage
Vag misoprostol
Prostaglandin- binds to myometrial cells causes strong contraction
103
Definition of menorrhagia
Heavy menstrual blood >80ml/ menses
104
Menorrhagia mx
If needs no contraception: mefenamic aide 500mg TDS / tranexamic acid 1g TDS
If needs contraception
1st line: IUS
then COCP, depo provers
105
Infertility Ix
Semen analysis
Serum progesterone taken 7day prior to next period
If >30nmo/l indicates ovulation
If <16nmol/l repeat if consistently low specialist
16-30nmol/l repeat
106
PCOS infertility mx
Weight reduction
Clomifene most effective- hypothalamic oestrogen Receptor mimic w/o activating them interferes with negative FB of oestrogen and inhibits FSH secretion
Metformin esp obese
107
What can you see in combined test for Down syndrome and when do you do it?
Offered 11-13
Unchallenged translucency thickened
High hCG
Low pref ass plasma ass protein A PAPP-A
108
Quadruple test what is it
Findings of Edward, down, NTD
Offered 15-20
Checks AFP, undone oestriol, hCG, inhibit A
Down: low AFP, UNCON OESTRIOL, high inhibit A & hCG
Edward’s: low AFP, UNCONJ OESTRIOL, HCG, normal inhibit A
NTD:high AFP, NORM UNCONJ OESTRIOL, HCG, INHIBIN A
109
HIV antiretroviral tx for preg pt and for baby
ALL preg pt offer antiretroviral regardless whether prev on it or not
Baby:
If mom’s viral load <50 copies/ml then only zidocudine offered otherwise triple ART used for 4-6 weeks
110
Mode of delivery in HIV + pt
If viral load <50 copies/mL vagina, recommended
Otherwise C-section. Start zidovudine 4 hours before C-section
111
Breastfeeding in HIV + pt
Not recommended!!!
112
Mx of Group B streptococcus in preg
Intrapartum ivermectin benzylpenicillin if CI ckindamycin
113
Vaginal candida mx
For F and preg
1st line: po fluconazole 150mg single dose
If unable to take oral clotrimazole 500mg intravag pessary
If preg only use local
114
Recurrent vag candidiasis mx and definition
>4 episodes/ year
Induction of po fluconazole for 3 days then maintenance for 6 months
Check BM
115
PID mx
Po ofloxacin + metronidazole
Or
Im ceftriaxone + po doxycycline + po metronidazole
