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ZMSRA > OBGYN > Flashcards

OBGYN Flashcards

1
Q

Levonorgestrel can Be taken

A

Within seventy two hours of unprotected sexual intercourse

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2
Q

How does uli pristal work

A

Inhibits Ovulation

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3
Q

When can ullipristal still be taken

A

No later than a hundred and twenty hours after unprotected intercourse

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4
Q

Big caution for ulliprisyal

A

Asthms

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5
Q

When can an IUD be used as a form of emergency contraception

A

Must be inserted within five days of unprotected sexual intercourse
If a woman presents after five days, then an r u d may be fitted up 25 days after the likely ovulation dates ie fourteen days

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6
Q

What is nexplanon

A

Subdormal contraceptive which slowly releases protester on hormone
Works by preventing ovulation

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7
Q

Adverse effects of nexplanon

A

A regular or heavy bleeding
Headache nausea breast pain

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8
Q

When is the early scan to confirm dates

A

10 - 13+6 weeks

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9
Q

When can I u d be relied on for contraception after insertion

A

Immediately

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10
Q

When can I us be relied upon for contraception following insertion

A

After seven days

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11
Q

The most significant risk of prescribing an oestrogen-only preparation rather than a combined oestrogen-progestogen preparation is

A

increased risk of endometrial cancer

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12
Q

COCP UKMEC 3

A

more than 35 years old and smoking less than 15 cigarettes/day

BMI > 35 kg/m^2*

family history of thromboembolic disease in first degree relatives < 45 years

controlled hypertension

immobility e.g. wheel chair use

carrier of known gene mutations associated with breast cancer (e.g. BRCA1/BRCA2)

current gallbladder disease

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13
Q

COCP UKMEC4

A

more than 35 years old and smoking more than 15 cigarettes/day

migraine with aura

history of thromboembolic disease or thrombogenic mutation

history of stroke or ischaemic heart disease

breast feeding < 6 weeks post-partum

uncontrolled hypertension

current breast cancer

major surgery with prolonged immobilisation

positive antiphospholipid antibodies (e.g. in SLE)

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14
Q

risks of HRT

A

Venous thromboembolism: a slight increase in risk with all forms of oral HRT. No increased risk with transdermal HRT.

Stroke: slightly increased risk with oral oestrogen HRT.

Coronary heart disease: combined HRT may be associated with a slight increase in risk.

Breast cancer: there is an increased risk with all combined HRT although the risk of dying from breast cancer is not raised.

Ovarian cancer: increased risk with all HRT.

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15
Q

NICE (2008) advise giving anti-D to non-sensitised Rh -ve mothers at

A

28 and 34 weeks

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16
Q

Medical management of urge urinary incontinence

A

antimuscarinics are first-line

NICE recommend oxybutynin (immediate release), tolterodine (immediate release) or darifenacin (once daily preparation)

mirabegron (abeta-3 agonist) may be useful if there is concern about anticholinergic side-effects infrail elderly patients

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17
Q

Medical management of stress incontinence

A

duloxetinemay be offered to women if they decline surgical procedures

a combined noradrenaline and serotonin reuptake inhibitor

mechanism of action: increased synaptic concentration of noradrenaline and serotonin within the pudendal nerve → increased stimulation of urethral striated muscles within the sphincter → enhanced

18
Q

Contraception is not required until when postpartum

A

Day twenty one

19
Q

The RCOG has produced guidelines suggesting the following classification of perineal tears:

A

first degree: superficial damage with no muscle involvement - do not require any repair
second degree: injury to the perineal muscle, but not involving the anal sphincter - requiresuturing

third degree : injury to perineum involving theanal sphincter complex (external anal sphincter, EAS and internal anal sphincter, IAS)
3a: less than 50% of EAS thickness torn
3b: more than 50% of EAS thickness torn
3c: IAS torn
require repair in theatreby a suitably trained clinician

fourth degree: injury to perineum involving the anal sphincter complex (EAS and IAS) and rectal mucosa

20
Q

When is the anomaly scan

A

18 - 20+6 weeks

21
Q

In continental screening when is the downs syndrome screening performed

A

11 - 13+6 weeks

22
Q

What cancers is COCP protective against

A

cOc - prOtective against Ovarian and endOmetrial cancer

23
Q

Which contraceptives inhibit ovulation

A

COCP
Despgertrel pill but not other POP
Injectable + implantable
Levenogestrel
Ullipristal

24
Q

How does IUS work

A

Prevents endometrial proliferation

25
Q

how does POP work

A

Thickens cervical mucus

26
Q

Endometriosis management

A

NSAIDs and/or paracetamol are the recommended first-line treatments for symptomatic relief
if analgesia doesn’t help then hormonal treatments such as the combined oral contraceptive pill or progestogens e.g. medroxyprogesterone acetate should be tried

27
Q

Premature ovarian Insufficiency management

A

hormone replacement therapy (HRT) or a combined oral contraceptive pill should be offered to women until the age of the average menopause (51 years)
it should be noted that HRT does not provide contraception, in case spontaneous ovarian activity resumes

28
Q

Drugs to be avoided in breastfeeding

A

antibiotics: ciprofloxacin, tetracycline, chloramphenicol, sulphonamides
psychiatric drugs: lithium, benzodiazepines
aspirin
carbimazole
methotrexate
sulfonylureas
cytotoxic drugs
amiodarone

29
Q

Follicular cyst features

A

Commonest typer of ovarian cyst
Commonly regress after several menstrual cycles

30
Q

Serous cystoadenoma features

A

the most common benign epithelial tumour which bears a resemblance to the most common type of ovarian cancer (serous carcinoma)
bilateral in around 20%

31
Q

Mucinous cydtoadenoma

A

second most common benign epithelial tumour
they are typically large and may become massive
if ruptures may cause pseudomyxoma peritonei

32
Q

Corpus luteum cyst features

A

during the menstrual cycle if pregnancy doesn’t occur the corpus luteum usually breaks down and disappears. If this doesn’t occur the corpus luteum may fill with blood or fluid and form a corpus luteal cyst
more likely to present with intraperitoneal bleeding than follicular cysts

33
Q

Who is screened for cervical ca and how often?

A

25-49 years: 3-yearly screening
50-64 years: 5-yearly screening

34
Q

When is medical or surgical management of miscarriage indicated

A

increased risk of haemorrhage
previous adverse and/or traumatic experience associated with pregnancy (for example, stillbirth, miscarriage or antepartum haemorrhage)
evidence of infection/

35
Q

Medical management of miscarriage

A

Vaginal misoprostol

36
Q

First line management of miscarriage

A

waiting for 7-14 days for the miscarriage to complete spontaneously
If expectant management is unsuccessful then medical or surgical management may be offered

37
Q

Ix reduced fetal movements

A

Initially, handheld Doppler should be used to confirm fetal heartbeat.
If no fetal heartbeat detectable, immediate ultrasound should be offered.
If fetal heartbeat present, CTG should be used for at least 20 minutes

38
Q

Secondary dysmenorrhoea cause and mx

A

endometriosis
adenomyosis
pelvic inflammatory disease
intrauterine devices*
fibroids

Clinical Knowledge Summaries recommend referring all patients with secondary dysmenorrhoea to gynaecology for investigation.

39
Q

Bishop score interpretation

A

a score of < 5 indicates that labour is unlikely to start without induction
a score of ≥ 8 indicates that the cervix is ripe, or ‘favourable

40
Q

Indications induction of labour

A

prolonged pregnancy, e.g. 1-2 weeks after the estimated date of delivery
prelabour premature rupture of the membranes, where labour does not start
maternal medical problems
diabetic mother > 38 weeks
pre-eclampsia
obstetric cholestasis
intrauterine fetal death

41
Q

Induction labour options

A

if the Bishop score is ≤ 6
vaginal prostaglandins or oral misoprostol
mechanical methods such as a balloon catheter can be considered if the woman is at higher risk of hyperstimulation or has had a previous caesarean
if the Bishop score is > 6
amniotomy and an intravenous oxytocin infusion

ZMSRA (12 decks)

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