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PA Conditions > Obs and Gynae > Flashcards

Obs and Gynae Flashcards

1
Q

define hyperemesis gravidarum
symptoms
investigations
management

A

Hyperemesis gravidarum- severe N&V during pregnancy. Leads to weight loss, dehydration, electrolyte imbalance, ketosis and requires hospitalization.

Symptoms:
* N&V
* Ptyalism
* Dehydration
* Weight loss

Investigations:
Electrolytes imbalances- low K+, Na+, ketonuria, alkalosis, vit deficiency, USS (determine stage of pregnancy, twins make symptoms worse due to higher levels of hcG, molar pregnancy)

Management:
* IV fluid and electrolyte replacement
* Antiemetic therapy: cyclicine
* Vitamins- thiamine
* Steroids
* Emotional support
* Nutritional support- rare

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2
Q

aim of booking visit at 8 weeks?
what things are done/ asked during this visit?

A
  • Categorize high/ low risk pregnancy- based on history, PMHx etc
  • Full history- PMHx, obstetric Hx, complications, FHx, safeguarding, DHx, SHx, mental health, weight, BMI, BP
  • Bloods- FBC, G&S, HBV, HIV, syphilis, rubella, sickle cell, thalassaemia
  • Screening for gestational diabetes
  • Assess pre-eclampsia risk
  • VTE score
  • Screening for chromosomal abnormalities
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3
Q

aims of dating and viability scan?

A
  • Single or multiple pregnancies
  • Viability
  • Location of pregnancy
  • Estimated date of delivery
  • Basic development checks
  • Sex
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4
Q

what trisomy’s are screened and what tests are used?

A
  • 13- Patau’s syndrome
  • 18- Edwards syndrome
  • 21- Down’s syndrome
  • Combined test- not diagnostic and is diagnosed via amniocentesis (HCG + PAPA-A blood tests)
  • Quadruple test- screens for T21 only (combination of 4 blood tests)
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5
Q

indications for growth scans?

A
  • Medical disorders. e.g. diabetes, hypertension
  • Multiple pregnancy
  • Risk of SGA- Smoker, age >40, previous SGA
  • Confirmed SGA
  • Difficult to measure SFH- High BMI, fibroid
  • Concerns about SFH
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6
Q

types of
non-pharmacological analgesia
pharmacological analgesia during labour

A

Non-pharmacological analgesia
* Relaxation techniques
* Massage
* Hydrotherapy
* Patterned breathing

Pharmacological analgesia
* Epidurals
* Paracetamol
* Nitrous oxide

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7
Q

what is dystocia in pregnancy?

A

Dystocia- difficult or obstructed labour

Causes of dystocia

  • Ineffective uterine contractions
  • Foetal size- too large
  • Position of the baby incorrect- occiput-posterior rather than occiput-anterior
  • Passage- CPD cephalopelvic disproportion where the pelvis is too small for the baby to pass through
  • Shoulder dystocia- baby’s shoulder impacts the maternal symphysis which prevents delivery of baby- OBS emergency and risk of hypoxia and future hypoxic injury
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8
Q

Risk factors for shoulder dystocia

A
  • Maternal DM
  • Maternal obesity
  • Previous shoulder dystocia
  • Macrosomia
  • Induction of labour- oxytocin
  • Assisted vaginal delivery- forceps
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9
Q

what is POI?
primary causes
secondary causes
potential risks caused by POI

A

Primary ovarian insufficiency- ovaries have stopped working before 40yrs causing irregular periods and reduced fertility.

Leads to increased risk of osteoporosis, IHD, CVD, and fracture risk due to lack of protective oestrogenic effect

Primary causes:
* Chromosomal abnormalities
* Enzyme abnormalities
* Autoimmune

Secondary causes:
* Chemo/ radiotherapy
* Hysterectomy
* Infection- PID

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10
Q

what are the contraindications for HRT?

A
  • FHx or individual Hx of breast, uterine or ovarian cancer, endometrial cancer
  • HTN
  • DVT
  • Liver disease
  • CHD/ stroke
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11
Q

who can have combined HRT?
who can have oestrogen only HRT?

A

combined- women who still have a uterus to protect uterus from excess oestrogen- uterine hyperplasia

oestrogen only- women who have had a hysterectomy

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12
Q

difference between sequential and continuous HRT?

A

Sequential HRT- involves taking oestrogen every day and taking progestogen for 10 to 14 days of each 28-day cycle.
A withdrawal bleed occurs at the end of each course of progestogen.
Given if its less than 6-12 months since LMP and taken until they reach 55yrs.

Continuous combined HRT- involves taking both oestrogen and progesterone together daily which results in NO bleeding.
Given if its been 12 months since LMP and taken daily.

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13
Q

methods of contraception that are/ not affected by enzyme inducing drugs?

A

Methods that are unaffected are
Progestogen injectables
IUS
IUD

Methods that are affected are
Combined methods
POP
implant

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14
Q

what are the enzyme inducing drugs that reduce effectiveness of contraception?

A

Antibiotics: rifampicin, rifabutin
Antiepileptics: e.g. carbamazepine, phenytoin, topiramate
Herbal remedies: St John’s Wort

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15
Q

what causes a Bartholin’s cyst?

A

If the glands become obstructed the fluid can backup and there is a risk of a painless swelling formation- Bartholin’s cyst.
If the fluid in the cyst become infected then is becomes an abscess.

STIs
unsafe sex

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16
Q

what is cervical ectropion?
risks and causes?

A

Benign gynaecological condition where cells that line the inside of the cervix spread onto the surface of the cervix due to increased cervical exposure to oestrogen

uncommon in postmenopausal women

Risks:
* >in women of the reproductive age
* Adolescents
* Pregnancy
* COCP

Causes:
Increased oestrogen levels causing proliferation and differentiation of cervical epithelium

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17
Q

management of cervical ectropion?

A

First line: discontinuing hormonal contraceptives

Asymptomatic ectropion- usually requires no treatment

Symptomatic ectropion- Cautery- 2 types
1. Electrocautery- cautery probe held against area for 30s while the area is treated with heat to destroy abnormal cells

  1. Cryotherapy- cautery probe held for 2min against area while the area becomes frozen
    92% cure rate with cautery treatment
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18
Q

conditions to look for when examining the vulva during a valval exam?

A

FGM
Bartholin’s cyst
lichen sclerosus- chronic inflammatory dermatological condition
abdnormal vaginal discharge (BV, candidiasis, STI, trichomoniasis)

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19
Q

conditions to look for when examining the cervix with speculum?

A

cervical ectropion
cervical cancer

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20
Q

managements for Bartholin’s cyst?

A

Usually require not treatment but depends of size of cyst and associated symptoms/ discomfort/ infection

  • Antibiotics- if infected
  • Sitz baths- sitting a warm bath several times a day for several day may help the cyst rupture and drain on its own
  • Surgical drainage- local anaesthetic
  • Marsupialization- If cysts recur then stitches can be placed on each side of a drainage incision to create a permanent opening less than 1/4-inch (about 6-millimeter) long. An inserted catheter may be placed to promote drainage for a few days after the procedure and to help prevent recurrence.
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21
Q

what is a cystocoele?
symptoms?
causes?
management?

A

cystocoele- prolapsed bladder due to weakening of the wall between the bladder and the vagina causing the bladder to descend into the vaginal canal.

symptoms: vaginal bulge, pressure on vagina, urinary incontinence/ hesitance

causes: vaginal birth, age, obesity, straining from constipation, weight lifting, surgery (hysterectomy), genetics

management:
pelvic floor exercises
vaginal pessary
surgery

22
Q

what is a rectocoele?
causes?
symptoms?
management?

A

prolapse of the wall between the rectum and the vagina and the front wall of the rectum sags and bulges into the vagina, and in severe cases, protrudes out of the vaginal opening.

causes: vaginal delivery/tear, episiotomy, aging, constipation, obesity, chronic coughing

symptoms:
Rectal pressure or fullness, or the sensation that something is stuck in the rectum
Difficulty having a bowel movement
Discomfort during sexual intercourse
A soft bulge of tissue that can be felt in the vagina (or protrudes outside of the body)

management:
pelvic floor exercises
bowel management
vaginal pessary
surgery

23
Q

risk factors for miscarriage?

A
  • Age
  • Smoking
  • Increased maternal age
  • Overweight
  • Previous miscarriage
  • Health conditions- DM
24
Q

Which contraception is associated with delayed return of fertility?

A

Depo-provera injections

25
Q

types of miscarriage?

A
  • Threatened- PV bleeding, cervical OS is closed and pregnancy is viable on USS (continues)
  • Inevitable- cervical OS is open, PV bleeding + abdo pain, most likely will lose pregnancy
  • Incomplete- miscarriage ongoing, heavy PV bleeding + abdo pain, some products of conception have passed, cervical OS is open and products present in canal
  • Complete- miscarriage has completed, products of conception have passed and cervical OS is closed, USS shows empty uterine cavity
  • Missed- dead embryo retained in the womb with no usual miscarriage symptoms experienced
26
Q

investigations and management for miscarriage?

A

Investigations: transvaginal USS

Management:
1. Conservative- for women who are not bleeding heavily, safety netting required about symptoms and what to expect, pregnancy test should be repeated within 3 weeks and if positive then TV USS (to ensure all products of conception have been removed)

  1. Medical: mifepristone at various doses and times -> pregnancy test 3 weeks later (if positive may need surgical management)
  2. Surgical: vacuum aspiration under GA
27
Q

risk factors for ectopic pregnancy?

A
  • Previous ectopic pregnancy
  • Previous PID or STI- chlamydia and gonorrhoea
  • Assisted conception- IVF
  • IUDs
  • Progesterone-only pill
  • Maternal age >40
  • Smoking
28
Q

symptoms of ectopic pregnancy?

A
  • Severe RIF/ LIF pain
  • Dark vaginal bleeding
  • Syncope
  • Shoulder tip pain- intraperitoneal bleeding irritates phrenic nerve
29
Q

differential diagnosis for ectopic pregnancy?

A
  • PID
  • Ovarian torsion
  • Ruptured ovarian cyst
  • Pyelonephritis
  • Appendicitis
  • UTI
  • Gastroenteritis
30
Q

investigations and management for ectopic pregnancy?

A

Investigations:
* Pregnancy test
* Abdominal USS

Management:

  • Acute- ABCDE + urgent salpingectomy
  • Conservative- careful monitoring (if unruptured and small)
  • Medical- single IM dose of methotrexate (destroys cells that are rapidly dividing), monitor HCG to ensure its falling, may still require surgery
  • Surgical- salpingotomoy (removal of ectopic only) or salpingectomy (removal of fallopian tube)
31
Q

what is pre-eclampsia?

A

Hypertensive disorder in pregnancy that commonly occurs after 20 weeks or as soon as the baby is delivered presents with HTN (>140/90mmHg) + proteinuria (300mg). Placental problem

  • Preeclampsia can cause your blood pressure to rise and put you at risk of brain injury.
  • It can impair kidney and liver function, and cause blood clotting problems, pulmonary oedema (fluid on the lungs), seizures and, in severe forms or left untreated, maternal and infant death.
  • Preeclampsia affects the blood flow to the placenta, often leading to smaller or prematurely born babies.
  • Eclampsia- tonic-clonic seizure secondary to pre-eclampsia
32
Q

risk factors for pre-eclampsia?

A
  • Previous HTN disease in previous pregnancy
  • Disease- kidney, DM, autoimmune
  • Age >40
  • BMI >35
33
Q

symptoms of pre-eclampsia?

A

Symptoms:
* Severe headache
* Vision problems, such as blurring or flashing
* Pain just below the ribs
* Vomiting
* Sudden swelling of the face, hands or feet

Triad- oedema + high BP + proteinuria

34
Q

investigations and management for pre-eclampsia?

A

Investigations:
* BP check
* Urinalysis-> protein
* If proteinuria present -> perform protein: creatinine ratio (if P:Cr >30 then significant proteinuria)

Management:

  • Mild preeclampsia- adequate BP control (beta-blockers) and seizure prevention (magnesium sulphate). Assessing foetus with serial growth scans
  • Severe preeclampsia- delivery of baby of placenta (even if preterm)
35
Q

complications of preeclampsia?

A

eclampsia- seizure
MI
pulmonary oedema
kidney failure
placental abruption
foetal growth restriction

36
Q

causes of late pregnancy bleeding?

A
  • Cervical ectropion
  • Placenta praevia- abnormally low lie of placenta in the uterus which can affect foetal lie and cause breech. If remains low lying then have to deliver via elective C-section. Normally not painful
  • Placental abruption- separation of the placenta from the uterine wall, painful bleeding that may be concealed or visible.
  • Placenta accreta- placenta may implant in previous c-section scar which can burrow in and integrate with uterine wall or surrounding structures and cause catastrophic bleeding and die immediately
37
Q

causes of post partum harmorrhage?
4 T’s

A

Bleeding after delivery, classified as mild,
moderate, severe

  1. Tone- placenta comes out but uterus does not contract properly (soft uterus does not control bleeding properly)
  2. Trauma- genital trauma, vaginal tear, cervical tear, episiotomy
  3. Tissue- retained placenta, placenta accreta, clots
  4. Thrombin- DIC, pre-existing maternal clotting problems
38
Q

types of incontinence?

A

urgency- sudden intense urge to urinate followed by involuntary loss of urine. will want to urinate in the night

stress- urine leaks when you exert pressure on the bladder by sneezing, coughing, laughing, exercisng, lifting heavy things

overflow- frequent/ contract dribbling of urine due to bladder not emptyping completely

functional- physical or mental impairement keeps you from making it to the toilet in time- RA

mixed- experiancing more than one type of incontinence (stress + urge)

39
Q

contracindactions for COCP?

A

BMI over 35
Age over 35 and smoking
Migraine with aura
Breast cancer
Breastfeeding
Postpartum (within 3-6 weeks depending on other VTE risk factors)
History of VTE or family history <45
Diabetic with microvascular complications
Prolonged immobility
Severe liver disease
History of ischaemic heart disease/stroke
Multiple risk factors for arterial cardiovascular disease

40
Q

within what timeframe can these emergancy contraceptives be taken to prevent pregnancy?

Levenorgestrel- levonelle
Ulipristal acetate- EllaOne
Cu-IUD

A

Levenorgestrel- levonelle= within 72hrs of UPSI

Ulipristal acetate- EllaOne= within 120hrs of UPSI

Cu-IUD= within 120hrs of UPSI or 5 days within eariliest expected date of ovulation

41
Q

what is an imperforate hymen?

A

thin membrane surrouding the opening of a vagina causing obstructions. can lead to back flow of blood during periods than cannot exit.
managed surgically via a small inscion.

42
Q

what is lichen sclerosus?

A

chronic inflammatory skin condition that causing itching and white discoloured skin around the vulva.

common in postmenopausal women

treated with steroid cream

increases risk of vulva, penis, anus cancer

43
Q

what do these mean?

ectocervix
external os
endocervix
internal os
transformation zone

A

Ectocervix: The outer part of the cervix that can be seen by the doctor in a pelvic exam

External os: The opening in the center of the ectocervix

Endocervix: A passage that connects the vagina to the uterus, also known as the endocervical canal

Internal os: The opening into the uterus from the cervix

Transformation zone: The border that overlaps the ectocervix and the endocervix

44
Q

what Abx is contraindicated at term pregnancy?

A

nitrofuratonin
can affect haemolysis of the newborn and cause neonatal jaundice

45
Q

what is PID?

causes?

complications?

A

Pelvic inflammatory disease (PID) is an infection of the female reproductive system which includes the womb, fallopian tubes and ovaries.

caused by STIs- chlamydia, gonorrhoea

complications: infertility, ectopic pregnancy

46
Q

What is the medical management for a missed miscarriage?

A

Medical management of a missed miscarriage involves giving oral mifepristone + 48 hours later, misoprostol (vaginal, oral or sublingual) unless the gestational sac has already been passed

47
Q

What is a myomectomy?

A

Myomectomy is surgery to remove uterine fibroids.

48
Q

When should anti-D prophylaxis be given to a mother who is having an abortion?
What should the mother’s Rhesus status be to warrant anti-D prophylaxis?

A

Anti-D prophylaxis should be given to women who are rhesus D negative and are having an abortion after 10+0 weeks’ gestation

49
Q

Causes of recurrent miscarriages?

A

antiphospholipid syndrome- most common

endocrine disorders: poorly controlled diabetes mellitus/thyroid disorders. Polycystic ovarian syndrome
uterine abnormality: e.g. uterine septum
parental chromosomal abnormalities
smoking

50
Q

When should serum progesterone levels be measures to investigate infertility?

A

serum progesterone 7 days prior to expected next period.

For a typical 28 day cycle, this is done on day 21.

51
Q

Treatment for thrush?

A
  • Oral anti-fungals (fluconazole 150mg single dose)
  • Topical agent for vulval symptoms (clotrimazole 1-
    2% applies 2-3x per day)
52
Q

Treatment for vaginal BV?

A

Oral metronidazole

PA Conditions (13 decks)

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