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phase 3a > Obs and Gynae > Flashcards

Obs and Gynae Flashcards

1
Q

Endometriosis Ix

A

laparoscopy with biopsy

TVS/TAS

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2
Q

Endometriosis examination findings

A

fixed retroverted uterus

adnexal mass

tender

sometimes normal

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3
Q

RF for PID

A
  • STI (chlam and gono)
  • unprotected sex
  • multiple sexual partners
  • IUD
  • termination
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4
Q

Presentation of PID

A

asymptomatic (subfert)

  • lower abdo pain
  • deep dyspareunia
  • PCB
  • dysuria
  • vaginal discharge
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5
Q

PID investigations

A

gold standard - laparoscopy with fimbrial biopsy

  • endocervical swabs
  • high vaginal swabs (TV, BV)
  • full STI screen
  • urine dip
  • preg test
  • pelvic USS
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6
Q

PID O/E

A

cervical excitation

severe - tachycardia and fever

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7
Q

Ix for incontinence

A

cystometry

stress: when pt coughs increased BP, AP, UF but no increase in DP

Urge: detrusor contractions on filling

urine dip to exclude infections

urinary diary can be helpful for urge

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8
Q

Pharmaceutical and surgical management of stress incontinence

A

Autologous rectus fascial sling

colposuspension (neck of bladder lifted and sutured back into place)

duloxetine (enhances urethral sphincter activity: 2nd line to surgery)

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9
Q

Management of urge incontinence

A

Lifestyle: caffeine, weight
bladder training: 6 weeks
Drugs: Oxybutynin, relax SM, increase bladder capacity -> Mirabegron if CI
Intravaginal oestrogens for post meno women

Secondary care

  • Botulinum toxin A injection: blocks neuromuscular trasmission, worry about retension
  • Sacral nerve stimulation
  • Cystoplasty​
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10
Q

USS findings for PCO

A

multiple (>12) small (2-8mm) follicles in an enlarged (>10mL) ovary

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11
Q

Describe the pathology of PCOS

A

disordered LH production

  • increased ovarian androgens
  • folliculogenesis disrupted -> XS small ovarian follicles, irregular/abscent ovulation

Compensatory insulin production (increased weight)

  • increased adrenal androgen production and decreased hepatic sex hormone binding globulin production
  • increased free androgen levels -> hirsutism
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12
Q

Investigations for ?PCOS

A

aim: find other causes

Testosterone and LH increased

FSH normal (increased in ovarian failure, decreased hypothalamic disease)

prolactin (increased prolactinoma)

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13
Q

PCOS management

A

lifestyle

Co-cyprindrol: hirsutism and acne

COCP - oligomenorrhoea, acne, hirsutism

eflornithine/lazer therapy - facial hirsutism

endometrial hyperplasia prevention(bleed once every 4 months)

  • cyclical progestogen (medroxyprogesterone)
  • COCP
  • IUS
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14
Q

Describe the degrees of prolapse

A

1st - lowest part halfway down vaginal

2nd - lowest part to introutus

3rd - lowest part outside vagina without straining

4th - uterus lies outside vagina

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15
Q

Specific prolapse symptoms

A

cystocoele - urgency, frequency, incomplete emptying (retension -> infection)

enterocoele - gurging sound when sitting

rectocoele - constipation, digitation

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16
Q

Prolapse causes

A
  • pregnancy and vaginal delivery
  • menopause (oestrong withdrawal reduced collagen)
  • increased abdo pressure
  • iatrogenic (pelvic surgery)
  • congential (abnormal collagen)
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17
Q

Management of prolapse

A

Lifestyle: weight, managing constipation
PFME: 16 week course
Vaginal oestrogen creams if atrophy

Pessary: ring or shelf - affects intercourse, changed every 6m
surgery: mesh repair, colposuspension, hysterectomy
​

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18
Q

Causes of menorrhagia

A
  • fibroids
  • polyps
  • adenomyosis
  • chronic pelvic infection
  • tumour - ovarian, endometrial, cervical
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19
Q

Investigations for menorrhagia

A

Hb

TVUS (endometrial thickness, fibrods, polyps, masses)

if thickness >10mm -> biopsy

hysteroscopy

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20
Q

What is a fibroid and what are causes and presentation

A

Benign tumour of myometrium

ax: oestrogen and progesterone dependent
sx: asymptomatic, menorrhagia, IMB, dysmenorrhoea, frequency and retension, impaired fert

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21
Q

Fibroid investigations

A

USS

Hysteroscopy

Hb (increased bc fibroids secrete erythropoietin)

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22
Q

Fibroid management

A
  • NSAIDS, tranexamic acid, progestodens
  • GnRH agonist for women near menopause only used 6/12 bc done density loss + HRT can use longer
  • resection, hysterectomy, myomectomy, ablation or embolization
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23
Q

Polyp RF, presentation, IX and Mx

A

-pt on tamoxifen for breast cancer

Sx: asy, menorrhagia, IMB

Ix: USS, hysteroscopy

Mx: resection or avulsion

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24
Q

Menorrhagia management

A

1st: IUS
2nd: COCP, NSAIDS, tranexamic acid
3rd: progestins(norethisterone), GnRH (6/12 only)
surgery: endometrial ablation(uterus <10 weeks), uterine artery embolisation (uterus >10 weeks), hysterectomy

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25
Q

causes of PCB

A
  • Infection
  • carcinoma (cervical vaginal)
  • cervical ectropion (cervix epi columnar instead of squamous)
  • atropic vagina
  • cervititis, vaginitis
  • trauma
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26
Q

Candidiasis

A

cottage cheese dischange and itching

Tx: clotrimazole PO fluconazole

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27
Q

Bacterial Vaginosis

A

grey/white discharge, fishy odor

1) increased pH
2) +ve whiff (fishy when 10% pot hydroxide)
3) Clue cells

Mx: metronidazole or clindamycin cream

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28
Q

Chalmydia

A

asyp, Reiters, abnormal

ECS, NAAT

Mx: azithromycin 2nd doxycycline

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29
Q

Gonorrhoea

A

asym, urethritis, cervicitis, bartholinitis

ECS NAAT

Mx: IM ceftriaxone, azithromycin

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30
Q

Genital warts

A

HPV (16/18)

Tiny flat patches-> papilloform swellings

Mx: podophyllin or imiquimod topical

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31
Q

Herpes

A

HSV type 2

painful vesicles and ulcers around introitus. local lymphadenopathy, dysuria, systemic features

VE/swabs

Mx: aciclovir or valaciclovir

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32
Q

Syphilis

A
  • chancre
  • > rash and flu symptmos
  • gential warts or oral growths

Syphilis EIA, VDRL

Mx: benpen IM

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33
Q

Trichomoniasis

A

offensive grey/green discharge , itching, cervicitis, dyspareunia

Polymorphonuclear lymphocytes on wet firm microscopy

Mx: metronidazole

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34
Q

Lichen infections presentations

A

Planus: plain, purple papules

Simple: pruritis, hypo/hyper pigmented labia majora

Sclerosis: pruritits, pink/while papules-> parchment

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35
Q

Lichen infections management

A

Planus/Sclerosis: high potency steriod cream

Simplex: Avoid, Steriod (betamethasone), Anti hist (hydroxyzine) Emollient

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36
Q

Lichen infections diagnosis

A

planus: clinical

simplex and sclerosis: biopsy

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37
Q

Gestational Diabetes RF

A

History: Person or family
Mum: overweight(>30), smoker
Previous births: still birth, macrosomia (>4.5kg)

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38
Q

Complications of gestational diabetes

A

fetal: congenital abnormalities, preterm labour, macrosomia/polyhydramnios

Maternal: UTI, Pre E, CS, db retinopathy

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39
Q

Ix and Mx for gestational diabetes

A

fasting glucose >5.6 or OGTT >7.8

Mx: increase insulin <6.0 in previous db

Diet->metformin -> insulin

aspirin to reduce pre-eclampsia risk

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40
Q

Pre - eclampsia pathology

A

incomplete trophoblastic invasion, reduced uteroplacental blood flow, endothelial damage

increased vascular perm (proteinuria)

vasocontriction (HTN, eclampsia)

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41
Q

Risk factors for pre-eclampsia

A

Mod

  • BMI >35
  • age>40
  • fam Hx
  • nulliparity

High

  • personal Hx
  • HTN
  • CKD
  • db
  • autoimmune

1 high or 2 mod = aspirin

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42
Q

Pre eclampsia presentation and examination findings

A

systolic BP >140 or diastolic BP >90 in the 2nd half of pregnancy
with ≥1+ proteinuria on reagent stick testing.

Asymptomatic

  • headache
  • N&V
  • visual disturbances
  • upper epi pain

O/E - oedema, hyper-reflexia

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43
Q

Pre-eclampsia complications

A
  • eclampsia (tx- mg sulphate)
  • Pulmonary oedema (Tx - 02, frusemide)

Baby: IUGR, abruption
Mum: Renal failure, HELLP,

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44
Q

Pre eclampsia investigations

A

Urine >30mg protein

fetal wellbeing: USS for growth, doppler artery, amniotic fluid volume

Monitor: LFT, U&E, FBC to guide delivery time

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45
Q

Pre-eclampsia management

A

<150/109

  • BP QDS
  • bloods 2 times weekly

>150/109

  • BP QDS
  • bloods 3 times weekly
  • labetalol or nifedipine

Mg Sulphate reduces eclampsia risk​

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46
Q

Symptoms of RBC isoimmunization

A

mild: neonatal jaundice ± anaemia
severe: in utero anaemia (cardiac failure, ascites, oedema, fetal death)

worse with successive pregs

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47
Q

Rhesus management

A

Booking at 28 weeks check all women for antibodies

  • <10 = sig problems unlikely check 2/4 weeks
  • >10 = further investigations

Doppler US every 2 weeks

Anti D at 28 weeks and within 72 hours of a sensitising event or delivery

Blood transfusion or delivery >36 weeks

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48
Q

What to look at on CTG

A

DR C BRAVADO

Define Risk

Contractions

Baseline RAte

Variability

Accel

Decel

Overall impression

49
Q

Combined test

A

10-14 weeks

  1. nuchal translucency
  2. B-HCG
  3. PAPPA

Downs, Edwards, Pataus

Risk >1 in 150 -> more testing

50
Q

Quad test

A

14-20 weeks

  1. alpha feto protein
  2. B- HCG
  3. oestriol
  4. inhibin A
51
Q

Amniocentesis what and risk

A

needle (US guided) into amniotic sack to remove fluid sample. Pt given anaesthic.

Risks

  • miscarriage 1%
  • infection
  • repeat procedure
  • punctured placenta
  • Rhesus
  • club foot (<15w)
52
Q

14 days after period unilateral pain

A

Mittelschmerz

53
Q

Whirlpool sign on pelvic USS?

A

Ovarian torsion

54
Q

Management for vaginal vault prolapse?

A

sacrocolpoplexy

55
Q

Endometriosis management

A

COCP

GnRH agonist

IUS

pain relief: naproxen

56
Q

PID management

A

Abx

IM ceftriaxone + PO doxy and metronidazole BD 14 days

Severe: doxy + IV ceft and metron -> PO doxy and mentron as above

57
Q

Types of incontinence

A

Functional incontinence: Can’t reach toilet bc poor mobility

Stress incontinence: leaking on effort or exertion, coughing sneezing, bc incompletely sphincter

Urge incontinence: leakage with or after urgency. destrusor instability or hyperreflexia -> contraction

58
Q

PCOS diagnostic criteria

A
  1. Polycystic ovaries (either 12 or more peripheral follicles or increased ovarian volume (greater than 10 cm3).
  2. Oligo-ovulation or anovulation.
  3. Clinical and/or biochemical signs of hyperandrogenism.
59
Q

PCOS complications

A
  • Infert
  • Endometrial hyperplasia and cancer
  • CVD
  • T2DM
  • Gestational db
60
Q

when to induce in pre-eclampsia

A

When to induce

  • Gestational HTN >40w
  • mild >37 w
  • mod/severe 34-36
  • monitor for 24 hours
  • discharge on BB
61
Q

What increases a womans risk of developing cervical cancer?

A

Younger women, associated with HPV 16+18
Increased risk of getting HPV

  • earler intercourse
  • multiple partners
  • STIs

General: smoking, CIN, OCP

62
Q

what is CIN?

A

Cervial intraepithelial neoplasia

most common type of abnormal cell found on colposcopy
2 and 3 are higher risk of cervical cancer

63
Q

What are the symptoms of cervical cancer?

A
  • bleeding
  • discharge
  • vaginal discomfort
  • urinary symptoms
64
Q

How do you manage cervical cancer?

A

stage 1: tachelectomy or hysterectomy
stage 2: radio, chemo, palliative

65
Q

What increases a womans risk of developing endometrial cancer

A

Menopausal women
unopposed oestrogen

  • early menarche
  • late menopause
  • nulli
  • HRT
  • obese
  • smoking
  • PCOS, db
66
Q

How does endometrial cancer present?

A

PMB

67
Q

How do you investigate PMB

A

TVUS if thickness >3mm -> biopsy

68
Q

How do you manage endometrial cancer?

A
  • hysterectomy ± node biopsy
  • radiotherapy (SE ulceration, bladder issues)
69
Q

What increases a womans risk of developing ovarian cancer?

A

increased ovulation

  • early menarche
  • late menopause
  • nulli
  • HRT
  • obese
  • smoking
  • BRCA 1/2
70
Q

How does ovarian cancer present?

A

vague GI symptoms

  • bloating/IBS
  • bowel habit change
  • urinary frequency
  • pelvic/abdo mass
71
Q

How do you investigate ?ovarian cancer

A

*if >50 with vague GI symptoms refer for USS*

  • CA 125
  • pelvic and abdo USS
  • CT

Risk assessment by Risk Malignancy index 1

72
Q

How do you manage confirmed ovarian cancer?

A
  • hysterectomy +chemo
  • palliative debulking
73
Q

What increases a womans chance of developing vulval cancer?

A
  • VIN
  • HPV
  • lichen sclerosis
74
Q

What is VIN?

A

vulval intraepithelial neoplasm

premalignant state occuring independently or in lichen sclerosus
px: pruritic lesions
ix: examination and biopsy
mx: wide local excision with life long follow up (HPV association)

75
Q

How does vulval cancer present?

A
  • non healing lesion/ulcer
  • lump
  • itching
  • soreness
  • bleeding
  • dysuria
76
Q

How would you investigate potenital vulval cancer?

A

Examination and biopsy

77
Q

what is the management of vulval cancer

A

surgery

78
Q

what types are each of the gynae cancers?

A

Cervical: Squamous
Endometrial: adenocarinoma
Ovarian: epithelial origin

79
Q

When is cervical cancer screening?

A

every 3 years from 25-49 then every 5 years until 65

80
Q

What does a -ve cervical cancer screening result mean and what action would then be taken?

A

normal cells

next smear in 3/5 years

81
Q

What does an inadequate cervical cancer screening result mean and what action would then be taken?

A

insufficient/unsuitable material

redo within 3 months

82
Q

What does a borderline cervical cancer screening result mean and what action would then be taken?

A

-abnormal nuclei but not definitely dyskaryosis

-> HPV DNA test
-: normal smear routine
+: colposcopy
?: smear/HPV in 6 months

83
Q

What does a mild dyskaryosis cervical cancer screening result mean and what action would then be taken?

A

CIN1

-> HPV DNA test
-: normal smear routine
+: colposcopy
?: smear/HPV in 6 months

84
Q

What does a moderate cervical cancer screening result mean and what action would then be taken?

A

CIN 2

-> colposcopy

85
Q

What does a severe cervical cancer screening result mean and what action would then be taken?

A

CIN 3

-> colposcopy

86
Q

What does a glandular neoplasia cervical cancer screening result mean and what action would then be taken?

A

adenocarcinoma

->cancer management

87
Q

Average age of menopause?

A

51

88
Q

what counts as early meno pause?

A

40-45 years old

89
Q

what are the most common menopause symptoms

A

Menstrual irregularity
hot flushes/sweats
Urinary symptoms: UTIs incontinence
Vaginal symptoms: dyspareunia, dryness
Disturbed sleep
Mood: anxiety, depression, memory loss, difficulty concentrating
loss of libido

90
Q

which diseases are associated with menopause?

A
  • Cardiovascular: stroke, coronary artery disease
  • osteoporosis
  • Alzheimers
91
Q

What management is availble for menopause?

A

Healthy lifestyle

HRT

92
Q

What are the risks of HRT?

A
  • VTE
  • stroke
  • breast cancer
  • endometrial cancer
93
Q

What is antepartum haemorrhage?

A

bleeding from 24w - birth

94
Q

How do you classify APH?

A
  • minor <50mls
  • major 50-1000 mls
  • massive >1000mls and/or shock
95
Q

What are the common causes of APH?

A

Placenta praevia
Placental abruption
Cervical Ectropion
Trauma
Infection

96
Q

What is placenta praevia and what are the risk factors?

A

Placental implatned low in uterus ± covering the OS

  • Previous CS
  • Hx
  • increased parity
  • increased age
97
Q

Presentation of placenta praevia?

A

Intermittent painless bleeding

98
Q

investigations in placenta praevia

A

DONT VE
USS- baby breech and transverse lie

fetal well being: CTG

99
Q

What is the management of placenta praevia?

A

C-section

100
Q

What is placental abruption and what are the risk factors ?

A

separation of the placenta

  • Hx
  • Pres E, HTN
  • IUGR, twins
  • smoking, cocaine
101
Q

How does placental abruption present?

A

abdo pain and bleeding (can be underestimated)

102
Q

Examination findings in placental abruption?

A

woody tender uterus

103
Q

Management of placental abruption

A
  • ABCDE
  • IV fluids
  • bloods, G&S
  • delivery if fetal distress or >37
104
Q

Cervical ectropion

what, presentation and management

A

Columnar epithelium present outside cervix, oestrogen related

Px: PCB
Mx: cautery

105
Q

What are desensitising events?

A
  • Abortion, miscarriage, ectopic
  • Aminocentesis
106
Q

Symptoms of Turners by age

A

newborn: SFD, cardiac stuff
infancy: feeding diffs, poor weight gain
Pre-school: short stature, OME
School: obesity, impaired puberty, learning diffs
adult: infertility, obesity, autoimmune disorders

107
Q

Physical features of Turners

A
  • low set ears
  • short webbed neck
  • wide spaced nipples
  • pectus excavatum
108
Q

Investigations for Turners

A

Chromosomal analysis

LH/FSH: decreased ages 4-10, increased otherwise

109
Q

Management of Turners

A

MDT: paeds, ophthal, ENT, dentist, cardio, urology

rhGH - increase growth
oestrogen and progesterone

110
Q

Cardiovascular problems associated with Turners

A

Coarctation of the aorta.

Bicuspid aortic valve; aortic stenosis.

Aortic aneurysms.

Mitral valve prolapse.

111
Q

What is HELLP syndrome?

A

Haemolysis Elevated Liver enzymes Low Platelets

112
Q

How does HELLP present?

A

Worse at night, non specific

  • headache
  • abdo pain
  • eye blurr

OE: oedema, HTN, proteinuria

113
Q

What increases risk of HELLP

A

History, nulli, >35 gestational HTN history, APS

114
Q

Investigations for HELLP

A
  • Haemolysis: blood film and high LDH
  • Elevated Liver: high AST or ALT
  • Low Platelets
115
Q

Management of HELLP

A

>34 weeks: delivery
<34weeks: corticosteriods

RC, platelets, FFP, cryoprecipitate, as needed

116
Q

What is a PPH

A

loss of >500ml blood <24 hours after delivery

117
Q

What are the causes of PPH?

A

Tone - most common
Tissue: retained placenta
Trauma: tears
Thrombin: DIC

118
Q

How do you manage PPH?

A

ABCDE
Group and save
Oxytocin - ergometrine - tranexamic acid
Uterine massage
B Lynch sutures if above not effective

119
Q

PPH risk factors?

A

Large Baby

Multip

Long Labour

phase 3a (9 decks)

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