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Obs & Gynae > Obs and gynae > Flashcards

Obs and gynae Flashcards

1
Q

What is the criteria for PCOS?

A

Must have 2 out of 3 criteria

1) Enlarged polycystic ovaries
2) Menstrual irregularities
3) Hyperandrogenism (androgens increased)

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2
Q

Symptoms for PCOS

A

Menstrual irregularities - oligomenorrhoea <9 periods/year or amenorrhoea

Hyperandrogenism - hirsutism, acne

Other symptoms - obesity, acanthosis nigricans, alopecia

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3
Q

Investigations for PCOS?

A

Hormonal blood tests - raised LH and raised LH:FSH ratio

Pelvic USS: 12 or more follicles or increased ovarian volume

Hyperinsulinemia

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4
Q

Mx for PCOS?

A

Reduce risks - weight loss, statins, stop smoking, healthy diet, exercise, antihypertensive

1st line - Clomiphene induces ovulation

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5
Q

What is an ectopic pregnancy?

A

Ectopic pregnancy is where fertilised egg implanted outside uterine cavity e.g. fallopian tubes and ovaries

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6
Q

Risk factors for ectopic pregnancy?

A

Sterilization, smoking, IUD or IUS, maternal age >35

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7
Q

Symptoms associated with ectopic pregnancy?

A

Missed period, constant lower abdominal pain in RIF/LIF, vaginal bleeding, referred shoulder tip pain

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8
Q

Investigation for ectopic pregnancy?

A

Transvaginal USS - identifies gestational sac in location

Positive pregnancy test

Serum hCG for confirmation

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9
Q

Mx for ectopic pregnancy?

A

Unruptured ectopic pregnancy - medical management using methotrexate

Ruptured ectopic pregnancy - laparoscopic salpingectomy to removed affected fallopian tube

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10
Q

What is endometriosis?

A

Growth of endometrial tissue outside uterus, commonly occurring in ovaries

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11
Q

Symptoms characteristic to endometriosis?

A

Chronic and cyclical pelvic pain for at least 6 months (associated with menstruation), deep dyspareunia and dysmenorrhoea

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12
Q

Mx for endometriosis?

A

Manage symptoms e.g. NSAIDs

Hormonal management e.g. GnRH to suppress ovarian function

Surgical management e.g. laparoscopic ablation - destroys endometrial tissue

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13
Q

What is benign ovarian cyst torsion?

A

Ovarian torsion is a condition where the ovary twists due to an ovarian mass such as a cyst or a tumour. It is more likely to occur with benign tumours.

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14
Q

Presentation for benign ovarian cyst torsion?

A

Sudden onset severe pelvic pain and palpable mass.

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15
Q

What presentation will show for ovarian cancer?

A

Abdominal distension and bloating, abdominal pain painless mass.

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16
Q

Investigations for ovarian cancer?

A

CA-125 tumour marker for ovarian cancer.

If CA-125 raised, do pelvic USS

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17
Q

What contraception reduces risk of ovarian cancer?

A

COCP reduces risk as fewer ovulations

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18
Q

Where is LH and FSH produced in body and its roles?

A

FSH stimulated development of follicles.

LH stimulate ovulation

Both are produced in anterior pituitary gland

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19
Q

Where is oestrogen and progesterone produced and its roles?

A

Oestrogen promotes female characteristics, it is a sex hormone produced by follicles in ovaries and corpus luteun

Progesterone thickens cervical mucus, alters endometrium and produced by corpus luteum.

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20
Q

What is the follicular phase, ovulation day and luteal phase?

A

Follicular phase day 1-14

Ovulation day 14

Luteal phase day 15-28

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21
Q

Difference between adenomyosis and endometriosis on bimanual examination?

A

Endometriosis - fixed retroverted uterus, uterosacral ligament nodules

Adenomyosis (endometrial tissue inside uterus) - boggy uterus

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22
Q

Best investigation to diagnose endometriosis?

A

Laparoscopy

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23
Q

Top causes of post-coital bleeding?

A

Cervical trauma, cervical polyps and cervical carcinoma.

24
Q

Cause of post menopausal bleeding?

A

Atrophic vaginitis

25
Q

Causes of PID?

A

N. gonorrhoeae, Chlamydia trachomatis.

26
Q

Presentation of PID?

A

Bilateral pelvic pain, vaginal discharge, dysmenorrhoea, fever, post-coital or inter-menstrual bleeding.

27
Q

What does Beta-HCG tumour marker indicate?

A

Germ cells tumour

28
Q

Medical Mx for abortion?

A

Abortion is ending of pregnancy <24 weeks, use misoprostol and mifepristone.

29
Q

What would be Mx after membrane sweep?

A

Induction of labour between 41+0 and 42+0 weeks.

30
Q

What is the weeks of each trimester 1,2,3?

A

Trimester 1 - week 1 to 13
Trimer 2 - week 14-26
Trimester 3 - week 27-40

31
Q

What is will be found on CTG indicating fetal hypxoxia?

A

Late decelerations

32
Q

Ovarian torsion vs ectopic pregnancy?

A

Ovarian torsion - abdominal mass no vaginal bleeding

Ectopic - vaginal bleeding, missed period

33
Q

What is the medical Mx for pregnant mother to prevent pre-eclampsia and VTE?

A

Dalteparin (from 28 weeks) for prophylaxis of VTE + 75mg aspirin (from 12 weeks) until 6 weeks postpartum

34
Q

What is premenstrual syndrome?

A

Symptoms linked to before and during start of menstruation e.g. breast tenderness, abdominal distention/bloating, loss of libido etc

35
Q

What is first line Mx for premenstrual syndrome?

A

SSRIs (e.g Citalopram 20mg OD initially for 3 months) are used off label as first line to help with mood/psychosomatic symptoms.

36
Q

What can cause foetal distress?

A

Foetal distress refers to multiple problems that occur before or during delivery.

Causes:

  • Shoulder dystocia
  • Multiple gestation
  • Umbilical cord prolapse (cord first)
  • Rh incompatibility
  • Cholestasis in pregnancy
37
Q

Presentation for foetal distress and Mx?

A
  • Decreased foetal movement
  • Abnormal CTG and fetal monitoring

Refer to hospital, to induce labour.

38
Q

What is female sexual dysfunction and its categories?

A

Female sexual dysfunction involves the decrease or increase of sexual responsiveness in females.

Sexual disinterest (absence or decrease in sexual interest/desire/thoughts/response)

Arousal disorder (lack of subjective and/or genital arousal)

Orgasmic disorder (absent or diminished intensity or delayed response to stimuli despite subjective arousal)

Dyspareunia (pain during intercourse or on attempted penetration, most common form is provoked vestibulodynia)

Persistent genital arousal (excessive genital arousal in the absence of stimulation)

39
Q

What conditions can cause sexual dysfunction?

A

Underactive thyroid, diabetes mellitus, hypertension, depression, drugs and alcohol.

40
Q

What medications can affect libido?

A
  • Antidepressants e.g. SSRI
  • Thiazide diuretics
  • Beta blockers
41
Q

What is miscarriage?

A

Spontaneous termination of pregnancy, early miscarriage occurs at <12 weeks, late miscarriage at 12-24 weeks.

42
Q

What is incomplete miscarriage?

A

Miscarriage with retained products of conception including fetus and placental tissue.

43
Q

What is inevitable miscarriage?

A

Vaginal bleeding with an opened cervix

44
Q

What is complete miscarriage?

A

Full miscarriage has occurred, no retained products of conception in uterus.

45
Q

What is missed miscarriage?

A

Fetus no longer alive, no symptoms occurred.

46
Q

What is the Mx for miscarriage >6weeks?

A

Medical Mx with misoprostol

Surgical Mx with vacuum aspiration

47
Q

What is threatened miscarriage?

A

Vaginal bleeding, closed cervical os and fetus alive.

48
Q

What is the action of misoprostol in miscarriage?

A

Misoprostol is a prostaglandin analogue, meaning it binds to prostaglandin receptors and activates them. Prostaglandins soften the cervix and stimulate uterine contractions.

49
Q

What is gravida and para and +?

A

Gravida is number of pregnancies, para delivery of foetus reaching 24 weeks regardless if it is alive. + means fetus not reaching 24 weeks.

50
Q

describe G3 P1+1 ?

A

Patient pregnant (before 24 weeks), had one abortion before 24 weeks, had one previous delivery.

51
Q

describe G2 + P2?

A

Patient had 2 pregnancies and 2 deliveries.

52
Q

What is pregnancy of unknown origin?

A

Woman has positive pregnancy test but no signs of intrauterine or extrauterine pregnancy on transvaginal USS.

53
Q

What is the investigation for pregnancy of unknown origin?

A

Serum B-HCG 48 hours apart.

  • If the levels fall then it is suggested that the foetus will not develop or there has been a miscarriage.
  • If there is only a slight increase or a plateau in B-hCG levels then this may indicate an ectopic pregnancy.
  • A large increase in B-hCG suggests the foetus is growing normally intrauterine.

Transvaginal USS at early days of gestation, the fetus may be too small, repeat scan at later date.

54
Q

Where can breast cancer metastasize too?

A
  • Bones
  • Liver
  • Lungs
  • Brain
55
Q

When are the routine scans for pregnancy?

A

routine scan (EDD, position of babies) - 12 weeks

Anomaly scan (11 conditions and organs) - 20 weeks + 6 weeks

Obs & Gynae (1 decks)

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