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Passmed finals > Obs and gynae > Flashcards

Obs and gynae Flashcards

1
Q

Causes of raised MCV anaemia

A

B12 deficiency

Folate deficiency

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2
Q

Hypersegmented neutrophils seen in

A

B12 deficiency

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3
Q

Drug treatment for stress incontinence

A

Duloxetine

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4
Q

What are bad on a CTG?

A

Late decelerations

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5
Q

Normal foetal HR

A

100-160bpm

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6
Q

Symptoms of premenstrual syndrome

A

Low mood
Irritability
Headaches
Sleep disturbance

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7
Q

Treatment of premenstrual syndrome

A

Lifestyle advice
Small, frequent meals, reduce smoking and alcohol

Drospirenone-containing COC = Yasmin
New generation COCP
CBT
SSRIs (setraline)

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8
Q

Scoring system to predict success of induction

A

Bishop’s score

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9
Q

Most likely location of ectopic pregnancy

A

Ampulla of fallopian tube

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10
Q

Antibiotic for PPROM (ruptured membrane too early)

A

10 days erythromycin

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11
Q

Higher folic acid dose in pregnancy

A

5mg

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12
Q

Symptoms of endometriosis

A

Menstrual irregularity
Pain and deep dysparaerina
Infertility
May have complex adhesions

Chocolate cysts

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13
Q

Medical management of inevitable miscarriage

A

Vaginal misoprostol

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14
Q

Contraindication for use of instruments in delivery

A

Head palpable abdominally

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15
Q

Initial management of cord prolapse

A

Insert hand into vagina to elevate the presenting part

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16
Q

When should you start continuous CTG monitoring?

A

New onset vaginal bleed while in labour

Suspected sepsis or chorioamnionitis (temp 38

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17
Q

27yo with 2 day hx of intermittent abdominal pain in the RLQ, what is your DDx?

A

Salpingitis
Appendicitis
Pyelonephritis
Mittelschmerz pain (of exclusion)

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18
Q

Important aspects of gynaecological history to elicit in history

A

Menstruation; LMP, any pain, number of pads (quantify bleeding), length of cycle, regularity, age of menarchy, age of menopause, PMS issues, gravity/parity, hx of termination/miscarriage

Contraception; type, when it was sited (important for mirena for example)
FH; any breast cancer or endometrial

Vaginal bleeding; spotting, IMB, post-coital bleeding

Post menopausal bleeding = red flag

Smear; are they up to date, any abnormalities,

Sexual history; high risk behaviours, number of partners, any sexual health screening

Previous surgery; abdominal

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19
Q

What’s in a mirena coil?

A

Progesterone

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20
Q

27yo woman with 6mo Hx of intermittent pelvic pain. The pain is worst before and during her period.
She reports deep dyspareunia and intermittent spotting
What is your DDx?

A

Endometriosis

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21
Q

Features of endometriosis

A 
25% asymptomatic 
25% associated with other organ pathology 
Dysmenorrhea 
Pre/post menopausal bleeding 
Deep dysparenunia
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22
Q

Gold standard Ix for diagnosis of endometriosis

A

Laparoscopy

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23
Q

RLQ pain in young female DDx

A

Appendicitis

Ectopic pregnancy

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24
Q

Initial tests for ectopic pregnancy

A

Pregnancy test

USS

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25
Q

27yo with 2 day hx of intermittent abdominal pain in the RLQ, what is your DDx?

A

Salpingitis
Appendicitis
Pyelonephritis
Mittelschmerz pain (of exclusion)

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26
Q

Important aspects of gynaecological history to elicit in history

A

Menstruation; LMP, any pain, number of pads (quantify bleeding), length of cycle, regularity, age of menarchy, age of menopause, PMS issues, gravity/parity, hx of termination/miscarriage

Contraception; type, when it was sited (important for mirena for example)
FH; any breast cancer or endometrial

Vaginal bleeding; spotting, IMB, post-coital bleeding

Post menopausal bleeding = red flag

Smear; are they up to date, any abnormalities,

Sexual history; high risk behaviours, number of partners, any sexual health screening

Previous surgery; abdominal

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27
Q

Initial tests for ectopic pregnancy

A

Pregnancy test

USS

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28
Q

RLQ pain in young female DDx

A

Appendicitis

Ectopic pregnancy

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29
Q

Gold standard Ix for diagnosis of endometriosis

A

Laparoscopy

30
Q

Features of endometriosis

A 
25% asymptomatic 
25% associated with other organ pathology 
Dysmenorrhea 
Pre/post menopausal bleeding 
Deep dysparenunia
31
Q

27yo woman with 6mo Hx of intermittent pelvic pain. The pain is worst before and during her period.
She reports deep dyspareunia and intermittent spotting
What is your DDx?

A

Endometriosis

32
Q

What’s in a mirena coil?

A

Progesterone

33
Q 
Lower abdominal pain 
Foul smelling vaginal discharge
Tender abdomen 
Obs stable 
DDx
A

Pelvic inflammatory disease

UTI

34
Q

What does INVITED MD stand for?

A 
Infection
Neoplasm 
Vascular
Idiopathic
Trauma 
Endocrine 
Degenerative 
Metabolic
35
Q

Treatment of gonorrhoea

A

IM ceftriaxone

Oral azithromycin

36
Q

Treatment of chlamydia

A

Azithromycin

37
Q

What is the cut off for Bishop’s score?

A

5

38
Q

1st, 2nd and 3rd line fertility treatments in PCOS

A

Metformin + clomifene
Ovarian drilling
Assisted conception

39
Q

How do you tell between a complete molar and partial molar pregnancy?

A

Partial molar you may see foetal tissue on USS whereas a complete would be a snowstorm appearance

40
Q

USS shows endometrial thickness 2mm, what do you do?

A

Reassure and discharge

5mm is the cut off where the risk of endometrial cancer is high and you would need to biopsy

41
Q

Cause of vaginal bleeding, have to rule out significant pathology, often in older women

A

Atrophic vaginitis

42
Q

Previous miscarriages and a rash on the leg that looks ‘mottled’ =>

A

Anti-phospholipid syndrome

Livedo reticularis is the rash

43
Q

Which gynaecological cancer classically causes bloating and pressure symptoms?

A

Ovarian cancer

44
Q

Female pt with amenorrhoea and newly diagnosed diabetes, encompassing diagnosis?

A

Haemochromatosis

Do iron studies

45
Q

Abdominal striae
Inability to get pregnant
Irregular periods

Ix?

A

Dexamethasone suppression test for Cushing’s

46
Q

1st line Ix if you suspect ovarian cancer?

A

CA-125

47
Q

Most common type of ovarian cancer

A

Epithelial

Most common being serous cystadenocarcinoma

48
Q

Weight gain
Heavy periods
Constipation
Young female

A

Hypothyroidism

49
Q

A 30-year-old African lady presents to the General Practitioner (GP) with a 6-month history of menorrhagia. This is associated with lower abdominal cramps, increased frequency of urination and swollen legs. The patient denies dysmenorrhoea.

On bimanual examination, the patient has an irregular and enlarged uterus.

Given the most probable diagnosis, what additional symptoms may they have?

A

Constipation

Most likely fibroids!

50
Q

A 28-year-old woman presents to her GP with abdominal discomfort, nausea and vomiting over the last few days. She also informs the doctor that she thinks she’s put on about 4kg of weight over the same time frame. She has a history of pelvic inflammatory disease, and is currently having in-vitro fertilisation.

On examination, her abdomen is distended.

What is the most likely diagnosis?

A

Ovarian hyperstimulation

51
Q

What should you offer patients with premature ovarian failure?

A

Fertility support

COCP to cover for oestrogen losses (needs to be opposed by progesterone)

52
Q

How do you Dx ovarian failure?

A

FSH levels persistently high

53
Q

Dx of PCOS

A

Sx -> TVUSS

TVUSS to check no increased endometrial thickness and also to count cysts

54
Q

Mx of PCOS

A

COCP
Clomifene for fertility and can add metformin if needed
Fertility guidance

55
Q

Drug for fertility in PCOS

A

Clomifene

56
Q

What’s the difference between a salpingectomy and salpingostomy and when might you use one vs the other

A

Salpingectomy removes the fallopian tube but there’s no chance of pregnancy if already damage to the other side (e.g. previous abscess leading to removal of the tube)

In these cases, you can do salpingostomy to cut the fallopian tube open and take an ectopic out

57
Q

Causes of gynaecomastia

A 
Congenital absence of testes causing lack of testosterone production:
Androgen resistance
Klinefelter’s syndrome(XXY)
Trauma to the testes(e.g. castration)
Congenital adrenal hyperplasia

Other causes:
Renal disease and dialysis
Testicular tumours (e.g. Leydig’s tumour) secreting oestradiol
Tumours producing hCG hormone e.g. renal cell carcinoma
Liver cirrhosis leading to reduced clearance of adrenal androgens by the liver
Hyperthyroidism
Obesity
Medications (e.g. oestrogen containing compounds, digoxin, testosterone inhibitors, steroids, anti-psychotics causing increased prolactin levels)
Idiopathic

58
Q

What is Asherman’s syndrome?

A

Adhesions in the uterus (often from previous surgery) lead to blockage of the menstrual cavity
Can have abdominal pain and long standing amenorrhoea

59
Q

What is a trachelectomy and when is it indicated?

A

Removal of cervix, upper vagina and lymph nodes

Indicated in cervical cancer when pt wishes to maintain fertility

60
Q

What do large pedunculated fibroids mean you can’t insert?

A

IUS
Because wont stay in
In these cases (when the pt doesn’t want surgery but wants management of fibroid Sx), can offer COCP

61
Q

Treatment of endometriosis in fallopian tubes causing infertility

A

Laparoscopic endometrial ablation

62
Q

Which drugs can cause hyperprolactinaemia (think of symptoms)

A

Anti-psychotics (e.g. risperidone)

63
Q

Inter-menstrual bleeding, abdo discomfort and raised CA-125 =>

A

Pelvic inflammatory disease or endometrial cancer

64
Q

The contraindications to HRT to really remember

A

Past, present or remitting breast cancer

Unprovoked PE in the past

65
Q

Causes of a painful period

A

Primary dysmenorrhea = often from very first having periods. Usually comes on with the period itself

No changes on TVUSS and pain before the period and not from very first period => endometriosis

PID but usually with other Sx such as vaginal discharge or RUQ pain

66
Q

Bleeding in 52 year old post-menopausal woman who has just started COCP 2 months ago
Mx?

A

This is normal within 3 months of starting COCP

After 3 months => cancer so 2ww

67
Q

Hormone levels in PCOS

A 
Normal FSH 
High LH 
High testosterone 
Low sex hormone binding globulin 
Raised LH:FSH ratio = KEY
68
Q

Most common ovarian tumour in young women

A

Germ cell tumour

69
Q

Most common ovarian tumour

A

Epithelial tumour

70
Q

A 56-year-old woman presents to her GP with an itch in her groin, which is especially worse at night. Examination of the anogenital area reveals several white thickened plaques.

Which of the following is the most likely diagnosis?

A

Lichen sclerosus

71
Q

What test should you do if the pt hasn’t had a period for a while

A

Pregnancy test

Passmed finals (17 decks)

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