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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
27yo with 2 day hx of intermittent abdominal pain in the RLQ, what is your DDx?
Salpingitis Appendicitis Pyelonephritis Mittelschmerz pain (of exclusion)
26
Important aspects of gynaecological history to elicit in history
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
27
Initial tests for ectopic pregnancy
Pregnancy test | USS
28
RLQ pain in young female DDx
Appendicitis | Ectopic pregnancy
29
Gold standard Ix for diagnosis of endometriosis
Laparoscopy
30
Features of endometriosis
``` 25% asymptomatic 25% associated with other organ pathology Dysmenorrhea Pre/post menopausal bleeding Deep dysparenunia ```
31
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?
Endometriosis
32
What’s in a mirena coil?
Progesterone
33
``` Lower abdominal pain Foul smelling vaginal discharge Tender abdomen Obs stable DDx ```
Pelvic inflammatory disease | UTI
34
What does INVITED MD stand for?
``` Infection Neoplasm Vascular Idiopathic Trauma Endocrine Degenerative Metabolic ```
35
Treatment of gonorrhoea
IM ceftriaxone | Oral azithromycin
36
Treatment of chlamydia
Azithromycin
37
What is the cut off for Bishop’s score?
5
38
1st, 2nd and 3rd line fertility treatments in PCOS
Metformin + clomifene Ovarian drilling Assisted conception
39
How do you tell between a complete molar and partial molar pregnancy?
Partial molar you may see foetal tissue on USS whereas a complete would be a snowstorm appearance
40
USS shows endometrial thickness 2mm, what do you do?
Reassure and discharge | 5mm is the cut off where the risk of endometrial cancer is high and you would need to biopsy
41
Cause of vaginal bleeding, have to rule out significant pathology, often in older women
Atrophic vaginitis
42
Previous miscarriages and a rash on the leg that looks 'mottled' =>
Anti-phospholipid syndrome | Livedo reticularis is the rash
43
Which gynaecological cancer classically causes bloating and pressure symptoms?
Ovarian cancer
44
Female pt with amenorrhoea and newly diagnosed diabetes, encompassing diagnosis?
Haemochromatosis | Do iron studies
45
Abdominal striae Inability to get pregnant Irregular periods Ix?
Dexamethasone suppression test for Cushing's
46
1st line Ix if you suspect ovarian cancer?
CA-125
47
Most common type of ovarian cancer
Epithelial | Most common being serous cystadenocarcinoma
48
Weight gain Heavy periods Constipation Young female
Hypothyroidism
49
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?
Constipation | Most likely fibroids!
50
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?
Ovarian hyperstimulation
51
What should you offer patients with premature ovarian failure?
Fertility support | COCP to cover for oestrogen losses (needs to be opposed by progesterone)
52
How do you Dx ovarian failure?
FSH levels persistently high
53
Dx of PCOS
Sx -> TVUSS | TVUSS to check no increased endometrial thickness and also to count cysts
54
Mx of PCOS
COCP Clomifene for fertility and can add metformin if needed Fertility guidance
55
Drug for fertility in PCOS
Clomifene
56
What's the difference between a salpingectomy and salpingostomy and when might you use one vs the other
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
Causes of gynaecomastia
``` 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
What is Asherman's syndrome?
Adhesions in the uterus (often from previous surgery) lead to blockage of the menstrual cavity Can have abdominal pain and long standing amenorrhoea
59
What is a trachelectomy and when is it indicated?
Removal of cervix, upper vagina and lymph nodes | Indicated in cervical cancer when pt wishes to maintain fertility
60
What do large pedunculated fibroids mean you can't insert?
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
Treatment of endometriosis in fallopian tubes causing infertility
Laparoscopic endometrial ablation
62
Which drugs can cause hyperprolactinaemia (think of symptoms)
Anti-psychotics (e.g. risperidone)
63
Inter-menstrual bleeding, abdo discomfort and raised CA-125 =>
Pelvic inflammatory disease or endometrial cancer
64
The contraindications to HRT to really remember
Past, present or remitting breast cancer | Unprovoked PE in the past
65
Causes of a painful period
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
Bleeding in 52 year old post-menopausal woman who has just started COCP 2 months ago Mx?
This is normal within 3 months of starting COCP | After 3 months => cancer so 2ww
67
Hormone levels in PCOS
``` Normal FSH High LH High testosterone Low sex hormone binding globulin Raised LH:FSH ratio = KEY ```
68
Most common ovarian tumour in young women
Germ cell tumour
69
Most common ovarian tumour
Epithelial tumour
70
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?
Lichen sclerosus
71
What test should you do if the pt hasn't had a period for a while
Pregnancy test

Passmed finals (17 decks)

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