Obs and gynae Flashcards
Causes of raised MCV anaemia
B12 deficiency
Folate deficiency
Hypersegmented neutrophils seen in
B12 deficiency
Drug treatment for stress incontinence
Duloxetine
What are bad on a CTG?
Late decelerations
Normal foetal HR
100-160bpm
Symptoms of premenstrual syndrome
Low mood
Irritability
Headaches
Sleep disturbance
Treatment of premenstrual syndrome
Lifestyle advice
Small, frequent meals, reduce smoking and alcohol
Drospirenone-containing COC = Yasmin
New generation COCP
CBT
SSRIs (setraline)
Scoring system to predict success of induction
Bishop’s score
Most likely location of ectopic pregnancy
Ampulla of fallopian tube
Antibiotic for PPROM (ruptured membrane too early)
10 days erythromycin
Higher folic acid dose in pregnancy
5mg
Symptoms of endometriosis
Menstrual irregularity
Pain and deep dysparaerina
Infertility
May have complex adhesions
Chocolate cysts
Medical management of inevitable miscarriage
Vaginal misoprostol
Contraindication for use of instruments in delivery
Head palpable abdominally
Initial management of cord prolapse
Insert hand into vagina to elevate the presenting part
When should you start continuous CTG monitoring?
New onset vaginal bleed while in labour
Suspected sepsis or chorioamnionitis (temp 38
27yo with 2 day hx of intermittent abdominal pain in the RLQ, what is your DDx?
Salpingitis
Appendicitis
Pyelonephritis
Mittelschmerz pain (of exclusion)
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
What’s in a mirena coil?
Progesterone
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
Features of endometriosis
25% asymptomatic 25% associated with other organ pathology Dysmenorrhea Pre/post menopausal bleeding Deep dysparenunia
Gold standard Ix for diagnosis of endometriosis
Laparoscopy
RLQ pain in young female DDx
Appendicitis
Ectopic pregnancy
Initial tests for ectopic pregnancy
Pregnancy test
USS
27yo with 2 day hx of intermittent abdominal pain in the RLQ, what is your DDx?
Salpingitis
Appendicitis
Pyelonephritis
Mittelschmerz pain (of exclusion)
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
Initial tests for ectopic pregnancy
Pregnancy test
USS
RLQ pain in young female DDx
Appendicitis
Ectopic pregnancy
Gold standard Ix for diagnosis of endometriosis
Laparoscopy
Features of endometriosis
25% asymptomatic 25% associated with other organ pathology Dysmenorrhea Pre/post menopausal bleeding Deep dysparenunia
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
What’s in a mirena coil?
Progesterone
Lower abdominal pain Foul smelling vaginal discharge Tender abdomen Obs stable DDx
Pelvic inflammatory disease
UTI
What does INVITED MD stand for?
Infection Neoplasm Vascular Idiopathic Trauma Endocrine Degenerative Metabolic
Treatment of gonorrhoea
IM ceftriaxone
Oral azithromycin
Treatment of chlamydia
Azithromycin
What is the cut off for Bishop’s score?
5
1st, 2nd and 3rd line fertility treatments in PCOS
Metformin + clomifene
Ovarian drilling
Assisted conception
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
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
Cause of vaginal bleeding, have to rule out significant pathology, often in older women
Atrophic vaginitis
Previous miscarriages and a rash on the leg that looks ‘mottled’ =>
Anti-phospholipid syndrome
Livedo reticularis is the rash
Which gynaecological cancer classically causes bloating and pressure symptoms?
Ovarian cancer
Female pt with amenorrhoea and newly diagnosed diabetes, encompassing diagnosis?
Haemochromatosis
Do iron studies
Abdominal striae
Inability to get pregnant
Irregular periods
Ix?
Dexamethasone suppression test for Cushing’s
1st line Ix if you suspect ovarian cancer?
CA-125
Most common type of ovarian cancer
Epithelial
Most common being serous cystadenocarcinoma
Weight gain
Heavy periods
Constipation
Young female
Hypothyroidism
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!
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
What should you offer patients with premature ovarian failure?
Fertility support
COCP to cover for oestrogen losses (needs to be opposed by progesterone)
How do you Dx ovarian failure?
FSH levels persistently high
Dx of PCOS
Sx -> TVUSS
TVUSS to check no increased endometrial thickness and also to count cysts
Mx of PCOS
COCP
Clomifene for fertility and can add metformin if needed
Fertility guidance
Drug for fertility in PCOS
Clomifene
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
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
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
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
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
Treatment of endometriosis in fallopian tubes causing infertility
Laparoscopic endometrial ablation
Which drugs can cause hyperprolactinaemia (think of symptoms)
Anti-psychotics (e.g. risperidone)
Inter-menstrual bleeding, abdo discomfort and raised CA-125 =>
Pelvic inflammatory disease or endometrial cancer
The contraindications to HRT to really remember
Past, present or remitting breast cancer
Unprovoked PE in the past
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
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
Hormone levels in PCOS
Normal FSH High LH High testosterone Low sex hormone binding globulin Raised LH:FSH ratio = KEY
Most common ovarian tumour in young women
Germ cell tumour
Most common ovarian tumour
Epithelial tumour
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
What test should you do if the pt hasn’t had a period for a while
Pregnancy test
