Obs and Gynae Flashcards by Georgia South

What is the first line treatment for a patient with menorrhagia?

Mirena coil (as long as they not trying to conceive)

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A patient comes into ED with scrotal pain and swelling, what are the possible differential diagnosis and how would you determine between them?

Torsion = sudden onset of severe pain with nausea and vomiting. The cremasteric reflex will be absent. May have bell clapper testis. 
Epididymo-orchitis = insidious onset and can have UTI/STI symptoms. The cremasteric reflex will still be present. 
Epididymitis = 15-30 (STD) or 60+ UTI.

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What area of the prostate undergoes hyperplasia in BPH?

Transitional area

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What is a epididymal cyst and how does it usually present?

A fluid filled cyst usually in the upper pole of the testis.

Painless scrotal mass

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O/E how does a epididymal cyst differ from a hydrocoele?

EC = painless cyst that you can get above and is palpable separately and it is fluctuant. It is also transilluminable.

Hydrocoele = soft non tender cystic swelling. Can get above the lesion however can not tell it from the testis as they are joined. Is also transilluminable

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How would you treat a epididymal cyst?

Asymptomatic = dont treat

Symptomatic = tapped or surgically removed.

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What is the pathophysiology of a hydrocoele?

Excess fluid in the tunica vaginalis

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What is a varicocoele?

Abnormal venous dilatation of the pampiniform plexus of the spermatic cord and scrotum.

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Which side is a varicocoele more likely?

Left side is much more common as the left testi vein drains directly into the renal vein with a lack of valves

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What is a infantile hydrocoele?

primary hydrocoele that interacts with the peritoneal cavity through a patent processus vaginalis. Small opening allowing a small amount of fluid to pass down the processus.

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How and when may a infantile hydrocoele present/

Near to birth. A fluid filled scrotum that is tense and non-tender and tends to be blue. It will disappear and when supine as the fluid returns to the abdomen.

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How is a infantile hydrocoele treated?

Usually left and observed (unless a hernia is suspected) until they child is about a year old where it is then surgically closed. Average age is 24-36 months old.

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What type of tumour are testicular tumours and what are the 2 subtypes?

Germ cell tumours

seminoma or teratoma

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Where do seminomas arise from?

Seminiferous tubules

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What is a teratoma?

mix of mature and immature cells often containing a wide range of tissues

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How may a testicular cancer present?

firm lump which may be painful or not. May have som para-aortic lymph node spread. May also experience testicular ache.

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How may you investigate possible testicular cancer?

Ultrasound
AFP, LDH, HCG - tumour markers
CT/MRI for metastasis diagnosis

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How may seminoma treatment differ from teratoma?

Seminoma = Chemo and radiotherapy sensitive

teratoma = Inguinal orchiectomy (castration)

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In testicular cancer where are metastasis likely to occur?

Lungs.

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What drug is given for the treatment of stress incontinence?

Duloxetine

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Definition.

Pre-eclampsia?

Hypertension and Proteinuria in a women over 24 weeks pregnant

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Definition

Placenta Praevia

A placenta situated in the lower part of the uterus near the cervix. Can be partially or fully covering the outlet

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Definition

Placental Abruption

Placenta separates from the wall of the uterus

Painful bleeding

Definition

Premature Labour

Labour earlier than 37 weeks gestation

Definition | Normal Labour

Pregnant women over 24 weeks gestation has regular painful uterine contractions and the cervix has dilated beyond 3cm The cervix is dilating 0.5cm per hour and the foetus is not distressed

Definition | Threatened preterm Labour

Women between 24-37 weeks gestation with a cervix under 3cm dilated

Definition | Latent phase of labour

Women over 37 weeks gestation who has a cervix dilated under 3cm

3 forms of abnormal labour

Under 0.5cm dilation per hour Foetal distress Lack of descent

What is the still birth rate (2020) in the UK per 1,000?

3.8 per 1,000

What is the neonatal death rate (2020) in the UK per 1,000 births?

1.3 per 1,000

What is the perinatal mortality rate in the UK per 1,000?

5 per 1,000

What is the maternal mortality rate per 100,000 in the UK?

7 per 100,000

Definition | Heavy Menstrual Bleeding

Menstrual bleeding with a heavy flow Typically determined by stats as over 80ml per period however in clinical context if a women finds it heavy then something should be done

Definition | Fibroids - Uterine

Benign tumour made of fibrous and muscular tissue. Occuring in the wall of the uterus and often causing heavy menstruation

Definition | Dysfunctional uterine bleeding

Heavy menstrual bleeding with no known cause

Definition | Prolapse - genitourinary

Organ displaced from its usual position | Due to vagina being empty space this area is more prone

Definition | Urinary incontinence - Stress

Incontinence when involuntary pressure is put on the bladder (coughing, laughing, sneezing)

Definition | Urinary incontinence - Urge

Involuntary contractions of the bladder muscle causing urgent need to urinate and a sudden loss of urine

Definition | Vasa Praevia

Foetal Blood vessels cross or run near the internal opening of the uterus

What 4 groups should be offered PrEP?

MSM High risk Sex workers Partner is new on HIV treatment (viral load) IVDU

What is PEP and what drugs are given as part of it? | How long does treatment last?

Post-exposure Prophylaxis Tenofovir and emtricitabine (1 tablet a day) and Raltegravir (1 tablet twice a day) 28 Days

How long after contact can PEP be given?

72 hours

A patient comes in for PEP what further testing needs to be done then and in the future?

Full screen and POC HIV test STI screen at 2 weeks HIV, syphilis, Heb B/C follow up and final HIV test at 12 weeks

What is the medication for PrEP?

Truvada (Emtricitabine / Tenofovir)

How often should someone on PrEP be monitored? | What monitoring should they have?

3 monthly | HIV test, Full STI testing and Renal assessment

What 5 drugs are used in Chemsex?

``` Crystal Meth Mephedrone GHB/GBL Ketamine MDMA ```

What vaccines are offered to MSM?

Hepatitis B | HPV (Men under 45 and now given to all boys age 12 - and girls)

A 25 year old girl with fishy smelling discharge (pH 5) Most likely cause? Management?

``` Bacterial Vaginosis Oral metronidazole (400mg BD 5-7 days) ```

20 year old with curdy white non-smelling discharge (pH 3.5). Most likely diagnosis Management

Candida | One dose of oral fluconazole

30 year old with painful ulcers and dysuria Most likely diagnosis Management

``` Herpes simplex (type 1) Acyclovir (500mg three times a day 5-10 days) ```

24 year old male with urethral discharge and testicular discomfort. Most likely diagnosis management

Chlamydia | Doxycycline (100mg BD 7 days)

Man with painless ulcer on penis for 2 weeks. most likely diagnosis management

Syphilis (treponema pallidum) | Single IM penicillin

Woman with frothy yellow discharge Most likely diagnosis management

``` Trichomonas Oral metronidazole (500mg BD 5-7 days) ```

Homosexual man with profuse yellow discharge and dysuria. Most likely diagnosis Management

Gonorrhoea | Single IM ceftriaxone 1g

Non-specific urethritis with negative chlamydia and gonorrhea tests Most likely diagnosis management

Mycoplasma Doxycycline (100mg BD 7 days) then Azithromycin (250mg, 4 tablets first day then two tablets for 2 days) §

What increases the risk of endometrial cancer? (9)

``` Nulliparous Late menopause/ Early menarche Obesity HNPCC PCOS Tamoxifen DM Oestrogen only (HRT/Contraceptive) ```

What is protective against endometrial cancer?

Combined oral contraceptive pill