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Phase 3a medicine > Obs&Gynae > Flashcards

Obs&Gynae Flashcards

1
Q

What are the two types or urinary incontinence?

A

Stress incontinence

Overactive bladder

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2
Q

What 5 things could you advise to conservatively manage urinary incontinence?

A
  1. Pelvic floor (stress)
  2. weight loss
  3. smoking cessation
  4. reduce caffeine intake
  5. avoid constipation
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3
Q

What may trigger leakage for someone with stress incontinence?

A

laughing/coughing/exercise

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4
Q

What are 3 key symptoms of someone with overactive bladder?

A
  • urgency
  • frequency
  • nocturia
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5
Q

what are 4 risk factors for urinary incontinence/prolapse?

A
  1. increasing age
  2. obesity
  3. smoking
  4. parity
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6
Q

What does gravidity mean?

A

number of pregnancies (regardless of outcome)

- INCLUDES CURRENT PREG

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7
Q

What does parity mean?

A

no of deliveries after 24 wks regardless of outcome

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8
Q

What are 2 risk factors for ovarian cancer?

A
  1. FH (BRCA1/BRCA2 gene)

2. many ovulations (early menarche/late menopause/nulliparity)

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9
Q

What is the classic symptom of endometrial cancer?

A

postmenopausal bleeding

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10
Q

What are 3 risk factors for endometrial cancer?

A
  1. obesity
  2. many ovulations (late menopause/early menarche etc)
  3. PCOS
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11
Q

Mutations of the BRCA2 gene are likely to increase the risk of which 2 cancers?

A
  1. breast cancer

2. ovarian cancer

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12
Q

Nulliparity is a risk factor for which 3 cancers?

A
  1. ovarian cancer
  2. endometrial cancer
  3. breast cancer
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13
Q

What are the characteristics of preeclampsia?

A
  1. BP >140/90mmHg
  2. After 20 weeks
  3. With proteinuria
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14
Q

What are 5 potential complications of preeclampsia to the mother?

A
  1. eclampsia
  2. cerebrovascular accident
  3. HELLP
  4. pulmonary oedema
  5. liver/renal failure
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15
Q

What are 3 potential complications of preeclampsia for the foetus?

A
  1. Fetal growth restriction
  2. Placenta abruption
  3. Fetal mortality
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16
Q

What are 5 risk factors for preeclampsia?

A
  1. HTN disease in prev pregnancy
  2. chronic kidney disease
  3. pre-existing HTN
  4. diabetes
  5. nulliparity
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17
Q

How would you confirm the diagnosis of preeclampsia?

A
  1. urine protein measurement (PCR)

2. sFlt-1:PIGF ratio assay

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18
Q

What is HELLP?

A

Haemolysis
Elevated Liver enzymes
Low Platelets

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19
Q

When is preeclampsia considered ‘early onset’?

A

Before 34 weeks

- typically foetus is growth restricted

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20
Q

Give 4 symptoms preeclampsia could present as?

A
  1. headache
  2. drowsiness
  3. epigastric pain
  4. nausea/vomiting
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21
Q

How do you treat eclampsia?

A

Magnesium sulphate and intensive surveillance for other complications

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22
Q

Which signs/symptoms would you expect to see if HELLP syndrome was present?

A
  1. Dark urine

2. Epigastric pain

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23
Q

What complication would you expect to see more commonly in early onset preeclampsia than late onset?

A

Foetal growth restriction

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24
Q

How would you reduce the risk of preeclampsia in vulnerable patients?

A

Low dose aspirin (75mg) started before 16wks

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25
Q

When would you give antihypertensives for preeclampsia? Which would you prescribe?

A

If BP >150/100mmHg

  • labetalol
  • second line: nifedipine
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26
Q

Where is the most common place for an ectopic pregnancy to grow?

A

Fallopian tubes - specifically ampullary

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27
Q

What could increase the risk of having an ectopic pregnancy? (4)

A
  1. prev ectopic
  2. prev fallopian tube surgery
  3. PID
  4. IVF
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28
Q

What are 4 of the most common symptoms of ectopic pregnancies?

A
  1. abdominal pain
  2. pelvic pain
  3. amenorrhoea
  4. vaginal bleeding (dark)
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29
Q

Which 3 symptoms would suggest intraperitoneal loss in a pt with ectopic pregnancy?

A
  1. syncope
  2. shoulder tip pain
  3. tachycardia
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30
Q

Why are ectopic pregnancies hard to diagnose?

A

Often present with atypical symptoms

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31
Q

What is the initial management of a suspected ectopic?

A
  1. pregnancy test
  2. observations
  3. abdo exam
  4. speculum
  5. bloods+cannulate (BHCG/group and save/FBC)
  6. transvaginal ultrasound
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32
Q

What is the medical management for ectopic pregnancy?

A

single dose methotrexate

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33
Q

What are the 4 indications for treatment with methotrexate in ectopic pregnancy?

A
  1. no significant pain
  2. unruptured ectopic with mass <35mm and no heartbeat
  3. no intrauterine pregnancy on scan
  4. serum hCG <1500 IU/L
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34
Q

What are 2 things you would want to check and 1 thing you would tell the patient when giving methotrexate?

A
  1. Check baseline LFT/EGFR function

2. tell pt they need to use contraception for next 3-6 months

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35
Q

Which hormone stimulates the production of milk?

A

Prolactin

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36
Q

What is the role of oxytocin in breastfeeding?

A

Causes contraction of myoepithelial cells surrounding mammary alveoli resulting in milk ejection

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37
Q

Which combination of maternal and fetal Rh statuses could risk Rhesus disease?

A

Rh-negative mother and Rh-positive baby

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38
Q

Give 4 cases in which Anti-D immunoglobulin should be given to mother?

A
  1. delivery of Rh +ve baby (live/stillborn)
  2. any ToP
  3. miscarriage if gestation >12 wks
  4. abdo trauma
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39
Q

What triad of symptoms would lead to a hyperemesis gravidarum diagnosis?

A
  1. 5% pre-pregnancy weight loss
  2. dehydration
  3. electrolyte imbalance
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40
Q

What is the first line medical management for hyperemesis gravidarum?

A
  1. antihistamine e.g. PROMETHAZINE or CYCLIZINE
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41
Q

Where is beta HCG produced?

A

placenta - synctiotrophoblast

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42
Q

What is the role of beta HCG?

A
  1. supports ovarian corpus luteum

2. corpus luteum then secretes progesterone that supports endometrium lining

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43
Q

Which 6 physiological effects does progesterone have on a pregnant woman?

A
  1. decreased BP
  2. constipation
  3. ureteral dilation
  4. bladder relaxation
  5. biliary stasis
  6. increased tidal volume
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44
Q

Why may pregnant women be more likely to develop anaemia?

A

Increased plasma volume disproportionate to increased RBC volume

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45
Q

Which 5 blood count results would you expect to be physiologically increased in pregnancy?

A
  1. WCC
  2. platelets
  3. ESR
  4. cholesterol
  5. fibrinogen
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46
Q

Which 3 blood test results would you expect to be physiologically decreased in pregnancy?

A
  1. albumin
  2. urea
  3. creatinine
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47
Q

Give 4 physiological changes caused by oestrogen in pregnancy?

A
  1. spider naevi
  2. palmar erythema
  3. skin pigmentation
  4. stimulate growth of myometrium
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48
Q

Why does glucose tolerance decrease in pregnancy?

A
  1. altered carb metabolism

2. antagonistic effects of human placental lactogen, progesterone and cortisol

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49
Q

What are 3 risk factors for developing gestational diabetes in pregnancy?

A
  1. BMI>30
  2. prev gestational diabetes
  3. 1st degree relative with diabetes
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50
Q

Why might the foetus develop hyperinsulinemia if mother is diabetic?

A
  1. glucose is transported across the placenta, but not insulin
  2. if mother’s blood glucose is high this can cause fetal hyperglycaemia
  3. the fetus increases its insulin levels to compensate
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51
Q

Give 4 complications of foetal hyperinsulinemia

A
  1. macrosomia
  2. organomegaly
  3. polyhydraminos
  4. increased rate of pre-term delivery
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52
Q

What is the management for gestational diabetes?

A
  1. Lifestyle
  2. metformin
  3. regular blood glucose monitoring
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53
Q

Why would you expect the cardiac output to increase in pregnancy?

A
  1. activation of renin-angiotensin aldosterone system
  2. results in increased plasma volume
  3. which in turn INCREASES STROKE VOLUME
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54
Q

Which 3 physiological changes happen to the urinary system during pregnancy?

A
  1. increased renal perfusion
  2. increased protein loss
  3. increased salt/water reabsorption
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55
Q

When are a couple considered ‘subfertile’?

A

If they haven’t conceived after a year of regular unprotected intercourse

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56
Q

What is the difference between primary and secondary subfertility?

A 
Primary = female has never conceived 
secondary = female has previously conceived (even if it ended in miscarriage etc)
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57
Q

What are the main causes for subfertility?

A
  1. anovulation (30%)
  2. male factor (25%)
  3. Tubal factor (25%)
  4. Unexplained (25%)
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58
Q

What preconception advice would you give to a couple trying to get pregnant? (5)

A
  1. intercourse 2-3x a week
  2. folic acid 0.4mg
  3. smoking cessation
  4. quit drinking
  5. Lose weight if BMI>30
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59
Q

What specific advice would you give to men trying to get pregnant? (3)

A
  1. don’t overheat testicles (think lorry driver)
  2. quit smoking/alcohol
  3. folic acid supplement
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60
Q

What test would you carry out as a GP to see if female is ovulating?

A

Mid-luteal progesterone level, 7 days before subsequent menstruation i.e. day 21 of 28 day cycle (expect to be above 30)

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61
Q

What criteria need to be met to diagnose PCOS?

A

2/3 of the Rotterdam Criteria

  1. oligo/amenorrhoea
  2. PCO on USS
  3. clinical/biochemical sign of hyperandrogenism
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62
Q

What physical signs might you notice in someone with PCOS? (4)

A
  1. acne
  2. obesity
  3. hirsutism
  4. alopecia
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63
Q

What can be offered to females with PCOS to address subfertility?

A
  1. clomifene/metformin

2. laparoscopic ovarian drilling/ gonadotrophins

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64
Q

Which key hormonal changes take place in patients with PCOS? (4 -big q)

A
  1. Raised levels of LH
  2. Raised ovarian androgen production
  3. Insulin resistance -> hyperinsulinemia
  4. Excess adrenal androgens -> reduced SHBG -> excess free androgen levels
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65
Q

The GP carries out a test for FSH in a female struggling to get pregnant. What would a low FSH suggest and how would you treat? (5)

A
  1. hypothalamic hypogonadism
  2. Kalman’s

Tx = gonadotrophins / normalise weight

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66
Q

The GP carries out a test for FSH in a female struggling to get pregnant. What would a high FSH suggest and how would you treat?

A

Menopause/ovarian failure

Tx = donor egg

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67
Q

The GP carries out a test for LH in a female struggling to get pregnant. What would a high LH suggest and how would you treat?

A

PCOS

Tx = clomifene/metformin
ovarian drilling/ gonadotrophin

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68
Q

Which infectious disease would you want to check for in a subfertile couple?

A

Rubella

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69
Q

What happens on days 1-4 of the menstrual cycle?

A

MENSTRUATION

- endometrium is shed once hormonal support is withdrawn

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70
Q

What happens on days 5-13 of the menstrual cycle?

A

PROLIFERATIVE PHASE

  1. pulses of GnRH from hypothalamus stimulate FSH and LH which induce follicular growth
  2. The follicles produce oestradiol which causes endometrium to proliferate and supress FSH production such that only one follicle matures
  3. As oestradiol levels rise they weirdly reach a positive feedback which leads to LH surge which causes ovulation
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71
Q

What happens on day 14-28 of the menstrual cycle?

A

LUTEAL PHASE

  1. follicle becomes corpus luteum
  2. corpus luteum produces relatively more PROGESTERONE than oestrogen which peak 7 days after ovulation
  3. glands swell/blood supply increases
  4. If corpus luteum not fertilised then it will fail and hormonal support is withdrawn leading to endometrium breakdown.
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72
Q

What are the causes of abnormal uterine bleeding?

A 
PALM COEIN 
(structural)
Polyps
Adenomyosis
Leiomyomas (fibroids)
Malignancy 
(non-structural)
Coagulopathy
Ovulatory dysfunction 
Endometrial 
Iatrogenic 
Not yet specified
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73
Q

What would a high/low antimullerian hormone result tell you?

A 
High = PCOS
Low = ovarian failure
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74
Q

How would you check the tubal patency of a subfertile female?

A

Hysterosalpingogram
OR
if high risk then laparoscopy/dye test

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75
Q

Give 2 hypothalamic causes of subfertility.

A
  1. Hypothalamic hypogonadism

2. Kallmann’s syndrome

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76
Q

You see a pt who runs ultra marathons and is severely underweight and struggling to get pregnant. What could be the cause? and treatment?

A

Hypothalamic hypogonadism
- reduction in hypothalamic GnRH causes reduced stimulation of FSH/LH and in turn reduced osetradiol levels.

Tx = normalise body weight

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77
Q

How does Kallmann’s cause subfertility?

A

GnRH neurones fail to develop

  • FSH/LH production not stimulated
  • oestradiol production not stimulated
  • anovulation
78
Q

Give 2 pituitary causes of subfertility

A
  1. hyperprolactinaemia

2. Sheehan’s syndrome

79
Q

How does hyperprolactinaemia cause subfertility?

A

excess prolactin secretion REDUCES GnRH release

80
Q

How is hyperprolactinaemia treated? What is the mechanism of the Tx?

A

Bromocriptine

  • dopamine agonist
  • dopamine inhibits prolactin release
81
Q

Give an adrenal cause of subfertility

A

Adrenal hyperplasia (excess androgens)

82
Q

Give 2 ovarian causes of subfertility

A
  1. PCOS

2. Premature ovarian failure

83
Q

What hormone changes take place in premature ovarian insufficiency/failure?

A
  1. ovary fails and stops oestradiol and inhibin production
  2. FSH/LH levels RISE
  3. AMH produced by follicles very low
84
Q

What is the best way to measure ovarian reserve?

A

Anti mullerian hormone (AMH)

- because it is produced in the ovary

85
Q

What are the long term risks of PCOS? (5)

A
  1. infertility
  2. miscarriage
  3. obesity
  4. diabetes
  5. endometrium Ca
86
Q

When would you recommend a subfertile couple begin assisted conception? (5)

A
  1. After 2 years of trying
  2. tubal blockage
  3. endometriosis
  4. male factor subfertility
  5. unexplained subfertility
87
Q

What are the two options for assisted conception?

A
  1. Intrauterine insemination (IUI)

2. In Vitro fertilisation (IVF)

88
Q

What are 5 risks of IVF?

A
  1. multiple pregnancy
  2. miscarriage
  3. ectopic pregnancy
  4. fetal abnormalities
  5. ovarian hyperstimulation syndrome
89
Q

What is the difference between primary and secondary amenorrhoea?

A

Primary = menstruation has not started by age of 16

Secondary = previously normal menstruation ceases for 3 months/more

90
Q

What are the 3 most common pathological causes of amenorrhea?

A
  1. premature menopause
  2. PCOS
  3. hyperprolactinaemia
91
Q

Give 4 physiological causes of secondary amenorrhea

A
  1. pregnancy
  2. lactation
  3. menopause
  4. drugs
92
Q

How does Sheehan’s syndrome cause amenorrhoea?

A

Severe post partum haemorrhage causes pituitary necrosis -> hypopituitarism

93
Q

What is the most common congenital cause of amenorrhea? How does it present?

A

Turners syndrome

  • missing X chromosome
  • short stature
  • poor secondary sex characteristics
94
Q

Which outflow tract problems could lead to primary amenorrhea? (2)`

A
  1. imperforate hymen

2. transverse vaginal septum

95
Q

Give 4 causes of primary amenorrhoea

A
  1. gonadal dysgenesis (e.g. Turner’s)
  2. androgen insensitivity syndrome
  3. functional hypothalamic amenorrhoea (e.g. 2ry to anorexia)
  4. congenital adrenal hyperplasia
96
Q

How would you investigate amenorrhoea? (4)

A
  1. exclude pregnancy with urinary/serum BHCG
  2. gonadotrophins level
  3. prolactin
  4. androgen levels
97
Q

Which condition causes endometrial tissue to break through into myometrium?

A

adenomyosis

98
Q

What mechanism does misoprostol use to induce termination of pregnancy?

A

Prostaglandin analogue

binds to myometrial cells causing strong contractions and cervical ripening

99
Q

What are the main side effects of misoprostol?

A
  • abdo pain

- diarrhoea

100
Q

Which drug is used alongside misoprostol to terminate pregnancies?

A

Mifepristone

101
Q

What blood test results would confirm menopause?

A
  • high FSH/LH

- low oestrogen

102
Q

What is the cause of the end of the menstrual cycle?

A

The demise of ovarian follicles

103
Q

Can a woman refuse emergency CS for foetal distress?

A

Yes

- unborn baby has no rights

104
Q

Give 5 risk factors of obesity during pregnancy to mother?

A
  1. pre-eclampsia
  2. VTE
  3. gestational diabetes
  4. mental health problems
  5. PPH
105
Q

Give 4 risks of obesity in pregnancy to the foetus?

A
  1. shoulder dystocia
  2. macrosomia
  3. stillbirth
  4. spina bifida
106
Q

What increases the risk of shoulder dystocia? (4)

A
  1. maternal diabetes
  2. large baby
  3. maternal obesity
  4. prev shoulder dystocia
107
Q

Which manoeuvre can help overcome shoulder dystocia?

A

McRobert’s manoeuvre

108
Q

What does small for gestational age (SGA) mean?

A

weight of fetus is less than tenth centile for its gestation

109
Q

What is intrauterine growth restriction? (IUGR)

A

where a fetus has failed to reach its own ‘growth potential’.

110
Q

What are risk factors for having a baby with IUGR? (4)

A
  1. smoking
  2. maternal stress
  3. severe anaemia
  4. substance abuse
111
Q

What are the two divisions of SGA babies?

A
  1. normal/constitutionally small

2. placenta mediated growth restriction

112
Q

What is placental insufficiency?

A

When oxygen/nutrients are not sufficiently transferred to the fetus via placenta during pregnancy

113
Q

What is the mechanism behind placental insufficiency?

A

failure of spiral uterine arteries to transform into large placental vessels

114
Q

What are the consequences of placental insufficiency on the fetus? (2)

A
  1. fetal hypoxemia

2. fetal growth restriction

115
Q

What are risk factors for placental insufficiency? (4)

A
  1. maternal hypertensive disorders
  2. smoking/alcohol/drugs
  3. primiparity
  4. advanced maternal age
116
Q

What are the main causes of antepartum haemorrhage? (2)

A
  1. placental abruption

2. placenta praevia

117
Q

What is placenta praevia?

A

When the placenta is implanted in the lower segment of the uterus

118
Q

What are the stages of the labour? (4)

A
  1. Latent phase
  2. First stage
  3. Second stage
  4. Third stage
119
Q

Why does the foetal head initially descend in transverse position?

A

The transverse diameter is greater than anterior/posterior diameter at PELVIC INLET

120
Q

What are the 8 movements of labour?

A
  1. Descent
  2. Engagement
  3. Flexion
  4. Internal rotation
  5. Extension
  6. Restitution
  7. External rotation
  8. Delivery of body
121
Q

Which factors encourage the foetal head to descend? (3)

A
  1. increased abdo muscle tone
  2. amniotic fluid pressure
  3. inc freq and strength of contractions
122
Q

What happens in the engagement stage of labour?

A

Largest diameter of foetal head descends into pelvis (head 3/5 palpable or less)

123
Q

What happens in the latent stage of labour? (3)

A
  1. contractions begin
  2. mucoid plug ‘show’
  3. cervix begins to efface and dilate (0-4cm)
124
Q

How long can the latent stage of labour last?

125
Q

What happens in the first stage of labour? (2)

A
  • established labour*
    1. stronger/more regular uterine contractions
    2. cervix continues to efface/dilate to 10cm
126
Q

What happens in the second stage of labour?

A

Full dilation to birth of foetus

127
Q

What happens in the third stage of labour?

A

From birth of baby to birth of placenta

128
Q

What causes the foetal head to flex during labour?

A

Pressure of uterine contractions forces occiput to come into contact with pelvic floor, foetal neck flexes to reduce head circumference

129
Q

By the second stage of labour which position would you expect the foetus to be in?

A

Expect it to have finished internal rotation

130
Q

What happens during the extension movement of the foetus during labour? (2)

A
  1. Foetal occiput slips beneath suprapubic arch

2. foetal head is born, facing maternal back with occiput anterior

131
Q

What happens during the restitution movement of the foetus during labour? (2)

A
  1. head is delivered and shoulders negotiate pelvic outlet

2. foetus may naturally align head with shoulders causing foetal head to externally rotate

132
Q

Why do healthcares delay cord clamping? (3)

A
  1. allows baby time to transition to extra-uterine life
  2. increase in RBC/iron/stem cells
  3. Reduce need for inotropic support
133
Q

What is a first degree perineal tear?

A

Small tear only affecting skin

134
Q

What is a second degree perineal tear?

A

Tears affecting muscle of perineum and the skin (require stitches)

135
Q

What is a third degree perineal tear?

A

tear that extends into anal sphincter

136
Q

What is the first line recommendation for induction of labour?

A

Membrane sweeping (treated as an adjunct)

137
Q

What is membrane sweeping?

A

Passing finger through the cervix and rotating it across the wall of the uterus to separate the chorionic membrane from the decidua

138
Q

Which scoring system is used to determine the ripeness of the cervix?

A

Bishop score

139
Q

What is the preferred method of pharmacological induction of labour?

A

Vaginal prostaglandin E2 (PGE2)

140
Q

What is the risk of PGE2 in inducing labour?

A

Uterine hyperstimulation

141
Q

What is a minor PPH?

A

Blood loss 500-1000ml without clinical shock

142
Q

What is a major PPH?

A

Blood loss greater than 1000ml and still bleeding OR clinical shock

143
Q

What are risk factors for PPH?

A
  1. multiple pregnancy
  2. previous PPH
  3. pre-eclampsia
  4. episiotomy
144
Q

What is endometriosis?

A

The presence of endometrial tissue outside of the endometrial cavity

145
Q

What are the three possible causes of endometriosis?

A
  1. retrograde menstruation
  2. embolisation
  3. metaplasia
146
Q

What is the typical presentation of someone with endometriosis? (5)

A
  1. young
  2. cyclical chronic pelvic pain
  3. dysmenorrhoea
  4. dyspareunia
  5. subfertile
147
Q

If a patient with suspected endometriosis also had dyschezia where would you expect endometrial tissue to have grown?

A

Pouch of Douglas

148
Q

What are risk factors for developing endometriosis? (3)

A
  1. FH of endometriosis
  2. nulliparous
  3. early menarche
149
Q

What can happen when endometrial tissue grows on the ovary?

A

Form an endometriomas (chocolate cyst)

- can rupture causing pain/inflammation

150
Q

What are the three main mechanisms of treating endometriosis pain?

A
  1. abolish cyclicity
  2. glandular atrophy
  3. address subfertility
151
Q

Which hormonal methods can be used to treat endometriosis?

A
  1. COCP
  2. POP
  3. Danazol
  4. GnRH modulators
152
Q

What is the purpose of COCP in treating endometriosis?

A

Ovarian suppression

153
Q

What is the purpose of POP in treating endometriosis?

A

Inhibits growth of endometrium

154
Q

What is the purpose of Danazol in treating endometriosis?

A

Steroid

  • inhibits mid cycle surges of FSH/LH
  • prevents steroidogenesis in corpus luteum
155
Q

Why does endometriosis regress during menopause/pregnancy?

A

It is oestrogen dependent

156
Q

How is endometriosis diagnosed?

A

Laparoscopy +/- biopsy

157
Q

Give 4 differential diagnoses of endometriosis?

A
  1. adenomyosis
  2. chronic PID
  3. chronic pelvic pain
  4. IBS
158
Q

What would make you suspect adenomyosis over endometriosis in a history of chronic pelvic pain?

A

Adenomyosis patients tend to be older and multiparous

159
Q

What is chronic pelvic pain?

A

Intermittent/constant pain in the lower abdo/pelvis for at least 6 months

160
Q

Which organisms are most commonly responsible for PID?

A

Chlamydia (60%)

Gonorrhoea

161
Q

If a young lady comes in who’s high risk sexually and has RUQ pain, what would you suspect?

A

Perihepatitis (Fitz-Hugh-Curtis syndrome)

  • due to adhesions between liver and anterior abdo wall
162
Q

What is a typical presentation of PID? (3)

A
  1. bilateral lower abdo pain
  2. deep dyspareunia
  3. abnormal vaginal bleeding/discharge

although often asymptomatic

163
Q

Which signs might you elicit in PID? (4)

A
  1. fever
  2. bilateral lower abdo tenderness
  3. cervical excitation
  4. tachycardia
164
Q

Which investigations would you carry out if you suspected PID?

A
  1. endocervical swab for C&G
  2. blood cultures if fever
  3. wet-mount vaginal smear (looking for pus cells)
165
Q

Give 3 differential diagnoses of PID

A
  1. ectopic pregnancy (do pregnancy test to rule out)
  2. acute appendicitis
  3. endometriosis
166
Q

What are late complications of PID? (3)

A
  1. ectopic pregnancy
  2. subfertility
  3. chronic pelvic pain
167
Q

What are the four main causes of PPH?

A
  1. Tone (lack of uterine tone)
  2. Tissue (retained products of placenta)
  3. Thrombin (clotting e.g. pre-eclampsia)
  4. Trauma (tears)
168
Q

How is PID treated?

A

With IM ceftriaxone followed by doxycycline + metronidazole

169
Q

What are fibroids?

A

Leiomyomata

- benign smooth muscle tumours of the myometrium

170
Q

What are risk factors for having fibroids? (5)

A
  1. increasing age (pre-menopause)
  2. black/asian
  3. obese
  4. affected first degree relative
  5. early menarche
171
Q

Why do fibroids regress after menopause?

A

Fibroids are oestrogen AND progesterone dependent so regress when sex hormones deplete

172
Q

What are the main presentations of fibroids? (4)

A
  1. asymptomatic (50%)
  2. menorrhagia
  3. erratic bleeding
  4. infertility
173
Q

How do you treat fibroids?

A
  1. GnRH agonist
  2. Ulipristal acetate
  3. myomectomy
174
Q

How would you differentiate between fibroids and adenomyosis?

175
Q

What are 4 complications of fibroids?

A
  1. torsion of pedunculated fibroid
  2. degenerations (red/hyaline)
  3. sarcomatous change
  4. complicates pregnancy
176
Q

What is a urethrocele?

A

A prolapse of the lower anterior vaginal wall (involving only the urethra)

177
Q

What is the name for a prolapse of the upper anterior vaginal wall involving the bladder?

178
Q

What is an apical prolapse?

A

Prolapse of uterus, cervix and upper vagina

179
Q

What is a prolapse of the upper posterior wall of the vagina called?

A

Enterocele

180
Q

What is a rectocele?

A

Prolapse of lower posterior wall of the vagina, involving anterior wall of the rectum

181
Q

What are the main causes of prolapse? (4)

A
  1. vaginal delivery/pregnancy
  2. menopause
  3. pelvic surgery
  4. chronic elevated abdo pressure (obesity/cough/constipation)
182
Q

What symptoms would you generally expect with a prolapse?

A
  1. dragging sensation

2. vaginal lump

183
Q

How are prolapses managed?

A
  1. weight loss/smoking/physio
  2. pessary
  3. surgical repair
184
Q

What is the difference between onset of primary and secondary dysmenorrhoea?

A

Primary = pain starts just before/within a few hours of period

Secondary = pain starts 3-4 days before onset of period

185
Q

What is the first line investigation in post menopausal bleeding?

A

Transvaginal ultrasound

186
Q

Which pharmcological management can be used during PMS?

A

SSRI continuously or just during luteal phase (proliferative phase)

187
Q

What are the symptoms of obstetric cholestasis?

A

Intense itching (without rash) typically worse on palms, soles and abdomen

188
Q

What is the management for obstetric cholestasis? (3)

A
  1. induction of labour at 37-38 weeks
  2. ursodeoxycholic acid
  3. vit K supplementation
189
Q

What blood results would you expect to see in obstetric cholestasis? (2)

A
  1. elevated bilirubin

2. mildly elevated LFTs

190
Q

What is the risk of pregnant people being infected with streptococcus agalactiae?

A

Causes Group B Strep (GBS) disease in the newborn which can cause pneumonia/meningitis/

191
Q

How does placental abruption usually present? (2)

A
  1. vaginal bleeding

2. continuous abdominal pain

192
Q

How is placental abruption managed when the fetus is alive and <36 weeks.

A

Admit and administer steroids

Phase 3a medicine (6 decks)

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