Obs Gynae Flashcards
Definition of Primary amenorrhoea
No periods since birth
13yo > and no other secondary sex characteristics (eg pubes)
15yo > And other puberty characteristics (eg titties)
Definitions:
1) Hypogonadotropic Hypogonadism
2) Hypergonadotropic Hypogonadism
1) Low LH and FSH. Problem with production
2) No responce to LH/FSH. Problem is in the ovaries
LH/FSH deficiency causes
Hypothalamus damage (radiotherapy)
Chronic condition, anorexia, coeliac, IBD, CKD.
Increased exercise or dieting
Growth and endocrine disorders
Hypergonadism
Turners syndrome xo
Damage to or lack of gonads
15 yo girl presents to GP. She is above average heigh, has deep voice, some facial hirsutism. Primary amenorrhoea
1) Likely diagnosis
2) Serious neonatal presentation
3) Hormone imbalances that will be present
4) Enzyme involved
5) Pattern of inheritance
1) Congenital adrenal hyperplasia
2) Electrolyte imbalance, hypoglycaemia
3) Low cortisol and aldosterone, raised androgens
4) 21-Hydroxylase deficiency
5) Autosomal dominant
Investigations for primary Amenorrhoea
1) Initial inx and why
2) Hormone inx and why
3) Imagining and why
1) FBC, ferritin (anaemia).
U/E for CKD.
Anti-ttg and anti-ema (coeliac)
2) TFTs (thyroid disease). FSH/LH (which hypogonadism). Prolatin (prolactinoma). Testosterone (PCOS)
3) wrist XR (bone age). MRI brain (pituitary). Pelvic USS (make sure all organs are there.
Pathology of androgen insensitivity syndrome
Body unable to respond to androgens
Will have female phenotype externally. But not female organs internally.
Definition of secondary amenorrhoea
No periods for 3 months following a regular cycle
Two most common causes of secondary amenorrhoea
Pregnancy and early menopause.
How can prolactin cause secondary amenorrhoea
Inhibits pituitary release of FHS and LH. Prolactinomas cause increased prolactin. Most common are pituitary adenomas - may be micro adenomas in which case would need repeat MRIs in order to identify development of tumour.
Inx for secondary amenorrhoea
Prolactin
FSH and LH (raised LH alone can indicate PCOS)
MRI head.
Management of amenorrhoea
Treat the cause
GnRH agonist can be used in hypodonotropic disease to promote fertility
If patient doesn’t want to be pregnant or it is an ovarian cause then COCP will provide hormone replacement therapy required.
Pt presents with PV bleeding and abdominal pain. They are pregnant.
1) What initial 2 tests should be done
2) The cervix is closed and their is a fatal HB. The pt wishes to cont with the pregnancy, how should this be managed?
1) Serum B HCG
2) Allow patient to go home with info + safety netting. To return is symptoms don’t settle in 14 days.
Pt presents with PV bleeding and abdominal pain. They are pregnant.
The TVUSS shows an open OS and retain products of conception.
1) How should this be initially managed.
2) How can this be medically managed
3) How can this be surgically managed
4) What must be done prior to surgery
Incomplete mistcarriage (can be managed the same as missed)
1) Expectant management - 7-14 days home, if symptoms don’t improve come back. Take pregnancy test at 3 weeks, should be negative.
2) Mistoprolol - prostogland - makes utters contract.
3) Manual vacuum aspiration
4) Anti-rhesus D immunoglobulin
What determines early and later miscarriage?
<12 weeks
12-24 weeks
common cause of miscarriage
genetic and chromosomal abnormalities
Patient presents with their third miscarriage. They have a PMH of DVT.
What 3 antibodies should be tested for?
Anti-phospholipid syndrome
Lupus anticoagulant
Anti-cardiolipin
Anti-b2-glycoprotein
Diseases that increase risk of miscarriage
Diabetes thyroid Inflam pelvic disease Thrombophilias cervical insufficiency
Inx needed for recurrent miscarriages
Pelvic USS Anti phospholipid abd Thrombophilia screen karyotyping Foetal genetic analysis
Patient presents with IF pain. They haven’t had a period in 9 weeks.
1) Likely diagnosis? Initial inx x 2
2) Criteria for expectant management?
3) Phamacological management and criteria
4) Pharmacological mx follow up
5) 2 x surgical procedures required
6) What should the pt receive prior to surgery
1) Ectopic preggers. TV USS + serum HCG
2) HCG < 1000, foetus < 35mm, no heart beat
3) HCG < 1500, no HB and <35mm. Single dose of methotrexate.
4) HCG at 4 and 7 days - should decline not plateau
5) Salpingectomy or salpingostomy
6) Anti-rhesus D immunoglobulin.
Pt presents with cyclical pelvic pain. And haematuria.
1) Most likely diagnosis and other common symptoms.
2) Gold standard inx
3) Staging system
4) Medical management. Hormonal and non-hormonal
5) surgical mx
1) Endometriosis. Deep dyspareunia
2) Laparoscopic surgery
3) ASRM (1 - 4)
4) Mefanamic acid. NSAIDS. COCP, Mirena coil. POP.
5) Surgical ablation. Adhesionolysis
Pregnant women (37yo) presents with painless vaginal bleeding at 32 weeks. She has not attended any of her antenatal scans. She smoked during the pregnancy.
1) Likely diagnosis
2) When is this normally diagnosed
3) Management (observations, drugs given, delivery)
1) Placenta previa
2) 20 week ananomaly scan
3) TV USS at 32 and 36 weeks. 34-35+6 weeks: give corticosteroids. Delivery at 36-37 weeks.
1) What is vasa previa
2) What are the risks
3) when are steroids given
4) when does delivery take place
1) Vessels outside of the placenta and lie over the internal OS.
2) Fetal death
3) 32 weeks
4) 34-36 weeks
34 week pregnant women presents with painful vaginal bleeding. She had known mildly raised BP throughout her pregnancy.
1) Diagnosis
2) Other signs and symptoms
3) Management (at least 7 things)
1) Placenta previa
2) WOODY ABDOMEN. Fetal distress. Hypotension + shock.
3) ….
Midwife, senior obstetrician, anaesthetist.
2 grey cannula
Bloods: usual + clotting + cm 4 units
Fluids + 0- + activate major haemorrhage pathway
steroids
rhesus prophylaxis (kleihauer test)
emergency c section
