OBS + GYNAE Flashcards
1
Q
Which form of contraception is effective immediately?
A
Copper IUD.
2
Q
Which form of contraception is effective after 2 days?
A
POP.
3
Q
Which forms of contraception are effective after 7 days?
A
COCP
Implant
Injection
IUS
4
Q
Which types of contraception consist of combined hormones?
A
COCP
5
Q
Which types of contraception contain only progesterone?
A
POP
Implant
Injection
IUS
6
Q
Which types of contraception are non-hormonal?
A
Copper IUD
7
Q
Mechanism of action of COCP?
A
Inhibits ovulation.
8
Q
Mechanism of action of POP?
A
Thickens cervical mucous.
9
Q
Mechanism of action of contraceptive implant?
A
Primary MoA = inhibits ovulation.
Secondary MoA = thickens cervical mucous
10
Q
Mechanism of action of contraceptive injection?
A
Primary MoA = inhibits ovulation.
Secondary MoA = thickens cervical mucous
11
Q
Mechanism of action of copper IUD?
A
Decreases sperm motility and survival due to toxic effects.
12
Q
Mechanism of action of hormonal IUS?
A
Primary MoA = prevents endometrial proliferation.
Secondary MoA = thickens cervical mucous.
13
Q
Most effective form of contraception?
A
Implant.
14
Q
How long does the contraceptive implant last?
A
3 years.
15
Q
How long does the Depo Provera last?
A
3 months.
16
Q
How long does the copper IUD last?
A
5-10 years.
17
Q
How long does the hormonal IUS last?
A
3-5 years.
18
Q
When does the POP provide immediate contraceptive protection?
A
If commenced up to or on dat 5 of the cycle.
19
Q
Instructions for missing 1 COCP at any time?
A
Take missed pill ASAP.
Take next pill at normal time, even if this means taking 2 pills in one day.
**No emergency contraception needed.
20
Q
Instructions if more than 1 COCP is missed?
A
1) Take the last pill ASAP.
2) Take the next pill at normal time, even if this means taking 2 pills in one day.
3) Use barrier contraception until the pill has been taken for 7 days.
**Further steps depend on the time of cycle that the pills have been missed and if the patient has had UPSI.
21
Q
Additional steps if 2 COCPs are missed and the patient has had UPSI in week 1 or the pill free interval?
A
Emergency contraception required.
22
Q
Additional steps if 2 COCPs are missed and the patient has had UPSI in week 2 of cycle?
A
Use barrier contraception until pill taking has been re-established for 7 days.
23
Q
Additional steps if 2 COCPs are missed and the patient has had UPSI in week 3 of cycle?
A
Omit the pill free interval.
24
Q
When is the cerazette (desogestrel) POP considered as being taken late?
A
If taken >12 hours late (>36 hours after last one).
25
When are all POPs aside from desogestrel considered as being taken late?
If taken >3 hours late (>27 hours after last one).
26
What actions are required if a patient takes a POP late
1) Take missed pill ASAP and take next pill at normal time, even if this means taking 2 in one day.
2) Continue taking the rest of the pack.
3) Extra precautions (condoms) should be used until pill-taking has been re-established for 48 hours.
27
UKMEC 3 COCP contraindications.
```
>35 + smoking <15 a day.
BMI >35
FHx thromboembolic ideas in primary relative <45 y/o.
Controlled HTN
Immobility (including wheelchair use)
BRCA carrier
Current gallbladder disease
```
28
UKMEC 4 COCP contraindications.
```
>35 + smoking >15 a day
Migraine with aura
PMHx thromboembolic disease or thrombogenic mutation
PMHx of stroke or IHD
Breastfeeding <6 weeks post party
Uncontrolled HTN
Current breast cancer
Major surgery with prolonged immobilisation
Positive antiphospholipid antibodies
```
29
When is contraception required from in the postpartum period?
From 21 days.
30
An inter-pregnancy interval of <12/12 is associated with which complications?
Increased risk preterm birth
Increased risk low birth weight
Small for gestational age baby
31
Which methods of contraception can be started any time postpartum regardless of breastfeeding?
POP
| Injectable contraception
32
How quickly is POP effective if started on day 21 in the postpartum period?
Immediately
33
How quickly is injectable contraception effective if given on or before day 21 in the postpartum period?
Immediately
34
How quickly is POP effective is started after day 21 in the postpartum period?
After 2 days.
35
1) Which injectable contraception can be given immediately after birth?
2) Which injectable contraception causes heavy bleeding if given immediately post partum?
1) Norethisterone.
| 2) Medroxyprogesterone.
36
When can the IUD or IUS be inserted to provide effective contraception?
Within 48 hours of delivery or after 4 weeks of delivery.
37
What are the contraindications to IUD/IUS insertion directly after childbirth?
Intrapartum/ postpartum sepsis
| Prolonged rupture of the membranes
38
Why can the COCP not be used for contraception in the first 21 days after childbirth?
Due to increased risk of VTE postpartum.
39
When can the COCP be used as contraception after childbirth?
On day 21 if not breastfeeding.
| After 6 weeks if breastfeeding.
40
What are the conditions that need to be met to ensure that lactational amenorrhoea as a form of contraception is effective?
Full breastfeeding
Amenorrhoeic
<6/12 postpartum
41
When is contraception required for peri-menopausal women?
If <50, until they are amenorrhoeic for 2 years.
| If >5/= 50, until they are amenorrhoieic for 1 year.
42
Which forms of contraception can be used up until the age of 50?
COCP
| Depo Provera
43
Which forms of contraception can be continued in patients older than 50?
POP
Implant
IUS
44
Management of uncomplicated candidiasis?
1st = PV clotrimazole
2nd = PO fluconazole or itraconazole
45
Management of complicated candidiasis?
**DM/ immunocompromised/ pregnant.
PV clotrimazole/ miconazole for 7/7.
46
Management of severe candidiasis?
1st = PO fluconazole
2nd = PV clotrimazole
47
Management of trichomonas?
PO metronidazole.
48
Pathognomonic feature of trichomonas?
Strawberry cervix.
49
Features of bacterial vaginosis?
Grey-white, thin, homogenous, fish-smelling discharge
Vaginal pH >4.5
No soreness, itching or irritation
50
Features of vaginal candidiasis?
Vulval itching/ soreness/ irritation/ inflammation
Vulval erythema
White cottage cheese-like, non-offensive discharge
Superficial dyspareunia
Dysuria
Vaginal excoriations
51
Features of trichomonas?
```
Frothy, yellow-green discharge
Vulval itching
Dysuria/ frequency
Offensive odour
Lower abdominal pain
pH >4.5
```
52
Management of symptomatic bacterial vaginosis?
```
1st = PO metronidazole
2nd = PV metronidazole/ PV clindamycin
```
53
Clinical features of primary episode of genital herpes?
```
Bilateral painful blisters
Blisters burst to leave erosions and ulcers
Dysuria
Vaginal + urethral discharge
Systemic upset
Pruritis
```
54
Clinical features of secondary episode of genital herpes?
Unilateral painful blisters
| Prodromal burning or tingling sensation (lasts hours to days)
55
Cause of genital herpes?
Herpes simplex 1 or 2
56
Management of primary episode of genital herpes?
Oral acyclovir
57
Management of infrequent recurrent episodes of genital herpes?
Episodic antiviral therapy
**Infrequent = <6 episodes a year
58
Management of frequent recurrent episodes of genital herpes?
Suppressive antiviral therapy
**Frequent = 6 or more episodes a year.
59
How should management change in a HIV positive patient with genital herpes?
Double the dose of acyclovir or extend the treatment period.
60
Clinical features of genital warts?
Single/ multiple lesions in areas of high friction
Can appear as cauliflower-like growths of varying sizes
Lesions can coalesce into larger plaques (DM or immunocompromise)
Can be keratinised/ non-keratinised or pedunculated.
Terminal haematuria may indicate lesions in distal urethra.
61
Management of genital warts?
1) None (self-resolving in 6/12)
2) Podophyllotoxin*/ Imiquimod
3) Cryotherapy*/ excision/ electrocautery.
*Often 1st line.
62
Method of termination of pregnancy if <9 weeks GA?
Mifeprostone + Prostaglandins (Misoprostol) 48 hours later.
63
Method of termination of pregnancy if <13 weeks GA?
Surgical dilatation + suction of uterine contents.
64
Method of termination of pregnancy if >15 weeks GA?
Surgical dilatation + evacuation of uterine contents.
65
Termination of pregnancy can take place up to what gestational age?
Up to 24 weeks GA.
66
HRT appropriate for patients with a uterus?
combined HRT
67
HRT appropriate for patients without a uterus?
Oestrogen only HRT
68
HRT appropriate for patients who are still menstruating or are within 12/12 of last period?
Oestrogen + cyclical progesterone.
69
HRT appropriate for post-menopausal women?
continuous combined HRT.
70
Risk factors for ectopic pregnancy?
Tubal damage (PID/ surgery/ ligation)
Previous ectopic
Endometriosis
IVF
71
Gold standard investigation for ectopic pregnancy?
TVUS
72
hCG value in ectopic pregnancy?
high - >1500
73
Most common site for an ectopic pregnancy?
Ampulla
74
Most dangerous site for an ectopic pregnancy?
Isthmus (increased risk of rupture)
75
When is surgical management of an ectopic pregnancy warranted?
```
Size >35mm
Ruptured ectopic
Pain present
Foetal heartbeat present
hCG >5000
```
**Compatible if another pregnancy present
76
When would medical management be advised over expectant for an ectopic?
If hCG >1000
77
When would expectant management be advised over medical for an ectopic?
If there is another intrauterine pregnancy
78
What does expectant management of an ectopic pregnancy involve?
Close monitoring for 48 hours.
| If hCG rises or symptoms manifest, intervention is required.
79
What does medical management of an ectopic pregnancy involve?
Giving methotrexate + following up.
80
How do you follow up a patient who has been given methotrexate for management of an ectopic pregnancy?
Measure hCG on days 4+7 after giving methotrexate.
**If hCG has not fallen by >/=15%, give a second dose.
81
What does surgical management of an ectopic pregnancy involve?
Salpingectomy (if contralateral tube is healthy)
Salpingotomy (if contralateral tube is not healthy + patient would like further children)
82
Women who have had medical management of an ectopic pregnancy with methotrexate must use contraception for how long after?
At least 3 months.
83
Describe features of a threatened miscarriage.
Painless vaginal bleeding + closed cervical os
**typically occurs at 6-9 weeks GA.
84
Describe features of a missed miscarriage.
no or very mild symptoms + closed os + foetus remains in utero.
85
Describe features of a complete miscarriage.
all foetal + placental tissue expelled and little bleeding afterwards.
86
Describe features of an incomplete miscarriage.
not all foetal + placental material expelled
heavy bleeding
crampy abdomen
87
Describe features of an inevitable miscarriage,
heavy bleeding
passing clots
pain
open cervical os
88
What does expectant management of a miscarriage involve?
wait for 7-14 days for spontaneous completion of miscarriage
**appropriate if no heavy bleeding
89
What does medical management of a miscarriage in T1 involve?
PV misoprostol ± antiemetics ± analgesia
90
What does medical management of a miscarriage in T2 involve?
PV mifepristone
91
What does surgical management of a miscarriage involve?
Vacuum aspiration under LA or surgical management in theatre under GA.
92
What are the indications for medical/ surgical management of a miscarriage?
Increased risk of haemorrhage (late T1/ coagulopathies/ unable to have RBC transfusion)
Evidence of infection
Previous adverse/ traumatic experience associated with pregnancy
93
T2 miscarriage is associated with what?
Bacterial vaginosis
94
If there is a threatened miscarriage of a T2 pregnancy >14 weeks GA, what should you do?
Attempt to save the pregnancy with cervical cerclage.
95
When is the booking appointment?
8-12 weeks
96
Bloods done at booking appointment?
```
FBC
ABO
Rh status
red cell alloantibodies
haemoglobinaopathies
Hep B
Syphilis serology
HIV
```
97
When is the early scan to confirm dates?
10-13.6 weeks
98
When is Down's syndrome screening carried out?
11-13+6 weeks
99
If Hb is <11 at the 16 week appointment, what should be done?
PO iron
100
When is the foetal anomaly scan?
18-20+6 weeks
101
when is the first dose of anti-D given?
28 weeks.
102
When is the second screen for anaemia/ atypical red cell alloantibodies done?
28 weeks.
103
When should you consider giving PO iron for a patient at the 28 week appointment?
Hb <10.5.
104
When is the 2nd dose of anti-D given?
36 weeks.
105
What does the combined test involve?
Nuchal translucency measurement
Serum beta hCG
PAPP-A
106
What results would you expect from the combined tests if a baby has trisomy 21?
high hCG
low PAPP-A
Thickened nuchal translucency
107
What results would you expect from the combined tests if a baby has trisomy 13/ 18?
Same as in T1 but a very low PAPP-A
108
Causes of increased AFP?
Neural tube defects
Abdominal wall defects
Multiple pregnancy
109
Causes of decreased AFP?
Down's syndrome
Edward's syndrome
Maternal diabetes
110
What is AFP?
A protein produced by a developing foetus.
111
Where should the uterine fundus be at 12 weeks?
Pubic symphysis.
112
Where should the uterine fundus be at 20 weeks?
Umbilicus.
113
Where should the uterine fundus be at 36 weeks?
Xiphoid process of sternum.
