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HYMS Y5 > OBS + GYNAE > Flashcards

OBS + GYNAE Flashcards

1
Q

Which form of contraception is effective immediately?

A

Copper IUD.

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2
Q

Which form of contraception is effective after 2 days?

A

POP.

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3
Q

Which forms of contraception are effective after 7 days?

A

COCP
Implant
Injection
IUS

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4
Q

Which types of contraception consist of combined hormones?

A

COCP

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5
Q

Which types of contraception contain only progesterone?

A

POP
Implant
Injection
IUS

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6
Q

Which types of contraception are non-hormonal?

A

Copper IUD

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7
Q

Mechanism of action of COCP?

A

Inhibits ovulation.

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8
Q

Mechanism of action of POP?

A

Thickens cervical mucous.

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9
Q

Mechanism of action of contraceptive implant?

A

Primary MoA = inhibits ovulation.

Secondary MoA = thickens cervical mucous

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10
Q

Mechanism of action of contraceptive injection?

A

Primary MoA = inhibits ovulation.

Secondary MoA = thickens cervical mucous

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11
Q

Mechanism of action of copper IUD?

A

Decreases sperm motility and survival due to toxic effects.

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12
Q

Mechanism of action of hormonal IUS?

A

Primary MoA = prevents endometrial proliferation.

Secondary MoA = thickens cervical mucous.

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13
Q

Most effective form of contraception?

A

Implant.

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14
Q

How long does the contraceptive implant last?

A

3 years.

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15
Q

How long does the Depo Provera last?

A

3 months.

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16
Q

How long does the copper IUD last?

A

5-10 years.

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17
Q

How long does the hormonal IUS last?

A

3-5 years.

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18
Q

When does the POP provide immediate contraceptive protection?

A

If commenced up to or on dat 5 of the cycle.

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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.

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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.

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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.

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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.

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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.

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24
Q

When is the cerazette (desogestrel) POP considered as being taken late?

A

If taken >12 hours late (>36 hours after last one).

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25
Q

When are all POPs aside from desogestrel considered as being taken late?

A

If taken >3 hours late (>27 hours after last one).

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26
Q

What actions are required if a patient takes a POP late

A

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.

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27
Q

UKMEC 3 COCP contraindications.

A 
>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
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28
Q

UKMEC 4 COCP contraindications.

A 
>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
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29
Q

When is contraception required from in the postpartum period?

A

From 21 days.

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30
Q

An inter-pregnancy interval of <12/12 is associated with which complications?

A

Increased risk preterm birth
Increased risk low birth weight
Small for gestational age baby

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31
Q

Which methods of contraception can be started any time postpartum regardless of breastfeeding?

A

POP

Injectable contraception

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32
Q

How quickly is POP effective if started on day 21 in the postpartum period?

A

Immediately

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33
Q

How quickly is injectable contraception effective if given on or before day 21 in the postpartum period?

A

Immediately

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34
Q

How quickly is POP effective is started after day 21 in the postpartum period?

A

After 2 days.

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35
Q

1) Which injectable contraception can be given immediately after birth?
2) Which injectable contraception causes heavy bleeding if given immediately post partum?

A

1) Norethisterone.

2) Medroxyprogesterone.

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36
Q

When can the IUD or IUS be inserted to provide effective contraception?

A

Within 48 hours of delivery or after 4 weeks of delivery.

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37
Q

What are the contraindications to IUD/IUS insertion directly after childbirth?

A

Intrapartum/ postpartum sepsis

Prolonged rupture of the membranes

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38
Q

Why can the COCP not be used for contraception in the first 21 days after childbirth?

A

Due to increased risk of VTE postpartum.

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39
Q

When can the COCP be used as contraception after childbirth?

A

On day 21 if not breastfeeding.

After 6 weeks if breastfeeding.

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40
Q

What are the conditions that need to be met to ensure that lactational amenorrhoea as a form of contraception is effective?

A

Full breastfeeding
Amenorrhoeic
<6/12 postpartum

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41
Q

When is contraception required for peri-menopausal women?

A

If <50, until they are amenorrhoeic for 2 years.

If >5/= 50, until they are amenorrhoieic for 1 year.

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42
Q

Which forms of contraception can be used up until the age of 50?

A

COCP

Depo Provera

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43
Q

Which forms of contraception can be continued in patients older than 50?

A

POP
Implant
IUS

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44
Q

Management of uncomplicated candidiasis?

A

1st = PV clotrimazole

2nd = PO fluconazole or itraconazole

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45
Q

Management of complicated candidiasis?

**DM/ immunocompromised/ pregnant.

A

PV clotrimazole/ miconazole for 7/7.

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46
Q

Management of severe candidiasis?

A

1st = PO fluconazole

2nd = PV clotrimazole

47
Q

Management of trichomonas?

A

PO metronidazole.

48
Q

Pathognomonic feature of trichomonas?

A

Strawberry cervix.

49
Q

Features of bacterial vaginosis?

A

Grey-white, thin, homogenous, fish-smelling discharge
Vaginal pH >4.5
No soreness, itching or irritation

50
Q

Features of vaginal candidiasis?

A

Vulval itching/ soreness/ irritation/ inflammation
Vulval erythema
White cottage cheese-like, non-offensive discharge
Superficial dyspareunia
Dysuria
Vaginal excoriations

51
Q

Features of trichomonas?

A 
Frothy, yellow-green discharge
Vulval itching
Dysuria/ frequency
Offensive odour
Lower abdominal pain
pH >4.5
52
Q

Management of symptomatic bacterial vaginosis?

A 
1st = PO metronidazole
2nd = PV metronidazole/ PV clindamycin
53
Q

Clinical features of primary episode of genital herpes?

A 
Bilateral painful blisters
Blisters burst to leave erosions and ulcers
Dysuria
Vaginal + urethral discharge
Systemic upset
Pruritis
54
Q

Clinical features of secondary episode of genital herpes?

A

Unilateral painful blisters

Prodromal burning or tingling sensation (lasts hours to days)

55
Q

Cause of genital herpes?

A

Herpes simplex 1 or 2

56
Q

Management of primary episode of genital herpes?

A

Oral acyclovir

57
Q

Management of infrequent recurrent episodes of genital herpes?

A

Episodic antiviral therapy

**Infrequent = <6 episodes a year

58
Q

Management of frequent recurrent episodes of genital herpes?

A

Suppressive antiviral therapy

**Frequent = 6 or more episodes a year.

59
Q

How should management change in a HIV positive patient with genital herpes?

A

Double the dose of acyclovir or extend the treatment period.

60
Q

Clinical features of genital warts?

A

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
Q

Management of genital warts?

A

1) None (self-resolving in 6/12)
2) Podophyllotoxin/ Imiquimod
3) Cryotherapy/ excision/ electrocautery.

*Often 1st line.

62
Q

Method of termination of pregnancy if <9 weeks GA?

A

Mifeprostone + Prostaglandins (Misoprostol) 48 hours later.

63
Q

Method of termination of pregnancy if <13 weeks GA?

A

Surgical dilatation + suction of uterine contents.

64
Q

Method of termination of pregnancy if >15 weeks GA?

A

Surgical dilatation + evacuation of uterine contents.

65
Q

Termination of pregnancy can take place up to what gestational age?

A

Up to 24 weeks GA.

66
Q

HRT appropriate for patients with a uterus?

A

combined HRT

67
Q

HRT appropriate for patients without a uterus?

A

Oestrogen only HRT

68
Q

HRT appropriate for patients who are still menstruating or are within 12/12 of last period?

A

Oestrogen + cyclical progesterone.

69
Q

HRT appropriate for post-menopausal women?

A

continuous combined HRT.

70
Q

Risk factors for ectopic pregnancy?

A

Tubal damage (PID/ surgery/ ligation)
Previous ectopic
Endometriosis
IVF

71
Q

Gold standard investigation for ectopic pregnancy?

72
Q

hCG value in ectopic pregnancy?

A

high - >1500

73
Q

Most common site for an ectopic pregnancy?

74
Q

Most dangerous site for an ectopic pregnancy?

A

Isthmus (increased risk of rupture)

75
Q

When is surgical management of an ectopic pregnancy warranted?

A 
Size >35mm
Ruptured ectopic
Pain present
Foetal heartbeat present
hCG >5000

**Compatible if another pregnancy present

76
Q

When would medical management be advised over expectant for an ectopic?

A

If hCG >1000

77
Q

When would expectant management be advised over medical for an ectopic?

A

If there is another intrauterine pregnancy

78
Q

What does expectant management of an ectopic pregnancy involve?

A

Close monitoring for 48 hours.

If hCG rises or symptoms manifest, intervention is required.

79
Q

What does medical management of an ectopic pregnancy involve?

A

Giving methotrexate + following up.

80
Q

How do you follow up a patient who has been given methotrexate for management of an ectopic pregnancy?

A

Measure hCG on days 4+7 after giving methotrexate.

**If hCG has not fallen by >/=15%, give a second dose.

81
Q

What does surgical management of an ectopic pregnancy involve?

A

Salpingectomy (if contralateral tube is healthy)

Salpingotomy (if contralateral tube is not healthy + patient would like further children)

82
Q

Women who have had medical management of an ectopic pregnancy with methotrexate must use contraception for how long after?

A

At least 3 months.

83
Q

Describe features of a threatened miscarriage.

A

Painless vaginal bleeding + closed cervical os

**typically occurs at 6-9 weeks GA.

84
Q

Describe features of a missed miscarriage.

A

no or very mild symptoms + closed os + foetus remains in utero.

85
Q

Describe features of a complete miscarriage.

A

all foetal + placental tissue expelled and little bleeding afterwards.

86
Q

Describe features of an incomplete miscarriage.

A

not all foetal + placental material expelled
heavy bleeding
crampy abdomen

87
Q

Describe features of an inevitable miscarriage,

A

heavy bleeding
passing clots
pain
open cervical os

88
Q

What does expectant management of a miscarriage involve?

A

wait for 7-14 days for spontaneous completion of miscarriage

**appropriate if no heavy bleeding

89
Q

What does medical management of a miscarriage in T1 involve?

A

PV misoprostol ± antiemetics ± analgesia

90
Q

What does medical management of a miscarriage in T2 involve?

A

PV mifepristone

91
Q

What does surgical management of a miscarriage involve?

A

Vacuum aspiration under LA or surgical management in theatre under GA.

92
Q

What are the indications for medical/ surgical management of a miscarriage?

A

Increased risk of haemorrhage (late T1/ coagulopathies/ unable to have RBC transfusion)
Evidence of infection
Previous adverse/ traumatic experience associated with pregnancy

93
Q

T2 miscarriage is associated with what?

A

Bacterial vaginosis

94
Q

If there is a threatened miscarriage of a T2 pregnancy >14 weeks GA, what should you do?

A

Attempt to save the pregnancy with cervical cerclage.

95
Q

When is the booking appointment?

A

8-12 weeks

96
Q

Bloods done at booking appointment?

A 
FBC
ABO
Rh status
red cell alloantibodies
haemoglobinaopathies
Hep B
Syphilis serology
HIV
97
Q

When is the early scan to confirm dates?

A

10-13.6 weeks

98
Q

When is Down’s syndrome screening carried out?

A

11-13+6 weeks

99
Q

If Hb is <11 at the 16 week appointment, what should be done?

100
Q

When is the foetal anomaly scan?

A

18-20+6 weeks

101
Q

when is the first dose of anti-D given?

102
Q

When is the second screen for anaemia/ atypical red cell alloantibodies done?

103
Q

When should you consider giving PO iron for a patient at the 28 week appointment?

104
Q

When is the 2nd dose of anti-D given?

105
Q

What does the combined test involve?

A

Nuchal translucency measurement
Serum beta hCG
PAPP-A

106
Q

What results would you expect from the combined tests if a baby has trisomy 21?

A

high hCG
low PAPP-A
Thickened nuchal translucency

107
Q

What results would you expect from the combined tests if a baby has trisomy 13/ 18?

A

Same as in T1 but a very low PAPP-A

108
Q

Causes of increased AFP?

A

Neural tube defects
Abdominal wall defects
Multiple pregnancy

109
Q

Causes of decreased AFP?

A

Down’s syndrome
Edward’s syndrome
Maternal diabetes

110
Q

What is AFP?

A

A protein produced by a developing foetus.

111
Q

Where should the uterine fundus be at 12 weeks?

A

Pubic symphysis.

112
Q

Where should the uterine fundus be at 20 weeks?

A

Umbilicus.

113
Q

Where should the uterine fundus be at 36 weeks?

A

Xiphoid process of sternum.

HYMS Y5 (11 decks)

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