Obs & Gynae Gang Flashcards
(105 cards)
1
Q
Why is mid-luteal progesterone taken and when should it be measured?
A
To assess if a woman is ovulating.
Measure 7 days before the period (day 21 in a 28 day cycle, day 28 in a 35 day cycle etc.)
2
Q
Name 5 causes of recurrent miscarriage?
A
Blood clotting disorders (e.g. APS, F5LD, or SLE), structural abnoramlities of the uterus, infection (e.g. BV in late miscarriage), Endocrine issues (PCOS, poorly controlled DM, hyperprolactinaemia, thyroid disease), smoking, low BMI, increasing maternal age. Most commonly idiopathic!
3
Q
Define recurrent miscarriage?
A
Loss of 3 or more pregnancies before 24 weeks
4
Q
What is seen in testing in a molar pregnancy?
A
Very high Beta-HCG (>100,000 in complete), snow storm appearance on TVUS
5
Q
How do you treat an overactive bladder?
A
Oxybutalin, Mirabegron or Tolterodine
6
Q
Complications of endometriosis?
A
Sub-fertility, adhesions, chocolate cysts, frozen pelvis
7
Q
What are the most common SEs of the 2 pills?
A
POP = irregular bleeding COCP = breakthrough bleeding
8
Q
Name 5 absolute contraindications to COCP?
A
<6 weeks post-partum and breastfeeding, >35 and smoking >15 a day, HTN >160/100, personal history of VTE/CVA/AF/severe cirrhosis/complicated DM/IHD, current breast cancer, migraine with aura
9
Q
How do you treat BV?
A
NOT pregnant = Metronidazole single dose or twice daily for 5-7 days
ARE pregnant = Metronidazole twice daily 5-7 days
10
Q
How do you treat thrush?
A
Oral fluconazole or Clotrimazole pessary. If pregnant MUST have pessary (for up to 7 days)
11
Q
How often should you recieve a smear test?
A
25-49 = every 3 years
50-64 = every 5 years
>=65 only one (if last test was abnormal)
12
Q
Which HPV causes cervical cancer, which causes genital warts?
A
Cancer = 16, 18 Warts = 6, 11
13
Q
What are the Fraser Guidelines and Gillick Competence?
A
Fraser Guidelines = used specifically to decide if a child can consent to contraceptive or sexual health advice and treatment
Gillick Competence = concerned with determining a child’s capacity to consent
14
Q
What are the types of female sexual dysfunction?
A
- Low sexual desire. This most common of female sexual dysfunctions = lack of sexual interest and willingness to be sexual.
- Sexual arousal disorder. Desire for sex may be intact, but there is difficulty becoming aroused or maintain arousal during sexual activity.
- Orgasmic disorder. Persistent or recurrent difficulty in achieving orgasm after sufficient sexual arousal and ongoing stimulation.
- Sexual pain disorder. Pain associated with sexual stimulation or vaginal contact.
15
Q
What is Paraphillia?
A
Abnormal sexual behaviors or impulses characterized by intense sexual fantasies and urges that keep coming back. E.g. exhibisionism, fetishism and paedophillia
16
Q
What does tamoxifen treat?
A
Oestrogen receptor positive breast cancer
17
Q
What does herceptin treat? what is it also known as?
A
HER2 positive breast cancer (aka Trastuzumab it can also treat stomach cancer)
18
Q
What does Bishops socre indicate?
A
Likelyhood of spontaneous labour
>=8 = spontaneous labour is likely
<=5 = spontaneous labour is very unlikely - consider IOL
19
Q
What is the name of the surgical procedure used to correct cystolcele or rectocele?
A
Colporrhaphy
20
Q
The copper coil can be given the longest after UPSI. How long after ovulation is it affective for?
A
5 days
21
Q
Name 5 complications of multiple pregnancy?
A
Preterm labour, Gestational HTN/DM, anaemia, birth defects, miscarriage, twin-twin transfusion syndrome, abnormal lie, PPH, vasa praevia, placental abruption, cord prolapse
22
Q
How do you treat GBS in pregnancy?
A
IV Benzylpenicillin during labour
23
Q
How is the 3rd stage of labour activley managed?
A
Syntocinon/Syntometrine, Delayed cord clamping, placental traction (to assist removal)
24
Q
When are the anomoly and dating scans performed?
A
Anomoly = 18-20+6 Dating = 10-13+6
25
In the normal menstrual cycle which cells are sensitive to LH/FSH, what do they synthesise?
Theca cells = sensitive to LH, they synthesise progesterone and testosterone.
Granulosa cells = sensitive to FSH, they convert testosterone to oestrogen
26
Which hormone stimulates ovulation?
LH.
| Oestrogen levels surge causing a surge in LH which causes ovulation
27
What does the corpus luteum release, what does this do?
Progesterone and oestrogen.
Progesterone acts to proliferate the endometrium for implantation.
Progesterone is secreted until the placenta can release it or the corpus luteum degenerates into the corpus albicans
28
A 16 year old girl has not started her periods, has no secondary sexual characteristic and has low FSH/LH on blood test. What is this condition and what can cause it?
Hypogonadotrophic hypogonadism
Causes = pituitary gland damage, hypothalamic issues, hyperprolactinaemia, hypo/hyperthyroidism and Kallmann's syndrome (anosmia)
29
A 16 year old girl has not started her periods, has no secondary sexual characteristic and has high FSH/LH on blood test. What is this condition and what can cause it?
```
Hypergonadotrophic Hypogonadism - problem is with the gonads themselves.
Swyer syndrome (46XY)
Turner's syndrome (45XO)
Premature Ovarian Failure (46XX)
```
30
A 16 year old girl has not started her periods, has secondary sexual characteristic and has a uterus present on US. What is this condition and what can cause it?
Outflow tract obstruction (imperforated hymen or transverse vaginal septum).
Patients may experience cyclical abdominal pain but no bleeding. Patients may also have bloating due to build up of menstrual blood in the vagina (haematocolpus)
31
A 16 year old girl has not started her periods, has secondary sexual characteristic and has no uterus present on US. What is this condition and what can cause it?
```
Androgen Insensitivity (46XY) - X-linked recessive condition where by patient is resistant to testosterone but is genetically male. There will be palpable abdominal hernias but breast development due to oestrogen.
OR
Mullerian Agenesis (46XX) - failure of the development of the mullerian duct causign missing uterus and vaginal hypoplasia
```
32
Define secondary amenorrhoea?
Cessation of menstruation for 3-6 months in women with previously normal and regular periods or for 6-12 months in women with previously irregular periods
33
What is the order of treatment for women with PCOS who are struggling to concieve?
```
Lifestyle changes ->
Metformin (if overweight) ->
Letrozole (1st line) ->
Clomifine (2nd line now) ->
Laparoscopic ovarian drilling ->
IVF/IUI
```
34
How many withdrawal bleeds should you aim for a year in a woman with PCOS?
4
| Giver her the combined OC pill
35
How do you treat excess hair in women with PCOS?
Topical elfornine
36
Which 2 conditions could cause secondary amenorrhoea by outflow tract obstruction?
Asherman's syndrome = complication of uterine surgery. Caused by adhesions (e.g. after evacuation of retained products of conception)
OR
Cervical stenosis = complication of cervical trauma.
Stenosis is the cervical canal (e.g. after treatment for cervical dyskaryosis)
37
What is SHeehan's syndrome? How will LH and FSH levels be?
A complication of PPH where under perfusion of the anterior pituitary due to hypotension causes necrosis.
Low LH and FSH
38
Sx, Ix and Mx of hyperprolactinaemia?
Galactorrhoea, amenorrhoea, infertility
Ix = pituitary MRI
Mx = cabergoline or bromocriptine (dopamine agnoists)
39
What is premature ovarian failure?
<40, not on hormonal contraception with:
Menopausal symptoms - including no or infrequent periods
AND elevated FSH (>30) on two blood samples taken 4-6 weeks apart.
40
What can cause premature ovarian fialure?
Chemo/radiotherapy
Idiopathic
Autoimmunie
Infection (e.g. mumps)
41
Mx of Heavy menstrual bleeding?
Not trying to concieve = IUS 1st line, OC pill 2nd line
| Trying to concieve = tranexamic acid
42
How do uterine polyps present?
Menorrhagia and intermenstrual bleeding
43
How does adenomyosis present? What is the gold standard ivestigation?
How can you treat?
Menorrhagia and dysmenorrhoea
Ix = 1st line = TVUS. Consider MRI. Gold standard = biopsy after hysterectomy
Tx = IUS 1st line or NSAIDs and tranexamic acid if trying to concieve
44
What is the most common cause of PID?
Chlamydia
45
What is Fitz Hugh Curtis Syndrome?
Perihepatic inflammation producing right upper quadrant pain
| Complication of PID
46
Ix for PID?
Laparoscopy with fimbrial biopsy and culture
47
How is the uterus in severe endometriosis?
Fixed and retroverted
| Examination is painful
48
What is the gold standard investigation of endometriossi?
Laparoscopic visulisation of the pelvis and biopsy
49
Above what blood pressure could pre-eclampsia be diagnosed?
140/90
50
What is bleeding before 24 weeks classed as? What is it classes as after 24 weeks?
```
Before = threatened miscarriage
After = APH
```
51
What are the best delivery plans in placenta praevia?
Elective C-section at 36-37 weeks (give antenatal steroids)
52
Mx of placental abruption?
Foetal distress = cat 1 C-section
<36 weeks and no distress = observe, steroids and plan delivery
>36 weeks and no foetal distress = deliver vaginally
53
What is Lochia?
Normal bleeding after birth, will reduce over time and get darker. Occurs for up to 6 weeks
54
What is the likely cause of failure to progress in the 1st and 2nd stage of labour? WHat is the Mx?
```
1st = insufficient contractions, Mx = AROM, oxytocin or C-section
2nd = poor descent, Mx = instrumental or C-section
```
55
RFs for shoulder dystocia?
GDM and foetal macrosomia, previous shoulder dystocia, obestiy, multiple pregnancy and instrumental delivery
56
What is seen on blood tests in PCOS?
Normal: FSH, oestrogen, prolactin and TSH
High: LH (can be normal), Progesterone, Testosterone and Insulin (insulin resistance)
Low: Sex hormone binding globulin
57
What are the absolute contraindications to the copper IUD?
PID, pregnancy, abnormal uterine bleeding, fibroids which distort the uterine cavity or malignancy of the genital tract
58
What is the most risky form of abnoraml lie?
Footling presentation
59
What are the absolute contraindications to ECV?
C-section delivery is required, APH in the last 7 days, Abnormal CTG, Major uterine anomoly, ruptured membranes, multiple pregnancy
60
What are the management options for endometrial cancer?
Total abdominal hysterectomy and bilateral salpingo-oophorectomy (with or without post operative radiotherapy).
Progesterone therapy if elderly and too frail for surgery
61
Where is the most dangerous place for an ectopic pregnancy to be?
The isthmus
62
Above which gestational age is it appropriate to reffer to EPAU? What is the maximum gestational age you should reffer to EPAU?
6 weeks - 18 weeks
63
Mx for PID?
IM ceftriaxone (single dose) plus oral doxycyline and oral metronidazole
OR
Oral ofloxacin and oral metronidazole
64
When would a woman over 65 get a cerivcal smear?
If she has not had a smear since 50 or younger, if her last smear cytology was abnormal
65
Why is it good to do an ultrasound scan between 16-24 weeks in multiple pregnancy? Why is it good to scan after 24 weeks?
To detect twin-twin transfusion syndrome
| After 24 weeks we scan to detect foetal growth restriction
66
What is the classical triad of vasa praevia?
Painless vaginal bleeding and foetal bradycardia AFTER rupture of membranes
67
What is the most common form of endometriosis? What are the Sx of rupture?
```
Endometrioma (endometrial tissue in/on the ovary).
Acute abdomen (very painful and tender) and a fluid filled pelvis
```
68
RFs for placental abruption?
ABRUPTION
Abruption in previous pregnancy, Blood pressure (HTN, or pre-eclampsia), Ruptured membranes (premature or prolonged), Unterine atony, Polyhydramnios, Twins (multiple pregnancy), Infection, Older age (>35), Narcotics (cocaine, anfetamines and smoking)
69
What is the pathway for the Mx of PPH caused by uterine atony?
```
Bimanual uterine compression
IV oxytocin/ergometrine
IM carboprost
Intramyometrial carboprost
Rectal misoprostol
Balloon tamponade
Other surgical interventions
```
70
How do you decide wether to do salpingectomy or salpinjotomy in ectopic pregnancy?
Salpingectomy if the women currently has 2 fallopian tubes
| Salpingotomy if she only has 1 (e.g. previous ovarian tumour)
71
Which diseases can be screened for at the booking appointment?
Hep B, HIV, Rubella and Syphillis
72
Sx of a ruptures ovarian cyst?
Sudden onset unilateral pelvic pain precipitated by intercourse or strenuous activity
73
What stage does 75% of endometrial cancers present at?
Stage 1
74
When should smear test be done i pregnancy?
3 months after delivery.
| UNLESS missed screening or previous abnormal smears
75
What is the inital management of shoulder dystocia?
Call for senior help, perform McRobert's maenouver and apply suprapubic pressure
76
What should you do in gestational DM if the inital FPG is <7mmol/l?
Diet and exercise advice and get the woman to measure her blood glucose,
If not controlled after 1-2 weeks add metformin. If still not controlled add insulin
77
Who should get anti D at 28 and 36 weeks?
Rhesus negative mothers who are NOT yet sensitized!
78
When can coild be inserted after birth?
From 4 weeks post-partum
79
When can IOL be offered to healthy women?
At 41 weeks
80
What is the order of Mx in IOL?
- Membrane sweep
- Prostaglandin E2 vaginall
- Maternal oxytocin infusion
- Amniotomy
- Cervical ripening balloon
81
What does a womans serum progesterone levels indicate in regards to ovulation?
```
<16 = repeate, if still low reffer to speicalist
16-30 = repeate
>30 = ovulation has occured
```
82
How long should people with unexplained infertility, mild endometriosis or mild male factor infertility try to concieve before being offered IVF?
2 years
83
Describe how HepB transmission during pregnancy can be controlled?
Babies born to women women with chronic or acute HepB should be given a complete course of vaccinations and HepB immunoglobulins.
C-section can reduce verticle transmission
Breastfeeding is not associated with transmission
84
How do combined contraceptives work? Give examples?
Inhibit ovulation
| COCP, contraceptive patch and contraceptive ring
85
How do progesterone only pill work?
Thickens the cervical mucous and suppresses ovulation
86
How does the progesterone only implant work?
Inhibits ovulation
87
How does the progesterone only injection work?
Thickens the cervical mucous and suppresses ovulation
88
How does the IUS work?
Thickens cervical mucous and thins the endometrium
89
How does the IUD work?
Kills sperm and can inhibit implantation after fertilisation occurs by causing an inflammatory response in the uterus
90
How do levonogestrel and ulipristal acetate work?
Inhibit ovulation
91
Sx and Mx of Chlamydia?
```
Sx = pain/cervical excitation, mucopurulent endocervical discharge, dysuria and intermenstrual or post-coital bleeding
Mx = 7 days oral doxycycline or single dose oral azithromycin
```
92
Sx and Mx of Gonnorhoea?
```
Sx = Thin, watery and green/yellow vaginal discharge, easily induced cervical bleeding, pain, dysuria
Mx = single dose IM ceftriaxone
```
93
Sx and Mx of Syphillis?
Sx (primary) = Painless/non-itchy chancre and bilateral inguinal lymphadenopathy
(secondary) = Painless/non-itchy affecting the palms and soles, condylomata lata, silvery-grey mucous membrane lesions and painless lymphadenopathy
Mx = IM benzylpenicillin (single dose if early, 3 doses if late)
94
Sx and Mx of Trichomoniasis?
```
Sx = offensive, frothy, yellow/green vaginal discharge, itchy vulva, pain, dysuria and strawberry (punctate and papilliform) cervix
Mx = oral metronidazole (single dose or for 7 days)
```
95
Sx and Mx of BV?
```
Sx = offensive, fishy smelling white/grey discharge
Mx = oral metronidazole (single dose or for 7 days)
```
96
Sx and Mx of Thrush?
```
Sx = pruritus, white thick non-offensive discharge, satellite lesions and dysuria
Mx = Vaginal clotrimazole/feticonazole or oral fluclonazole
```
97
Mx of genital warts?
Topical = Podophyllotoxin (small non-keratinised lesions), Imiquimod (larger kertatinised lesions)
Physical ablation = excision, cryotherapy, electrotherapy, laser surgery
98
When is the COCP immediatley effective?
If started on days 1-5
99
What is a galactocoele?
A painless breast lump appearing after the cessation of breast feeding. Patient is afebrile
100
What should be done with a baby born to a mother who is Hep B surface antigen positive?
Give the Hep B vaccine and 0.5ml of HBIG within 12 hours of birth AND give further Hep B vaccine at 1-2 and 6 months
101
When is alpha feto protein high?
Neural tube defects, abdominal wall defects and multiple pregnancy
102
How late can you be on POP without having to take action? If you are more late than this what should you do?
Traditional = 3 horus late, desogesterol = 12 hours late
| If more than this time use barrier protection for 48 hours
103
When should you reffer to maternal foetal medicine if foetal movements are not felt?
By 24 weeks
104
What is the treatment for vaginal vault prolapse?
Sacrocolpoplexy
105
What is the most common ovarian cancer?
Serous carcinoma
