Obstetrics 2 Flashcards
Describe the competency assessment for individuals seeking abortion in Australia based on age.
More than 16 years old: considered competent. Less than 14 years old: deemed immature. 14-16 years old and independent: considered competent. If less than 14 years old: inform parents or guardian. If less than 14 years old and a victim of rape: involve sexual assault authorities.
What are the steps involved in the process of abortion in Australia?
- Counselling about abortion. 2. Obtain informed consent from the patient or guardian if the patient is immature. 3. Perform the abortion.
Do only physicians have the authority to perform abortions in Australia?
Yes, only physicians are allowed to perform abortions. If a physician refuses, they must refer the patient to another provider.
Where are abortions legally allowed to be performed in Australia?
Abortions are only legally allowed to be performed in tertiary hospitals.
Define osteoporosis and list some common causes.
Osteoporosis is a condition characterized by weakened bones. Common causes include being female (especially white), having a family history of osteoporosis, postmenopausal status, low BMI (less than 19), alcohol consumption, smoking, caffeine intake, cortisone use, lack of exercise, low calcium intake, anorexia nervosa, renal failure, celiac disease, and hyperthyroidism.
Describe the classification of bone density based on T scores in osteoporosis.
Osteopenia is defined as T scores between -1 and -2.5, while osteoporosis is diagnosed when T scores are less than -2.5.
What are some common symptoms and manifestations of menopause?
Hot flashes, migraine, rapid heartbeat, dysfunctional bleeding (anovulation), urogenital atrophy, itching, dryness, watery discharge, urinary frequency, urinary incontinence, urinary urgency, increased infection risk, back pain, joint pain, muscle pain, osteopenia, and the risk of osteoporosis development over time.
How is osteoporosis diagnosed and what is the investigation of choice?
Osteoporosis is diagnosed based on T scores and the presence of minimal trauma fractures. The investigation of choice is a DEXA scan. X-ray is crucial if a fracture is suspected.
What are some preventive measures and treatments for osteoporosis?
Preventive measures include calcium and vitamin D supplements. Treatment options include bisphosphonates (except Zoledronic for esophagitis), Raloxifene (for patients with a history of breast cancer), Strontium Ranelate, HRT, and Calcitriol.
Describe the immediate benefit of giving Hormone Replacement Therapy (HRT)
Decreased flushing
What is the most common cause of dysfunctional bleeding near menopause?
Anovulation
What is the first step in diagnosing cancer endometrium?
Hysteroscopy and biopsy
What should be considered in case of bleeding after sex?
Atrophic vaginitis
What is the most common cause of postmenopausal bleeding?
Atrophic vaginitis
Why does the risk of infections increase in the elderly?
Atrophic vaginitis
What is the most common cause of infection in this context?
Bacterial vaginosis
What is the least symptom to consider normal at menopause?
Depression
What is an important differential diagnosis to consider in this context?
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What is the least symptom to improve with Hormone Replacement Therapy (HRT)?
Depression
What is the duration limit for Hormone Replacement Therapy (HRT)?
Not more than 5 years
What is the mode of administration for Hormone Replacement Therapy (HRT)?
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What are the indications for cyclic administration of HRT?
Perimenopausal
What are the indications for continuous administration of HRT?
Postmenopausal with unpredictable bleeding
What are the complications associated with long-term HRT use?
Breast Cancer, Endometrial Cancer, Coronary disease, Stroke, PE, DVT especially with estrogen
What are the contraindications for HRT in the context of estrogen-dependent tumors?
Breast, Endometrial tumors
What is the best approach for women with a history of DVT regarding estrogen use?
Not to give estrogen at all
What is the recommended estrogen administration for women with a history of DVT if necessary?
Estrogen patch
What is the hormone therapy approach for women with a history of hysterectomy?
Estrogen alone without progesterone
What is the recommended treatment for women with a history of breast cancer as first and second lines?
1st line: Paroxetine, 2nd line: Clonidine
What is the best treatment for women complaining of only atrophic vaginitis?
Estrogen cream
What should be considered for a woman on HRT for 5 years?
Trial of stoppage
What are the indications for high-dose estrogen use (Microgynon 30-50)?
Enzyme inducer drug
Where is the main site of action of low-dose progesterone-only pills (POP)?
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Describe the main site of action of progestin-only pill (normal dose)
Acts on the cervix
Describe the main site of action of Combined Oral Contraceptive (COC)
Acts on the ovary
Describe the hypothalamo-pituitary-ovarian axis
Regulates the female reproductive system
Do COCs decrease the risk of dysmenorrhea, functional ovarian cysts, PID, ovarian and endometrial cancer, and benign breast diseases?
Yes
List the cancers that COCs decrease the risk of
Endometrial, ovarian, colon, benign breast disorders
List the cancers that COCs increase the risk of
Cervical, breast
What are the absolute contraindications of COCs?
Pregnancy 1-3 weeks, CV and coronary diseases, thromboembolic disorders, focal migraine with aura, liver failure, estrogen-dependent tumors
What are the relative contraindications of COCs?
Smoking, breastfeeding, hypertension, diabetes mellitus, estrogen-dependent tumors
What should be done if a pill is missed in Week 3 of COC cycle?
Omit the pill-free interval
Explain the 7 Day Rule for missed pills in COC
Take the forgotten pill as soon as possible; if >12 hours, use condoms for 7 days; if this extends beyond the last hormone pill, continue without a pill-free interval
What are the indications for Progesterone-only Contraceptive Pills?
Ages >45, contraindication to estrogen, diabetes mellitus, hypertension, migraine, chloasma, lactation
What are the contraindications for Progesterone-only Contraceptive Pills?
Pregnancy, abnormal bleeding, ectopic pregnancy, enzyme inducer drugs
Describe Depo-Provera
Injectable contraception with the least failure rate of 1/1000, delays fertility for 6 months, may cause weight gain
Describe Implanon
Subdermal implant for 3 years
When is Emergency Contraception needed?
After condom rupture, unplanned sex, rape, or missed pill in the 1st week
How is Emergency Contraception administered using Postinor?
Levonorgestrel 750 mcg tablet followed by another tablet after 12 hours; limited to the first 72 hours with a failure rate of 2-3%
List the types of IUCD
Copper, Mirena
What are the absolute contraindications of IUCD?
Pregnancy, bleeding disorders, PID, cervical distortion, previous ectopic pregnancy
List complications of IUCD
Ectopic pregnancy, bleeding, PID, perforation
Do
What is the first step in evaluating infertility according to the content?
Describe
How is anovulation diagnosed based on the content?
Define
What is the main benefit of Jasmin according to the content?
How
How is tubal ligation typically performed according to the content?
Describe the process of IVF for a female near menopause who wants to get pregnant.
IVF is used for females near menopause who want to conceive by fertilizing an egg with sperm outside the body, then implant the embryo into the uterus.
What is the cause of male infertility in cystic fibrosis?
The absence of the vas deferens is the cause of male infertility in cystic fibrosis.
Define Asherman’s syndrome and its symptoms.
Asherman’s syndrome involves adhesions inside the uterus, leading to symptoms like oligo or amenorrhea.
Explain the difference in ascites between ovarian cancer and liver cirrhosis.
In ovarian cancer, ascites present with central dullness and peripheral resonance, while in liver cirrhosis, ascites show central resonance with peripheral dullness.
Describe the characteristics of a dermoid cyst (teratoma).
Dermoid cysts are solid and cystic masses containing tissues like skin, hair follicles, sweat glands, teeth, and more. They are commonly found in the ovary.
How can premenstrual syndrome be managed effectively?
Premenstrual syndrome can be managed by noting symptoms in a diary, practicing relaxation techniques, and if needed, using SSRIs for severe symptoms.
What is the recommended approach for dealing with excessive menstrual bleeding?
The guidelines suggest checking TSH levels first, followed by transvaginal ultrasound if TSH is normal, and then investigating other systemic causes if needed.
Royal Australian College of General Practitioners (RACGP)
https://www1.racgp.org.au › ajgp › august › manageme…
A woman having an ultrasound to investigate the cause of her heavy menstrual bleeding has a pelvic (preferably transvaginal) ultrasound, which assesses ..
Explain the source and characteristics of a Krukenburg tumor.
A Krukenburg tumor is a metastasis on the ovary originating from gastrointestinal cancers like stomach or colon. It presents as a solid and cystic mass on ultrasound.
Investigation for an ovarian mass includes both transvaginal and transabdominal ultrasound. Simple, anechoic cysts <5 cm in premenopausal women are likely to be benign and do not require further follow-up. The use of the cancer antigen 125 (Ca125) tumour marker can be unreliable in premenopausal women given the low sensitivity for ovarian cancer; however, it is useful in postmenopausal women. Ca125 is used in conjunction with ultrasound findings and is used to determine risk of ovarian cancer through the risk of malignancy index (RMI).
How does age impact the most common cause of infertility in females over 40 years old?
The age of the female, being over 40 years old, is the most common cause of infertility due to decreased quantity and quality of ova.
What are the psychological and physical symptoms associated with premenstrual syndrome?
Psychological symptoms of premenstrual syndrome include tension, irritability, tiredness, mood changes, anxiety, while physical symptoms include breast swelling, abdominal bloating, and migraines.
