Obstetrics and Gynaecology Flashcards
what does bishops score assess
induction: dilation, effacement, station, cervical position
when do you give anti D if mother is rhesus negative?
28 weeks and after a sensitising event (72h)
management of detrusor over activity
bladder training
oxybutynin
mirabegron
management of stress incontinence
pessary, colposuspension, tension free vaginal tape
diagnosis of PCOS
> 12 small follicles in an enlarged ovary +
hirsutism, oligomenorrhea, high testosterone
investigations in PCOS
LH and FSH on days 2-5 prolactin testosterone TFTs TVUSS BMs cholesterol
cortisol - rule out cushings
17 hydroxyprogesterone - rule out CAH
DHEAs
diagnosis of GDM
> 5.6 random glucose
>7.8 OGTT - 24-28 weeks
management of GDM
lifestyle
metformin / glibenclamide
insulin if >7
risk factors for breast ca
lots of oestrogen:
nulliparity, early menarche, late menopause, combined HRT, not breast feeding, obesity
risk factors for ovarian cancer
lots of oestrogen:
nulliparity, early menarche and late menopause
risk factors for endometrial cancer
HRT (oestrogen), nulliparity, early menarche, lat menopause, PCOS, diabetes
risk factors for cervical cancer
HPV 16 + 18
types of ovarian cancer
serous adenocarcinoma
thecoma - sex cell
teratoma/dermoid - germ cell
investigations in ovarian cancer
risk of malignancy index:
CA125
menopausal status
USS
CT
hormone drugs used in treatment of breast cancer
tamoxifen - ER +ve
trastuzumab - HER2 +ve
investigation in endometrial cancer
TVUSS (should be under 4mm thick)
pipelle biopsy
hysteroscopy
FIGO staging
cervical cancer screening
liquid based cytology every 3 years from age 25-49 and 5 years from 50-64
management of grade 1-3 CIN
1: repeat smear in 1 year
2: colposcopy +/- LETZ
3: LETZ
presentation and complications of endometriosis
subfertility, dysmenorrhea, deep dyspareunia (bleeding from elsewhere)
fibrosis, adhesions, chocolate cysts, frozen pelvis
management of endometriosis
trial hormones for 3-6 months: COCP, POP, mirena, goserelin
diagnostic laparoscopy and diathermy
causes of primary amennhorreah
imperforate hymen, X0, hyperprolactinaemia, hypothalamic, CAH, kallmans
causes of secondary ammennhorreah
(ie none for 6 months)
pregnancy, premature ovarian failure, adhesions, high prolactin, Sheehans, PCOS, cushings
when to check LH and FSH, progesterone
LH and FSH: days 2-5 (should be low)
progesterone: day 21
investigations in subfertility
STI screen
hormones: Lh and FSH, progesterone, prolactin, TFTs
sperm count (>4 million) morphology and motility
hysterosalpingogram with methylene blue
presentation in PID
abdo pain, bleeding, discharge, pareunia, cervical excitation and adnexal tenderness
management of PID
likely chlamydia / gonorrhoea
IM ceftriaxone and oral doxycycline
open os with retained products?
incomplete miscarriage
open os with empty uterus
inevitable miscarriage
closed os and large uterus with yolk sac
threatened miscarriage
management of miscarriage
expectant: wait 2 weeks and see if will resolve (threatened) or pass naturally
medical: misoprostol PV / PO mifepristone
surgical
presentation and investigations in gestational trophoblastic disease?
PV bleeding, morning sickness
very high beta HCG
TVUSS - snowstorm appearance
investigations in ectopic pregnancy
beta hCG - 48 hours apart (plateaus)
TVUSS - no yolk sac
management of ectopic
methotrexate if small, low hCG and patient well
laparoscopy
anti D
management of hypertension in pregnancy
labetalol and hydralazine
management of eclampsia
magnesium sulphate
management of pre eclampsia
methyl dopa
what is HELLP syndrome
assoc with htn and eclampsia
haemolysis, elevated liver enzymes, low platelets
can cause DIC, pulmonary oedema and renal failure
what is done at booking
chlamydia FBC blood group and rhesus status RBC antibodies SCD / thalassemia Hep B, HIV, rubella, syphilis urine dip
screening for downs syndrome
combined test 11-14 weeks
PAPP-a (low), beta hCG (high)
nuchal translucency
quadruple at 14-20 weeks:
b hCG and inhibin A (high)
oestriol and AFP (low)
