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Obstetrics, Gynaecology & Breast Flashcards

1
Q

In which days of the menstrual cycle is the highest chance of pregnancy?

A

Day 8-19

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2
Q

Name the forms of combined oral contraception

A
  • Pill
  • Patch
  • Ring
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3
Q

Name the non-contraceptive effects of combined contraceptives

A
  • Regulate/reduce bleeding
  • Stop ovulation (premenstrual syndrome)
  • Reduction in functional ovarian cysts
  • 50% reduction in ovarian and endometrial cysts
  • Improves acne/hirsutism
  • Reduction in benign breast disease, rheumatoid arthritis, colon cancer and osteoporosis
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4
Q

Name some of the side effects of the combine oral contraceptive

A
  • Breast tenderness
  • Nausea
  • Headache
  • Initial irregular bleeding
  • Mood changes
  • Weight gain
  • Increased VTE risk
  • Arterial thrombosis
  • Increased risk of cervical cancer and breast cancer
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5
Q

Name the contraindications for the progesterone only pill

A

Personal history of breast cancer or liver tumour

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6
Q

Name some of the side effects of the progesterone only pill

A
  • Appetite increase
  • Hair loss/gain
  • Mood change
  • Bloating or fluid retention
  • Headache
  • Acne
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7
Q

Name some of the side effects of the depo injection

A
  • Weight gain
  • Delayed return of fertility
  • Bone density
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8
Q

Name some of the side effects of the progesterone implant

A
  • 30% have prolonged/frequent bleeding

- Mood changes

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9
Q

Name some of the benefits of the IUS

A

-Reduces menstrual bleeding

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10
Q

Name some of the options for emergency contraception and when they need to be taken by

A
  • Copper IUD (within five days of UPSI or day 19)
  • Levonorgestrel pill (72 hours)
  • Ullipristal pill (within 5 days)
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11
Q

Name the drugs used for a medical termination of pregnancy

A
  • Mifepristone

- Misoprostol

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12
Q

Name the causes of pelvic inflammatory disease

A
  • STIs
  • Uterine instrumentation
  • Post-partum
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13
Q

How does pelvic inflammatory disease present?

A
  • Lower abdominal pain
  • Deep dyspareunia (painful intercourse)
  • Vaginal discharge
  • intermenstrual/post-coital bleeding
  • Dysmenorrhoea
  • Fever
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14
Q

What investigations should be done for pelvic inflammatory disease?

A
  • Swabs for chlamydia and gonorrhoea
  • FBC, CRP & cultures if unwell
  • TVS
  • Laparoscopy
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15
Q

Name the complications of pelvic inflammatory disease

A
  • Tubo-ovarian abscess
  • Fitz-Hugh-Curtis syndrome (liver capsule inflammation)
  • Recurrent PID
  • Ectopic pregnancy
  • Subfertility
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16
Q

How can pelvic inflammatory disease be managed?

A
  • Ceftriaxone
  • Doxycycline
  • Metronidazole
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17
Q

How does gonorrhoea infection present?

A
  • Asymptomatic
  • PID
  • Epididymitis
  • Discharge
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18
Q

How is gonorrhoea managed?

A

Ceftriaxone

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19
Q

How does chlamydia present?

A
  • Discharge
  • Dysuria
  • Intermenstrual/post-coital bleeding
  • Conjunctivitis
  • Epididymitis
  • PID
  • Reactive arthritis
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20
Q

How is chlamydia managed?

A
  • Doxycycline

- Azithromycin if pregnant

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21
Q

How does trichomonas vaginalis present?

A
  • Asymptomatic

- Vaginal discharge

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22
Q

What are the complications of trichomonas vaginalis?

A
  • Miscarriage

- Preterm labour

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23
Q

How can trichomonas vaginalis be managed?

A

Metronidazole

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24
Q

How can anogenital warts be treated?

A
  • Podophyllotoxin
  • Imiquimod
  • Cryotherapy
  • Diathermy
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25
How does syphilis present?
- Local ulcer | - Rash, mucosal ulceration, neuro symptoms, alopecia
26
How can syphilis be treated?
- Benzathine penicillin | - Doxycycline
27
How can urinary incontinence be assessed?
- 3 day urinary diary - Urine dipstick - Bladder scan - Urodynamics
28
Name the non-pharmacological managment options for incontinence
- Pelvic floor muscle training - Smoking cessation - Weight loss - Diet changes - NO alcohol or caffeine - Physiotherapy - Surgery
29
Name the medical treatment for stress incontinence
Duloxetine
30
How can urge incontinence be managed?
- Anti-muscarinic (oxybutinin etc.) - Beta-3 adrenoceptor agonists (mirabegron) - Alpha-blockers (tamsulosin etc.) - Anti-androgen drugs (male only - finasteride etc.)
31
How can a missed miscarriage be managed?
- Prostaglandins (misoprostol) | - Surgical management of miscarriage
32
How can an ectopic pregnancy be managed?
- Methotrexate - Salpingectomy - Conservative
33
How does placenta praevia present?
- Painless PV bleeding - Malpresentation of the fetus - Incidental
34
How can placenta praevia be managed?
C-section
35
How can PPH be managed
- Medical: oxytocin, ergometrine, carbaprost and TXA - Balloon tamponade - Surgical: B lynch suture, ligation of vessels and hysterectomy
36
How does placental abruption present?
- Pain - Vaginal bleeding - Increased uterine activity
37
How can preterm delivery be managed?
- Steroids - Transfer to unit with NICU facilities - Aim for vaginal delivery
38
Name the neonatal morbidities resulting from prematurity
- RDS - Intraventricular haemorrhage - Cerebral palsy - Nutrition - Temperature - Jaundice - Infections - Visual impairment - Hearing loss
39
What is HELLP syndrome?
- Haemolysis - Elevated liver enzymes - Low platelets
40
How can pre-eclampsia be managed?
- Labetolol, methyldopa or nifedipine - Steroids if gestation <36 weeks - Aspirin in subsequent pregnancies
41
How can eclampsia be managed?
- IV magnesium sulphate - IV labetolol or hydrallazine - Avoid fluid overload
42
How should VTEs be managed in pregnancy?
LMWH e.g. dalteparin
43
How should women with epilepsy be managed during pregnancy?
- High dose folic acid | - Lamotrigine or levetiracetam
44
Name the presentation of hyperemesis gravidarum
- Severe nausea and vomiting - Dehydration - Electrolyte imbalance - Ketonuria - Weight loss > 5%
45
How can hyperemesis gravidarum be managed?
- Self care advice - Adequate fluid intake - Oral anti-emetics - Consider hospital admission
46
How can atrophic vaginitis be managed?
- Topical HRT - Modified release vaginal tablet - Vaginal ring
47
How does a fibroadenoma of the breast present?
- Well circumscribed - Freely mobile - Non-painful
48
How does endometriosis present?
- Dysmenorrhoea - Dyspareunia - Cyclical or chronic pelvic pain - Subfertility - Bloating/lethargy/constipation - Menorrhagia - Adnexal tenderness - Chocolate cysts
49
How can endometriosis be investigated?
- Laparoscopy - Transvaginal USS - MRI
50
How can endometriosis be managed?
- COC pill - Medroxyprogesterone acetate - GnRH agonist - Levonorgestrel intrauterine system - Surgery (lesion removal, ovarian cystectomy and bilateral oophrectomy) - Pain relief: NSAIDs, paracetamol and COC
51
How do fibroids present?
- Asymptomatic - Excessive or prolonged heavy periods - Lethargy and pallor - Iron deficiency anaemia - Pelvic pain - Recurrent miscarriage or infertility
52
How can fibroids be investigated?
- Pregnancy test - FBC - Pelvic USS - TVUS - MRI - Endometrial histology - Hysteroscopy
53
How can fibroids be managed?
- NSAIDs - TXA - Mirena coil - GnRH agonists - Surgery (myomectomy, ablation and hysterectomy)
54
What blood results would be expected for someone going through the menopause?
- Low oestrogen and progesterone levels | - Increased LH and FSH
55
How does PCOS present?
- Oligomenorrhoea - Infertility or subfertility - Acne - Hirsutism - Alopecia - Obesity - Mood swings, depression and anxiety - Sleep apnoea - Normal to slightly raised testosterone - Elevated LH and normal FSH - USS scan showing characteristic ovaries
56
How can PCOS be managed?
- Lifestyle interventions (weight loss etc.) - COC pill - Metformin - Clomifene
57
Name some of the causes of secondary amenorrhoea?
- PCOS - Early menopause - Thyroid disease - Prolactinoma - Androgen secreting tumour - Pituitary failure
58
How does cervical cancer present?
- Abnormal vaginal bleeding - Vaginal discharge - Vaginal discomfort - Painless haematuria and rectal bleeding
59
How does endometrial cancer present?
- Post-menopausal bleeding - HNPCC - PCOS - Tamoxifen use
60
How does ovarian cancer present?
- Abdominal discomfort and bloating - Urinary frequency - Fatigue, weight loss, anorexia and depression - Pelvic or abdominal mass - PV bleeding - Ascites - CA 125
61
Name the drugs used for a medical termination of pregnancy
- Mifepristone | - Misoprostol

Finals (18 decks)

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