Obstetrics, Gynaecology & Breast Flashcards
In which days of the menstrual cycle is the highest chance of pregnancy?
Day 8-19
Name the forms of combined oral contraception
- Pill
- Patch
- Ring
Name the non-contraceptive effects of combined contraceptives
- 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
Name some of the side effects of the combine oral contraceptive
- Breast tenderness
- Nausea
- Headache
- Initial irregular bleeding
- Mood changes
- Weight gain
- Increased VTE risk
- Arterial thrombosis
- Increased risk of cervical cancer and breast cancer
Name the contraindications for the progesterone only pill
Personal history of breast cancer or liver tumour
Name some of the side effects of the progesterone only pill
- Appetite increase
- Hair loss/gain
- Mood change
- Bloating or fluid retention
- Headache
- Acne
Name some of the side effects of the depo injection
- Weight gain
- Delayed return of fertility
- Bone density
Name some of the side effects of the progesterone implant
- 30% have prolonged/frequent bleeding
- Mood changes
Name some of the benefits of the IUS
-Reduces menstrual bleeding
Name some of the options for emergency contraception and when they need to be taken by
- Copper IUD (within five days of UPSI or day 19)
- Levonorgestrel pill (72 hours)
- Ullipristal pill (within 5 days)
Name the drugs used for a medical termination of pregnancy
- Mifepristone
- Misoprostol
Name the causes of pelvic inflammatory disease
- STIs
- Uterine instrumentation
- Post-partum
How does pelvic inflammatory disease present?
- Lower abdominal pain
- Deep dyspareunia (painful intercourse)
- Vaginal discharge
- intermenstrual/post-coital bleeding
- Dysmenorrhoea
- Fever
What investigations should be done for pelvic inflammatory disease?
- Swabs for chlamydia and gonorrhoea
- FBC, CRP & cultures if unwell
- TVS
- Laparoscopy
Name the complications of pelvic inflammatory disease
- Tubo-ovarian abscess
- Fitz-Hugh-Curtis syndrome (liver capsule inflammation)
- Recurrent PID
- Ectopic pregnancy
- Subfertility
How can pelvic inflammatory disease be managed?
- Ceftriaxone
- Doxycycline
- Metronidazole
How does gonorrhoea infection present?
- Asymptomatic
- PID
- Epididymitis
- Discharge
How is gonorrhoea managed?
Ceftriaxone
How does chlamydia present?
- Discharge
- Dysuria
- Intermenstrual/post-coital bleeding
- Conjunctivitis
- Epididymitis
- PID
- Reactive arthritis
How is chlamydia managed?
- Doxycycline
- Azithromycin if pregnant
How does trichomonas vaginalis present?
- Asymptomatic
- Vaginal discharge
What are the complications of trichomonas vaginalis?
- Miscarriage
- Preterm labour
How can trichomonas vaginalis be managed?
Metronidazole
How can anogenital warts be treated?
- Podophyllotoxin
- Imiquimod
- Cryotherapy
- Diathermy
How does syphilis present?
- Local ulcer
- Rash, mucosal ulceration, neuro symptoms, alopecia
How can syphilis be treated?
- Benzathine penicillin
- Doxycycline
How can urinary incontinence be assessed?
- 3 day urinary diary
- Urine dipstick
- Bladder scan
- Urodynamics
Name the non-pharmacological managment options for incontinence
- Pelvic floor muscle training
- Smoking cessation
- Weight loss
- Diet changes
- NO alcohol or caffeine
- Physiotherapy
- Surgery
Name the medical treatment for stress incontinence
Duloxetine
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.)
How can a missed miscarriage be managed?
- Prostaglandins (misoprostol)
- Surgical management of miscarriage
How can an ectopic pregnancy be managed?
- Methotrexate
- Salpingectomy
- Conservative
How does placenta praevia present?
- Painless PV bleeding
- Malpresentation of the fetus
- Incidental
How can placenta praevia be managed?
C-section
How can PPH be managed
- Medical: oxytocin, ergometrine, carbaprost and TXA
- Balloon tamponade
- Surgical: B lynch suture, ligation of vessels and hysterectomy
How does placental abruption present?
- Pain
- Vaginal bleeding
- Increased uterine activity
How can preterm delivery be managed?
- Steroids
- Transfer to unit with NICU facilities
- Aim for vaginal delivery
Name the neonatal morbidities resulting from prematurity
- RDS
- Intraventricular haemorrhage
- Cerebral palsy
- Nutrition
- Temperature
- Jaundice
- Infections
- Visual impairment
- Hearing loss
What is HELLP syndrome?
- Haemolysis
- Elevated liver enzymes
- Low platelets
How can pre-eclampsia be managed?
- Labetolol, methyldopa or nifedipine
- Steroids if gestation <36 weeks
- Aspirin in subsequent pregnancies
How can eclampsia be managed?
- IV magnesium sulphate
- IV labetolol or hydrallazine
- Avoid fluid overload
How should VTEs be managed in pregnancy?
LMWH e.g. dalteparin
How should women with epilepsy be managed during pregnancy?
- High dose folic acid
- Lamotrigine or levetiracetam
Name the presentation of hyperemesis gravidarum
- Severe nausea and vomiting
- Dehydration
- Electrolyte imbalance
- Ketonuria
- Weight loss > 5%
How can hyperemesis gravidarum be managed?
- Self care advice
- Adequate fluid intake
- Oral anti-emetics
- Consider hospital admission
How can atrophic vaginitis be managed?
- Topical HRT
- Modified release vaginal tablet
- Vaginal ring
How does a fibroadenoma of the breast present?
- Well circumscribed
- Freely mobile
- Non-painful
How does endometriosis present?
- Dysmenorrhoea
- Dyspareunia
- Cyclical or chronic pelvic pain
- Subfertility
- Bloating/lethargy/constipation
- Menorrhagia
- Adnexal tenderness
- Chocolate cysts
How can endometriosis be investigated?
- Laparoscopy
- Transvaginal USS
- MRI
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
How do fibroids present?
- Asymptomatic
- Excessive or prolonged heavy periods
- Lethargy and pallor
- Iron deficiency anaemia
- Pelvic pain
- Recurrent miscarriage or infertility
How can fibroids be investigated?
- Pregnancy test
- FBC
- Pelvic USS
- TVUS
- MRI
- Endometrial histology
- Hysteroscopy
How can fibroids be managed?
- NSAIDs
- TXA
- Mirena coil
- GnRH agonists
- Surgery (myomectomy, ablation and hysterectomy)
What blood results would be expected for someone going through the menopause?
- Low oestrogen and progesterone levels
- Increased LH and FSH
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
How can PCOS be managed?
- Lifestyle interventions (weight loss etc.)
- COC pill
- Metformin
- Clomifene
Name some of the causes of secondary amenorrhoea?
- PCOS
- Early menopause
- Thyroid disease
- Prolactinoma
- Androgen secreting tumour
- Pituitary failure
How does cervical cancer present?
- Abnormal vaginal bleeding
- Vaginal discharge
- Vaginal discomfort
- Painless haematuria and rectal bleeding
How does endometrial cancer present?
- Post-menopausal bleeding
- HNPCC
- PCOS
- Tamoxifen use
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
Name the drugs used for a medical termination of pregnancy
- Mifepristone
- Misoprostol
