Obstetrics/Gynaecology/Breast/Contraception Flashcards
1
Q
Mechanism and risks COCP
A
Inhibits ovulation
Cervical and breast cancer, VTE
2
Q
Mechanism and risks POP
A
Thickens cervical mucous
Breast cancer
3
Q
Mechanism injectable and how often
A
Inhibits ovulation and thickens mucous
12w
4
Q
Contraception most associated weight gain
A
Injectable
5
Q
Mechanism implant and how long lasts
A
Inhibits ovulation and thickens mucous
3y
6
Q
Irregular bleeding common contraception adverse
A
POP
Implant
IUS
7
Q
COCP missed 2 pills
A
Condom 7d
Week 1 - emergency
Week 2 - none
Week 3 - skip pill free week
8
Q
Emergency cannot use with asthma
A
Ullupristal
9
Q
Most common breast cancer
A
Invasive ductal carcinoma
10
Q
Breast cancer screening
A
Every 3y between 50 to 70
11
Q
When do masectomy and when wide local excision
A
Masectomy - multifocal, or >4cm
Wide locatl - solitary and <4cm
12
Q
Treatment for auxillary node clearance
A
If no lymphadenopathy - US then sentinal node biopsy if positive
If lymphadenopathy - auxillary node clearance
13
Q
When is radiotherapy used breast cancer
A
If masectomy - T3 or above
If wide local - always
14
Q
Hormonal therapy for oestrogen +ve receptors breast cancer
A
Premenopausal - tamoxifen
Postmenopausal - anastrazole (aromatase inhibitors)
15
Q
Treatment for Her2 positive breast cancer
A
Trastuzumab (Herceptin)
16
Q
Prognosis criteria for breast cancer
A
Nottingam prognostic index
17
Q
Mastitis/abscess treatment
A
1) Continue breast feeding
2) Fluclox if systemicaly unwell
18
Q
Treatment fibroadenoma
A
Conservative, unless >3cm then resection
19
Q
Mechanism tamoxifen
A
Oestreogen receptor antagonist and partial agonist
20
Q
Anastrozole mechanism
A
Reduced peripheral oestrogen synthesis
21
Q
“Snowstorm appearance”
A
Breast implant rupture
22
Q
“Halo sign”
A
Breast cyst
23
Q
Diagnosis atrophic vaginitis
A
By exclusion
24
Q
Treatment atrophic vaginitis
A
Lubricants and oestrogen creams
25
Most common ectopic location and most dangerous
Common - ampulla
| Dangerous - isthmus
26
Diagnose ectopic
Transvaginal US
27
Ectopic treatment decide method
Expectant - asymptomatic and <35mm and hCG < 1000
Medical - little pain, hCG < 1500
Surgery - size > 35mm, rupture, pain, heatburn, hCG > 5000
28
Ectopic medical treatment
Methotrexate
29
Diagnose pelvic inflammatory disease
High vaginal swab and NAAT
| HIV and syphilis tests
30
Treatment PID
IM ceftiaxone and oral deoxycycline and oral metronodazol
31
Identify Fits Hugh Curtis syndrome
PID and RUQ pain
32
Treatment urge incontinence
1) Antimuscurinics (oxybutynin) and bladder retraining
33
Treatment stress incontinence
1) Pelvic floor exercises
2) Surgery
2) Duloxetine
34
Cervical cancer screening
5 yearly from 25 to 64
35
Endometriosis diagnosis
Laparoscopy
36
Endometriosis treatment
1) NSAID - mefanemic acid
2) COPC
3) Referal - GnRH analogue or surgery
37
Fibroid diagonsis
Transvaginal US
38
Fibroids treatment
1) IUS - if no distortion
2) COCP and NSAID
3) GnRH to reduce size and myomectomy
39
Fibroid complication during pregnancy
Degeneration - pain and fever and vomiting
40
Menopause definition
If under 50 - 24m after last period
| If over 50 - 12m after last period
41
Treatment menopause
1) Lifestyle
2) HRT - progesterone only if no uterus
3) SSRI/CBT
42
Commonest ovarian cyst
Follicular cyst - benign
43
Ovarian cyst contains hair/teeth
Dermoid cyst
44
Diagnosis ovarian cyst
US
45
Can be massive ovarian cyst
Mucinous cystadenoma
46
Staging for cervical cancer system
FIGO
47
Cervical cancer treatment
Hysterectomy and lymph node clearance
Cone biopsy if want to preserve fertility
48
Diagnose endometrial cancer
Transvaginal US
| Hysteroscopy and biopsy
49
Risks ovarian cancer
Many ovulations
| BRCA 1 and 2
50
Diagnosis ovarian cancer
CA125
US
CT scan establish and stage
51
FIGO staging ovarian cancer
1) Confined ovary
2) Outside ovary but in pelvis
3) Outside pelvis but in abdomen
4) Outside abdomen
52
Most common ovarian tumour
Serous tumour
53
"Signet ring"
Krukenberg tumour in ovary from GI tract
54
Infertility diagnosis
Progesterone levels 7 days before next period
| Semen analysis
55
Termination of pregnancy method
<9w - mifepristane
| >9w - surgery
56
Definition miscarriage and still birth
Miscarriage <24w
| Stillbirth >24w
57
Treatment miscarriage
1) Expectant
2) Vaginal misoprostol
3) Surgery
58
What is adenomyosis
Endometrial tissue within myometrium
59
Identify adenomyosis
Large boggy uterus
| Painful and heavy periods
60
What is cervical ectropion
Elevated oestrogen levels cause larger areas columnar epithelium at ectocervix
61
"Snow storm"
Complete hydaidiform mole
62
Treatment dysmenorrhoea
1) NSAID - mefenamic acid
| 2) COCP
63
"Whirlpool sign"
Ovarian torsion
64
Diagnosis ovarian torsion
Laparoscopy, also for treatment
65
What is Meigs syndrome
Benign ovarian cyst causing ascites and pleural effusion
66
What is Sheehans syndrome
Postpartum pituitary infarction causing global hypopituiritism
67
"Chocolate cyst"
Endiometriotic cyst
68
How long pregnancy test positive after miscarriage
4w
69
What is Asherman syndrome
Scar tissue in uterus following previous surgery causing amenorrhoea
70
What is premature ovarian failure
<40y
71
Diagnose VTE in pregnancy
1) Doppler US
2) Ventilation perfusion scan
Cannot use D dimer or wells score in pregnancy
72
Treatment VTE in prengnacy
1) LMWH
73
Treatment eclampsia
1) Magnesium sulphate
| 2) Calcium gluconate
74
HELPP syndrome
Haemolysis, elevated liver enzymes and low platelets
75
Treatment postpartum haemorrhage
1) IV syntocin or ergometrine
2) Intrauterine baloon tamponade, B lynch suture, uterine artery ligation
3) Hysterectomy
76
"Woody uterus"
Placental abruption
77
Diagnosis placental abruption
Clinical, US exclude placenal praevia
78
Treatment placental abruption
<36w - steroids if no distress, caesarean if distress
>36w - vaginal no distress, caesarean distress
79
Treatment cord prolapse
Patient get on all 4s
Tocolytics reduce contractions
If cord past introitis minimal handling
80
Postnatal depression assessment
Edinburgh postnatal depression scale
81
Baby blues treatment
Reassurance and follow up
82
Postnatal depression treatment
1) CBT
| 2) SSRI - sertraline or paroxetine
83
Peurperal psychosis treatment
Admission together with baby
84
Gestational diabetes diangosis
Oral glucose tolerance test:
- fasting 5.6
- 2h 7.8
85
Treatment gestational diabetes
If fasting <7:
1) Diet and exercise
2) Metformin after 2w
3) Insulin
If fasting >7:
1) Insulin
86
Gestational diabetes complications
Macrosomia
| Polyhydramnios
87
Epilepsy drug choice in pregnancy
Lamotrigine
88
Identify pregnancy induced hypertension
20 weeks or later
| No proteinuria, no oedema
89
Identify pre-eclampsia
Pregnancy induced hypertension and proteinuria (>0.3g/24h)
90
Pre-eclampsia prophylaxis
Aspirin 75mg from 12w to birth
91
Hypertension treatment pregnancy
1) Labetolol
| 2) Nifedepine
92
Obesity treatment in pregnancy
Folic acid 5mg from conception to 12w
| Screening for gestational diabetes at 24 and 28w
93
Levothyroxine in pregnancy
Increase by 30-50%
94
Cut of for iron therapy in pregnancy
1st trimester - <110
2/3rd trimester - <105
Post partum <100
95
Identify hypermesis gravidarum
Triad:
- 5% pre pregnancy weight loss
- dehydration
- electrolyte imbalance
96
Scoring system hypermesis gravidarum
PUQE
97
Treatment hypermesis gravidarum
1) Oral cyclizine or promethazine
2) Ondansetron or metochlopramide
Admit if unable to keep things down, ketones
98
Diagnosis placental praevia
Transvaginal US
99
Treatment low lying placenta at 20w
1) Reasses at 34w and scan every 2
| 2) If still low at 37w then elective caecaerean
100
Treatment bleeding placental praevia
1) Emergency caecrean if not able to stabilise
101
Definition of premature labour
<37w
102
Diagnosis preterm prelabour rupture of membranes
Speculum first then US
103
Treatment preterm prelabour rupture of membranes
Oral erythromycin 10d
Corticosteroids
Consider delivery at 34w
104
Diagnosis preterm labour in tact membranes
<30w - speculum
| >30w - transvaginal US
105
Treatment preterm labour in tract membranes
Tocylysis - nifedepine
Corticosteroids if <35w
IV magnesium sulphate if <34w
106
Drug to suppress lactation
Dopamine agonist (eg cabergoline)
107
What is vasa praevia
Foetal vessels are within foetal membrane and travel across internal cervical OS
108
Stages of labour
1) Onset to cervix fully dilated
2) Full dilation to delivery foetus
3) Delivery foetus to delivery placenta
109
When is anti-D prophylaxis given if needed routine
Week 28 and week 34
110
When is presentation checked and external cephalic version offered if indicated
Week 36
111
When is induction if late
Week 41
112
When is anomaly scan
18-21w
113
When is early scan confirm dates
10-14w
114
When is booking visit
8-12w
115
When is down syndrome screening
11-14w
116
Increases AFP
Neural tube defect
| Abdominal wall defect
117
Decreases AFP
Down syndrome
| Trisomy 18
118
Breastfeeding contraindications
```
Lithium, benzos
Methotrexate
Sulphonylureus
Asprin
Amiodarone
Some antibiotics
```
EPILEPSY DRUGS SAFE
119
Breech presentation treatment
36w - offer external cephalic conversion
| If fails - planned caesarean
120
Down syndrome reslts
Increased HCG
Increased nuchal translucency
Decreased PAPP-A
121
Treatment group B strep in pregnancy
Intrapartum antibiotics:
| - benzylpenicillin
122
Induction of labour scoring
Bishop score:
| - >8 high chance
123
Induce labour
Membrane sweep
Vaginal prostaglandin
Oxytoxin infusion
124
Intrahepatic cholestasis of pregnancy treatment
Ursodeoxycholic acid
| Induction at 37w
125
When to refer if no movements felt
24w
