pass med Q's - Gynae Flashcards
how does the combined contraceptive pill work
inhibits ovulation
increased risks with combined contraceptive
increased risk
- blood clots
- MI / strokes
- breast + cervical cancer
how does the IUS (Mirena coil) work
prevents endometrial proliferation + thickens cervical mucus
side effect of IUS
irregular bleeding
- many patients become amenorrhoeic
how longer after insertion can an IUS be relied on
7 days
how does the IUD (copper coil) work
decreases sperm motility + survival
side effect of IUD
heavier, longer, more painful periods
how long after insertion can an IUD be relied on
immediately
when is contraception required from post partum
contraception required from 21 days post partum
for how long post partum is the contraceptive pill contraindicated for
6 weeks
what emergency contraceptives are available?
how long after UPSI are they effective for?
levonorgestrel - 72 hours UPSI
ulipristal (Ella one) - 120 hours UPSI
IUD - 5 days USPI
symptoms of endometriosis
chronic pelvic pain
dysmenorrhoea
dyspareunia
sub fertility
how does the uterus feel on examination in endometriosis
decreased motility
tender nodularity in posterior fornix
gold standard investigation of endometriosis
laparoscopy
tx of endometriosis
NSAIDS / paracetamol
combined contraceptive pill
what is endometriosis a risk factor for
ectopic pregnancy
risk factors for ectopic pregnancy
endometriosis damage to tubes -- pelvic inflammatory disease previous ectopic progesterone pill IVF
most common site of ectopic pregnancy
ampulla
most common site of a ruptured ectopic pregnancy
isthmus
classical presentation of an ectopic pregnancy
6-8 weeks since last period, abdominal pain, small PV bleed dark blood, cervical excitation, high beta-HCG
Ix of an ectopic
pregnancy test + transvaginal USS
medical management of an ectopic
IM methotrexate
when is surgical management of an ectopic needed
size > 35 mm
severe pain / haemodynamic compromise
visible fetal heart beat
beta -HCG > 1500
options for surgical ectopic management
salpingectomy
– salpingotomy if there is contralateral tube damage
1st line management of heavy periods
Mirena coil (IUS) - Tranexamic acid if they don't want/need contraception
1st line management of painful periods
Mefenamic acid / ibuprofen
- COC 2nd line
1st line management of a fibroid
if < 3cm and not distorting cavity a Mirena coil is first line
- other options : COC, tranexamic acid
surgical management of fibroids
indicated if > 3cm or distorting the cavity or if definite management wanted by patient
- myomectomy if they still want to preserve fertility
- hysterectomy if they don’t
what drug can be given prior to surgery to shrink fibroid size
GnRh agonists e.g. leuprolide
what drug is used to induce ovulation in patients with PCOS
letrozole (aromatase inhibitor)
PCOS patients who undergo IVF are at risk of what
ovarian hyperstimulation syndrome
presentation of ovarian torsion
deep abdominal pain – onset may occur with exercise
nausea + vomiting
unilateral tender adnexal mass
USS findings ovarian torsion
free fluid
whirlpool sign
tx ovarian torsion
laparoscopy
most common ovarian cyst
follicular cyst
features of a complex cyst
how should these be managed ?
solid mass
multiloculated
- measure CA 125, aFP, beta HCG + cystectomy to exclude malignancy
features of a simple cyst
how should these be managed ?
thin walled
non- located
< 5cm
- reassurance, repeat USS in 8 weeks UNLESS symptomatic – then offer cystectomy
high voiding detrusor pressure + low peak flow suggests what type of incontinence
overflow
management of urge incontinence
bladder retraining
antimuscarinics – oxybutinin / tolterodine
(mirabegron can be given if can’t take antimusc)
management of stress incontince
pelvic floor muscle training
investigations of incontinence
bladder diary
vaginal examination for prolapse
urodynamic studies if there is diagnosis uncertainty / plans for surgery
presentation of a vesicovaginal fistulae
continuous dribbling often after a prolonged labour
- investigate with urinary dye studies
what is a rokitansky protuberance seen in
a teratoma (dermoid cyst) - most common benign tumour in patients < 25
treatment of pelvic inflammatory disease
oral ofloxacin + oral metronidazole
or IM ceftriaxone + oral doxycycline + oral metronidazole
what lymph nodes do endometrial + ovarian tumours spread to
para aortic nodes
what lymph nodes do cervical carcinomas spread to
pelvic nodes
