Pass Medicine Notes Flashcards
What is cabergoline used for?
Cabergoline is a dopamine receptor agonist which inhibits prolactin production causing suppression of lactation.
How do ectopic pregnancies present?
A typical history is a female with a history of 6-8 weeks amenorrhoea who presents with lower abdominal pain and later develops vaginal bleeding.
Streptococcus agalacticae is the bacterium which causes what disease?
Streptococcus agalacticae is the bacterium which causes Group B Streptococcal disease (GBS).
What is the medication of choice in suppressing lactation when breastfeeding cessation is indicated?
Cabergoline - dopamine agonist
How does PCOS present?
- subfertility and infertility
- menstrual disturbances: oligomenorrhea and amenorrhoea
- hirsutism, acne (due to hyperandrogenism)
- obesity
- acanthosis nigricans (due to insulin resistance)
What is acanthosis nigricans?
Darkening of the skin in the folds of the skin.
What causes acanthosis nigricans?
The most common cause of acanthosis nigricans is being very overweight. Other causes include: type 2 diabetes. conditions that affect hormone levels – such as Cushing’s syndrome, polycystic ovary syndrome or an underactive thyroid.
What is a risk factor of progesterone HRT?
HRT: adding a progestogen increases the risk of breast cancer.
Progestogens carry the increased risk of breast cancer, venous thromboembolism and cardiovascular disease.
When is HRT indicated?
Hormone replacement therapy (HRT) should be considered for patients presenting with vasomotor symptoms such as hot flushes, night sweats and palpitations in menopause.
Note: If a patient only presents with urogenital symptoms, topical oestrogens may be appropriate (e.g. oestradiol creams or pessaries). Topical oestrogens act locally to reduce vaginal dryness, reduce UTI recurrence, reduce dyspareunia.
What is the risk of oestrogen only HRT?
If the patient has not had a hysterectomy, their HRT regime must include oestrogen and progestogen. This is because unopposed oestrogen therapy causes hypertrophy of the uterus and a 5-10x increased risk of endometrial carcinoma.
What are the features of endometrial cancer?
- postmenopausal bleeding is the classic symptom
- premenopausal women may have a change intermenstrual bleeding
- pain and discharge are unusual features
What is the role of metformin in the treatment of PCOS?
Increases peripheral insulin sensitivity.
Both hyperinsulinaemia and high levels of luteinizing hormone are seen in PCOS and there appears to be some overlap with the metabolic syndrome.
Treats fertility by increasing ovulation.
What is adenomyosis?
Adenomyosis is a condition in which the inner lining of the uterus (the endometrium) breaks through the muscle wall of the uterus (the myometrium). Adenomyosis can cause menstrual cramps, lower abdominal pressure, and bloating before menstrual periods and can result in heavy periods.
- Treated with a hysterectomy.
Features:
Features
- dysmenorrhoea
- menorrhagia
- enlarged, boggy uterus
Why is folic acid taken in pregnancy?
Prevent neural tube defects in the baby such spina bifida.
Raised proteinuria can be a sign of what in pregnancy?
There is also usually increased urine protein and the threshold for excessive proteinuria in pregnancy is >300 mg/24 hours versus >150 in non-pregnant patients. However, protein should still be monitored as proteinuria can be a feature of pre-eclampsia.
Tumour markers
What is Lochia?
Lochia is the bleeding that presents for the first 2 weeks following giving birth, whether this is by vaginal birth or caesarian section. Due to the higher risk of post-partum haemorrhage in caesarian section however, a detailed history and examination should take place in this case for any concerning features.
Lochia typically takes the course of fresh bleeding, which undergoes colour changes before finally stopping. The patient can be reassured and advice should be given to her regarding lochia. Specifically, she should be told that if this begins to smell badly, its volume increases or it doesn’t stop, she should seek medical help. In this case the volume is not excessive and there are no concerning features to the lochia or abnormal observations.
Late vs Early onset sepsis bugs:
Sepsis in the neonate often presents with non-specific features. Therefore, one must have a high index of suspicion and a low threshold for investigation. Sepsis in the neonate can broadly be divided into early-onset (<48 hours since birth) and late-onset (>48 hours from birth).
Early-onset sepsis is associated with acquisition of micro-organisms from the mothers birth canal. Late-onset sepsis normally occurs due to hospital acquired pathogens such as Staphylococcus epidermidis and Staphylococcus aureus.
What is the gold standard for investigating endometriosis?
Laparoscopy is the gold-standard investigation for patients with suspected endometriosis.
In the case of pregnancy of unknown location, serum bHCG levels >1,500 points toward what?
Ectopic pregnancy
What is Rhesus disease?
A condition where antibodies in a pregnant womans blood destroy her babies blood cells, aka haemolytic disease of the fetus and newborn (HDFN).
- can lead to jaundice and anaemia in the baby - does not harm the mother.
What is given as a form of prophylaxis to women whom have already had pre-eclampsia in a previous pregnancy?
Low dose asprin
Why is low dose asprin given as prophylaxis for pre-eclampsia?
Inhibits thromboxane, which is a hormone that raises bloodpressure.
What is the approach to managing a women with postmenopausal bleeding?
Endometrial cancer is a common cancer in postmenopausal women and it is important to rule this out in all women that present with post-menopausal bleeding.
The first step in the investigation of possible endometrial cancer is to perform a trans-vaginal ultrasound scan to measure the endometrial thickness.
If the endometrial lining is thickened then a hysteroscopy will be preformed and an endometrial biopsy taken.
Treatment for endometrial cancer is usually laparoscopic hysterectomy with bilateral salpingo-oophorectomy, with or without radiotherapy.
Heart murmurs sounds
Lydia is a 26-year-old woman who has come to her GP complaining of low mood, sleep disturbance and headaches. She says the symptoms come on around the same time each month and seem to stop just before her period. In between episodes she feel fine but is concerned about how these symptoms are affecting her performance at work. She does not plan to have children for at least the next couple of years.
Given the likely diagnosis which treatment is appropriate for Lydia at this stage?
The likely diagnosis is premenstrual syndrome and appropriate treatments include combined oral contraceptive (often taken continually with no pill free break) and SSRIs. Patients should also be referred for CBT.
Explain the treatment of pre-menstrual syndrome fully:
Mild: Life-style modifiers, small frequent meals, exercise etc.
Moderate: Combined oral contraceptive.
Severe: SSRI’s (setraline).
What are the risk factors for endometrial cancer?
HNPCC/Lynch syndrome is a strong risk factor for endometrial cancer. The combined oral contraceptive pill is protective against endometrial cancer. Other main risk factors include obesity, increased number of ovulations (for example fewer pregnancies, early menarche, and late menopause), as well as some medications such as tamoxifen, and medical conditions such as diabetes and polycystic ovarian syndrome.
How does the combined oral contraceptive affects cancer risks how?
Combined oral contraceptive pill:
- increased risk of breast and cervical cancer
- protective against ovarian and endometrial cancer
A 22-year-old female, gravidity 1 and parity 0 at 10 weeks’ gestation is involved in a high speed vehicle collision and her abdomen hits the steering wheel. Maternal vital signs are stable. No uterine contractions are present, and there is no vaginal bleeding. U/S shows an intact placenta. Which is the most appropriate next step?
Blood and rhesus testing.
A pregnant woman with abdominal trauma should have Rhesus testing asap because women who are Rhesus-negative should be given anti-D to prevent Rhesus isoimmunization.
When should you admit a women to hospital with hyperemesis?
Nausea and vomiting in pregnancy: Admission should be considered in cases of ketonuria and/or weight loss despite use of oral anitemetics.
What is used for eclampsia prophylaxis in pre-eclampsis?
IV magnesium sulphate is used for eclampsia (seizure) prophylaxis.
Contraceptives - time until effective (if not first day period):
Instant?
2 days?
7 days?
Contraceptives - time until effective (if not first day period):
Instant: IUD
2 days: POP
7 days: COC, injection, implant, IUS
What is placenta praevia and how does it present?
Placenta praevia describes a placenta lying wholly or partly in the lower uterine segment.
The bleeding associated with placenta praevia is painless and usually bright red. Meanwhile the bleeding associated with placental abruption is associated with pain and is usually dark red. The pattern of previous bleeding also favours placenta praevia. Though vasa praevia can also present with painless vaginal bleeding other expected features would include fetal bradycardia and membrane rupture.
