passmed 01/06 Flashcards
subfertility and PCOS management?
Clomifene
in preterm prelabour rupture of membranes, how is antenatl steroid given?
IM dexamethasone
endometrial cancer risk factors?
EXCESS OESTROGEN:
nulliparity
early menarche
late menopause
unopposed oestrogen
Metabolic syndrome:
> obesity
>DM
> PCOS
tamoxifen
HNPCC
how is endometrial cancer investigated?
> 55 present with bleed
tVUSS >4 bad sign
hysteroscopy w endometrial biopsy
most common cause of puritus vulvae?
contact dermatitis
stress incontinence is managed with?
why?
SNRI -
sphincter tone is increased during filling phase of urinary bladder dysfunction
how can an overactive bladder / urge incontinence be managed?
1) bladder diary 3 days minimum
2) vaginal exam : prolapse
3) urine dipstick
4) urodynamic studies
1) bladder retraining: 6 weeks
2) bladder stabilising drugs oxybutynin - anticholinergic (but not in frail old women)
tolterodine
darifenac
mirabegron- beta 3 agonist - old frail
3) Surgery: Botox, percutaneous tibial nerve stimulation
ulipristal acetate 30mg
ellaOne - 120 hours
progesterone receptor modulator
delays ovulation and thickens endometrial lining
levonorgestrol -
72 hours
progesterone derivative
when should 3mg levonorgestrel be given?
this is the double dose
BMI >26.5
>70kg
asthmatic women 4 days post UPSI
can she be given ellaOne?
no as ulipristal is contraindicated in asthma
can give copper coil
Injectable contraceptive
medroxyprogesterone acetate
150mg
IM every 12 weeks
inhibits ovulation
UKMEC - breast cancer
what does colposcopy do - HPV + and low level dyskaryosis on cytology?
allows closer examinarion of cervix and identification of disease
what does abnormal cytology mean?
borderline changes in squamous or endocervical cells.
low-grade dyskaryosis.
high-grade dyskaryosis (moderate).
high-grade dyskaryosis (severe).
invasive squamous cell carcinoma.
glandular neoplasia
Cervical interaepithelial neoplasia how to treat it?
large loop excision of transformation zone
/ cryotherapy
after LLETZ invited at 6 months for test of cure repeat
ovarian cancer -
serous carcinoma’s
epithelial in origin
BRCA1
BRCA2
raised ca 125 35IU/mL
first trimester diff?
Miscarriage
Ectopic
implantation
cervical ectropion
vaginitis
trauma
polyps
when would you arrange immediate EPU assessment in first trimester bleed?
<10 weeks pregnant?
if worried about ectopic
abdominal, cervical,pelvic motion tenderness
so if pain
or on examination
pain
or obs suggest ruptured ectopic
or shoulder tip pain
stress incontinence medical management?
duloxetine
palpable bladder after urinating? in urinary incontinence?
think overflow due to urinary retention
when is cyclical vs continuous used in menopausal HRT?
cyclical for peri menopause
> don’t want to overload with oestrogen
continuous is for post menopause
in trasngender male pt - (assigned female at birth) is contraception needed?
yes - use copper coil, oestrogen is contraindiacyed
can use POP
IUS
Depo-provera
if ruptures can cause pseudomyxoma peritonei
mucinous cystadenoma
Older woman with labial lump and inguinal lymphadenopathy
→ ?vulval carcinoma
62-year-old woman presents
‘leaks’ small amounts of urine’
increased urinary frequency
she has slight suprapubic tenderness
initial best investigation?
urinalysis
with COCP if 2 pills missed in 1st week?
UPSI - use EC
if sex in pill free week or week 1
COCP 2 or more pills missed in week 2?
if taken 7 days in a row protected
but if not taken 7 days in a row use condom or abstain from sex
why do GNRH agonist treat in shrinking fibroids prior to surgery?
act to overstimulate GNRH in opposition to of GnRH axis which reduces oestrogen and progesterone concentration
because oestrogen is decreased increassed risk o bone mineral density loss and hot flush, vaginal dryness
UKMEC 4 conditions for OCP
positive antiphospholipid antibodies (SLE)
Anticardiolipin antibody IgG and IgM titres
Anti-beta2-glycoprotein I antibody IgG and IgM titres
Lupus anticoagulant
what is a vaginal vault prolapse?
This is a long-term complication of vaginal hysterectomy with anteroposterior repair
vagina loses its normal shape and sags
