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Passmed > Passmed obs and gynae > Flashcards

Passmed obs and gynae Flashcards

1
Q

What does cyclical mastalgia vary with?

A

Phases of the menstrual cycle - tends to be worse 1-2 weeks before menstruation

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2
Q

What is blood stained discharge most associated with?

A

Papilloma

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3
Q

What are the main risks of axillary node clearance?

A

Lymphoedema and functional arm impairment

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4
Q

What is used in the management of ER positive breast cancer patients in pre and peri menopausal women?

A

Tamoxifen (selective oestrogen receptor modulator)

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5
Q

What is a histological feature of carcinoma-in-situ?

A

Comedo necrosis

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6
Q

What is used in post-menopausal ER positive breast cancer patients?

A

Aromatase inhibitors - anastrozole

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7
Q

When does perimenopausal change to post-menopausal?

A

12 months after last period

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8
Q

What is indicated in breast cancer patients with palpable axillary lymphadenopathy?

A

Axillary node clearance indicated at primary surgery

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9
Q

How do aromatase inhibitors work?

A

Inhibition of peripheral oestrogen synthesis

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10
Q

When are breast fibroadenomas indicated for excision?

A

If >3cm

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11
Q

How is lactational mastitis treated in breastfeeding women?

A

Continue breastfeeding - if effective milk removal hasn’t improved symptoms in 12-24h then 10 days flucloxacillin

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12
Q

What is the pathway for a woman who is 28 and has a breast lump?

A

Non-urgent referral - woman under 30y with painful/painless breast lump

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13
Q

What is the chance of a woman who is BRCA1/2 positive to pass it on to her children?

A

50% - as they’re almost always heterozygous and is autosomal dominant

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14
Q

What is the main complication of aromatase inhibitors?

A

Osteoporosis and osteoporotic fractures

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15
Q

What is recommended in women after wide local excision?

A

Whole breast radiotherapy

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16
Q

What is green and brown nipple discharge associated with?

A

Duct ectasia

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17
Q

What is a very loose rule for wide local excision vs mastectomy?

A

Tumour size more than 4cm - very loose rule

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18
Q

Describe the pathway when a woman with breast cancer with no palpable axillary lymphadenopathy.

A

Ultrasound
If negative then sentinel node biopsy is indicated

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19
Q

What is a snowstorm sign indicative of on breast ultrasound?

A

Implant rupture

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20
Q

Who is periductal mastitis more common in and how does it present? Treatment?

A

Smokers - presents with recurrent infections
Tx- co-amoxiclav

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21
Q

What is Mondor’s disease?

A

Localised thrombophlebitis of a breast vein

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22
Q

Which type of chemotherapy is used in breast cancer patients who are node positive?

A

FEC-D chemotherapy1

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23
Q

What is neo-adjuvant chemotherapy used for in breast cancer?

A

To downsize primary tumour so breast conserving surgery can be used rather than a mastectomy
(reducing perioperative risks and cosmetically favoured)

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24
Q

How does a breast abscess typically present?

A

Breastfeeding women presenting with very painful, red swelling above areola

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25
Q

What is fibroadenosis?

A

‘Lumpy’ breasts in middle aged women
Symptoms may worsen prior to menstruation

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26
Q

What is fat necrosis of the breast?

A

Benign lump of degeneration and scarring of adipose tissue
Usually trauma causes it
Can mimic breast cancer

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27
Q

What is given to rhesus negative pregnant women?

A

Anti-D at 28 and 34 weeks

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28
Q

What is the first step when you’re exposed to chickenpox in pregnancy?

A

Test for VZV antibodies

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29
Q

What is the most common cause of postpartum haemorrhage?

A

Uterine atony - inadequate uterine contractions (effective contractions required for haemostasis)

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30
Q

Which food do pregnant women need to avoid eating and why?

A

Liver - contains high level of vitamin A which may cause birth defects

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31
Q

What are the choice of SSRIs in breastfeeding?

A

Sertraline or paroxetine

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32
Q

What is the management of a pregnant woman with a blood pressure over 160/110?

A

Arrange obstetric assessment in hospital

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33
Q

Explain blood pressure medications during pregnancy?

A

If on ACEi or ARBs for pre-existing hypertension - stopped and offered labetalol or nifedipine.

(Nifedipine if asthmatic)

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34
Q

What is the correct positioning for women with cord prolapse?

A

On all fours - knees and elbows

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35
Q

When is the screen for gestational diabetes done and how?

A

OGTT - 24 to 28 weeks

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36
Q

When should a referral be made to maternal unit when no maternal movement is felt?

A

By 24 weeks

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37
Q

What Bishop score indicates a cervix is ripe?

A

Above 8 - high chance of spontaneous labour/response to interventions that will induce labour

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38
Q

What is the normal fetal heart rate?

A

110/120 - 160

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39
Q

Describe the categories of C-sections

A

1 - immediate threat to life of baby or mother
2 - maternal/fetal compromise not immediately life threatening
3 - stable mother and baby but c-section required
4 - elective c section

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40
Q

Management if baby loses more than 10% of birth weight in the first week?

A

Refer to midwife-led breastfeeding clinc

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41
Q

What is given to mothers at risk of pre-eclampsia?

A

Low dose aspirin to be prescribed from week 12 to birth

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42
Q

What are the medical treatment for PPH secondary to uterine atony?

A

Oxytocin, ergometrine, carboprost, misoprostol

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43
Q

Management for baby blues?

A

Reassure, support and follow up

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44
Q

What is the medication of choice to suppress lactation and why is it done?

A

Cabergoline - dopamine agonists - suppresses prolactin and thus lactation

Lactation is suppressed as this may be uncomfortable for the mother and mastitis/breast abscess may occur

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45
Q

Mnemonic for medications to cease in pregnancies?

A

LAMBAST CCC

Lithium
Amiodarone
Methotrexate
Benzodiazepines
Aspirin
Sulphonamide
Tetracyclines

carbimazole, ciprofloxacin, chloramphenicol

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46
Q

How is postpartum thyroiditis managed?

A

Propranolol - no thyroid medications used

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47
Q

Mnemonic for placental abruption risk factors?

A

ABRUPTION

Abruption previously
Blood pressure (htn, pre-ecl)
Ruptured membranes
Uterine injury
Polyhydramnios
Twins/multiple gestation
Infection of uterus
Older age
Narcotic use

48
Q

Results of trisomy disorders in quadruple testing?

A

Similar between trisomy 13, 18 and 21

hCG is lower in Edward’s and Patau but raised in Down’s

49
Q

What is the symphysis-fundal height and how big should it be?

A

Top of pubic bone to top of uterus

Should match gestational age in weeks to within 2 cm

etc 24cm (22-26)

50
Q

Describe the management of gestational diabetes?

A

FPG <7 diet/exercise, 2w no improvement - metformin

FPG >7 insulin

51
Q

How does intrahepatic cholestasis affect childbirth?

A

Plan to induce labour at 37 weeks as it increases the chance of stillbirth

52
Q

MMR and pregnancy?

A

Avoid during pregnancy and before attempting to get pregnant.
Wait for 28d after MMR

53
Q

Most important investigation for first trimester bleeding?

A

Transvaginal ultrasound

54
Q

What is placenta accreta?

A

Attachment of placenta to the myometrium due to a defective decidua basalis - doesn’t properly separate during labour - increased risk of PPH

55
Q

How does chorioamnionitis present?

A

Maternal pyrexia, maternal tachycardia and fetal tachycardia

56
Q

Which dose of folic acid should obese women have?

A

High dose - 5mg

57
Q

What are the indications for higher dose folic acid?

A

MORE:

Metabolic - t1dm, coeliacs
Obesity - >30 bmi
Relative (PMHx)
Epileptic medications

(and haem conditions)

58
Q

What delivery method should be recommended for grade III/IV placenta praevia?

A

Elective C section at 37-38 weeks

59
Q

What is the tern used to describe the position of the head in relation to the ischial spine?

60
Q

What is a main contraindication for epidural anaethesia during labour?

A

Coagulopathy

61
Q

Can you breastfeed while on amiodarone?

62
Q

What is the main complication of labour induction?

A

Uterine hyperstimulation - high contraction frequency and duration

63
Q

What is the most common ovarian cancer?

A

Serous carcinoma

64
Q

What is the most common cause of postcoital bleeding?

A

Cervical ectropion

65
Q

What is a potential side effect of ovulation induction?

A

Ovarian hyperstimulation syndrome - GI symptoms

66
Q

What is the drug of choice for medical management of ectopic pregnancy?

A

Methotrexate

67
Q

What else should be offered to women having medical management of ectopic pregnancy?

A

Antiemetics and analgesia

68
Q

What is a common cause of secondary amenorrhoea in athletes?

A

Hypothalamic hypogonadism - low levels of fat means less GnRH - hypogonadism

69
Q

What is used first line for hyperemesis gravidarum?

A

Antiemetics - antihistamines (promethazine/cyclizine)

70
Q

What is given to women in hospital with hyperemesis gravidarum?

A

IV saline 0.9% with potassium

71
Q

What management is needed for ectopic pregnancy if there’s abdominal pain?

A

Surgical management

72
Q

What are the medical abortion tablets?

A

Mifepristone then prostaglandins (misoprostol)

73
Q

What is the first line management for menorrhagia?

A

Mirena coil (intrauterine system)

74
Q

When isn’t expectant management suitable in a miscarriage?

A

Evidence of infection or increased bleeding risk

75
Q

What are the classic symptoms of endometriosis?

A

Pelvic pain, dysmenorrhoea, dyspareunia and subfertility

76
Q

How long will a urine pregnancy test remain positive after termination?

A

Up to 4 weeks

77
Q

What is the most common cause of postmenopausal bleeding?

A

Vaginal atrophy

78
Q

When is contraception needed after menopause?

A

> 50 is 12 months after last period
<50 is 24 months after last period

79
Q

What needs to be ruled out in women with recurrent vaginal candidiasis?

A

Diabetes - Hba1c

80
Q

How does pelvic inflammatory disease cause RUQ pain?

A

Causes perihepatitis (Fitz-Hugh Curtis syndrome)

81
Q

What is the gold standard investigation for endometriosis?

A

Laparoscopy

82
Q

What is the risk malignancy index (RMI) based on in ovarian cancer?

A

CA-125 levels, US findings and menopausal status

83
Q

What does whirlpool sign on imaging suggest?

A

Ovarian torsion

84
Q

What should be tried if NSAIDs/paracetamol doesn’t help endometriosis?

A

COCP or POP

85
Q

What is the first line treatment for urinary incontinence?

A

Urge - bladder retraining
Stress - pelvic floor muscle training

86
Q

What is stress incontinence?

A

Incontinence when laughing or coughing

87
Q

What is the treatment for vaginal vault prolapse?

A

Sacrocolpoplexy

88
Q

What is used in stress incontinence when pelvic floor muscle exercises don’t work?

A

Duloxetine

89
Q

What is the first line treatment for primary dysmenorrhoea?

A

NSAIDs such as mefenamic acid

90
Q

What is the investigation of choice for ectopic pregnancy?`

A

Transvaginal ultrasound

91
Q

What is contraindicated in medical management of ectopic pregnancy and indicates for surgical management?

A

Presence of foetal heartbeat

92
Q

What is the medical management of an incomplete miscarriage?

A

Only vaginal misorpostol

93
Q

What is the hyperemesis gravidarum diagnostic triad?

A

5% pre-pregnancy weight loss
dehydration
electrolyte imbalance

94
Q

When you add progesterone to HRT which cancer does it increase the risk of?

95
Q

What is required to classify miscarriages?

A

Fetal heartbeat, cervical os open/closed, size of uterus

96
Q

How does an imperforate hymen present?

A

Cyclical pain without menstrual bleeding

97
Q

How does adenomyosis present?

A

> 30, dysmenorrhoea, menorrhagia, enlarged and boggy uterus

98
Q

What is the first line treatment for menorrhagia?

A

Insertion of IUS

99
Q

What is the most common cause of pelvic inflammatory disease?

100
Q

What is the first line management in an older woman with new onset non-specific abdo pain/bloating?

A

Measure CA-125 levels

101
Q

What is the next step for cervical screening after two repeat inadequate samples?

A

Colposcopy

102
Q

Which medication is used to shrink uterine fibroids and what is their side effect?

A

GnRH agonists and loss of bone mineral density

103
Q

How does fibroid degeneration present in pregnancy?

A

Low grade fever, pain and vomiting

104
Q

Is ondansetron safe in pregnancy?

A

Associated with a small increased risk of cleft palate/lip if used in first trimester

105
Q

What is the most appropriate investigation to diagnose premature ovarian failure?

106
Q

How do you properly diagnose primary ovarian insufficiency?

A

Not based off one FSH
-If normal, repeat FSH at 4-6 weeks

107
Q

When are ectopic pregnancies managed surgically?

A

bHCG over 5000
More than 35mm in size

108
Q

Which HRT option doesn’t appear to increase the risk of VTE?

A

Transdermal HRT

109
Q

What are the typical blood results for PCOS?

A

Raised LH:FSH level
Normal/raised testosterone
SHBG is normal/low

110
Q

What is the first investigation in patients with urinary incontinence?

A

Urinalysis

111
Q

If a sperm sample is abnormal, when should the test be repeated?

A

In 3 months

112
Q

How does complete hydatidiform mole present?

A

Uterus size greater than expected for gestational age and abnormally high bHCG

113
Q

What is endometrial hyperplasia caused by?

A

Oestrogen unopposed by progesterone

114
Q

What is the definition of premature ovarian failure?

A

Onset of menopausal symptoms and elevated gonadotrophin levels before the age of 40

Passmed (6 decks)

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