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Phase 3A Medicine > Random gynae > Flashcards

Random gynae Flashcards

1
Q

Risk factors for Lichen Sclerosis

A

Autoimmune: T1DM, HypOthyroidism, alopecia, vitiligo

Preceding infections may play a part

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2
Q

Peaks of lichen sclerosis?

A

Pre-pubertal and post-menopausal

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3
Q

Tx of lichen sclerosis?

A

Topical steroids, e.g. Clobetasol propionate

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4
Q

Describe the histology of the cervix

A

Endocervix = columnar epithelium -produce mucus
Ectocervix = mature squamous epithelium
Where they meet = squamocolumnar junction
Inbetween = transformation zone (sub-columnar cells multiply and transform into immature squamous cells through metaplasia)

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5
Q

How often is cervical screening offered and for which age groups?

A 
25-49 = every 3 years
50-65 = every 5 years
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6
Q

Factors that protect against T1 endometrial cancer?

A
  • Breastfeeding
  • Pregnancy at a later age
  • Hormonal contraceptives
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7
Q

RFs for endometrial cancer?

A
  • Tamoxifen
  • Oestrogen therapy (w/o progesterone)
  • Obesity
  • HNPCC
  • Chronic anovulation (e.g. PCOS)
  • Nulliparous
  • Late menopause
  • Diabetes
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8
Q

What might you see on a TVUS for endometrial cancer?

A

Endometrial thickness > 4cm

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9
Q

What are the symptoms of ovary hyperstimulation?

A
  • Abdo pain
  • N+V
  • Shifting dullness
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10
Q

What is a Bartholin abscess? Management?

A

Bartholin’s glands are a pair of glands located next to the entrance to the vagina. These are normally about the size of a pea, but can become infected and enlarge - forming a Bartholin’s abscess.

This can be treated by antibiotics, by the insertion of a word catheter or by a surgical procedure known as marsupialization.

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11
Q

Complication of fibroids in pregnancy? Presentation? Management?

A

Red degeneration - haemorrhage into tumour - commonly occurs during pregnancy.
This usually presents with low-grade fever, pain and vomiting.
The condition is usually managed conservatively with rest and analgesia and should resolve within 4-7 days.

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12
Q

Threatened miscarriage

A
  • Cervical os is closed
  • Mild bleeding w/ mild/no pain
  • < 6 weeks - watchful waiting
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13
Q

Inevitable miscarriage

A
  • Cervical os is open
  • Bleeding + clots
  • Pain
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14
Q

Incomplete miscarriage

A
  • Cervical os is open

- Partially expelled products of contraception

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15
Q

Complete miscarriage

A
  • Cervical os is closed

- Hx of pregnancy, US now shows no fetal tissue

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16
Q

Missed miscarriage

A
  • Cervical os is
  • Fetus dead but retained
  • Uterus = small for dates
  • May have a history of threatened miscarriage
  • Persistent dark brown discharge
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17
Q

RFs for ectopic

A
  • PID
  • Tubal surgery
  • Prev ectopic
  • Smoking
  • Gynae surgery
  • > Age
  • IVF
  • IUCD use
  • Adhesions from infection/inflammation
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18
Q

Mx of ectopic

A

Check if haemodynamically stable, ABCDE, crossmatch, fluids, FBC

  • Early, haem stable + hCG declining –> watchful waiting
  • If found later –> methotrexate w/contraception
  • Haem unstable –> surgery (salpingectomy/salpingotomy)
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19
Q

SEs of methotrexate

A
  • Conjunctivitis
  • Stomatitis
  • Diarrhoea
  • Abdo pain
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20
Q

How would a ruptured ectopic present?

A

Referred shoulder pain (blood in peritoneum)

- particularly on urination/defecation

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21
Q

Most common location for ectopic?

A

Ampulla of fallopian tubes

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22
Q

Risks to mother in multiple preg

A
  • Anaemia
  • Pre-term
  • Polyhydramnios
  • HTN
  • Malpresentation
  • Instrumental delivery
  • PPH
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23
Q

Risks to babies in multiple preg

A
  • TTT syndrome
  • Miscarriage/stillbirth
  • Fetal growth restriction
  • Prematurity
  • Locked twins (heads intertwined - monoamniotic)
  • Twin anaemia-polycythaemia syndrome
  • Congenital abnormalities
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24
Q

Antenatal care in multiple preg

A

FBC @ booking, 20wks, 28wks
USS 2-weekly from 16wks for monochorionic; 4-weekly from 20wks for dichorionic
Planned birth (32 –> 37+6wks), triplets before 35+6wks
CORTICOSTEROIDS

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25
Q

3 puerperium infections - organisms + presentation + management

A

Endometritis:

  • Group A beta-haem strep
  • Fever/low abdo pain
  • IV Clindamycin and Gentamicin (Refer to the hospital)

UTI:

  • E.coli, klebsiella, proteus
  • Fever/low abdo pain/dysuria/freq/urgent
  • Trimethoprim

Lactation mastitis:

  • S. Aureus
  • Breast pain/erythema, fever
  • Oral flucloxacillin if bacterial culture/infected nipple fissure

Chorioamnionitis:
- Tx with erythromycin (Post-labour)

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26
Q

Drugs that can NOT be used in breastfeeding

A
  • Abx: Ciprofloxacin, Tetracycline, Chloramphenicol, Sulphonamide
  • Psych: Lithium, Benzos, Fluoxetine
  • Aspirin
  • Carbimazole
  • Methotrexate
  • Sulphonylureas
  • Cytotoxic drugs
  • Amiodarone`
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27
Q

Tx of UTI in pregnancy

A
  • Nitrofurantoin (NOT 3rd tri due to haem disease of newborn)
  • Amoxicillin (NOT if allergic)
  • Cefalexin

7 days of treatment

NOT trimethoprim in 1st tri due to neural tube defects, ideally never in pregnancy

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28
Q

RFs associated with UTIs in pregnancy

A
  • Preterm delivery and preterm PROM
  • Placental abruption
  • Pre-eclampsia
  • Low birth weight
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29
Q

Anaemia in pregnancy

Defining Hb level?

A

< 105 g/L

30
Q

antenatal Hb screening when?

A

Booking

28 weeks

31
Q

Anaemia in pregnancy

RFs

A
  • Multiple preg
  • Frequent preg
  • Prev anaemia (hookworm/malaria/mennorrhagia)
  • Poor diet
32
Q

Discuss rhesus incompatibility

A
  • Baby = anti-D +ve
  • Mum = anti-D -ve
    Baby’s blood gets into mum at birth or sensitisation events (e.g. APH/amniocentesis procedure/abdo trauma) –> mum creates anti-D antibodies –> destroys baby’s blood cells —> fine in this pregnancy BUT in future pregs —> antibodies can cross the placental membrane and destroy babies blood cells
33
Q

When should you give anti-D

A
  • Routinely at 28 weeks gestation and birth

- Within 72hrs of any sensitisation event

34
Q

What is Kleihauer test?

A

After 20 weeks gestation - assesses how much of foetal blood is in mother

35
Q

WHich SSRIs are safe in breastfeeding

A

Sertraline or Paroxetine

36
Q

RFs of VTE in preg

A
  • Fx of unprovoked VTE
  • > 35yrs
  • > 30 BMI
  • Smoker
  • Immobility
  • Varicose veins
  • Pre-eclampsia
  • Low risk thrombophilia
  • Multiple pregnancy
37
Q

What should you always think of in collapsed pregnant/post partum woman?

A

VTE! PE!!!

38
Q

Tx of VTE in preg

A

ANY risk factor –> LMWH and for 6weeks post-partum
Start if suspecting VTE and continue until ruled out
Might adjust the dose according to Anti-factor Xa levels
Warfarin is CI in preg

39
Q

Definition of hyperemesis

A
  • Preg vomiting that continues beyond normal 4-10wks
  • Weight loss >5% body mass
  • Ketosis
  • Electrolyte imbalance and dehydration
40
Q

Pathophysiology of hyperemesis

A
  • hCG from trophoblastic cells peaks at 10/11 weeks and can cause vomiting
  • Therefore, conditions associated with higher hCG levels are more likely to cause vom (MOLAR pregs or multiple pregs)
41
Q

When does pre-eclampsia occur?

A
  • 20 weeks into gestation and up to 6 weeks postpartum
42
Q

What is pre-eclampsia

A
  • Hypertension (> 140syt or >90 dyst)
  • Proteinuria (>0.3g/24hrs)

(If no proteinuria –> gestational HTN)

43
Q

Pathophys of pre-eclampsia

A
  • Spinal artery fails to dilate completely due to incomplete trophoblastic invasion of spinal artery –> decreased placental blood flow
  • Fibrosis and ischaemia of placenta –> release inflammatory proteins –> travel into mums arteries and cause damage:
    o Vasoconstriction (HTN)
    o Increase vascular permeability (proteinuria)
    o Clotting dysfunction
44
Q

High risk for pre-eclampsia and Tx?

A
  • Pre-eclampsia/HTN in prev preg
  • CKD
  • Autoimmune disease, e.g. SLE, antiphospholipid
  • DM1/2

–> Give aspirin at 12 weeks if one of these

45
Q

Moderate risk for pre-eclampsia and Tx?

A
  • Age > 35/40
  • BMI > 25
  • First pregnancy
  • > 10 yrs since the last preg
  • Multiple pregnancy
  • Fx of preeclampsia

–> Give aspirin at 12 weeks if >1 of these

46
Q

HELLP

A 
Haemolysis
Elevated
Liver enzymes
Low
Platelets
47
Q

GBS in pregnancy

A
  • 30% = colonised with GBS normally
  • In pregnancy - can cause problems
    Mother: endometritis, cystitis, chorioamnionitis (may cause miscarriage/premature labour/intrauterine fetal death)
    Baby: pneumonia, sepsis, meningitis, septic arthritis
    Treat with Ben Pen/Clindamycin
    If isolated during labour - give prophylactic few hours b4 birth
48
Q

Measles in pregnancy

A
  • Measles = Paramyxovirus
  • Symptoms: CCCK, rash - maculopapular
  • If a maternal rash appears 6 DAYS before delivery or after delivery - give human normal immunoglobulin to baby immediately after birth/exposure
  • Prevents neonatal subacute sclerosing parencephalitis
49
Q

Rubella in pregnancy

A
  • Foetus most at risk in 1st 16 WEEKS
  • If IgM found in first 16wks a TOP is offered
  • Woman should have MMR pre-pregnancy (can’t have in pregnancy as live vaccine)
  • Can be tested for immunity and if not, can have two doses of vaccine 3 months apart pre-pregnancy
  • Can also have the vaccine post-birth
  • BABY: congenital deafness (5-7 wks), congenital cataracts (8-9wks), congenital heart disease (PDA/pulmonary stenosis) (5-10 wks), learning difficulties
50
Q

Cytomegalovirus in pregnancy

A
  • Maternal infection - mild
  • If mum infected –> 40% of foetuses are infected
    Out of these: 90% = normal at birth, 10% = symptomatic
  • Congenital problem: IUGR, MICROCEPHALY, hearing/vision loss, jaundice, learning difficulties, hepatosplenomegaly, thrombocytopenia
  • Ganciclovir for babies born with CMV
  • Can be detected at birth (Guthries) - PCR of DNA
51
Q

Toxoplasmosis

A
  • RISK if higher LATER in preg but SEVERITY is higher EARLIER in preg
  • Symps: fever, rash, eosinophilia
  • BABY: Triad = intracranial calcification, hydrocephalus, chorioretinitis (inflamm of choroid + retina)
  • Treat mother with SPIROMYCIN
52
Q

Parvovirus B19

A

(slapped cheek syndrome)

  • In pregnancy - often asymp or slapped cheek
  • BABY: foetal suppression of erythropoiesis, cardiac toxicity, fetal hydrops fetalis, severe foetal anaemia
  • Mum: pre-eclampsia looking syndrome, miscarriage
  • Serial US looking for anaemia
53
Q

Hep B

A
  • ALL MOTHERS SHOULD BE SCREENED

- Give IMMUNIGLOBULINS and VACCINATE BABIES of carriers/infected mothers

54
Q

Varicella Zoster in preg

A
  • Mum: varicella pneumonitis, hepatitis, encephalitis
  • Baby: Severe neonatal varicella syndrome

Exposure in preg:

  • If had chickenpox = safe
  • If not sure about immunity –> check VZV IgG
  • If not immune –> Give IV VZV immunoglobulins within 10 days of exposure

Developing VZV in preg

  • ORAL ACICLOVIR if within 24hrs and >20wks - 7-day course
  • Admission if chest/CNS symptoms

Congenital VZV:

  • IUGR
  • Microcephaly, hydrocephalus, learning disability
  • Scars and skin changes
  • Limb hypoplasia
  • Cataracts/inflamm of eyes
55
Q

Gonococcal conjunctivitis

A
  • 4 days post-birth –> PURULENT DISCHARGE and LID SWELLING
  • BABY: Cefotaxime and Chloramphenicol
  • MOTHER: Active gonorrhoea infection –> Ben Pen
56
Q

Placental abruption RFs

A
  • Maternal HTN
  • Previous abruption
  • Maternal trauma
  • Smoking/alcohol/drugs - COCAINE
  • Short umbilical cord
  • Sudden decompression of uterus
  • Thrombophilia
  • Multiparity
  • Maternal age >35yrs
  • Multiple pregnancies
57
Q

Placenta praevia RFs

A
  • Insufficient uterine wall (prev. C/S, abortion, uterine surgery, multiparity)
  • Multiple pregnancies
  • Maternal age >35yrs
  • Fibroids
  • Maternal smoking
  • Assisted conception
  • Prev placenta praevia
58
Q

What is placenta accreta

A
  • Placenta invade the uterine wall
    o Usually myometrium = increta
    o Can be serosa too, and even reach other organs = percreta
  • Colour doppler USS
  • C-section + Steroids
  • Complex uterine surgery but hysterectomy is recommended
59
Q

What is vasa praevia

A
  • fetal vessels run across os
  • Unprotected by the umbilical cord
  • Membrane ruptures –> risk of fetal haemorrhage
  • Need C/S
60
Q

4T’s of PPH

A

T- Tone (uterine atony - doesn’t contract back down) = most common
T - Trauma (tears/repairs)
T - Tissue (retained placenta)
T- Thrombin (bleeding disorder/DIC/pre-eclampsia)

61
Q

PPH blood loss definition

A

Loss of:

  • 500 ml after vaginal birth
  • 1000 ml after C/S

Minor: 500-1000
Mod: 1000-1500
Sev: 1500-2000
BAD: >2000

62
Q

PPH other criteria

A
  • 10% decrease in haematocrit

- Change in HR, BP, O2 sats

63
Q

PPH Tx

A

If emergency:

  • ABCDE
  • 15L/min O2
  • TWO large bore cannulas!
  • Crossmatch 4-6L of blood

Mechanical:

  • Fundal massage
  • Empty bladder

Medical:

  • Oxytocin/Syntoncinon
  • Ergometrine (NOT if HTN)

Surgical:

  • Balloon tamponade
  • B-lynch suture
  • Evacuation of retained products
  • Uterine artery ligation
  • LAST RESORT = hysterectomy
64
Q

Define prem labour

A

Contractions of sufficient strength + frequency to effect progressive effacement of the dilation of cervix BEFORE 37 WEEKS

65
Q

How to investigate preterm labour risks

A
  • TVUS - measure cervical length

- Vaginal swab - Fetal fibronectin!

66
Q

Tx of preterm labour

A
  • Mother: tocolytics

- Baby: steroids (lungs) + Magnesium sulphate (neuroprotectin - cerebral palsy)

67
Q

define PROM

A

< 37 weeks

68
Q

RFs of PROM

A
  • infection
  • multiple preg
  • polyhydramnios
  • malpresentation
69
Q

Tx of PROM

A
  • < 24 weeks = poor prognosis (pulmonary hypoplasia even w/steroids)
  • 24-34 weeks = steroids + erythromycin, daily review
  • 34+ weeks = induce labour!
    DO NOT PUT FINGERS IN, SPECULUM EXAM ONLY
70
Q

Shoulder dystocia manoeuvres

A
  • McRoberts’ manoeuvre - flexion and abduction of the maternal hips, bringing the mother’s thighs towards her abdomen –> increases the relative anterior-posterior angle of the pelvis
  • Episiotomy (may make delivery easier)
  • Internal rotation manoeuvres
  • Last line = Symphysiotomy and the Zavanelli (but cause sig. maternal mortality so last resort)
71
Q

Amniotic fluid embolism

A
  • LIQUOR enters the maternal circulation
  • ANAPHYLAXIS, DYSPNOEA, HYPOXIA, HTN
  • May be accompanied by seizures +/- DEATH
  • Can happen w/membrane rupture, labour, C/S, TOP
  • RF = eclampsia
  • Tx = resus, supportive

Phase 3A Medicine (17 decks)

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