Repro Flashcards
What is meant by gravidity?
The number of times a woman has been pregnant, regardless of the outcome
What is meant by parity?
The total number of pregnancies carried over the threshold of viability (24 weeks)
How are multiple pregnancies counted in terms of parity?
They are counted as one pregnancy
What specific symptoms should you ask about in a gynae history?
Abdominal/pelvic pain or swellling, vaginal discharge, abnormal vaginal bleeding, pain during sex, itching/skin changes
What extra things should be asked about in a gynae history?
Menstrual history, contraception/HRT use, smears, previous gynae/obstetric history
When taking an obstetric history, what points should you clarify in the first instance?
Gestation, single or multiple pregnancy, first pregnancy or not
What specific symptoms should you ask about in an obstetric history?
Abdominal/pelvic pain, vaginal discharge, vaginal bleeding, nausea/vomiting, headaches/visual changes, swelling
What are the two most important things to ask about in an obstetric history?
Foetal movements and mental health
What extra things should be asked about in an obstetric history?
Current pregnancy (is antenatal care up to date, have they had any problems) and previous pregnancies (any complications, type of delivery etc)
What specific symptoms should you ask about in a male sexual history?
Abdominal/pelvic pain, testicular pain/swelling, urethral discharge or bleeding, skin changes, dysuria
What extra things must you remember to ask females in a sexual history?
Is there any chance they could be pregnant? When was their last period? Have they ever been pregnant before? Are they on any contraception? Are they up to date on their smears?
What questions must you ask about each sexual encounter in a sexual history?
Was it a male or female partner? Was it a regular partner? Was the sex consensual? What type of sex was it? Did they use a condom?
What questions should you ask in a sexual history to establish an individual’s risk of BBVs?
Have they ever had sex with someone from overseas? Have they ever had sex with someone who they knew had HIV/hepatitis? Have they ever injected drugs or had sex with someone who did? Have they had any non-professional tattoos or piercings? Have they ever paid for sex or been paid for sex?
What should you always warn patients at the end of a sexual history if they are undergoing STI testing?
To abstain from sex until the results come back or make sure they use a condom
What conditions should you always ask about a personal/family history of when discussing contraceptive options?
Migraines with aura, VTE, breast/cervical cancer
What should you always warn patients about at the end of a contraceptive history?
To continue using condoms in order to prevent STIs
It is important to warn patients that they might experience what symptom after a speculum examination?
Light spotting
How many times should you rotate the brush in a smear? How many times should you dunk it against the base of the pot?
5 / 10
At what age would women receive a smear every 3 years?
25 - 49
At what age would women receive a smear every 5 years?
50 - 64
Results of a smear test will usually be in the post in what timeframe? Patients should contact their GP if they haven’t received them by when?
2 weeks / 4 weeks
What is the action of a smear result saying ‘we found no HPV’?
Return for routine smear in 3/5 years
What is the action of a smear result saying ‘we found HPV but no cell changes’?
Return for a smear in 1 year
What is the action of a smear result saying ‘we found HPV with cell changes’?
Refer for colposcopy
What is the action of a smear result saying ‘unclear result’?
Return for another smear
After you have placed a urine sample on a pregnancy test, how long should you wait before reading the results?
3 minutes
On a urinary pregnancy test, what do each of the following results imply: 1) 2 lines? 2) 1 line on ‘C’? 3) 1 line on ‘T’?
1) Positive 2) Negative 3) Invalid
Testing for each of the following sexually transmitted infections should take place how long after potential exposure: 1) Chlamydia/Gonorrhoea? 2) HIV? 3) Syphilis/Hepatitis?
1) 2 weeks 2) 4 weeks 3) 3 months
Sexual health serology (HIV, hepatitis, syphilis) is taken as a single blood test in what vacutainer?
Gold
What colour of swab is used to take a chlamydia/gonorrhoea NAAT from the vulvo-vagina, pharynx or rectum?
Orange
What colour of tube is used to take a chlamydia/gonorrhoea NAAT from a first pass urine sample?
Yellow
How should chlamydia/gonorrhoea NAAT testing take place in women?
Vulvo-vaginal swabs
How should chlamydia/gonorrhoea NAAT testing take place in men?
First pass urine sample
What colour of swab is used to take a sample for HSV or syphilis serology?
Red
What colour of swab is used to take a high vaginal sample for microscopy and gram stain to detect candida, group b strep, trichomonas or BV?
Blue
What colour of swab is used to take urethral chlamydia/gonorrhoea gram stain, microscopy and culture in symptomatic males?
Blue
How is vaginal candidiasis treated?
Fluconazole 150mg one-off dose + Clotrimazole 1% cream 2-3 times daily
How are bacterial vaginosis and trichomonas vaginalis treated?
Metronidazole 400mg BD for 7 days
How is chlamydia treated?
Doxycycline 100mg BD for 7 days
How is gonorrhoea treated?
IM ceftriaxone 1g one-off dose
A test of cure for gonorrhoea is required after how long?
2 weeks
How is syphilis treated?
IM benzylpenicillin 2.4 million units one-off dose
What blood tests are taken for syphilis serology?
Syphilis IgG and IgM plus EIA
How are genital herpes treated?
Aciclovir 400mg TDS for 5 days
What investigations should you consider at the end of a sexual history?
Any required swabs, bloods for sexual health serology, CRP and FBC, urinary pregnancy test, urinalysis, MSSU for culture and sensitivity
What is the standard outpatient treatment for PID?
Ofloxacin and metronidazole 400mg BD for 14 days
What is the outpatient treatment for PID in those aged < 18 or at high risk of gonorrhoea?
1g IM ceftriaxone one-off dose and doxycycline 100mg and metronidazole 400mg BD for 14 days
What are the absolute contraindications to using combined hormonal contraceptives?
Smoker aged > 35 years, < 6 weeks post-partum or breastfeeding, migraine with aura, breast/cervical cancer, VTE, hypertension/CVD
How do combined hormonal contraceptives, the implant, injection and IUS work?
Inhibition of ovulation, thickening of cervical mucus, thinning of the endometrium
What are the main hormonal effects that may be experienced with combined or progesterone only methods of contraception (apart from IUS)?
Weight gain, acne, mood change, headache
What are the two main risks of combined hormonal contraceptives?
VTE and increased risk of breast and cervical cancer
Contraception should ideally be started within the first 5 days of regular menstruation. If this does not occur, which contraceptives require 7 days of condom use?
Combined methods, implant, injections and IUS
What is the advice if one COCP is missed?
Take it ASAP, even if it is with the next pill
What is the advice if two COCPs are missed in the first week?
Take one pill ASAP, use condoms for the next 7 days, consider emergency contraception if had sex that week
What is the advice if two COCPs are missed in the second week?
Take one pill ASAP, use condoms for the next 7 days
What is the advice if two COCPs are missed in the third week?
Take one pill ASAP, use condoms for the next 7 days, omit the pill-free interval
What advice should be given to someone on the COCP with diarrhoea and/or vomiting?
Use condoms for 7 days
What are the absolute contraindications to the use of the progesterone only pill?
Breast cancer and liver cirrhosis
How does the progesterone only pill work?
Increasing cervical mucus and thinning the endometrium
How should the progesterone only pill be taken?
At the same time every day with no pill-free interval
Contraception should ideally be started within the first 5 days of regular menstruation. If this does not occur, which contraceptives require 2 days of condom use?
Progesterone only pill
What is the advice if one POP is missed (< 3 hours)?
Take it ASAP
What is the advice if two POPs are missed? (> 3 hours or > 12 hours for Cerazette)
Use condoms for 2 days and consider emergency contraception if had sex 2-3 days before or during the break
What are some side effects specific to the contraceptive injection?
Weight gain, osteoporosis, delay in return of fertility
What is the main contraindication to the use of intra-uterine contraceptive devices?
Any pelvic infection within the last 3 months or any gynae malignancy
What should you do before inserting an intra-uterine contraceptive?
STI test
How does the copper-IUD work?
Copper acts as a spermicide and causes intra-uterine inflammation
Which is the only contraceptive that is likely to make periods heavier?
Copper-IUD
When can the copper-IUD be used for emergency contraception?
Up to 120 hours after unprotected sex or up to 5 days after expected ovulation
Those who use the copper-IUD for emergency contraception require what follow-up?
Pregnancy test 3-6 weeks later
When can ulipristal acetate be used for emergency contraception?
Within 120 hours of unprotected sex
A second dose of emergency contraception is required if vomiting occurs within what timeframe?
3 hours
When can levonorgestrel be used for emergency contraception?
Within 72 hours of unprotected sex
When should the dose of levonorgestrel for emergency contraception be doubled?
BMI > 26 or weight > 70kg
Which causes of a testicular swelling will be continuous with the testis?
Tumour and hydrocele
Which causes of a testicular swelling will be separate from the testis?
Epididymal cyst and varicocele
Which testicular swellings will transilluminate?
Hydroceles and epididymal cysts
What are some investigations you might consider in someone with a testicular swelling?
Ultrasound, fluid aspirate, bloods for HCG and AFP
A varicocele is more common on which side? Why is it important to be aware of these?
Left side - can be a sign of renal cancer
When performing inspection as part of a breast exam, you should ask the woman to sit in what three different positions?
Hands on thighs, hands on hips, hands behind head
How should you position patients when palpating during a breast exam?
At 45 degrees on the bed with their arm behind their head
Which lymph nodes should you palpate during a breast exam?
Axillary, supraclavicular and all head/neck nodes
What is the further management after history and examination of a woman with a breast lump?
Referral to breast clinical for imaging (US/mammography) and biopsy
What is a good system to use for explaining your findings of a breast lump?
Size, site, shape/consistency, mobility, skin changes
When taking a history of a breast lump, you should always ask if there is any relationship with what?
The menstrual cycle
What are some important questions to ask about the characteristics of a breast lump in a history?
Is it hard or soft? Is it smooth or irregular? Is it mobile? Is it painful?
What are some specific symptoms related to breast pathology you should ask about when taking a history of a breast lump?
Any nipple discharge or bleeding? Any changes in the skin of the breast or nipple?
In a history of a breast lump, you should take a focused O+G history. What sort of things should you include?
Menstrual history, use of contraceptives/HRT, pregnancies/breastfeeding
What procedure is a risk factor for the development of breast cancer and may be a useful thing to ask about during past medical history?
Radiation to the chest
When is it normal to feel foetal movements by?
20 weeks - however, they may be noticed earlier in multiparous women
If a woman reports any change in foetal movements, what investigations should be done?
CTG and ultrasound
What are some important points to discuss before beginning a pregnant abdomen exam?
Single/multiple pregnancy? First pregnancy? Gestation? How have things been going so far? Foetal movements? Maternal mental health?
What are some questions you should ask women before beginning a pregnant abdomen exam to ensure their comfort?
Do they need to go to the toilet? Are they currently in any pain? Get them to tell you if they feel breathless at any point.
What are you looking for on inspection of a pregnant abdomen?
Skin changes, size of bump, symphyseal-fundal height
Symphyseal-fundal height should be measured at all antenatal appointments from what point in pregnancy?
24 weeks
The symphyseal-fundal height in cm should correlate roughly with what?
The gestation in weeks (+/- 2)
When should the fundus be roughly at the height of the umbilicus? What should the fundus be roughly at the height of the xiphisternum?
20 weeks, 36 weeks
What should you palpate during a pregnant abdomen exam and what are you trying to find out?
Palpate the top of the bump (fundus) for height, the sides of the bump for lie and the bottom of the bump for presentation and engagement
The lie and presentation of a baby is only relevant after what gestation?
36 weeks
Where should you try to auscultate for a foetal pulse? What should you do at the same time?
Roughly at the anterior shoulder, you should feel the maternal pulse at the same time
If the presenting part feels hard and round, what is the most likely presentation?
Cephalic
If the presenting part is broad, soft and poorly defined, what is the most likely presentation?
Breech
When may you not be able to feel the presenting part of a foetus?
If they are in a transverse lie
What are the three potential ways a foetus can lie in the abdomen?
Longitudinal, oblique or transverse
What further assessment is always required after a pregnant abdomen examination?
BP and urinalysis
For a singleton pregnancy, when is the fundus usually palpable?
12 weeks
When are the two different types of Down’s syndrome screening in pregnancy used?
Combined test (bloods + US) is used from 11-13+6 weeks; 2nd trimester screening (bloods only) is used from 15-20 weeks
What bloods are tested for in combined Down’s syndrome screening and what do they show if positive for the condition?
Beta HCG (high) and PAPP-A (low)
What US measurement is used for combined Down’s syndrome screening? What happens to this measurement if positive for the condition?
Nuchal translucency - will be increased in Down’s
What four bloods are tested for in second trimester Down’s syndrome screening and what do they show if positive for the condition?
Beta HCG and inhibin-A are high; AFP and unconjugated oestriol are low
The results of Down’s syndrome screening are combined with what factors to produce a personalised risk?
Gestational age and maternal age
If the results of Down’s syndrome screening come back as > 1/150, what further tests are offered?
CVS (11-14 weeks) or amniocentesis (> 15 weeks)
Women who are at high risk of developing pre-eclampsia should be taking what medication and when?
75mg aspirin OD from 12 weeks
What supplements should all women take in pregnancy?
Folic acid 400mcg until 12 weeks, vitamin D 10mcg throughout pregnancy and breastfeeding
Pre-eclampsia can only be diagnosed when hypertension and proteinuria are present at what gestation?
> 20 weeks
If a woman has suspected pre-eclampsia, what further investigations should be done?
Spot urine PCR, bloods (particularly FBC and LFTs for HELLP syndrome)
What is the first-line antihypertensive to use in pregnancy?
Oral labetalol
Women with pre-eclampsia need to be admitted- what for?
Regular blood pressure measurements and blood tests, also US scans
Delivery is suggested for women with pre-eclampsia beyond what gestation? This can be delayed by 24-48 hours to allow what to be done?
34 weeks - to allow maternal corticosteroids to be given to mature the foetal lungs
