Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Year 3 Revision > Repro Management Pathways (God help us all) > Flashcards

Repro Management Pathways (God help us all) Flashcards

1
Q

Medical management of DUB

A 
Progestrogen (synthetic progesterone)
COPC
NSAIDs
Anti-fibrinolytics e.g. tranexamic acid
Mirena coil
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Surgical management of DUB

A

Endometrial resection/ablation

Hysterectomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What HRT is required after an endometrial ablation and hysterectomy?

A

Endometrial ablation - combined HRT

Hysterectomy - oestrogen only HRT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Indications of intra-uterine insemination

A

Sexual problems
Same sex relationships
Discordant blood borne viruses
Abandoned IVF

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Indications for IVF

A 
Unexplained (>2 years duration)
Pelvic disease (endometriosis, tubal disease, fibroids)
Anovulatory infertility (after failed ovulation induction)
Failed intra-uterine insemination (after 6 cycles)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are the 5 steps in IVF?

A
  1. Down regulation (give GnRH agonist [buserelin] to suppress spontaneous ovulation)
  2. Ovarian stimulation (SC FSH with maybe LH)
  3. Oocyte collection
  4. Fertilisation
  5. Embryo transfer (usually 1)

Would also give progesterone suppositories for 2 weeks then do pregnancy test after 16 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Management of male infertility

A

Lifestyle advice (common sense)
Treat any specific cause
Intracytoplasmic sperm injection (may require surgical sperm aspiration)
Donor insemination

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Medical abortion procedure <10 weeks gestation

A

Mifepristone 200mg PO (progesterone antagonist)
Misoprostol 800mcg PV/SL (24-48 hours later)

Can self-administer misoprostol at home (not if under 16)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Medical abortion procedure >10 week gestation

A

Mifepristone 200mg PO (progesterone antagonist)
Repeated doses of misoprostol 800mcg PV/SL (24-48 hours later, up to 4 doses)

Inpatient procedure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

When would MTOP have to be performed in England?

A

20 weeks and over.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Surgical abortion procedure <14 weeks gestation

A

Cervical priming via misoprostol or osmotic dilators
Electric vacuum aspiration (general anaesthetic)
Manual vacuum aspiration (up to 10 weeks, local anaesthetic)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Surgical abortion procedure >14 weeks gestation

A

Cervical priming via misoprostol or osmotic dilators
Dilatation and evacuation
Needs to be done in specialist centre in England

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

When is antibiotic prophylaxis required for abortion?

A

All surgical termination of pregnancy

Medical termination of pregnancy with increased risk of STI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is the antibiotic prophylaxis for abortion?

A

7 days 100mg doxycycline BD
OR
1g oral azithromycin and 500mg for 2 days after

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What three things do you need to consider prophylaxis for after abortion?

A

Antibiotics
Rhesus iso-immunisation (anti-D to at risk Rhesus negative women)
VTE (high risk get LMWH for 1 week post abortion)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is the guidance of women receiving hormonal contraception after abortion?

A

Immediately effective if started within 5 days after abortion
If after 5 days:
POP effective after 2 days
CHC/DMPA/SDI/IUS effective after 7 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What 3 drugs can you use to treat hypertension in pregnancy?

A

Labetalol
Methyldopa (alpha blocker)
(Nifedipine unlicenced but can still use)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Drug management of N&V in pregnancy.

A

Cyclizine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Drug management of UTI in pregnancy.

A

Nitrofurantoin, cefalexin

Trimethoprim in 3rd trimester

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Drug management of pain in pregnancy.

A

Paracetamol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Drug management of heartburn in pregnancy.

A

Antacids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Management of pregnant women with significant VTE risk/VTE.

A

LMWH at delivery and up to 7 days post-partum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Definition of highly active anti-retroviral therapy

A

A combination of 3 drugs from at least 2 drug classes to which the virus is susceptible

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

How long to give PEP to a neonate who’s mother has HIV?

A

4 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Drugs included in PrEP

A

Tenofovir

Disoproxil/emtricitabine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

PrEP eligibility criteria

A

MSM condomless anal sex with 2+ partners in last year and likely in next 3 months
Rectal bacterial STI in last year
Partner of someone with HIV VL >50

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What prophylactic treatment is given for women at high risk of pre-eclampsia, and what are the risk factors?

A

Apirin 75mg daily from 12 weeks until birth
Risk factors:
Hypertensive disease during previous pregnancy
CKD
Autoimmune disease
Diabetes
Chronic hypertension

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Management of cervical shock.

A

Remove products from cervix
IV fluid resuscitation
Uterotonics may be required

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Management of pregnancy in patient with anti-phospholipid syndrome or thrombophilia.

A

Low dose aspirin

Daily LMWH injections

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Management of patient with ectopic pregnancy who is well and compliant with follow up visits

A

Watchful waiting

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Management of ectopic pregnancy in woman who is stable, has low bhCG and the ectopic is small and unruptured

A

Medical management:

Methotrexate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Management of ectopic pregnancy in woman who is acutely unwell

A

Surgery (salpingotomy/salpingectomy)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Molar pregnancy management

A

Surgical and tissue for histology

Follow up with molar pregnancy services

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Chlamydia management in pregnancy

A

Erythromycin
Amoxicillin
Test of cure at 3 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

When should you give anti-D to a rhesus negative pregnant lady?

A

Any surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

First line medications for hyperemesis gravidarum

A

Cyclizine
Prochlorperazine
Both IV or IM

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Second line medications for hyperemesis gravidarum

A

Ondansetron (serotonin inhibitor)
Metoclopramide
XONVEA UK

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Supplementary medications for hyperemesis gravidarum

A

Thiamine/pabrinex
Ranitidine and PPI (omeprazole)
Oral prednisolone tapered

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Management of large for dates delivery with no diabetes

A

Do not do induction of labour

40
Q

Management of polyhydramnios

A

Counsel patient (increased risk in labour)
Serial USS
IOL by 40 weeks

41
Q

Management of twin-to-twin transfusion syndrome (TTTS)

A

Before 26 weeks - fetoscopic laser ablation
After 26 weeks - amnioreduction/septostomy
Deliver between 34-36 weeks

42
Q

When would you do a caesarian section in multiple pregnancy?

A

Triplets or more

Mono-chorionic mono-amniotic twins

43
Q

What is the HbA1C target for type 1 and 2 diabetes pre-pregnancy?

A

48mmol/mol

44
Q

At what HbA1c should pregnancy be avoided?

A

Above 86 mmol/mol

45
Q

What drugs should you give if planning a pre-term pregnancy and why?

A 
Steroids (foetal lung maturity)
Magnesium sulphate (some protection against cerebral palsy)
46
Q

Should you change asthma therapy in pregnancy?

A

No, the drugs are safe (can even take during labour)

47
Q

Management of VTE risk in the perpuerium?

A

LMWH
Switch to warfarin on 5th post-natal day
6 weeks-3 months therapy

48
Q

Management of anti-phospholipid syndrome that has previously caused pregnancy complications

A

Low dose aspirin and LMWH

49
Q

After what gestation should you offer induction of labour?

A

42 weeks

50
Q

Management of foetal distress

A 
Change maternal position
IV fluids
Stop syntocinon
Scalp stimulation
Consider tocolysis (terbutaline s/c)
Maternal assessment
Foetal blood sampling
Operative delivery
51
Q

What are the conditions that must be met to do an operative vaginal delivery?

A

Cervix must be fully dilated

Head below ischial spine

52
Q

Indications for instrumental delivery

A

Delay (failure to progress stage 2)
Foetal distress

These are main ones but there are a few others

53
Q

Management of anti-phospholipid syndrome that has previously caused pregnancy complications

A

Low dose aspirin and LMWH

54
Q

Management of pre-eclampsia

A

Antenatal screening
Treat hypertension
Maternal and foetal surveillance
Timing of delivery

55
Q

Prophylactic management of women with risk factors for pre-eclampsia

A

150mg aspirin started before 16 weeks

56
Q

When would you treat hypertension in pregnancy and what is the target?

A

If BP >150/100 regardless of aetiology

Aim for 140-150/90-100

57
Q

Does treating hypertension in pregnancy decrease risk of pre-eclampsia?

A

No

58
Q

First line drugs for hypertension in pregnancy?

A

Methyldopa
Labetolol
Nifedipine SR

59
Q

Second line drugs for hypertension in pregnancy?

A

Hydralazine

Doxazosin

60
Q

When should you deliver a baby in pre-eclampsia?

A 
If at term
Inability to control BP
Rapidly deteriorating biochem/haematology
Eclampsia
Other crisis
Foetal compromise (US/CTG)
61
Q

Prophylactic/treatment of eclamptic seizures

A

Magnesium sulphate (loading dose then infusion)
If further seizures administer 2g
If persistent seizures consider diazepam IV

62
Q

What medication should you give in labour with pre-eclampsia and what should you not give and why?

A 
Give epidural (lowers blood pressure)
Don't give ergometrine (increases blood pressure)
63
Q

Management of peurperal psychosis

A 
Emergency admission to specialised mother-baby unit
Antidepressants
Antipsychotics
Mood stabilisers
ECT
64
Q

Management of mild-moderate post-natal depression.

A

Self help

Counselling

65
Q

Management of moderate-severe post-natal depression.

A

Psychotherapy
Anti-depressants
Maybe admission

66
Q

Lowest risk SSRIs in pregnancy

A

Sertraline

Fluoxetine

67
Q

Lowest risk TCAs in pregnancy

A

Imipramine

Amitriptyline

68
Q

Are atypical or typical antipsychotics safer in pregnancy?

A

Typical

69
Q

Is lithium safe in breastfeeding?

A

No

70
Q

Placental abruption management

A

Resuscitate mother
Assess and deliver the baby
Manage complications

71
Q

Placenta praevia management

A

Admit for at least 24 hours until bleeding has ceased
Anti-D if rhesus negative
Steroids if not at term
TED stockings
Prevent and treat delivery
Delivery plan at/near term
Give magnesium sulphate if planning delivery early

72
Q

When to do c-section or vaginal delivery in pregnancy?

A

C-section - if placenta covers os or <2cm from os

Vaginal - placenta >2cm from os and no malpresentation

73
Q

Placenta accreta management

A 
Prophylactic internal iliac artery balloon
Caesarean hysterectomy
Blood loss >3l expected
OR 
Conservative management
74
Q

Vasa praevia management

A

Steroids
Consider inpatient management if risk of preterm birth
Delivery by elective c-section 34-36 weeks
If ante-partum haemorrhage do emergency c-section

Send placenta for histology

75
Q

What do you give in active management of the 3rd stage of labour?

A

Syntocinon/syntometrine IM/IV

76
Q

What are the drugs you would use in post-partum haemorrhage and what do they do?

A 
Syntocinon - oxytocin analogue
Ergometrine 
Carboprost/haemabate
Misoprostol
(all contract uterus)
Tranexamic acid (anti-fibrinolytic)
77
Q

What are the non-medical parts of managing post-partum haemorrhage?

A

Uterine massage (bi-manual compression)
Insert
Foley catheter for tamponade
Examination under anaesthesia if persistent bleeding

78
Q

What can interventional radiology and surgery do to control post-partum haemorrhage?

A 
Radiology - arterial embolisation
Surgical:
Undersuturing
Brace sutures (B-lynch)
Uterine artery ligation
Internal iliac artery ligation
Hysterectomy
79
Q

Management of cord prolapse

A

Immediate delivery (caesarean or forceps)
Tocolytics
Maternal positions to relieve pressure

80
Q

Management of amniotic fluid embolus

A

Supportive ITU

81
Q

Shoulder dystocia management

A 
Call for help
Evaluate for episiotomy
Legs to chest (McRoberts' manoeuvre)
Suprapubic pressure
Remove posterior arm
Roll patient on to hands and knees
82
Q

Breech presentation management

A

If not in labour can do external cephalic version (ECV)

Obstetric input

83
Q

Prolapse management

A

Conservative (stop smoking, lose weight, stop straining, exercise/physio)
Pessaries
Surgery (depends on type of prolapse)

84
Q

How long should women try lifestyle advice before referring to physio for prolapse?

A

3 months

85
Q

What is the non-pharmacological management of menopause?

A

Lifestyle advice (diet, weight loss, exercise idk why this would help lol)
Caffeine and alcohol intake reduction (reduces hot flushes)
CBT
Mindfulness

86
Q

Management of menorrhagia in menopause.

A 
Mefenamic acid (NSAID)
Tranexamic acid
Progesterones
IUS
Endometrial ablation
Hysterectomy
87
Q

What are the contra-indications for HRT?

A 
Breast cancer
Undiagnosed abnormal vaginal bleeding
Endometrial cancer
Pregnancy
Active thrombo-embolic disorder
Recent MI
Active liver disease
Porphyria cutanea tarda
88
Q

If women aren’t suitable for HRT, what can they be given to help with menopause symptoms?

A

Clonidine (for flushing)
SSRIs
Vaginal lubricants (regelle, yes, sylk)

89
Q

Ovarian germ cell cancer management

A

Fertility sparing

Unilateral salpingoophrectomy with maybe chemo

90
Q

Non-germ cell ovarian cancer management

A

Stage 1A - only surgery

The rest - chemo and surgery

91
Q

What all needs to be removed in ovarian cancer surgery for staging?

A

Total abdominal hysterectomy
Bilateral salpino-oophrectomy
Infracolic omentectomy
(retroperitoneal lymph node assessment)

92
Q

Should you give neo-adjuvant chemo before operating on stage III-IV ovarian cancer?

A

Yes

Better progression free and overall survival

93
Q

What can be used to medically manage fibroids?

A

GnRH analogues
Mirena coil
Progesterones

94
Q

What are the 3 main chemotherapy drugs used in gynae malignancy?

A

Cisplatin
Carboplatin
(paclitaxel less important?)

95
Q

At what stage does cervical cancer need chemoradiotherapy?

A

Ib2 and above

96
Q

When would cervical cancer be treated with palliative intent?

A

If it has spread out of the pelvis

97
Q

Radial scar management

A

Excise or sample extensively by vacuum biopsy

Year 3 Revision (70 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions