Sexual health/gynae/obs Flashcards
What is the recommended duration of treatment for PEP?
4 weeks
What should women with hypothyroidism do with their levothyroxine dose if they become pregnant?
Increase levothyroxine by up to 50%
What is the management of placental abruption in <36 weeks?
Admit and administer steroids if foetus is okay
C-section if signs of foetal distress or maternal instability
What is the management of placental abruption in >36 weeks?
foetal distress - c-section immediately
no distress - deliver vaginally
What risk factor is most associated with testicular cancer?
Infertility (think of undescended testes being infertile)
What is used for the medical management of an ectopic pregnancy?
methotrexate
When would you do expectant management of an ectopic pregnancy?
- <35mm
- unruptured
- asymptomatic
- no foetal heartbeat
- hCG <1,000
What is the management of genital warts?
Cryotherapy or podophyllum
How does the COCP prevent pregnancy?
Inhibits ovulation
How does the desogestrel pill prevent pregnancy?
Inhibits ovulation and thickens cervical mucus
How does the IUD work?
prevents endometrial proliferation and thickens cervical mucus
What is the management of vaginal candidiasis?
oral fluconazole 150mg
or 500mg clotrimazole pessary if not (e.g. in pregnancy)
What are the first line treatments of heavy menstrual bleeding?
mefenamic acid 500mg or tranexamic acid 1g if wanting to conceive
Mirena coil if not wanting to conceive
What is klinefelter’s syndrome?
XXY
male external genitalia, tall, small testes, gynaecomastia
What are the hormonal levels found in klinefelters?
High LH and FSH and low testosterone
What are the features of androgen insensitivity syndrome?
Genetically male with female external genitalia
Which drugs reduce the efficacy of the COCP?
Carbemazepine, phenytoin, rifampicin, St John’s Wort, Alcohol, Smoking
What is the management of someone with a primary herpes infection in their 3rd trimester?
Oral aciclovir 400mg TDS, until delivery, elective caesarian
What is the management of a UTI in the first trimester?
7-day course of nitrofurantoin
What is the management of a UTI in the third trimester?
7 day course of trimethoprim
What type of hepatitis is common in pregnant women?
Hepatitis E
If a smear is HPV positive but normal cytology when do you retest?
In 12 months, then 12 months again if the same, then refer for colposcopy
Which STI causes painful ulcers?
Herpes Simplex Virus
Which STI causes painless ulcers?
Syphilis
How often is routine screening for cervical cancer?
Every 3 years (25-50) 5 years (50-64)
What is the management of BV?
Metronidazole
- if not, topical clindamycin
Which infection has clue cells on microscopy?
Bacterial vaginosis
What is the main side effect of the injectable contraceptive?
weight gain
Which factors indicate an organic cause of erectile dysfunction?
gradual onset of symptoms, lack of tumescence, normal libido
What investigations should you do for erectile dysfunction?
CV risk, free testosterone in morning (if low measure again plus FSH, LH and prolactin)
What is the management of erectile dysfunction?
- PDE-5 inhibitors (sildenafil)
- vacuum erection devices
- stop cycling
What are the different categories of C section?
- cat 1 - immediate threat to life of mum or baby (within 30 mins)
- cat 2 - maternal or foetal compromise (within 75 mins)
- cat 3 - delivery required, but mum and baby stable
- cat 4 - elective
Name a GnRH agonist
Goserelin - causes gynaecomastia
What antibiotics do you use for a UTI in pregnancy?
Nitrofurantoin 1st line - but not near term
amoxicillin 2nd line
Trimethoprim - terataogenic not 1st term
Which immunoglobulin is most present in breast milk?
IgA
Which immunoglobulin can cross the placenta?
IgG
What hepatitis antigens would show a previous hep B and hep C infection?
Anti-HBc (HB caught)
Anti-HCV (HC caught - no vaccine)
Anti-HBs (HB vaccine), HBsAg (active infection)
How do you differentiate between endometriosis and fibroids?
Endo - more pain than bleeding, deep dyspareunia
Fibroids - more bleeding, frequent urination, can feel mass on examination
What is the management of fibroids?
GnRH agonists, then surgical myomectomy, uterine artery embolisation
How should induction be done for different bishop scores?
< 6 vaginal prostaglandins or oral misoprostol or balloon catheter
> 6 amniotomy and IV oxytocin infusion
What doses of folic acid should be taken in pregnancy?
400mcg until 12th week
5mg until 12th week - if high risk, BMI > 30, coeliac, thalassaemia, diabetes, NTD pmh
What is the management of cord prolapse?
- presenting part pushed back into uterus
- cord kept warm
- patient asked to go on all fours
- tocolytics to reduce contractions
- fill bladder
- C section is first line
What is the time frame for taking the emergency contraceptive pills?
Levonogestrel - within 72hrs
Ulipristal (EllaOne) - within 120hrs
What cardiac signs are normal in pregnant women?
third heart sound, peripheral oedema, ejection systolic murmur, forceful apex beat
What are the common features of endometrial hyperplasia?
painless vaginal bleeding - intermenstrual, can be post menopause
When can you start the COCP after having a baby?
21 days if not breastfeeding
6 weeks if breastfeeding
How often is cervical cancer screening normally?
5 years
What is the first line investigation for post-menopausal bleeding?
Transvaginal ultrasound - best at looking at endometrial thickness
How does placenta previa typically present?
painless bleeding, no scan at 20weeks, foetus and mum not unwell.
Use transvaginal ultrasound to diagnose
What is the management of varicella zoster in pregnant women?
if exposed: check IgG
give aciclovir (IgG shortage)
if develops chickenpox - see specialist and give antivirals
What is the medical management of a primary PPH?
IV oxytocin, IV ergometrin, IM carboprost (except in asthmatics), sublingual misoprostol
What is the first line surgical management of a primary PPH?
Intrauterine balloon tamponade
Which antihypertensives should be stopped in pregnancy?
ACE inhibitors and ARBs
When should 75mg aspirin be given as pre-eclampsia prophylaxis?
1 or more high risk RFs
- hypertension, diabetes, CKD, autoimmune, previous HTN in pregnancy
2 or more moderate - first pregnancy, over 40, multiple pregnancy, FH, BMI > 35
What is the first-line management of intrahepatic cholestasis of pregnancy?
Ursodeoxycholic acid
Which cancers does the COCP have an impact on? (and what impact)
Breast and cervical - increases risk
Ovarian and endometrial - decreases risk
What is the management if there is reduced foetal movements? - less than 10 in 2 hrs.
- handheld doppler for HR
- if cannot find, ultrasound
- if can find HR - CTG for 20 mins to assess foetus
What are the three levels of placenta accreta?
Accreta - attach to myometrium
Increta - into myometrium
percreta - into perimetrium - most severe
What drug is used for induction of labour?
Oxytocin (syntocin)
What type of anticoagulant can be used in pregnancy?
LMWH
What is the treatment of syphilis?
benzathine benzylpenicillin
What are the features of pre-eclampsia?
BP > 140/90
1 of organ dysfunction or +ve proteins on urine dip
What is the management of pre-eclampsia?
Oral labetalol
Nifedipine if asthmatic
What is the difference in presentation between Hep E and HELLP?
Hep E - anytime in pregnancy, can also cause low platelets and deranged LFTs
HELLP - third trimester, pre-eclampsia symptoms
What medications are taken for a medical abortion?
oral mifepristone (anti-progesterone to kill foetus) followed by vaginal misoprostol 24-48 hours later (to stimulate uterine contractions)
What is the most common cause of painless vaginal bleeding late in pregnancy?
Placenta previa
Which conditions should all pregnant women be screened for?
hep B, HIV, Syphilis
What is the first line management of non-pregnant women with vaginal thrush?
Oral fluconazole
What are the features of an ovarian cyst?
unilateral dull ache, may be intermittent or worse with intercourse, can cause bloating and urinary frequency
What food should be avoided during pregnancy?
Liver (high levels of vitamin A), raw eggs/meat, unpasturised milk
When should women be screened for gestational diabetes?
24-28 weeks with OGTT
What is the management of trichomonas vaginalis?
oral metronidazole
What is the management of premenstrual syndrome?
mild - lifestyle
moderate - COCP new gen
severe - SSRI continuously or during luteal phase
What is the management of an 55+ y/o female with post menopausal bleeding?
refer to gynae (suspected endometrial cancer)
transvaginal ultrasound to measure endometrial thickness. then hysteroscopy.
What is the Risk malignancy index for ovarian cancer based on?
CA125, menopausal status, ultrasound findings
How long after taking ulipristal can women start taking regular hormonal contraception?
5 days
What is the management of type 1a cervical cancers?
cone biopsy if wanting to maintain fertility.
gold standard - hysterectomy with lymph node clearance
What is the management of irregular bleeding caused by nexplanon?
COCP for 3 months
When is Anti-D IgG given in rhesus negative mothers?
antepartum haemorrhage, invasive prenatal testing, ectopic, miscarriage > 12 weeks, termination of pregnancy, delivery of +ve baby
How soon after taking levonogestrel for emergency contraception can you start hormonal contraception?
immediately
Which fluids are used for hyperemesis gravidarum?
0.9% saline with potassium
In which condition is ullipristal contraindicated?
severe asthma
What is the first line management of eclampsia?
Magnesium sulphate
When do you do chorionic venous sampling vs amnioscentesis?
CVS - 11-13 weeks
amnioscentesis - 15 weeks onwards
What is the first line management of infertility in PCOS?
Clomifene
metformin can be used in patients who are obese
Which vaccines are routinely offered to pregnant women?
pertussis and influenza
What can you give for PPH if atony is suspected?
oxytocin, ergometrin, carboprost, misoprostol. if not working, intra-uterine balloon tamponade
What is the management of placental abruption?
If < 36 weeks and foetal distress - C-section, if no distress, monitor and give steroids
If > 36 weeks and foetal distress - C-section, if no distress, vaginal delivery
What do the different types of decelerations on a CTG mean?
VEAL CHOP
variable decelerations - cord compression
early decelerations - head compression
accelerations - normal
late decelerations - placental insufficiency
Is it oestrogen or progesterone that increases the risk of breast cancer?
ProBREASTarone, cervical.
oestrogENDOMETRIAL, ovarian.
Which test is the best for detecting ovulation?
Day 21 progesterone
Which blood test is used to monitor LMWH?
Anti-Xa activity
When would you consider giving flucloxacillin for mastitis?
if systemically unwell, if nipple fissures present, if symptoms do not improve after 12-24 hours of milk removal
How long does it take for contraceptives to become effective?
IUD - instant
2 days - POP
7 days - COCP, injection, implant, IUS
What is the most effective form of contraception?
Nexplanon implant, lasts 3 years
What is the management of a missed miscarriage?
Mifepristone then misoprostol 48hrs after, pregnancy test 3 weeks after.
In incomplete miscarriage, just misoprostol
What is the definition of pre-eclampsia?
hypertension > 140/90 over 20 weeks gestation, plus one of proteinuria or organ dysfunction
What can be used to prevent hypertensive disorders in pregnancy?
Low dose aspirin from 12 weeks until birth
What is the management of pre-eclampsia?
Oral labetalol (nifedipine if asthmatic)
How do you induce labour?
If Bishop score < 6 membrane sweep, vaginal prostaglandins
If Bishop score > 6 amniotomy and IV oxytocin infusion
what can be used as a tocolytic?
Terbutaline
What do you do if a smear sample is inadequate?
repeat in 3 months
What antibiotics do you give in PID?
Ceftriaxone (for gonorrhoea), Doxycycline (for chlamydia) and metronidazole
What is the gold standard investigation for endometriosis?
Laparoscopy - no point in USS
What is the management of endometriosis?
NSAIDs + paracetamol
2nd line: COCP, progestrogens (medroxyprosterone acetate)
Specialist: GnRH analogues, laparoscopic excision or endometrial ablation
