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Finals Revision > Women's health > Flashcards

Women's health Flashcards

1
Q

What is adenomyosis? What are the symptoms?

A

Endometrial tissue in the myometrium
Sx = enlarged boggy uterus, dysmenorrhoea and menorrhagia seen in multiparous women >30

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2
Q

Ix and Mx of adenomyosis?

A

Ix = MRI
Mx = Definitive magament with hysterectomy. Also can give TXA, GnRH agonists and uterine artery embolization

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3
Q

After how many hours does action need to be taken if a contraceptive pill is missed?

A

POP if >3 hours late (>27 hours since the last pill)
COCP if >12 hours late (>36 hours since the last pill)

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4
Q

What should you do if a non-immune woman is exposed to chicken pox in pregnancy?

A

If =< 20 weeks give VZIG ASAP
if >20 weeks give VZIG or acyclovir 7-14 days after exposure

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5
Q

How do you investigate an ectopic pregnancy?

A

Transvaginal USS

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6
Q

How many cervical smears with positive HPV but negative cytology in a row warrants referral to colposcopy? How long do you leave between each swab?

A

3
Leave 12 months between each

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7
Q

How many cervical smears with inadequate sample in a row warrants referral to colposcopy? How long do you leave between each swab?

A

2
Leave 3 months between each

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8
Q

What is the first and second line management for dysmenorrhoea?

A

1st line = NSAIDs
2nd line = COCP

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9
Q

What is false labour?

A

Occurs in the last 4 weeks of pregnancy, there are irregular contractions felt in the lower abdomen with no cervical changes

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10
Q

How do you manage DVT in pregnancy?

A

LMW Heparin
In those with extremes of weight measure peak anti-Xa activity

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11
Q

Who should take 5mg of folic acid when pregnant?

A

Women with:
Family /personal Hx of NTD (in either parent)
BMI >30
On anti-epileptics
Has DM, Coeliac’s disease or thalassaemia trait

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12
Q

What is the most common cause of decreased variability in foetal heart rate (occurring for less than 40 mins)?

A

Foetal sleeping

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13
Q

When is standard anti-natal testing done? What does it test for and what is an abnormal result?

A

Combined test at 11-13+6 weeks
Tests Beta-hCG, PAPP-A and nuchal translucency
Abnormal if raised Beta-hCG, low PAPP-A and thickened nuchal translucency

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14
Q

When is the quadruple anti-natal test done?

A

In those with abnormal combined test results or who book late
Done at 15-20 weeks

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15
Q

What results from the quadruple anti-natal test imply Down’s syndrome?

A

Low alpha fetoprotein, low unconjugated oestriol, high beta hCG and high inhibin A

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16
Q

What results from the quadruple anti-natal test imply Edward’s syndrome?

A

Low alpha fetoprotein, low unconjugated oestriol, low beta hCG and normal inhibin A

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17
Q

What results from the quadruple anti-natal test imply NTD?

A

Normal unconjugated oestriol, beta hCG and inhibin A
High alpha fetoprotein

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18
Q

Mx of hyperemesis gravidarum?

A

1st line = antihistamines e.g. cyclizine
2nd line = metoclopramide (can cause EPSx) or ondansetron (can cause cleft lip)
Also IV hydration and pabrinex if Sx of Wernicke’s encephalopathy

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19
Q

Describe androgen insensitivity syndrome?

A

X-linked recessive, 46 XY karyotype but female phenotype
Sx = primary amenorrhoea, little/no pubic hair, breast development may occur, there may be groin swelling from the undescended testes
Ix = raised testosterone

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20
Q

Name 3 things which increase the risk of cervical ectropion?

A

Ovulation, pregnancy and COCP

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21
Q

What is the target BP when managing hypertension in pregnancy?

A

<135/85

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22
Q

What is the difference between the baby blues and post-natal depression?

A

Baby blues is seen 3-7 days after birth where as post-natal depression is seen within 1 month and peaks at 3 months

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23
Q

What should you do with a complex (multi loculated) ovarian cyst?

A

Biopsy it to exclude malignancy

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24
Q

How long after child birth is contraception not required for anyone?

A

21 days

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25
When can the IUD/IUS be inserted after child birth?
Within the first 48hours or after the first 4 weeks
26
Which drug can be used to shrink fibroids? What is an important side effect to note?
GnRH agonists They reduce bone mineral density by reducing oestrogen and progesterone concentrations
27
Describe Androgen Insensitivity Syndrome
X linked recessive condition. Babies are 46XY but have a female phenotype They have primary amenorrhoea, little/no pubic hair, undescended testes may cause groin swellings. They may have some breast development.
28
Mx of endometriosis?
NSAIDs/paracetamol 1st line If this fails trial COCP (can try POP if COCP is contraindicated) 2nd line = GnRH agonists (e.g. goserelin) or surgery
29
What is the management for large fibroids causing fertility issues in women who wish to conceive? What is a common complication
Myomectomy is the only management Adhesions are the most common complication seen
30
How should gestational diabetes be managed?
5.6 < FPG < 7 = trial of diet and exercise changes, if this fails add metformin FPG >7 = start insulin
31
What classes women as high risk of gestational diabetes? When should you offer them an OGTT?
1st degree relative with DM, BMI >30 or previous baby weighing >= 4.5kg offer OGTT at 24-28 weeks If gestational diabetes in previous pregnancy offer OGTT at booking and 24-28 weeks
32
How should you manage a women with preexisiting diabetes who becomes pregnant?
Stop all oral glycaemics except metformin and commence insulin
33
Can you have a vaginal birth if you have a classical (vertical C-section scar)?
NO - deliver in hospital with C-section at 37 weeks
34
Describe the categories of C-section?
Cat 1 = deliver within 30 mins, immediate threat to life Cat 2 = deliver within 75 mins, compromise but no immediate threat to life Cat 3 = delivery required but mum and baby stable Cat 4 = elective C-section
35
What is the gold standard management of stage 1A cervical cancer? How can we manage if the patient wishes to remain fertile?
GS = Hysterectomy +/- lymph node clearance To remain fertile = cone biopsy with negative margins
36
What procedure can be done to maintain fertility in women with a stage A2 cervical cancer?
Radical trachelectomy
37
How should symphysis-fundal height relate to gestation? What should you do if it doesn't?
From 20 weeks it should closely match gestational age (+/- 1 or 2 cm) If it doesn't perform USS
38
When should you offer ECV?
36 weeks in nulliparous women 37 weeks in multiparous women
39
What should you do if foetal fibronectin is raised?
Administer steroids to the mother - this is a sign premature labour may occur
40
What are the indications for a Cat 1 C-section?
Uterine rupture, major placental abruption, cord prolapse, foetal hypoxia and persistent foetal bradycardia (HR <100 BPM)
41
When should you do continuous CTG monitoring?
If ?chorioamnionitis/sepsis/temp >38 degrees, if severe HTN , if oxytocin is being used, if there is significant meconium or if there is fresh vaginal bleeding
42
What are late decelerations? What should you do if they occur?
Decrease in heart rate which lags the onset of contractions and dosent return to normal until 30secs after the contraction. This indicates foetal distress. Do urgent foetal blood sampling, if pH <7.2 or foetal hypoxia do urgent C-section
43
What are the BM targets in women with gestational diabetes?
Fasting <5.3 1hr post-prandial <7.8 2hrs post-prandial <6.4
44
True or false, a woman with a PMH of breast cancer must have the copper coil?
True! PMH of breast cancer excludes the use of all hormonal contraceptives
45
How long does the copper IUD last for?
5-10 years
46
Describe Fitz-Hugh Curtis Syndrome?
PID (lower pelvic pain, dyspareunia, dysuria and discharge) which leads to perihepatitis (RUQ pain)
47
Describe Mirizzi syndrome?
Impaction of a gallstone in the cystic duct leading to common hepatic duct compression and jaundice
48
Mx of PID?
IM Ceftriaxone, PO Doxycycline and PO Metronidazole
49
What is Renal Agenesis?
Abnormality of the foetal kidneys leading to oligohydramnios. It can develop into Potter sequence (pulmonary hypoplasia and limb deformities)
50
What is Bartter Syndrome?
Polyhydramnios between 24-30 weeks secondary to renal tubular disorders and tubular hypokalaemic acidosis
51
What may be the most appropriate contraceptive option if a patient has a medical disorder e.g. HTN +/- menstrual issues?
IUD (Mirena coil)
52
Describe missed (delayed) miscarriage?
A gestational sac containing a dead foetus before 20 weeks without expulsion symptoms
53
Describe ovarian hyperstimulation syndrome?
Occurs secondary to gonadotrophin therapy (given to initiate ovulation). It causes ascites, vomiting, diarrhoea and increased haematocrit
54
What is the role of MgSO4 in pre-eclampsia?
Treats pre-eclamptic seizures but can also be given to prevent seizures if the BP >160/110
55
What should you monitor once MgSO4 is given? How long should you give it for? How do you reverse OD?
Monitor reflexes, RR, O2 saturations and urine output. Continue treatment for 24 hours after delivery or the last seizure If OD (respiratory depression) give calcium gluconate
56
True or false, those on anti-epileptics should not breastfeed?
FALSE! Breast feeding is generally safe on anti-epileptics
57
What is the most common adverse effect of the POP?
Irregular vaginal bleeding
58
What should you do with a patient presenting with secondary dysmenorrhoea?
Refer to gynae
59
Describe how you would induce labour?
1st line = membrane sweep 2nd line if bishops =<6 = vaginal prostaglandin E2 (dinoprostone) or oral prostaglandin E1 (misoprostol) 2nd line if bishops >6 = maternal oxytocin infusion or amniotomy
60
When should rhesus negative women be given anti-d?
28 and 34 weeks
61
When should you do an urgent obstetrics referal for ?pre-eclampsia?
New onset BP >=140/90 after 20 weeks and 1 of proteinuria or signs of organ involvement
62
What is the diagnostic criteria for PCOS?
Oligomenorrhoea, clinical/biochemical signs of hyperandrogenism and polycystic ovaries on USS
63
Can you offer ECV in the early stages of labour?
Yes, providing the amniotic sac has not ruptured
64
How does the COCP affect cancer risk?
Increased risk of breast and cervical cancer Decreased risk of ovarian and endometrial and colorectal cancer
65
Mx of urgency incontincence?
1st line = bladder retraining 2nd line = oxybutynin, tolterodine or mirabegron (use in MG patients or the elderly/frail)
66
Mx of stress incontinence?
1st line = pelvic floor exercises 2nd line = surgery or duloxetine
67
In oral emergency contraception, how quickly can patients restart their normal contraceptive pill?
Levonorgestrel EC = can start the pill again immediately Ulipristal EC = must wait 5 days before restarting the pill (use barrier contraception for 7 days)
68
When should we surgically manage an ectopic pregnancy?
>35mm, has a heart beat, Beta hCG >5000, is painful, is ruptured or if there is another viable pregnancy
69
When should we medically manage an ectopic pregnancy?
<35mm, no heart beat, Beta hCG 1500-5000 and there is no significant pain. Patient must be happy to return for follow up! Give methotrexate!
70
Mx of menorrhagia if contraception is required?
1st line = Mirena coil 2nd line = COCP
71
Mx of menorrhagia if contraception is not required?
1st line = Mefenamic acid (if painful) or Tranexamic acid (if painless)
72
Define Gestational HTN?
Seen after 20 weeks BP >140/90 or an increase of >30 systolic or >15 diastolic since booking without proteinuria or oedema
73
True or false, pre-eclampsia can cause polyhydramnios?
FALSE It can cause oligohydramnios
74
Define the degrees of perianal tear?
1st degree = superficial tear only, no muscular damage, no Mx required 2nd degree = damage to the perineal muscles only, suture on the ward 3rd degree = damage to the perineal muscles and anal sphincter, suture in theatre 4th degree = damage to the perineal muscles, anal sphincter and rectal mucosae, suture in theatre
75
How do we confirm ovulation, what should you do with the results?
Monitor progesterone 7 days before the next menstrual period (in a 28 day cycle do at day 21) <16 = refer to gynae, 16-30 repeat test >30 = ovulation has occured
76
Can you have the MMR vaccine whilst pregnant?
No and avoid coming pregnant within 28 days of receiving the vaccine
77
Mx of Dysmenorrhoea?
1st line = NSAID 2nd line = COCP
78
True or false, Hep B can be transmitted to the foetus in the womb and to the baby during breast feeding?
FALSE Hep B can be transmitted to the foetus in the womb but can not be transferred during breast feeding (unlike HIV which is transferred in both)
79
What can we give to frail elderly women with endometrial cancer who are not considered fit for surger?
Progesterone therapy
80
What can cause increased nuchal translucency?
Down's syndrome, abdominal wall defects and congenital heart defects
81
Mx of bleeding in early pregnancy?
If <6 weeks with no pain or signs of ectopic pregnancy manage conservatively If >= 6 weeks refer to EPAU
82
What is risk malignancy index (used in ovarian cancer) based on?
US findings, menopausal status and CA125 levels
83
Mx of placental abruption?
If the foetus is alive and <36 weeks deliver via c-section if distressed, if no distress admit for observation and administer maternal corticosteroids. If foetus is alive and >36 weeks, deliver via c-section if distressed, if no distress deliver vaginally If foetal is dead induce vaginal delivery
84
Mx of infertility in PCOS?
Clomifene 1st line If obese use metformin
85
Ix of ectopic pregnancy?
TVUS
86
True or false, endometriosis is a RF for ectopic pregnancy?
TRUE
87
True or false, tamoxifen does not affect the risk of endometrial hyperplasia?
FALSE It is unopposed oestrogen so will increase the risk of endometrial hyperplasia
88
Ix of placenta praevia?
TVUS Do NOT perform digital vaginal exam!
89
What should you do in recurrent vaginal candidiasis? What counts as recurrent?
>= 4 episodes/year Do a high vaginal swab for STIs and BMs to exclude DM
90
Mx of atrophic vaginitis?
Do TVUS to exclude other causes! 1st line = vaginal lubricants and moisturisers 2nd line = TOP oestrogen
91
Where are most ectopic pregnancies seen?
The ampulla of the fallopian tubes
92
What is the main complication of IOL? How do you treat?
Uterine hyperstimulation Mx = stop oxytocin/remove prostaglandin and consider tocolysis
93
True or false endometriosis can cause sub fertility?
TRUE
94
What is seen in HELLP Syndrome? Mx?
N&V, RUQ pain and lethargy Ix = Haemolysis, Elevated liver enzymes and low platelets Mx = deliver the baby
95
Describe intrahepatic cholestasis of pregnancy?
Sx = intense pruritus worse on the palms, soles and abdomen, may be jaundice Ix = raised bilirubin Mx = ursodeoxycholic acid, vit K and induction of labour at 37-38 weeks
96
Name the high risk factors for pre-eclampsia (if 1 or more present give 75mg aspirin from 12 weeks)
HTN in previous pregnancy CKD Autoimmune disease (e.g. SLE or Anti-phospholipid syndrome) T1DM or T2DM Chronic HTN
97
Name the moderate risk factors for pre-eclampsia (if 2 or more present give 75mg aspirin from 12 weeks)
First pregnancy Aged 40 or older Pregnancy interval of more than 10 years BMI >= 35 Family Hx of pre-eclampsia Multiple pregnancy

Finals Revision (23 decks)

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