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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
Q

When can the IUD/IUS be inserted after child birth?

A

Within the first 48hours or after the first 4 weeks

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26
Q

Which drug can be used to shrink fibroids? What is an important side effect to note?

A

GnRH agonists
They reduce bone mineral density by reducing oestrogen and progesterone concentrations

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27
Q

Describe Androgen Insensitivity Syndrome

A

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.

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28
Q

Mx of endometriosis?

A

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

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29
Q

What is the management for large fibroids causing fertility issues in women who wish to conceive? What is a common complication

A

Myomectomy is the only management
Adhesions are the most common complication seen

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30
Q

How should gestational diabetes be managed?

A

5.6 < FPG < 7 = trial of diet and exercise changes, if this fails add metformin
FPG >7 = start insulin

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31
Q

What classes women as high risk of gestational diabetes? When should you offer them an OGTT?

A

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

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32
Q

How should you manage a women with preexisiting diabetes who becomes pregnant?

A

Stop all oral glycaemics except metformin and commence insulin

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33
Q

Can you have a vaginal birth if you have a classical (vertical C-section scar)?

A

NO - deliver in hospital with C-section at 37 weeks

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34
Q

Describe the categories of C-section?

A

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

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35
Q

What is the gold standard management of stage 1A cervical cancer? How can we manage if the patient wishes to remain fertile?

A

GS = Hysterectomy +/- lymph node clearance
To remain fertile = cone biopsy with negative margins

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36
Q

What procedure can be done to maintain fertility in women with a stage A2 cervical cancer?

A

Radical trachelectomy

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37
Q

How should symphysis-fundal height relate to gestation? What should you do if it doesn’t?

A

From 20 weeks it should closely match gestational age (+/- 1 or 2 cm)
If it doesn’t perform USS

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38
Q

When should you offer ECV?

A

36 weeks in nulliparous women
37 weeks in multiparous women

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39
Q

What should you do if foetal fibronectin is raised?

A

Administer steroids to the mother - this is a sign premature labour may occur

40
Q

What are the indications for a Cat 1 C-section?

A

Uterine rupture, major placental abruption, cord prolapse, foetal hypoxia and persistent foetal bradycardia (HR <100 BPM)

41
Q

When should you do continuous CTG monitoring?

A

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
Q

What are late decelerations? What should you do if they occur?

A

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
Q

What are the BM targets in women with gestational diabetes?

A

Fasting <5.3
1hr post-prandial <7.8
2hrs post-prandial <6.4

44
Q

True or false, a woman with a PMH of breast cancer must have the copper coil?

A

True! PMH of breast cancer excludes the use of all hormonal contraceptives

45
Q

How long does the copper IUD last for?

A

5-10 years

46
Q

Describe Fitz-Hugh Curtis Syndrome?

A

PID (lower pelvic pain, dyspareunia, dysuria and discharge) which leads to perihepatitis (RUQ pain)

47
Q

Describe Mirizzi syndrome?

A

Impaction of a gallstone in the cystic duct leading to common hepatic duct compression and jaundice

48
Q

Mx of PID?

A

IM Ceftriaxone, PO Doxycycline and PO Metronidazole

49
Q

What is Renal Agenesis?

A

Abnormality of the foetal kidneys leading to oligohydramnios. It can develop into Potter sequence (pulmonary hypoplasia and limb deformities)

50
Q

What is Bartter Syndrome?

A

Polyhydramnios between 24-30 weeks secondary to renal tubular disorders and tubular hypokalaemic acidosis

51
Q

What may be the most appropriate contraceptive option if a patient has a medical disorder e.g. HTN +/- menstrual issues?

A

IUD (Mirena coil)

52
Q

Describe missed (delayed) miscarriage?

A

A gestational sac containing a dead foetus before 20 weeks without expulsion symptoms

53
Q

Describe ovarian hyperstimulation syndrome?

A

Occurs secondary to gonadotrophin therapy (given to initiate ovulation). It causes ascites, vomiting, diarrhoea and increased haematocrit

54
Q

What is the role of MgSO4 in pre-eclampsia?

A

Treats pre-eclamptic seizures but can also be given to prevent seizures if the BP >160/110

55
Q

What should you monitor once MgSO4 is given? How long should you give it for? How do you reverse OD?

A

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
Q

True or false, those on anti-epileptics should not breastfeed?

A

FALSE!
Breast feeding is generally safe on anti-epileptics

57
Q

What is the most common adverse effect of the POP?

A

Irregular vaginal bleeding

58
Q

What should you do with a patient presenting with secondary dysmenorrhoea?

A

Refer to gynae

59
Q

Describe how you would induce labour?

A

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
Q

When should rhesus negative women be given anti-d?

A

28 and 34 weeks

61
Q

When should you do an urgent obstetrics referal for ?pre-eclampsia?

A

New onset BP >=140/90 after 20 weeks and 1 of proteinuria or signs of organ involvement

62
Q

What is the diagnostic criteria for PCOS?

A

Oligomenorrhoea, clinical/biochemical signs of hyperandrogenism and polycystic ovaries on USS

63
Q

Can you offer ECV in the early stages of labour?

A

Yes, providing the amniotic sac has not ruptured

64
Q

How does the COCP affect cancer risk?

A

Increased risk of breast and cervical cancer
Decreased risk of ovarian and endometrial and colorectal cancer

65
Q

Mx of urgency incontincence?

A

1st line = bladder retraining
2nd line = oxybutynin, tolterodine or mirabegron (use in MG patients or the elderly/frail)

66
Q

Mx of stress incontinence?

A

1st line = pelvic floor exercises
2nd line = surgery or duloxetine

67
Q

In oral emergency contraception, how quickly can patients restart their normal contraceptive pill?

A

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
Q

When should we surgically manage an ectopic pregnancy?

A

> 35mm, has a heart beat, Beta hCG >5000, is painful, is ruptured or if there is another viable pregnancy

69
Q

When should we medically manage an ectopic pregnancy?

A

<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
Q

Mx of menorrhagia if contraception is required?

A

1st line = Mirena coil
2nd line = COCP

71
Q

Mx of menorrhagia if contraception is not required?

A

1st line = Mefenamic acid (if painful) or Tranexamic acid (if painless)

72
Q

Define Gestational HTN?

A

Seen after 20 weeks
BP >140/90 or an increase of >30 systolic or >15 diastolic since booking without proteinuria or oedema

73
Q

True or false, pre-eclampsia can cause polyhydramnios?

A

FALSE
It can cause oligohydramnios

74
Q

Define the degrees of perianal tear?

A

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
Q

How do we confirm ovulation, what should you do with the results?

A

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
Q

Can you have the MMR vaccine whilst pregnant?

A

No and avoid coming pregnant within 28 days of receiving the vaccine

77
Q

Mx of Dysmenorrhoea?

A

1st line = NSAID
2nd line = COCP

78
Q

True or false, Hep B can be transmitted to the foetus in the womb and to the baby during breast feeding?

A

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
Q

What can we give to frail elderly women with endometrial cancer who are not considered fit for surger?

A

Progesterone therapy

80
Q

What can cause increased nuchal translucency?

A

Down’s syndrome, abdominal wall defects and congenital heart defects

81
Q

Mx of bleeding in early pregnancy?

A

If <6 weeks with no pain or signs of ectopic pregnancy manage conservatively
If >= 6 weeks refer to EPAU

82
Q

What is risk malignancy index (used in ovarian cancer) based on?

A

US findings, menopausal status and CA125 levels

83
Q

Mx of placental abruption?

A

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
Q

Mx of infertility in PCOS?

A

Clomifene 1st line
If obese use metformin

85
Q

Ix of ectopic pregnancy?

A

TVUS

86
Q

True or false, endometriosis is a RF for ectopic pregnancy?

A

TRUE

87
Q

True or false, tamoxifen does not affect the risk of endometrial hyperplasia?

A

FALSE
It is unopposed oestrogen so will increase the risk of endometrial hyperplasia

88
Q

Ix of placenta praevia?

A

TVUS
Do NOT perform digital vaginal exam!

89
Q

What should you do in recurrent vaginal candidiasis? What counts as recurrent?

A

> = 4 episodes/year
Do a high vaginal swab for STIs and BMs to exclude DM

90
Q

Mx of atrophic vaginitis?

A

Do TVUS to exclude other causes!
1st line = vaginal lubricants and moisturisers
2nd line = TOP oestrogen

91
Q

Where are most ectopic pregnancies seen?

A

The ampulla of the fallopian tubes

92
Q

What is the main complication of IOL? How do you treat?

A

Uterine hyperstimulation
Mx = stop oxytocin/remove prostaglandin and consider tocolysis

93
Q

True or false endometriosis can cause sub fertility?

A

TRUE

94
Q

What is seen in HELLP Syndrome? Mx?

A

N&V, RUQ pain and lethargy
Ix = Haemolysis, Elevated liver enzymes and low platelets
Mx = deliver the baby

95
Q

Describe intrahepatic cholestasis of pregnancy?

A

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
Q

Name the high risk factors for pre-eclampsia (if 1 or more present give 75mg aspirin from 12 weeks)

A

HTN in previous pregnancy
CKD
Autoimmune disease (e.g. SLE or Anti-phospholipid syndrome)
T1DM or T2DM
Chronic HTN

97
Q

Name the moderate risk factors for pre-eclampsia (if 2 or more present give 75mg aspirin from 12 weeks)

A

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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