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MSRA > Women's Health > Flashcards

Women's Health Flashcards

1
Q

When can pts restart their pill after taking levonorgestrel?

A

Hormonal contraception can be started immediately after using levonorgestrel (Levonelle) for emergency contraception

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2
Q

How does imperforate hymen present?

A

At puberty, girls usually do not have any problems from an imperforate hymen until they start their period. The imperforate hymen blocks the blood from flowing out. As the blood backs up the vagina, it causes: Mass or fullness in the lower part of the belly (from the buildup of blood that can’t come out)

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3
Q

When is the POP effective?

A

2/7 after taking, unless taken on first day of period

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4
Q

How do we treat eclampsia?

A

Mag Sulph first line

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5
Q

Levonorgestrel must be taken within x hours of UPSI

A

Levonorgestrel must be taken within 72 hours of UPSI

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6
Q

How frequent is cervical cancer screening?

A

Cervical cancer screening
25-49 years: 3-yearly
50-64 years: 5-yearly

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7
Q

What should we do with chickenpox exposure in pregnancy?

A

first step is to check varicella zoster immunoglobulins (unless had before/had vaccine). If -ve, antivirals are given 7-14/7 afterwards

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8
Q

What is the gold standard ix for endometriosis? First line?

A

Laparotomy
1st line = TVUS

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9
Q

Which medicine for nausea can causes EPSEs?

A

Metoclopramide is an option for nausea and vomiting in pregnancy, but it should not be used for more than 5 days due to the risk of extrapyramidal effects

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10
Q

What are EPSEs?

A

tremor

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11
Q

How can we treat vasomotor symptoms like flushing in the menopause?

A

SSRI e.g. fluoxetine

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12
Q

Why does the Mirena lead to light bleeding/amenorrhoea?

A

This is because the Mirena intrauterine system (IUS) releases a small amount of the hormone levonorgestrel into the uterus. This hormone has multiple effects, one of which is to thin the lining of the uterus which reduces menstrual flow and can lead to amenorrhoea in some women. Initially, this may cause irregular spotting or light bleeding but over time (usually within 3-6 months), periods tend to become lighter and less painful, and some women stop having periods altogether.

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13
Q

What is chorioamnionitis?

A

Chorioamnionitis is an infection of the amniotic fluid and fetal membranes, usually caused by ascending bacterial infection from the vagina and cervix.

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14
Q

How does chorioamnionitis present?

A

The patient’s presentation with PPROM, abdominal pain, uterine contractions, ‘flu-like symptoms’, fever, and foul-smelling discharge are all characteristic features of chorioamnionitis.

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15
Q

How does candida present?

A

The patient’s symptoms of a curd-like white vaginal discharge and pain during sexual intercourse are indicative of candidal vulvovaginitis, commonly caused by Candida albicans. This condition is characterised by pruritus, dyspareunia (painful sexual intercourse), and a thick, white ‘cottage cheese’ like discharge.

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16
Q

When do we test for coagulation disorders with heavy menstrual bleeding?

A

Testing for coagulation disorders (for example, von Willebrand’s disease) should be considered in women who have had heavy menstrual bleeding since menarche and have personal or family history suggesting a coagulation disorder.

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17
Q

When are we concerned about BP in pregnancy?

A

Above 160.80mmHg and proteinuria

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18
Q

What is the most common inherited bleeding disorder?

A

Von Willebrand’s Disease

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19
Q

How do we investigate for VWD?

A

prolonged bleeding time
APTT may be prolonged
factor VIII levels may be moderately reduced
defective platelet aggregation with ristocetin

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20
Q

How do we manage urge incontinence if bladder training is unsuccessful?

A

Muscarinic antagonist e.g. Tolterodine = ‘told her to hold it in!’
Others include oxybutynin and solifenacin

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21
Q

When do you feel a firm, woody uterus?

A

Placental abruption

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22
Q

What is Sheehan’s syndrome?

A

Sheehan’s syndrome (otherwise known as postpartum hypopituitarism) is a reduction in the function of the pituitary gland following ischaemic necrosis due to hypovolaemic shock following birth.

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23
Q

How does hypopituitarism present?

A

Amenorrhoea, problems with milk production and hypothyroidism

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24
Q

How must we manage a pt with placenta praevia who has just gone into labour in the community?

A

If a woman with known placenta praevia goes into labour (with or without bleeding), an emergency caesarean section should be performed

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25
Q

How does the COCP impact breast milk production?

A

Significantly reduces it, so is contraindicated in breast feeding mothers

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26
Q

When must levonorgestrel be taken?

A

Within 72H of UPSI

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27
Q

What conditions is premature menopause associated with?

A

Premature menopause is associated with increased all cause mortality including increased risk of osteoporosis and cardiovascular disease

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28
Q

When do women need contraception post-partum?

A

21 days

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29
Q

What abx prophylaxis do we give in PPROM?

A

10 days erythromycin should be given to all women with PPROM

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30
Q

How does ectopic pregnancy present?

A

amenorrhoea, abdominal pain and vaginal bleeding in combination with shoulder tip pain suggesting peritoneal bleeding

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31
Q

What is HELPP syndrome?

A

HELLP syndrome is a severe form of pre-eclampsia whose features include: Haemolysis (H), elevated liver enzymes (EL), and low platelets (LP).

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32
Q

How do we treat atrophic vaginitis?

A

Treatment is with vaginal lubricants and moisturisers, if these do not help then topical oestrogen cream can be used.

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33
Q

How does atrophic vaginitis present?

A

Atrophic vaginitis often occurs in women who are post-menopausal women. It presents with vaginal dryness, dyspareunia and occasional spotting. On examination the vagina may appear pale and dry.

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34
Q

Give a RF for cervical cancer

A

Human papillomavirus infection (particularly 16,18 & 33) is by far the most important risk factor

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35
Q

Give the main adverse effect of the nexplanon implant.

A

Irregular menstrual bleeding. The Nexplanon implant, which contains the progestin etonogestrel, mainly functions by inhibiting ovulation. However, it also alters the endometrium and cervical mucus, which can lead to changes in menstrual bleeding patterns. According to UK guidelines, up to 1 in 5 women may experience amenorrhoea after a year of use, while others may have frequent or prolonged bleeding.

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36
Q

Where do you see cervical exitation?

A

Cervical excitation is found in both pelvic inflammatory disease and ectopic pregnancy.

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37
Q

How do we suppress lactation?

A

Cabergoline - dopamine receptor agonist which inhibits prolactin production causing suppression of lactation

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38
Q

How do we reduce occurrence of pre-eclampsia in women at high risk of developing it?

A

There is A level data showing that low-dose aspirin started at 12-14 weeks’ gestation is more effective than placebo at reducing occurrence of pre-eclampsia in women at high risk, reducing perinatal mortality and reducing the risk of babies being born small for gestational age

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39
Q

What is placenta praevia?

A

Placenta praevia refers to a pathological positioning of the placenta in the lower segment of the uterus, either wholly or partly. If the placenta overlies the internal cervical os then this is classed as ‘major praevia’, whereas in ‘minor’ or ‘partial’ praevia it does not. Bleeding from the placenta can occur spontaneously, as a result of trauma, or at the onset of labour as the cervix opens.

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40
Q

Infertility in PCOS - clomifene is typically used first-line

A

Infertility in PCOS - clomifene is typically used first-line

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41
Q

What is Asherman’s syndrome?

A

Asherman’s syndrome, or intrauterine adhesions, may occur following dilation and curettage. This may prevent the endometrium responding to oestrogen as it normally would.

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42
Q

When can the copper IUD be given as contraception?

A

The copper intrauterine device can be inserted for emergency contraception within 5 days after the first unprotected sexual intercourse in a cycle, or within 5 days of the earliest estimated date of ovulation, whichever is later

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43
Q

What is a molar pregnancy?

A

Molar pregnancy is a form of gestational trophoblastic disease. In a normal pregnancy, half of the chromosomes come from the father and half come from the mother. Molar pregnancies may be partial or complete.

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44
Q

What is the difference between a complete and incomplete hydatidiform mole.

A

A complete hydatidiform mole has a 46 XX or 46 XY karyotype with all of the genetic material deriving from the father. This is most commonly due to abnormal fertilisation of an empty ovum. A partial hydatidiform mole has a karyotype of 69 XXX or 69 XXY and contains both maternal and paternal chromosomes.

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45
Q

How do we manage uterine atony?

A

Bimanual uterine compression
IV oxytocin
IM carboprost

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46
Q

What is the most common cause of early onset sepsis in the neonate?

A

The most likely pathogen is Group B Strep which is a common commensal of the female genital tract.

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47
Q

What are the most common causes of late onset sepsis in the neonate?

A

Late-onset sepsis normally occurs due to hospital acquired pathogens such as Staphylococcus epidermidis and Staphylococcus aureus.

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48
Q

When can we use instrumental delivery?

A

When the cervix is fully dilated

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49
Q

How do we manage stress incontinence in pts who don’t respond to pelvic floor muscle exercises.

A

Duloxetine may be used in patients with stress incontinence who don’t respond to pelvic floor muscle exercises and decline surgical intervention

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50
Q

What antibiotic is ceftriaxone? Can it be given with breast feeding?

A

Ceftriaxone is a third-generation cephalosporin antibiotic which is considered safe for use in breastfeeding mothers according to the British National Formulary (BNF). It has a low oral bioavailability, and therefore minimal amounts would be absorbed by the infant through breast milk.

51
Q

Can we give Mirena as emergency contraception?

A

No

52
Q

Give the RFs for placental abruption

A

Risk factors for ABRUPTION:
A for Abruption previously;
B for Blood pressure (i.e. hypertension or pre-eclampsia);
R for Ruptured membranes, either premature or prolonged;
U for Uterine injury (i.e. trauma to the abdomen);
P for Polyhydramnios;
T for Twins or multiple gestation;
I for Infection in the uterus, especially chorioamnionitis;
O for Older age (i.e. aged over 35 years old);
N for Narcotic use (i.e. cocaine and amphetamines, as well as smoking)

53
Q

What does unopposed oestrogen increase the risk of?

A

Endometrial ca

54
Q

When can oestrogen not be given by itself as HRT?

A

If the woman has a womb

55
Q

What does progesterone in HRT increase the risk of?

A

Breast ca, VTE

56
Q

What is the most common cause of post-coital bleeding

A

Cervical ectropion

57
Q

How do we treat infertility in PCOS?

A

Clomifene first line, metformin second line

58
Q

When can Down’s screening be performed?

A

Down’s syndrome screening including the nuchal scan is done at 11-13+6 weeks

If the patient requests the screening later in the pregnancy, either the triple or quadruple test should be offered between 15 and 20 weeks.

59
Q

Give a disadvantage of using depo-provera.

A

Depo Provera is the main injectable contraceptive used in the UK*. It contains medroxyprogesterone acetate 150mg. It is given via in intramuscular injection every 12 weeks. It can however be given up to 14 weeks after the last dose without the need for extra precautions**

The main method of action is by inhibiting ovulation. Secondary effects include cervical mucus thickening and endometrial thinning.

Disadvantages include the fact that the injection cannot be reversed once given. There is also a potential delayed return to fertility (maybe up to 12 months)

60
Q

When is ECV offered?

A

ECV should be offered from 36 weeks if the baby is still breech.

If the lady was multiparous ECV would be offered from 37 weeks.

61
Q

What is dilation and curettage used for?

A

This procedure involves dilating the cervix and scraping or suctioning tissue from the lining of the uterus. It’s typically used to diagnose or treat conditions such as heavy bleeding or to clear the uterine lining after a miscarriage or abortion

62
Q

What are sometimes referred to as chocolate cysts because of their external appearance?

A

Endometriotic cyst

63
Q

Which is the most common ovarian cancer?

A

Serous carcinoma

64
Q

What are follicular cysts?

A

Follicular cysts
commonest type of ovarian cyst
due to non-rupture of the dominant follicle or failure of atresia in a non-dominant follicle
commonly regress after several menstrual cycles

65
Q

How do we treat hyperemesis gravidarum?

A

Cyclizine is correct. This patient has a likely diagnosis of hyperemesis gravidarum given the presentation of nausea and vomiting in association with pregnancy. The recommended initial anti-emetic agent of choice is an antihistamine such as cyclizine.

66
Q

Why do we take a serum progesterone?

A

Serum progesterone is taken to confirm ovulation in patients who are struggling to conceive.

67
Q

When do we take a serum progesterone level?

A

It should be taken 7 days before the next expected period to coincide with ovulation. For a typical 28 day cycle, this is done on day 21.

68
Q

What is first-line is primary amenorrhoea?

A

NSAIDs such as mefenamic acid and ibuprofen are effective in up to 80% of women. They work by inhibiting prostaglandin production
combined oral contraceptive pills are used second line

69
Q

Give three causes of secondary amenorrhoea

A

Secondary dysmenorrhoea typically develops many years after the menarche and is the result of an underlying pathology. In contrast to primary dysmenorrhoea the pain usually starts 3-4 days before the onset of the period

endometriosis
adenomyosis
pelvic inflammatory disease
intrauterine devices*
fibroids

70
Q

What is oligohydramnios?

A

In oligohydramnios there is reduced amniotic fluid. Definitions vary but include less than 500ml at 32-36 weeks and an amniotic fluid index (AFI) < 5th percentile.

71
Q

What makes up the amniotic fluid?

A

Foetal urine

72
Q

When do we offer the MMR vaccine in pregnancy?

A

If a pregnant woman is not immune to rubella, she should be offered the MMR vaccination in the post-natal period

73
Q

What does the COCP protect against?

A

increased risk of breast and cervical cancer
protective against ovarian and endometrial cancer

cOc - prOtective against Ovarian and endOmetrial cancer.

74
Q

Why do we give aspirin in pts with diabetes in pregnancy?

A

Patients with diabetes (type 1 and 2) should take aspirin 75mg daily from 12 weeks gestation to reduce the risk of pre-eclampsia. They are also at higher risk of neural tube defects, therefore should take the higher dose of folic acid, 5mg daily, whilst trying to conceive until 12 weeks gestation. Pregnant women who have risk factors such as this should be referred at booking to Consultant lead antenatal care.

75
Q

What is mefenamic acid?

A

NSAIDs such as mefenamic acid are the first line treatment for primary dysmenorrhoea

76
Q

When is VBAC contraindicated?

A

Planned vaginal birth after caesarean (VBAC) is contraindicated in patients with previous vertical (classical) caesarean scars, previous episodes of uterine rupture and patients with other contraindications to vaginal birth (e.g. placenta praevia). Women with two or more previous caesarean sections may be offered VBAC.

77
Q

What is seen on the combined test in Down’s syndrome?

A

In Down’s the papa leaves (the others are high)

Thickened nuchal translucency, increased B-HCG, reduced PAPP-A

78
Q

What is the first-line mx of shoulder dystocia?

A

Shoulder dystocia: McRoberts manoeuvre (hyperflexion of the maternal legs) is the first management approach, then episiotomy if unsuccessful

79
Q

How does nexplanon prevent pregnancy/

A

Inhibition of ovulation. Nexplanon, also known as the etonogestrel contraceptive implant, primarily works by inhibiting ovulation. The progestogen component in Nexplanon suppresses the mid-cycle surge in luteinising hormone (LH), preventing the release of an egg from the ovaries. This is its primary method of contraception.

80
Q

How do we treat large uterine fibroids in infertility

A

The only effective treatment for large fibroids causing problems with fertility is myomectomy if the woman wishes to conceive in the future

81
Q

What increases the risk of ovarian cancer?

A

risk factors relate to increased number of ovulations

82
Q

Why do we give GnRH agonists with fibroids?

A

For patients with uterine fibroids, GnRH agonists e.g. leuprolide may reduce the size of the fibroid but are typically useful for short-term treatment

83
Q

When can we give the EllaOne emergency pill?

A

Levonelle is most effective if taken within 72 hours of unprotected intercourse (it may be used until 96 hours but its effectiveness decreases over time) and can be used more than once during a menstrual cycle. ellaOne (ulipristal acetate) is effective if taken within 120 hours of unprotected intercourse. Previously it was advised that ulipristal could only be used once during a menstrual cycle. However, this guidance has now changed. Please see the link for more details.

The copper intrauterine device would be a viable alternative but did not appear on the list of options.

84
Q

How do we manage mothers at higher risk of GBS?

A

Maternal intravenous antibiotic prophylaxis should be offered to women with a previous baby with early- or late-onset GBS disease

85
Q

Can you give COCP to smokers?

A

Combined oral contraceptive pills (COCPs) are contraindicated in women over 35 years old who smoke more than 15 cigarettes per day due to the significantly increased risk of cardiovascular events, such as myocardial infarction and stroke.

86
Q

What is a monochorionic twin pregnancy?

A

In a monochorionic twin pregnancy the two fetuses share a single placenta, meaning that blood can flow between the twins.

87
Q

What is TTTS?

A

Twin-to-twin transfusion syndrome
In TTTS, one fetus, the ‘donor’ receives a lesser share of the placenta’s blood flow than the other twin, the ‘recipient’. This is due to abnormalities in the network of placental blood vessels. The recipient may become fluid-overloaded whilst the donor can become anaemic. One fetus may have oligohydramnios and the other may have polyhydramnios as a result of differences in urine production, causing additional problems.

88
Q

How do you manage PPROM in a 30w mother?

A

This woman is only 32 weeks gestation and it could be that she is going into labour with the rupture of the membranes. You therefore want to admit her and treat her with steroids to promote lung maturation of the baby. Because of the risk of sepsis and post-natal infection you would want to treat with antibiotics, currently erythromycin is recommended, but always consult your hospital guidelines. If a swab isolated Group B streptococcus you would treat with penicillin and clindamycin, but again, consult your hospital guidelines. If the woman does not progress to labour, she may be able to be managed at home and advised to take her temperature every 4-8 hours and to return to the hospital if she spikes a temperature. You should consider delivery at 34 weeks where the risks of infection may outweigh the risk of prematurity now you have allowed the lungs to mature.

89
Q

Why do we give folic acid to 12w of pregnancy?

A

Neural tube defects tend to arise within the time-frame of the folic acid prescription, i.e. 12 weeks. Hence no need for folate after 12 weeks.
Meanwhile, vitamin D is for the whole pregnancy.

90
Q

When would you consider gonadal dysgenesis?

A

Raised FSH/LH in primary amenorrhoea

91
Q

What is Kallman syndrome?

A

Kallmann syndrome is a congenital form of hypogonadotropic hypogonadism, caused by an abnormally functioning hypothalamus. Patients with Kallmann syndrome may present similarly to the above case, but blood results would show low GnRH, FSH, and LH. Exam questions also often mention an absence of the sense of smell, which can be seen in Kallmann syndrome.

92
Q

What is the SSRI of choice in pregnant women

A

Sertraline or paroxetine

93
Q

How do we treat gestational diabetes if diet/metformin hasn’t been sufficient?

A

In gestational diabetes, if blood glucose targets are not met with diet/metformin then insulin should be added

94
Q

A 27-year-old woman complains of an offensive ‘musty’, frothy, green vaginal discharge. On examination you an erythematous cervix with pinpoint areas of exudation. Dx?

A

Trichomonas vaginalis

95
Q

A 22-year-old woman presents with a thin, purulent, and mildly odorous vaginal discharge. She also complains of dysuria, intermenstrual bleeding and dyspareunia. A swab shows a Gram-negative diplococcus. Dx? Tx?

A

Gonorrhoea
IM ceftriaxone

96
Q

How do we manage contraceptive patch delays?

A

If the contraceptive patch change is delayed greater than 48 hours, the patch should be changed immediately and a barrier method of contraception used for the next 7 days

97
Q

What are the fasted GDD diagnostic thresholds?

A

GDD diagnostic thresholds fasted/2hr are 5678

98
Q

How does congenital rubella syndrome present?

A

The neonate has congenital rubella syndrome with the classic triad of sensorineural deafness, eye abnormalities and congenital heart disease. The foetus is particularly at risk if the maternal primary infection occurs in the first trimester of pregnancy.

99
Q

How do we manage premature labour?

A

This woman is now in premature labour, although at 3cm dilated it is still in an early stage. Therefore, it may be stopped by administering tocolytic medication. In case the labour continues and delivery is required, steroids are given as a pre-emptively to help the foetal lungs mature.

100
Q

What is the Mirena IUS?

A

Levonorgestrel

101
Q

What is Erb’s palsy?

A

Erb’s palsy occurs due to damage to the upper brachial plexus most commonly from shoulder dystocia. Damage to these nerve roots results in a characteristic pattern: adduction and internal rotation of the arm, with pronation of the forearm. This classic physical position is commonly called the ‘waiter’s tip’.

102
Q

How would we advise HIV +ve pts when it comes to breastfeeding?

A

Contraindicated - formula feed only

103
Q

Why do we give aspirin in pre-eclampsia?

A

Increase placental blood flow

104
Q

What is clomifene used for?

A

induce ovulation in a number of conditions

105
Q

Which contraceptive is contraindicated in wheelchair users?

A

COCP - increased VTE risk

106
Q

What is second line in htn in pregnancy?

A

Nifedipine

107
Q

How long is the nexplanon (etonogestrel) implant effective for?

A

3years

108
Q

What is the Coombs test used for?

A

Direct Coombs: Is a investigation used to look for autoimmune haemolytic anaemia,
Indirect: Used antenatally to detect antibodies in the maternal blood that can cross the placenta and result in haemolytic disease of the newborn.

109
Q

Which drugs should be avoided in breastfeeding?

A

B - benzodiazepam, Bromocriptine
I - Iodine
L - Lithium, Laxatives
E- ergotamine
C- Carbimazole, Chloramphenicol
T- Tetracycline
H- Hormones (sex)
R- Radioisotopes

110
Q

What causes ovulation?

A

LH surge

111
Q

Which cyst iIf ruptures may cause pseudomyxoma peritonei?

A

Mucinous cystadenoma

112
Q

What is the most common type of epithelial cell tumour?

A

Serous cystadenoma

113
Q

When is ulipristal contraindicated?

A

Severe asthma i.e. controlled with oral steroids, you should be cautious due to the anti-glucocorticoid effect of ulipristal acetate.

114
Q

How does the POP work?

A

Thickens cervical mucous

115
Q

How does the COCP work?

A

Inhibits ovulation

116
Q

How does desogestrel work?

A

The only POP to inhibit ovulation

117
Q

At which point in the menstrual cycle do progesterone levels peak?

A

Luteal phase

118
Q

When do we give anti-D in rhesus negative women?

A

anti-D at 28 + 34 weeks

119
Q

When do we do the anomaly scan?

A

18 - 20+6 weeks

120
Q

When do we do the booking visit?

A

8-12 weeks

121
Q

When is the injection effective?

A

7 days

122
Q

What is the Edinburgh scale used for?

A

The Edinburgh Scale is a screening tool for postnatal depression

123
Q
A

MSRA (21 decks)

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