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Phase 3a > Women's Health (things I forget) > Flashcards

Women's Health (things I forget) Flashcards

1
Q

Describe HELLP syndrome

A
  • Severe form of pre-eclampsia
  • (H)aemolysis, (E)levated (L)iver enzymes, (L)ow (P)latelets
  • Malaise/nausea/vomiting/headache
  • HTN with proteinuria
  • Epigastric/upper abdominal pain
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2
Q

What is Sheehan syndrome?

A

Hypopituitarism caused by ischaemic necrosis due to blood loss and hypovolaemic shock

  • Agalactorrhoea
  • Amenorrhoea
  • Sx of hypothyroidism
  • Sx of hypoadrenalism
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3
Q

What is Asherman’s syndrome?

A

Intrauterine adhesions that commonly occur following dilation and curettage

  • Secondary amenorrhoea
  • Significantly lighter periods
  • Dysmenorrhoea
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4
Q

What are risk factors for endometrial hyperplasia?

A
  • Unopposed oestrogen
  • Tamoxifen (selective oestrogen receptor modulator)
  • Obesity
  • Early menarche/late menopause
  • Age >35
  • Smoking
  • Nulliparity
  • Sex cord stromal tumours (granulosa cell tumours/sertoli cell tumours/thecomas/fibromas)
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5
Q

What are the clinical features of endometrial hyperplasia?

A

Abnormal bleeding = intermenstrual/post-menopausal/menorrhagia/irregular

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6
Q

What is the management for endometrial hyperplasia?

A
  • Simple = high dose progestogens (e.g. IUS)
  • Hysterectomy
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7
Q

What is the most common cause of post-menopausal bleeding?

A

Vaginal atrophy

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8
Q

What are the investigations for post-menopausal bleeding?

A
  • Transvaginal USS
  • Pipelle biopsy
  • Hysteroscopy with biopsy
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9
Q

What is cervical ectropion?

A

Increased columnar epithelium on ectocervix due to elevated oestrogen levels

  • Vaginal discharge
  • Post-coital bleeding (most common cause)
  • Inter-menstrual bleeding
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10
Q

What is the most common cause of pyrexia in pregnancy?

A

Chorioamnionitis - usually the result of an ascending bacterial infection of amniotic fluid/membranes/placenta –> P-PROM

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11
Q

What is the management for chorioamnionitis?

A
  • Emergency delivery
  • IV abx
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12
Q

What increased risk is there when taking HRT + a progestogen?

A

Breast cancer

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13
Q

What is lochia and how does it present?

A
  • Bleeding present for first 2 weeks following giving birth
  • Fresh bleeding –> colour change (brown) –> stops
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14
Q

What is the main complication of induction of labour and how is it managed?

A
  • Uterine hyperstimulation
  • Administer tocolytic agents to relax uterus/slow contractions
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15
Q

What is the first-line method of inducing labour?

A

Vaginal prostaglandins

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16
Q

What are some causes of an increased nuchal translucency?

A
  • Down’s syndrome
  • Congenital heart defects
  • Abdominal wall defects
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17
Q

What findings of the combined test would suggest a high risk of Down’s syndrome?

A
  • Thickened nuchal translucency
  • High beta-hCG
  • Low PAPP-A
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18
Q

What findings of the quadruple test would suggest a high risk of Down’s syndrome?

A
  • High hCG
  • High inhibin A
  • Low AFP
  • Low oestriol
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19
Q

What findings of the quadruple test would suggest a high risk of Edward’s syndrome?

A
  • Low hCG
  • Low oestriol
  • Low AFP
  • Normal inhibin A
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20
Q

What findings of the quadruple test would suggest a high risk of neural tube defects?

A
  • High AFP
  • Normal hCG
  • Normal inhibin A
  • Normal oestriol
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21
Q

What should be given to patients at moderate/high risk of pre-eclampsia?

A

Low-dose aspirin (75-150mg) daily for duration of pregnancy

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22
Q

What is the management for eclampsia?

A

Magnesium sulphate (prophylaxis and treatment) = continue for 24 hours after delivery/last seizure

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23
Q

What is the order of management for gestational HTN?

A
  • Labetalol (beta blockers) - first line
  • Nifedipine (CCB) - if asthma
  • Methyldopa - contraindicated in depression

Admit if >160/110

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24
Q

What is the management for hyperemesis gravidarum?

A
  • Antihistamines - promethazine
  • IV saline + potassium
  • Ondansetron (risk of cleft lip/palate in first trimester)
  • Metoclopramide/domperidone (extra-pyramidal side effects)
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25
Q

What is a threatened miscarriage?

A
  • NOT A MISCARRIAGE
  • Bleeding +/- pain
  • Before 24 weeks
  • Cervical os closed
  • Fetus alive
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26
Q

What is a missed (delayed) miscarriage?

A
  • Gestational sac contains dead fetus before 20 weeks without symptoms of expulsion
  • Light vaginal bleeding/discharge
  • Symptoms of pregnancy disappear
  • Cervical os closed
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27
Q

What is the difference between an inevitable miscarriage and an incomplete miscarriage?

A

Inevitable:
- Heavy bleeding with clots
- Pain
- Cervical os open
- Possible foetus with heartbeat

Incomplete:
- Bleeding
- Pain
- Cervical os open
- Products of conception

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28
Q

What is a complete miscarriage?

A
  • No cardiac activity
  • Crown rump length >7mm
  • Gestational sac >25mm
  • Cervical os closed
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29
Q

What is the management for miscarriages?

A
  • Missed = oral mifepristone + misoprostol 48 hours later
  • Incomplete = single dose of misoprostol

IF EVIDENCE OF INFECTION/HAEMODYNAMIC INSTABILITY:
- Surgery = vacuum aspiration (suction curettage)

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30
Q

What is the management for ectopic pregnancies?

A
  • Expectant management = monitor b-hCG levels over 48 hours
  • Medical = methotrexate
  • Surgical = salpingectomy/salpingotomy
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31
Q

What are the clinical features of uterine fibroids?

A
  • Menorrhagia
  • Anaemia
  • Bulk-related symptoms e.g. bloating/urinary frequency
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32
Q

Describe uterine fibroids in pregnancy

A
  • Sensitive to oestrogen –> can grow during pregnancy
  • May undergo red or ‘carneous’ degeneration if growth outstrips blood supply
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33
Q

What is the management for fibroids?

A
  • IUS/COCP/tranexamic acid = if <3 cm and not distorting uterine cavity
  • GnRH agonists = shrink (induce menopausal-like state)
  • Surgery = myomectomy
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34
Q

What are the investigations for PCOS?

A
  • Pelvic USS
  • LH + FSH
  • Prolactin
  • TSH
  • Testosterone
  • Sex hormone-binding globulin
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35
Q

Describe stereotypical PCOS findings

A
  • raised LH:FSH ratio (raised LH)
  • Testosterone normal/mildly elevated
  • Serum sex hormone binding globulin (SHBG) normal/low
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36
Q

What criteria is used for PCOS?

A

Rotterdam criteria - 2 of 3 features:
- Oligomenorrhoea/amenorrhoea (oligoovulation/anovulation)
- Clinical/biochemical signs of hyperandrogenism (hirsutism/acne/elevated testosterone)
- Polycystic ovaries on USS (either >12 follicles or increased ovarian volume >10cm3)

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37
Q

What is the management for PCOS?

A
  • Oligomenorrhoea/hirsutism/acne = COCP/oral progestogen/IUS
  • Infertility = referral/clomifene citrate/metformin
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38
Q

How does metformin help in PCOS?

A
  • Appetite reduction
  • Decreases androgen production
  • Decreases LH secretion from anterior pituitary
  • Decreases SHBG in liver
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39
Q

Describe perineal tears

A

First degree:
- Superficial/no muscle involvement
- No repair required

Second degree:
- Injury to perineal muscle but not anal sphincter
- Suture on ward

Third degree:
- Injury to perineum involving anal sphincter complex
- Repair in theatre

Fourth degree:
- Injury to perineum involving anal sphincter complex and rectal mucosa
- Repair in theatre

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40
Q

What should be given to all patients with PPROM?

A

10 days oral erythromycin and antenatal corticosteroids

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41
Q

Describe placenta accrete spectrum

A

Placenta accreta = myometrium

Placenta increta = deep myometrium

Placenta percrata = past myometrium and perimetrium

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42
Q

What are the investigations for obstetric cholestasis?

A
  • LFTs
  • Bile acids
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43
Q

What is the management for intrahepatic cholestasis?

A
  • Induction of labour at 37-38 weeks (to avoid risk of stillbirth)
  • Ursodeoxycholic acid
  • Chlorphenamine and aqueous cream
  • Vitamin K supplementation
  • Antihistamines
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44
Q

What is the first line emergency contraception?

A

Copper IUD

  • Must be inserted within 5 days of UPSI
    OR
  • May be fitted up to 5 days after likely ovulation date
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45
Q

Describe the hormonal forms of emergency contraception

A

Levonorgestrel:
- Must be taken within 72 hours of UPSI
- Single dose (doubled if BMI >26/weight >70kg/enzyme-inducing drugs)
- Repeat dose if vomiting within 3 hours
- Hormonal contraception can be started immediately after
- No effect on breastfeeding

Ulipristal:
- Must be taken within 120 hours (5 days) of UPSI
- Hormonal contraception started 5 days after
- Breastfeeding should be delayed for one week

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46
Q

What are some contraindications for prescribing ulipristal acetate?

A
  • Diseases of malabsorption e.g. crohns
  • Allergy
  • Asthma
  • Breastfeeding
  • Severe hepatic dysfunction
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47
Q

What is the guidance for folic acid?

A
  • All women = 400mcg of folic acid until 12th week
  • Higher risk = 5mg of folic acid from before conception until 12th week

^ higher risk = taking antiepileptic drugs/coeliac/diabetes/thalassaemia/obesity/neural tube defects

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48
Q

What are the basic investigations for infertility?

A
  • Semen analysis
  • Serum progesterone 7 days prior to expected next period
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49
Q

What is the management for infertility due to ovulation disorders?

A
  • Exercise/weight loss
  • Letrozole
  • Clomifene citrate
  • GnRH therapy
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50
Q

What is a complication of ovulation induction?

A

Ovarian hyperstimulation syndrome - ovarian enlargement and formation of multiple cystic spaces
- Hypovolaemic shock
- Acute renal failure
- VTE

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51
Q

What are the investigations for endometriosis?

A
  • Vaginal examination = fixed retroverted uterus/tender uterus/visible vaginal endometriotic lesions
  • Laparoscopy + biopsy = gold standard
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52
Q

What is the management for endometriosis?

A
  • FIRST LINE = NSAIDs + COCP
  • GnRH analogues
53
Q

What is RMI?

A

Risk malignancy index - estimates risk of ovarian mass being malignant

  • Menopausal status
  • USS findings
  • CA125 levels
54
Q

What is secondary dysmenorrhoea associated with?

A
  • PID
  • Endometriosis
  • Adenomyosis
  • Fibroids

REFER

55
Q

What is the most common causative organism, investigation and management for BV?

A
  • Anaerobic bacteria - Gardnerella vaginalis
  • Whiff test +ve
  • Clue cells on microscopy
  • pH >4.5
  • Oral metronidazole
56
Q

What is the causative organism and management for trichomonas vaginalis?

A
  • Trichomonas vaginalis = protozoan
  • Oral metronidazole
57
Q

What is the causative organism and management for gonorrhoea?

A
  • Neisseria gonorrhoea - gram-negative diplococcus
  • IM ceftriaxone
58
Q

What is the causative organism and management for chlamydia?

A
  • Chlamydia trachomatis - gram-negative bacteria
  • Doxycycline
59
Q

What are the investigations for urinary incontinence?

A
  • Bladder diaries
  • Vaginal examination
  • Urinalysis
  • Urodynamic studies
60
Q

What medications are used in urinary incontinence?

A

Urge = muscarinic antagonists e.g. oxybutynin/tolterodine/solifenacin

Stress = duloxetine

61
Q

What medical management is used for menopause?

A
  • Uterus = oral/transdermal combined HRT
  • No uterus = oral/transdermal oestrogen
  • Vasomotor symptoms = fluoxetine/citalopram/venlafaxine
62
Q

What are the genotypes for common causes of primary amenorrhoea?

A

45XO = Turner syndrome

46XY = Androgen insensitivity syndrome

63
Q

What are the clinical features of hydatidiform moles?

A
  • Large uterus
  • Significantly elevated serum hCG levels
  • HTN
  • Severe N+V –> hyperemesis gravidarum
64
Q

What are the stages of labour?

A

Stage 1 = onset of true labour to fully dilated cervix
- Latent phase = 0-3/4 cm
- Active phase = 4-10 cm

Stage 2 = full dilation to delivery of fetus

Stage 3 = delivery of fetus to completed delivery of placenta/membranes

65
Q

What is symphysis-fundal height and what should it be?

A
  • Top of pubic bone to top of uterus (cm)
  • Should match gestational age in weeks to within 2cm after 20 weeks
66
Q

What are the instructions for missed POP?

A
  • Take missed pill ASAP and then take next pill at usual time
  • Continue with rest of pack
  • Extra precautions until pill-taking has been resumed for 48 hours
67
Q

What are the instructions for 1 missed COCP?

A
  • Take missed pill ASAP and then take next pill at usual time
  • No additional contraception needed
68
Q

What are the instructions for 2+ missed COCP?

A
  • Take missed pill ASAP and then take next pill at usual time
  • Extra precautions until pill-taking has been resumed for 7 days
  • Days 1-7 = emergency contraception
  • Days 8-14 = no need for emergency contraception
  • Days 15-21 = finish pills and start new pack without pill-free interval
69
Q

What are contraindications to the COCP?

A
  • > 35 and smoking >15 cigarettes/day
  • Migraine with aura
  • History of thromboembolic disease
  • History of stroke/IHD
  • Breastfeeding <6 weeks post-partum
  • Uncontrolled HTN
  • Current breast cancer
  • Major surgery with prolonged immobilisation
  • Positive antiphospholipid antibodies e.g. SLE
70
Q

What is the mechanism of action of the COCP?

A
  • Oestrogen and progesterone
  • Inhibits ovulation
  • 7 days to become effective
71
Q

What is the mechanism of action of the POP?

A
  • Progesterone only
  • Thickens cervical mucus and inhibits ovulation (desogestrel)
  • Takes 48 hours to become effective
72
Q

What is the mechanism of action of the injectable contraceptive?

A
  • Progesterone only
  • Inhibits ovulation and thickens cervical mucus
  • Effective immediately if given during days 1-5 - if not takes 7 days to become effective
  • Lasts 12 weeks
73
Q

What is the mechanism of action of the implantable contraceptive?

A
  • Progesterone only
  • Inhibits ovulation and thickens cervical mucus
  • Effective immediately if given during days 1-5 - if not takes 7 days to become effective
  • Lasts 3 years
74
Q

What is the mechanism of action of the IUS?

A
  • Progesterone only
  • Prevents endometrial proliferation and thickens cervical mucus
  • 7 days to become effective
  • Lasts 5 years
75
Q

What is the mechanism of action of the IUD?

A
  • No hormones
  • Decreases sperm motility and survival
  • Effective immediately
  • Lasts 5 years (copper on stem only) or 10 years (copper on stem and arms)
76
Q

What methods of contraception are recommended in patients with epilepsy?

A

IUD/IUS/injection

77
Q

What methods of contraception can be continued past 50 years of age?

A

Implant/POP/IUS

78
Q

What is the management for PMS?

A
  • Lifestyle
  • COCP
  • SSRI (severe)
79
Q

What is the investigation for premature ovarian insufficiency?

A

Elevated FSH levels on 2 samples taken 4-6 weeks apart

80
Q

What is Mittelschmerz?

A
  • Usually mid cycle pain
  • Often sharp onset
  • Little systemic disturbance
  • May have recurrent episodes
  • Usually settles over 24-48 hours
81
Q

What is the management for shoulder dystocia?

A
  • McRobert’s manoeuvre (flexion and abduction of hips - bringing thighs towards abdomen)
  • Suprapubic pressure used to improve effectiveness of McRoberts manoeuvre
82
Q

What is the management for chickenpox in pregnancy?

A
  1. Check for varicella antibodies
  2. Oral aciclovir (or valaciclovir) at day 7-14 after exposure
  3. Oral aciclovir if >20 weeks and presents within 24 hours of onset of rash
83
Q

What is the investigation for gestational diabetes?

A

Oral glucose tolerance test:
- Fasting glucose >5.6mmol/L
- 2-hour glucose >7.8mmol/L

If fasting glucose >=7mmol/L, commence insulin (short acting only)

84
Q

What are the investigations for premature rupture of membranes?

A
  • Speculum examination = pooling of amniotic fluid in posterior vaginal fornix/absence of vaginal discharge
  • Test fluid for PAMG-1 (amnisure) or insulin-like growth factor binding protein 1
  • USS = may show oligohydramnios
85
Q

What is the management for premature labour?

A

Tocolytic medication - stop labour
Steroids (dexamethasone) - help foetal lungs mature in case labour continues and delivery is required

86
Q

What are the risk factors for cord prolapse?

A
  • Prematurity
  • Multiparity
  • Polyhydramnios
  • Multiple pregnancy
  • Abnormal presentations e.g. breech/transverse
87
Q

What is the management for cord prolapse?

A
  • Presenting part of fetus may be pushed back into uterus to avoid compression
  • Minimal handling/keep warm and moist if cord past level of introitus
  • Patient on all fours
  • Tocolytics to reduce uterine contractions
  • Retrofilling bladder with 500-700ml of saline
88
Q

What scoring system is used for labour?

A

Bishop score - evaluating cervical readiness for labour

<5 = indicates labour unlikely to start without induction
>8 = indicates cervix is ripe/favourable and high chance of spontaneous labour

89
Q

How does ovarian cancer commonly present and what is the initial investigation?

A

> 50 years with IBS-like symptoms in the last 12 months

  • Bloating
  • Abdominal/pelvic pain
  • Early satiety
  • Diarrhoea/urinary symptoms
  • CA-125 level
90
Q

What is the management for pelvic organ prolapse?

A
  • Weight loss
  • Pelvic floor muscle exercises
  • Ring pessary
  • Surgery
91
Q

What is the difference between OA and OP

A

Occiput anterior - head down and facing mother’s spine

Occiput posterior - head down and facing mother’s naval

92
Q

How does labour differ in OA and OP presentation?

A

OA:
- Ideal

OP:
- Labour likely to be longer and more painful
- Earlier urge to push
- May rotate spontaneously to OA

93
Q

What is the classic presentation for vasa praevia?

A
  • Rupture of membranes
  • Painless vaginal bleeding
  • Foetal bradycardia (foetal distress)
94
Q

What is the classic presentation for placenta praevia?

A
  • Painless vaginal bleeding
  • No foetal distress
95
Q

What are the risk factors for placenta praevia?

A
  • Multiparity
  • Previous c-section
  • Multiple pregnancy
  • Increased age
  • IVF
  • Maternal smoking
  • Structural uterine abnormalities e.g. fibroids
96
Q

What are the risk factors for placental abruption?

A
  • Multiple pregnancy
  • Smoking
  • Previous abruption
  • Maternal smoking
  • Pre-eclampsia
  • HTN
97
Q

When is AFP raised in pregnancy?

A
  • Abdominal wall defects e.g. gastroschisis/omphalocele
  • Multiple pregnancy
  • Neural tube defects
98
Q

When is AFP decreased in pregnancy?

A
  • Down’s syndrome
  • Trisomy 18 (Edward’s)
  • Maternal diabetes mellitus
99
Q

What are the findings for molar pregnancy?

A
  • High beta hCG
  • Low TSH
  • High T4
100
Q

What are normal laboratory findings in pregnancy?

A
  • Reduced urea
  • Reduced creatinine
  • Increased urinary protein loss
101
Q

Describe the bishop score

A

0-3
- Cervical position
- Cervical consistency
- Cervical effacement (thinning/shortening of cervix)
- Cervical dilation
- Foetal station (position of head)

<5 unlikely to start without induction
>8 high chance of spontaneous labour/response to interventions

102
Q

What are the mechanisms of labour?

A
  • Descent
  • Flexion
  • Internal rotation
  • Extension
  • Restitution
  • External rotation
  • Delivery of body
103
Q

What is the management for induction of labour?

A

<6 = vaginal prostaglandins
>6 = amniotomy and IV oxytocin infusion

104
Q

Why is misoprostol not used in induction?

A

Too strong - can cause hyperstimulation and foetal distress

105
Q

What is human chorionic gonadotrophin (HCG)?

A
  • Secreted by syncytiotrophoblast into maternal bloodstream
  • Acts to maintain production of progesterone by corpus luteum in early pregnancy
  • Can be detected from day 8 after conception
106
Q

What is the management for cord prolapse?

A
  • Presenting part of foetus may be pushed back into uterus
  • Keep cord warm and moist
  • Patient go on all fours
  • Tocolytics = reduce uterine contractions (relax uterine muscles)
  • Retrofilling bladder with 500-700ml of saline
  • C-section
107
Q

What medication can be used to improve success rate of external cephalic version?

A
  • Tocolytic agent with beta-mimetic effect
  • E.g. terbutaline, ritodrine, salbutamol
108
Q

What medication is used for suppressing lactation?

A

Cabergoline

109
Q

What are the categories of caesarean sections?

A

1:
- Immediate threat to life e.g. uterine rupture/major placental abruption/cord prolapse
- Delivery within 30 minutes

2:
- Maternal/foetal compromise which is not immediately life-threatening
- Delivery within 75 minutes

3:
- Delivery is required but mother and baby are stable

4:
- Elective

110
Q

Describe amniotic fluid embolisms

A

Foetal cells/amniotic fluid enters the mother’s bloodstream
- Chills/shivering/sweating
- Anxiety
- Coughing
- Cyanosis
- Hypotension
- Bronchospasms
- Tachycardia/arrhythmia/MI

111
Q

What are the different types of breech presentation?

A

Complete - both legs flexed at hip/knees (looks cross-legged)

Frank (most common) - both legs flexed at hip and extended at knees

Footling - one or more legs extended at hip (foot is presenting part)

112
Q

What is en caul?

A
  • Foetus is born still inside amniotic sac
  • Sac is opened by midwife/doctor
113
Q

What is delayed cord clamping?

A

Cord clamping delayed 1-2 to allow blood to be transferred to baby - increases RBCs/iron/stem cells

114
Q

What are signs on examination of pelvic inflammatory disease and what is the management?

A
  • Cervical motion tenderness and adnexal tenderness
  • IM ceftriaxone (single dose) + doxycycline (14 days) + metronidazole (14 days)
  • Leave coil in and only take out if no improvement after 72 hours
115
Q

When is axillary node clearance done in breast cancer?

A

When >3 sentinel nodes are involved in sentinel node biopsy

116
Q

When are patients referred via the 2 week wait pathway for breast cancer?

A
  • > 30 with unexplained breast/axilla lump with or without pain
  • > 50 with symptoms in one nipple: discharge/retraction/changes of concern
117
Q

Describe the triple assessment process?

A
  1. History and examination
  2. Imaging (USS or mammogram)
  3. Biopsy (core or fine needle aspiration)
118
Q

What is an investigation for teratomas (dermoid cyst)?

A

Histopathological analysis - Rokitansky’s protuberance

119
Q

What is given in premature labour?

A

Vaginal progesterone - decreases myometrium activity and prevents cervix remodelling

If not - steroids and abx (10 days abx in PPROM)

120
Q

What are the clinical features of ovarian tumours?

A
  • Acute abdomen
  • Amenorrhoea
  • Hirsutism
  • Thyrotoxicosis
  • Rupture/haemorrhage
121
Q

What is haematocolpos?

A

Accumulation of blood in vagina usually due to imperforate hymen

122
Q

When may CA-125 be raised?

A
  • Adenomyosis
  • Ascites
  • Endometriosis
  • Menstruation
  • Breast cancer
  • Ovarian cancer
  • Ovarian torsion
  • Endometrial cancer
  • Liver disease
  • Metastatic lung cancer
123
Q

Which antibiotics are safe in pregnancy and breastfeeding?

A

Cephalosporins e.g. ceftriaxone and cefotaxime

124
Q

What are the cut off values for amniotic fluid index?

A

5 < x < 24

<5 = oligohydramnios
>24 = polyhydramnios

125
Q

What are the most common types of vaginal cancer?

A

Majority = secondary cancer

Most common primary = squamous cell carcinoma

126
Q

What is the most common type of ovarian cancer?

A

Epithelial - serous carcinoma

127
Q

What is CIN grade 1 and what is the management?

A

Low grade cervical intraepithelial neoplasia - low grade abnormal changes in transformation zone

  • No treatment necessary
  • Follow up in 12 months
128
Q

What are some physiological changes of pregnancy?

A
  • Increased blood volume
  • Increased CO
  • Increased HR
  • Decreased vascular resistance
  • Increased tidal volume
  • Increased intra-gastric pressure
  • Decreased gut motility
  • Increased uterine size

Phase 3a (21 decks)

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