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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 are the investigations for post-menopausal bleeding?

A
  • Transvaginal USS
  • Pipelle biopsy
  • Hysteroscopy with biopsy
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8
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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9
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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10
Q

What is the management for chorioamnionitis?

A
  • Emergency delivery
  • IV abx
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11
Q

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

A

Breast cancer

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12
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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13
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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14
Q

What is the first-line method of inducing labour?

A

Vaginal prostaglandins

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15
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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16
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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17
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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18
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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19
Q

What is the order of management for gestational HTN?

A
  • Labetalol (beta blockers) - first line
  • Nifedipine (CCB) - if asthma
  • Methyldopa - contraindicated in depression
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20
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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21
Q

What is a threatened miscarriage?

A
  • NOT A MISCARRIAGE = vaginal bleeding during pregnancy
  • Painless bleeding before 24 weeks
  • Cervical os closed
  • Fetus alive
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22
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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23
Q

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

A

Inevitable:
- Heavy bleeding with clots
- Pain
- Cervical os open

Incomplete:
- Bleeding
- Pain
Cervical os open
- NOT ALL PRODUCTS OF CONCEPTION EXPELLED

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24
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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25
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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26
Q

What are the clinical features of uterine fibroids?

A
  • Menorrhagia
  • Anaemia
  • Bulk-related symptoms e.g. bloating/urinary frequency
27
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
28
Q

What is the management for fibroids?

A
  • IUS/COCP/tranexamic acid = if <3 cm and not distorting uterine cavity
  • GnRH agonists = shrink
  • Surgery = myomectomy
29
Q

What are the investigations for PCOS?

A
  • Pelvic USS
  • LH + FSH
  • Prolactin
  • TSH
  • Testosterone
  • Sex hormone-binding globulin
30
Q

Describe stereotypical PCOS findings

A
  • raised LH:FSH ratio
  • Testosterone normal/mildly elevated
  • Serum sex hormone binding globulin (SHBG) normal/low
31
Q

What criteria is used for PCOS?

A

Rotterdam criteria - 2 of 3 features:
- Oligomenorrhoea/amenorrhoea
- Clinical/biochemical signs of hyperandrogenism (hirsutism/acne/elevated testosterone)
- Polycystic ovaries on USS

32
Q

What is the management for PCOS?

A
  • Oligomenorrhoea/hirsutism/acne = COCP/oral progestogen/IUS
  • Infertility = referral/clomifene citrate/metformin
33
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

34
Q

What should be given to all patients with PPROM?

A

10 days erythromycin

35
Q

Describe placenta accrete spectrum

A

Placenta accreta = myometrium

Placenta increta = deep myometrium

Placenta percrata = past myometrium and perimetrium

36
Q

What is a complication of intrahepatic cholestasis?

A

Stillbirth

37
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
38
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
- Caution in severe asthma
- Hormonal contraception started 5 days after
- Breastfeeding should be delayed for one week

39
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

40
Q

What are the basic investigations for infertility?

A
  • Semen analysis
  • Serum progesterone 7 days prior to expected next period
41
Q

What is the management for infertility due to ovulation disorders?

A
  • Exercise/weight loss
  • Letrozole
  • Clomifene citrate
  • GnRH therapy
42
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

43
Q

What is the management for endometriosis?

A
  • FIRST LINE = NSAIDs + COCP
  • GnRH analogues
44
Q

What is RMI?

A

Risk malignancy index - estimates risk of ovarian mass being malignant

  • Menopausal status
  • USS findings
  • CA125 levels
45
Q

What is secondary dysmenorrhoea associated with?

A
  • PID
  • Endometriosis
  • Adenomyosis
  • Fibroids

REFER

46
Q

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

A
  • Anaerobic bacteria - Gardnerella vaginalis
  • Oral metronidazole
47
Q

What is the causative organism and management for trichomonas vaginalis?

A
  • Trichomonas vaginalis = protozoan
  • Oral metronidazole
48
Q

What is the causative organism and management for gonorrhoea?

A
  • Neisseria gonorrhoea - gram-negative diplococcus
  • IM ceftriaxone
49
Q

What is the causative organism and management for chlamydia?

A
  • Chlamydia trachomatis - gram-negative bacteria
  • Doxycycline
50
Q

What are the investigations for urinary incontinence?

A
  • Bladder diaries
  • Vaginal examination
  • Urinalysis
  • Urodynamic studies
51
Q

What medications are used in urinary incontinence?

A

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

Stress = duloxetine

52
Q

What medical management is used for menopause?

A
  • Uterus = oral/transdermal combined HRT
  • No uterus = oral/transdermal oestrogen
  • Vasomotor symptoms = fluoxetine/citalopram/venlafaxine
53
Q

What are the genotypes for common causes of primary amenorrhoea?

A

45XO = Turner syndrome

46XY = Androgen insensitivity syndrome

54
Q

What are the clinical features of hydatidiform moles?

A
  • Large uterus
  • Significantly elevated serum hCG levels
  • HTN
  • Severe N+V –> hyperemesis gravidarum
55
Q

What are the stages of labour?

A

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

Stage 2 = full dilation to delivery of fetus

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

56
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
57
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
58
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
59
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
60
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
61
Q

What is the management for PMS?

A
  • Lifestyle
  • COCP
  • SSRI (severe)
62
Q

What is the investigation for premature ovarian insufficiency?

A

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

63
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
64
Q
A

Phase 3a (21 decks)

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