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AKT > Womens > Flashcards

Womens Flashcards

1
Q

Drugs contraindicated in breast feeding

A

Abx - Ciprofloxacin, Tetracyclines, chloramphenicol, sulphonimides
psych - litihium, benzodiazepines
aspirin
carbimazole
methotrexate
sulfonylureas (gliclazide)
cytotoxic drugs
amiodarone

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2
Q

Urge incontinence Mx

A

1 - bladder retraining
2 - Oxybutynin/ Tolterodine/ Darifenacin (all these are antimuscarinics and can not be used with Amitriptyline)
3 - Mirabegron (esp in frail elderly)

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3
Q

Stress incontinence Mx

A

1 - pelvic floor training
2 - duloxetine
3- surgery - tape procedure

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4
Q

Chickenpox exposure in pregnancy (within 10 days of exposure)

A

1st - check varicella antibodies
a) <20/40 + not immune = VZIG
b) >20/40 + not immune = VZIG/ Aciclovir

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5
Q

Chickenpox confirmed in pregnancy (<24hr rash onset)

A

> 20/40 = oral aciclovir
<20/40 = oral aciclovir (used with caution)

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6
Q

Hirsutism (PCOS) Mx

A

COCP
Topical eflornithine

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7
Q

Depo Provera adverse effects

A

irregular bleeding
weight gain
increased risk of osteoporosis
delayed return to fertility
CONTRAINDICATION: Breast ca

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8
Q

Routine antenatal care 8-12 weeks

A

Booking visit: general info, obs, bloods, urine dip, urine culture, HIV, Hep B, Syphilis

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9
Q

Routine antenatal care 10-14 weeks

A

Confirm dates (+ exclude multiple pregnancy)
Nuchal scan - Downs screening (from 11 weeks)

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10
Q

Routine antenatal care 18-21 weeks

A

Anomaly scan

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11
Q

Routine antenatal care 28 weeks

A

Routine care: BP, Urine, SFH, second screen for anaemia/ atypical red cell
First Anti-D prophylaxis to rhesus neg women

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12
Q

Routine antenatal care 34/40

A

second anti D prophylaxis

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13
Q

Routine Antenatal care 36/40

A

Check position - offer ECV if indicated

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14
Q

Missed COCP rules

A

Missed 1 pill: take last pill immediately, no emergency contraception required

Missed 2 pills: take last pill immediately, use protection for next 7 days
- If Week 1: emergency contraception should be given
- If Week 2: no emergency
- If Week 3: no pill free interval (go back to back)

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15
Q

Obese (BMI >30) women pregnancy rules

A

Folic acid 5mg OD until week 13 (first trimester)
Diabetes screen (OGTT) @ 24-28 weeks
BMI >35 = consultant led birth

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16
Q

Cerazette (Desogestrel) MOA

A

Inhibit ovulation

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17
Q

Gestational diabetes criteria

A

Fasting glucose >5.6
2 hour glucose >7.8

If fasting glucose >7 = need insulin immediately

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18
Q

HRT complications

A

Breast Ca (increased with progestogen)
Endometrial Ca (oestrogen-only should not be given with those with uterus)
VTE (increased risk with progestogen) - if high risk for Haem rv)
Stroke
IHD

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19
Q

COCP and endometrial ca relation

A

COCP is protective against endometrial ca due to progestogen counteracting the oestrogenic effects of endometrial proliferation

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20
Q

Pre-existing hypertension in pregnancy definition

A

BP >140/90 before 20/40
no proteinuria
If on ACEi pre pregnancy, needs to be stopped and switched (eg labetalol)

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21
Q

Pregnancy induced hypertension definition

A

BP >140/90 after 20/40
no proteinuria
BP resolves after birth (typically after one month)

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22
Q

pre-eclampsia definition

A

PIH with proteinuria

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23
Q

Emergency contraception options

A

1) Levonorgestrel - <72 hrs from UPSI
if vomit <3hrs needs to be taken again
hormone contraception can be started immediately
double dose if BMI >26 (overweight)

2) Ullipristal (EllaOne) - <120hrs from UPSI
hormone contraception can be started 5 days
caution in asthma
breastfeeding should be delayed by one week

3) IUD - copper coil - <120hrs from UPSI
can be kept as long term contraception

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24
Q

Starting POP rules

A

if first 5 days - can start immediately without extra
if after 5 days - can start immediately with extra protection for 2 more days

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25
Q

STI screening in pregnancy includes (4)

A

Syphilis
Hep B
HIV
Hep C (only in high risk eg IVDU)

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26
Q

Pelvic inflammatory disease Mx

A

PO Ofloxacin + PO Metronidazole
OR
IM Ceftriaxone + PO DOxy + PO Metro

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27
Q

Nexplanon (implant) MOA

A

inhibits ovulation

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28
Q

IUD post partum, when for contraception?

A

4 weeks post partum
or during c section

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29
Q

Vaginal Candidiasis (thrush)

A

1st - oral fluconazole (contraindicated if pregnant)
2nd - Clotrimazole pessary

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30
Q

Methotrexate in breastfeeding? safe or contraindicated

A

contraindicated

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31
Q

COCP UKMEC 4 (risk unacceptable)

A

> 35yo + smoking >15 cigarettes/day
migraine with aura
PMH VTE
PMH CVA/ IHD
breast feeding < 6 weeks post-partum
uncontrolled hypertension
current breast cancer
major surgery with prolonged immobilisation (if planning surgery to switch to POP 4 weeks prior to surgery)
positive antiphospholipid antibodies (e.g. in SLE)

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32
Q

COCP UKMEC 3 (disadvantages outweigh advantages)
(7)

A

> 35yo + smoke <15 cig/day
BMI > 35 kg/m^2
FHx VTE < 45 years
controlled hypertension
immobility e.g. wheel chair use
carrier of known gene mutations associated with breast cancer (e.g. BRCA1/BRCA2)
current gallbladder disease

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33
Q

Missed POP rules

A

1) if >3 hrs late [unless Desogestrel/ Cerezette (12 hrs)]
- missed pill taken asap + next pill taken normal time (can take 2 at once but should not take more than 2 in one day)
- additional contraceptive precautions (eg condoms) for 48 hours
- emergency contraception if UPSI during missed pill period or within 48 hours of restarting

34
Q

Urge incontinence Mx

A

1st - bladder retraining
2nd - Oxybutynin/ Tolterodone/ Darifenacin
3rd - Mirabegron (use instead of Oxybutynin for frail elderly)

35
Q

Stress incontinence Mx

A

1st - Pelvic floor training
2nd - Surgery - tape procedures
3rd - duloxetine

36
Q

What treatment is given for Group B strep prophylaxis during labour

A

IV Benzylpenicillin (during, not before, labour)

37
Q

Group b strep prophylaxis indications (during labour)

A

Prolonged rupture of membranes
previous siblings with GBS
maternal pyrexia
Premature birth?

38
Q

Depo-provera SE (4) and contraindications

A

SE/
irregular bleeding
weight gain
increase risk of osteoporosis
delay in return to fertility

Contraindication/
current breast Ca UKMEC 4
past breast Ca UKMEC 3

39
Q

Iron deficiency anaemia in Pregnancy levels and treatment

A

Treat with oral iron with the following cut offs
1st trimester - <110
2nd - <105
3rd - 100
Continue iron for three months after corrected levels

40
Q

PCOS biochemistry results

A

raised LH: FSH ratio
testosterone normal or slightly raise
sex binding hormone globulin normal or low

41
Q

Rhesus negative women management

A

Anti-D at 28 and 34 weeks OR Single dose Anti D at 28 weeks only

42
Q

Starting COCP rules

A

first 5 days of cycle- no barrier contraception
after 5 days or cycle - need barrier contraception for 7 days

43
Q

Screening for gestational diabetes criteria (5) - OGTT ASAP and 24-28 weeks (if first test normal)

A

BMI >30
Hx macrosomia weight >4.5kg (9.9ibs)
Hx gestational diabetes
1st degree relative with diabetes
Ethnicity - Asian, African, Middle east

44
Q

Vaginal thrush (candidiasis) Mx

A

1st Oral Fluconazole
2nd Vaginal Clotrimoxazole pessary (if unable to take oral eg pregnancy)

45
Q

How long after emergency contraception can hormone contraception be started
- Levonorgestrel
- Ullipristal

A

Levonorgestrel - immediately
Ullipristal - 5 days

46
Q

Contraceptives time till effective
IUD
POP
COCP/ implant/ injection/ IUS

A

IUD - instant
POP - 2 days
COCP - 7 days

47
Q

Postpartum thyroiditis criteria (3)

A

<12 months post partum
Clinical features of hypothyroid
TFTs only

48
Q

Three stages + Mx of postpartum thyroiditis

A

1 - thyrotoxicosis - propranolol for symptoms, no treatment for hyperthyroid required
2 - hypothyroid - levothyroxine
3 - euthyroid - high recurrence in future pregnancies

49
Q

UKMEC 4 criteria for POP (2)

A

current pregnancy
<5years Breast Ca

50
Q

Menorrhagia Mx

A

1st - IUS (Mirena)
2nd - COCP
3rd - Depo

If no need for contraception - tranexamic acid/ mefenamic acid

If need for urgent cessation of bleeding - Norethisterone

51
Q

Starting POP rules

A

If first 5 days - start immediately, no protection required
if after 5 days - start immediately, protection required for 2 days

52
Q

Hep B in Pregnancy, Mx of newborn

A

Newborn - Vaccine +/- Immunoglobulin (if mother does not have immunity)

53
Q

Complications of gestational diabetes
Maternal(2)
Neonate (5)

A

Maternal - polyhydramnios, preterm labour
Neonatal - macrosomia, hypoglycaemia, respiratory distress syndrome, shoulder dystocia, HYPOMag/ Calc

54
Q

Lactation Mastitis Mx

A

1st - supportive - analgesia, warm compress, continue breast feeding
2nd - Antibiotics (Fluclox 500mg qds 14/7 or Erythromycin 500mg qds 14/7) if:
- Sx do not resolve after 24hrs or are worsening after 12hrs
- Nipple fissure infected
- Positive blood culture
3rd - Co-Amox (broad spec) if still no improvement >48 hours

55
Q

Physiological/ Functional ovarian cysts
- Follicular
- Corpus Luteum

A

Follicular - most common
Corpus Luteum - can fill with blood/ pus

56
Q

Dermoid cyst teratoma median age

A

Median age 30 (most common benign tumour under 30)

57
Q

Meigs syndrome (3)

A

Benign Ovarian tumour (usually fibroma)
Ascites
pleural effusion

58
Q

Rhesus prevention in pregnancy

A

Test for D Antibodies in all Rh -ve at booking
Give Anti-D to ALL Rh -ve at 28 and 34 weeks

59
Q

When to give Anti D Immunoglobulin (8)

A

delivery of Rh+ve baby
any termination of pregnancy
miscarriage >12/40
ectopic pregnancy surgically managed (medical Mx not required)
External Cephalic Version
Amniocentesis/ CVS/ fetal blood sampling
Abdominal trauma - eg RTA
Antepartum haemorrhage

60
Q

Starting HRT

A

Uterus in situ? - yes -> combined HRT
- no -> Oestrogen only

Perimenopausal - Cyclical
Menopausal - Continuous

Hx of VTE - yes -> topical preparation

Mirena coil in situ for contraception - Oestrogen only (as progesterone from coil)

61
Q

Most common ovarian cyst

A

serous cystadenoma

62
Q

Semen analysis time requirements

A

Abstain for 2-5 days
deliver sample within 1 hour

63
Q

Trans contraception
Male (female at birth)
Female (male at birth)

A

Male (female at birth) - condoms
Female (male at birth) - copper IUD

64
Q

COCP risks

A

VTE
heart attacks, strokes
breast, cervical Ca

65
Q

HRT Contraindications (4)

A

Current or past Breast ca
Oestrogen sensitive Ca
Undiagnosed vaginal bleeding
Untreated endometrial hyperplasia

66
Q

HRT Risks (increase risk of…) (5)

A

VTE - no risk with transdermal
Strokes
IHD
Breast Ca
Ovarian Ca

67
Q

Menopause Mx without HRT

A

Vasomotor - fluoxetine, citalopram, venlafaxine

Vaginal dryness - vaginal lubricant, vaginal oestrogens

Psychological - CBT, antidepressant

68
Q

Intrahepatic Cholestasis in Pregnancy Mx

A

Induction of labour at 37-38 weeks
Ursodeoxycholic acid - started by obs
vitamin k supplement

69
Q

Vitamin supplements recommended during pregnancy (2)

A

Folic acid 400mcg for 12 weeks
Vitamin D 10mcg throughout pregnancy

70
Q

Post partum mental health Mx

A

Baby blues/ postnatal depression
- reassurance and support
- Fluoxetine (SSRI) if severe (OK in breast feeding)

Puerperal psychosis
- Urgent admission

71
Q

Cervical screening whilst pregnant

A

delay screening 3 months post partum

72
Q

Newborn to mother with Hep B

A

Hep B vaccine + Hep B Immunoglobulin

73
Q

Contraceptives in Epilepsy

A

UKMEC 1: IUD, IUS, Depo
UKMEC 2: implant
UKMEC 3: POP, COCP (therefore do not use Disad > adv)

74
Q

Vaginal discharge DDx

A

Candida - creamy cottage cheese, no odour

Bac Vaginosis - grey discharge, fishy smell

Trichomantis - strawberry cervix

75
Q

Meig’s syndrome (3)

A

Ovarian tumour (usually Fibroma)
Ascites
Pleural effusion

76
Q

Most common Ovarian tumour
- under 25
- 18-40 (reproductive age)

A

Under 25 - Dermoid cyst (teratoma)
Reproductive age - Follicular cyst

77
Q

Depot contraception main side effect

A

reduced bone mineral density

78
Q

Cyclical breast pain Mx

A

Ibuprofen, bra support, analgesia

79
Q

Vaginal prolapse score (POP-Q )

A

Stage 0: no prolapse
Stage 1: more than 1 cm above the hymen
Stage 2: within 1 cm proximal or distal to the plane of the hymen
Stage 3: more than 1 cm below the plane of the hymen but protrudes no further than 2 cm less than the total length of the vagina
Stage 4: there is complete eversion of the vagina

80
Q

Non Lactational Mastitis Mx

A

Co-Amoxiclav 625mg TDS 10-14 days

81
Q

vaginal lichen sclerosis Mx

A

top steroid

82
Q
A

AKT (21 decks)

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