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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
STI screening in pregnancy includes (4)
Syphilis Hep B HIV Hep C (only in high risk eg IVDU)
26
Pelvic inflammatory disease Mx
PO Ofloxacin + PO Metronidazole OR IM Ceftriaxone + PO DOxy + PO Metro
27
Nexplanon (implant) MOA
inhibits ovulation
28
IUD post partum, when for contraception?
4 weeks post partum or during c section
29
Vaginal Candidiasis (thrush)
1st - oral fluconazole (contraindicated if pregnant) 2nd - Clotrimazole pessary
30
Methotrexate in breastfeeding? safe or contraindicated
contraindicated
31
COCP UKMEC 4 (risk unacceptable)
>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)
32
COCP UKMEC 3 (disadvantages outweigh advantages) (7)
>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
33
Missed POP rules
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
Urge incontinence Mx
1st - bladder retraining 2nd - Oxybutynin/ Tolterodone/ Darifenacin 3rd - Mirabegron (use instead of Oxybutynin for frail elderly)
35
Stress incontinence Mx
1st - Pelvic floor training 2nd - Surgery - tape procedures 3rd - duloxetine
36
What treatment is given for Group B strep prophylaxis during labour
IV Benzylpenicillin (during, not before, labour)
37
Group b strep prophylaxis indications (during labour)
Prolonged rupture of membranes previous siblings with GBS maternal pyrexia Premature birth?
38
Depo-provera SE (4) and contraindications
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
Iron deficiency anaemia in Pregnancy levels and treatment
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
PCOS biochemistry results
raised LH: FSH ratio testosterone normal or slightly raise sex binding hormone globulin normal or low
41
Rhesus negative women management
Anti-D at 28 and 34 weeks OR Single dose Anti D at 28 weeks only
42
Starting COCP rules
first 5 days of cycle- no barrier contraception after 5 days or cycle - need barrier contraception for 7 days
43
Screening for gestational diabetes criteria (5) - OGTT ASAP and 24-28 weeks (if first test normal)
BMI >30 Hx macrosomia weight >4.5kg (9.9ibs) Hx gestational diabetes 1st degree relative with diabetes Ethnicity - Asian, African, Middle east
44
Vaginal thrush (candidiasis) Mx
1st Oral Fluconazole 2nd Vaginal Clotrimoxazole pessary (if unable to take oral eg pregnancy)
45
How long after emergency contraception can hormone contraception be started - Levonorgestrel - Ullipristal
Levonorgestrel - immediately Ullipristal - 5 days
46
Contraceptives time till effective IUD POP COCP/ implant/ injection/ IUS
IUD - instant POP - 2 days COCP - 7 days
47
Postpartum thyroiditis criteria (3)
<12 months post partum Clinical features of hypothyroid TFTs only
48
Three stages + Mx of postpartum thyroiditis
1 - thyrotoxicosis - propranolol for symptoms, no treatment for hyperthyroid required 2 - hypothyroid - levothyroxine 3 - euthyroid - high recurrence in future pregnancies
49
UKMEC 4 criteria for POP (2)
current pregnancy <5years Breast Ca
50
Menorrhagia Mx
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
Starting POP rules
If first 5 days - start immediately, no protection required if after 5 days - start immediately, protection required for 2 days
52
Hep B in Pregnancy, Mx of newborn
Newborn - Vaccine +/- Immunoglobulin (if mother does not have immunity)
53
Complications of gestational diabetes Maternal(2) Neonate (5)
Maternal - polyhydramnios, preterm labour Neonatal - macrosomia, hypoglycaemia, respiratory distress syndrome, shoulder dystocia, HYPOMag/ Calc
54
Lactation Mastitis Mx
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
Physiological/ Functional ovarian cysts - Follicular - Corpus Luteum
Follicular - most common Corpus Luteum - can fill with blood/ pus
56
Dermoid cyst teratoma median age
Median age 30 (most common benign tumour under 30)
57
Meigs syndrome (3)
Benign Ovarian tumour (usually fibroma) Ascites pleural effusion
58
Rhesus prevention in pregnancy
Test for D Antibodies in all Rh -ve at booking Give Anti-D to ALL Rh -ve at 28 and 34 weeks
59
When to give Anti D Immunoglobulin (8)
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
Starting HRT
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
Most common ovarian cyst
serous cystadenoma
62
Semen analysis time requirements
Abstain for 2-5 days deliver sample within 1 hour
63
Trans contraception Male (female at birth) Female (male at birth)
Male (female at birth) - condoms Female (male at birth) - copper IUD
64
COCP risks
VTE heart attacks, strokes breast, cervical Ca
65
HRT Contraindications (4)
Current or past Breast ca Oestrogen sensitive Ca Undiagnosed vaginal bleeding Untreated endometrial hyperplasia
66
HRT Risks (increase risk of...) (5)
VTE - no risk with transdermal Strokes IHD Breast Ca Ovarian Ca
67
Menopause Mx without HRT
Vasomotor - fluoxetine, citalopram, venlafaxine Vaginal dryness - vaginal lubricant, vaginal oestrogens Psychological - CBT, antidepressant
68
Intrahepatic Cholestasis in Pregnancy Mx
Induction of labour at 37-38 weeks Ursodeoxycholic acid - started by obs vitamin k supplement
69
Vitamin supplements recommended during pregnancy (2)
Folic acid 400mcg for 12 weeks Vitamin D 10mcg throughout pregnancy
70
Post partum mental health Mx
Baby blues/ postnatal depression - reassurance and support - Fluoxetine (SSRI) if severe (OK in breast feeding) Puerperal psychosis - Urgent admission
71
Cervical screening whilst pregnant
delay screening 3 months post partum
72
Newborn to mother with Hep B
Hep B vaccine + Hep B Immunoglobulin
73
Contraceptives in Epilepsy
UKMEC 1: IUD, IUS, Depo UKMEC 2: implant UKMEC 3: POP, COCP (therefore do not use Disad > adv)
74
Vaginal discharge DDx
Candida - creamy cottage cheese, no odour Bac Vaginosis - grey discharge, fishy smell Trichomantis - strawberry cervix
75
Meig's syndrome (3)
Ovarian tumour (usually Fibroma) Ascites Pleural effusion
76
Most common Ovarian tumour - under 25 - 18-40 (reproductive age)
Under 25 - Dermoid cyst (teratoma) Reproductive age - Follicular cyst
77
Depot contraception main side effect
reduced bone mineral density
78
Cyclical breast pain Mx
Ibuprofen, bra support, analgesia
79
Vaginal prolapse score (POP-Q )
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
Non Lactational Mastitis Mx
Co-Amoxiclav 625mg TDS 10-14 days
81
vaginal lichen sclerosis Mx
top steroid
82

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