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phase 3a mine > womens 2 > Flashcards

womens 2 Flashcards

1
Q

incontinence first line
(Each type)

A

urge incontinence: bladder retraining
stress incontinence: pelvic floor muscle training

Oxybutynin and botulin injections are treatment options used further down the line if required

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2
Q

emergency contracpetion options

A

best = copper IUD
- most effective
- up to 5d after (or up to 5 days before likely ovulation date!)

Levonorgestrel
- up to 72 h after
- [best in first half of cycle as prevents ovulation]

Ulipristal acetate
- up to 5d
- not for severe asthma
- delay breastfeeding for 1w
- [best in first half of cycle as prevents ovulation]

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3
Q

how long til menopause

what ages is it for
- early menopause
- premature ovarian failure

A

12m if 50+
24m if <50

early menopause <45
premature ovarian failure <40

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4
Q

copper IUD effect on periods

A

heavier

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5
Q

COCP/ smoking

A

no no no

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6
Q

length of time for copper/mirena coil

A

copper - 5-10y
mirena- 3-5y

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7
Q

tx for baby blues / post natal depression

A

baby blues - reassure

post-natal depression - CBT (and reassure)

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8
Q

vomiting in preg tx

A
  1. promethazine (antihistamine)
  2. ondasteron
  3. metoclopramide
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9
Q

how long post partum for smear to be

A

12w

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10
Q

down syndrome suggested by what (on US and bloods)

A

↑ HCG,
↓ PAPP-A, t
hickened nuchal translucency

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11
Q

time until contraceptives become effective
- IUD
- IUS
- POP
- COCP
- injection
- implant

A

instant: IUD
2 days: POP
7 days: COC, injection, implant, IUS

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12
Q

fetal movements
- normal when
- refer when

A

18-20
24

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13
Q

shoulder dystocia
- RF
- tx
- complications

A

RF
- DM - fetal macrosomia
- high BMI
- long labour

TX
- get consultant
- mc roberts manouvre (mums hips flexed and abducted)
- episiotomy and above manouvre again
- suprapubic pressure (after mc rob)
- c sec (last resort)
- careful with forceps/ oxytocin as we dont want to rush birth and injure baby

complications
- blood loss for mum
- perineal tears for mum
- brachial plexus injury for baby
- death for baby

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14
Q

Hydatidiform mole symptoms

A

first trimester/ early 2nd - bleeding
naus/vom

uterus large for dates
hCG high

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15
Q

miscarriage distinction symptom-wise
- threatened
- missed (delayed)
- inevitable
- incomplete
- complete

A

Threatened miscarriage (ongoing pregnancy)- painless vaginal bleeding typically around 6-9 weeks

Missed (delayed) miscarriage (found on scan/ exam)- light vaginal bleeding and symptoms of pregnancy disappear

Inevitable miscarriage (cervical os open)- complete or incomplete depending or whether all fetal and placental tissue has been expelled.

Incomplete miscarriage (cervical os open and bleeding begun but not all expelled) - heavy bleeding and crampy, lower abdo pain.

Complete miscarriage (all expelled)- little bleeding

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16
Q

ectopic preg presentation

A

6-8w normally, missed periods
lower abdo pain, often one side
bleeding follows

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17
Q

placental abruption presentation

A

constant lower abdo pain
more shocked than would expect based on blood
uterus tense and tender
normal lie/presentation
distressed fetus maybe

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18
Q

placenta previa presentation

A

bleeding but NO pain
uterus not tender
fetal lie/ position abnormal maybe

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19
Q

vasa praevia presentation

A

blood loss
fetal bradycardia

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20
Q

pregnancy + chicken pox exposure … tx?

A

if doubt, check whether mum is immune by seeing if she has varicella antibodies

exposure/ prevention
<20w preg – give immunoglob (<10d post exposure)
>20w preg – antibodies or aciclovir (7-14d post exposure)

def have it
- oral aciclovir <20w, consider if >20w

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21
Q

Terbutaline (medication)

A

tocolytic - anti-contractions (opposite of vaginal prostaglandins and oxytocin / synometrin)

good for if umbilical cord prolapse (along with emergency C sec)

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22
Q

normal CTG

A

accelerations present
variability >5bpm
no decelerations (must resolve by end of contraction)
HR 110-160

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23
Q

abnormal CTG causes

  • high HR
  • low HR
  • low variability
  • decelleration independant of contraction
  • late deceleration
A

high HR
- hypoxia
- premature
- maternal pyrexia

low hR
- mum B block
- high fetal vagal tone

low bpm variability (<5)
- hypoxia
- premature

decelleration independant of contraction
- cord compression

late deceleration (lags contraction onset, and doesnt resolve til 30s post contraction end)
- fetal distress - asphyxia / placental insufficiency

24
Q

infertility investigations

A

semen analysis

serum progesterone 7 days prior to expected next period. For a typical 28 day cycle, this is done on day 21. (luteal phase is always same lenght (14d), it is just folluclar phase length that varies person to person)

25
Q

thrush tx

A

oral fluconazole 150 mg as a single dose first-line!!!

clotrimazole 500 mg intravaginal pessary as a single dose if oral therapy is contraindicated (2nd line!!!)

if pregnant then only local treatments (clotrimazole)

Recurrent (4 episodes /yr)…..
- check compliance
- swab to culture
- DM check
- oral fluconazole

26
Q

preterm prelabour rupture of membranes mx

A

admit + monitor for chorioamnionitis (amniotic infection)
10 days (penacillin /) erythromycin
antenatal corticosteroids (reduce risk of resp distress)
consider early delivery from 34w

27
Q

US signs

hypoechoic mass
whirpool sign
beads on a string
snow storm

A

hypoechoic mass - fibroid
whirpool sign - ovarian torsion
beads on a string - salpingits (chronic if lots of beds)
snow storm/ multiple anechoic spaces / grapes; and large for dates uterus - hydatidiform mole (preg complication)

28
Q

endometrial cancer
- symptoms
- investigations
- management

A
  • bleeding (normally only symptom. sometimes pain/discharge), normally post-menopause
  • first line = transvag US (should be <4mm)
  • hysteroscopy and biopsy

-hysterectomy + salpingoopherectomy
- radiotherapy if advanced disease
- progestin if cant do above(oldies)

29
Q

transvag uterus diameter should be?

A

<4mm

otherwise think endometrial cancer

30
Q

preg vom 1st and 2nd line

When should you admit pt

A

1- oral cyclizine / promethazine. Antihistamines are first-line

2- Ondansetron (a 5-HT3 reception antagonist) and domperidone (dopamine receptor antagonist) are second-line antiemetic.

// ginger and P6 (wrist) acupressure: CKS suggest these can be tried but there is little evidence of benefit

admit (IV hydration) if high urine ketones, unable to keep fluids/ antiemetics down, suspected hyperemesis grav, not improving with above, weight loss (5% pre-preg weight)

31
Q

COCP questions

A

are pregnant
are a smoker and over 35 years old
are over 35 years old and stopped smoking less than one year ago
have a BMI of greater than 35kg/m2
suffer from migraine with aura
are breastfeeding baby up to 6 months
have cardiovascular and venous thromboembolism risk factors
have a family history of breast cancer
post-coital / intermenstrual bleeding

if so, consider mirena/copper coil / POP

32
Q

depot s/e

A

Weight gain
Periods heavy

33
Q

abortion risk counselling

A

Blood loss
Retained products
Infection
Mechanical
Future reduced fertility
Womb scarring/ adhesion
Perforation (rare)
Psychological

34
Q

STI test - what is inlcuded and when are they accurate

A

HIV - 4/7-12w (but may show up sooner (for all))
Two blood tests (3m )
Syphilis - 12w
Gonorrhoea - 2w
Chlamydia - 2w
Hep B/C - 12w

35
Q

bishops score?
used when?

A

A Bishop’s score of ≥ 8 indicates that the cervix is ripe, or ‘favourable’ - there is a high chance of spontaneous labour, or response to interventions made to induce labour. a score of < 5 indicates that labour is unlikely to start without induction

if too low - can sweep membranes (if not yet ruptured), vaginal prostaglandins and then oxytocin next line

36
Q

calculating bishops score

A

Cervical position
- Posterior 0
- Intermediate 1
- Anterior 2

Cervical consistency
- Firm 0
- Intermediate 1
- Soft 2

Cervical effacement
- 0-30% 0
- 40-50% 1
- 60-70% 2
- 80% 3

Cervical dilation
- <1 cm 0
- 1-2 cm 1
- 3-4 cm 2
- >5 cm 3

Fetal station
- -3 0
- -2 1
- -1, 0 2
- +1,+2 3

A Bishop’s score of ≥ 8 indicates that the cervix is ripe, or ‘favourable’ - there is a high chance of spontaneous labour, or response to interventions made to induce labour. a score of < 5 indicates that labour is unlikely to start without induction

37
Q

bacterial vaginosis : Amsel diagnostic criteria

A

3 out of:

  • thin, white homogenous discharge
  • clue cells on microscopy: stippled vaginal epithelial cells
  • vaginal pH > 4.5
  • positive whiff test (addition of potassium hydroxide results in fishy odour)
38
Q

discharge - how is it?? and tx

  1. BV
  2. TV
  3. Thrush
  4. Gon
  5. Chlamid
A
  1. BV - thin, white/grey, fishy, ph >4.5
    - Lifestyle - avoid excess cleaning
    - New sexual partners
    - Abx cause
    - Metronidazole tx
  2. TV -yellow/green, foul-smelling ‘musty’, frothy, strawberry cervix (erythematous cervix with pinpoint areas of exudation.)
    - Metronidazole tx
  3. Thrush - curd like, cottage cheese, white
    - Abx cause
    - tx: oral fluconazole (1st) ; clotrimazol topical (2nd/preg)
  4. Gon - thin, yellow/green, purulent, mildly odourous .
    - dysuria, intermenstrual bleeding and dyspareunia also
    - IM ceftriaxone
  5. Chlamid - phlegmy- purulent, smelly, yellowish, odourous
    - tx: doxycycline (azithromycin if preg)
39
Q

rhesus
- which is the problematic
- then what

A

rhesus negative

give anti-D at 28 + 34 weeks (or single dose at 28w)

40
Q

what medication to supress lactation

A

cabergoline

eg if taking formula for baby’s needs

41
Q

COCP UKMEC 3/4
- what is UKMEC 3/4?
- what are the contraindiactions under each category

A

UKMEC 3: disadvantages generally outweigh the advantages
UKMEC 4: represents an unacceptable health risk

Examples of UKMEC 3 conditions include
more than 35 years old and smoking less than 15 cigarettes/day
BMI > 35 kg/m^2*
family history of thromboembolic disease in first degree relatives < 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

Examples of UKMEC 4 conditions include
more than 35 years old and smoking more than 15 cigarettes/day
migraine with aura
history of thromboembolic disease or thrombogenic mutation
history of stroke or ischaemic heart disease
breast feeding < 6 weeks post-partum (NOT6M anymore)
uncontrolled hypertension
current breast cancer
major surgery with prolonged immobilisation
positive antiphospholipid antibodies (e.g. in SLE)

Diabetes mellitus diagnosed > 20 years ago is classified as UKMEC 3 or 4 depending on severity

42
Q

implant contraindications
- what is UKMEC 3/4?
- what are the contraindiactions under each category

A

UKMEC 3: disadvantages generally outweigh the advantages
UKMEC 4: represents an unacceptable health risk

current breast cancer is UKMEC 4,
past breast cancer is UKMEC 3

43
Q

salpingectomy vs salpingotomy

A

for ectopic surgery

salpingectomy - no RF for fertility

salpingotomy - other RF for fertility (e.g. PID, prev ectopic) so best chance of preserving fertility

44
Q

prophylaxis for potential group b strep infection

A

benzylpenicillin

and also tx, plus gentamycin i think

45
Q

which HRT is worst for breast cancer

A

combined

46
Q

mittelschmirz

=?
INV
Tx

A

transient sharp pain mid-cycle , due to ovulation

may have small free fluid on USS
normal FBC

no tx / conservative

47
Q

when do external cephalic eversion

A

nulliparous - from 36w
multiparous - from 37w

if at term/ labour - dont do ECV, just emergency Csec/ IOL

48
Q

when is cervical excitation seen

A

PID
ectopic

49
Q

when would you do a co-prescription of COCP

A

with implant and heavy menstrual bleeding

50
Q

Fitz Hugh Curtis syndrome?

A

in PID - when there is perihepatic inflammation leading to RUQ pain

51
Q

how far into preg before you can be diagnosed with pre-eclampsia/ gestational DM

A

20 weeks

so if raised BP before then - its chronic!

52
Q

what vaccine is offered between 16-32 w

A

pertussis, diptheria + tetanus

+ influenza

53
Q

once diagnosed with gestational DM, what are the glucose targets (3- fasting, 1h, 2h)

A

fasting: 5.3mmol/L
1 hour postprandial: 7.8 mmol/L or
2 hours postprandial: 6.4 mmol/L

54
Q

which medications should be stopped at 50y

A

COCP
depot injection

switch to non-hormonel or progesterone only (until post menopausal)

55
Q

mastitis tx

A

continue breastfeeding
consider flucoxacillin (think - like cellulitis)

phase 3a mine (16 decks)

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