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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
thrush tx
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
preterm prelabour rupture of membranes mx
admit + monitor for chorioamnionitis (amniotic infection) 10 days (penacillin /) erythromycin antenatal corticosteroids (reduce risk of resp distress) consider early delivery from 34w
27
US signs hypoechoic mass whirpool sign beads on a string snow storm
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
endometrial cancer - symptoms - investigations - management
- 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
transvag uterus diameter should be?
<4mm otherwise think endometrial cancer
30
preg vom 1st and 2nd line When should you admit pt
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
COCP questions
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
depot s/e
Weight gain Periods heavy
33
abortion risk counselling
Blood loss Retained products Infection Mechanical Future reduced fertility Womb scarring/ adhesion Perforation (rare) Psychological
34
STI test - what is inlcuded and when are they accurate
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
bishops score? used when?
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
calculating bishops score
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
bacterial vaginosis : Amsel diagnostic criteria
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
discharge - how is it?? and tx 1. BV 2. TV 3. Thrush 4. Gon 5. Chlamid
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
rhesus - which is the problematic - then what
rhesus negative give anti-D at 28 + 34 weeks (or single dose at 28w)
40
what medication to supress lactation
cabergoline eg if taking formula for baby's needs
41
COCP UKMEC 3/4 - what is UKMEC 3/4? - what are the contraindiactions under each category
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
implant contraindications - what is UKMEC 3/4? - what are the contraindiactions under each category
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
salpingectomy vs salpingotomy
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
prophylaxis for potential group b strep infection
benzylpenicillin and also tx, plus gentamycin i think
45
which HRT is worst for breast cancer
combined
46
mittelschmirz =? INV Tx
transient sharp pain mid-cycle , due to ovulation may have small free fluid on USS normal FBC no tx / conservative
47
when do external cephalic eversion
nulliparous - from 36w multiparous - from 37w if at term/ labour - dont do ECV, just emergency Csec/ IOL
48
when is cervical excitation seen
PID ectopic
49
when would you do a co-prescription of COCP
with implant and heavy menstrual bleeding
50
Fitz Hugh Curtis syndrome?
in PID - when there is perihepatic inflammation leading to RUQ pain
51
how far into preg before you can be diagnosed with pre-eclampsia/ gestational DM
20 weeks so if raised BP before then - its chronic!
52
what vaccine is offered between 16-32 w
pertussis, diptheria + tetanus + influenza
53
once diagnosed with gestational DM, what are the glucose targets (3- fasting, 1h, 2h)
fasting: 5.3mmol/L 1 hour postprandial: 7.8 mmol/L or 2 hours postprandial: 6.4 mmol/L
54
which medications should be stopped at 50y
COCP depot injection switch to non-hormonel or progesterone only (until post menopausal)
55
mastitis tx
continue breastfeeding consider flucoxacillin (think - like cellulitis)

phase 3a mine (16 decks)

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