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MSRA > Womens health > Flashcards

Womens health Flashcards

1
Q

Contraceptive patch, missed patch

A

week 1/2 -
if delay <48 hrs - change immediately, nil further precautions
If >48hrs - change immediately, barrier contraception 7 days, ? emergency contra if UPSI in past 5 days

Week 3 - remove immediately, start new patch on usual day of next cycle

delay is starting new cycle - 7 days barrier

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2
Q

Risks/ benefits COCP

A

Advantages - reduced risk ovarian + endometrial, reduced risk colorectal

Disadvantages - inc risk breast/cervical, inc risk VTE/stroke

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3
Q

Absolute CI COCP

A

> 35 and smoking >15
Migraine w/ aura
Hx thromboembolic disease/stroke/ischaemic HD
Breast feeding <6w postpartum
Uncontrolled HTN
Major surg (stop 4w before)
+ve Amtiphospholipic antibodies
Current breast Ca

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4
Q

COCP - 2 or more missed pills

A

week 1 - consider emergency coontra
week 2 - no need for contra
week 3 - omit pill brekak

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5
Q

Emergency contra

A

1.5 mg levonorgestrel - 72 hrs, rpt if vom within 3 hrs, restart contraception immediately. Inhib ov

30 mg Ulipristal - 120hrs, NB Caution in severe asthma, 5-day break before contraception, 7 day break breastfeeding. inhib ov

IUD - withing 5 days UPSI or up to 5 days after expected ovulation date, inhib implant

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6
Q

Contraception - method of action

A

Inhib- ov - COCP, desogestrel, Depo, implant

POP - thicken cervical mucus
IUS - prevent proliferation
IUD - dec sperm motility

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7
Q

postpartum contraception

A

nil req for first 21 days

Can start POP at any time
If breastfeeding - COCP CI for 6 w

Lactational amenorrhea - 98%^ effective for the first 6mo if woman only breastfeeding

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8
Q

Antenatal care - 8-20w

A

8-12w - booking bloods/urine + uterine culture
Check HIV/HepB/Syph

10-14w- dating scan

11-14 - downs screening (inc nuchal)

18-21 Anomaly scan

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9
Q

Antenatal care >21w

A

28w - second screen anaemia, 1st dose anti-D if Rh -ve

34w - second dose anti-D

36w - offer ECV if indicated

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10
Q

amenorrhoea, lower abdominal pain, shoulder tip pain, PV bleed

A

Ectopic

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11
Q

Bleeding in early preg, vomiting, uterus large for dates

A

Hydatidiform mole

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12
Q

ROM then immediate bleeding

A

Vasa praevia
Fetal brady sometimes seen

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13
Q

Drugs CI in breastfeeding

A

Aspirin
Abx - cipro, tetracycline, chloramphenicol, sulphonamides
lithium/benzos
Carbimazole, methotrexate, amiodarone
Sulphonylureas

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14
Q

Common CTG findings

A

Baseline Brady - inc fetal vagal tone, maternal BB
Baseline tachy - maternal fever/inf, hypoxia
Early dec - brady for curation of contraction - innocuous
Late dec - Brady which lags the onset of contraction and does not return to normal till 30s after contraction ends - fetal distress

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15
Q

Chicken pox in preg

A

If nil prev vacc - Oral aciclovir/valaciclovir on day 7-14 after exposure

If pregnant woman dev chicken pox - give Aciclovir if presents within 24 hours of onset of rash

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16
Q

Antenatal testing - inc HCG, dec PAPP-A, dec AFP, thickened nuchal (11-13+6w)

A

Downs

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17
Q

Antenatal testing - Dec HCG, dec AFP, inc PAPP-A, thick translucency

A

Edwards syndro

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18
Q

Antenatal testing - raised AFP

A

Neural tube defects

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19
Q

Tx and monitoring for eclampsia

A

Pre-eclampsia = pregnancy induced HTN >20, proteinuria

Tx = magnesium sulphate to prevent and treat seizures, give once decision to deliver has been made
Monitor Urine output, reflexes, RR and sats while giving

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20
Q

Best anti-epileptic to use in pregnancy and breastfeeding

A

Best = lamotrigine
Avoid Na Val (neural tube defects)

Most anti-epileptics ok while breastfeeding

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21
Q

Tx for GDM

A

If fasting glucose <7 - advise of diet/exercise and recheck in 2w
If not met - metformin

If >7 - start short acting insulin
If 6-6.9 and evidence of macrosomnia/hydramnios - offer insulin

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22
Q

Tx for existing DM in preg

A

Stop orl hypoglycaemic agents (apart from metformin) and start insulin

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23
Q

Tx for HIV in pregnancy

A

If viral load <50 - vaginal birth (otherwise Csec)
Start Zidovudine inf 4 hours before c sec

neonate - if maternal load <50 - PO zidovudine 4-6. If >50 - triple therapy

Avoid breastfeeding

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24
Q

Induction of labour

A

Bishop score:
<5 - labour unlikely to start without induction
5-8 - high chance spontaneous labour

Induction methods:
- membrane sweep
- Vaginal PGE2
- Oral prostaglandin E1
- maternal oxytocin infusion
- amniotomy

NICE
If score < 6 - vaginal prostaglandins or oral misoprostol
If >6 - amniotomy and an intravenous oxytocin infusion

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25
intense itching in preg, worse on hands, jaundice
Intrahepatic cholestasis of pregnancy Tx induction at 37-29w Ursodeoxycholic acid Vit K supp
26
Causes of oligohydramnios
(<500ml at 32-36w) Causes: PROM, renal angenesis, IUGR, post-term, pre-eclampsia
27
Degree of perineal tears
1 - superficial, conservative 2 - inj to muscle - suture on ward 3 - inj to muscle and anal sphincter - repair in theatre 4 - in to anal sphincter and rectal musoca - repair in theatre
28
Types of placental acreta
acreta - villa attach to myometrium Increta - invade into myometrium percreta - invade through myometrium
29
Tx for post-partum haemorrhage
1 - mechanical stimulation of uterus, catheterise 2- IV oxytocin inf, ergometrine (unles Hx HTN), IM Carboprost (unless Hx asthma), sublingual misoprostol
30
Features for pre-eclampsia
HTN, proteinuria, headache, visual disturbances, papilloedema, hyperreflexia, reduced plt count
31
RFs for pre-eclampsia and management of risk
High risk factors - HTN in prev pregnancy, chronic HTN CKD, SLE/APS, DM Moderate RFs - first preg, age >40, BMI >35, FHx, twins If 1 or more High risk or 2+ mod risk - offer aspirin from 12 gestation
32
Third trimester - abdominal pain, N/V, headache, jaundice, hypogly
Acute fatty liver of pregnancy Inv - ALT raised Tx supportive car, once stabilise - deliver
33
Features in fetal alcohol syndrome
learning difficulties characteristic facies - smooth philtrum, thin vermilion, microcepthaly IUGR
34
Tx for PPROM
Admit 10/7 erythromycin Antenatal corticosteroids deliver at 34w
35
Which situations should Anti-D be given to Rh -ve mum
any delivery or termination miscarriage if gestation is > 12 weeks ectopic pregnancy (if managed surgically) external cephalic version antepartum haemorrhage amniocentesis, chorionic villus sampling, fetal blood sampling abdominal trauma NB babies should have cord blood taken for FBC, blood group and direct coombs Kleihauer test - measures the level of mixing
36
Tx for RA in preg
Symptoms tend to improve during preg - stop methotrexate 6 mo before conception Avoid leflunomide Sulfasalazine and hydroxychloroquine - safe to use Can use low dose corticosteroids NSAIDs can be used till 32w
37
Features of congenital rubella syndrome
deafness, cataracts, conge heart disease (PDA), growth retardation, hepatosplenomegaly, cerebral palsy NB - if infection = high risk if within first 8-10w, low risk if inf after 16w non-immune mothers should be offered MMR in post-natal period
38
RFs for cervical cancer
HPV 16,18 Smoking Many sexual partners, high parity COCP NB screening - 25-49yrs =3, 50-64 = 5yr
39
Delayed puberty with short stature
Turners Prader-willi Noonan
40
Delayed puberty with normal stature 4
PCOS, Androgen insensitivity Kallman Kleinfelters
41
RFs for ectopic preg
Damage to tubes (PID, surgery), Prev ectopic, endometriosis, IUCD, POP, IVF
42
Mx for ectopic
Expectantant, <35mm, asymptomatic, hcg <1000 Medical (Methotrexate) - < 35mm, no significant pain, hCG < 1500 Surgical (salpingectomy unless RF for infertility) - > 35mm, ruptured, pain, visible fetal heartbeat
43
RFs and Protective factors for endometrial cancer
RFs - excess oestrogen - nulliparity, early menarche, late menopause, unopposed HRT - obesity, DM, PCOS - Tamoxifen - HNPCC Protective -COCP, multiparty, smoking
44
Chronic pelvic pain, dysmenorrhoea that starts a few days before her period, pain on deep penetration (dyspareunia), occasional painful bowel movements
Endometriosis Ix - laproscopy Tx - NSAIDs and/or paracetamol, COCP/progestogens secondary - GnRH analogues, laparoscopic excision/ablation
45
Ts for menorrhagia (>80ml per menses)
IUS, COCP, long acting progestogens Mefanamic acid, tranexamic acid
46
Non hormonal tx for post-menopausal vasomotor symptoms
Fluoxetine, citalopram, venlefaxine
47
post-menopausal, abdominal bloating and pain, urinary symptoms, early satiety
Ovarian Ca (Ca 125) RFs - BRCA1/2, many ovulations (early menarche, late menopause, nulliparity)
48
Most common type ovarian cyst
Follicular cyst - from rupture of non-dom follicle commonly regress after several cycles
49
Most common benign ovarian tumour in women < 30
dermoid cyst (mature cystic teratoma) - sometimes has hair teeth etc often asymptomatic
50
Key points ; Corpus luteum cyst Mucinous cystadenomas
Corpus luteum cysts - can lead to intraperitoneal bleeding if they fill with blood or fluid and do not regress. Mucinous cystadenomas can grow large and may cause pseudomyxoma peritonei if ruptured.
51
Lower abdominal pain, deep dyspareunia, menstrual irregularities, discharge + excitation, fever Tx
PID most common cause = chlamydia, others = gonorrhoea Tx - check for pregnancy stat IM ceftriaxone + followed by 14 days of oral doxycycline + oral metronidazole
52
Unilateral dull abdominal ache, intermittent, worse during intercourse, urinary symptoms
Large ovarian cyst
53
Subfertility, obesity, oligomenorrhoea, hirsuitism and acne, acanthosis nigrans
PCOS Pelvic Uss - multiple cysts Bloods - raised LH:FSH ratio Check for impaired glucose tolerance Rotterdam Dx criteria: 2 of the following: infrequent ovulation, hyperandrogenism, and polycystic ovaries on ultrasound
54
Tx for PCOS
Subfertility - weight loss + clomifene COCP - cycle regulation, hirsutism and acne Anti-androgens (spiro, finasteride) may help with hirsutism/.acne if COCP ineffective Consider metformin in obese pts
55
Tx for prementrual syndrome
= emotional symptoms during luteal phase of the cycle COCP, SSRIs
56
Tx for urinary incontinence
Urge - bladder retraining 6w, oxybutinin (mirabegon in elderly) Stress - pelvic floor training 3 mo, surgical procedures/duloxetine
57
Mx fo uterine fibroids
If fibnroid is less than 3cm in size and not distorting the uterine cavity, - medical Tx (IUS, tranexamic acid, COCP) GnRH agonists - can be used for short period to shrink fibroid pre surgery (myomectomy)
58
Tx for candidiasis
Cottage cheese discharge, itchiness RFs = diabetes mellitus, antibiotic use, pregnancy, and immunosuppression Tx - oral fluconazole 150 mg or clotrimazole 500 mg intravaginally >4 episodes per year, consider induction-maintenance regime -Induction = oral fluconazole every 3 days for 3 doses, maintenance = weekly doses
59
Offensive yellow/green frothy discharge Vulvovaginitis pinpoint erythema on cervix
Trichonomax vaginalis Tx = metronidazole
60
Offensive grey discharge thin and fishy +ve whiff test
Bacterial vaginosis Tx PO metronidazole, or clindamycin
61
painless genital ulcer, 4 months later, painful defecation, lymphadenopathy discharge
Lymphogranuloma Venereum - STD caused by Chlamydia T Stage 1 - self limiting painless ulcer Stage 2 - lymphadenitis, proctocolitis, cervicitis

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