zero to finals Flashcards
what can be used if there are contraindications to HRT
clonidine
what is an agonist of alpha 2 adrenergic receptors adn imidazoline receptors
clonidine
inidcations for HRT
premature ovarian insuffiency, vasomotor symptoms, low mood decreased. libido poor sleep joint pain, osteoporosis
best way to delvier oestrogen
patches
best way of providing progesterone
intrauterine device eg Mirena coil
should stop what 4 weeks before major surgery
oestrogen containing contraceptive or HRT
oestrogenic side effects
Nausea and bloating
Breast swelling
Breast tenderness
Headaches
Leg cramps
progestogenic side effects
Mood swings
Bloating
Fluid retention
Weight gain
Acne and greasy skin
what are the most common ovarian cyst
follicular cyst
when do folliculaar cysts tend to disappear
after a few menstrual cycles
corpus leteum cysts are often seen in
early pregnancy
dermoid cysts are particularly associated with
ovarian torsion
what increases the risk of ovarian cancer
the more ovulations
what is the tumour marker to remeber for ovarian cancer
ca- 125
cyst greater than – need referral to gynae
5cm
ovarian torsion may show
whirlpool sign, free fluid in pelvis and oedema of the ovary
the outer area of the cervix. visible on speculum exmantintion should eb
stratified squamous epithelium
vault prolapse is when
the top of the vagina descends into the vagina
antidepressant that can be given for stress incontinece
duloxetine
first line for urge inconcinence
bladder retraining
medication for urge incontince
anti cholinergics eg oxybutyin, tolterodine and solifenacin
alternative to anti cholinergics for urge incontince
Mirabegron
management for atrophic vaginitis
topical eostrogen
most common bacterial cause of barthoins abscess
e. coli
word catheter and marsupialisation are surgeries for
bartholins cyst
lichen sclerosis is thought to be what
autoimmune condition
mainstay of treatment for lichen sclerosus
topical steriods
upper vagina, cervixm uterus and fallopian tubes develop from the
paramesonephric ducts (mullerian ducts)
vaginal agenesis refers to an
absent vagina
in androgen insensitivity syndrome there are what instead of ovaries
testes
how does androgen insensitivity often present
infancy with inguinal hernia containing testes or at puberty with primary amenorrhoea
cervical cancer tends to peak in what age group
reproductive years
most common cause of cervical cancer
HPV
how does HPV promote the development of cnacer
it inhibits tumour supressor genes
how is CIN diagnosed
at colposcopy
smear sample looking for precancerous changes called
dyskaryosis
how often is smears in under 50
every 3 years
how often is smears in over 50
every 5
when do you get first smear
25
colposcopy if use acetic acid adn iodine solution
abnormal cells will turn white with the acid and with the iodine abnormal cells will not stain and healthy will stain a brown
usually management for CIN
LLETZ (large loop excision of the transformation zone) or cone biopsy
bavacizumab can be used for
metastatic or recurrent cervical cancer
current NHS vaccine for HPV is
Gardasil
HPV what causes cervical cancer
16 and 18
most endometrial cancers are what kind of cancers
ADENOCARCINOMAS!!!
KEY RF FOR ENDOMETRIAL CANCER ARE
OBESITY AND DIABETES
any woman presenting iwth postmenopausal bleeding has what until proven otherwise
endometrial cancer
endometrial hyperplasia may be trated with
progestogens eg Intrauterine Mirena or oral progestogen eg medroxyprogesterone or levonorgestrel
what appears to be protective against endometrial cancer in post menopasual woman by being anti oestrogenic
smoking
pipelle biopsy is highly sensitivie for
endometrial cancer
what may be used to slow the progression of endoemtrial cancer
progesterone
usual management for endometrial cancer
TAH and BSO - total abdominal hysterectomy with bilateral salpingo-oophorectomy
what cancer often presents late due to non specific symptoms and so has often already spread beyond the pelvis
ovarian
epithelial cell tumours are the most common ovarian cancer and out of these what is the most common
serous
krukenberg tumour refers to a metastasis in the ovary ususally from the
stomach
kruckenberg tumours have a characteristic
signet ring cells on histology
factors that reduce risk of ovarian caner
CCP, breastfeeding and pregnancy
ovarian mass may press on what nerve
obturator causing referred hip or groin pain
before referral for ovarian cancer what should you do
Ca125 blood test
most vulval cancer are
squamous cell carcinomas
around 5% of women with — get vulval cancer
lichen slerosus
vulvar cancers most frequently affects the
labia majora
is bacterial vaginosis sexually transmitted
no
what is the friendly bacteria in th vagina
lactobacilli
most common bacteria associated with bacterial vaginosis
gardnerella vaginalis
standard presenting feature of bacterial vaginosis is
fishy smelling dischage
bacterial vaginosis occurs with a pH greater than
4.5
clue cells on microscopy means
bacterial vaginossi
antibiotic of choice for treating bacterial vaginosis
Metronidazole
what to avoid if taking metronidazole
alcohol
thick white discharge that does not typically smell
candidiasis
warning if using antifungal cream or pessaries
they can damage latex condoms adn prevent spermicides working so alternative contraceptive is required for at least 5 days after use
what test are used to diagnose chlamydia
Nucleic acid amplification test (NAAT)
first line for chlaymdia is
doxycycline
what is doxycycline contraindicated in
pregancny and breastfeeding
what is a condition affecting the lymphoid tissue around the site of infectin with chlamydia
lymphogranuloma venerum
what infects mucous membranes with a columnar epithelium
gonorrhoea
yellow or green discharge
gonorrhoea
what is used to detect chlamydia and gonorrhoea
NAAT
NAAT can detect wether there is gonoccal infection or not but what is needed to see the specific bacterial and their antibiotic sensitivies
charcoal swab for microscopy
antiotic for gonorrhoea
IM ceftriaxone or oral ciprofloxacin
what is the parametrium
connective tissue around the uterus
what can exclude PID
abscence of pus cells
what is a complication of PID
Fitz hugh curtis syndrome
vaginal discharge frothy and yellow- green and may have a fish smell
trichomoniasis
strawberry cervix called colpitis macularis
trichomniasis
vaginal ph is also above 4.5 in
trichomoniasis and bacterial vaginosis
treatment for trichomoniasis
metronidazole
ulcers or blistering lesions affecting the genital area
genital herpes
what is used to treat genital herpes
aciclovir
what occurs whenn HIV is not treated
aids
what is HIV
RNA retrovirus
what HIV is the most common type
1
HIV destroys what cells
CD4 T helper cells
if someone with HIV takes a antibody test how long can it take before the test can become positive
45 days- unless you do a point of care test with the result showing in minites
usual starting regime for HIV
two NRTIs ( tenofovir plus emtricitabine) plus a third agent ( bictergravir)
what is given as prophylaxis to all HIV postivie patietns with a CD4 count under 200 to protect against peumocystis jirovecii pneumonia
co- trimoxazole
what is an infusion that can be given during. labour and delivery in those with HIV
IV Zidovudine
what does Trepnoema pallidum cause
syphilis
development of gummas in
tertiary syphillis
Condylomata lata (grey wart-like lesions around the genitals and anus)
secondary syphilis
argyll robertson pupil is a specific finding in
neurosyphilis
what is the standard treatment for syphilis
IM benzathine benzylpenicillin
what contraception should you avoid if got breast cancer
an hormonal contraceptions so go for copper coil or barrier methods
if got cervical or endmetrial cancer what contraception to avoid
intrauterine system ie Mirena
in wilsons disease you should avoid what contraception
copper coil
why should the progesterone injection be stopped before 50 years of age
risk of osteoporosis
how lo after is fertility said to return after giving birth
21 days after
lactational amenorrhoea is consideref effective for up to
6 months after birth
what contraception can be started at any time after birth
progesterone only pilll and implant
what contraception should be avoided if breastfeeding
combined contraceptive
what can be inserted either within 48hrs of birth or more than 4 weeks after birth but not inserted in between
copper coil or intrauterine system eg Mirena
what are the only method of contraception that protect against STIs
barrier methods
the COCP is licensed for use up to the age of
50
what is the primary mechanism of action of the COCP
preventing ovulation
Nice recommend using a pill with what first line
Levonorgestrel or norethisterone
what is first line for pre menstrual syndrome
Yasmin and other cocps containing drospirenone
dianette contains
cyproterone acetate
what is common in first 3 months of using COCP
unscheduleed bleeding
no additional contraception is needed if the pill is started up to day – of the menstrual cycle
5
when should you use extra contraception eg condoms for the first 7 days of consistne use of pill
if starting pill after day 5 of the menstrual cycle or switching from a progesterone only pill unless swithcing from deogestrel
missing a pill is when
been 48hrs since the last pill was taken
what to do if missed a pill
take the missed pill asap even if it means taking two pills on the same day
when need emergency contraception
if on day 1-7 of packet and forgotten to take pill
cocp should be stopped how long. before a major operation
4 weeks
how is the progesterone only pill taken
continously
absolute contraindication to progesterone only pill
active breast cancer
traditional progestene only pill cannot be delayed more than
3 hours
the desogestrel only pill (eg Cerazette) can be taken up to how many hours late
12
what progesterone only pill inhibits ovulation
desogestrel
if dont start progesterone only pill on day 1-5 of menstrual cycle what needs to be done
pregnancy needs to be excluded and additional contraception is required for 48hrs
additional contraception is required if start after day 5 on menstrual cycle. how long is additional contraception required for for cocp and progesterone only
COCP- 7 days
progesterone only - 48hrs
progesterone only injection is also known as
depot medroxyprogesterone acetate (DMPA)
how often is DMPA given
every 12/13 weeks
after stopping the progesterone injection how long may it take for fertility to return
12 months
Depo -provera is the IM injection and what si the subcutaenous injection device that can be self injected by the patient (progesterone injections)
sayana press
what contraception can cause osteoporosis
DMPA
if start progesterone injections after day 5 hw many days of extra contraception is needed
7
2 side effects that are unique to progesterone injections are
weight gain and osteoporosis
progesterone only implant lasts for how long
3 years
what is the progesterone implant used in the UK
Nexplanon
inserting the progesterone implant after day 5 of menstrual cycle requires how many days of extra contraception
7
what is a form of long acting reversible contraception
coils
what are the intrauterine devices
copper coil and levonorgestrel intrauterine system
levonorgestrel intrauterine system contains what that is slowly released into the uterus
progesterone
PID is a contraindication for what contraception
coils
what is done in those under 25 before coil inserted
screening for chlamydia and gonorrhoea
before the coil is removed women need to do what for 7 days prior
abstain from sex or use condoms
contraception contraindicated in wilsons
copper coil
copper coil can be used as emergency contraception if inserted up to how many days after an episode of unprotected intercourse
5
when should copper coils be inserted
It can be inserted at any time in the menstrual cycle and is effective immediately
copper coil is liccensed for how long after insertion
5-10
Levonorgestrel intrauterine system , most are licensed for 5 excpet what is licensed for 3
Jaydess
when is the mirena coil only licensed for 4 years
if on hrt
the LNG - IUS can be inserted
can be inserted up to day 7 of the menstrual cycle without any need for additional contraception. If it is inserted after day 7, pregnancy needs to be reasonably excluded, and extra protection (i.e. condoms) is required for 7 days.
coil that can be used for heavy menstrual bleeding and endometrial protection for women on hrt
mirena
what are often discovered incidentally during smear tests in women with an intrauterine device (coil)
actinomyces- like organisms
what are the 3 options for emergency contraception
Levonogestrel - 72hrs
Ulipristal -120hrs
copper coil- 5 days
what is the most effective emergency contraception
copper coil
what is the thing with oral emergency contraception
the sooner it is taken the more effective it is
when does ovulation occur
14 days before the end of the cycle
what does levonorgestrel work by doing
preventing or delaying ovulation
N+V is common side effect from levonorgestrel but what should be done if vomitting occurs within 3 hours of taking the pill
dose should be repeated
ulipristal acetete is a
selective progesterone receptor modulator
brand name of uliprstal
ella one
how long after taking levonorgestrel or ulispristal can the combined or profesterone only pill be started
levo- immediately but extra contraception for 7 days if cocp or 2 days if progesterone only
uli- wait 5 dyas and then 7 for cocp and 2 for progesterone only
female sterilisation procedure is called
tubal occlusion
male sterilisation procedure is called
vasectomy
what is the most accurate marker of ovarian reseve
anti mullerian hormone
what is a scan to assess the shape of the uterus and the patency of the fallopian tube s
Hystersalpingogram
drug that can stimulate ovulation
clomifene
what is intra uterine insemination
involves collecting and separating out high-quality sperm, then injecting them directly into the uterus to give them the best chance of success
what is intracytoplasmic sperm injectin
involves injecting sperm directly into the cytoplasm of an egg.
ectopic pregnancy typically presents around how many weeks gestation
6-8
what needs to happen to all ectopic pregnancies
need to be terminated
what is medical management for an ectopic
methotrexate
after woman has methotrxate for ectopic how long should they not get pregnant for
3 months
first line for ectopic pregnancy
laparascopic salpingectomy
time limit between early and late miscarriage
12 weeks
medical management for a miscarriage after 6 weeks
misoprostol
misoprostol is an
prostaglandin analogue
surgical management for a miscarriage
vacuum aspiration
a cause for recurrent miscarriage
anti phospholipid syndrome
management for anti phospholipid syndrome and miscarriage
low dose aspirin or LMWH
abortion can be done up to
24 weeks if gretaer risk to mother
mifepristone is what kind of drug
anti- progestogen
what drug is given first for abortion
mifepristone then misoprostol 1-2 days after
other criteria for hypemesis gavidarum
More than 5 % weight loss compared with before pregnancy
Dehydration
Electrolyte imbalance
how is a hydatidiform mole like a pregnancy
it grows inside the uterus but is a tumour
complete mole
A complete mole occurs when two sperm cells fertilise an ovum that contains no genetic material (an “empty ovum”)
partial mole
two sperm cells fertilise a normal ovum (containing genetic material) at the same time. now has 3 sets of choromosomes
in what kind of mole may fetal material form
partial
can the moles metastasise
yes
manageement of moles in preg
evacuation of the uterus to remove the mole
