Gynae Flashcards by Jade Kiersten

If 1st repeat smear at 12 months is still HrHPV positive what do you do?

Repeat smear at 24 months (12 months later)

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What to do if sample is inadequate for smear

repeat at 3 months

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What to do if 2 consecutive smears are inadequate?

colposcopy

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What do you do if repeat smear at 24 months is still HrHPV positive?

colposcopy

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primary amenorrhoea and raised LH/FSH - what to consider

gonadal dysgenesis eg turners

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Widely spaced nipples and primary amenorrhoea

turners

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Most common identifiable cause of post coital bleeding

cervical ectropion

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Causes of post coital bleeding

ectropion
cervicitis
trauma
polyps
cervical cancer

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first line treatment urge incontinence

bladder retraining

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first line treatment stress incontinence

PFMT

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How long is bladder retraining for?

minimum 6 weeks

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treatment primary amenorrhoea

NSAIDs eg mefanamic acid
COCP 2nd line

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What should be done for all women with secondary dysmenorrhoea?

refer to gynae

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Commonest type of ovarian cyst

follicular

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cause of follicular ovarian cyst

non rupture of dominant follice or failure of atresia of non-dominant follicle

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dermoid cyst contains

can contain hair and teeth

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what % dermoid ovarian cyst bilateral

10-20

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HPV types most associated with cervical cancer

16,18 and 33

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HPV lined to genital warts

6 and 11

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what % of cervical cancer is SCC and adenocarcinoma

SCC - 80%
Adenocarcinoma - 20%

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features of cervical ca

may be picked up on smear
abnormal bleeding - postcoital, IMB, PMB
discharge

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risk factors cervical ca

HPV 16,18,33
smoking
HIV
Many sexual partners, early intercourse
high parity
COCP

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PFMT - what it involves

NICE recommends at least 8 contractions performed 3 times per day for minimum 3 months

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first line meds for urge incontinence

antimuscarinics

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antimuscarinic examples

oxybutynin, tolterodine, darifenacin

who to avoid IR oxybutynin in

frail old women

when does progesterone peak?

luteal phase

what part of menstrual cycle is secretory phase?

luteal

What does peak of LH coincide with?

ovulation

when does basal body temp rise in mentrual cycle?

following ovulation

how often cervical screening age 25-64

every 5 years

can women over 64 have smear test?

age range for cervical smear

25-64

cervical smear - when after pregnancy

3 months post partum usually

HIV and cervical screening

annual cervical cytology

stage of menstrual cycle best for smear

mid cycle

gold standard investigation for endometriosis

diagnostic laparoscopy

management of endometriosis

NSAIDs and paracetamol COCP or prostestogens surgery, GnRH analogues

most likely causative agent of thrush

candida albicans

risk factors thrush

diabetes pregnancy HIV steroids, antibiotics

features of thrush

cottage cheese discharge itch vulvitis erythema, fissuring, satellite lesion

investigation for thrush

not usually indicated if clinical features

1st line treatment for thrush

oral fluconazole single dose

what if oral fluconazole CI for thrush?

clotrimazole pessary

when are oral treatment contraindicated for thrush?

pregnancy

how many episodes for thrush to be recurrent?

4 or more per year

what to do if recurrent thrush

confirm with high vaginal swab check glucose exclude lichen sclerosus consider induction maintenance regime

what is induction maintenance regime for thrush

induction - oral fluconazole every 3 days for 3 doses maintenance - oral fluconazole weekly for 6 months

missed miscarriage

gestational sac containing dead fetus before 20 weeks without symptoms of explusion

threatened miscarriage

painless bleeding before 24 weeks closed cervical os

inevitable miscarriage

heavy bleeding cervical os open

is dilation and curettage a treatment for endometriosis?

can mirena be used for endometriosis?

yes

stage 1 ovarian ca

confined to ovary

stage 2 ovarian ca

outside ovary but within pelvis

stage 3 ovarian ca

outside pelvis but within abdomen

stage 4 ovarian ca

distant mets

risk factors ovarian ca

many ovulations BRCA

protective factors ovarian ca

COCP breastfeeding multipel pregnancies

investigations ovarian ca

ca125 USS

How to diagnose ovarian ca

diagnostic laparoscopy

investigation of choice for ectopic pregnancy

TV-USS

2 investigations for suspected ectopic pregnancy

TV-USS Bhcg

what is sheehans syndrome

hypopituarism caused by ischaemic necrosis due to blood loss and hypovolaemic shock

features of sheehans

agalactorrhoea amenorrhoea hypothyroid/jhypoadrenalism

investigations menorrhoagia

FBC routine TV-USS if indicated eg Post coital bleeding, pelvic pain

menorrhagia treatment - does not require contraception

mefanamic acid or tranexamic acid

when are mefanamic/tranexamic acid started for menorrhagia?

day 1

treatment for menorrhagia if requires contraception - 1st line

mirena

treatment for menorrhagia if requires contraception

mirena COCP Long acting progestogens

What med can be used short term for rapidly stop heavy menstrual bleeding?

norethisterone

LH and FHS in premature ovarian failure

raised

management of premature ovarian failure

HRT or COCP until 51yrs

3 categories of menopaise management

lifestyle HRT non hormonal

lifestyle modifications for menopause

exercise, weight loss, stress management, sleep hygiene

contraindications HRT

current or past breast ca oestrogen sensitive cancer undiagnosed vaginal bleeding untreated endometrial hyperplasia

if woman has uterus, what kind of HRT?

with progesterone - do not give unopposed oestrogen as risk of endometrial ca

HRT risks

VTE stroke heart disease breast ca ovarian ca

does transdermal HRt increase risk of VTE?

non hormonal treatment vasocmot symptoms menopause

fluoxetine, citalopram or venlafaxine

treatment for vaginal dryness menopause

lubricant or moisturiser

test to confirm menopause

FSH

organisms causing PID - most common

chlamydia

other organisms causing PID

neisseria gonorrhoea mycoplasma genitalium mycoplasma hominis

features PID

lower abdo pain fever deep dyspaerunia dysuria discharge cervical excitation

investigation PID

pregnancy test high vaginal swab screen chlamydia and gonorrhoea

first line treatment PID

im ceftriaxone and oral doxy and oral metronidazole for 14 days

alternative treatment PID

oral ofloxacin and oral metronidazole

complications PID

Fitz-hugh-curtis infertility chronic pelvic pain ectopic pregnancy

fitz-hugh curtis - what is it

perihepatitis RUQ pain

what medications may worsen stress incontinence

alpha blockers

risk factors endometrial ca

nulliparity early menarche and late menopause unoppossed oestrogen obesity, DM, PCOS tamoxifen HNPCC

protective factor endometrial ca

multiparity COCP smoking

classical presentation endometrial ca

PMB

first line investigation PMB

TV-USS hysteroscopy with biopsy

normal endometrial thickness

<4mm

treatment endometrial ca

surgery - TAH and BSO post op radiotherapy

Androgen insensitivity syndrome inheritance

x linked

chromosomes in Androgen insensitivity syndrome

46XY

complete Androgen insensitivity syndrome

normal female genitalia absent uterus and fallopian tubes primary amenorrhoea inguinal testes

partial Androgen insensitivity syndrome

variable genitalia reduced hair but not absent infertility

treating Androgen insensitivity syndrome

bilateral orchidectomy oestrogen therapy surgery

medication for stress incontinence

duloxetine

infertility in PCOS 1st line

clomifene

treatment for PCOS

weight reduction COCP clomifene

when is progesterone taken to confirm ovulation - how many days before period?

first line management for miscarriage

expectant

when are miscarriages best managed medically or surgically?

increase risk of haemorrhage previous trauma evidence of infection

what are factors for increase risk of haemorrhage - miscarriage

late first trimester coagulopathies

when to refer early for fertility - male

previous surgery on genitalia previous STI varicocoele systemic illness abnormal genitalia

when to refer early for fertility - female

over 35 amenorrhoea previous STI previous pelvic surgery abnormal genital exam

risk factor ectopic pregnancy

PID surgery previous ectopic IUD POP IVF

pelvic pain around ovulation with no PV bleeding

mittelschmerz

First line anti-emetic for N+V in pregnancy

cyclizine

Risk factors hyperemesis gravidarum?

twins trophoblastic disease nulliparity obesity FH or personal history

triad of hyperemesis gravidarum

5% pre pregnancy weight loss dehydration electrolyte imbalance

associations fibroids

afro-caribbean

features of fibroids

asymptomatic menorrhagia lower abdo pain and bloating urinary symptoms

diagnosis fibroids

TV-USS

Treatment to shrink fibroids

GnRH agonists myomectomy, hysterectomy

management of symptoms related to fibroids

LNG-IUS NSAIDs TXA COCP

hyperemesis gravidarum - max time use of metoclopramide and why

5 days EPSE

around 80% of vulval carcinomas are...

SCC

risk factor vulval ca

age HPV VIN immunosuppression lichen sclerosus

features vulval ca

lump or ulcer inguinal LN itching, irritation

need for contraception - how long over and under 50 years

over - 1 year under - 2 years

definition recurrent miscarriage

3 or more consecutive

causes recurrent miscarriage

antiphospholipid syndrome endocrine - DM, PCOS uterine abnormality smoking

Which is not a feature of OHSS? VTE, jaundice, ascites, oliguria, vomiting

jaundice

women with OAB not responding to medical treatment

botulinum toxin type A injection

What meds are CI for patients with myaesthenia gravis?

anticholinergic

5 criteria for expectant management ectopic pregnancy

<35mm no fetal heartbeat asymptomatic bhcg<1000 and declining unruptured

secondary amenorrhoea with low gonadotrophins indicates

hypothalmic cause

Amsels criteria used for

Amsels criteria

thine, white homogenous discharge clue cells pH >4.5 positive whiff test

strawberry cervix indicates

trichomonas vaginalis

treatment trichomonas vaginalis

oral metronidazole

treatment gonorrhoea

im ceftriaxone

2 anti-emetics first line for N+V in pregnancy

cyclizine promethazine

meigs syndrome

fibroma ovarian tumour ascites pleural effusion

management fo ectopic pregnancy if heartbeat

surgery

ectopic - salpingectomy vs salpingotomy

salpingotomy if risk factor for infertility

symptoms PMS

anxiety, stress, fatigue, mood swings bloating , breast pain

management of PMS

sleep, exercise, smoking, alcohol, small balanced meals COCP SSRI

SSRI how to take for PMS

continuously or days 15-28 (luteal phase)

40 year old female - after how long of trying to conceive to refer

6 months

Atrophic vaginits features

dryness dyspaerunia spotting

Atrophic vaginitis treatment

lubricants moisturisers topical oestrogen if others do not work

Gynae Flashcards

(148 cards)