PLAB 1 August 2024 > OBS & GYN > Flashcards

OBS & GYN Flashcards

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1
Q

Define pathological amenorrhea.

A

Failure to menstruate for at least 6 months.

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2
Q

Classification of amenorrhea?

A

◉ Primary amenorrhea:
◆ Lack of menstruation before the age of 15;
◆ Lack of menstruation before the age of 13 (without breast developments).

◉ Secondary amenorrhea
◆ Cessation of menstrual cycles following the appearance of it.

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3
Q

Causes of amenorrhea?

A

◉ Pregnancy

◉ Hypothalamic
* Most common
* Low BMI
* Excessive exercise
* Low GnRH ⟶ ⬇︎FSH and ⬇︎ LH ⟶ ⬇︎ oestrogen

◉ Polycystic ovarian syndrome

◉ Hyperprolactinaemia
* Pituitary tumors
* Antipsychotic agents
* Hypothyroidism

◉ Premature ovarian failure
* ⬆︎FSH levels

◉ Anatomical problems
* Usually results in primary amenorrhea
* Imperforated hymen
* Mullerian agenesis
* Asherman syndrome

◉ Thyroid problems

◉ Post-pill amenorrhea
* > 6 months amenorrhea after stopping the combined oral contraceptives
* Low-normal levels of oestrogen, FSH, LH
* Mildly raised prolactin

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4
Q

Anaemia of pregnancy

A

◉ First trimester
◆ < 110 g/L

◉ Second trimester
◆ < 105 g/L

◉ Third trimester
◆ < 100 g/L

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5
Q

What is the management of anaemia of pregnancy?

A

Ferrous sulphate.

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6
Q

What are the sympotms (presentation) of antiphospholipid syndrome?

A
  • ≥ 3 unexplained consecutive miscarriages before 10 weeks gestation (1st trimester)
  • ≥ 1 second trimester miscarriages
  • Vascular thrombosis (arterial or venous)
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7
Q

What is the investigation in antiphospholipid syndrome?

A
  • Lupus anticoagulant
  • Anticardiolipin antibody
  • Anti-b₂-gylcoprotein I antibody
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8
Q

Rx of antiphospholipid syndrome?

A
  • Low dose AAS (75 mg)
  • Heparin
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9
Q

What is the cause of Bacterial Vaginosis?

A

◆ Gardnerella vaginalis

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10
Q

Symptoms of Bacterial Vaginosis

A
  • (Homogenous) grey-white discharge
  • Thin and profuse discharge
  • Fishy smell (when KOH added)
  • ⬇︎PH (>4.5)
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11
Q

Rx of Bacterial Vaginosis

A
  • Metronidazole
  • Clindamicine
    ➔ May resolve spontaneously
    ➔ High recurrence rate
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12
Q

OBS & GYN

What are the main risks for cervical cancer?

A

◆ HPV (Human papillomavirus) (HPV 16, 18, 31 and 33).
- Multiple sexual partners
- Smoking
- Immunossupression
- Combined oral contraceptives pills (they don’t wear condoms)

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13
Q

Management of pathological CTG

A

◉ Conservative management
◆ Most initial / appropriate:Change mothers position
◆ Start intravenous fluids

◉ Expedite delivery

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14
Q

Describe the presentation of ectropion

A

➔ The ectocervix (the vaginal part of the cervix) is lined by stratified squamous epithelium.

➔ The endocervix (the bit inside the uterus) is lined with columnar epithelium

➔ The columnar epithelium (marches over) migrates to the outside covering the ectocervix.

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15
Q

What is the cause of ectropion?

A

⬆︎ leves of oestrogen
- Pregnancy
- COCP
- Ovulation phase in young women

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16
Q

Sympotms of ectropion

A
  • Ussually asymptomatic
  • Post-coital bleeding
  • Non purulent discharge
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17
Q

Rx of ectropion

A

If not bleeding, no therapy
* Stop COCP
- Silver nitrate (ablation)
* Cryotherapy
* Diathermy (ablation)

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18
Q

What organisms cause cervicites?

A
  • Chlamydia
  • Neisseria gonorrhoeae
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19
Q

Symptoms of cervicites

A
  • Usually asymptomatic
  • Vaginal discharge
  • Lower abdominal pain
  • Intermenstrual bleeding
  • Post coital bleeding
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20
Q

Regarding the following test:
Vulvovaginal swab for Nucleic Acid Amplification Test (NAAT)

When is this test performed (to diagnose what conditions)?

A
  • Chlamydia
  • Gonorrhoea
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21
Q

How is the diagnosis of cervicites made?

A

Step 1
- Vulvovaginal swab NAAT

—> If positive for gonorrhoea then step 2:

Step 2
- “Endocervical swab” & ‘high vaginal swab’ for culture

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22
Q

What is the investigation done in Ectropion?

A
  • Colposcopy: red ring around the cervical os.
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23
Q

What is the organism that causes chickenpox?

A

Varicela zoster virus.

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24
Q

Describe the (infectious) risk period for neonatal varicella.

A

If the mother develops chickenpox:
- 7 days before given birth
- 7 days after given birth

—> IVIG given to neonate.

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25
What is the `treatment` for **neonatal varicella**?
IVIG.
26
What is the **time period risk** of infection for *Fetal Varicella Zoster*?
Before 20 weeks gestation.
27
What are the **(fetal) symptoms** for `fetal varicella zoster`?
- Skin scarring - Microphtalmia (eye defects) - Limb hypoplasia - Microcephaly - Learning disabilities
28
What is the `investigation` in **Bacterial Vaginosis**
`Microscopy:` - Positive whiff test - **Clue cells positive**
29
# `In a pregnant patient` What is the *management* for `chickenpox` **WITHOUT RASH** development?
**STEP 1** - Check if exposure was within the exposure period. - If yes, then proceed to step 2. **STEP 2** - If patient is immunocompetent: * Check for past history of varicella * If past history is positive, then varicella IgG serology **is not required**. - If patient is immunocompromised: * Varicella IgG serology REGARDLESS of past hx of varicella. **STEP 3** - If patient doesn’t have varicella IgG antibodies: Aciclovir FROM DAY 7 after exposure (not before).
30
What is the `exposure period` for **chicken pox**?
- 2 days before the rash develops - To 5 days after the rash appeared or until vesicles dried and crusted.
31
# In a pregnant patient What is the *management* for `chickenpox` **WITH RASH** development?
Aciclovir
32
Describe what is **chorioamnionitis**.
Infection caused after rupture of the membranes (prolonged) —> ascending of vaginal bacteria —> infection of the chorion and amnion membranes of fetus.
33
What are the **risk factors** for `chorioamnionitis`
- Prolonged labour - Internal/Invasive monitor of labour - Multiple vaginal exams - Amniotic fluid with meconium
34
Symptoms of **chorioamnionitis**
- Fever - Tachycardia - Abdominal pain - Uterine tenderness - Fetal distress - Foul smelling amniotic fluid
35
Management of **chorioamnionitis**
IV antibiotics
36
What is the **cause** of `Trichomoniasis`?
Trichomonas vaginalis.
37
What are the **symptoms** of `trichomoniasis`?
* Frothy yellow - green discharge * Smelly odour * Itching * Strawberry cervix * Motile organisms
38
Rx of `trichomoniasis`
Metronidazole.
39
What is the `cause` of **candidiasis** (vulvovaginal)?
Candida albicans.
40
What are the **symptoms** of `genital candidiasis`?
* White cheese like discharge * No smell (odourless) * Itching
41
What is the **Rx** of `candidiasis`?
Clotrimazole.
42
What is the **reccomended contraception** for `menorrhagia` in a *young woman* **NOT sexually active**?
IUS
43
What is the **reccomended contraception** for `dysmenorrhoea`?
**NSAID's:** * Mefenamic acid.
44
# `Sexually active women` What is the reccomended **contraception** for `menorrhagia, dysmenorrhoea, fibroids` (not distorting the uterine cavity)?
► IUS mirena (levonorgestrel IUS). **< 20 YO** * COCP * POP * Implant **Woman with sickle cell disease** * Depo-provera IM
45
What is the reccomended **emergency contraception**?
**Within 72h** * Levonelle pill **Within 120h** * IUD * Ellaone pill
46
Which contraception has the `lowest pearl index`?
Etonegestrel implant (Nexplanon).
47
What is the **absolute contraindication** of COCP?
Migraine with aura.
48
# `Short term and easy reversible` What is the recommended **post-partum contraception**?
► POP (progesterone only pill) * To be given at 6 week post birth.
49
Describe the **STEP BY STEP** **management** for `menorrhagia`.
**First line:** * Levonorgestrel-releasing intrauterine system (MIRENA) **Second line:** * Tranexamic acid *`OR`* * NSAIDS *`OR`* * COCP **Third line** * Norethisterone *`OR`* * Injected long acting progestogens ➔ **When to pick `endometrial ablation`** * Family completed * Low hemoglobin
50
What are the **symptoms** of `acute fatty liver of pregnancy`?
➔ **Same as HELLP syndrome** **`Except:`** * No haemolysis * Ammonia * Hypoglycaemia
51
What is the **management** of `eclampsia`?
► `MgSO4` **Loading dose** * 4-6g IV + 100ml normal saline (5-15min). **Maintenance** * 1g infusion per hour over 24h **Recurrence seizures** * Bolus of 2-4g ► `Delivery at the earliest`
52
Describe `MgSO4 toxicity`
⬆︎ **MgSO4 plasma [.]** * Decreased urinary output * QRS widening * QT interval prolongation **10 mEq/L** * Loss of deep tendon reflexes **15 mEq/L** * Atrioventricular block * Respiratory arrest **25 mEq/L** * Cardiac arrest
53
# Obs & Gyn What is the **therapeutic range** for magnesium sulfate?
4 - 8 mEq/L.
54
# Obs & Gyn Management of MgSO4 toxicity?
* Stop MgSO4 infusion * Calcium gluconate 1g over 10 min.
55
**Symptoms** of `ectopic pregnancy`?
* Lower abdominal pain * Vaginal bleeding * Amenorrhoea (6-8weeks) * Shoulder tip pain (due to peritoneal bleeding) ## Footnote Located usually on the fallopian tubes.
56
What are the **risk factors** for `ectopic pregnancy`?
* `Pelvic inflammatory disease` * Previous ectopic * Endometriosis * Previous tubal surgery * Assisted reproductive treatments
57
What is the **management** of `ectopic pregnancy`?
**Medical management:** ➔ `Methotrexate` * Haemodynamically stable * No significant pain * Fetal mass < 35mm with no heartbeat * Serum hCG < 5000 IU/L **Surgical management:** ➔ `Laparatomy` * Haemodynamically unstable * Pain * Ruptured ectopic * Visible heartbeat * Cannot come for a follow up ## Footnote ➔ `Laparascopy`: if haemodynamically STABLE.
58
Symptoms of **endometrial cancer**
* Post menopausal bleeding
59
**Risk factors** of endometrial cancer
* Nulliparity * Early menarche * Late menopause * Obesity * PCOS * Tamoxifen (antiestrogen used in breast cancer) * Unopposed oestrogen (HRT, adding progestogen ⬇︎ the risk)
60
What is the **investigation** done in `endometrial cancer`?
**First line** * Transvaginal ultrasound * Endometrium > 4 mm thickness (proceed to following step) **Definitive diagnosis** * Hysteroscopy with endometrial biopsy
61
Describe what is endometriosis.
Endometrial tissue outside the uterine cavity.
62
Symptoms of `endometriosis`
* Chronic pelvic pain * Dysmenorrhoea * Deep dyspareunia * Infertility
63
What is the **investigation** done in `endometriosis` (ENDOMETRIAL TISSUE OUTSIDE THE UTERUS)?
**Gold standard** - Laparascopy (diagnosis and treatment ablation) ➔ Transvaginal ultrasound often normal
64
**Causes** of female infertility?
- Tubal damage due to PID. - Ovulation failure. - Unexplained.
65
What is the investigation done in female infertility?
**1. Mid-luteal progesterone** - Taken 7 days prior to expected menstruation date - Day 21 on a 28 day cycle. **2. FSH** **3. LH** **4. Hysterosalpingogram (HSG)** **5. Laparoscopy (tubal patency)**
66
Differential diagnosis of female infertility.
**PCOS** - FSH: normal - LH: high - Oestradiol: normal to mild elevation - Prolactin: normal to mild elevation **Premature ovarian failure** - FSH: high - LH: high - Oestradiol: low - Prolactin: normal **Prolactinoma** - FSH: decreased - LH: decreased - Oestradiol: decreased - Prolactin: very high **Sheehan’s syndrome** - FSH: low - LH: low - Oestradiol: low - Prolactin: low **Turner syndrome** - FSH: high - LH: high - Oestradiol: very low - Prolactin: normal
67
Describe the different fibroid locations.
**Submucosal fibroids** - Beneath the endometrium, bulges into the uterine cavity. **Intramural fibroids** - Most common - Within the uterine wall **Subserosal fibroids** - Outside of the uterus wall
68
What is the management of asymptomatic fibroids?
- Annual follow up to monitor size. - If rapid growth or suspected malignancy investigate
69
What is the management of **fibroids** with `menorrhagia`?
**First line:** * MIRENA (if no uterine distortion) **Second line:** * Tranexamic acid *`OR`* * NSAIDS *`OR`* * COCP **Third line** * Norethisterone *`OR`* * Injected long acting progesterones
70
What is the management of **fibroids** with `SEVERE menorrhagia`?
Ulipristal acetate.
71
What is the **SURGICAL** management of **fibroids** with `menorrhagia`?
* Hysterectomy * Myomectomy * Uterine artery embolization * Endometrial ablation (fibroids < 3cm)
72
Describe the time period for cervical screening | `Testing for cytology and HPV`
**25 - 49 yo:** - Every 3 years **50 - 64:** - Every 5 years
73
Describe the time period for **breast screening**.
**50 - 70 YO** Every 3 years.
74
Describe the **cervical screening** `step by step`. | **`HR-HPV`**
**Step 1 `HR-HPV test`:** `- If negative:` ◆ Routine recall (25-49 every 3 years, 50-64 every 5 years). `- If positive:` ◆ Cytology triage **Step 2 HR-HPV + ➜ `Cytology triage`:** `- If cytology normal:` ◆ Re-test HR-HPV in 12 months. `- If cytology abnormal:` ◆ Colposcopy referral
75
What is the *step by step management* of `genital herpes` on a **pregnant woman** on the `1st and 2nd trimester`?
**1st episode of genital herpes:** - Aciclovir 400 mg 3x/day for 5 days; - From the 36th week: aciclovir 400 mg 3x/day until birth; - C-section birth. **Recurrent genital herpes:** - Risk of neonatal herpes is low for vaginal birth. - From the 36th week: aciclovir 400 mg 3x/day until birth.
76
What is the *step by step management* of `genital herpes` on a **pregnant woman** on the `3rd trimester`?
**1st episode of genital herpes:** - Aciclovir 400 mg 3x/day `until birth`; - C-section birth. **Recurrent genital herpes:** - Risk of neonatal herpes is low for vaginal birth. - From the 36th week: aciclovir 400 mg 3x/day until birth.
77
What is the **screening time** for `gestational diabetes`?
24 - 28 weeks.
78
How is the **diagnosis** of `gestational diabetes` done?
**Oral glucose tolerance test:** `Fasting:` ≥ 5.6 mmol/L `2h glucose level:` ≥ 7.8 mmol/L
79
How is the **treatment** of `gestational diabetes` done?
**Fasting glucose < 7mmol/L:** - Diet and exercise; - Monitor glucose at home 4x/day (fasting and 1h post meals); - Offer metformin if glucose ⬆︎ after 1-2 weeks. **Fasting glucose ≥ 7mmol/L:** - Insulin (with or w/out metformin) - Diet and exercise. ## Footnote **NO WEIGHT LOSS!**
80
What are the **symptoms** of `molar pregnancy`?
- Hyperemesis (due to ⬆︎ hCG); - Painless 1st trimester vaginal bleeding; - Uterus large for date.
81
What are the **investigations** in `molar pregnancy`?
- **βhCG:** ⬆︎⬆︎ - **USS**: snowstorm/grapes - Large theca lutein cysts
82
What is the **management** of `molar pregnancy`?
- Suction curettage; - Monitor urine and serum hCG twice a week until normal values. - Chemo if choriocarcinoma or ⬆︎⬆︎ βhCG even after uterive evacuation.
83
When can a woman conceive again after molar pregnancy?
**6 months:** - after normalisation of hCG. **12 months:** - after completing chemo | Contraception: oral or barrier.
84
What are the `indications` for the use `HRT`?
**After menopause:** - Hot flashes - Night sweats - Mood and sleep disturbances - Headaches **Early menopause:** - HRT until 51 years of age - Prevents osteoporosis - Cardio protective
85
What are the **risks** associated with `HRT`?
- Breast cancer - Endometrial cancer (if not given progestogen) - Ovarian cancer - Thromboembolism - Stroke
86
Which is the **safest HRT** on a patient with: - Migraines - Risk of clots - Risk of stroke - Smoker
Transdermal HRT.
87
# Systemic HRT When to use `Oestrogen-only` **HRT**?
- Hysterectomy - IUS | No need for progestone to protect the endometrial lining.
88
In what situations is advisable to take `combined` **HRT**? | **`Both oestrogen and progestorone.`**
- Intact womb. - To prevent against endometrial cancer.
89
# Combined HRT When to use `sequential/cyclical` **HRT**?
- Early menopause - Still bleeding - First 14 days oestrogen only - Later 14 days oestrogen & progestorone.
90
# Combined HRT When to use `continuous` **HRT**?
- Menopausal women for > 12 months - Continuous oestrogen & progestorone
91
What is the **investigation** done in `hyperemesis gravidarum`?
- Electrolytes - Ketonuria
92
What is the **treatment** of `hyperemesis gravidarum`?
- Normal saline + K⁺ **1st line antiemetics:** - Cyclizine - Prochlorperazine - Promethazine - Chlorpromazine - Doxylamine with pyridoxine **2nd line antiemetics:** - Metoclopramide - Ondaserton - Domperidone **3rd line antiemetics:** - Corticosteroids `Other medications:` - Thiamine (wernick encephalophathy) - LMWH
93
Symptoms of intrahepatic cholestasis of pregnancy.
- Pruritus 2nd and 3rd trimester, worse at night (w/out rash) - Bile acid ≥ 19 micromols
94
Investigation in intrahepatic cholestasis of pregnancy
- Bile acids > 19 - LFT's.
95
Rx of constipation in pregnancy.
- Isphagula (small hard stools) - Lactulose (when stools remain hard) - Senna (stools soft but difficult to pass)
96
# Obs & Gyn Management of stress incontinence
- Pelvic floor exercise - Surgical tape procedure - Duloxetine (non surgical candidates)
97
# Obs & Gyn Management of urge incontinence
- Bladder retraining (increase time in between need to void); - Anti-muscarinic agents (oxybutin, tolterodine)
98
Define threatened miscarriage.
- Vaginal bleeding - Fetal heart present - Cervical os closed - Little to no pain.
99
Define missed miscarriage.
- Fetus is dead but retained; - Cervical os is closed.
100
Define inevitable miscarriage.
- Heavy bleeding and clots; - Cervical os is opened.
101
Define incomplete miscarriage.
- Not all conception products have been expelled.
102
Define complete miscarriage.
- Heavy bleeding and clots; - Complete expulsion of all products of conception; - USS: empty uterine cavity.
103
What are the **rules** for `missed COCP` pills?
◉ **1 pill is missed:** - Take the pill ASAP even if 2 pills are taken on the same day; - Continue with the rest of the pack as usual; - No additional contraception needed. ◉ **2 pills missed:** - Take the pill ASAP even if 2 pills are taken on the same day; - Continue with the rest of the pack as usual; - `No UPSI until COCP have been taken for 7 days in a row.` ► **When were the pills missed?** ◆ `Pill free week:` emrgency contraception if UPSI. ◆ `Week 1:` emergency contraception if UPSI. ◆ `Week 2:` No need for emergency contraception. ◆ `Week 3:` No need for emergency contraception + omit free pill week.
104
What are the **rules** for `missed POP` pills?
◉ **Traditional POP's:** ➜ `> 3h late (> 27h since last pill):` - Take the missed pill ASAP - Continue with the pack **AT THE USUAL TIME**. - No UPSI on the next 48h. - If UPSI occurred after missed pill ⟶ emergency contraception. ◉ **Cerazette (desogestrel):** ➜ `> 12h late (>36h from last pill):` - Take the missed pill ASAP - Continue with the pack **AT THE USUAL TIME**. - No UPSI on the next 48h. - If UPSI occurred after missed pill ⟶ emergency contraception.
105
What is the dose of **folic acid** taken in `pregnancy` and for how long? | For all women.
- 400 mcg/day for the first 12 gestational weeks.
106
In **which conditions** is acid folic `increased` (in pregnant women)? What is the **dose**?
**Dose:** - 5 mg daily for the first 12 gestational weeks. **Conditions:** - *BMI > 30* - *DM* - *On antiepileptic medication* - Previous pregnancy with neural tube defect - Family hx of neural tube defect - Personal hx of neural tube defect ## Footnote 1st three condition more important.
107
In **which conditions** is acid folic `taken throrought the pregnancy`? What is the **dose**?
- Sickle cell disease - Thalassemia - Thalassemia trait ➜ 5mg/daily for the entire gestation.
108
How is **ultrasound diagnosis** of `miscarriage` done?
**Crown to rump lenght `miscarriage`:** - ≥ 7 mm - No heartbeat **Gestational sac:** - ≥ 25 mm - No fetal pole
109
What are the **contraception methods** influenced by `hepatic enzyme inducers`?
- COCP - POP - Implants
110
What are the **contraception methods** `SAFE` when taken with `hepatic enzyme inducers`?
- Mirena - Copper IUD - Depo-provera injections
111
What are the `hepatic enzyme inducers drugs`?
**CRAP GPs** - **C**arbamazepine - **R**imfapicine - **A**lcohol (chronic) - **P**henytoin - **G**riseofulvin - **P**henorbabitone - **S**ulfonylureas
112
Risk factors for ovarian cancer?
- ⬆︎ age - Gene mutation BRCA1 and BRCA2 - Family hx - Nulliparity - Obesity - Smoking
113
Protective factors against ovarian cancer.
- COCP - Pregnancy
114
**Symptoms** of `ovarian cancer`?
➔ **Patient > 50 YO** - Vague abdominal symptoms - Abdominal distension - Bloating - Early satiety - Loss of apetite - Pelvic pain
115
What is the step by step **management** of `ovarian cancer`?
**1st step:** - Abdominal examination **2nd step:** `➜ Normal abdominal examination:` - Test CA-125 - If CA-125 ≥ 35UI/ml **`⟶`** urgent abdominal and pelvis USS - If USS abnormal **`⟶`** GYN urgent referral. `➜ Abnormal abdominal examination` - Ascites, pelvic, abdominal mass. - GYN urgent referral.
116
What is the cause of PID?
- Chlamydia - Neisseria gonorrhea
117
Risk factors for PID
- < 25 YO - New / multiple sexual partners - Previous STI's - IUD's - Uterine instrumentation
118
Symptoms of PID?
- Lower abdominal pain - Dyspareunia - Vaginal bleeding - Purulent vaginal / cervical discharge - Fever - Cervical motion tenderness
119
Rx of PID?
**Outpatient** `Option A` - Single dose of 1g of ceftriaxone IM / 500 mg ceftriaxone IM **+** - Oral doxycycline 100 mg / twice a day for 14 days **+** - Metronidazole 400 mg / twice a day for 14 days `Option B` - Oral metronidazole **+** oral ofloxacin for 14 days. **Inpatient:** `Option A` - Ceftriaxone IV +Doxycycline IV + Oral metronidazole `Option B` - IV metronidazole + IV ofloxacin
120
What is placenta abruption?
- Premature separation of the placenta before birth; - Bleeding can be concealed (behind the placenta); - Bleeding can be through the cervix.
121
What are the `risk factors` for **placenta abruption**?
- Pre-eclampsia - Multiparity - Trauma - Cocaine - Smoking
122
What is the `management` for **placenta abruption**?
- Fluid resuscitation - Blood transfusion - C-section and delivery
123
Describe what is placenta praevia?
When the placenta lies in the lower uterine segment (entirely or partially).
124
What are the `symptoms` for **placenta praevia**?
- Painless vaginal bleeding - Abnormal fetal lie
125
What is the `management` for **placenta praevia**?
- Continuous monitoring - C-section
126
What is the `investigation` done in **placenta praevia**?
- Speculum exam - Transvaginal USS. | **Digital cervical exam `NOT DONE!!`**
127
DDx of antenatal haemorrhage.
**Placenta praevia:** - CTG no fetal distress; - Painless bleeding - Blood is from maternal circulation **Placenta abruption:** - CTG with fetal distress - `Painful` bleeding (might be absent if concealed). **Vasa praevia:** - CTG with fetal distress (fetoplacental circulation) - Painless bleeding
128
What are the **symptoms** of `PCOS`?
- Oligoamenorrhea - Subfertility - Hirsutism - Acne - Obesity - Hyperglicemia - Acanthosis nigricans - Alopecia
129
What **investigation** is done in `PCOS`?
- ⬆︎LH:FSH - ⬆︎ Testosterone - USS: Multiple cysts in the ovaries or ↑ ovarian volume.
130
What is the **management** of `PCOS`? - Fertility improvement - Fertility/Pregnancy - Regular periods - Hyperglycaemia - Last line
- **Fertility improvement:** weight loss - **Fertility:** Clomifen - **For regular periods:** COCP - **Hyperglycaemia:** Metformin - **Last line:** laparascopic ovarion drilling
131
When can COCP be used postpartum?
**Not breastfeeding:** ≥ 6 weeks **Breastfeeding:** ≥ 6 months | < 6 weeks: risk of clots. >6 and < 6 months: ⬇︎ breast milk.
132
# **Postpartum contraception** Woman who is not breastfeeding. | When should contraception be initiated?
- 3 weeks (21 days). - `NOT COCP` (> 6 weeks only). | < 6 weeks: risk of clots.
133
# **Postpartum contraception** When can IUS/IUD be inserted after birth?
- Within 48h postpartum OR - After 28 days postpartum | Risk of uterine perforation.
134
What ACEi antihypertensives are safe postpartum?
- Enalapril.
135
# **Post-pill amenorrhea** After how long should the patient **wait before investigations can be done**?
6 months.
136
What investigations are done in **post-pill amenorrhea**?
- **FSH:** normal - **LH:** Normal - **Oestrogen:** normal - **Thyroid function:** normal - **Prolactin:** slightly elevated
137
What is the treatment of **post-pill amenorrhea**?
- Reassurance - Clomiphene *(to induce ovulation if wanting to get pregnant)*.
138
How is the **diagnosis** of `pre-eclampsia` made?
➜ Hypertension ➜ ≥ 20 weeks gestation ➜ And/or one of the following: ► **Protein:Creatinine ratio:** - PCR ≥ 30 mg/mmol ► **Albumin:Creatinine ratio:** - ACR ≥ 8 mg/mmol ► **24h urine protein:** - ≥ 0.3 g/24h
139
Management of pre-eclampsia?
**First line:** - Labetalol oral - Hydralazine (IV) - Nifedipine or methyldopa ► MgSO₄ ► Delivery
140
Define premature ovarian syndrome.
- Onset of menopausal symptoms; - ↑ gonadotropin - `< 40 years`.
141
**Investigation** done in `premature ovarian failure`?
-⬆︎ FSH: >25 IU/L (Taken 4 weeks apart) - ⬇︎ Oestradiol
142
**Management** of `premature ovarian failure`?
HRT until 51 years of age.
143
Describe the different menopause terms.
**Premature menopause:** - 12 months of amenorrhoea - < 40 years **Early menopause:** - 12 months of amenorrhoea - 40 - 45 YO **Menopause:** - 12 months of amenorrhoea - > 45 YO **Perimenopause:** - Symptoms of menopause - < 12 months of amenorrhoea
144
When does PMS happen?
- Luteal phase (after ovulation and before menstruation).
145
Management of PMS?
COCP.
146
Management of ⬇︎ fetal movements.
`> 28 weeks gestation + mother sure of ⬇︎ fetal movements` **First step:** - Fetal hand-held dopller ultrasound - If visible fetal heartbeat go to next step. **Second step** - CTG `> 28 weeks gestation + mother UNSURE of ⬇︎ fetal movements` - Mother should lie on her side for 2h - Count fetal movements - If < 10 ⟶ go to hospital.
147
Explain how does **Rhesus negative pregnancy** happens.
- Rh negative mother gives birth to Rh positive baby; - Antibodies formed cause haemolysis in subsequent pregnancies.
148
Explain the `prevention of Rh incompatibility` in pregnancy.
- All Rh negative mothers should be tested for anti-D antibody; **Not previously sensitised mothers** -Offer anti-D immunoglobulin at 28 weeks (single dose) or at 28 and 34 weeks (2 doses).
149
# **Rh incompatibility** When can anti-D immunoglobulin be given within 72h?
- Delivery of Rh positive infant - Abortion - Miscarriage after 12 weeks - Ectopic pregnancy - Antepartum haemorrhage - Amniocentecis and chorionic villus sampling
150
Name the teratogenic medications.
- Warfarin - Methotrexate - Sodium valproate - Retinoids | Use of contraception whiles taking these drugs.
151
What is the **Rx of UTI** in `pregnant woman`?
**Trimethoprim** - Avoid in the 1st trimester **Nitrofurantoin** - Avoid at term (from 37 weeks) **2nd & 3rd trimester:** - Cefalexin - Trimethoprim
152
What is drug of choice for **pain relief** in `pregnancy`?
Paracetamol.
153
Management of postmenopausal UTI?
**1st line:** - Vaginal oestrogen **2nd line:** - Prophylatic antibiotics
154
Postpartum endometritis Rx
IV co-amoxiclav.
155
When are **ultrasounds** offered thorought the course of an `uncomplicated pregnancy`.
**10 - 13 weeks:** dating scan **18 - 20 weeks:** fetal anomaly scan
156
Nutrional supplements of an uncomplicated pregnancy?
**Folic acid:** 400 mcg per day until 12 weeks. **Vitamin D:** 10 mcg/day for the entire pregnancy.
157
Pregnancy trimesters in weeks.
**- 1st trimester:** conception until 12 weeks. **- 2nd trimester:** 13 weeks until 27 weeks. **- 3rd trimester:** 28 weks to term.
PLAB 1 August 2024
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