O&G

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  1. Risk factors for endometrial cancer
    • Nulliparity
    • Obesity
    • Early Menarche/Late menopause
    • lack of breastfeeding
    • Tamoxifen HRT
  2. Diagnosis of endometrial cancer
    Endometrial Biopsy during D&C
  3. Treatment for endometrial Cancer
    • Total hysterectomy + Bilateral Salpingoophorectomy + LN dissection
    • +/- RadioT and ChemoT
  4. DDx for Post Menopausal Bleeding
    • Atrophic Vaginitis
    • Vaginal trauma
    • Vaginal infectoin

    • Cervical atrophy
    • Cervical polyp
    • Cervical cancer

    • uterine polyp/fibroid
    • Endometrial atrophy
    • Hyperplasia
    • Endometriosis
  5. General checklist for post-operative care
    • Monitor vitals for 24hours
    • Analgesia
    • Fluid maintenance balance whlist NGT?
    • IDC
    • DVT prevention (stockings, leg physio)
    • Check wound sites
  6. Reccurent bleeds following endometrial cancer surgery causes
    • Vaginal atrophy
    • vaginal infection
    • Vault carcinoma recurrence
    • Vault Granulation
    • Bladder infection
  7. Investigaoins to cary out with continuous bleeds following endometrial cancer surgery
    • FBC,
    • urine MCS
    • PEx speculum  bimanual
    • vaginal swab
    • PR
  8. What is the MC cause of PMB and what is treatment
    • vaginal atrophy
    • loss of rugae
    • increased redness, dryness
    • reduced exudate

    Topical Oestrogen
  9. Woman presents with pelvic pain to ED. What to do
    • 1. ABC
    • shock? BP, HR, T
    • IM morphine if not contraindicated

    • 2. Further history
    • Nildocaaf
    • Period Hx - LMP, menarche, period cycle length, spotting, pain, contraception,
    • Sexual Hx - contraception, partners, dysparenuria
    • Pregnancy Hx -
    • Papsmear Hx -

    • 3. Ix
    • FBC
    • biochem
    • bHCG
    • Urine MCS
    • DNA cervical swab (Gon, CHlamyd)
    • USS pelvis (uterus, adnexal masses, Doppler blood fow, Inflammatory reactors)
  10. Pelvic Pain DDx
    • PID
    • accute apendicitis
    • ovarian cyst
    • threatened abortion
    • ectopic

    unlikely - bowel issues (colic, IBS,) acute cystitis
  11. MC STD?
    S&S

    Detection
    • Chlamydia
    • PCB, IMB, discharge

    urine MCS, endocervical sample
  12. Common places for Ectopic Pregnancy
    • Fallopian tube 95% (Ampulla, isthmus, fimbirae, interstitium)
    • Ovaries
    • Peritoneal cavity
  13. RFs/Aetiology for ectopic
    • Tubal diseases (PID/Chlamyd)
    • previous ectopic
    • previous tubal surgery
    • subfertility
    • IUD
  14. Spontaneous abortion frequency
    MC cause
    MC weeks to occur in
    20-24%

    • most likely due to chromosomal abnormlaities, however exact is unkonwn
    • Most commonly in middle first trimester
  15. some pain to the shoulder, previous use of IUD, has not got menstrual period as expected
    possible ectopic pregancy (ruptured)
  16. PEx to be carried out if suspecting threatened pregnancy, miscarriage, ectopic or molar
    • Obs - Shock?
    • bimanual - cervical excitement, fornices pain,
  17. Investigations to perform if suspecting threatened pregnancy, miscarriage, ectopic or molar
    • Obs - shock?
    • FBC,
    • Hb and group&hold
    • bHCG quantitative (multiple reads)
    • TVS - visible sac (@4.5weeks), HR (@5weeks), free fluid within peritoneal cavity (ruptured ectopic)

    checking for high hCG against no sac/HR visible
  18. Management of miscarriages
    • Hx
    • PEx - BP, T, HR, bimanual
    • Ix
    • Hb + group&hold
    • bHCG and quantitative hCG
    • TVS - location

    • expectant wait
    • surgical management
    • medical (misoprostol or PV gamepostrol with mifepristone Progesterone antagonist)
  19. Miscarriage RFs
    • advanced maternal age (pooor quality eggs)
    • medical/endocrine disorddres
    • uterine/chromosomal abnomralities
    • infections,drugs,chemicals
  20. Gestational Trophoblastic disease types
    • Complete Hydatidiform
    • Partial Hydatidiform 46XXY. XYY, XXX
    • Malignant GTD
  21. Gestational Trophoblastic disease S&S
    • usual - PV bleed, pain
    • increased uterus size, very high bHCG, hyperemesis gravidarum, big theca-lutein cells
  22. Gestational Trophoblastic disease treatment
    • suction D&C
    • ?hysterectomy
    • rho-Gram antibodies against Rh + blood cells from fetus

    • F/U
    • Contraception during treatment
    • Serial bHCGs until bHCG dropping for 6/12 monthly. plateua or increasing warrants investigations

    • investigations for persistent bHCG -
    • full works - FBC, U+E, Cr, bHCG, TSH, LFTs
  23. Malignant GTN or GTD types
    • invasive mole, persistent GTD
    • Choriocarcionma
    • placental sitaion of trophoblastic cells
  24. Hyperemesis Gravidarum
    6-8 week mark most common

    • non-pharma
    • smaller, more frequent meals,
    • don't mix solids and fluids
    • stop prenatal vitamins apart from folic acid
    • increse sleep n rest

    rehydrate patient

    • Pharma - Metoclopramide (class A) + Vit B6 Restivite
    • Ondansetron (class b) VSDs etc
    • Steroids - cleft palate
  25. Chlamydia First line treatment
    Azithromycin 1g Stat
  26. Gonorrhoea 1st line treatment
    Ceftriaxone 500mg IM stat in 2ml 1% lignocaine
  27. UTI - first line treatment
    • Trimethorim 300mg daily for 14/7. 
    • cephalexin 500mg BD for 14/7
  28. PID first line treatment
    • Doxycycline 100mg BD 14/7
    • + Metronidazole 400mg BD for 14/7
    • + azithromycin 1g stat
    • + (if gonorrhea) Ceftriaxone 500mg IM stat in 2ml 1% lignocaine
  29. Herpes treatment 1st line
    Acyclovir 400mg TDS for 5-10/7
  30. Essential HTN can lead to what in gestation
    • Gestational HTN
    • Abruptio placenta
    • IGUR
    • IU fetal demise (IUFD)
  31. Clinical evaluation of HTN in pregnancy
    mother and fetus
    • mother:
    • body weight/BMI
    • CNS - headache, visual disturbances, reflexes, irritabilty
    • Bleeding, petechaie
    • RUQ/epigastric hepatic pain, N + V
    • UO and color
    • non-dependednt oedema

    Fetus:

    • fetal movement
    • Fetal HR
    • Growth serial scans
    • Biophysical profile
    • Doppler studeies
  32. Lab evaluation of gestational HTN (think of clinical evaluation)
    • bleeding - Hb, platelets, blood fild, PTT, INR, fibrinogen, D-dimer
    • liver - ALT, AST, LDH, bilirubin
    • kidneys - proteinuria, creatinine, uric acid
    • 24 hour collection for total protein and Creatinine clearance
  33. Mgmt of HTN in pregnancy
    not ACEi, diuretics, propanolol

    • Methyldopa PO 250-500mg TDS, QDS
    • or 
    • Labetalol 100-300 mg PO BD or TDS
    • or 
    • Nifedipine 30-50mg PO OD
  34. Pre-eclampsia? what is it
    • HTN (pre-existing or gestational) with NEW onset of PROTEINURIA
    • continue if normal, may be delivering 34-36 mark depending on fetal size etc
  35. Management of Pre-eclampsia
    Immediate reduction of BP

    • Hyrdralazine 5-10mg IV bolus over 5min, q15-30min
    • Labetalol 20-50mg IV q10min or Nifedipine 10-20mg PO q20-60min

    Prevent seizure

    • MgSO4
    • Contineu and manage for 12-24hrs post=partum cos highest risk of seizure
  36. Pre-cclamspia clinical investigations checklist
    check bleeding - FBC, INR, aPTT

    check liver - liver enzymes, LDH, bilirubin, albumin

    Check urine - Cr, Uric acid, Urine Dip collection +24hr
  37. Eclampsia definition
    • occurence of at least 1 generalised convulsion (60-70secs) in setting of pre-eclampsia in absence of other nruo conditions
    • 2-3% of severely pre-eclamptic women.
  38. Eclampsia managemet
    • ABC
    • roll patient to LLDP
    • Oxygen (hypoventilation during convulsion)
    • anti HTN therapy _ Hydralazine
    • MGSO4 to prevent further seizures

    DEFINITIVE TREATMENT - delivery of baby, irrespective of GA, due to risk of maternal morbidity
  39. DDx for seizure in pregnancy
    • stroke
    • hypertensive disorder
    • SOL in CNS
    • Hypoglycaemia
    • TTP
    • illicit drugs
  40. MgSO4 toxicity
    hyporeflexia, flushing, cardiorespiratory depreession, weakness, somnolence
  41. Why UTI more common in pregnancy?
    why treat asymptomatic UTIs in preganncy
    increased urinary stasis from progesterone and mehcanical factros

    increased risk of progession to cystitis, pyelonephritis and increased risk of pre-term labour.
  42. treatment of UTI in pregancy
    • uncomplicated
    • 1st line - amoxcilicin 250-500mg PO

    Pyelonephritis - admit and IV antibiotics.
  43. T1/T2 bleeding investigations
    • B-hCG --> lower than expected if spontaneous abortion of ectopic
    • US - confirm iuntra-uterine pregnancy and fetal viability
    • FBC
    • Group n hold
  44. Clinical features of ectopic pregnancy
    • Temperature
    • Tenderness - abdominal
    • Tenderness - bimanual
    • Tissue - palpable adnexal mass (50%)
  45. If ectopic pregnancy ruptures
    • acute abdomen with increasing pain
    • abdominal distension
    • shock
  46. ectopic pregnancy risk factors
    • Previous ectopic
    • gyne causes: IUD, PID, Salpingitis, Infertility, Clomiphene citratie (used for ovulation)
    • Previous procedures: ectopic removal/tubal ligation, abdo surgeries, IVF pregnancies + induction
    • smoking
    • abnormal uterus.
  47. ectopic pregnancy investigations
    • serial B-hCG levels, non-doubling. 
    • US checking for when serum B-hCG >1500 TVUS or bHCG>6000 Transabdomial US
  48. Ectopic pregnancy Treatment
    Conservativ, maintain haemodynamic stabilitiy

    • Surgical lap
    • - salpingostomy
    • salpingectomy

    • Monitor B-hCG for weeks until non-detectable
    • consider Rhogram

    MethoTreXate if small unruptured ectopic with no hepatic/renal dysfunction
  49. Antepartum Haemorrhage definition:
    what to asks
    Vaginal bleeding from 20wk to term

    • how much bleeding?
    • Description of colour, clotting
    • Contractions/cramping present?
  50. DDx for antepartum haemorrhage
    • Placenta praevia, Abruptio PLacentae (MC pathological)
    • Vasa Praveia

    Shedding of cervical mucous plug (MC normal)

    • Cervical lesion
    • Uterine rupture.
  51. What hormones could indicate the completion of menopause
    • FSH (increased)
    • Oestradial (decreased) - hence osteo
    • Inhibin B (decreased)
  52. Investigations to carry out in the clinical evaluation of a menopausal woman
    • FSH, oestradial, 
    • Serum androgens (free androgen index)
    • TSH
    • lipids, glucose
    • chem 20

    TVUS

    • BMD + Hydroxy vit D
    • pap
    • mammogram
  53. Premenopausal diagnosic criter
    PM is diagnosed with amenorrhea <4 months, in a less than 40 year old, with FSH readings >40 on 2 separate occasions.
  54. Bleeding in a patient on HRT; what to do
    • reassure if within first 12 months, normal.
    • however after 12 months, needs investigations for pathology. 
    • TVUS - uterine pathology
    • +/- endometrial biopsy

    again, breakthru bleeds are expected on sequential HRT>
  55. on HRT,
    persistent mastalgia, N+H,

    what to do
    • reduce oestrogen dose, 
    • or switch to transdermal
    • or switch to tibolone
  56. on HRT,
    PMS type symptoms - what to do
    reduce progesterone dose or switch progestogen type
  57. which type of HRT suits

    Cause of menopause (natural vs surgical)
    Urogenital symptoms are main issue
    Smoking status
    Hepatic or concurrent disease present
    • hysterectomy - no uterus, therefore ET alone is good - ET alone is not as bad as EPT for breast cancer, CHD, VTE. 
    • Urogenital only - dryness, atrophy, dysparenuria,  - oestrogen cream

    smoking status - OCP not recommended, DVT risk

    Hepatic or concurrent - patches
  58. Is tibolone suited best for everyone with cancers
    • Tibolone - synthetic steroid with androgenic, progestogenic, oestrogenic properties, reduces cancer risks in all BUT those with previous breast cancer.
    • HIgher risk of recurrence if previously treated for breast cancer c.f. control
  59. What are some non-hormonal alternatives for relieving vasomotor symptoms
    • gabapentin
    • venlaxafine
    • paroxetine - caution in women with tamoxfen + breast cancer
    • clonidinee
  60. Which weeks of T1 are highly susceptible to teratogens
    weeks 2-8 post-concentpion = the embryonic periods where fetal organs are developing

    weeks 0-2 (conception to 2 weeks post) there is an all-or-none survival or death mechanism. 

    Fetal period (K9-) fetus is less susceptible to teratogens, but drug toxicieities, behavioural teratogenicity (vision, hearing, neurodevelopment) and vascular insults (IUGR) can be caused.
  61. when is N+V most common
    • occurs in K5-6,
    • peaks at K8
    • by K12 60% of vomiting has resolved
  62. what is hyperemesis gravidarum
    intractable vomiting resulting in dehydration, weithg loss, electrolyte imbalance

    may require hospitalisation and IV fluid rehydration.
  63. what hormones influence vomiting?what invesitgations should be performed
    • bHCG
    • hence higher in twin pregnancies, molar pregnancies
    • TVUS can help.
  64. what investigations would be performed for hyperemesis gravidarum
    • serum electrolyes - K, Na
    • FBC - Increased haematocrit concentration due to depeletded plasma volume
    • LFTs - transaminase elevation, check jaundice
    • TSH - only TSH lowered and T4 should be raised, not T3 and T4 and reduced TSH (true hyperthyoidism)
    • US - multiple pregnancy or GTD
  65. what advice to avoid vomiting
    • conservative 
    • avoid spicy food, fatty foods, caffienes
    • increase hydration
    • eat small amounts, small snacks
    • eating before rising
  66. anti N + V medications
    • Vit B6,
    • ginger,
    • antihistamines
    • dopamine antagonists, 
    • phenothiazines
    • metoclopramide.
  67. Steroids help in refractory cases, but why not used genearlly
    methylprednisolone is associated with cleft lip/palate before K10, with 3-4 fold increase
  68. what would be indicatioins for hospitalisation
    • significant dehydration
    • inability to tolerate PO
    • 2+ ketonuria in the setting of hyperemeiss.
  69. GORD reasoning in rpegnancy
    • increased PG
    • thus, reduced LOS pressure, incerased intra-gastric pressure, reduced pyloric sphincter tone
    • increased gastric pressure - worsens from T1 to T3.
  70. Main medication for GORD
    worry in pregnancy
    • antacid
    • Fe needs acid for absorption - thus Fe deficiency should watch outn 

    • Alginates - barrier added
    • H2receptor antagnosits 
    • Promotility - metoclopramisde
    • PPIs - omperazole is B3.
  71. Uterine fibroids occur in how many
    20-40% of women of repro age
  72. aetiolgoy of pain due to fibroids in pregnancy
    • impaired fibroid perfusion
    • vessel occlusion or fibroid volume too much with growth
    • inflammatroy process producing CKs and Prostaglandins and thus cellular injury.
  73. WHen is pubic symphisitis most common
    K10-12 when the high relaxin concentrations cause widening of the symphysis pubis.
  74. how common is bleeding in pregnancy
    in T1- 20-40%
  75. what are the serious causes of bleeding in pregnancy
    • threatened
    • actual M/C
    • GTD
    • PLacenta preavia
    • Placental abruption
    • Prematuer labour

    TVUS done at first triage.
  76. in triage with PV bleed during pregnancy, what are you hoping for
    • patient stable
    • no adnexal masses
    • no intraperitoneal bleeing sigsn
    • fetal heart sounds on TVUS or abdominal.
  77. when is abstinence from coitus recommended in prengnayc
    • wommen at risk for PTL
    • antepartuum haemorhage because of praevia
  78. why is cervical bleeding more common in pregnancy
    • stromal oedema
    • increased vasularity
    • enlargement of glandurlar structures.
  79. what organisms cause cervicitis
    • Chlamdyia 50%
    • N. gonorrhea
    • Trichomonas vaginalins,
    • HSV type 2
    • HPV.
  80. what is the empirical treatment(s) for cervicitis
    • azithromycin or
    • ceftriaxone or metronidazole
  81. Risk factors for Pre-term delivery
    • Previous PTL delivery, or late miscarraiage
    • multipregnancy
    • cervical surgery
    • uterine anomalies
    • Pre-eclampsia and IUGR
Author
ID
318727
Card Set
O&G
Description
UQ MBBS IV 4th year O&G rotation
Updated
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