General gynae

Bacteria that commonly cause pre pubertal vaginal discharge

group A streptococcus (gram positive cocci)

How does ectopic ureter present in prepubertal girls?

• clear watery discharge

• other congenital abnormalities

What is a disulfiram reaction?

When metronidazole is taken with alcohol it interferes with the break down causing nausea, dizziness

Antibiotics treatment for PID

• cetriaxone 1g IM or 2g IV

• metronidazole 400 mg BD for 14 days

• doxycycline 100mg BD for 14 days

Risk of infertility after PID

10% after one episode

20% after two episodes

Sign of TOA on ultrasound

Cogwheel

trichomonas vaginalis - presentation, diagnosis and management

Presentation - yellow frothy discharge, strawberry cervix

Diagnosis - microscopy

Management - metronidazole

What is a medical term for genital warts

condylomata accuminata

What vaccine is used for HPV and what types does it protect from?

Gardasil 9

• 6, 11, 16,18

• 31, 33, 45, 52, 58

Management of chlamydia - pregnant and non pregnant

Non - pregnant

• doxycycline 100mg BD for 7 days or azithromycin

Pregnant

• azithromycin 1g stat then 500mg OD for 2 days

What type of bacteria is gonorrhoea? diagnosis and management

gram -ve diplococci

diagnosis - NAAT

management - ceftriaxone 1g stat

Definition and causes of ophthalmia neonatum

• conjunctivitis in newborn

• first 5 days - gonorrhoea

• after 5 days - chlamydia

• couple of weeks - herpes

What is the causative organism of chancroid and presentation?

haemophilis ducreyi

Presentation

• painful ulcers

• lymphadenopathy

• buboes (abscess)

Commonest cause of abnormal vaginal discharge?

bacterial vaginosis

What is the oral and topical management of bacterial vaginosis?

• oral metronidazole 400mg BD for 7 days

• or topical metronidazole gel 0.75% OD for 5 days

• or topical clindamycin 2% OD for 5 days

What is the most common causative agent of candida?

candida albicans in 80%

What is the treatment of candida in acute presentation in pregnant and non pregnant?

Non pregnant - fluconazole 150mg PO stat

in pregnant - clotrimazole pessary 200mg for 3 days

What is the treatment of recurrent candida in pregnant and non pregnant?

In non pregnant

• fluconazole 150mg PO x 3 every 72 hours

• then fluconazole 150mg PO once a week for 6 months

In pregnant

• imidazole pessary for 7 days

• clotrimazole 500mg PV once a week

Diagnosis of PCOS

Rotterdam criteria

1. irregular cycles >35 days

2. hyperandrogegism - either clinical or biochemical high testosterone

3. ultrasound >20 follicles on one or more than 10 on both

   1. high AMH used in young adults

first line medical management for PCOS in woman not wanting pregnancy

• BMI<25

• BMI >25

• BMI<25 - COCP or mirena

• BMI >25 - COCP + metformin

medical management for PCOS in woman wanting pregnancy - 1st 2nd and 3rd line

1. letrozole

2. clomiphene + metformin

3. gonadotrophin

WHO aim of cervical cancer eradication - number of cases

<4 cases per 100,000

What is the current global uptake of cervical cancer and what is the aim?

current 21%

aim 90%

What is the management of ovarian cysts in post menopausal women

• <3cm no need to follow up

• RMI <200, cyst 3-5cm, asymptomatic - follow up in 4-6 months

• RMI <200, cyst >5cm or symptomatic - BSO

• RIM > 200 - MDT + CTAP

chance of malignancy in pre menopausal ovarian cysts

3 in 1000

Tumour markers in pre menopausal cysts and when

if < 40yo and complex cyst

• Ca 125, LDH, HCG, AFP

percentage of negative endometrial biopsies that will have endometrial hyperplasia

2%

Risk of endometrial cancer

• hyperplasia without atypia in 20 years

• hyperplasia with atypia in 20 years

<5%

29%

Patient with endometrial hyperplasia without atypia declines mirena, next line management and dose

continuous progesterone norethisterone 10-15mg/day

if endometrial hyperplasia without atypia is managed with continuous progesterone what is the follow up?

• biopsy in 6 months, repeat biopsy in 6 months - should be two negative

• then annual follow up

What is the follow up for women with endometrial hyperplasia with atypia who refuse TAH + BSO but agree to IUS

• biopsy every 3 months until two negative biopsies

• then every 6-12 months until hysterectomy

Woman with endometrial hyperplasia with atypia who wants to conceive has IUS, what is the follow up and when should she conceive?

• biopsy every 3 months until 1 negative biopsy , if negative then IVF

Classification of fibroids

mode of action of TXA

prevent plasminogen to plasmin

What is the most common malignant ovarian cyst in adolescents? How does it present?

Juvenile granulose cell tumour

• oestrogen secreting so precocious puberty

Tumour markers:

• granulosa cell tumour

• epithelial tumour

• sertoli leydig (2)

• embryonal (2)

• dysmerginoma (2)

• yolk sac

• immature teratoma

• granulosa cell tumour - oestrogen

• epithelial tumour - CA 125

• sertoli leydig (2) - testosterone and AFP

• embryonal (2) - HCG and AFP

• **dysmerginoma (2) - LDH and HCG

• yolk sac - APF

• immature teratoma - AFP and LDH

post menopausal woman with PMB but thin endometrium on scan what is the chance of cancer?

0.5%

Incidence of PMS normal vs severe

40% of women

5% severe

Diagnosis of PMS

• symptom diary for 2 months or

• GnRH analogue for 3 months will help symptoms

Management of PMS

1. - CBT, exercise, Vitamin B6

• continuous drospirenone COC

• low dose 10mg SSRI

2. higher dose SSRI

• oestrogen patches with micronised progesterone

3. GnRH analogue 6 months + HRT - ensure DEXA

4. TAH + BSO + HRT ensure DEXA

Criteria name to diagnose IBS

Rome IV

Endometrioma wanting to conceive

• spontaneous - cystectomy but might effect reserve

• ART - offer IVF without cystectomy

Endometriosis findings on TVUS

• ground glass echogenecity

• absence of solid components

• no papillary projections

Dose of progesterone in cyclical vs continuous HRT? What is the first and second steps if unscheduled bleeding takes place?

cyclical - 200mg OD for 2 weeks

• increase to 3 weeks

• if lasts for more than 3 months and ET >7mm - biopsy

continuous - 100mg OD

• increase to 200mg OD

• if lasts > 6 months and ET>4mm - biopsy

Treatment of lichen sclerosis

topical clobetasol 0.05% or betamethasone 0.05%

Most common causes of veno-venous and veno arterial ECMO

veno-venous

• acute respiratory distress syndrome

veno arterial

• pulmonary embolism

• myocardial infarction

adolescent <16 lacks capacity, who can consent for treatment?

one parent or legal guardian is enough to sign

however if parent refuses treatment , act in the best interest of patient

McCune Albright syndrome

precocious puberty

cafe au lait spots

at what figo classification of fibroids should myomectomy be in 2 stage surgery

stage 2 > 50% intramural

ryeqo mode of action and side effect

GnRH antagonist

osteoporosis

When using oxytocin in labour how should hyponatraemia be managed?

125-130

• 80ml per hour fluid intake

• VBG in 4 hours

<125

• 30 ml per hour

• VBG in 2 hours

• stop oxytocin