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RW Obstetrics & Gynae > Clinical Obs & Gynae > Flashcards

Clinical Obs & Gynae Flashcards

1
Q

What is quick-starting, in terms of contraception?

A

Quick-starting contraception is the initiation of a method of contraception without waiting for the next period, or after giving emergency contraception; this may mean that there exists a small risk of pregnancy.

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2
Q

What contraceptives can be quick started, and which cannot?

A

COC, POP pills and implant can be quick started. Copper IUD (unless as EC), IUS and Co-cyprindiol cannot be quick started

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3
Q

What is bridging, in terms of contraception?

A

Bridging methods of contraception are short-term methods which are quick-started and continued until a suitable time is available (or pregnancy has been excluded), when a preferred long-term method can be initiated. The same methods that can be quick started can be used for bridging

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4
Q

What are the indications for endometrium sampling?

A
  • Abnormal uterine bleeding
  • Investigation for infertility
  • Spontaneous and therapeutic abortion
  • Assessment of response to hormonal therapy
  • Endometrial ablation
  • Work up prior to hysterectomy for benign indications
  • Incidental finding of thickened endometrium on scan
  • Endometrial cancer screening in high risk patients
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5
Q

Menorrhagia

A

Prolonged and heavy menstrual flow

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6
Q

Metrorrhagia

A

Regular intermenstrual bleeding

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7
Q

Polymenorrhoea

A

Menses occurring at <21 day interval

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8
Q

Menometorrhagia

A

Prolonged menses and intermenstrual bleeding (menorrhagia + metorrhagia)

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9
Q

Amenorrhoea

A

Absence of menstruation >6 months

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10
Q

Oligomenorrhoea

A

Infrequency of periods - menses at intervals of >35 days

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11
Q

Dysmenorrhoea

A

Menstruation associated with pain that reduces quality of life

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12
Q

What is the pearl index for failure rate?

A

No. of accidental pregnancies x 1200/ Total number of months of exposure (means No. of contraceptive failures per 100 women users per months of the year/year)

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13
Q

What are the rules of criteria for NHS funded Assisted conception in NW?

A
  • Unexplained infertility of at least two years
  • Unexplained infertility of at least two years
  • Female partner under the age of 42
  • If neither have a genetic child
  • Female partner’s BMI between 18.5 and 30
  • Both partners must be non-smoking
  • Both partners to abstain from illegal substances
  • Neither partner should drink alcohol prior to or during treatment
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14
Q

Which organisation is the UKs regulator overseeing use of gametes and embryos in treatment and research?

A

The Human Fertilisation and Embryology Authority (HFEA)

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15
Q

Up to how many days development is research permitted in embryos?

A

14 days (until presence of primitive streak)

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16
Q

Up to how many weeks gestation is abortion permitted in UK?

A

24 weeks (later if severely handicapped or significant risk to maternal life)

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17
Q

What are the 5 main questions that must be considered with reproductive ethical problems?

A

1) Is it legal?
2) Is it practical?
3) Do we have all the appropriate information?
4) Do all individuals involved understand what is involved?
5) Is treatment ethical?

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18
Q

What are the cut off weeks for each trimester?

A

1st trimester - complete at 13 weeks
2nd trimester - complete at 28 weeks
3rd trimester - complete at 40 weeks

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19
Q

How is gestation determined during pregnancy?

A

Dates and ultrasound

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20
Q

What marker is used to measure pregnancy, and how early can this be detected?

A

ẞhCG, can be detected as early as 10 days after fertilisation

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21
Q

What are the 4 outcomes of fertilisation?

A 
Normal pregnancy (developing embryo in normal location)
Ectopic pregnancy (abnormal location)
Molar pregnancy (abnormal site)
Miscarriage (normal embryo)
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22
Q

Causes of bleeding in early pregnancy

A 
Miscarriage
Ectopic
Molar 
Implantation bleeding
Chorionic haematoma
Infection (cervical/vaginal)
Malignancy (cervical, vaginal)
Polyp
Unrelated: haematuria, PR bleed
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23
Q

What is the partner notification look back period for gonorrhoea?

A

Male urethral - 2 weeks

Any other infection - 3 months

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24
Q

What is the partner notification look back period for non-specific urethritis and trichonomonas vaginalis?

A

4 weeks

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25
Q

What is the partner notification look back period for chlamydia?

A

Male urethra symptoms - 4 weeks

All other cases - 6 months

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26
Q

What is the partner notification look back period for HIV?

A

4 weeks

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27
Q

What is the partner notification look back period for syphylis?

A

Primary - 90 days
Secondary - 2 years
Other infections - 3 months before most recent -ve test

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28
Q

Which infections is partner notification not required for?

A

Warts, Herpes, Vaginal thrush, bacterial vaginosis

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29
Q

Who is HBV vaccinations offered to at sexual clinics?

A 
• MSM
• High prevalence countries
• Sexual assault
• Contacts
(Now part of routine vaccination in childhood)
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30
Q

Who is HPV vaccinations offered to at sexual clinics?

A

MSM <46y

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31
Q

What drug is given as pre-exposure prophylaxis (PreP)?

A

Truvada

32
Q

What is given as post-exposure prophylaxis (PEPSE) for HIV and Hep B?

A

Hep B - HBV vaccine and immunoglobulins

HIV - 3 antriretrovirals

33
Q

Which 2 STIs commonly move together to form urethritis?

A

Gonorrhea and chlamydia

34
Q

What the is infective organism involved in chlamydia?

A

Chlamydia trachomatis

35
Q

What the is infective organism involved in gonorrhoea?

A

Neisseria gonorrhoeae

36
Q

What the is infective organism involved in syphilis?

A

Treponema pallidum

37
Q

Which microorganism predominates in a healthy vagina, and what does it produce?

A

Lactobacillus, which produces lactic acid +/- hydrogen peroxide to suppress growth of other bacteria

38
Q

Which other organisms are part of the normal vaginal flora?

A

Lactobacillus (dominant), strep viridans, group B beta haemolytic strep and candida (in small numbers)

39
Q

what is the normal vaginal pH?

A

4 to 4.5

40
Q

What causes bacterial vaginosis?

A

Imbalance of vaginal flora, also possibly role of gardnerella vaginallis, mobiluncus or other organisms

41
Q

What is NAAT?

A

Nucleic Acid Amplification Testing - molecular test with detects the genetic material of the causative organism. Can be used on non-invasive samples e.g. vaginal swab and urine sample

42
Q

What is the current stance on sperm donor anonymity?

A

Currently the parents receiving the donation get key details, e.g. ethnicity, personal characteristics, year of birth and medical history. Also if there are donor siblings. At 16 the child will get these details, then at 18 they will get the donors name, DOB and last address

43
Q

What is the criteria for competence under the Fraser Guidelines?

A
  • Have to understand the options and situation
  • Has to be in their best interest
  • Mental and physical health likely to suffer if not carried out
  • Have to be advised to tell a parent or guardian
44
Q

What is the pregnancy risk mid-cycle following UPSI?

A

30%

45
Q

How long does the ovum and sperm survive in the tract?

A

Sperm - 5 days, ovum for 24hrs

46
Q

which type of HIV is responsible for the global pandemic starting in the 1980s?

A

HIV-1 Group M

47
Q

What is the target site for HIV?

A

CD4+ receptors

48
Q

What is the definition of an opportunistic infection?

A

an infection caused by a pathogen that does not normally produce disease in a healthy individual. - It uses the “opportunity” afforded by a weakened immune system to cause disease

49
Q

Which organism is involved in pneumocystis pneumonia?

A

Pneumocystis jiroveci

50
Q

Which group has the highest risk of HIV in the UK?

A

MSM

51
Q

Who is most likely to be undiagnosed or present late?

A

Heterosexual males

52
Q

True or False: HIV in PWID us common

A

False

53
Q

Which services should offer opt-out testing for HIV?

A

Those in higher risk groups (TOP services, GUM, drug dependency services) and those where the risks of undiagnosed HIV are unacceptably high(antenatal, assisted conception services)

54
Q

What is the miscarriage rate of amniocentesis and chorionic villus sampling?

A

1% and 2%

55
Q

True or false: half of maternal suicides happen up to 12 weeks postnatally

A

True

56
Q

What are the risk factors for mental health issues to screen for in antenatal appointments?

A
  • Young/ single, domestic issues, lack support, substance abuse, unplanned/unwanted preg, pre-existing mental illness
57
Q

Which antianxiolytics should be avoided during pregnancy and why?

A

Benzodiazepines due to cleft and neonatal withdrawal problems

58
Q

What are the principles of treatment of psychiatric disorders during pregnancy?

A
  • Drugs with low risk to both mother and foetus
  • Lowest dose monotherapy (avoid depot)
  • Increase screening of foetus- cardio and growth
  • Encourage breastfeeding whenever possible
59
Q

Which tissues produce oxytocin before labour?

A

Decidual and extraembryonic foetal tissue and placenta

60
Q

What are the methods of testing foetal DNA?

A
  • Skin/urine cells via amniocentesis
  • Placenta via chorionic vollus biopsy
  • Foetal blood sampling (rarely used)
  • Foetal DNA from maternal serum (new) (NIPT)
61
Q

What analyses are available for the whole genome?

A
  • Standard karyoptype
  • Array CGH (gold standard)
  • Quantification of foetal DNA in maternal serum
  • Whole genome sequencing
62
Q

What analyses are available for the targeting certain areas of the genome?

A
  • Point mutation testing
  • Fluorescence in-situ Hybridisation (FISH)
  • Quantitative Fluorescent PCR (QF-PCR)
63
Q

What is Array Comparative Genomic Hybridisation (Array CGH)?

A

Essentially counts the amount of each chromosome, so picks up duplication or deletion (can’t detect balanced mutation however)

64
Q

What are the differences between mutations and polymorphisms?

A

Mutations are de novo (parents dont have it), bigger, affects known gene and previously reported in same phenotype

65
Q

How does nuchal thickness help indicate possibility of Down’s Syndrome?

A

Certain thickness indicates slower development of the lymphatics, associated with Down’s Syndrome

66
Q

what is the advantages and disadvantages of Non-Invasive Prenatal Testing of foetal DNA via maternal serum?

A

Advantage is that it is non-invasive which minimises miscarriage risk. Disadvantage is that only 10% of the DNA comes from the foetus, so any mutations in maternal DNA will be picked up

67
Q

Robertsonian Translocation

A

Rearrangement involving afrocentric chromosomes (chromosomees with one long end and one short end with limited genes on it). The afrocentric chromosomes have broken at the centromere, and the 2 long ends have joined together

68
Q

Aneuploidy

A

Presence of an abnormal number of chromosomes in a cell i.e. too many or too few

69
Q

What are the 2 main types of US techniques used in O&G?

A

Transabdominal and transvaginal

70
Q

True or False, the bladder must be full during an transabdominal scan

A

True, because it acts as an acoustic window, and displaces gas-filled bowel loops

71
Q

Which US technique has better resolution and why?

A

Transvaginal as it is closer to the organs

72
Q

When is CT scanning often used in O&G?

A

As second line investigation after USS, especially in patients with acute abdominal pain

73
Q

Which imaging technique is best to diagnose endometriosis?

A

MRI, as endometriosis deposits contain altered blood and haemoglobin degradation productions which cause characteristic signal changes on MRI

74
Q

What is Hysterosalpingography (HSG) and when is it used?

A

x-ray screening procedure using radioopague contrast into the uterine cavity. Tests the tubal latency, as the contrast should flow from the uterus down the fallopian tubes into the abdominal space

75
Q

Which imaging technique is bet for determining O&G cancer staging?

A

CT for detecting metastases. MRI is better for detecting local disease in cervical cancer, and USS is used for initial diagnoses esp in endometrial cancer and ovarian. However CT is best for mets and therefore staging

RW Obstetrics & Gynae (3 decks)

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