Clinical- Week 1 Flashcards
1
Q
after 1 episode of chlamydia, what is the chance of tubal blockage?
A
10%
2
Q
after 3 episodes of chlamydia, what is the chance of tubal blockage?
A
50%
3
Q
what is the maximum waiting time for IVF treatment?
A
12 months
4
Q
what is the most common reason for requiring assisted conception therapy?
A
male factor
5
Q
what is the optimal BMI for males and females before starting assisted contraception therapy?
A
19-29
6
Q
what folic acid supplementation should be taken preconception and up to 12 weeks gestation?
A
0.4mg per day
5mg per day if high risk
7
Q
what does folic acid supplementation during/before pregnancy prevent?
A
neural tube defects
8
Q
what kind of vaccine is the rubella vaccine?
A
live attenuated vaccine
9
Q
what does the antral follicle count measure?
A
a womens ovarian reserve (number of eggs she has left)
10
Q
what are the 5 main treatments available for assisted conception?
A
- donor insemination
- intra-uterine insemination (IUI)
- in vitro fertilisation (IVF)
- intra-cytoplasmic sperm injection (ICSI)
- surrogacy
11
Q
how is intra-uterine insemination achieved?
A
semen inserted into uterine cavity around time of ovulation
12
Q
what is the main pro and con for using a stimulated menstrual cycle in intra-uterine insemination?
A
- improves success rate
- increases rate of multiple pregnancy
13
Q
below what motile sperm count should ICSI be used instead of IVF?
A
below 1 x 10^6 motile sperm
14
Q
how long must a couple be trying to conceive unsuccessfully (unexplained) for IVF to be an option?
A
over 2 years of unexplained infertility
15
Q
during IVF treatment, why is the first step down regulation?
A
to artificially put women in menopause, so the doctor can time IVF cycle precisely with no spontaneous ovulation
16
Q
what are the main side effects of down regulation during IVF?
A
hot flushes
mood swings
headaches
nasal irritation
17
Q
how do you achieve down regulation during IVF?
A
synthetic gonadotrophin releasing hormone analogue (buserelin)
-injection or nasal spray
18
Q
in down regulation during IVF treatment, what does the endometrium look like?
A
thin endometrium (similar to menopausal women)
19
Q
what is the next step in IVF treatment after down regulation?
A
ovarian stimulation
20
Q
how do you achieve ovarian stimulation during IVF?
A
gonadotrophin hormone
21
Q
what is the purpose of ovarian stimulation in IVF treatment?
A
causes follicular development
22
Q
what are the 2 main side effects of gonadotrophin hormone given during ovarian stimulation in IVF?
A
- mild allergic reactions
- ovarian hyperstimulation syndrome (OHSS)
23
Q
in IVF treatment, after gonadotrophin hormone is given, what is the next step?
A
HCG injection
24
Q
what is the purpose of the HCG injection given in IVF treatment?
A
mimics spontaneous LH surge
caused resumption of meiosis in oocyte
25
how long after the HCG injection in IVF treatment are oocytes collected?
36 hours
26
how long before a sperm sample is collected for IVF must the male abstain?
72 hours
27
what are the main risks of egg collection in IVF?
- bleeding
- pelvic infection
- failure to obtain oocytes
28
what happens to the eggs when they are collected for IVF?
eggs are separated from follicular fluid and collected in cell culture medium
incubated at 37 degrees
29
in the normal development of a human embryo, at what day is a blastocyst formed?
day 5
30
in the normal development of a human embryo, at what day should it be entering the uterus?
day 5
31
in the normal development of a human embryo, at what day should it be starting to implant?
day 7
32
compare the number of embryos that can be transferred in patients under 40 and over 40?
under 40- no more than 2 embryos (usually just 1)
| over 40- 3 in exceptional circumstances
33
what luteal support is given after embryo transfer in IVF?
progesterone (cyclogest) pesaries for 2 weeks
34
when do you do a pregnancy test in the process of IVF?
2 weeks after embryo transfer
35
if the pregnancy test is positive during IVF treatment, what is the next scan?
transvaginal scan, 5 weeks after embryo transfer
36
what is ovarian hyperstimulation syndrome? (OHSS)
over-enlarged ovaries- excess follicles
37
why do patients with ovarian hypestimulation syndrome accumulate fluid centrally? eg ascited, pleural effusion, pericardial effusion
membranes become leaky
38
what is the treatment of ovarian hyperstimulation syndrome if it occurs before embryo transfer?
- coasting
- elective egg freeze
- single embryo transfer
39
what is coasting in IVF?
withholding gonadotrophins and HCG injection in order to reduce estradiol to let ovarian hyperstimulation syndrome settle
40
what is the treatment of ovarian hyperstimulation syndrome if it occurs after embryo transfer?
- monitor with scans/bloods
- antithrombotic: fluids, TED stockings, fragmin
- analgesia
- drain fluid
- hospital admission if required
41
as you increase the age of the patient, what happens to the rate of IVF success?
success rate decreases
42
what authority regulates assisted reproductive technologies?
human fertilisation and embryo authority (HFEA)
43
up to how many days gestation, is embryo research permitted by the law?
14 days
44
up to how many weeks gestation, is abortion permitted by the law?
24 weeks
| later if severely handicapped or significant risk to maternal life
45
what are the 7 requirements for NHS funded fertility treatments?
- unexplained infertility for at least 2 years
- female partner under the age of 40
- female partner BMI between 18.5 and 30
- both partners non smoking
- both partners abstaining from illegal substances
- no alcohol for both partners before and during treatment
- dont already have a genetic child
46
what is menorrhagia?
abnormally heavy amd prolonged bleeding at menstruation
47
at what day in the menstrual cycle is there a peak of FSH, LH and oestrogen?
day 12
48
in the follicular phase of the menstrual cycle, what hormone stimulates follicle development and causes granulosa cells o produce oestrogens?
FSH
49
in the menstrual cycle, what happens to the levels of FSH when levels of oestrogen (and inhibin) produced by the dominant follicles increase?
FSH production becomes inhibited
50
in the menstrual cycle, what happens to the follicles when FSH production become inhibited by oestrogen?
atresia of all the follicles but the dominant follicle
51
in the menstrual cycle, what hormone surge causes ovulation?
LH
52
in the menstrual cycle, what happens to the follicle during ovulation?
follicle ruptures and releases oocyte
53
in the menstrual cycle, what produces progesterone?
corpus luteum
54
in the menstrual cycle, at how many days post-ovulation does luteolysis occur?
14 days post-ovulation
55
in the menstrual cycle, at what day does the endometrial proliferative phase begin?
day 5
56
what hormone induces growth of endometrial glands and stroma in the proliferative phase?
oestrogen
57
what hormone induces endometrial glandular secretory activity in the luteal phase?
progesterone
58
in the endometrial menstruation phase of the menstrual cycle, what causes shedding of the functional endometrial layer?
arteriolar constriction
59
why do scars not form during endometrial menstruation and shedding of the functional endometrial layer?
fibrinolysis inhibits scar tissue formation
60
how long does menstruation usually occur? when does the peak occur?
4-6 days
| peak day 1-2
61
what is the normal menstrual cycle length?
21- 35 days
| average 28 days
62
what volume of blood is usually lost in a normal menstruation?
<80ml
63
is intermenstrual bleeding or post-coital bleeding normal?
no
64
what is metorrhagia?
regular intermenstrual bleeding
65
what is polymenorrhoea?
menses occuring at <21 day interval
66
what is polymenorrhagia?
increased bleeding and frequent cycle
67
what is menometorhagia?
prolonged menses and intermenstrual bleeding
68
what is amenorrhoea?
absence of menstruation >6 months
69
what is oligomenorrhoea?
menses at intervals of >35 days
70
what is dysfunctional uterine bleeding?
non-organic menorrhagia
| absence of pathology
71
what are uterine fibroids?
benign smooth muscle tumours (leiomyoma) of the uterus
72
what is adenomyosis?
a condition where endometrial glands and stroma iare found in the myometrium of the uterus
73
what are endocervical or endometrial polyps?
benign tumours on the surface of the endocervix or endometrium
74
what is cervical eversion?
when the columnar epithelium of the endocervix come out onto the ectocervix and undergoes transformation into squamous cells
75
what is pelvic inflammatory disease?
infection of the upper part of the female reproductive tract (uterus, uterine tubes, ovaries, inside of pelvis)
76
what is endometriosis?
when the endometrium lining grows outside of the uterus (this will bleed every month at mensturation)
77
what type of drugs can cause organic menorrhagia?
anticoagulants
78
what is gestational trophoblastic disease?
when abnormal trophoblastic cells grow inside the uterus after conception
79
what is postpartum bleeding?
loss of lots of blood within 24 hours following childbirth
80
what can dysfunctional uterine bleeding be subdivided into?
anovulatory DUB
| ovulatory DUB
81
at what ages does anovulatory dysfunctional uterine bleeding occur?
extremes of reproductive life
82
at what ages does ovulatory dysfunctional uterine bleeding commonly occur?
35-45 years olds
83
compare the cycles of anovulatory and ovulatory dysfunctional uterine bleeding?
anovulatory- irregular cycle
| ovulatory- regular cycle
84
why does ovulatory dysfunctional uterine bleeding occur?
corpus luteum not producing enough progesterone
85
what is danazol primarily used for?
steroid with main use in endometriosis
86
how is endometriosis treated?
- gonadotrophin releasing hormone analogues
| - danazol
87
compare the HRT needed for endometrial ablation vs hysterectomy? (when treating menorrhagia)
endometrial ablation- combined HRT required
hysterectomy- oestrogen only-HRT
88
compare retention of fertility with medical and surgical treatments for menorrhagia?
medical- fertility can be retained
| surgery-fertility is lost
89
what non-medical non-surgical method of treating menorrhagia is there?
progestogen-releasing IUCD
90
what is oligoasthenospermia?
low sperm count and low motility
91
what is teratoasthenospermia?
abnormal sperm and low motility
92
what is the normal pH of the vagina?
less than 4.5 (acidic)
93
what bacteria is part of the normal vaginal flora and helps to maintain the acidic pH of the vagina?
Lactobacillus spp
94
what 2 substances do Lactobacillus spp produce to maintain acidic pH of the vagina and suppress growth of other bacteria?
lactic acid and hydrogen peroxide
95
what 4 organisms are part of the normal vaginal flora?
Lactobacillus spp.
Strep viridans
Group B beta-haemolytic Strep
Candida spp.
96
what are the 3 most common genital tract infections which are non-sexually transmitted?
candida infection
bacterial vaginosis
prostatitis (can sometimes be sexually transmitted)
97
what are the 4 most predisposing factors for candida infection? (candida overgrowth)
- recent antibiotic therapy
- high oestrogen levels (pregnancy, some contraceptives)
- poorly controlled diabetes
- immunocompromised patients
98
what is the presentation of candida infection? (vaginal thrush)
intensely itchy white vaginal discharge
99
how do you diagnose candida infection? (vaginal thrush)
-clinical diagnosis
-high vaginal swab for culture
(posteriof fornix of vagina)
100
what type of candida are most thrush infections?
Candida albicans
101
what is the treatment of candida infection?
topical clotrimazole pessary or cream
| PO fluconazole
102
what organisms cause bacterial vaginosis?
Gardnerella vaginalis
Mobiluncus sp.
Anaerobes
103
what are the symptoms of bacterial vaginosis?
thin, watery, fishy smelling vaginal discharge
104
how do you diagnose bacterial vaginosis?
- clinical diagnosis
- vaginal pH above 4.5
- high vaginal swab for microscopy
105
what is seen in microscopy for bacterial vaginosis?
clue cells
106
what is the treatment of bacterial vaginosis?
PO metronidazole
107
what are the 3 classifications of prostatitis?
1. acute bacterial prostatitis
2. chronic bacterial prostatitis
3. chronic prostatitis/chronic pelvic pain syndrome
108
what are the symptoms of acute bacterial prostatitis?
symptoms of UTI but may also have lower abdominal pain/back/perineal/penile pain and tender prostate on examination
109
what are the 2 primitive genital tracts? (indicate which is for which remains for sex)
```
wolffian duct (males)
mullerian duct (females
```
110
what cause the development of the wolffian duct and degeneration of mullerian duct in males?
testosterone
| mullerian inhibiting factor
111
what does the wolffian duct develop into in males?
reproductie tract
112
what causes the development of the mullerian duct and the degeneration of wolffian duct in females?
lack of testosterone and mullerian-inhibiting factor
113
around how many weeks can you start to tell the sex of a fetus?
16 weeks
114
on what chromosome is the sex determining region?
chromosome Y
115
how is androgen insensitivity disorder inherited?
X-linked recessive disorder
116
what is the karotype of androgen insensitivity disorder?
46XY
117
what happens to the wolffian duct and mullerian duct in androgen insensitivity disorder?
wolffian duct is not developed
| mullerian inhibition occurs
118
describe the phenotype of androgen insensitivity syndrome?
```
female genitals, short vagina
absence of uterus and ovaries
primary amenorrhoea
lack of pubic hair
(looks like a female until puberty)
```
119
what is the normal volume of a testis?
12-25ml
120
what condition is a congenital absence of vas deferens associated with?
CF
121
what muscle surround the testes?
cremasteric muscle
122
describe the position of the epididymis in compared to the testes?
superior and posterior to the testes
123
what is the tunica vaginalis made from?
descended peritoneum
124
when should the testes drop into the scrotal sac from the abdominal cavity?
before birth
125
why is it important that the testes descend?
lower temperature outside body to facilitate spermatogenesis
126
what muscle contracts in the scrotal sac to lower or tests according to external temperature?
dartos muscle
127
what is the name for undescended testes in adulthood?
cryptorchidism
128
are patients with cryptorchidism fertile?
if unilateral usually fertile
129
what should be performed in patients with cryptorchidism and why?
orchidopexy before age of 14 years to minimise risk of testicular germ cell cancer
130
if an adult have undescended testes what should you consider?
orchidectomy
131
where does spermatogenesis occur?
seminiferous tubules
132
where does testosterone production occur?
leydig cells
133
in the seminiferous tubules, where are the most mature sperm?
in the lumen
134
what hormones do sertoli cells secrete?
- inhibin hormones
| - activin hormones
135
what cells form the blood-testes barrier?
sertoli cells
136
what hormones stimulate spermatogenesis?
FSH and testosterone
137
what hormone decreases the secretion of FSH?
inhibin
138
what hormone stimulates testosterone secretion?
LH
139
what does testosterone do to the release of GnRH and LH?
decreases it
140
is testosterone an anabolic or catabolic hormone?
anabolic
141
how often is gonadotrophin releasing hormone released from the hypothalamus in males?
every 2-3 hours
142
what cells does LH act on?
leydig cells
143
what cells does FSH act on?
sertoli cells
144
what hormone stimulates FSH production?
GnRH
| activin
145
what capacitation of sperm?
biochemical and electrical events before fertilisation
146
what is an acrosome reaction?
when the sperms head which is full of enzymes breaks through the egg
147
after fertilisation what happens to the zona pellucida and why?
thickens to stop another egg getting in
148
what 3 substances are released from the seminal vesicles? what are they for?
fructose- energy
prostaglandins- stimulates motility
fibrinogen- clot precursor
149
what duct does the seminal vesicles release fluid into?
ejaculatory duct
150
what is the pH of fluid from the prostate? why is this important?
alkaline (neutralises vaginal acidity)
151
what enzymes are produced by the prostate gland?
clotting enzymes
152
what is the function of the bulbourethral glands?
secretes mucous for lubrication of semen
153
what fills with blood during an erection?
corpora cavernosa
154
what autonomic nervous system controls erection and ejaculation?
erection- parasympathetic
| ejaculation- sympathetic
155
what is a retrograde ejaculation?
when ejaculate goes into the bladder
156
what is the definition of male infertility?
infertility resulting from failure of the sperm to normally fertilise the egg
157
what is hypospadias?
urethra opening is not at the tip of the penis
158
what is the most common tumour in young males?
seminoma
159
what is the most common cause of male infertility?
idiopathic
160
what are the 3 common causes of obstructive male infertility?
cystic fibrosis
vasectomy
infection
161
why are patients with Kallmann's syndrome infertile?
hypothalamus doesn't produce gonadotrophin releasing hormone
162
what sensory deficit is kallmanns syndrome associated with?
loss of smell
163
how to you measure testicular volume?
orchidometer
164
describe the testicular volume of obstructive male infertility?
normal testicular volume
165
describe the endocrine features of obstructive male infertility?
normal LH, FSH and testosterone
166
what is the karotype of kleinfelters?
XXY
167
describe the testicular volume of non-obstructive male infertility?
low testicular volume
168
is the vas deferens present in non-obstructive male infertility?
yes
169
describe the endocrine features of non-obstructive male infertility?
high LH, FSH
| low testosterone
170
how long does an IVF treatment take in average?
about 6 weeks
| -if baseline scans are appropriate
171
in obstructive azoospermia where do you aspirate the sperm from?
epidiymis
172
in non-obstructive azoospermia where do you aspirate the sperm from?
testicular tissue
173
what are the 3 phases of the uterine cycle?
menstrual phase
proliferative phase
secretory phase
174
what defines post menopausal bleeding?
abnormal uterine bleeding after a year after cessation of menstruation
175
what defines dysfunctional uterine bleeding?
abnormal/irregular uterine bleeding with no organic cause
176
what can tamoxifen be used for?
to treat an oestrogen sensitive breast cancer
177
why can tamoxifen cause abnormal uterine bleeding?
encourages endometrium to proliferate
178
at what endometrial thickness in postmenopausal women is an indication for biopsy?
greater than 4mm (should usually be 1mm)
179
what camera allows you to look into the endometrial cavity?
hysteroscope
180
what are the 2 ways of sampling the endometrium?
endometrial pipelle
| dilatation and curretage
181
what is disynchrony of the endometrium?
when some glads respond to progesteone and so go into the secretory phase while others dont
182
why do anovulatory women's endometriums not go into a secretory phase?
no corpus luteum to secrete progesterone
183
endometrial hyperplasia or carcinomas are derived from what cells?
glandular cells
184
endometrial sarcomas are derived from what cells?
stromal cells
185
which is the more thorough sampling method- endometrial pipelle or dilatation and curretage?
dilatation and curretage
186
why does the endometrium in anovulatory dysfunctional bleeding not go into the secretory phase?
no corpus luteum so no progesterone secretion
187
when do endometrial polyps tent to occur?
around/after menopause
188
what causes a complete mole?
1 or 2 sperms combine with an egg which has lost it's DNA- only paternal DNA
189
what is the karotype of a complete mole
46 XX or 46 YY or 46 XY
| if only single sperm, it duplicates to form a complete set
190
what causes a partial mole?
egg is fertilised by 2 sperms of 1 sperm which has reduplicated itself
191
what is the kartype of a partial mole?
69 XXX or 69 XYY or 69XXY
192
which type of moles are more likely to develop into a choriocarcinoma?
complete moles
193
what is a choriocarcinoma?
malignant tumour of trophoblast
194
what hormone is the growth of leiomyomas (uterine fibroids) dependent on?
oestrogen
195
why is there a much reduced rate of leiomomas in post-menopausal women?
reduced oestrogen
196
what organisms cause acute bacterial prostatitis?
```
UTI organisms:
E. coli and other coliforms
Enterococcus sp.
STI organisms in under 35 year olds:
Chlamydiatrachomatis
Neisseria gonorrhoea
```
197
how do you diagnose acue bacterial prostatitis?
clinical signs
+MSSU for culture and sensitivity
+first pass urine (if considering STI)
198
what is the treatment for acute bacterial prostatitis? (Not STI cause)
ciprofloxacin 28 days
| or trimethoprim 28 days
199
what organism causes chlamydia?
Chlamydia trachomatis
200
what organisms causes gonorrhoea?
Neisseria gonorrhoeae
201
what organisms causes syphilis?
Treponema pallidum
202
what virus causes genital warts?
human papilloma virus
203
what parasite causes pubic lice/crabs?
phthirus pubis
204
where can chlamydia trachomatis infect?
endocervix, urethra, rectum, throat and eyes
205
what is the most common bacterial STI in UK?
Chlamydia trachomatis
206
chlamydia is an obligate intracellular bacteria, what does this mean?
cannot reproduce outside a host cell
207
why can chlamydia not stain with Gram stain?
no peptidoglycan in the cell wall
208
what are the 3 serological groupings of chlamydia and what infection does this respond to?
Serovars A-C: trachoma
Serovars D-K: genital infection
Serovars L1-L3: lymphogranuloma venereum
209
what is the treatment of uncomplicated chlamydia?
Azithromycin 1g PO stat dose
210
why can lymphogranuloma venerum be mistaken for crohns disease?
inflammation of the rectus, irritation and tenesmus
| if treated with normal azithromycin 1g stat dose, fistulas will form
211
what group of patients get lymphogranuloma venerum?
patients with receptive anal sex
| biggest outbreak in men who have sex with men
212
what does neisseria gonorrhoea look like on Gram stain?
gram negative diplococcus
- often intracellular
- look like 2 kidney beans
213
compare the amount of discharge in gonorrhoea and chlamydia?
gonorrhoea- lots of discharge
| chlamydia- less discharge
214
what tests are done for the diagnosis of chlamydia and gonrrohoea?
nucleic acid amplification tests (NAAT) or PCR
additionally for gonorrhoea: microscopy and culture and sensitivies
215
how are samples for or chlamydia and gonorhoea testing taken?
males: 1st pass urine
females: high vaginal swab or vulvo-vaginal swab or endocervical swab
both: rectal and throat swabs
216
what are the only swabs that can be used for gonorrhoea culture on selective agar plates?
high vaginal swabs
217
why are swabs from GP patients looking for gonorrhoea often falsetly culture negative?
organism would die during transit to lab
218
when taking swabs for chlamydia and gonorrhea, compare what swabs are needed for screening vs symptomatic?
asymptomatic: high vaginal swab/vulvo-vaginal swab
symptomatic: endocervical swab
219
how long after chlamydia and gonorrhoea do you do test of cure tests?
5 weeks
220
why does it take 5 weeks to do a test of cure test for chlamydia and gonorrhoea?
because you can still pick up dead organisms on PCR/NAAT up until then
-dont want a falst positive
221
what is the treatment for N. gonorrhoea?
IM ceftriazone and PO azithromycin
222
how do you diagnose Treponema pallidum? (syphyllis)
- swab of primary chancre for PCR
| - serology for non-specific and specific antibodies (blood test)
223
what are the 4 stages of syphilis?
1- primary chancre
2- bacteria circulating in blood, multiple manifestations
3- latent period (no symptoms)
4- late stage (cardiovascular or neurovascular complications)
224
what is tarbes?
slow degeneration of neural tracts (particularly DMCL) in syphilis, loss of touch, vibration and proprioception
225
why do patients with syphilis present with a high-stamping get?
loss of proprioception in feet due to tarbes
| rely on their ears to find out where feet are
226
what condition do you get pseudotabes in?
diabetes
227
the widespread rash found in the second stage of syphilis affects which parts of the body primarily?
palms and soles
228
what non-specific serological tests are used to tell to you about response to therapy for syphilis?
venereal diseases research laboratory (VDRL)
| rapid plasma reagin (RPR)
229
what specific antibodies are used to test for syphilis?
T. pallidum particle agglutination assay (TPPA)
T. pallidum haemagglutination assay (TPHA)
IgM and IgG ELISA (screening)
230
why are TPPA and TPHA not useful for monitoring response to therapy in syphilis?
remain positive for life
231
why can syphilis not be cultured for sensitivities?
organism cannot be grown in artificial culture medium
232
what is the treatment of syphilis?
IM long-acting penicillin
233
what is the most common viral STI?
genital warts
234
does HPV contain DNA or RNA?
DNA
235
what types of HPV most commonly cause genital warts?
6 and 11
236
what types of HPV are associated with cervical cancer?
16 and 18
237
how do you diagnose genital warts?
clinical diagnosis
238
what is the treatment of genital warts?
cryotherapy
| podophyllotoxin cream/lotion
239
do genital warts recur?
yes
240
the vaccine given to 11-13 year old girls immuneses against which types of HPV?
6, 11, 16, 18
241
does HSV contain DNA or RNA?
DNA
242
where does the herpes simplex virus hide from the immune system?
sacral root ganglion
243
how do you diagnose genital herpes?
swab of deroofer blister for PCR
244
describe trichomonas vaginalis?
single celled protozoal parasite
245
how does trichmonas vaginalis divide?
binary fission
246
how do you diagnose trichomonas vaginalis?
high vaginal swab for microscopy
| no good test for males
247
what is the treatment of trichomonas vaginalis?
PO metronidazole
248
what is the treatment of pubic lice? (phthirus pubis)
malathion lotion
249
when do the 1st, 2nd and 3rd trimesters complete?
1st completes at 12 weeks
2nd completes at 28 weeks
3rd completes at 40 weeks
250
how many weeks is term?
37-42 weeks
251
how do we estimate gestation dates?
using ultrasound
252
how early can pregnancy be detected by a urine test?
10 days after fertilisation
253
what type of US scan is gold standard for suspected miscarriage?
transvaginal scan
254
what is seen on speculum exam for a threatened miscarriage?
os is closed
255
what is seen on speculum exam for an inevitable miscarriage?
products are sited at open os
256
what is seen on speculum for a complete miscarriage?
products sited in vagina
257
what is early fetal demise?
pregnancy has been lost but not expelled
mean sac diameter over 25mm
fetal pole over 7mm
258
compare MVA to surgical treatment of abortion?
MVA- local anaesthetic
| surgical- general anaesthetic
259
compare a miscarriage and ectopic pregnancy in terms of main presenting symptom- bleeding or pain?
miscarriage- bleeding > pain
| ectopic- pain > bleeding
260
what is the drug treatment for a medical termination of pregnancy?
- mifepristone
| - misoprostol
261
what is the medical management for a ectopic pregnancy?
methotrexate IM or PO
262
what is seen on USS of a molar pregnancy?
snow storm appearance +/- fetus
263
in a molar pregnancy, what does the overgrowth of placental tissue look like?
grape like clusters
264
when does implantation bleeding occur?
10 days post-ovulation (can be mistaken for a period)
265
what is a chorionic haematoma?
pooling of blood between endometrium and embryo due to separation
266
at what stage in pregnancy does a chorionic haematoma occur?
first trimester, early pregnancy
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what is the treatment for a chorionic haematoma?
self limited so resolves
| reassurance and surveillance
