High Yield Exam Cram Flashcards
1
Q
Describe the process of oocyte maturation
A
2
Q
Describe the process of sperm development
A
3
Q
How many days does it take to produce a sperm?
A
64 days
4
Q
In the male, which cells does LH act upon?
A
LH acts on Leydig cells which make testosterone (negative feedback via testosterone)
5
Q
In the male, which cells does FSH act upon?
A
FSH acts on Sertoli cells which produce Sperm (negative feedback via Inhibin)
fSh, Sertoli, Sperm
6
Q
What is a normal sperm count?
A
> 15 million/ ml
7
Q
What is a normal sperm motility (%)?
A
> 32%
8
Q
which cells produce oestrogen?
A
Granulosa cells
9
Q
What stimulates granulosa cells to produce oestrogen?
A
FSH
(F is next to G in the alphabet - Fhs Granulosa)
10
Q
What produces progesterone?
A
Corpus luteum
11
Q
What stimulates theca cells?
A
LH
(t and L look similar)
12
Q
What do theca cells produce?
A
Androgens
thecA Androgens
13
Q
Which hormone drives the follicular phase?
A
Oestrogen
14
Q
Which hormone spikes and results in ovulation?
A
LH
15
Q
Which hormone drives the luteal phase?
A
Progesterone
16
Q
When in the cycle is the follicular phase?
A
0-14 days
17
Q
On which day does ovulation occur?
A
14
18
Q
on which day of the cycle does menstruation start?
A
day 28
19
Q
List the stages of embryo implantation
A
20
Q
Which part of the blastocyst forms the baby and which part forms the placents?
A
inner cell mass forms the baby
outer shell of trophoblastic cells forms the placenta
21
Q
What hormones are needed during embryogenesis to form male genitals?
A
Testosterone and anti-mullerian hormone
22
Q
Which hormone is needed during embryogenesis to form testes? (bonus points if you remember the gene that encodes it)
A
Testes determining factor produced from the SRY gene
23
Q
What is
A) Gravidity
B) Parity
A
Gravidity = Total number of pregnancies, including miscarriages and terminations (Grand Total)
Parity = Number of pregnancies that Progressed past 24 weeks
24
Q
What ultrasound scan sign is associated with - dichorionic/diamniotic twins?
A
lambda sign
25
What gestation should dichorionic/diamniotic be delivered?
37 weeks
26
What ultrasound scan sign is associated with - Monochorionic/diamniotic twins
T sign
27
What gestation should monochorionic/diamniotic be delivered?
36 weeks
28
What gestation should triplets be delivered?
35 weeks
29
What happens to insulin in pregnancy and why?
Insulin deficiency occurs due to human placental lactogen
30
What happens to iodine levels during pregnancy?
Iodine levels fall causing an iodine deficiency
31
what happens to the immune system during pregnancy?
Immunosuppression (to tolerate the baby!)
32
Name the heart murmur that is normal in pregnancy
End diastolic murmur
33
What happens to systemic vascular resistance in pregnancy?
reduces
34
What happens to blood gas in pregnancy
Compensated respiratory alkalosis
35
Is hydronephrosis in pregnancy normal?
Yes
36
What pathological urine findings are in fact normal in pregnancy?
Glycosuria and microscopic haematuria
37
Should you lie a pregnant woman on the left or on the right?
LEFT lateral tilt
38
When in the pregnancy would you expect to feel foetal movement?
>20 weeks
39
When is the dating scan carried out?
10-14 weeks
40
What is the purpose of the dating scan?
Estimates due date
How many babies are in there
How is baby developing (+ nuchal translucency)?
41
What else is done at the same time as the 10-14 week scan?
Blood screening for rubella, hepatitis B, syphillis, HIV, anaemia, isoimmunisation (anti-D) & genetic screen for chance of downs/edwards/pataus
42
What happens at the 18-21 week scan?
this is the anomaly scan- it is looking for defects
43
Describe the screening that can be carried out for genetic anomalies such as downs, edwards and pataus and list the gestatation that each can be done at
44
What is the risk of miscarriage with chorionic villous sampling?
1:200 (0.5%)
45
What is the risk of miscarriage with amniocentesis?
1:100 (1%)
46
what is the definition of miscarriage?
Foetal loss<24 weeks
47
What is the definition of chronic/essential hypertension?
Hypertension present pre-pregnancy or ≤ 20 weeks gestation
48
What is the definition of gestational hypertension?
Hypertension present >20 weeks gestation
49
What is the definition of pre-eclampsia?
Hypertension present >20 weeks gestation with proteinuria or end organ malfunction
50
What is the definition of HELLP syndrome?
increased liver enzymes
decreased platelets
haemolysis
51
How is pre-eclampsia managed?
Magnesium sulphate, labetalol, corticosteroids & deliver the baby!)
52
What is the definition of eclampsia?
Pre-eclampsia with seizures
53
What is the management of eclampsia?
Magnesium sulphate, labetalol, corticosteroids & deliver the baby
54
What is the management of HELLP syndrome?
Magnesium sulphate, labetalol, corticosteroids & deliver the baby
55
What HbA1c should you aim for if you are diabetic and hoping to get pregnant?
HbA1c < 6.5% (48)
56
What sugar level should you aim for if you are diabetic and hoping to get pregnant?
4-7
57
What are the most common bacterial causes of chorioamnionitis?
usually E.coli or Group B strep
58
What are the foetal consequences of chorioamnionitis
Neonatal sepsis
Foetal brain damage and death
59
What are the foetal consequences of chicken pox infection in the 1st 28 weeks of pregnancy
Skin scarring, neurological issues, congenital eye disease, limb hypoplasia
60
What are the foetal consequences of parvovirus infection in the 1st 12-20 weeks of pregnancy
Anaemia, cardiac failure, hydrops fetalis & foetal death
61
What are the foetal consequences of toxoplasmosis infection in the third trimester of pregnancy
Hydrocephalus, intracranial calcification, microcephaly, chorioamnionitis, ventriculomegaly, hepatosplenomegaly, IGR, miscarriage, intrauterine death
62
What are the foetal consequences of HIV infection in pregnancy
Pre-eclampsia, miscarriage, pre-term birth, low birth weight.
63
Can you have a natural birth and breastfeed if you are infected with HIV?
Yes, but viral load must be <50 (undetectable viral load) for a safe vaginal birth & Breastfeeding
64
What are the foetal consequences of Hep B infection in pregnancy
Liver cirrhosis
65
What is given to HepB +ve mothers to reduce the chances of passing HepB onto the baby?
Offer mothers tenofovir monotherapy in 3rd trimester
66
Is hep C problematic in pregnancy?
No, birth and breastfeeding are safe. Hep C cannot be treated in pregnancy
67
What are the foetal consequences of syphillis infection in pregnancy
Miscarriage, stillbirth, hydrops fetalis, IUGR, congenital infection.
68
When does congential syphillis infection manifest?
Any time after birth
69
How does congenital syphillis present in children >2 years old?
Hutchinson’s Triad (deafness, interstitial keratitis & widely spaced, peg like teeth).
70
what is the fist line anti-sickness drug in pregnancy?
Cyclizine
71
What is the firstline antihypertensive in pregnancy?
Labetalol
72
What anti-epileptic drugs are safe for use in pregnancy?
lamotrigine + GIVE FOLIC ACID
73
Which diabetic medications are safe for use in pregnancy?
Insulin (T1) or metformin (Gestational/T2DM)
74
Which medication is used to manage thromboembolism in pregany?
LMWH
75
why is lithium contraindicated in pregnancy?
causes epstein's anomaly
76
what is the medical management of an ectopic pregnancy?
Methotrexate
77
What is the surgical management of an ectopic pregnancy?
Salpingectomy
78
What is an antepartum haemorrage?
Significant blood loss >24 weeks gestation
79
What is the management of an antepartum haemorrage?
Delivery
80
Breech babies may turn themselves up to ___ weeks gestation
36
81
What is the management of a breech baby between 37 and 39 weeks?
a planned external cephalic version
82
When would a a planned external cephalic version be attempted?
between 37-39 weeks
83
what happens if a planned cephalic version does not work?
c-section
84
what is considered to be a term baby?
37-42 weeks
85
What is a normal foetal heart rate?
110-160bpm
86
What are the three stages in the induction of labour
1. Ripen the cervix
2. Rupture the membranes
3. Start the contractions
87
Which drug is used to ripen the cervix?
Misoprostol
88
what must the bishops score be before rupture of membranes can be attempted?
>7
89
What medication is administered to try and start contractions?
IV Syntocin (oxytocin)
90
What should syntocin be titrated to achieve?
4-5 contractions in 10 minutes
91
Describe the 3 stages of labour
LAT PAD
92
At what rate should a primigravid women dilate during the first stage of labour?
0.5cm/hr
93
At what rate should a parous women dilate during the first stage of labour
1cm/hr
94
What should be given if women are not dilating fast enough during the first stage of labour?
IV Syntocin- contractions will increase which will push the baby's head onto the cervix and cause it to dilate more quickly
95
what is extremely preterm delivery?
24-28 weeks
96
What is very preterm delivery?
28-32 weeks
97
What is mildly preterm delivery?
32-36 weeks
98
Name the type of drug that prevents contractions and delays labour
Tocolytics
99
What is Remifentanil?
IV painkiller with push button used in birth.
100
Why must women on remifentanil be on a consultant led unit?
it causes a reduction in respiratory rate
101
Why must women who have had an epidural be on a consultant led unit?
It reduces BP which can affect baby
102
Describe the positions of a baby during the process of birth
103
The CTG is found to be abnormal and a fetal blood sample is collected. What actions should be taken in each scenario if foetal blood sampling revealed the following:
104
What % of pregnancies are affected by placental abruption?
0.6%
105
Describe the different tears which can occur during childbirth
106
What is the most significant cause of maternal mortality?
PPH
107
What is the most common cause of PPH?
Uterine atony
108
What is the most common cause of PPH?
Uterine atony
109
how many women suffer a PPH?
8:1000
110
What amount of blood must be lost before it is considered a PPH?
200ml
111
How many ml of blood loss constitutes a major bleed?
>2000ml
112
What is the difference between a primary and a secondary PPH?
Primary = within 24hrs of birth
Secondary = 24hrs – 6 weeks after birth
113
How is PPH managed?
uterine massage oxytocin, ergometrine, carboprost & tranexamic acid. If this fails, hysterectomy
114
What is considered
A) Extremely low birthweight
B) Very low birthweight
C) Low birthweight
Extremely low = <1000g
Very low = 1500-2500g
Low = <2500g
115
What medication is given if a women has a retained placenta?
Oxytocin
116
What does the neonatal heel prick test for?
Sickle cell
Cystic fibrosis
Congenital hypothyroid
Phenylketonuria
Medium chain acyl-CoA dehydrogenase deficiency
Maple syrup urine
Isovaleric acidaemia
Glutaric acidaemia Type I
Homocystinuria
117
for how many weeks can a woman feel low post partum before it is classified as post partum depression
<2 weeks = baby blues
>2 weeks = post partum depression
118
Up to how many weeks can a medical abortion be offered
24 weeks (but only 20-21 weeks in grampian)
119
Can a women take the pills for an abortion at home?
Yes, if she is less than 10 weeks pregnant
120
What medications are used to achieve a medical abortion
Mifepristone then Misoprostol
121
What options are available if a woman wants to have a surgical abortion?
Vacuume aspiration if she is <14 weeks pregnant
Dilatation and evaculation if she is >14 weeks pregnant
Both surgical options also require mifepristone in order to end the pregnancy
122
What is the medical management of ectopic pregnancy?
Methotrexate
123
What is the most common cause of cervical cancer?
HPV16 & 18
124
When in a woman's life should she be screened for HPV?
Every 5 years between 25-64
125
In which order are cervical abnormalities investigated?
126
which area of the cervix should a smear test sample?
The transformation zone
127
What type of epithelium can be found
A) on the outer surface of the cervix (vaginal side)
B) Inside the cervical Os
A) Stratified squamous non-keratinised
B) Simple columnar
128
When can a coil be fitted post-partum?
Coils can be fitted within 48 hrs of birth. If not fitted within 48 hrs, mothers will need to wait 4 weeks.
129
If a mother does not have a coil, what is the gold-standard contraception if she is breastfeeding?
POP
130
How long after starting on the Implant, patch, ring, COC, POP can a woman have unprotected sex?
If started/inserted on day 5 of your cycle or before, protection against pregnancy is immediate.
If started/inserted after day 5, it is not protective against pregnancy for 7 days
131
How long after inserting the IUD can a woman have unprotected sex?
If inserted within 1st 7 days of cycle you are protected against pregnancy immediately.
If inserted after day 7, it is not effective against pregnancy for 7 days
132
How long after inserting the copper coil can a woman have unprotected sex?
Immediately
133
How long after unprotected sex can a copper coil be inserted?
within 120 hrs
134
What is the gold standard emergency contraception?
Copper coil
135
How long after unprotected sex can Levonorgestrel (Levonelle/PlanB) be taken?
within 72 hours
(L looks like an upside down 7)
136
How does Levonorgestrel work?
Contains oestrogen and progesterone
Stops ovulation and inhibits implantation
137
What is the advantage of Levonorgestrel over EllaOne?
Can use multiple times in a cycle
138
How long after unprotected sex can Ullipristal (EllaOne) be taken?
120 hrs
139
How does Ullipristal (EllaOne) work?
Progesterone receptor modulator
140
Name the pathogen that causes gonorrhoea
Neisseria Gonorrhoea
141
Name the pathogen that causes chlamydia
Chlamydia Trachomatis
142
Name the pathogen that causes genital herpes
Herpes simples 1 + 2
143
Name the pathogen that causes Trichomoniasis (green, frothy, stinky vag)
Trichomoniasis vaginalis (parasite!)
144
Name the pathogen that causes syphillis
Treponema pallidum
145
What is gonorrhoea treated with?
cephtriaxone
146
What is chlamydia treated with?
Doxycycline (azithromycin if preg)
147
What is herpes treated with?
Aciclovir & lidocaine ointment
148
What is trichomoniasis treated with?
Metranizadole
149
What is syphillis treated with?
Early (<2Y) + No neuro signs = doxycycline
Late (>2Y) / Neuro signs = Benzathine penicillin & doxycycline
150
Explain how HRT is prescribed
151
What is the most common ovarian cancer?
Serous carcinoma
152
What is the serum biomarker used to detect ovarian cancer?
Ca-125
153
What genetic mutation is linked to ovarian, fallopian tube and breast cancer?
BRACA
154
What increases the risk of ovarian cancer?
More ovulations = more risk (early menarche, late menopause, nulliparity)
155
What is the most common endometrial cancer?
Endometrial carcinoma
156
What are the risk factors associated with endometrial cancer?
Unopposed oestrogen, metabolic syndromes (diabetes, obesity, PCOS) HNPCC
157
How is post-menopausal bleeding investigated?
transvaginal USS (endometrial thickness >4cm)
158
What is protective against endometrial cancer?
Smoking
159
What is the most common cancer of the vulva and cervix?
Squamous cell carcinoma
160
Name a scoring system for pelvic organ prolapse
POPO SCORE/ Baden-Walker-Halfway Grading
161
Describe management of pelvic organ prolapse
Pessaries and pelvic floor physio. May need surgery.
162
List the 4 types of FGM
Type 1 = Cliteridectomy
Type 2 = excision of cliterorus and labia/parts of labia
Type 3 = Infibulation (sealing the vagina)
Type 4 = Other
