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Final year > Medicine 2 > Flashcards

Medicine 2 Flashcards

1
Q

Name 3 features of prader wili syndrome.

A

floppy infant, poor feeding, slow devleopment

Excessive hunger leading to obesity and T2DM

Intellectual impairment
Sexual dysfunction-unable to have children

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2
Q

Name 4 causes of hypotonia in an infant.

A

Prader willi
Neonatal sepsis
hypothyroidism
Maternal drug use/myasthenia gravis

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3
Q

What is the most common heart defect seen in downs, edwards and pataus? What kind of murmur is seen?

A

VSD (pansystolic)

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4
Q

Why shouldn’t children take aspirin? What is the one exception?

A

Risk of reye’s syndrome

Kawasaki disease

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5
Q

Which disease causes a strawberry tongue? Name 4 other symptoms.

A 
Scarlet fever
Fever
Rash
Sore throat 
Swollen lymph nodes
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6
Q

How long does a patient have to wait before becoming pregnant, after being on methotrexate?

A

6 months

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7
Q

What should be prescribed with methotrexate and when is it taken?

A

folic acid

taken at least 24hrs after treatment

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8
Q

Is risk of colorectal ca higher in crohns or UC?

A

UC

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9
Q

What is seen on endoscopy with crohn’s vs UC?

A

Crohn’s- cobblestone appearance

UC-Pseudopolyps

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10
Q

What other disease are UC patients at risk of getting?

A

primary sclerosing cholangitis

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11
Q

After what does subacute (De Quervain’s) thyroiditis occur? Is it hyper or hypothyroidism?

A

viral infection

Hyperthyroidism

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12
Q

What happens in phase 1 of subacute (de quervain’s) thyroiditis? Then phase 2,3,&4.

A

Painful goitre
Hyperthyroidism
Raised ESR

2-euthyroid
3-hypothyroid
4-resolution

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13
Q

Name 4 drug causes of a prolonged QT interval.

A 
amiodarone
TCA
SSRI's (citalopram mainly)
erythromycin
haloperidol
ondansetron
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14
Q

Name 4 non drug causes of prolonged QT interval.

A 
hypocalcaemia
hypokalamia
hypomagnesaemia
acute MI
hypothermia
SAH
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15
Q

Which zone of the lung does idiopathic lung fibrosis/SLE affect?

A

lower zones

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16
Q

Name 4 causes of upper zone pulmonary fibrosis.

A

TB
hypersensitivity pneumonitis/extrinsic allergic alveolitis
sarcoidosis

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17
Q

Name the triad of symptoms experienced in intestinal angina/chronic mesenteric ischaemia.

A

severe, colicky post prandial abdo pain
bruit over upper abdomen
weight loss

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18
Q

What is the gold standard ix in acute mesenteric ischaemia? What PMH do most of these patients have?

A

CT abdo with contrast

AF

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19
Q

Name 3 antibodies found in patients with coeliac disease. What is the definitive ix for this disease?

A

IgA
TTG
Anti-gliadin
Anti-casein

Duodenal biopsy

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20
Q

Name 3 features of multiple myeloma.

What simply, is multiple myeloma?

A

hypercalcaemia
renal failure
high protein
osteoporosis/bone pain

neoplasm of bone marrow plasma cells

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21
Q

What does the CRAB mnemonic stand for in multiple myeloma?

A

Calcium (hyper)
Renal failure
Anaemia
Back pain (bone lesions)

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22
Q

What are 2 ix you can do for multiple myeloma?

A 
U&E
FBC
Calcium
Protein
Electrophoresis  
Bone scan
Bone marrow biopsy
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23
Q

Name 2 treatments of mult myeloma.

A

chemotherapy/supportive

bone marrow transplant

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24
Q

What is ABCD of hodgkins lymphoma.

What kind of cells would you see?

A

Asymptomatic lymphadenopathy
B symptoms (weight loss, fever, night sweats)
Cough
Dyspnoea

Reed sternberg

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25
Q

What kind of lymphoma can malaria cause?

A

Burkitt’s

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26
Q

What condition leads to miscarriages in women with it being the cause of many DVT’s in under 50’s?

A

anti phospholipid syndrome-more common in females

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27
Q

Name 4 causes of hyposplenism.

A

sickle cell
coeliac disease
SLE
splenectomy

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28
Q

What do you see on a blood film with splenectomy/hyposplenism. What does this show?

A

howell-jolly bodies

RBC with nuclear remnants

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29
Q

Which condition shows an isolated rise in Hb levels? Name the mutation.

A

Polycythaemia Vera

JAK2

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30
Q

Name 4 features of polycythaemia vera.

A 
Pruritis
hyperviscosity
splenomegaly
plethora
haemorrhage
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31
Q

Name 4 features of polycythaemia vera.

A 
Pruritis
hyperviscosity
splenomegaly
plethora
haemorrhage
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32
Q

What nose symptom is associated with acne rosacea?

A

rhinopyma

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33
Q

What happens in a factor 5 leiden mutation?

A

protein C resistance therefore factor 5 broken down much more slowly

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34
Q

What 3 functions does the DCML pathway have?

A

Fine touch
Proprioception
Vibration

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35
Q

What 3 functions does the spinothalamic pathway have?

A

Pain
Temp
Crude touch

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36
Q

Name 2 extrapyramidal motor pathways.

A

tectospinal
rubrospinal
vestibulospinal
reticulospinal

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37
Q

Which 2 types of arrhythmia usually recover from vagal manouveres?

A

AVRT/AVNRT

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38
Q

Infarct of which artery in MI causes bradycardia?

A

RCA

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39
Q

What is the mode of action of dabigatran?

A

inhibits thrombin

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40
Q

Name 3 symptoms seen in Budd Chairi syndrome.

A

abdo pain, hepatomegaly, ascites due to blockage of hepatic vein

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41
Q

Name the mechanism of adenosine.

A

Blocks conduction at AV node

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42
Q

What is WPW an example of?

A

AVRT

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43
Q

Name 3 causes of scarring baldness (i.e. non reversible hair loss within follicle).

A

chronic discoid lupus
lichen planus
lichen sclerosus
scleroderma

neoplasm
burns
infections

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44
Q

Name 1 cause of non scarring baldness (i.e. preservation of follicles).

A

alopecia areata
telogen effluvium
androgenic alopecia

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45
Q

What is telogen effluvium?

A

hair loss caused by stress, shock or traumatic event

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46
Q

Does alopecia areata only affect the scalp?

A

no, can affect any hair area-armpits, eyebrows

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47
Q

what test is done to determine if hair loss is abnormal?

A

pull test (clump of hair tugged-if more than 6 hairs come out, this is +ve)

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48
Q

name 2 lab tests done in alopecia.

A

TFT

ferritin

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49
Q

Name 3causes of intra epidermal blistering.

A 
chickenpox
eczema
impetigo
herpes simplex+zoster
pemphigus
scabies
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50
Q

What virus is chickenpox caused by?

A

varicella zoster

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51
Q

What happens if latent VZV is reactivated?

A

person will get shingles (herpes zoster)

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52
Q

what is given to immunocompromised pts, neonates and pregnant women as prophylaxis against chicken pox?

A

varicella zoster immunoglobulin (VZIG)

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53
Q

What is the rx of chicken pox?

A

paracetemol
NSAIDS
Aciclovir

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54
Q

Name 3 complications of chicken pox.

A 
pneumonia
cerebellar ataxia
encephalitis
pulm and GI bleeding
cerebral haemorrhage
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55
Q

What is a complication of eczema caused by a virus?

A

eczema herpeticum

caused by herpes simplex

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56
Q

What SPECIFIC virus causes cold sores commonly around mouth and nares and is spread by salivary contact?

A

herpes simplex virus 1

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57
Q

What SPECIFIC virus causes sores on genitals and is spread by genital contact?

A

herpes simplex 2

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58
Q

What is the disease called that causes painful dermatomal rash, facial paralysis and hearing loss on affected side?

A

RAMSAY HUNT AKA-herpes zoster oticus-shingles affecting facial nerve

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59
Q

Name 2 topical abx used to treat limited impetigo.

A

fusidic acid and mupirocin

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60
Q

What is the name of the AI condition that causes painful blisters to occur in the epidermis of skin and mucous membranes and can be fatal?

A

pemphigus vulgaris

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61
Q

What AI condition causes large itchy blisters/bullae in basement membrane of skin?

A

bullous pemphigoid

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62
Q

What cream is used to treat scabies?

A

permethrin cream

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63
Q

Name 3 features of Pataus and what trisomy is it?

A

Microcephalic
Cleft lip/palate
Polydactyly

trisomy 13

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64
Q

Name 3 features of Edwards and what trisomy is it?

A

Micrognathia
Rocker bottom feet
Low set ears
Overlapping fingers

trisomy 18

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65
Q

Name 3 features of fragile x.

A

Macrocephaly
Large ears
Macro-orchidism

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66
Q

Name 3 features of Noonan syndrome.

A

webbed neck
pectus excavatum
short stature
pulmonary stenosis

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67
Q

Name 3 features of William syndrome.

A

short
learning difficulties
friendly extrovert

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68
Q

Name 3 causes of kussmauls sign and what is this sign?

A 
inc JVP on inspiration
Seen in restrictive RV filling
Constrictive pericarditis
Right MI
Right HF
Massive PE
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69
Q

What causes pulsus paradoxus and explain what this means.

A

cardiac tamponade
Drop in systolic BP>10mmhg on inspiration (inc venous return to right side and dec in left ventricular filling and thus dec in CO)

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70
Q

What is the medical treatment of a prolactinoma?

A

dopamine agonist-bromocriptine

Inhibits release of prostaglandin

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71
Q

Name 4 management measures to prevent further stroke/TIA.

A

Antihypertensives
Statins/ezetimibe
Aspirin/clopidogrel
Lifestyle

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72
Q

If a carotid artery is blocked>50% what surgery is done?

A

carotid endarterectomy (remove clot)

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73
Q

Name some symptoms that you might see in a lacunar infarct. Name 4.

A 
pure motor stroke
sensorimotor stroke
clumsiness
hemiballismus (flinging limbs)
pure motor
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74
Q

In OBSGYN hx what should you ask about in:

a) menstrual hx
b) obstetric hx
c) gynae hx
d) 2 other important topics

A

a) 1st day of last period and duration, regular? how often? intermenstrual bleeding? post coital bleeding? menorrhagia? Start of menarche and menopause
b) gravidity+parity-(G-no. of times been pregnant. P-no. of times given birth to foetus after 24 weeks, whether stillborn or alive). Mode of delivery, previous miscarriages, comp. during pregnancy/delivery, birth weights (prematurity)
c) Past gynae issues, any prev ops, FH, PMH, DH, SH (occupation), system review (urinary, bowel, weight changes)
d) smears, contraception

IMPACT ON QOL

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75
Q

What is the role of inhibin? What is it made by and why?

A

Made by corpus luteum and selectively inhibits FSH-prevents formation of any follicles!!

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76
Q

Name 8 causes of acute pelvic pain.

A 
Mittleschmerz
UTI
Dysmenorrhoea 
Ovarian torsion
PID
Appendicitis
Ectopic pregnancy
Miscarriage
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77
Q

Name 6 causes of chronic pelvic pain.

A 
Endometriosis
IBS
Ovarian cyst
Psychological
Adhesions 
Urogenital prolapse
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78
Q

Name an example of a GNRH agonist used in prostate, breast ca, endometriosis, fibroids and cyclical pain.

A

goserelin aka zoladex

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79
Q

Name 4 ix that you might consider in pelvic pain.

A 
USS
pregnancy test
vaginal swabs
MSU
Laparoscopy
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80
Q

Name 4 causes of post coital bleeding.

A 
50% unknown
30% Ectropion (more common in COCP users)
cervical cancer
cervical polyps 
trauma
cervicitis
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81
Q

Name 4 causes of intermenstrual bleeding.

A 
ectropion
missed pill
fibroids
cervical or endometrial polyps
physiological spotting
pregnancy related 
cervicitis
endometrial ca
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82
Q

What is tested for in:

a) endocervical NAAT swabs
b) high vaginal charcoal swabs

A

a) chlamydia and gonorrhoea

b) bact vaginosis, candida, trichomonas, GBS

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83
Q

What is the dx until proven otherwise in post menopausal bleeding/early menopause/prim ovarian failure? (bleeding after 12 months of amenorrhoea.

A

endometrial cancer

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84
Q

How is menopause confirmed?

A

no bleeding for more than 12months/1 year

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85
Q

What cancer does the tumour marker CA-125 indicate?

A

ovarian cancer

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86
Q

Name 4 causes of post menopausal bleeding.

A

Common:
Vaginal atrophy
HRT
ENDOMETRIAL CA

Trauma
Polyps
vaginal/cervical/ovarian ca
Endometrial hyperplasia

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87
Q

Over how many mm of endometrial thickness makes endometrial cancer likely? What is the diagnostic ix?

A

> 5mm

Pipelle/hysteroscopic biopsy

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88
Q

Name 5 vulval/labial masses.

A

bartholin cyst/abcess
Vulval carcinoma
Bartholins tumour/carcinoma
fibroma/lipoma/leiomyoma

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89
Q

When do you refer to gynae for ovarian cyst. Name 4.

A

multilocular (more likely to be malignant
post menopause (abnormal)
>5cm
Symptomatic

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90
Q

Name 3 features of a lipoma.

A

soft, moveable and painless

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91
Q

Name 2 causes of primary dysmenorrhoea.

A

spiral artery vasospasm

myometrium contraction

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92
Q

Name 4 RF for prim dysmenorrhoea.

A

nulliparity
menorrhagia
smoking
early menarche

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93
Q

Name 3 rx for dysmenorrhoea.

A

mefanemic/tranexamic acid
COCP
IUS

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94
Q

Name 5 causes of primary amenorrhoea.

A 
imperforate hymen
genetic
congenital adrenal hyperplasia
turners syndrome
excessive exercise/low weight
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95
Q

Name 5 causes of secondary amenorrhoea.

A 
exercise/low weight
pregnancy!!
ashermans syndrome
PCOS
premature ovarian failure
Chronic conditions (e.g. thyroid)
Pituitary-prolactinoma, other
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96
Q

What 5 points are crucial to cover with a p/c of amenorrhoea

A 
eating/exercise habits
any acne/hirsuitism
pregnancy?
gynae hx
FH
ANy galactorrhoea (r/o prolactinoma)
menstrual hx
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97
Q

Name 6 ix for amenorrhea.

A 
pregnancy test
FSH/LH 
androgen level
Insulin level
BMI
Prolactin levels
Thyroid
Pelvic USS
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98
Q

Name 4 rx for amenorrhoea.

A 
metformin in PCOS
COCP/POP to regulate periods
hormone replacement
manage weight
Surgery for hymen
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99
Q

What do you call the dx when you cannot find a cause for the menorrhagia?

A

dysfunctional uterine bleeding

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100
Q

Name 5 causes of menorrhagia.

A 
polyps
fibroids
adenomyosis
copper system
hyper/hypothyroidism
abnormal clotting disorders
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101
Q

Name 5 steps in assessing a lady with menorrhagia.

A 
FBC for anaemia
Abdo exam
pelvic/bimanual
clotting studies
speculum
TV USS
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102
Q

Name 4 mx options in menorrhagia.

A

Mirena (IUS)
COCP
Tranexamic acid
Progesterone (oral/implant/depot)

Uterine ablation
Hysterectomy

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103
Q

Why do you get a rise in FSH during menopause?

A

Reduced follicle count means no inhibin is produced to stop FSH rising

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104
Q

What 2 major conditions are associated with menopause bc of lack of oestrogen?

A

inc VTE risk (Stroke etc)

osteoporosis

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105
Q

Name 3 lifestyle changes that could be implemented in menopause.

A

stop smoking alcohol caffeine
inc weight loss
exercise
calcium supplements

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106
Q

Name rx for menopause in women with and w/o uterus

A

oestrogen+progesterone

oestrogen alone

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107
Q

What preparation of oestrogen can cause VTE risk in menopause rx?

A

oral not transdermal (so opt for transdermal in those with VTE risk)

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108
Q

Name 3 SE of taking:

a) progesterone
b) oestrogen in menopause

A

a) weight gain, fluid retention, mood swings, pelvic pain

b) bloating, cramps, breast tenderness

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109
Q

When are you at risk of breast ca during menopause?

A

if you take oestrogen and progesterone

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110
Q

Name 3 benefits of HRT.

A

reduced risk of CVS disease and osteoporosis
Improved mood, urogenital, vasomotor (hot flushes, sweats)
reduced risk of colorectal ca

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111
Q

Name some causes of urogenital prolapse in:

a) ant compartment
b) middle
c) post

A

a) urethrocele, cystocele or both
b) vaginal, uterus!!, enterocele (pouch of douglas and small intestine)
c) rectocele

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112
Q

Name 3 RF of prolapse.

A 
obesity
constipation
obstetric-multiparity, vaginal birth, inc birth weight, prolonged delivery
inc age
heavy lifting
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113
Q

How do you examine a pt with urogenital prolapse.

A

standing-strain and cough

left lateral position

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114
Q

Name 5 rx of urogenital prolapse.

A

Lifestyle-weight loss, pelvic floor exercise,smoking, rx constipation/cough

Vag oestrogen cream 
vaginal pessary
colporrhapy (strengthen muscles by tightening)
colposuspension
hysterectomy
sacrohysteropexy
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115
Q

Name 4 RF for urinary incontinence.

A

Inc age
vag delivery
obesity

forceps
UTI
heavy babies
stool impaction

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116
Q

Name 3 rx for urge incontinence.

A

reduce caffeine, lose weight

bladder train

meds: oxybutynin (muscarinic antagonist) and tolterodine
BOTOX-SE: urinary retention=catheter, UTI
desmpressin for nocturnal symptoms

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117
Q

Name 2 rx for stress incontinence.

A

pelvic floor exercise
surgery: colposuspension, urethral sling
bulking agents

Last line: duloxetine

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118
Q

What is the most common type of cervical cancer?

A

squamous cell carcinoma

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119
Q

Name the 3 cancers that most commonly metastasise to bone.

A

breast lung prostate

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120
Q

What is the main RF for cervical ca?

A

persistent HPV infection

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121
Q

When is a cervical smear taken after pregnancy?

A

3 months after

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122
Q

When do you NOT refer for colposcopy in cervical ca?

A

when there is only mild dyskaryosis and HPV test is -ve

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123
Q

What happens if a cervical smear is inadequate?

A

repeat 3 times and if still inadequate, colposcopy

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124
Q

Name 2 bizarre protective factors against endometrial ca.

A

COCP

smoking

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125
Q

Name 4 sx of ovarian cancer.

A

Decreased appetite/full quickly
bloating/abdo pain
urinary frequency/urgency
vag bleeding

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126
Q

Name a cancerous RF for endometrial ca and ovarian ca.

A

hereditary non polyposis colorectal ca

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127
Q

Name 2 genetic RF for ovarian ca.

A

HNPCC

BRCA1&2

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128
Q

Name the mx of ovarian ca.

A

oophorectomy+hysterectomy and chemo

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129
Q

What age group commonly get vulval cancer?

A

elderly over 75

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130
Q

Name 3 RF for vulval ca. How do you diagnose?

A

lichen sclerosus
HPV
VIN

Examine and biopsy

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131
Q

What do you call this comp of having fibroids:

-bleeding into fibroid with vomiting, pain and fever.

A

red degeneration

132
Q

Name 3 sx of having fibroids.

A

menorrhagia
pelvic pain
infertility

133
Q

What imaging is done to diagnose fibroids?

A

abdo USS

134
Q

Name 3 mx techniques for fibroids.

A 
mirena/COCP/tranexamic-menorrhagia+pain
GnrH agonist-reduce size
myomectomy
hysterectomy
uterine a. embolisation
135
Q

Name some sx of endometriosis.

A 
cyclical pelvic pain
dysmenorrhoea
dyspareunia 
dysuria
subfertility
136
Q

What 3 things can be seen on laparoscopy of endometriosis.

A

chocolate cysts
kissing ovaries
adhesions

137
Q

Name 3 mx strategies for endometriosis.

A

hysterectomy
analgesia
COCP/progesterone/IUD to suppress ovulation
laser ablation (always returns tho)

138
Q

What is adenomyosis? Name 4 sx.

A 
endometrial tissue invading into myometrium
menorrhagia
dysmenorrhoea
pelvic pain
deep dyspareunia
irregular bleeding
139
Q

Who gets adenomyosis?

A

multiparous women as it occurs after trauma in delivery

140
Q

What is the curative mx of adenomyosis?

A

hysterectomy

141
Q

Cervical polyps usually asymptomatic-however what sx can it show?

A

any dysfunctional bleeding-inter menstrual, post coital, menorrhagia, post menopausal

142
Q

What is the mx of polyps and why?

A

removal-can undergo metaplastic change

143
Q

Who is most likely to get ectropian?

A

pregnancy

those on COCP

144
Q

How do pts with ectropian present?

A

discharge(due to glandular columnar epithelium)

post coital bleeding (vascular)

145
Q

Name 3 rx of ectropian IF symptomatic.

A

stop COCP
laser ablation
cryotherapy
diathermy

146
Q

Name 2 features seen in PCOS.

A

excess androgens

multiple cysts

147
Q

How do pts with PCOS present? Name 6

A 
oligo/amenorrhoea 
infertility
hirsuitism
male pattern baldness
chronic pelvic pain
obesity
depression
acanthosis nigricans
Acne
148
Q

what drug is used in PCOS to help with fertility? Name 2 drawbacks

A

clomifene induces ovulation

multiple pregnancy
ovarian hyperstimulation

149
Q

What is the fx of bartholin glands?

A

secrete mucus to lubricate vagina

150
Q

A bartholin ccyst is a clinical dx in all but which situation?

A

> 40y/o do a biopsy to exclude vulval cancer

151
Q

What is the rx for bartholin cyst? Name 2 and explain their mechanism.

A

word catheter-insert into cyst and leave to drain for 4 weeks-LOCAL
marsupialisation-incision into cyst, leave open to drain-suture back cyst wall-GA

152
Q

Name 3 ddx of lichen sclerosis.

A

candida
vitiligo
VULVAL ca

153
Q

What is the mx of lichen sclerosis? What are pts at risk of getting in chronic cases?

A

top steroids

squamous cell ca

154
Q

What is a dermoid cyst/mature teratoma lined with? What is likely to happen with this ovarian cyst?

A

epithelial cells

cause TORSION

155
Q

What is another name for endometrioma?

A

chocolate cyst seen in endometriosis

156
Q

Name 3 sx some may find in ovarian cyst.

A

dull ache in abdo
back pain
voiding problems if pressing on bladder etc
dyspareunia

157
Q

Name 4 comps of ovarian cysts.

A

torsion
rupture
haemorrhage
infertility

158
Q

Name 3 ix done in ovarian cysts.

A

TVUSS
needle aspiration of cyst
bloods-b HCG, AFP, LDH

159
Q

Name 2 mx options for ovarian cysts.

A
  1. watchful waiting-may regress after 3 menstrual cycles

2. surgical resection-cystectomy/oophorectomy depending on fertility wishes

160
Q

Name 2 mechanisms of COCP.

A
  • decreases LH and FSH so prevents ovulation

- thickens cervical mucus

161
Q

Name 3 CI of COCP.

A 
hx of VTE and IHD
uncontrolled HTN
smoking >15 a day
breast ca
breastfeeding<6 weeks post partum
162
Q

Name 2 alternative routes of administration for COCP apart from oral.

A

transdermal

vaginal ring

163
Q

Name 3 SE of COCP.

A

breast tenderness
mood swings
breakthrough bleeding

164
Q

When shouldn’t you use the progesterone only PILL? WHat can be used instead?

A

weight>70kg

Implant is fine at any weight

165
Q

Which progesterone only method of administration can take up to a year before fertility returns?

A

Injectable

166
Q

What are you at high risk of getting in first 20 days of IUD copper implant? What is an alternative?

A

PID

Mirena IUS

167
Q

Name 3 emergency contraceptive devices and up to how long after intercourse they can be used.

A

Levonorgesterel-72hours
Ulipristal (EllaOne)-120hours
IUD

168
Q

How many days after childbirth is contraception needed? What shouldn’t be used if breastfeeding and has been <6weeks?

A

21 days

COCP

169
Q

What 3 contraceptives can be started within 48hrs of childbirth?

A

IUD
IUS
POP

170
Q

How long does lactational amenorrhoea/contraception last?

A

up to 6 months post partum

171
Q

Name 3 specific comps of hysterectomy.

A

bowel and bladder dysfunction
prolapse
early menopause
abscess

172
Q

Which part of the placenta produces B-HCG?

A

syncytiotrophoblast

173
Q

What happens to BP in first and second trimester?

A

drops

174
Q

What happens to maternal breathing during pregnancy and why?

A

hyperventilate-get rid of own and foetus CO2

175
Q

Where to pregnant women feel the pain of appendicitis and why?

A

lower part of RUQ in 3rd trimester due to visceral organ dsiplacement

176
Q

Why are you at inc risk of heartburn, kidney stones, UTI and gallstones during pregnancy?

A

relaxed smooth muscle (GB, urethra, lower oesophageal sphincter)
and inc calcium

177
Q

Which trimester is pruritis most common? What are the 2 differentials?

A

3rd
Polymorphic eruption of pregnancy
obstetric cholestasis

178
Q

What syndrome in the upper limb is common during pregnancy, due to fluid retention?

A

carpal tunnel syndrome

179
Q

What are braxton hicks contractions?

A

high amplitude low frequency contractions during 3rd trimester

180
Q

What do you call the breast milk that is produced in the first 3 days post partum, which contains IgA,M,G and white cells?

A

colostrum

181
Q

Which hormone/neurotransmitter inhibits prolactin?

A

dopamine

182
Q

Which hormone is released to promote milk production in breastfeeding? Where in the pituitary is it made?

A

prolactin

ANTERIOR pituitary

183
Q

Which hormone is released to promote milk ejection in breastfeeding? Where in the pituitary is it made?

A

oxytocin

POSTERIOR pituitary

184
Q

How many antenatal appts does a:

a) nulliparous
b) multiparous woman have?

A

a) 10

b) 7

185
Q

What 3 things are done at all antenatal appointments?

A
  • BP
  • Urine dip
  • symphysiofundal height
186
Q

What supplement should all pregnant women take and for how long?

A

folic acid
400micrograms
up to 12 weeks

187
Q

Name some foods that shouldn’t be eaten during pregnancy.

A

soft cheeses, pate, semi raw eggs (mayo), raw meat

188
Q

What 5 things are done at a booking antenatal appt?

A 
bloods
Urine dip-proteinuria 
BP
BMI
Urine culture
189
Q

When is:

a) chorionic villous sampling
b) amniocentesis done? What does each test for?

A

a) 11-14 weeks-genetic conditions (downs), CF

b) 15 weeks-downs, CF AND neural tube defects

190
Q

How can you prevent haemolytic disease of the newborn? What can be given to pregnant mum IF she is rhesus -ve?

A

IM injection of anti-D antibody

191
Q

What is involved in the combined test for downs?

A 
nuchal translucency (thickened)
B HCG (inc)
Plasma protein A (low)
192
Q

Name 5 situations where it is beneficial to have pregnancy in consultant led obstetric unit.

A
  • hx of VTE
  • hyperthyroid
  • haemoglobinopathies (sickle cell, thalassaemia)
  • HIV/Hep
  • cardiac
  • hypertension
  • diabetes
  • epilepsy
193
Q

Name the 3 methods of pain relief during labour.

A

Entonox-quick acting but can feel nauseous and lightheaded
IM/IV opioid- limited effectiveness, usual SE of resp depression
Epidural/spinal-epidural anaesthesia-can get shivering, dizziness and hypotension

194
Q

What is the normal heart rate of a foetus?

A

110-160

195
Q

Name 3 causes of fetal tachycardia.

A

fetal hypoxia
chorioamnionitis
hyperthyroidism

196
Q

Name 3 causes of fetal bradycardia.

A

cord prolapse
epidural
rapid fetal descent

197
Q

What is a normal baseline variability?

A

5-25

198
Q

What are normal accelerations?

A

inc in baseline of >15bpm for>15secs

199
Q

Are early decelerations normal or abnormal and when do they occur?

A

normal

occur when uterus contracts

200
Q

What does a late deceleration indicate?

A

lack of blood supply to fetus causing hypoxia and acidosis

201
Q

What does a sinusoidal pattern indicate on a CTG? Name 3.

A

severe fetal hypoxia
severe fetal anaemia
haemorrhage

202
Q

What 2 things can be done when there is a pathological CTG?

A

fetal blood sampling

hasten delivery

203
Q

What is very worrying on a CTG. Name the one thing

A

deceleration of over 3 mins

204
Q

Which diagnosis is most likely in a lady presenting with APH with hx of previous C sections?

A

uterine rupture

205
Q

Name 3 important causes of APH. Above how many weeks does it have to occur for it to count as APH?

A

placenta praevia
placental abruption
vasa praevia

> 24weeks

206
Q

Name 3 comps of APH.

A

AKI
DIC
preterm labour

207
Q

Name 4 signs of ectopic pregnancy.

A

initially amenorrhoea for 6-8wks
lower abdo pain
shoulder tip pain
vaginal bleeding

208
Q

Miscarriage: painless vag bleeding <24 weeks-what type is it?

A

threatened

209
Q

Miscarriage: light vag bleeding with dissaperance of pregnancy symptoms-what type is it?

A

missed

210
Q

Miscarriage: heavy vag bleeding with clots-what type is it?

A

inevitable

211
Q

What is the dx?
tense woody uterus
SHOCK out of proportion to visible blood loss

A

placental abruption

212
Q

After 18weeks, more than how many minutes without fetal movement is regarded as abnormal?

A

> 75mins

213
Q

Name 3 cause of reduced fetal movements.

A

alcohol opiates smoking
stillbirth
anterior placenta

214
Q

What 2 meds are given in a medical TOP? Explain role of each

A

mifepristone-blocks progesterone and causes shedding and thinning of endometrium
misoprostol-softens cervix and causes contraction of uterus

215
Q

What is done in a surgical TOP?

A

Widening of cervix
local/GA/local+sedation
suction of contents

216
Q

What is the definitive diagnostic ix of ectopic pregnancy?

A

laparoscopy

217
Q

If serum HCG<1500 and there is no fetal heartbeat due to ectopic, what is given to disrupt cell division and end pregnancy?

A

IM methotrexate

218
Q

If serum HCG>5000 and there is a fetus which could rupture and there is pain, what surgical procedure is done to remove ectopic? a) to preserve fertility b)not bothered about fertility

A

a) salpingotomy

b) salpingectomy

219
Q

What 3 things make you most suspicious of gestational trophoblastic disease/molar pregnancy?

A

uterus large for dates
extremely high B HCG
exaggerated sx of pregnancy-hyperemesis

220
Q

Name 3 rx of gestational trophoblastic disease/molar pregnancy.

A

suction curretage
medical-oxytocin
chemotherapy!

221
Q

Name 3 mx strategies for N+V during pregnancy.

A

dry biscuits
ginger
small, frequent meals

222
Q

Name 5 complications of hyperemesis gravidarum

A 
hyponatraemia
hypokalaemia
acidosis
mallory weis tear
thiamine deficiency and wernickes
223
Q

What ix is the definitive diagnostic ix to diagnose placenta praevia?

A

transvaginal USS

224
Q

Name 4 RF of placenta preavia.

A

prev one
prev c section
advancing age of mum
multiple pregnancy

225
Q

If at 32 weeks, placenta praevia is still present on scan, what is the definitive mx and when is it done?

A

c section 36-38weeks

226
Q

What examination MUST NOT be done in placenta praevia?

A

vaginal examination

227
Q

What is the definitive management of placenta accreta?

A

leave placenta in utero and remove by doing hysterectomy

228
Q

Name 6 causes of rhesus sensitisation.

A 
APH
Amniocentesis/CVS
trauma
ECV
delivery of fetus 
ectopic
miscarriage 
TOP
229
Q

What test is done to determine how much fetal blood has mixed with mothers blood?

A

kleihauers test

230
Q

What is the management of prolonged pregnancy? Name both

A

1) membrane sweep at 41

2) IOL at 42

231
Q

Name 3 causes of oligohydramnios.

A

placental insufficiency
PROM
renal agenesis
obstructive uropathy

232
Q

Name 3 causes of polyhydramnios.

A 
duodenal atresia
oesophageal atresia
diaphragmatic hernia
maternal diabetes
macrosomia
233
Q

Name 2 uses of indomethacin.

A
  • retain water and prevent urination of fetus to prevent polyhydramnios
  • close patent ductus arteriosus
234
Q

Name 4 complications of polyhydramnios.

A

Preterm labour-more pressure on uterus
Abnormal lie-more space for fetus to move
PPH
cord prolapse

235
Q

Which intervention carries increased likelihood of multiple pregnancy?

A

IVF

236
Q

What do you call the condition where twins do not get an equal amount of blood supply in the uterus?

A

twin twin transfusion syndrome

237
Q

Caused by alcohol, what is the condition called that causes brain damage in fetus?

A

fetal alcohol syndrome

238
Q

Name 3 CI of ECV.

A

multiple pregnancy
recent APH
PROM
uterine abnormalities

239
Q

Name 3 comps of ECV

A

Placental abruption
Uterine rupture
Fetal distress

240
Q

What abx should all mothers with PROM recieve?

A

erythromycin

241
Q

What is the main infection you are worried about in PROM? What is the management?

A

chorioamnionitis

delivery of foetus and IV abx for mother

242
Q

Name 3 methods of IOL.

A

Membrane sweep
Vag prostaglandins (pessary, oral or gel)
amniotomy+/-oxytocin

243
Q

Name 2 1st line drugs used in primary PPH.

A

Syntocinon (synth oxytocin)

ergometrine

244
Q

Name 3 non pharmacological mx strategies of primary PPH.

A

bimanual compression
uterine artery ligation
hysterectomy
balloon tamponade

245
Q

How soon after labour does primary PPH occur?

A

<24hours

246
Q

Name 2 causes of secondary PPH. What timeframe does secondary PPH occur?

A

infection-endometritis

retained products

247
Q

Name 4 ix done in secondary PPH and why.

A

Blood cultures and swabs for infection
speculum
USS for retained products

248
Q

What condition can a newborn get after a c section?

A

transient tachypnoea of newborn

249
Q

Name 2 CI’s of VBAC.

A

prev uterine rupture

classical incision

250
Q

Name 2 comps of VBAC.

A

Risk of uterine rupture

Risk of anal sphincter injury

251
Q

Name 3 RF for tears during vag birth.

A

shoulder dystocia
macrosomia
forceps
primigravida mother

252
Q

Name 3 RF for shoulder dystocia.

A 
macrosomia
prev dystocia
maternal diabetes
IOL
Prolonged labour
253
Q

Name 3 mx strategies for shoulder dystocia.

A

mcroberts manouvre- hyperflex maternal hips+apply suprapubic pressure
corkscrew manouvre- grasp post arm and rotate shoulders
Fracture clavicle
cut pubic symphysis
return foetus for c section

254
Q

Name 3 RF for cord prolapse.

A

polyhydramnios
PROM
breech
long cord

255
Q

What is tocolysis? Give a drug example. When is it used?

A

prevention of uterine contraction
terbutaline
cord prolapse

256
Q

What is the mx of cord prolapse?

A

knee to chest position and lift cord up

emergency c section

257
Q

Name 3 RF for uterine rupture.

A

prostaglandins
c section
multiple pregnancy

258
Q

What is the mx of amniotic fluid embolus and why?

A

resuscitation

presents too similarly to PE, eclampsia, sepsis

259
Q

Name 3 causes of puerperal pyrexia.

A

endometritis
wound infection
mastitis
VTE

260
Q

What medication do you start from 12 weeks to birth, in a pregnant lady with hypertension?

A

aspirin 75mg daily

261
Q

If pre existing HTN before pregnancy, and pt on ACE-i/ARB, what needs to be done?

A

switch to labetalol as ACE-i/ARB bad for foetus

262
Q

Name 2 CI’s of labetelol and 3 SE’s.

A

CI:
-asthma
-cardiogenic shock
SE: Postural hypotension, headache, N+V

263
Q

Name 2 CI’s of nifedipine and 3 SE’s.

A

CI:
-aortic stenosis
-angina
SE: oedema, dizziness, flushing

264
Q

What BP makes you very worried in pre eclampsia?

A

160/110

265
Q

What is the pathophys of pre eclampsia?

A

lack of remodelling of spiral arteries leading to high resistance low flow system

266
Q

Name 4 sx of pre eclampsia.

A 
Often asymptomatic
Facial swelling
Vomiting
Frontal headache
severe epigastric pain
267
Q

Name 3 foetal and 3 maternal comps of pre eclampsia.

A

Foetal- IUGR, prematurity, hypoxia

Maternal-eclampsia, placental abruption, AKI, DIC, haemorrhage

268
Q

Name the 1st and 2nd line drugs used in pre eclampsia. What is the choice of VTE prophylaxis?
If a foetus needs delivering at <34 weeks, what should be given and why?

A

labetelol
nifedipine
Methyldopa

LMWH

IM steroids to assist fetal lung maturation

269
Q

What kind of seizures do you see in eclampsia?

A

tonic clonic

270
Q

How do you treat eclampsia?

A

magnesium sulphate

271
Q

What does HELLP stand for?

A

Haemolysis
Elevated liver enzymes
Low platelets

272
Q

Name 3 sx of HELLP.

A 
RUQ pain
N+V
tiredness
headache
vision problems
273
Q

Name 3 maternal comps of diabetes during pregnancy.

A

Pre eclampsia risk
injury from delivering big baby
CVS risk
Worsening retinopathy+nephropathy

274
Q

Name 3 foetal comps of diabetes during pregnancy.

A

Pre term
Miscarriage/stillbirth
TTN
Risk of diabetes in later life

275
Q

If a foetus from a diabetic mother comes out hypotonic, floppy, fitting or with LOC, what should you give and why?

A

IV dextrose for hypoglycaemia

276
Q

Which anti diabetic drug is safe to use in breastfeeding?

A

metformin

277
Q

If pt is on oral hypoglycaemics during pregnancy for diabetes, what should they be on instead?

A

only metformin and insulin

278
Q

What is the ix of choice when screening for gest diabetes? Above what number is abnormal?

A

oral glucose tolerance test

7.8mmol/l

279
Q

In pregnancy, what presents with intense itching, jaundice, pale stools and dark urine?

A

obstetric cholestasis

280
Q

Name 4 mx steps of obstetric cholestasis.

A

delivery of foetus
top antihistamine
ursodeoxycholic acid
Vit K

281
Q

When is a pregnant woman at highest risk of VTE?

A

post partum

282
Q

Is D dimer a useful test for VTE in pregnant lady?

A

no bc d dimer already elevated in pregnancy

283
Q

Which condition may present itself during pregnancy? How do you treat? Name the 2.

A

thalassaemia-folate and blood transfusion

284
Q

What 2 rx do you give in sickle cell during pregnancy?

A

folate and iron

285
Q

Name 2 effects of anaemia on pregnancy.

A

low birth weight

prematurity

286
Q

What should newborn babies be given at birth in mothers who are epileptic?

A

1mg vit K to prevent haemorrhage

287
Q

Are anti epileptic drugs safe during breast feeding?

A

yes!

288
Q

If an epileptic lady has a seizure during the 2nd half of pregnancy, what must you check for?

A

eclampsia!!

289
Q

Name 3 features of fetal anticonvulsant syndrome (children exposed to valproate and carbamezepine).

A

thin upper lip
triangular forehead
micrognathia
medial deficiency of eyebrow

290
Q

What is the ideal rx of choice for depression during pregnancy?

A

CBT

291
Q

Having a low BMI during depression, what 3 things may occur during pregnancy?

A

low birth weight
prematurity
Anaemia

292
Q

If a mother is anxious, tearful and irritable during the first few days after birth (most commonly after first child), what is the likely diagnosis?

A

baby blues

293
Q

Within how many months after birth does post natal depression occur?

A

<12months

294
Q

If a mother has severe mood swings and disordered perception during first few weeks after giving birth, what is the likely dx?

A

postnatal psychosis

295
Q

What is the recommended SSRI of choice in breastfeeding women?

A

paroxetine

296
Q

Name 3 situations that may inc risk of mother-foetus HIV transmission.

A

PROM
vag delivery
instrumental delivery

297
Q

Name 3 mx strategies of maternal HIV during pregnancy.

A

Antiretrovirals
Plannes c-section
Avoid breastfeeding

298
Q

Name 2 features of the vaginal discharge in:

  • candida
  • trichomonas vaginalis
  • bacterial vaginosis
A
  • curd like, non offensive
  • yellow, frothy, offensive discharge, strawberry cervix
  • thin, fishy, white/grey discharge
299
Q

Name 2 features of the vaginal discharge in:

  • gonorrhoea
  • chlamydia
  • foreign body
  • ectropion
  • cervical ca
A
  • thin, watery, yellow
  • thick, copious amounts of purulent discharge
  • offensive, bloody discharge
  • inc amount of normal
  • persistent, not responding to rx
300
Q

Name 3 RF of STI’s.

A

<25years old
New partner
Unprotected sex

301
Q

Which STI’s can affect the eyes?

A

chlamydia and gonorrhoea can cause conjunctivitis

302
Q

Name 3 presentations of chlamydia and gonnhoroea in females.

A

dysuria
pelvic pain
discharge

303
Q

Name 3 presentations of chlamydia and gonorrhoea in males.

A 
dysuria
discharge
testicular pain (chlamydia)
epididymal pain (gonorrhoea)
304
Q

Name 2 possible abx for rx of chlamydia.

A

azithromycin one off dose

doxycycline 7 days

305
Q

Name the initial rx of choice in gonorrhoea.

A

IM ceftriaxone

306
Q

Name 3 comps of chlamydia.

A

reactive arthritis
PID
epididymo-orchitis

307
Q

Who should be contacted in chlamydia for:

a) symptomatic men
b) women and asymptomatic men

A

a) partners from 4 weeks preceding sx

b) partners from last 6 months

308
Q

Who should be contacted in gonorrhoea for:

a) symptomatic men
b) women and asymptomatic men

A

HALF of chlamydia times

a) partners from 2 weeks preceding sx
b) partners from last 3 months

309
Q

Name the organism in syphilis.

A

treponema pallidum

310
Q

What is a chancre in syphilis?

A

painless genital ulcer

311
Q

What is the treatment of syphilis?

A

benzathine penicillin

312
Q

What is the reaction to syphilis treatment called that leads to fever, chills, headache and myalgia?

A

Jarisch Herxheimer

313
Q

Which organism causes genital warts? how is it trasmitted?

A

human papilloma virus 11 and 16

skin to skin contact

314
Q

Name 3 mx of genital warts.

A

cryotherapy/excision for few

cream for many-podophyllotoxin/imiquimod

315
Q

What organism causes genital herpes?

A

herpes simplex virus

316
Q

Which HSV causes:

a) genital+cold sores
b) genital+anal

A

a) HSV 1

b) HSV 2

317
Q

Name 2 features of genital herpes. What is the rx?

A

painful
itchy
oral aciclovir

318
Q

If a pregnant lady acquires genital herpes in trimester 3, what is the mx option of choice?

A

c section bc no maternal abx present

319
Q

Name 3 ix done in men and women to test for trichomonas.

A

high vaginal women

urethral swab/first void urine in men

320
Q

What is the mx medication of choice in trichomonas? What other condition uses this treatment?

A

metronidazole

bacterial vaginosis

321
Q

What cells are seen on microscopy in bacterial vaginosis?

A

clue cells

gardnerella vaginalis

322
Q

How do you treat candida during pregnancy?

A

intravaginal cream OR pessary

clotrimazole

323
Q

Name 2 at risk groups for HIV.

A

MSM
IV drug users
unprotected intercourse with partner from africa

324
Q

What determines whether prophylactic rx is needed in HIV

A

CD4 count

325
Q

How can you manage HIV during pregnancy?

A

ART during
ART for newborn
c section
no breastfeeding

Final year (8 decks)

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