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
2
Q
Name 4 causes of hypotonia in an infant.
A
Prader willi
Neonatal sepsis
hypothyroidism
Maternal drug use/myasthenia gravis
3
Q
What is the most common heart defect seen in downs, edwards and pataus? What kind of murmur is seen?
A
VSD (pansystolic)
4
Q
Why shouldn’t children take aspirin? What is the one exception?
A
Risk of reye’s syndrome
Kawasaki disease
5
Q
Which disease causes a strawberry tongue? Name 4 other symptoms.
A
Scarlet fever Fever Rash Sore throat Swollen lymph nodes
6
Q
How long does a patient have to wait before becoming pregnant, after being on methotrexate?
A
6 months
7
Q
What should be prescribed with methotrexate and when is it taken?
A
folic acid
taken at least 24hrs after treatment
8
Q
Is risk of colorectal ca higher in crohns or UC?
A
UC
9
Q
What is seen on endoscopy with crohn’s vs UC?
A
Crohn’s- cobblestone appearance
UC-Pseudopolyps
10
Q
What other disease are UC patients at risk of getting?
A
primary sclerosing cholangitis
11
Q
After what does subacute (De Quervain’s) thyroiditis occur? Is it hyper or hypothyroidism?
A
viral infection
Hyperthyroidism
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
13
Q
Name 4 drug causes of a prolonged QT interval.
A
amiodarone TCA SSRI's (citalopram mainly) erythromycin haloperidol ondansetron
14
Q
Name 4 non drug causes of prolonged QT interval.
A
hypocalcaemia hypokalamia hypomagnesaemia acute MI hypothermia SAH
15
Q
Which zone of the lung does idiopathic lung fibrosis/SLE affect?
A
lower zones
16
Q
Name 4 causes of upper zone pulmonary fibrosis.
A
TB
hypersensitivity pneumonitis/extrinsic allergic alveolitis
sarcoidosis
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
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
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
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
21
Q
What does the CRAB mnemonic stand for in multiple myeloma?
A
Calcium (hyper)
Renal failure
Anaemia
Back pain (bone lesions)
22
Q
What are 2 ix you can do for multiple myeloma?
A
U&E FBC Calcium Protein Electrophoresis Bone scan Bone marrow biopsy
23
Q
Name 2 treatments of mult myeloma.
A
chemotherapy/supportive
bone marrow transplant
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
25
What kind of lymphoma can malaria cause?
Burkitt's
26
What condition leads to miscarriages in women with it being the cause of many DVT's in under 50's?
anti phospholipid syndrome-more common in females
27
Name 4 causes of hyposplenism.
sickle cell
coeliac disease
SLE
splenectomy
28
What do you see on a blood film with splenectomy/hyposplenism. What does this show?
howell-jolly bodies
RBC with nuclear remnants
29
Which condition shows an isolated rise in Hb levels? Name the mutation.
Polycythaemia Vera
JAK2
30
Name 4 features of polycythaemia vera.
```
Pruritis
hyperviscosity
splenomegaly
plethora
haemorrhage
```
31
Name 4 features of polycythaemia vera.
```
Pruritis
hyperviscosity
splenomegaly
plethora
haemorrhage
```
32
What nose symptom is associated with acne rosacea?
rhinopyma
33
What happens in a factor 5 leiden mutation?
protein C resistance therefore factor 5 broken down much more slowly
34
What 3 functions does the DCML pathway have?
Fine touch
Proprioception
Vibration
35
What 3 functions does the spinothalamic pathway have?
Pain
Temp
Crude touch
36
Name 2 extrapyramidal motor pathways.
tectospinal
rubrospinal
vestibulospinal
reticulospinal
37
Which 2 types of arrhythmia usually recover from vagal manouveres?
AVRT/AVNRT
38
Infarct of which artery in MI causes bradycardia?
RCA
39
What is the mode of action of dabigatran?
inhibits thrombin
40
Name 3 symptoms seen in Budd Chairi syndrome.
abdo pain, hepatomegaly, ascites due to blockage of hepatic vein
41
Name the mechanism of adenosine.
Blocks conduction at AV node
42
What is WPW an example of?
AVRT
43
Name 3 causes of scarring baldness (i.e. non reversible hair loss within follicle).
chronic discoid lupus
lichen planus
lichen sclerosus
scleroderma
neoplasm
burns
infections
44
Name 1 cause of non scarring baldness (i.e. preservation of follicles).
alopecia areata
telogen effluvium
androgenic alopecia
45
What is telogen effluvium?
hair loss caused by stress, shock or traumatic event
46
Does alopecia areata only affect the scalp?
no, can affect any hair area-armpits, eyebrows
47
what test is done to determine if hair loss is abnormal?
pull test (clump of hair tugged-if more than 6 hairs come out, this is +ve)
48
name 2 lab tests done in alopecia.
TFT
| ferritin
49
Name 3causes of intra epidermal blistering.
```
chickenpox
eczema
impetigo
herpes simplex+zoster
pemphigus
scabies
```
50
What virus is chickenpox caused by?
varicella zoster
51
What happens if latent VZV is reactivated?
person will get shingles (herpes zoster)
52
what is given to immunocompromised pts, neonates and pregnant women as prophylaxis against chicken pox?
varicella zoster immunoglobulin (VZIG)
53
What is the rx of chicken pox?
paracetemol
NSAIDS
Aciclovir
54
Name 3 complications of chicken pox.
```
pneumonia
cerebellar ataxia
encephalitis
pulm and GI bleeding
cerebral haemorrhage
```
55
What is a complication of eczema caused by a virus?
eczema herpeticum
| caused by herpes simplex
56
What SPECIFIC virus causes cold sores commonly around mouth and nares and is spread by salivary contact?
herpes simplex virus 1
57
What SPECIFIC virus causes sores on genitals and is spread by genital contact?
herpes simplex 2
58
What is the disease called that causes painful dermatomal rash, facial paralysis and hearing loss on affected side?
RAMSAY HUNT AKA-herpes zoster oticus-shingles affecting facial nerve
59
Name 2 topical abx used to treat limited impetigo.
fusidic acid and mupirocin
60
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?
pemphigus vulgaris
61
What AI condition causes large itchy blisters/bullae in basement membrane of skin?
bullous pemphigoid
62
What cream is used to treat scabies?
permethrin cream
63
Name 3 features of Pataus and what trisomy is it?
Microcephalic
Cleft lip/palate
Polydactyly
trisomy 13
64
Name 3 features of Edwards and what trisomy is it?
Micrognathia
Rocker bottom feet
Low set ears
Overlapping fingers
trisomy 18
65
Name 3 features of fragile x.
Macrocephaly
Large ears
Macro-orchidism
66
Name 3 features of Noonan syndrome.
webbed neck
pectus excavatum
short stature
pulmonary stenosis
67
Name 3 features of William syndrome.
short
learning difficulties
friendly extrovert
68
Name 3 causes of kussmauls sign and what is this sign?
```
inc JVP on inspiration
Seen in restrictive RV filling
Constrictive pericarditis
Right MI
Right HF
Massive PE
```
69
What causes pulsus paradoxus and explain what this means.
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)
70
What is the medical treatment of a prolactinoma?
dopamine agonist-bromocriptine
Inhibits release of prostaglandin
71
Name 4 management measures to prevent further stroke/TIA.
Antihypertensives
Statins/ezetimibe
Aspirin/clopidogrel
Lifestyle
72
If a carotid artery is blocked>50% what surgery is done?
carotid endarterectomy (remove clot)
73
Name some symptoms that you might see in a lacunar infarct. Name 4.
```
pure motor stroke
sensorimotor stroke
clumsiness
hemiballismus (flinging limbs)
pure motor
```
74
In OBSGYN hx what should you ask about in:
a) menstrual hx
b) obstetric hx
c) gynae hx
d) 2 other important topics
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
75
What is the role of inhibin? What is it made by and why?
Made by corpus luteum and selectively inhibits FSH-prevents formation of any follicles!!
76
Name 8 causes of acute pelvic pain.
```
Mittleschmerz
UTI
Dysmenorrhoea
Ovarian torsion
PID
Appendicitis
Ectopic pregnancy
Miscarriage
```
77
Name 6 causes of chronic pelvic pain.
```
Endometriosis
IBS
Ovarian cyst
Psychological
Adhesions
Urogenital prolapse
```
78
Name an example of a GNRH agonist used in prostate, breast ca, endometriosis, fibroids and cyclical pain.
goserelin aka zoladex
79
Name 4 ix that you might consider in pelvic pain.
```
USS
pregnancy test
vaginal swabs
MSU
Laparoscopy
```
80
Name 4 causes of post coital bleeding.
```
50% unknown
30% Ectropion (more common in COCP users)
cervical cancer
cervical polyps
trauma
cervicitis
```
81
Name 4 causes of intermenstrual bleeding.
```
ectropion
missed pill
fibroids
cervical or endometrial polyps
physiological spotting
pregnancy related
cervicitis
endometrial ca
```
82
What is tested for in:
a) endocervical NAAT swabs
b) high vaginal charcoal swabs
a) chlamydia and gonorrhoea
| b) bact vaginosis, candida, trichomonas, GBS
83
What is the dx until proven otherwise in post menopausal bleeding/early menopause/prim ovarian failure? (bleeding after 12 months of amenorrhoea.
endometrial cancer
84
How is menopause confirmed?
no bleeding for more than 12months/1 year
85
What cancer does the tumour marker CA-125 indicate?
ovarian cancer
86
Name 4 causes of post menopausal bleeding.
Common:
Vaginal atrophy
HRT
ENDOMETRIAL CA
Trauma
Polyps
vaginal/cervical/ovarian ca
Endometrial hyperplasia
87
Over how many mm of endometrial thickness makes endometrial cancer likely? What is the diagnostic ix?
>5mm
Pipelle/hysteroscopic biopsy
88
Name 5 vulval/labial masses.
bartholin cyst/abcess
Vulval carcinoma
Bartholins tumour/carcinoma
fibroma/lipoma/leiomyoma
89
When do you refer to gynae for ovarian cyst. Name 4.
multilocular (more likely to be malignant
post menopause (abnormal)
>5cm
Symptomatic
90
Name 3 features of a lipoma.
soft, moveable and painless
91
Name 2 causes of primary dysmenorrhoea.
spiral artery vasospasm
| myometrium contraction
92
Name 4 RF for prim dysmenorrhoea.
nulliparity
menorrhagia
smoking
early menarche
93
Name 3 rx for dysmenorrhoea.
mefanemic/tranexamic acid
COCP
IUS
94
Name 5 causes of primary amenorrhoea.
```
imperforate hymen
genetic
congenital adrenal hyperplasia
turners syndrome
excessive exercise/low weight
```
95
Name 5 causes of secondary amenorrhoea.
```
exercise/low weight
pregnancy!!
ashermans syndrome
PCOS
premature ovarian failure
Chronic conditions (e.g. thyroid)
Pituitary-prolactinoma, other
```
96
What 5 points are crucial to cover with a p/c of amenorrhoea
```
eating/exercise habits
any acne/hirsuitism
pregnancy?
gynae hx
FH
ANy galactorrhoea (r/o prolactinoma)
menstrual hx
```
97
Name 6 ix for amenorrhea.
```
pregnancy test
FSH/LH
androgen level
Insulin level
BMI
Prolactin levels
Thyroid
Pelvic USS
```
98
Name 4 rx for amenorrhoea.
```
metformin in PCOS
COCP/POP to regulate periods
hormone replacement
manage weight
Surgery for hymen
```
99
What do you call the dx when you cannot find a cause for the menorrhagia?
dysfunctional uterine bleeding
100
Name 5 causes of menorrhagia.
```
polyps
fibroids
adenomyosis
copper system
hyper/hypothyroidism
abnormal clotting disorders
```
101
Name 5 steps in assessing a lady with menorrhagia.
```
FBC for anaemia
Abdo exam
pelvic/bimanual
clotting studies
speculum
TV USS
```
102
Name 4 mx options in menorrhagia.
Mirena (IUS)
COCP
Tranexamic acid
Progesterone (oral/implant/depot)
Uterine ablation
Hysterectomy
103
Why do you get a rise in FSH during menopause?
Reduced follicle count means no inhibin is produced to stop FSH rising
104
What 2 major conditions are associated with menopause bc of lack of oestrogen?
inc VTE risk (Stroke etc)
| osteoporosis
105
Name 3 lifestyle changes that could be implemented in menopause.
stop smoking alcohol caffeine
inc weight loss
exercise
calcium supplements
106
Name rx for menopause in women with and w/o uterus
oestrogen+progesterone
| oestrogen alone
107
What preparation of oestrogen can cause VTE risk in menopause rx?
oral not transdermal (so opt for transdermal in those with VTE risk)
108
Name 3 SE of taking:
a) progesterone
b) oestrogen in menopause
a) weight gain, fluid retention, mood swings, pelvic pain
| b) bloating, cramps, breast tenderness
109
When are you at risk of breast ca during menopause?
if you take oestrogen and progesterone
110
Name 3 benefits of HRT.
reduced risk of CVS disease and osteoporosis
Improved mood, urogenital, vasomotor (hot flushes, sweats)
reduced risk of colorectal ca
111
Name some causes of urogenital prolapse in:
a) ant compartment
b) middle
c) post
a) urethrocele, cystocele or both
b) vaginal, uterus!!, enterocele (pouch of douglas and small intestine)
c) rectocele
112
Name 3 RF of prolapse.
```
obesity
constipation
obstetric-multiparity, vaginal birth, inc birth weight, prolonged delivery
inc age
heavy lifting
```
113
How do you examine a pt with urogenital prolapse.
standing-strain and cough
| left lateral position
114
Name 5 rx of urogenital prolapse.
Lifestyle-weight loss, pelvic floor exercise,smoking, rx constipation/cough
```
Vag oestrogen cream
vaginal pessary
colporrhapy (strengthen muscles by tightening)
colposuspension
hysterectomy
sacrohysteropexy
```
115
Name 4 RF for urinary incontinence.
Inc age
vag delivery
obesity
forceps
UTI
heavy babies
stool impaction
116
Name 3 rx for urge incontinence.
reduce caffeine, lose weight
bladder train
meds: oxybutynin (muscarinic antagonist) and tolterodine
BOTOX-SE: urinary retention=catheter, UTI
desmpressin for nocturnal symptoms
117
Name 2 rx for stress incontinence.
pelvic floor exercise
surgery: colposuspension, urethral sling
bulking agents
Last line: duloxetine
118
What is the most common type of cervical cancer?
squamous cell carcinoma
119
Name the 3 cancers that most commonly metastasise to bone.
breast lung prostate
120
What is the main RF for cervical ca?
persistent HPV infection
121
When is a cervical smear taken after pregnancy?
3 months after
122
When do you NOT refer for colposcopy in cervical ca?
when there is only mild dyskaryosis and HPV test is -ve
123
What happens if a cervical smear is inadequate?
repeat 3 times and if still inadequate, colposcopy
124
Name 2 bizarre protective factors against endometrial ca.
COCP
| smoking
125
Name 4 sx of ovarian cancer.
Decreased appetite/full quickly
bloating/abdo pain
urinary frequency/urgency
vag bleeding
126
Name a cancerous RF for endometrial ca and ovarian ca.
hereditary non polyposis colorectal ca
127
Name 2 genetic RF for ovarian ca.
HNPCC
| BRCA1&2
128
Name the mx of ovarian ca.
oophorectomy+hysterectomy and chemo
129
What age group commonly get vulval cancer?
elderly over 75
130
Name 3 RF for vulval ca. How do you diagnose?
lichen sclerosus
HPV
VIN
Examine and biopsy
131
What do you call this comp of having fibroids:
| -bleeding into fibroid with vomiting, pain and fever.
red degeneration
132
Name 3 sx of having fibroids.
menorrhagia
pelvic pain
infertility
133
What imaging is done to diagnose fibroids?
abdo USS
134
Name 3 mx techniques for fibroids.
```
mirena/COCP/tranexamic-menorrhagia+pain
GnrH agonist-reduce size
myomectomy
hysterectomy
uterine a. embolisation
```
135
Name some sx of endometriosis.
```
cyclical pelvic pain
dysmenorrhoea
dyspareunia
dysuria
subfertility
```
136
What 3 things can be seen on laparoscopy of endometriosis.
chocolate cysts
kissing ovaries
adhesions
137
Name 3 mx strategies for endometriosis.
hysterectomy
analgesia
COCP/progesterone/IUD to suppress ovulation
laser ablation (always returns tho)
138
What is adenomyosis? Name 4 sx.
```
endometrial tissue invading into myometrium
menorrhagia
dysmenorrhoea
pelvic pain
deep dyspareunia
irregular bleeding
```
139
Who gets adenomyosis?
multiparous women as it occurs after trauma in delivery
140
What is the curative mx of adenomyosis?
hysterectomy
141
Cervical polyps usually asymptomatic-however what sx can it show?
any dysfunctional bleeding-inter menstrual, post coital, menorrhagia, post menopausal
142
What is the mx of polyps and why?
removal-can undergo metaplastic change
143
Who is most likely to get ectropian?
pregnancy
| those on COCP
144
How do pts with ectropian present?
discharge(due to glandular columnar epithelium)
| post coital bleeding (vascular)
145
Name 3 rx of ectropian IF symptomatic.
stop COCP
laser ablation
cryotherapy
diathermy
146
Name 2 features seen in PCOS.
excess androgens
| multiple cysts
147
How do pts with PCOS present? Name 6
```
oligo/amenorrhoea
infertility
hirsuitism
male pattern baldness
chronic pelvic pain
obesity
depression
acanthosis nigricans
Acne
```
148
what drug is used in PCOS to help with fertility? Name 2 drawbacks
clomifene induces ovulation
multiple pregnancy
ovarian hyperstimulation
149
What is the fx of bartholin glands?
secrete mucus to lubricate vagina
150
A bartholin ccyst is a clinical dx in all but which situation?
>40y/o do a biopsy to exclude vulval cancer
151
What is the rx for bartholin cyst? Name 2 and explain their mechanism.
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
Name 3 ddx of lichen sclerosis.
candida
vitiligo
VULVAL ca
153
What is the mx of lichen sclerosis? What are pts at risk of getting in chronic cases?
top steroids
| squamous cell ca
154
What is a dermoid cyst/mature teratoma lined with? What is likely to happen with this ovarian cyst?
epithelial cells
| cause TORSION
155
What is another name for endometrioma?
chocolate cyst seen in endometriosis
156
Name 3 sx some may find in ovarian cyst.
dull ache in abdo
back pain
voiding problems if pressing on bladder etc
dyspareunia
157
Name 4 comps of ovarian cysts.
torsion
rupture
haemorrhage
infertility
158
Name 3 ix done in ovarian cysts.
TVUSS
needle aspiration of cyst
bloods-b HCG, AFP, LDH
159
Name 2 mx options for ovarian cysts.
1. watchful waiting-may regress after 3 menstrual cycles
| 2. surgical resection-cystectomy/oophorectomy depending on fertility wishes
160
Name 2 mechanisms of COCP.
- decreases LH and FSH so prevents ovulation
| - thickens cervical mucus
161
Name 3 CI of COCP.
```
hx of VTE and IHD
uncontrolled HTN
smoking >15 a day
breast ca
breastfeeding<6 weeks post partum
```
162
Name 2 alternative routes of administration for COCP apart from oral.
transdermal
| vaginal ring
163
Name 3 SE of COCP.
breast tenderness
mood swings
breakthrough bleeding
164
When shouldn't you use the progesterone only PILL? WHat can be used instead?
weight>70kg
| Implant is fine at any weight
165
Which progesterone only method of administration can take up to a year before fertility returns?
Injectable
166
What are you at high risk of getting in first 20 days of IUD copper implant? What is an alternative?
PID
| Mirena IUS
167
Name 3 emergency contraceptive devices and up to how long after intercourse they can be used.
Levonorgesterel-72hours
Ulipristal (EllaOne)-120hours
IUD
168
How many days after childbirth is contraception needed? What shouldn't be used if breastfeeding and has been <6weeks?
21 days
COCP
169
What 3 contraceptives can be started within 48hrs of childbirth?
IUD
IUS
POP
170
How long does lactational amenorrhoea/contraception last?
up to 6 months post partum
171
Name 3 specific comps of hysterectomy.
bowel and bladder dysfunction
prolapse
early menopause
abscess
172
Which part of the placenta produces B-HCG?
syncytiotrophoblast
173
What happens to BP in first and second trimester?
drops
174
What happens to maternal breathing during pregnancy and why?
hyperventilate-get rid of own and foetus CO2
175
Where to pregnant women feel the pain of appendicitis and why?
lower part of RUQ in 3rd trimester due to visceral organ dsiplacement
176
Why are you at inc risk of heartburn, kidney stones, UTI and gallstones during pregnancy?
relaxed smooth muscle (GB, urethra, lower oesophageal sphincter)
and inc calcium
177
Which trimester is pruritis most common? What are the 2 differentials?
3rd
Polymorphic eruption of pregnancy
obstetric cholestasis
178
What syndrome in the upper limb is common during pregnancy, due to fluid retention?
carpal tunnel syndrome
179
What are braxton hicks contractions?
high amplitude low frequency contractions during 3rd trimester
180
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?
colostrum
181
Which hormone/neurotransmitter inhibits prolactin?
dopamine
182
Which hormone is released to promote milk production in breastfeeding? Where in the pituitary is it made?
prolactin
| ANTERIOR pituitary
183
Which hormone is released to promote milk ejection in breastfeeding? Where in the pituitary is it made?
oxytocin
| POSTERIOR pituitary
184
How many antenatal appts does a:
a) nulliparous
b) multiparous woman have?
a) 10
| b) 7
185
What 3 things are done at all antenatal appointments?
- BP
- Urine dip
- symphysiofundal height
186
What supplement should all pregnant women take and for how long?
folic acid
400micrograms
up to 12 weeks
187
Name some foods that shouldn't be eaten during pregnancy.
soft cheeses, pate, semi raw eggs (mayo), raw meat
188
What 5 things are done at a booking antenatal appt?
```
bloods
Urine dip-proteinuria
BP
BMI
Urine culture
```
189
When is:
a) chorionic villous sampling
b) amniocentesis done? What does each test for?
a) 11-14 weeks-genetic conditions (downs), CF
| b) 15 weeks-downs, CF AND neural tube defects
190
How can you prevent haemolytic disease of the newborn? What can be given to pregnant mum IF she is rhesus -ve?
IM injection of anti-D antibody
191
What is involved in the combined test for downs?
```
nuchal translucency (thickened)
B HCG (inc)
Plasma protein A (low)
```
192
Name 5 situations where it is beneficial to have pregnancy in consultant led obstetric unit.
- hx of VTE
- hyperthyroid
- haemoglobinopathies (sickle cell, thalassaemia)
- HIV/Hep
- cardiac
- hypertension
- diabetes
- epilepsy
193
Name the 3 methods of pain relief during labour.
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
What is the normal heart rate of a foetus?
110-160
195
Name 3 causes of fetal tachycardia.
fetal hypoxia
chorioamnionitis
hyperthyroidism
196
Name 3 causes of fetal bradycardia.
cord prolapse
epidural
rapid fetal descent
197
What is a normal baseline variability?
5-25
198
What are normal accelerations?
inc in baseline of >15bpm for>15secs
199
Are early decelerations normal or abnormal and when do they occur?
normal
| occur when uterus contracts
200
What does a late deceleration indicate?
lack of blood supply to fetus causing hypoxia and acidosis
201
What does a sinusoidal pattern indicate on a CTG? Name 3.
severe fetal hypoxia
severe fetal anaemia
haemorrhage
202
What 2 things can be done when there is a pathological CTG?
fetal blood sampling
| hasten delivery
203
What is very worrying on a CTG. Name the one thing
deceleration of over 3 mins
204
Which diagnosis is most likely in a lady presenting with APH with hx of previous C sections?
uterine rupture
205
Name 3 important causes of APH. Above how many weeks does it have to occur for it to count as APH?
placenta praevia
placental abruption
vasa praevia
>24weeks
206
Name 3 comps of APH.
AKI
DIC
preterm labour
207
Name 4 signs of ectopic pregnancy.
initially amenorrhoea for 6-8wks
lower abdo pain
shoulder tip pain
vaginal bleeding
208
Miscarriage: painless vag bleeding <24 weeks-what type is it?
threatened
209
Miscarriage: light vag bleeding with dissaperance of pregnancy symptoms-what type is it?
missed
210
Miscarriage: heavy vag bleeding with clots-what type is it?
inevitable
211
What is the dx?
tense woody uterus
SHOCK out of proportion to visible blood loss
placental abruption
212
After 18weeks, more than how many minutes without fetal movement is regarded as abnormal?
>75mins
213
Name 3 cause of reduced fetal movements.
alcohol opiates smoking
stillbirth
anterior placenta
214
What 2 meds are given in a medical TOP? Explain role of each
mifepristone-blocks progesterone and causes shedding and thinning of endometrium
misoprostol-softens cervix and causes contraction of uterus
215
What is done in a surgical TOP?
Widening of cervix
local/GA/local+sedation
suction of contents
216
What is the definitive diagnostic ix of ectopic pregnancy?
laparoscopy
217
If serum HCG<1500 and there is no fetal heartbeat due to ectopic, what is given to disrupt cell division and end pregnancy?
IM methotrexate
218
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) salpingotomy
| b) salpingectomy
219
What 3 things make you most suspicious of gestational trophoblastic disease/molar pregnancy?
uterus large for dates
extremely high B HCG
exaggerated sx of pregnancy-hyperemesis
220
Name 3 rx of gestational trophoblastic disease/molar pregnancy.
suction curretage
medical-oxytocin
chemotherapy!
221
Name 3 mx strategies for N+V during pregnancy.
dry biscuits
ginger
small, frequent meals
222
Name 5 complications of hyperemesis gravidarum
```
hyponatraemia
hypokalaemia
acidosis
mallory weis tear
thiamine deficiency and wernickes
```
223
What ix is the definitive diagnostic ix to diagnose placenta praevia?
transvaginal USS
224
Name 4 RF of placenta preavia.
prev one
prev c section
advancing age of mum
multiple pregnancy
225
If at 32 weeks, placenta praevia is still present on scan, what is the definitive mx and when is it done?
c section 36-38weeks
226
What examination MUST NOT be done in placenta praevia?
vaginal examination
227
What is the definitive management of placenta accreta?
leave placenta in utero and remove by doing hysterectomy
228
Name 6 causes of rhesus sensitisation.
```
APH
Amniocentesis/CVS
trauma
ECV
delivery of fetus
ectopic
miscarriage
TOP
```
229
What test is done to determine how much fetal blood has mixed with mothers blood?
kleihauers test
230
What is the management of prolonged pregnancy? Name both
1) membrane sweep at 41
| 2) IOL at 42
231
Name 3 causes of oligohydramnios.
placental insufficiency
PROM
renal agenesis
obstructive uropathy
232
Name 3 causes of polyhydramnios.
```
duodenal atresia
oesophageal atresia
diaphragmatic hernia
maternal diabetes
macrosomia
```
233
Name 2 uses of indomethacin.
- retain water and prevent urination of fetus to prevent polyhydramnios
- close patent ductus arteriosus
234
Name 4 complications of polyhydramnios.
Preterm labour-more pressure on uterus
Abnormal lie-more space for fetus to move
PPH
cord prolapse
235
Which intervention carries increased likelihood of multiple pregnancy?
IVF
236
What do you call the condition where twins do not get an equal amount of blood supply in the uterus?
twin twin transfusion syndrome
237
Caused by alcohol, what is the condition called that causes brain damage in fetus?
fetal alcohol syndrome
238
Name 3 CI of ECV.
multiple pregnancy
recent APH
PROM
uterine abnormalities
239
Name 3 comps of ECV
Placental abruption
Uterine rupture
Fetal distress
240
What abx should all mothers with PROM recieve?
erythromycin
241
What is the main infection you are worried about in PROM? What is the management?
chorioamnionitis
| delivery of foetus and IV abx for mother
242
Name 3 methods of IOL.
Membrane sweep
Vag prostaglandins (pessary, oral or gel)
amniotomy+/-oxytocin
243
Name 2 1st line drugs used in primary PPH.
Syntocinon (synth oxytocin)
| ergometrine
244
Name 3 non pharmacological mx strategies of primary PPH.
bimanual compression
uterine artery ligation
hysterectomy
balloon tamponade
245
How soon after labour does primary PPH occur?
<24hours
246
Name 2 causes of secondary PPH. What timeframe does secondary PPH occur?
infection-endometritis
| retained products
247
Name 4 ix done in secondary PPH and why.
Blood cultures and swabs for infection
speculum
USS for retained products
248
What condition can a newborn get after a c section?
transient tachypnoea of newborn
249
Name 2 CI's of VBAC.
prev uterine rupture
| classical incision
250
Name 2 comps of VBAC.
Risk of uterine rupture
| Risk of anal sphincter injury
251
Name 3 RF for tears during vag birth.
shoulder dystocia
macrosomia
forceps
primigravida mother
252
Name 3 RF for shoulder dystocia.
```
macrosomia
prev dystocia
maternal diabetes
IOL
Prolonged labour
```
253
Name 3 mx strategies for shoulder dystocia.
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
Name 3 RF for cord prolapse.
polyhydramnios
PROM
breech
long cord
255
What is tocolysis? Give a drug example. When is it used?
prevention of uterine contraction
terbutaline
cord prolapse
256
What is the mx of cord prolapse?
knee to chest position and lift cord up
| emergency c section
257
Name 3 RF for uterine rupture.
prostaglandins
c section
multiple pregnancy
258
What is the mx of amniotic fluid embolus and why?
resuscitation
| presents too similarly to PE, eclampsia, sepsis
259
Name 3 causes of puerperal pyrexia.
endometritis
wound infection
mastitis
VTE
260
What medication do you start from 12 weeks to birth, in a pregnant lady with hypertension?
aspirin 75mg daily
261
If pre existing HTN before pregnancy, and pt on ACE-i/ARB, what needs to be done?
switch to labetalol as ACE-i/ARB bad for foetus
262
Name 2 CI's of labetelol and 3 SE's.
CI:
-asthma
-cardiogenic shock
SE: Postural hypotension, headache, N+V
263
Name 2 CI's of nifedipine and 3 SE's.
CI:
-aortic stenosis
-angina
SE: oedema, dizziness, flushing
264
What BP makes you very worried in pre eclampsia?
160/110
265
What is the pathophys of pre eclampsia?
lack of remodelling of spiral arteries leading to high resistance low flow system
266
Name 4 sx of pre eclampsia.
```
Often asymptomatic
Facial swelling
Vomiting
Frontal headache
severe epigastric pain
```
267
Name 3 foetal and 3 maternal comps of pre eclampsia.
Foetal- IUGR, prematurity, hypoxia
| Maternal-eclampsia, placental abruption, AKI, DIC, haemorrhage
268
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?
labetelol
nifedipine
Methyldopa
LMWH
IM steroids to assist fetal lung maturation
269
What kind of seizures do you see in eclampsia?
tonic clonic
270
How do you treat eclampsia?
magnesium sulphate
271
What does HELLP stand for?
Haemolysis
Elevated liver enzymes
Low platelets
272
Name 3 sx of HELLP.
```
RUQ pain
N+V
tiredness
headache
vision problems
```
273
Name 3 maternal comps of diabetes during pregnancy.
Pre eclampsia risk
injury from delivering big baby
CVS risk
Worsening retinopathy+nephropathy
274
Name 3 foetal comps of diabetes during pregnancy.
Pre term
Miscarriage/stillbirth
TTN
Risk of diabetes in later life
275
If a foetus from a diabetic mother comes out hypotonic, floppy, fitting or with LOC, what should you give and why?
IV dextrose for hypoglycaemia
276
Which anti diabetic drug is safe to use in breastfeeding?
metformin
277
If pt is on oral hypoglycaemics during pregnancy for diabetes, what should they be on instead?
only metformin and insulin
278
What is the ix of choice when screening for gest diabetes? Above what number is abnormal?
oral glucose tolerance test
| 7.8mmol/l
279
In pregnancy, what presents with intense itching, jaundice, pale stools and dark urine?
obstetric cholestasis
280
Name 4 mx steps of obstetric cholestasis.
delivery of foetus
top antihistamine
ursodeoxycholic acid
Vit K
281
When is a pregnant woman at highest risk of VTE?
post partum
282
Is D dimer a useful test for VTE in pregnant lady?
no bc d dimer already elevated in pregnancy
283
Which condition may present itself during pregnancy? How do you treat? Name the 2.
thalassaemia-folate and blood transfusion
284
What 2 rx do you give in sickle cell during pregnancy?
folate and iron
285
Name 2 effects of anaemia on pregnancy.
low birth weight
| prematurity
286
What should newborn babies be given at birth in mothers who are epileptic?
1mg vit K to prevent haemorrhage
287
Are anti epileptic drugs safe during breast feeding?
yes!
288
If an epileptic lady has a seizure during the 2nd half of pregnancy, what must you check for?
eclampsia!!
289
Name 3 features of fetal anticonvulsant syndrome (children exposed to valproate and carbamezepine).
thin upper lip
triangular forehead
micrognathia
medial deficiency of eyebrow
290
What is the ideal rx of choice for depression during pregnancy?
CBT
291
Having a low BMI during depression, what 3 things may occur during pregnancy?
low birth weight
prematurity
Anaemia
292
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?
baby blues
293
Within how many months after birth does post natal depression occur?
<12months
294
If a mother has severe mood swings and disordered perception during first few weeks after giving birth, what is the likely dx?
postnatal psychosis
295
What is the recommended SSRI of choice in breastfeeding women?
paroxetine
296
Name 3 situations that may inc risk of mother-foetus HIV transmission.
PROM
vag delivery
instrumental delivery
297
Name 3 mx strategies of maternal HIV during pregnancy.
Antiretrovirals
Plannes c-section
Avoid breastfeeding
298
Name 2 features of the vaginal discharge in:
- candida
- trichomonas vaginalis
- bacterial vaginosis
- curd like, non offensive
- yellow, frothy, offensive discharge, strawberry cervix
- thin, fishy, white/grey discharge
299
Name 2 features of the vaginal discharge in:
- gonorrhoea
- chlamydia
- foreign body
- ectropion
- cervical ca
- thin, watery, yellow
- thick, copious amounts of purulent discharge
- offensive, bloody discharge
- inc amount of normal
- persistent, not responding to rx
300
Name 3 RF of STI's.
<25years old
New partner
Unprotected sex
301
Which STI's can affect the eyes?
chlamydia and gonorrhoea can cause conjunctivitis
302
Name 3 presentations of chlamydia and gonnhoroea in females.
dysuria
pelvic pain
discharge
303
Name 3 presentations of chlamydia and gonorrhoea in males.
```
dysuria
discharge
testicular pain (chlamydia)
epididymal pain (gonorrhoea)
```
304
Name 2 possible abx for rx of chlamydia.
azithromycin one off dose
| doxycycline 7 days
305
Name the initial rx of choice in gonorrhoea.
IM ceftriaxone
306
Name 3 comps of chlamydia.
reactive arthritis
PID
epididymo-orchitis
307
Who should be contacted in chlamydia for:
a) symptomatic men
b) women and asymptomatic men
a) partners from 4 weeks preceding sx
| b) partners from last 6 months
308
Who should be contacted in gonorrhoea for:
a) symptomatic men
b) women and asymptomatic men
HALF of chlamydia times
a) partners from 2 weeks preceding sx
b) partners from last 3 months
309
Name the organism in syphilis.
treponema pallidum
310
What is a chancre in syphilis?
painless genital ulcer
311
What is the treatment of syphilis?
benzathine penicillin
312
What is the reaction to syphilis treatment called that leads to fever, chills, headache and myalgia?
Jarisch Herxheimer
313
Which organism causes genital warts? how is it trasmitted?
human papilloma virus 11 and 16
| skin to skin contact
314
Name 3 mx of genital warts.
cryotherapy/excision for few
| cream for many-podophyllotoxin/imiquimod
315
What organism causes genital herpes?
herpes simplex virus
316
Which HSV causes:
a) genital+cold sores
b) genital+anal
a) HSV 1
| b) HSV 2
317
Name 2 features of genital herpes. What is the rx?
painful
itchy
oral aciclovir
318
If a pregnant lady acquires genital herpes in trimester 3, what is the mx option of choice?
c section bc no maternal abx present
319
Name 3 ix done in men and women to test for trichomonas.
high vaginal women
| urethral swab/first void urine in men
320
What is the mx medication of choice in trichomonas? What other condition uses this treatment?
metronidazole
bacterial vaginosis
321
What cells are seen on microscopy in bacterial vaginosis?
clue cells
| gardnerella vaginalis
322
How do you treat candida during pregnancy?
intravaginal cream OR pessary
| clotrimazole
323
Name 2 at risk groups for HIV.
MSM
IV drug users
unprotected intercourse with partner from africa
324
What determines whether prophylactic rx is needed in HIV
CD4 count
325
How can you manage HIV during pregnancy?
ART during
ART for newborn
c section
no breastfeeding
