Miscellaneous Flashcards
What is hCG secreted by, and how early can it be detected?
In blood = 8 days after conception Secreted by syncytiotrophoblast Maintains production of progesterone by corpus luteum
What is Meigs syndrome?
Benign ovarian tumour (usually fibroma) associated with ascites + pleural effusion
When does lochia persisting become abnormal?
6 weeks postpartum
Vasa previa presentation
Rupture of membranes then painless bleeding, bradycardia + late decels on CTG
When is transdermal HRT useful?
Bypasses hepatic system so less chance of clotting
What is the aim of antiretroviral treatment for HIV?
Keep CD4 >350 Keep viral load <50
Pt with high risk for gestational diabetes - what + when to investigate?
BM or OGTT as soon after booking visit as poss If normal, repeat at 24 - 28 weeks
Investigations for DIC
Elevated PT + APTT Low platelets
High risk factors for pre-eclampsia
Personal hx Diabetes HTN CKD Autoimmune eg SLE, antiphospholipid syndrome
Moderate risk factors for pre-eclampsia
BMI >35 Fam hx pre-e Age >40 First pregnancy Multiple pregnancy Pregnancy interval >10 years
Protective + risk factors for fibroids
Exercise, smoking + multiparity = protective
Fam hx, obesity, African, early menarche = risk factors
What is vulvodynia?
Sharp burning pain in vagina with no cause
Provoked by tampons + sex
When does uterus reach umbilicus during pregnancy?
20 weeks
What swabs can you do for PPROM?
If not sure about PPROM - swab vaginal fluid for insulin like growth factor binding protein 1 or placental alpha microglobulin 1
Management of PPROM under 34 + over 37 weeks
Under 34 weeks: delay delivery unless infection
Over 37 weeks: induce
What is anovulatory dysfunctional uterine bleeding?
Irregular + unpredictable uterine bleeding in first 2 years of menses
Due to inadequate gonadotrophin release + LH surge, leading to anovulation
What is the histology of the epithelium in the vagina, fallopian tubes, cervix, endometrium + ovary?
Cervix = stratified squamous
Ovary = cuboidal cells
Endometrium = pseudostratified columnar with tubular glands
Vagina = glycogen containing stratified squamous
Fallopian tubes = columnar ciliated
What is a luteoma of pregnancy?
Benign solid ovarian tumour that develops during pregnancy
What are the signs + investigation results of congenital adrenal hyperplasia in late onset women?
Hirsutism, multiple ovarian cysts
Due to 21-hydroxylase deficiency
Causes menstrual irregularity
Raised serum-17-hydroxyprogesterone
How to make the diagnosis of uterine hyperstimulation syndrome?
One of the following:
>6 contractions in 10 mins
<60s between contractions
Best anticonvulsant in pregnancy
Lamotrigine
What is ovarian stromal hyperthecosis?
Hyperplasia of ovarian stroma + clusters of luteinising cells.
Increased androstenodione + testosterone = hirsutism + virilisation
Conversion of androstenodione to oestrogen = hyperoestrogenic state causing endometrial hyperplasia
S+S of adrenal tumour
Symptoms of virilisation, HTN, hypokalaemia + easy bruising
What are the investigation results for DIC?
Thrombocytopenia
Increased PT + APPT
Elevated D dimer
Schistocytes on blood smear
What follow up care is given to babies born from HIV+ mums?
Antiretrovirals 4hrs after delivery + continuing for 4-6 weeks
Blood test within first 2 days, discharge, 6 weeks, 12 weeks + 18 months
What is the classical sign of Jiroveci pneumonia?
Desaturations with exercise
When are FBCs done during pregnancy?
At booking + at 28 weeks
What is a chancroid?
Tropical STD - forming painful ulcers + lymphadenopathy
What does Trichomonas look like?
Motile, flagellated protozoon
Which cells produce testosterone + Anti-Mullarian hormone?
Testosterone = Leydig cells
Anti-mullerian = Sertoli cells
What hormones are increased in pregnancy?
Oestriol
Behcets disease - S+S + management
S+S: Inflammation of blood vessels, genital + mouth ulcers, red painful eyes, headaches, painful joints
Treat with steroids + immunosuppressants
Prolactinoma, S+S + management
Prolactin producing tumour of pituitary gland
Galactorrhoea, amenorrhoea, low libido
Dopamine agonists eg Cabergoline
VBAC chance of success + risk of rupture
Risk of rupture 0.5%
Chance of success = 75%
Vasa praevia - when does the bleeding occur?
Usually after a SROM
What is the management of placenta praevia
a) presenting in shock or >37 weeks
b) presenting <37 weeks with intermittent bleeding
A) LSCS + Xmatch for 4-6 units
B) Steroids + anti D, elective LSCS at 39 weeks
What is the management of placental abruption if
a) CTG normal + >37 weeks
b) CTG normal + <37 weeks
a) amniotomy induction
b) conservative, discharge as high risk
When to give VTE prophylaxis (how many points for what type)?
4 points: LMWH from 1st trimester until 6w PP
3 points: LMWH from 28w until 6w PP
2 during pregnancy: mobilise + hydrate
2 points PP: 10 days LMWH
Syphilis treatment
Penicillin G
When do you do test of cure for gonorrhoea?
NAAT after 2 weeks
Blood cultures after 72 hrs
What scores 4 points on VTE prophylaxis?
Previous unprovoked VTE
OHSS
What scores 3 points on VTE prophylaxis?
Previous provoked VTE
Known high risk thrombophilia
Medical co-morbidities: cancer, HF, SLE etc
Hyperemesis
Surgery in pregnancy
