New - Passmed Flashcards
What sign occurs on USS with ovarian torsion?
Whirpool sign
What does a fibroid look like on USS
Hypoechnoic mass
What does a complete hydriadid mole look like on USS
Snowstorm apparance
What does chronic salpingitis look like on USS
Beads-on-a-string’ sign refers to a finding in chronic salpingitis, with mural nodules appearing as ‘beads’ and the relatively-thin wall appearing as ‘string’.
When is the booking visit done
8-12 weeks
What occurs on the booking visit
GENERAL HISTORY
GENERAL INFO:
- e.g. diet, alcohol, smoking, folic acid, vitamin D, antenatal classes
INVESTIGATIONS:
BP, urine dipstick, check BMI
Booking bloods:
- FBC, blood group, rhesus status, red cell alloantibodies,
- haemoglobinopathies
- hepatitis B, syphilis, HIV test
Urine dip and MC&S to detect asymptomatic bacteriuria
When is the dating scan done
10-14 weeks
When can the down syndrome screening (w Nuchal translucency) be done
11-14 weeks
What do you do at 16 weeks in terms of appointments?
Information on the anomaly and the blood results. If Hb < 11 g/dl consider iron
Routine care: BP and urine dipstick
When is the anomaly scan?
18 - 21
What is checked at the anomaly scan
foetal anomalies
Placental position
Amniotic fluid volume
What occurs at 28 weekls?
Routine care: BP, urine dipstick, SFH
Second screen for anaemia and atypical red cell alloantibodies. If Hb < 10.5 g/dl consider iron
First dose of anti-D prophylaxis to rhesus negative women
what are RF from miscarriage
modifiable:
- smoking, alcohol, drugs
- high caffeine intake
- obesity
- infection
- food poisoning
non modifiable:
- thyroid, HTN, DM
- unusual uterine shape
- cervical incontinence
- medications (methotrexate)
- advanced maternal age
What does the mother experience in Twin to Twin Transfusion Syndrome
sudden increases in the size of their abdomen and/or any breathlessness, which may be the result of polyhydramnios affecting the recipient twin.
What non-HRT med is good at preventing vasomotor sx in menopause
SSRI
How do you describe waiter’s tip occurring in Erb’s palsy
adduction and internal rotation of the arm, with pronation of the forearm
How do you describe Klumpfe’s palsy
Damage to LOWER brachial plexus > affects the HAND
What is another name for trisomy 13
Patau Syndrome
What is the cause and presentation of PATAU
Failure of midline fusion
7Ps
HoloProsencephaly, microcephaly, Palate, lip cleft Poor eyes (micropthalmia) Polydactyly, rockerbottom feet Pump disease PKD aPlasia of cutis
What is trisomy 18 name
Edward’s syndrome
What are features of EDWARDS
PRINCE Ed turned 18
Prominent occiput, microagnatia, cleft lip Rocker bottom feet Intellectual disability Non-dysjunction in meiosis Clenched fists Ears - low set
Explain fts of Kleinefelters
MALE PHENOTYPE, XXY
Testicular dysgenesis
Eucnohnoid growth pattern (tall, slim, long extremities=
Gynaemcomastia and reduced vody hair
Testicular hypoplasia, normal sized penis
Reduced fertility, azozspermia
Osteoporosis
Explain fts of Turners
Female phenotype Short stature High arched palate, low posterior hairline Webbed neck Wide carrying angle
What are gonads like in Turners
STREAK gonads (gonadial dysgenesis)
What is the genotype in turners
45 X
What are the three types of incorrect placental invasion into uterus
Placenta accreta: though endometrium
Placenta increta: through myometrium
Placenta percreta: through to abdomen
What is haematocolpos
An inperforate hymen, causing the vagina to become blood filled and dilated with concurrent uterine distension and cyclical abdo pai
How do you manage haematocolpos
hymenectomy
What are the layers that you cut through in C section
Skin Fascia (Camper, Scarpa) Anterior rectus sheath Rectus Abdominis Parietal peritoneum, visceral peritoneum Uterus
What tests can screen for aneuploidy
Combined test
Quadruple test
Integrated test
Harmony test
Explain components of combined test
USS + bhCG + PAPP-A
What will Down’s SYndorme results be for Combined test
increased nuchal transulucenty
high bhCG
low PAPP A
What are components of quadruple test
AFP + bHCG + Inhibin A + unconj estriol
WHen is quadruple test done
14-20 weeks
What is integrated test
Quadruple + NT + PAPP A
What is the triple test^
AFP + bHCG + unconj estriol
ABE
When are triple/quadruple test performed
When combined screening for Down’s was missed
When can you give whooping cough vaccine in preg
16-32 weeks
Molar pregnancy sx
light PV bleed
large for dates uterus (should only be palpable after 12 weeks normally)
hyperemesis
hyperthyroidism
How does a molar pregnancy cause hyperthyroidism
because high beta hCG > similar to TSH > stimulates T4 production > thyrotoxicosis
List the four types of gestational trophoblastic disease
Partial mole
Complete mole
Choriocarcinoma
Invasive mole
What is a partial mole
Ovum fertilised by 2 sperm. > 69 chromosomes.
May have some human limbs
What is a complete mole
Ovum has NO chromosome
Fertilised by 1 or2 sperm
forms fluid filled sacs
46 XY, 46 YY, 46XX
what is an invasive mole
mole invades myometrium
what is a chorioacarcionomaa
a malignancy of trophoblastic cells that arises from molar pregnancy
what is the danger with choriocarcinoma
that it could metastise haematogenously to the lungs
How do you investigate GTD
urine bHCG
serum bHCG (HIGH)
TVUSS (snowstorm appearance)
(high T3)
How do you manage GTD
URGENT REFERRAL FOR SPECIALIST CENTRE FOR EVACUARTION OF POC
+ histology for ,malignancy
What should you do as followup for GTD
Monitor betaHCG - if it does not fall you many need to start chemo
contraception next 12m
what are reasons for giving anti-D prior to 12 weeks gestation
MUTE
Molar pregnancy
Uterine bleedings (repeated, heavy, with abdominal pain)
TOP
Ectopic pregnancy (surgical Mx - NICE, all - RCOG)
Who do you give aspirin 75mg to to prevent PET
women at high risk:
- Prior HTN during pregnancy
- chronic HTN
- DM
- AI disease (SLE, APS)
- CKD
or women with 2 or more moderate risk factors:
- primiparity, preg interval >10 years
- advanced maternal age
- BMI >35
- FH PET
- Multiple preg
what are risks of ECV
Placental abruption Premature ROM Cord accident Transplacental haemorrhage Foetal bradycardiA
WHAT ARE CONTRAINDICATIONS FOR ECV
MATERNAL:
- multiple gestation
- APH in last 7 days
- ROM
- pre-eclampsia /HTN
- plan to deliver by CS
FOETAL:
- Foetal abnormality e.g. hydrocephalus
- placenta previa
- oligo/polyydramsnios
- multiple gestation
if at risk of VTE, how do you manage a pregnant woman
give LMWH prophylactic dose
how many RF do you need to be started on VTE prophylaxis?
4+ RF: from first trimester
3RF; from second trimester
what are RF for VTE prophylaxis
NON_PREG RELATED Obesity (BMI >30) Age > 35 SMoker Varicose veins immobility FH of VTE in first deg reltive Thrombophilia
PREG RELATED
Parity >=3
Multiple pregnancy
IVF/ART
