New - Passmed Flashcards by Laura Lazzari

What sign occurs on USS with ovarian torsion?

Whirpool sign

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What does a fibroid look like on USS

Hypoechnoic mass

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What does a complete hydriadid mole look like on USS

Snowstorm apparance

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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’.

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When is the booking visit done

8-12 weeks

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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

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When is the dating scan done

10-14 weeks

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When can the down syndrome screening (w Nuchal translucency) be done

11-14 weeks

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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

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When is the anomaly scan?

18 - 21

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What is checked at the anomaly scan

foetal anomalies
Placental position
Amniotic fluid volume

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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

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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

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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.

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What non-HRT med is good at preventing vasomotor sx in menopause

SSRI

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How do you describe waiter’s tip occurring in Erb’s palsy

adduction and internal rotation of the arm, with pronation of the forearm

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How do you describe Klumpfe’s palsy

Damage to LOWER brachial plexus > affects the HAND

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What is another name for trisomy 13

Patau Syndrome

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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

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What is trisomy 18 name

Edward’s syndrome

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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

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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

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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