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O&G (19/06) Flashcards

1
Q

Treatment for stage 1 cervical cancer?

A

Cone biopsy

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2
Q

Treatment for stage 2 cervical cancer?

A

Radical hysterectomy (radical trachelecomy to preserve fertility)

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3
Q

Treatment for stage 3+ cervical cancer?

A

Chemo-radiotherapy

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4
Q

A 22 year old girl presents to rapid access clinic with persistent bloating, 5kg weight loss and lower abdominal pain. Abdominal examination demonstrates tense ascites. VE reveals a mobile AV uterus with a firm right-sided adnexal mass. What would be the most appropriate next step in her management?

A

Urgent ultrasound abdomen/pelvis

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5
Q

Epithelial cancers of the ovary?

A

Serous and mucinous cystadenoma (serous is more common)

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6
Q

Stages of ovarian cancer?

A

Stage 1 - limited to ovaries
Stage 2 - limited to pelvis
Stage 3 - limited to abdomen
Stage 4 - distant mets

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7
Q

Treatment for vulval cancer?

A

Can perform wide local excision (1a), groin lymphadenectomy or radical vulvectomy

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8
Q

Cause of urge incontinence?

A

Overactive destrusor activity

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9
Q

Invasive options if incontinence caused by destrusor activity?

A

Botox injection
* Percutaneous sacral nerve stimulation
* Augmentation cystoplasty
* Urinary diversion

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10
Q

Surgical management of stress incontinence?

A

Colposuspension or
Autologus rectal fascia sling
Can also offer mid-urethral mesh sling but should not be offered first line as per NICE guidance

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11
Q

Staging of pelvic organ prolapse?

A

POPQ score - 1 to 4

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12
Q

Treatment options for uterine prolapse?

A
  • Vaginal hysterectomy +/- sacrospinous fixation
  • Sacrospinous hysteropexy
  • Manchester repair (a.k.a Fothergill operation)
  • Sacro-hysteropexy with mesh
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13
Q

Treatment for rectocele?

A

Posterior repair

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14
Q

Treatment for cystocele?

A

Anterior repair

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15
Q

Primary amenorhoea

A

Girls who have not established menstruation by the age of 13 years and have no secondary sexual characteristics (such as breast development).
* Girls who have not established menstruation by the age of 15 years and have normal secondary sexual characteristics.

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16
Q

Submucosal fibroids can lead to what?

A

Menorrhagia or IMB

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17
Q

Gold standard Ix for endometriosis?

A

Diagnostic laproscopy

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18
Q

Mood disturbance associated with which phase of menstrual cycle?

A

Luteal

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19
Q

Rotterdam criteria for PCOS:

A

Oligo/anovulation (> 2 years)
* Clinical or biochemical features of hyperandrogenism
* Polycystic ovaries on ultrasound (> 12 in one ovary measuring 2-9 mm in diameter)
Associated with insulin resistance

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20
Q

How long can clomiphene be used for?

A

6 months

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21
Q

MOA of clomiphene in pcos?

A

selective estrogen receptor modulator (SERM)

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22
Q

Surgical treatment to enhance fertility in PCOS?

A

Laparoscopic ovarian drilling

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23
Q

AMH demonstrates what?

A

Ovarian reserve

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24
Q

When is laproscopy and dye performed?

A

Subfertility with history of tubal disease

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25
Q

Investigating subfertiltiy

A

Blood hormones: day 2-3 FSH, LH and oestradiol. AMH demonstrates ovarian reserve
* STI screening
* TVUS and antral follicle count
* Tubal assessment (HYSTEROSALPINGOGRAM or LAP+DYE)
* Semen analysis

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26
Q

Treatment for Failed IUI/ovulation induction?

A

ICSI

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27
Q

Ovarian causes of amenorrhoea?

A

POI, menopause, Turner’s syndrome (46XO), gonadal dysgenesis, androgen insensitivity

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28
Q

Causes of POI?

A

Chemo/radiotherapy exposure.
Addisions, thyroid disease
Genetic
Idiopathic

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29
Q

When to give continuous combined HRT?

A

Tend to give continuous to women who are definitely post-menopausal otherwise can cause erratic bleeding in perimenopausal women

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30
Q

history of poor memory, difficulty in word finding and difficulty in planning.

A

Alzheimer’s disease

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31
Q

uterine rupture

A

This may be preceded by hypercontractility of the uterus. The rupture results in fetal compromise with reduced fetal movements and bradycardia. Rupture into the bladder may result in haematuria. Suprapubic pain is a classic symptom.

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32
Q

Antibiotics for endometritis?

A

Clindamycin and gentamicin

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33
Q

Definition of pre-eclampsia?

A

BP >140/90 and proteinuria with any of the following
Severe headache
Visual disturbance
Severe RUQ pain / vomiting / liver tenderness
Papillodema
>3 beats of clonus
HELLP
Platelets <150, ALT >70

BP >160/110 and proteinuria (PCR >30*)

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34
Q

Contraindication to ergometrine?

A

Blood pressure issues.

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35
Q

Contraindication to carboprost?

A

Asthma

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36
Q

Treatment for pyloric stenosis?

A

Pyloromyotomy

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37
Q

Sign of duodenal atresia?

A

Abdominal X-ray – ‘double bubble’

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38
Q

Ix for hirschsprung’s disease?

A

Full length rectal biopsy

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39
Q

Intussception management?

A

Reduction with air insufflation
Operative reduction

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40
Q

Treatment of pyelonephritis?

A

IV Ceftriaxone and Gentamicin

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41
Q

When to do DMSA?

A

DMSA (dimercaptosuccinic acid scintigraphy) 4-6 months after infection
Used to detect renal parenchymal defects i.e. scarring
In all children under 3 with atypical/recurrent UTI
In all children over 3 with recurrent UTI

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42
Q

Microbe cause of epiglottitis?

A

Haemophilus influenzae B

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43
Q

Treatment for eppiglottitis?

A

IV Ceftriaxone

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44
Q

Which scan increases risk of maternal breast cancer?

A

CTPA

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45
Q

Which scan increases the risk of childhood malignancy?

A

V/Q scan

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46
Q

Antihypertensive in labour?

A

PO labetalol

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47
Q

Which malignant breast cancer affects young women?

A

Dysgerminoma

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48
Q

What is not a common cause for oligomenorrhoea?

A

Copper IUD

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49
Q

Can obesity cause oligomenorrhoea?

A

Yes!

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50
Q

During the evaluation of secondary amenorrhea in a 24-year-old woman, hyperprolactinaemia is diagnosed. Which of the following conditions could cause increased circulating prolactin concentration and amenorrhea in this patient?

A

Stress

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51
Q

A 4 year old boy is brought to the emergency department due to non blanching rash on both his legs. He also has swelling to his face and abdominal distension. He has been unwell for 4 days leading up to this with abdominal pain and bloody diarrhoea. Blood tests show an acute renal injury, anaemia, and thrombocytopenia. His urine dip shows 3+ proteinurea and haematuria. What is the most likely diagnosis?

A

Haemolytic uraemic syndrome

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52
Q

Rash behind the ears?

A

Measles

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53
Q

Definitive management of septic arthritis?

A

Joint aspiration and washout with IV antibiotics

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54
Q

Lumacaftor is a novel drug used to treat Cystic Fibrosis. What is it’s mechanism of action?

A

prevents misfolding and increases protein trafficking

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55
Q

A 7 year old child with Down Syndrome presents to A&E with bilious vomiting and some abdominal distension.
What is the most likely diagnosis?

A

Volvulus

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56
Q

A neonate born at 34 weeks is found in NICU to be passing bloody stools and have profound abdominal distension. Given the likely diagnosis, the consultant asks the keen medical student what would be an X-ray sign for an urgent laparotomy?

A

Rigler’s sign
The situation is describing NEC

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57
Q

An atypical UTI in children usually requires further investigations. Which of these options are listed in the NICE guidelines as a feature?

A

Increased UTI

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58
Q

When to do an USS during an acute UTI?

A

During acute infection if atypical UTI or child less than 6 months with recurrent UTI

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59
Q

Signs of atypical UTI

A

Poor urine flow.
Abdominal or bladder mass.
Raised creatinine.
Sepsis.
Failure to respond to treatment with suitable antibiotics within 48 hours.
Infection with non-E. coli organisms.

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60
Q

When to do an USS 6 weeks following UTI?

A

Within 6 weeks for children aged 6 months and over with recurrent UTI.
Within 6 weeks, for all children younger than 6 months of age with first-time UTI that responds to treatment.

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61
Q

When to do a DMSA scan at 4-6 months following UTI?

A

All children aged under 3 years with atypical or recurrent UTI.
All children aged 3 years or over with recurrent UTI.

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62
Q

When to offer IV syntocinon?

A

2 hours after ARM if labour has not ensued

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63
Q

Major PPH

A

> 1000ml

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64
Q

Treatment for toxoplasmosis?

A

Spiromycin

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65
Q

First line for agitated patients medication?

A

PO, is it haloperidol?

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66
Q

HSV in third trimester?

A

Offer C-section delivery
If vaginal delivery, give IV aciclovir intrapartum and to the neonate

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67
Q

Neonate with HIV positive mother with >50 copies/mL treatment

A

Triple ART within 4 hours of birth for 4 weeks if high risk
Do PCR test at 6 weeks, 12 weeks and 18 months

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68
Q

Why stop methyldopa post-partum?

A

Can cause depression

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69
Q

Mode of delivery for MCMA twins?

A

Elective C section at 32 weeks

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70
Q

When to deliver MCDA twins?

A

36 weeks

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71
Q

When to do deliver DCDA twins?

A

37 weeks

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72
Q

Lamda sign indicates which twins?

A

DCDA

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73
Q

How long to avoid conceiving after methotrexate?

A

3 months

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74
Q

Management for mole pregnancy?

A

Suction cutterage

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75
Q

MOA of ullipristal?

A

Progesterone receptor modulator - inhibits ovulation

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76
Q

MOA of mirena?

A

Thins the womb lining

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77
Q

MOA of POP?

A

Thickens cervical mucus

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78
Q

Effect of clomphiene?

A

Increases chance of multiple pregnancy

79
Q

BV treatment?

A

Metronidazole (fishy smell)

80
Q

What is colpocleisis?

A

Involves closure of the vagina to treat prolapse

81
Q

Does uterine artery embolism affect fertility?

A

Yes

82
Q

Cysts in young women?

A

<50mm = doesn’t require follow up
50-70mm = require yearly USS f/u
>70mm = Requires further imaging and maybe surgical intervention

83
Q

Constituents of RMI?

A

USS features, menopausal cysts + CA 125 (concerning if over 35)

84
Q

How frequently does puerperal psychosis reccur?

A

50%

85
Q

PMS Ix?

A

Must do a menstrual diary
Treat with COCP and referral for CBT
Can give SSRI for severe PMS

86
Q

Cause of cerebral palsy?

A

Hypoxic ischaemic encephalopathy

87
Q

Treatment for ASD?

A

Transcatheter closure

88
Q

Treatment of PDA?

A

Indomethacin is first line. Otherwise may need surgical ligation or percutaneous catheter device closure

89
Q

Treatment for pulmonary stenosis?

A

Transcatheter balloon dilatation

90
Q

TOF treatment?

A

Prostaglandin E1 infusion, blalock-Taussig shunt
Definitive surgery from 4 months

91
Q

First line treatment for CF?

A

rhDNAse

92
Q

Chronic otitis media treatment?

A

Clotrimazole

93
Q

Treatment for scarlet fever?

A

Pencillin V for 10 days. Avoid school for 24 hours after starting antibiotics

94
Q

What kind of laxative is movicol?

A

Osmotic

95
Q

Senna is what kind of laxative?

A

Stimulant

96
Q

Definitive management of Hirschsprung’s disease?

A

Anorectal pull-through

97
Q

Treatment for sebhorreic dermatitis in children?

A

Ketoconazole shampoo/creams

98
Q

What causes molluscum?

A

Pox virus

99
Q

When can you give tetracyclines?

A

Over 12 years old

100
Q

Treatment for headlice?

A

Dimeticone 4% lotion

101
Q

Describe HSP?

A

IgA vasculitis

102
Q

At what age is an MCUG recommended?

A

Before 6 months of age

103
Q

X-ray sign of SUFE?

A

Trethowan’s sign

104
Q

Duchenne muscular dystrophy?

A

Cretinine kinase raised. Do muscle biopsy

105
Q

First line treatment for absence seizure?

A

Ethosuximide or valproate

106
Q

First line treatment for focal seizure?

A

Levetiracetam or lamotrigine

107
Q

SE of valproate?

A

Weight gain, hair loss

108
Q

SE of lamotrigine?

A

Rash

109
Q

Treatment for hydrocephalus?

A

Ventriculoperitoneal shunt

110
Q

Management of migraine?

A

1: paracetamol
2: Nasal sumatriptan
3: Combination therapy

Prophylactic treatment:
Topiramate or propanaolol

111
Q

Risk of topiramate?

A

Foetal malformations

112
Q

When to correct congenital hydrocele?

A

2 years, observe before this

113
Q

What is hypospaias?

A

Urethral opening is not on the head of the penis.
don’t allow circumcision before it is repaired.

114
Q

What is paraphimosis?

A

Paraphimosis is a common urologic emergency that occurs in uncircumcised males when the foreskin becomes trapped behind the corona of the glans penis. This can lead to strangulation of the glans and painful vascular compromise, distal venous engorgement, edema, and even necrosis.

115
Q

Treatment of paraphimosis?

A

Manipulation with topical analgesia
Puncture technique
Surgical reduction - circumcision

116
Q

Management of phimosis?

A

<2yo - reassure and review in 6 months (personal hygiene promotion)
>2yo - circumcision or topical steroid creams (depends on severity)

117
Q

Balanitis Xerotica Obliterans (BXO)

A

= pathological phimosis = scarring of foreskin; rare before 5y

§ S/S: haematuria, painful erections, recurrent UTI, weak stream, swelling, redness, tenderness

118
Q

Balanoposthitis

A

inflamed/purulent discharge from foreskin
Single attacks common

Management:
Warm baths
Broad spectrum ABX
Recurrent (rare) - circumcision

119
Q

Complications of nephrotic syndrome:

A

Risk of thrombosis loss of AT-III in the urine - hypercoagulable state
Risk of infection loss of immunoglobulin in urine - infection risk (esp. NHS bacteria)
Hypercholesterolaemia urinary albumin loss - less oncotic pressure - hepatic cholesterol synthesis

120
Q

Cyanotic heart disease

A

Hyperoxia (nitrogen washout test): To determine the presence of HD in a cyanosed neonate

1) 100% O2 for 10mins
2) If right radial artery PaO2 from blood gas stays low (<15kPa, 113mmHg) à diagnose of cyanotic CHD

o Only if lung disease and persistent pulmonary HTN of the newborn have been excluded
o If PaO2 >20kPa then it is not cyanotic HD

121
Q

Steroid ladder?

A

– Help (hydrocortisone) Every (Eumovate) Busy (Betnovate) Dermatologist (Dermovate)

122
Q

Hypogonadotrophic (low LH and FSH) hypogonadism:

A

Hypothalamo-pituitary disorders – panhypopituitarism, intercranial tumours

Kallmann’s syndrome (LHRH deficiency and anosmia), Prader-Willi syndrome

Hypothyroidism (acquired)

123
Q

Hypergonadotrophic (high LH and FSH) hypogonadism:

A

Congenital – cryptorchidism, Klienfelter’s syndrome (47 XXY), Turner’s syndrome (45 XO)

§ Acquired – testicular torsion, chemotherapy, infection, trauma, autoimmune

124
Q

Small testes in precocious puberty

A

Tumour or CAH (adrenal cause)

125
Q

GOLD-STANDARD ix in precocious puberry?

A

GnRH simulation test

126
Q

Isolated short stature in a young girl

A

Must exclude Turner’s syndrome

127
Q

Chondromalacia patellae?

A

Grating sensation

128
Q

Reactive arthritis also known as?

A

Reiter’s syndrome (can’t see/pee/climb a tree)

129
Q

“Loss of internal rotation of a flexed hip” describes?

A

SUFE

130
Q

“Ash leaf patch”

A

Tuberous sclerosis

131
Q

Gower’s sign?

A

Ducehnne muscular dystrophy. Walking up legs
o Pseudohypertrophy of calves (due to replacement of muscle fibres by fat and fibrous tissue)
o Primary dilated cardiomyopathy

132
Q

Types of migraine?

A

Episodic = <15 days/month
Chronic = ≥15 days/month

133
Q

West syndrome

A

à EEG (hypsarrhythmia – disordered activity in the brain)

134
Q

Benign Rolandic Epilepsy (BRE) (most common childhood epilepsy)

A

S/S: seizures of face / upper limbs during sleep with hypersalivation & speech arrest

o AKA: Sylvian seizures

o Childhood (age 3-12yo) seizures – outgrown at end of puberty
DON’T TREAT

135
Q

Treatment for focal seizure?

A

Carbamezapine, lamotrigine

136
Q

Beta chains on what chromsome?

A

11

137
Q

Omphalocele (SAC)

A

Omphalocele / Exomphalos = bowel protruding out the body with a peritoneal covering / umbilical attached

o Manage with staged closure starting immediately, finishing at 6-12 months

o Chromosomal abnormalities in 15% of cases (Trisomy 13 (Patau’s), 18 (Edward’s), 21 (Down’s); Turner’s)

138
Q

Gastroschis (NO SAC)

A

Gastroschisis = paraumbilical abdominal wall defect à abdominal contents outside body, without peritoneal covering

o Manage with immediate surgery (cover with cling-film) “Gastro-ski-sis”

139
Q

Umbilical hernia repair

A

<1yo à watch and wait

o >1yo à large or symptomatic = surgical repair 2-3yo; small or asymptomatic = surgical repair 4-5yo

140
Q

Target sign in what condition?

A

Intussception

141
Q

William’s syndrome

A

Short stature
Learning difficulties
Friendly, extrovert personality
Transient neonatal hypercalcaemia
Supravalvular aortic stenosis

142
Q

Which antipsychotic is good for negative symptoms?

A

Clozapine

143
Q

Benign rolandic epilepsy EEG?

A

EEG characteristically shows centrotemporal spikes

144
Q

Terbutaline is what?

A

tocolytics

145
Q

The key investigation in pyloric stenosis is what?

A

Ultrasound

146
Q

Postpartum thyroiditis treatment?

A

Give propanalol

147
Q

A baby is born by elective Caesarean section at 38 weeks performed due to pregnancy-induced hypertension. At one hour the female baby is noted to be grunting with mild intercostal recession. Oxygen saturations are 95-96% on air. What is the most likely cause of her respiratory distress?

A

Transient tachnopnea of the newborn

148
Q

Pain after exercise
Intermittent swelling and locking

A

Osteochondritis dissecans

149
Q

Chondromalacia patellae

A

Softening of the cartilage of the patella
Common in teenage girls
Characteristically anterior knee pain on walking up and down stairs and rising from prolonged sitting
Usually responds to physiotherapy

150
Q

The diagnostic investigation for necrotising enterocolitis?

A

Abdo X-ray

151
Q

Turner’s syndrome is associated with aortic coarctation

A

YES

152
Q

Ovarian torsion may be associated with what on USS?

A

with a whirlpool sign on ultrasound imaging

153
Q

SSRI with worst discontinuation symptoms?

A

Paroextine

154
Q

First line treatment for delirium tremens?

A

Oral lorazepam
Also give IV thiamine

155
Q

What is buprenorphine?

A

Sublingual medication for opioid withdrawal

156
Q

Lofexidine?

A

2nd line medication for opioid withdrawal

157
Q

Follow up after opioid detox?

A

At least 6 months with drugs and alcohol service
CBT offered

158
Q

Withdrawing benzos?

A

1/8th of the daily dose every fortnight
Switch to diazepam

159
Q

Drugs for AD?

A

Acetylcholinesterase inhibitors, memantine (NMDA antagonist)

160
Q

10-20 MMSE?

A

Moderate AD

161
Q

What can be given for lewy body dementia?

A

Donepezil, rivastigmine, clonazepam

162
Q

GAD disorder treatment ladder?

A

Step 1 - CBT
Step 2 - Sertraline
Step 3 - specialist assessment

163
Q

First line for OCD

A

CBT with ERP

164
Q

Second line for OCD

A

SSRI - sertraline for at least 12 months following remission of symptoms

165
Q

third line OCD?

A

Clomipramine or alternative SSRI

166
Q

First line PTSD?

A

Trauma-focused CBT or EMDR therapy

167
Q

Second line PTSD?

A

SSRI (paroxetine/mirtazapine) or venlaxafine
Consider antipsychotics if not responsive

168
Q

What is different about PTSD management?

A

Sertraline not first line, give paroxetine or mirtazapine

169
Q

Routine referral to community eating disorder service?

A

BMI 15-17

170
Q

Urgent referral to community eating disorder service?

A

BMI <15

171
Q

Admit in anorexia nervosa?

A

BMI <15

172
Q

Bulimia nervosa treatment?

A

Family therapy/BN-focused guided self-help/CBT
SSRI such as fluoxetine

173
Q

When to urgently refer bulimia?

A

Daily purging with significant electrolyte imbalance, comorbidity

174
Q

Treatment for hypersexuality?

A

CBT based treatments

175
Q

First line treatment for PND?

A

SSRI

176
Q

First line treatment for depression in children?

A

CBT!!!
Only give fluoxetine in severe cases

177
Q

Conduct disorder?

A

Family education
Parent management training and family therapy

178
Q

MOA of clozapine?

A

Blocks D1 and D4 receptors

179
Q

SSRIs in third trimester?

A

Risk of persistent pulmonary hypertension of the newborn

180
Q

Worst SSRI in pregnancy?

A

Paroextine

181
Q

MMSE normal cut off?

A

<24

182
Q

Normal MoCA cut off?

A

<26

183
Q

AMTS dementia score?

A

A score of <6 is significant for dementia or delirium

184
Q

Antipsychotic MOA?

A

is antagonism of dopamine D2 receptors in the mesolimbic dopamine pathway.

185
Q

Atypical antipsychotic available as depot?

A

Risperidone

186
Q

Treatment for akathisia?

A

Review medication, consider propranolol

187
Q

Memantine MOA?

A

NMDA receptor blocker

188
Q

Acamprosate CI?

A

Hepatic or renal impairment

189
Q

Disulfiram CI?

A

Cardiac disease, hypertension, previous CVA, psychosis

190
Q

Pre-cursor to PTSD?

A

Acute stress reaction

191
Q

3 main symptoms of PTSD?

A
  • Hyperarousal: Persistent anxiety, hypervigilance, poor concentration, insomnia, irritability, exaggerated startle response
  • Intrusions: Flashbacks, nightmares, vivid memories, frequent thoughts of incident
  • Avoidance: Avoid reminders, inability to recall some of the events, poor interest in everyday life,
    emotional detachment, avoids discussing incident
192
Q

Categories of depression?

A

Mild Depression- 2 core symptoms and 2 additional symptoms
Moderate Depression- 2 core symptoms and 3 additional symptoms
Severe depression- 3 core symptoms and 4 additional symptoms

193
Q

Naltrexone

A

opioid antagonist. Reduces reinforcing actions of alcohol (e.g the pleasure)

194
Q

Which part of the brain is affected first in AD?

A

Hippocampus

V Flashcards (17 decks)

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