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Y4 - Finals Edition > O&G CBLs > Flashcards

O&G CBLs Flashcards

1
Q

At what gestation do women have a dating scan and anomaly scan?

A
  • Dating scan ideally 10-14 weeks
    • combined test for trisomy 21 !
  • Anomaly scan
    • 18 to 21 weeks (20+6)
      • to identify abnormalities
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2
Q

What is Nuchal translucency?

A

Ultrasound appearance of collection of fluid under skin, behind neck of foetus, in the 1st trimester

increased is > 3.5mm

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3
Q

Conditions to be picked up in anomaly scan

A
  • anencephaly
  • open spina bifida
  • cleft lip
  • diaphragmatic hernia
  • gastroschisis (in sac)
  • exomphalos
  • cardiac abnormalities: TOF, AVSD, TOF, HLHS
  • bilateral renal agenesis
  • lethal skeletal dysplasia
  • trisomy 18 Edwards
  • trisomy 13 pataus
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4
Q

Turner’s syndrome commonly associated with what cardiac abnormality

A

Coarctation of aorta

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5
Q

Invasive tests offered during pregnancy

A
  1. CHORIONIC VILLOUS SAMPLING
    - 11-14 weeks
    - 1/2% risk of miscarriage
    - foetal cells removed from chorion
  2. Amniocentesis
    - 15 weeks onwards
    - 1 in 200 loss rate
    - foetal cells withdrawn from amniotic fluid

Other risks
- failure to get sample
- foetal injury (rare)
- maternal bowel injury
- amniotic fluid leakage
- chorioamnionitis
- discomfort

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6
Q

Infective Causes of ventriculomegaly

A
  • idiopathic
  • may occur with other intracranial or CNS abnormalities
  • chromosomal: TRISOMY 21
  • viral infections: CMW, Toxoplasmosis
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7
Q

What types of screening are available in the UK for identification of foetuses with major structural abnormality?

A

NIPT
- 9 weeks , not on NHS

Combined
- 11-14 weeks
- PAPPA
- free beta HCG
- NT

Quadruple
- 14-20 weeks
- HCG
- AFP
- oestriol
- inhibin A

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8
Q

What should normal VP measurement be?

A

VP measurement - posterior horn of lateral ventricle in brain

< 10mm

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9
Q

Factors predisposing for multiple pregnancy?

A
  • advanced maternal age (>35 years)
  • previous multiple pregnancy
  • use of fertility enhancing treatment
  • maternal history of dizygotic twins
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10
Q

How might ultrasound be used to classify twin pregnancies, what signs might you look out for?

A

Lambda sign = dichorionic

T sign = Monochorionic

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11
Q

Twin to twin transfusion syndrome

A

Large central artery to vein connections from donor to recipient

5 stages : Quintero staging

Stage 1 - bladder of donor twin visible, doppler of both twins are normal

Stage 2 - bladder of donor not visualised, doppler still normal

Stage 3 - non visualised bladder, abnormal doppler

Stage 4 - one or both fetuses have hydrops

Stage 5 - one or both fetuses have died

MANAGEMENT
- foetoscopic laser ablation

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12
Q

What is the maximum vertical amniotic fluid pocket for oligohydraminos and polyhydraminos?

A
  • Oligohydraminos: <2cm
  • Polyhydraminos: >8cm
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13
Q

Twin reversed arterial perfusion sequence (TRAP)

A

one twin has absent or non-functioning heart

receives all its blood supply from normal heart.

ACARDIAC-ACEPHALIC TWIN

Mx = radio-frequency ablation needle

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14
Q

Twin anaemia polycythaemia sequence (TAPS)

A

Tiny peripheral artery to vein connections

Slow transfusion of RBC through very small placental AV anastomoses

Leads to anaemia in one twin and polycythaemia in co-twin

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15
Q

Male types of male sub-fertility

A

Normospermia = normal sperm quality

Oligospermia = reduced sperm count

Asthenospermia = reduced sperm motility

Teratospermia = reduced sperm morphology

Cryptospermia = very low sperm count (< 2 million/ml)

Combination: oligoteratoasthenospermia = low sperm count, reduced morphology and motility

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16
Q

Parameters recorded on male semen analysis?

A
  • Volume > 1.5ml
  • Concentration > 15million/ml
  • Motility excellent + sluggish > 32%
  • Total sperm count > 39 million
  • Normal morphology > 4%
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17
Q

Outline baseline management and investigations for azoospermia (no sperm) and describe how to interpret them?

A

Azoospermia
1. History: childhood (undescended testes), surgery, chemo, cystic fibrosis

  1. Examination
    - secondary sexual characteristics
    - tall? Klinefelters?
    - palpate testes size
  2. Tests
    - Blood: FSH, LH, testosterone, prolactin, oestradiol. TFTs, karyotype, cystic fibrosis
  3. Radiology: USS testes
    - testicular sperm extraction: TESA, PESA (epididymis), TESE (teste biopsy), MESA
18
Q

Low FSH / LH / Testosterone indicative of

A

Hypogonadotrophic hypogonadism

19
Q

Low FSH / LH

high testosterone

A

Anabolic steroid use

20
Q

High FSH / LH /

Low testosterone

A

Testicular failure

21
Q

Why male fertility might be declining?

A
  • lifestyle = sedentary, alcohol, smoking
  • diet = higher oestrogen content, fast food
  • environmental = pesticides, fertilisers, chemicals
22
Q

Investigations for fertility in females

A

Ovarian reserve assessment
- Anti-mullerian hormone
- Day 2-4 FSH/LH
- Ovulation FSH / LH
- LH
- thyroid function
- prolactin

USS for pelvic anatomy

Tubal patency:
- HyCoSy
- Hysterosalpingogram (HSG)
- Laparoscopy and dye

23
Q

Treatment options for female infertility

A
  1. Ovulation induction: CLOMIPHENE CITRATE (anti-oestrogen) or LETROZOLE (aromatase inhibitor)
  2. Artificial insemination
24
Q

Investigations for PCOS

A
  1. Anti-mullerian hormone (raised >40 in PCOS)
  2. Early follicular phase gonadotropins LH/FSH with ratio > 3:1
  3. Impaired glucose tolerance test
  4. Ultrasound (Rotterdam criterion)
25
Q

Criteria used for PCOS

A

ROTTERDAM CRITERIA

  1. oligo / anovulation
  2. Biochemical signs of hyperandrogenism: clinical –> acne, hirsutism, acanthosis nigrans
  3. Polycystic ovaries on USS
26
Q

What drug might be given to induce ovulation?

A

CLOMIPHENE CITRATE

27
Q

Types of incontinence

A

STRESS
- increase intrabdominal pressure

URGE
- due to involuntary contraction of bladder muscles

Overflow
- due to blockage of urethra

Mixed
- features of both
- treat the more dominant

28
Q

NOTES URINARY INCONTINENCE

What questions may be helpful in forming a differential diagnosis?

A

OAB: frequency (8 times per day), nocturia (> 1 per night), urgency (desire to void), urge incontinence, nocturia.

Stress: leaking with coughing, laughing or straining, incontinence.

SUI: Defined as “involuntary loss of urine on effort or physical exertion, or on sneezing or coughing.”

Voiding dysfunction: hesitancy, incomplete emptying.

Lifestyle: fluid intake (caffeine), BMI and physical activity.

POP: pelvic heaviness or bulge

Bowels / sexual history / mental health concerns.

Parity.

PMHx / previous surgery / drug history.

29
Q

Grade of uterine prolapse on examination

A
  1. Descent within vagina
  2. Descent to hymen
  3. Descent beyond hymen
  4. Uterus outside of vagina (Procidentia)
30
Q

Key investigations in a patient presenting with incontinence

A
  1. Urine dipstick
    a. UTI, kidney bladder stones, diabetes
  2. Post micturition bladder scan
    a. to assess post void residual volume
  3. Bladder diary
    a. minimum of three days
  4. USS
    a. to exclude pelvic mass
  5. Proctogram / ARMS if bowel symptoms co-exist
31
Q

Non-surgical treatment first line for stress incontinence

A
  1. Pelvic floor exercises (w/ physio)
    • at least 3 months
    • 8 pelvic contractions 3 times a day
32
Q

Patient presents with the following:

Why might these be important in her main complaint of urinary incontinence.

On examination she has a BMI of 35, an elevated JVP and pitting oedema to the mid-calf. Why may these signs be important in explaining her main complaint

A

raised BMI associated with urinary incontinence

heart failure —> predispose to coughing

diuretic use —> increase frequency of bladder emptying

33
Q

What simple non-pharma logical measures might you suggest for OAB?

A

Bladder re-training:

  • Minimum of six weeks if there is urgency or mixed incontinence.
  • Techniques to increase the length of time between feeling the need to urinate and actually having to pass urine.

Avoid caffeine or fizzy drinks

Drink more water

34
Q

What surgical options are available for overactive bladder?

A
  1. BOTOX
    - 80% effective, temporary
  2. Sacral nerve stimulation
    - implantation of leads into S2,3,4
  3. Percutaneous sacral nerve stimulation
35
Q

Risk factors for development of prolapse

A

Increased age

Occupation where heavy lifting has been involved

Previous hysterectomy

Raised BMI of 35

Chronic cough

36
Q

Grading systems used to grade size of prolapse

A

Baden Walker system
0 = normal position
1 = descent halfway to hymen
2 = descent to hymen
3 = descent halfway past hymen
4 = maximum descent

POP Q

37
Q

22 F , AED

PC: severe adbo pain + vomitting

HPC: abdo bloated 2 wks

OE: large tender mass arising from pelvis (size 28 week pregnancy)

LMP: two weeks ago

No contraception

key investigations

A

Urine dipstick —> UTI

Urine pregnancy test —> pregnancy

Bloods
- FBC, U&Es, LFTs, calcium profile
- amylase
- Ca125

Urgent Imaging
- USS or CT

38
Q

Differential diagnoses

22 F , AED

PC: severe adbo pain + vomitting

HPC: abdo bloated 2 wks

OE: large tender mass arising from pelvis (size 28 week pregnancy)

LMP: two weeks ago

Positive pregnancy test

Solid complex mass occupying most of abdomen

A
  1. Molar pregnancy (unlikely to be this large)
  2. Germ cell ovarian tumour secreting HCG
  3. Fibroid uterus in pregnancy with red degeneration
  4. Sarcoma in pregnancy
39
Q

What is red degeneration?

A

Ischaemia or necrosis of fibroid because its too large for blood supply

40
Q

Ovarian cancer key features

A
  • abdominal pain
  • abdominal distention
  • reduced appetite (early satiety)
41
Q

What investigations would you like to arrange next for patient with suspected ovarian cancer?

A
  • pelvic ultrasound followed by a CT
  • investigation of raised Ca125
  • Image urinary tract because of abnormal U&Es
42
Q

What is the risk of malignancy index used for?

A

OVARIAN CANCER

RMI = USS x Menopausal status x Ca125

U= 0 for ultrasound
M= 1 for premenpausal , 3 for postmenopausal
Ca125

Y4 - Finals Edition (40 decks)

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