OBGYN Passmed Flashcards
What stage of oogenesis do cells develop to in utero?
Prophase I
What stage are secondary oocytes held at until fertilisation?
Metaphase II
How does GFR change in pregnancy?
Increases by 30-60%
What is the definition of primary amenorrhoea?
Failure to establish menstruation by 15 years old in girls with normal secondary sexual characteristics (such as breast development), or by 13 years old in girls with no secondary sexual characteristics
What are possible causes of primary amenorrhoea?
- Gonadal dysgensis (eg, Turner’s) –> the most common cause. 2. Congenital malformations of the genital tract 3. Functional hypothalamic amenorrhoea (eg, secondary to anorexia) 4. Congenital adrenal hyperplasia 5. Imperforate hymen
What are possible causes of secondary amenorrhea?
- EXCLUDE PREGNANCY*
1. Hypothalamic amernorrhoea (eg, secondary stress, excess exercise) 2. PCOS 3. Hyperprolactinaemia 4. Premature ovarian failure 5. Thyrotoxicosis
If a girl presented with amenorrhoea, and her gonadotrophins came back high, what would this indicate?
Gonadal dysgenesis (eg, Turner’s), or ovarian issue (Premature ovarian failure)
If a girl presented with amenorrhoea, and her gonadotrophins came back low, what would this indicate?
Hypothalamic cause
How does stroke volume change during pregnancy?
Increases (and consequently increases cardiac output)
What are the three types of foetal lie
- Longitudinal (normal) 2. Transverse 3. Oblique
Risk factors for transverse lie foetuses
- Previous pregnancy 2. Fibroids or other pelvic tumour 3. Twins/Triplets 4. Prematurity (common up to 32 weeks) 5. Polyhydraminos 6. Foetal abnormalities
What cells line the ectocervix?
Stratified squamous non-keratinised epithelium
What fascia encases the axillary contents?
clavipectoral fascia
What is the combined test for Down’s syndrome?
HCG (increased), Pregnancy-associated plasma protein A (decreased PAPP-A), nuchal translucency via ultrasound (thickened)
If the combined test for Down’s syndrome returns as abnormal, what investigation is next?
Non invasive prenatal screening test or CVS/amniocentesis (invasive)
What does the non invasive prenatal screening test analyse?
Small DNA fragments that are circulating in pregnant women’s blood. Derived form placental cells. It has a high specificity and sensitivity for Down Syndrome
When should Down’s syndrome screening be carried out?
11-13 weeks
What is HCG levels in Edwards and Patau syndrome vs Down’s?
Edward + Patau syndrome have lower HCG, Downs has higher
What chromosome abnormality is Edward syndrome associated with?
Trisomy 18
What chromosome abnormality is Patau syndrome associated with?
Trisomy 13
What is seen on histology with a yolk sac tumour?
Schiller-Duval bodies
What is the most common ovarian tumour?
Serous cystadenoma (lined with ciliated cells, benign)
What is the most common germ cell tumour?
Teratoma
What is the recommended folic acid amount, and when should it be taken?
400mcg OD 3 months before conception up to 12 weeks gestation
What condition is classically associated with rhesus disease
Hydrops fetalis (a type of haemolytic disease of the newborn)
What is done if a routine cervical smear test returns positive for high-risk human papillomavirus (hrHPV)
Examine sample cytologically
What are FSH and LH in Turner’s syndrome?
Raised
Why is anaemia associated with pregnancy?
Haemodilution by the increased plasma volume
What is the most common cause of PPH?
Uterine atony
What volume is uterine atony diagnosed at?
> 500ml
What time must postpartum haemorrhage occur in to be primary?
24 HOURS
What is the treatment pathway for PPH
- ABC approach: 2 peripheral cannulae (14 gauge), lie woman flat, bloods (group+save), warmed crystalloid infusion
- Mechanical: palpate uterine fundus and rub to stimulate contractions, catheterisation to prevent bladder distension and monitor urine output
- Medical: IV oxytocin, ergometrine (unless hx of HTN), carboprost (unless hx of asthma), misoprostol
- surgical: intrauterine balloon tamponade
What is the most common cause of pelvic inflammatory disease
Chlamydia trachomatis
What is Fitz-Hugh-Curtis syndrome and what is it associated with
Adhesions of the liver to the peritoneum, associated with pelvic inflammatory disease
What is the most common causative organism for mastitis?
S.aureus
What is the most common causative organism for mastitis?
S.aureus
What is Sheehan’s syndrome
When the anterior pituitary gland is damaged (ischaemic necrosis) due to significant blood loss, which can happen after delivery if the mother has experienced significant blood loss
What are the classic symptoms of Sheehan’s syndrome?
no galactorrhoea, amenorrhoea, hypothyroid symptoms, hypoadrenalism
What occurs in the proliferative phase of the menstrual phase?
Thickening of the endometrium in response to oestrogen secreted from the mature follicle.
What days is the follicular phase between?
5-13
What day does ovulation occur at?
14
What day is the luteal phase (secretory) phase between?
15-28
(in fancy medical terms) what occurs in PCOS?
Normogonadadotropic normostrogenic anovulation
What drug class are anastrozole and letrozole and how do they work?
Aromatase inhibitors that reduce peripheral oestrogen synthesis
What cancer is smoking protective against?
Endometrial cancer
How does vasa praevia present?
Fresh PV bleeding immediately following membrane rupture, and fetal heart rate abnormalities
What is placenta praevia?
When the blood vessels of the fetus cross or run near to the internal opening of the uterus, beneath the baby. Therefore, the vessels are at high risk of rupture, and there is a high fetal mortality rate
What is placental abruption? How does it usually present?
Abnormal separation from the uterine wall. Usually presents with haemorrhage in the second trimester
What is placenta praevia? How does it usually present?
Placenta that lies in the lower uterine segment. Usually presents with painless vaginal bleeding after 28 weeks
What is placenta accreta?
The placenta grows too deeply into the uterine wall, which is usually discovered after the third stage of labour
What are first line medications for hyperemesis gravidarum
Antihistamines: oral cyclizine or promethazine. Or phenothiazines: oral propchlorperazine or chlopromazine
What is HELLP syndrome?
Obstetric complication characterised by haemolysis, elevated liver enzymes (-> jaundice), and low platelets. Often occurs on a background of pregnancy-induced hypertension or pre-eclampsia
What branches of the intercostal nerves innervate the breast?
T4-T6
What structure produces hCG and when?
Secreted by the syncytiotrophoblast to stimulate corpus luteum to secrete progesterone. This is after implantation (around day 6-7).
What is dysmenorrhoea?
Excessive pain in the menstrual period
What causes primary dysemnorrhoea?
No underlying pelvic pathology. There may be excessive endometrial prostaglandin production
What is first and second line management of dysmenorrhoea?
First line: NSAIDs such as mefenamic acid
Second line: COC
What is secondary dysmenorrhoea?
Secondary dysmenorrhoea typically develops many years after the menarche and is the result of an underlying pathology. In contrast to primary dysmenorrhoea the pain usually starts 3-4 days before the onset of the period
What is the management of a patient presenting with secondary dysmenorrhoea?
Refer all patients to gynae for investigation
What are causes of secondary dysmenorhoea?
Endometriosis, adenomyosis, PID, intrauterine devices, fibroids
What patients is oral fluclonazole C/I in? What alternate treatment should be given for thrush?
Pregnant. Instead give clotrimazole pessary
What are the 4 types of ovarian tumour?
Surface derived tumour, germ cell tumour, sex cord stromal tumour, metastasis
What is the most common type of ovarian tumour?
Surface derived tumour
What is the most common ovarian tumour?
Serous tumour
