Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Phase 4 > Obs and Gynae > Flashcards

Obs and Gynae Flashcards

1
Q

What is cystocele?

A

defect in the anterior vaginal wall, allowing the bladder to prolapse backwards into the vagina

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

what is a grade 1 cystocele?

A

mild - the bladder droops only a short way into the vagina

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

what is grade 2 cystocele?

A

medium - bladder sunk to reach opening of vagina

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

what is grade 3 cystocele?

A

advances - bladder bulges out through opening of vagina

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

what are 7 risk factors for pelvic organ prolapse?

A

advanced age and post menopause low oestrogen
overweight
childbirth - vaginal delivery
constipation and straining
heavy lifting
chronic cough
previous pelvic surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are 6 symptoms of cystocele?

A

pelvic heaviness/fullness
bluge in vagina
aching/pressure in lower belly/pelvis/back that get worse with standing/lifting/coughing
frequent UTIs and LUTS
pain during sex
constipation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are 6 symptoms of pelvic organ prolapse?

A

pelvic heaviness/fullness
bluge in vagina
urinary incontinance
constipation
pelvic/back/abdo pain
sexual dysfunction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is the conservative management for pelvic organ prolapse?

A

physio - pelvic floor exercise
weight loss
lifestyle changes
symptom treatement
vaginal oestrogen cream

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

what are the 5 different types of pessaries that can be used for vaginal prolapse?

A

Ring
shelf/gellhorn - flat disc with stem
Cube
Donut
Hodge - rectangularish

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

what should be given with pessaries to protect from vaginal irritation?

A

oestrogen cream

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

what is the difinitive treatment for pelvic organ prolapse?

A

surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is rectocele?

A

defect in the posterior vaginal wall, allowing the rectum to prolapse forwards into the vagina.
particularly associated with constipation
can develop faecal loading and urinary retention

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

what is uterovaginal prolapse?

A

where the uterus +/- the vagina itself descends out of the vagina

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

what are 6 risk factors for vaginal fistula?

A

childbirth
injury
surgery
infection
radiation
IBD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

what is a vesicovaginal fistula?

A

urinary bladder and vagina fistula

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

what is an enterovaginal fistula?

A

opening between small intestine and vagina

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

what are 4 investigations of vaginal fistulae?

A

Dye test - into bladder and rectum to check for leakage
Imaging - USS, CT, MRI
conoloscopy
cystourethroscopy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is triple assessment of breast lumps?

A

clinical assessment - Hx and exam

Imaging - USS, mamography

histology - fine needle/core biopsy

each scored 1-5 from normal to malignant

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

what is fibroadenoma?

A

Benign tumours of stromal/epithelial breast duct tissue
most common cause of breast mass
normally more likely in early reproductive years
painless, smooth, round, firm, well defined, mobile, usually <3cm

Surgical excision if >3cm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

what does a fibroadenoma look like on imagina?

A

Mammogram - well-circumscribed, oval hypodense or isodense mass, may have calcifications

US - Well-circumscribed, round to ovoid or macrolobulated mass with uniform hypoechoginecity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

what is a fibrocystic breast ?

A

usually in pre/perimenopausal women
Lumpiness, breast pain, fluctuation in beast size
sometimes tender
fluctuate with menstruation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

what are 5 management options for cyclical breast pain?

A

wear supportive bra
NSAIDs
Avoid caffeine
Apply heat
Hormonal tx - danazol, tamoxifen - specialist

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

what are breast cysts?

A

benign individual fluid filled lumps - most common cause of breast lump

can be painful and may fluctuate in size over cycle

Smooth
well circumscribed
mobile
Possibly fluctuant

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

what do breast cysts look like on mammography?

A

halo appearance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

what do breast fat necrosis lumps present with?

A

Painless, hard, fixed, irregular masses, can cause skin changes

very like malignancy and require biopsy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

what are 5 risk factors for fat necrosis?

A

Trauma
Biopsy
breast infection
smoking
obesity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

what is breast papilloma?

A

breast lump usually in ducts
usually benign but can be associated with cancer

bloody nipple discharge is typical

Common premenopausal

Lumpectomy due to increased risk of malignancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

what are breast abscesses?

A

breast lump typical in breastfeeding
ruptured sub-areolar ducts leak into periductal space
must be differentiated from inflammatory breast cancer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

what is breast lipoma?

A

benign tumours of adipose tissue
soft, painless, mobile, no skin changes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

what is galactocele?

A

occur in lactating women often after stopping
breast milk filled cysts due to lactiferous ducts being blocked
firm mobile, painless lump usually beneath areola

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

what is the most common causative pathogen of infective mastitis?

A

staphylococcus aureus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

what are 4 bacteria that can cause mastitis/breast absecesses?

A

S. Aureus - most common
strep
enterococcal species
anaerobes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

what is mastitis?

A

inflammation of breat with or without infection
common with breast feeding

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

what are breast absecesses?

A

a localised area of infection with a walled off collection of puss - with or without mastitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

what are 6 symptoms of mastitis?

A

fever
decreased milk outflow
breast warmth, tenderness, swelling, redness
breast pain
purulent nipple discharge
flu like symptoms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

what may be felt in breast abcesses?

A

Swollen fluctuant tender lump

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

what are 3 investigations for breast abscess?

A

breast ultrasound
needle aspiration drainage
cystology of nipple discharge/aspiration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

what are 3 investigations for mastitis?

A

milk/aspirate/discharge/biopsy culture and sensitivity
histopathological exam of biopsy
pregnancy test

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

what lifestyle treatment is there for breastfeeding mastitis?

A

continue breastfeeding/expressing milk
heat packs
warm showers
simple analgesia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

what is the treatment of suspected infective lactational mastitis?

A

Abx - flucloxacillin or erythromyacin (in allergy) for 10 days if still symptomatic 12-24 hours after 1st presentation with lifestyle management

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

what is the Abx management of non-lactational mastitis?

A

Co-Amoxiclav

2 - erythromycin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

what is the treatment of breast abscess?

A

surgical drainage

Abx
US breast

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

what are 5 signs of silicone breast implant rupture?

A

Change in breast shape and size
increasing pain
increased firmness
swelling over weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

what is ductal ectasia?

A

benign condition of milk duct due to walls thickening and getting blocked
more common in women approaching menopause
often asymptomatic but can cause discharge from breast, lumps under nipple or rarely breast pain
can be surgically treated

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

What is the name of the extention of breast tissue to the axilla?

A

tail of spence

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

what is the name of a breast milk filled cyst caused by lactiferous duct blockage?

A

galactocele

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

what chemical has a inhibitory effect on prolactin?

A

Dopamine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

what enzyme in adipose tissue converts androgens to oestrogen?

A

aromatase

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

which common heart meds can cause gynaecomastia?

A

Spiro

Also digoxin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

what is intraductal papilloma?

A

a benign wart like lump that develops in one or more of the milk ducts in the breast
can cause a lump, nipple discharge and pain or discomfort

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

What is the healthhy bacteria in the vagina?

A

lactobilli - produce lactic acid and reduce pH of vagina (<4.5)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

What is normal vaginal pH?

A

3.5-4.5

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

what is the most common cause of vaginal thrush?

A

Candida albicans

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

What are 4 risk factors for thrush?

A

increased oestrogen (pregnancy)
poorly controlled diabetes
immunosuppresion
Broad spectrum ABx

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

what are the symptoms of vaginal thrush?

A

thick white discharge
vulva and vaginal itching and irritation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

What are 6 complications of vaginal thrush?

A

erythema
fissures
oedema
pain during sex (dyspareunia)
dysuria
excoriation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

what is one test that can be used to distiguish between trush and BV/trichomonas?

A

vaginal pH swab
>4.5 in BV and Trichomonas
<4.5 in candidiasis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

what swab is used for vaginal MCS?

A

charcoal swab - for BV, candidiasis, gonorrhoea, trichomonas, other bacteria

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

What is the management for thrush?

A

antifungal cream - clotrimazole 5g 10% single dose
antifungal pessary - clotrimazole 500mg single dose
Oral antifungal - fluconazole 150mg single dose

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

what should you tell patients using antifungal creams?

A

can degrade latex condoms and prevent spermacides from working => use other forms of birth control for at least 5 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

what are 9 risk factors for ectopic pregnancy?

A

Prev ectopic
tubal surgery
Hx of STD
Smoking
IVF
IUD pregnancy
Black ethnicity
age <18 first intercourse
age >35 at time of presentation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

what is the presentation of an ectopic pregnancy?

A

Missed period
Constant lower RIF/LIF pain
Vaginal bleeding
lower abdo or pelvic tenderness
cervical motion tenderness
Shoulder tip pain - peritonitis
Dizziness or syncope

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

when does ectopic pregnancy usually present?

A

6-8 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

what hCG level will mean pregnancy is visible on USS?

A

> 1500 IU/L

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

what are the 6 criteria for expectant management of ectopic pregnancies?

A

available for follow up
unruptured
mass <35mm
no heart beat
no significant pain
HCG <1500 IU/L

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

what drug is used for medical management of ectopic pregnancies?

A

IM methotrexate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

what is the criteria for medical management of ectopic pregnancies?

A

HCG levels <5000 IU/L
Confirmed absence of intrauterine pregnancy on US
<35mm
minimal pain
no heart beat

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

what is the criteria for surgical management of ectopic pregnancy?

A

> 35mm mass
Significant pain
foetal heartbeat visible on TVUS
Serum hCG >5000

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

what is the 1st line surgical management in women with no fertility risk factors?

A

Laproscopic Salpigectomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
70
Q

What embrionic structure does the female genital system develop from?

A

paramesonephric (mullerian) ducts

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
71
Q

what are 4 abnormal female organ formations?

A

bicornuate uterus - heart shaped
imperforate hymen
transverse vaginal septae - septum in vagina
vaginal hypoplasia and agenesis - abnormally small/absent vagina

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
72
Q

what is androgen insensitivity syndrome?

A

a condition where cells are unable to respond to androgen hormones due to a lack of androgen receptors. X-linked recessive genetic condition, caused by a mutation in the androgen receptor gene on the X chromosome. Extra androgens are converted into oestrogen, resulting in female secondary sexual characteristics despite XY genetics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
73
Q

what are the complications of androgen insensitivity syndrome?

A

slightly taller than average female
no pubic or facial hair
increased risk of testicular cancer unless removed from abdomen
infertility

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
74
Q

what is the usual presentation of androgen insensitivity syndrome?

A

inguinal hernias
primary amenorrhoea

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
75
Q

What is menopause?

A

no periods for 12 months due to the end of menstruation

Average age 51

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
76
Q

what is premature menopause?

A

Menopause before 40 years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
77
Q

What cells secrete oestrogen?

A

ganulosa cells

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
78
Q

What are 8 perimenopausal symptoms?

A

Hot flushes
emotional lability/low mood
reduced libido
premenstrual syndrome
irregular periods
joint pain
heavier/lighter periods
vaginal dryness and atrophy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
79
Q

What are 4 conditions menopause increases the risk of?

A

CVD and stroke
osteoporosis
pelvic organ prolapse
urinary incontinance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
80
Q

when should FSH be used to diagnose menopause?

A

<40 years
<45 years with menopausal symptoms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
81
Q

How long is contraception required after menopause?

A

2 years if <50
1 year is >50

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
82
Q
A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
83
Q

what is the management of perimenopausal symptoms?

A

HRT
tibolone - synthetic steroid
clonidine - reduces hot flushes
CBT
SSRIs
testosterone gel for libido
vaginal oestrogen/moisturisers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
84
Q

what is adenomyosis?

A

Endometrial tissue inside the myometrium

More common with mutiparous women

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
85
Q

What are 5 presetations of adenomyosis?

A

Dysmenorrhoea
menorrhagia
dyspareunia (pain in intercourse)
Infertility
Enlarged/tender (boggy) uterus but softer than w/ fibroids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
86
Q

what is the 1st line investigation for adenomyosis ?

A

TV ultrasound

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
87
Q

What is the gold standard investigation for adenomyosis?

A

histological exam after hysterectomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
88
Q

what are 2 non-contraceptive treatments for mennhoragia?

A

Tranexamic acid - when no pain (antifibrinolytic reduces bleeding)

Mefenamic acid - with pain (NSAID - reduced bleeding and pain)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
89
Q

What are 3 contraceptive managements options for mennorhagia?

A

1 - IUS - mirena coil
2 - COCP
4 - cyclical oral progestogens

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
90
Q

what are 4 specialist managements of menorrhagia?

A

GnRH analogues to induce meno-pause like state
endometrial ablation
uterine artery embolisation
hysterectomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
91
Q

what are 9 complications of adenomyosis in pregnancy?

A

infertility
miscarriage
preterm birth
small gestation
preterm premature rupture of membranes
malpresentation
c-section
PPH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
92
Q

What is asherman’s syndrome?

A

where adhesions form in uterus following damage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
93
Q

What are 3 risk factors for ashermans syndrome?

A

dilation and curettage (after retained products of conception)
uterine surgery
pelvic infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
94
Q

what are 4 presentations of asherman’s syndrome?

A

secondary amenorrhoea
light periods
dysmenorrhoea
infertility

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
95
Q

What are 4 investigations for asherman’s syndrome?

A

hysteroscopy
hysterosalpingography
sonohysterography
MRI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
96
Q

What is lichen sclerosus?

A

a chronic inflamatory autoimmune skin condition causing patches of shiny white skin on labia, perineum and perianal skin most commonly as well as axilla and thighs. can also affect men on foreskin and glans penis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
97
Q

what are 3 risk factors for lichen sclerosus?

A

Postmenopausal
Autoimmunity - thyroid, T1DM
Site of injury - Koebner phenomenon

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
98
Q

what is lichen planus?

A

autoimmune condition causing chronic inflammation with shiny purplish flat top raised areas with white lines across surface called wickhams striae

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
99
Q

what are 7 presentations of lichen sclerosus?

A

white skin patches
itching
soreness
skin tightness
painful sex
erosions
fissures

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
100
Q

what is the appearance of lichen sclerosis?

A

Porcelain white
shiny
tight
thin
slightly raised
papules or plaques

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
101
Q

what is the management for lichen sclerosus?

A

topical steroids - dermovate - clobetasol propionate 0.05%
OD for 4 weeks then gradually reducing in frequency
emollients

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
102
Q

what is a key complication of lichen sclerosus?

A

5% risk of developing squamous cell carcinoma of the vulva

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
103
Q

what are 4 complications of lichen sclerosis?

A

pain and discomfort
sexual dysfunction
bleeding
narrowing of vaginal or urethral openings

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
104
Q

what is atrophic vaginitis?

A

atrophy of the vaginal mucosa due to lack of oestrogen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
105
Q

What are 6 patient presentations of atrophic vaginitis?

A

itching
dryness
dyspareunia (painful sex)
bleeding (due to inflammation)
recurrent UTIs, Stess incontinance, prolapse
White, yellow possibly malodorous discharge

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
106
Q

what are 6 signs of atrophic vaginitis on examination?

A

pale mucosa
thin skin
reduced skin foldes
erythema and inflammation
dryness
sparse pubic hair

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
107
Q

what is the management of atrophic vaginitis?

A

topical oestrogen - cream, pessaries, ring

Systemic HRT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
108
Q

what are 3 contraindications to use of topical oestrogens in atrophic vaginitis?

A

Angina
VTE
breast cancer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
109
Q

what are the 4 parameters to measure ‘normal’ menstruation by?

A

Frequency
regularity
duration
volume

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
110
Q

what are 4 risk factors for abnormal uterine bleeding?

A

Extremes of reproductive age
PCOS
endocrine disorders - hypothyroid, hyperprolactinoma
obesity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
111
Q

what is the emergency management of excessive uterine bleeding?

A

1st - hormone therapy - 25mg IM conjugated oestrogens

2nd - Tranexamic acid, Surgery

Blood products and fluids if haemodynamically unstable

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
112
Q

what are the two types of endometrial hyperplasia

A

hyperplasia without
atypical hyperplasia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
113
Q

what is the treatment for endometrial hyperplasia?

A

progestogens - IUS or continuous oral progestogens

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
114
Q

what is a normal endometrial thickness post menopause?

A

<4mm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
115
Q

what are endometriomas seen in the ovaries often called?

A

chocolate cysts (from endometriosis)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
116
Q

what are some possible cause of endometriosis?

A

retograde menstruation through fallopian tubes into abdomen
Embryonic cells meant to be endometrial tissue remained outside uterus in development of fetus
lymphatic spread
metaplasia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
117
Q

what are 7 presentations of endometriosis?

A

cyclical abdominal or pelvic pain
deep dyspareunia
dysmenorrhoea
cyclical bleeding from other sites
subfertility
fixed retroverted uterus
palpable mass - endometrioma
Dyschezia - painful pooping

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
118
Q

what is the gold standard investigation for endometriosis?

A

laproscopic surgery + biopsy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
119
Q

what is the medical management of endometriosis?

A

1 - NSAIDs
2 - COCP or Progesterone only, depo, implant or IUS
3 - GnRH analogous

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
120
Q

what are 4 risk factors for fibrids?

A

increased patient weight
40+
black ethnicity
low vit D

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
121
Q

What is a complete mole in a molar pregnancy?

A

when 2 sperm cells fertalise an ovum with no genetic materium and combine genetically to form a tumour with 46 paternal chromosomes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
122
Q

what is a partial mole in a molar pregnancy?

A

when 2 sperm fertilise a normal ovum at the same time causing a haploid cell (3 sets of chromosomes which divides and multiplies to form a partial mole - there may be some foetal material

usually 69 chromosomes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
123
Q

what are 6 possible indications of molar pregnancy compared to normal pregncncy?

A

severe morning sickness
vaginal bleeding
increased enlargement of uterus
abnormally high hCG
thyrotoxicosis (hcg can mimic TSH and stimulate thyroid)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
124
Q

what is a sign of molar pregnancy on USS?

A

snow storm appearance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
125
Q

what is the management of molar prregnancy?

A

evacuation of uterus
histology
referal to gestational trophoblastic disease centre
hCG level monitoring

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
126
Q

what can be a complication of molar pregnancy?

A

metastasis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
127
Q

what are 6 presentations of prolactinoma?

A

amenorrhoea/oligomenorrhoea
infertility
galactorrhoea
lowered libido
erectile dysfunction
visual deterioration (bilateral temoral hemianopia)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
128
Q

what is the most common type of pituitary tumour in women?

A

prolactinoma - 50%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
129
Q

what is the 1st line medical treatment of prolactinoma?

A

dopamine agonist - carbergoline 0.5mg once weekly

(2nd line OCP in premeno women)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
130
Q

what is the surgical management of prolactinoma?

A

tras-sphenoidal surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
131
Q

what is the most common type of ovarian tumour?

A

epithelial cell tumour

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
132
Q

what are beingn ovarian tumours?

A

dermoid cysts
germ cell tumours

teratomas. particularly associated with ovarian torsion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
133
Q

What are the 3 diagnostic features for PCOS diagnosis?

A

Rotterdam criteria

Anovulation/oligoovulation
Hyperandrogenism (hirsutism and acne)
Polycystic ovaries on USS

2 features = diagnosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
134
Q

What are 5 potential presentations of ovarian cysts?

A

pelvic pain - w/ torsion, rupture or haemorrhage
bloating
fullness in abdomen
palpable pelvic mass (V large cysts)
Infertility

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
135
Q

what are 5 medications that can cause hirsutism?

A

Phenytoin
Ciclosporins
corticosteroids
testosterone
Anabolic steroids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
136
Q

what are 4 differentials for hisutism?

A

Medications
Ovarian or adrenal tumours
Cushings
Congenital adrenal hyperplasia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
137
Q

what is the mechanism for insulin resistance in PCOS?

A

Insulin promotes the release of androgens and supresses sex hormone binding globulin (produced in liver)

SHBG normally binds to androgens and suppresses function

High insulin levels also contribute to halting development of follicles in ovaries leading to anovulation and multiple partially developed follicles

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
138
Q

what are functional cysts?

A

follicular cysts for developing follicles can sometimes fail to rupture and release the egg and therefore persist for a short while

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
139
Q

what is the most common type of ovarian cyst?

A

functional (follicular) cysts

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
140
Q

what type of cysts are often seen in early pregnancy?

A

corpus luteum cysts - may cause pelvic discomfort pain or delayed menstruation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
141
Q

What are 5 types of ovarian cysts?

A

serous cystadenomas
Mucinous cystadenoma
Endometriomas
dermoid cysts
sex cord stromal tumours (can be benign or malig)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
142
Q

what are serous cystadenomas?

A

benign ovarian tumours of epithelial cells

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
143
Q

what are mucinous cystadenomas?

A

benign ovarian tumour of epithelial cells which can grow very large

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
144
Q

what are endometriomas?

A

ovarian cysts made of endometrial tissues - patient with endometriosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
145
Q

what are dermoid cysts?

A

AKA teratomas

come from germs cells - hair, skin, teeth, bones

associated with ovarian torsion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
146
Q

what are sex cord stromal tumours?

A

rare tumours that can be benign or malignant arising from connective tissue or embryonic structures

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
147
Q

what is the management of simple ovarian cysts in premenopausal women?

A

<5cm - will almost always resolve in 3 cycles
5-7cm - routine referral to gyne
>7cm - surgical evaluation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
148
Q

what are 2 possible surgical managements of ovarian cysts?

A

ovarian cystectomy
oophorectomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
149
Q

what is the presentation of ruptured ovarian cysts?

A

Pain - sudden onset severe pelvic pain
Peritonism
Haemodynamic instability
GI symptoms
Urinary symptoms - dysuria, urinary frequency
Fever

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
150
Q

What is Meig’s syndrome?

A

ovarian fibroma (benign ovarian tumour)
pleural effusion
Ascites

typically in older women. removal of tumour results in complete resolution of symptoms.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
151
Q

when is ovarian torsion more likely?

A

In pregnancy
with a mass >5cm
before menarche and women of rFeproductive age
fertility treatment - ovarian hyperstimulation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
152
Q

what are 4 features of ovarian torsion?

A

unilateral sudden onset severe pain
nausea and vomiting
palpable mass
localised tenderness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
153
Q

what can be seen on US in ovarian torsion?

A

Whirlpool sign
free fluid in pelvis and oedema of ovary

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
154
Q

How is ovarian torsion definitively diagnosed?

A

Laparoscopy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
155
Q

what are 3 STDs that can cause PID?

A

Neisseria gonorrhoea
Chlamydia trachomatis
Mycoplasma genitalium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
156
Q

What are non STDs that can cause PID?

A

Gardenerella vaginalis (associated with BV)
Haemophilus influenzae
Escheriachia coli

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
157
Q

what are 6 presentations of PID?

A

pelvic/low abdomen pain
abnormal discharge
abnormal bleeding
dyspareunia
fever
dysuria

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
158
Q

what 4 things may be found on a PID examination?

A

pelvic tenderness
cervical motion tenderness
cervicitis
purulent discharge

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
159
Q

What are 7 investigations for PID

A

NAAT swabs for gonorrhoea, chlamydia, mycopasma genitalium
HIV test
Syphilis test
High vag swab for BV, candidiasis, trichomoniasis
Look for pus cells on microscope (absence excludes PID)
Pregnancy test (?ectopic)
Inflammatory markers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
160
Q

what is the management of PID?

A

1 - Stat IM 1g Ceftriaxone + 14 days Doxycycline 100mg BD PO + Metronidazole 400mg BD PO

2 - Ofloxacin PO + Metronidazole PO

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
161
Q

What are 6 complications of PID?

A

Sepsis
abscess
infertility
chronic pelvic pain
ectopic pregnancy
Fiz-hugh-curtis syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
162
Q

what is fiz-hugh-curtis syndrome?

A

inflammation and infection of liver (Glisson’s) capsule causing adhesions between liver and peritoneum => RUQ pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
163
Q

What is the treatment for PID?

A

IM Ceftriaxone 1g (for gonorrhoea)
Doxycycline 100mg BD 14 days (chalmidia, MG)
Metronidazole 400mg BD 14 days (anaerobes)

if have coil => leave in unless not responding after 72 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
164
Q

what are 8 non-diagnostic features that may be present in PCOS?

A

insulin resistance and diabetes
acanthosis nigricans
CVD
hypercholesterolaemia
endometrial hyperplasia and cancer
Obstructive sleep apnoea
depression and anxiety
sexual problems

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
165
Q

what are 4 hormonal blood tests for PCOS?

A

Raised LH
raised LH to FSH ratio
raised testosterone
Raised insulin
normal or raised oestrogen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
166
Q

What can be seen on USS of PCOS?

A

‘string of pearls’ appearance

> 12 cysts on a single ovary
OR
10cm3 ovarian volume => diagnostic criteria

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
167
Q

what test can be used for diabetes in PCOS?

A

Oral glucose tolerance test

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
168
Q

what is impaired fasting glucose on OGTT?

A

fasting 6.1-6.9 mmol/L

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
169
Q

what is impaired glucose tolerance of OGTT?

A

at 2 hours
glucose 7.8-11.1 mmol/L

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
170
Q

what is diabetes in OGTT?

A

Plasma glucose >11.1 at 2 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
171
Q

What medication can be given for weight loss that impairs lipid absorption?

A

Orlistat - lipase inhibitor
BMI >30

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
172
Q

What can be used to reduce risk of endometrial cancer in people with PCOS?

A

cyclical progesterone or COCP to induce withdrawal bleed
Mirena coil

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
173
Q

what are 4 medications that can be used for fertility in PCOS?

A

Clomifene
Laproscopic ovarian drilling
Metformin
Letrozole

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
174
Q

what 2 medications can be used to treat hirsutism?

A

co-cyprindiol
topical elfornithine

Specialist - electrolysis, laser removal, spiro, finasteride, flutamide, cyproterone acetate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
175
Q

what is the surgical management of ectopics?

A

laproscopic salpingectomy or salpingotomy

when there is pain, mass >35mm, visible heartbeat or HCG >5000

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
176
Q

what medication do you need to give Rhesus -ve women in surgical ectopic removal?

A

anti rhesus D

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
177
Q

What counts as a miscarriage?

A

<24 weeks gestation

early <12 weeks
late 12-24 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
178
Q

what are 5 risk factors for miscarriage?

A

Maternal age >35
Hx of previous miscarriages
Prev cervical cone biopsy
Lifestyle - smoking, alcohol, obesity
Medical conditions - uncontrolled diabetes, thyroid disorders

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
179
Q

what is recurrent miscarriage?

A

3+ consecutive miscarriages

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
180
Q

what are 7 causes of recurrent miscarriages?

A

Idiopathic
Antiphospholipid syndrome
hereditary thrombophilia - Factor V leiden, prothrombin mutation, protein s deficiency
uterine abnormalities
genetic factors
chronic histiocytic intervillositis
Chronic disease - DM, Thyroid disease, SLe

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
181
Q

what can be given to women with antiphospholipid syndrome to increase chance of successful pregnancy?

A

low dose aspirin
LMWH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
182
Q

what is a missed miscarriage?

A

when the foetus is no longer alive but no symptoms have occurred

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
183
Q

what is a threatened miscarriage?

A

vaginal bleeding with closed cervix and alive foetus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
184
Q

what is an inevitable miscarriage?

A

vaginal bleeding and open cervix

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
185
Q

what is an incomplete miscarriage?

A

retained products of conception remain in uterus after miscarriage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
186
Q

what is a complete miscarriage?

A

a full miscarriage has occurred with no products remaining

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
187
Q

what is anembryonic pregnancy?

A

a gestational sac is present but contains no embryo

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
188
Q

what are 3 features looked for on ultrasound to confirm pregnancy?

A

mean gestational sac diameter
foetal pole and crown rump length
foetal heart beat

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
189
Q

at what gestational crown rump length is a foetal heart beat expected?

A

7mm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
190
Q

at what mean gestational sac diameter is a foetal pole expected?

A

25mm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
191
Q

what is the management of a miscarriage <6 weeks?

A

expectant management
Repeat urine pregnancy test after 7-10 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
192
Q

what is the management for miscarriage >6 weeks?

A

referral to early pregnancy assessment unit
USS for location and viability

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
193
Q

what is expectant management of miscarriage?

A

repeat urine pregnancy test 3 weeks after bleeding and pain settle to confirm complete miscarriage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
194
Q

what is medical management of miscarriage >6 weeks?

A

Misoprostol (prostaglandin analogue to stimulate cervical ripening and uterine contractions)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
195
Q

what are 4 side effects of misoprostol?

A

heavier bleeding
pain
vomiting
diarrhoea

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
196
Q

what is the surgical management of miscarriage?

A

manual vacuum aspiration (LA) <10 weeks
electric vacuum aspiration (GA)
+ misoprostol
+ anti D to -ve women

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
197
Q

what is the management of threatened miscarriage?

A

Vaginal progesterone 400mg BD

if they have vaginal bleeding and have previously miscarried

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
198
Q

what is the management of incomplete miscarriage?

A

medical - misoprostol
surgical - evacuation under GA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
199
Q

when should a pregnancy test be done after a miscarriage >6 weeks?

A

3 weeks post symptoms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
200
Q

What are the 2 legal documents for abortion?

A

1967 abortion act
1990 human fertilisation and embryology act

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
201
Q

what are the legal requirements for abortion?

A

2 medical practitioners sign to agree abortion is indicated
must be carried out by registered medical practitioner in NHS hospital or approved premise

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
202
Q

what are 3 indications for abortion post 24 weeks?

A

continuing pregnancy risks life of woman
Termination prevents grave permanent injury to physical or mental health of the woman
substantial risk of physical or mental abnormalities in the child

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
203
Q

what 2 medications are used in a medical abortion?

A

mifepristone (anti-progestogen)
misoprostol (prostaglandin analogue) 1-2 days later

Anti-D in rhesus -ve mother if >10 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
204
Q

what are 3 surgical managements of termination of pregnancy?

A

Cervical priming - misoprostal, mifepristone or osmotic dilaters
Vacuum aspiration
Dilation and curettage - between 14-24 weeeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
205
Q

what is used to confirm successful termination of pregnancy?

A

Urine pregnancy test at 3 weeks post termination

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
206
Q

what are 5 complications of abortion?

A

Bleeding
Pain
Infection
Failure of abortion
Damage to cervix or other structures

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
207
Q

What is an USS signs of diamniotic dichorionic twins?

A

lambda or ‘twin peak’ sign

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
208
Q

what is an USS sign of monochorionic diamniotic twins?

A

T sign

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
209
Q

what are 7 risks to the mother with multiple pregnancy?

A

anaemia
polyhydramnious
HTN
malpresentations
spont preterm labour
instrumental delivery/caesarian
PPH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
210
Q

what are 7 risks to the foetuses in multiple pregnancy?

A

Miscarriage
Stillbirth
foetal growth restriction
prematurity
twin-twin transfusion syndrome
twin anaemia polycythaemia sequence
congenital abnormalities

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
211
Q

what is twin-twin transfusion syndrome?

A

only monochorionic multiples
Abnormal connection between blood supply of babies causing shunting of blood to one foetus (recipient) and away from the other (donor)
The recipient gets overloaded and therefore HF and polyhydramnios.
The donor gets growth restricted, anaemic and oligohydramnios
Tx - laser seperation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
212
Q

what is twin anaemia polycythaemia sequence?

A

similar to twin to twin but less acute
one twin becomes anaemic whilst the other develops polycythaemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
213
Q

whenis the monitoring for anaemia in multiple pregnancy?

A

booking
20 weeks
28 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
214
Q

what is the scan monitoring for monochorionic twins?

A

every 2 weeks from 16 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
215
Q

what is the scan monitoring for dichorionic twins?

A

every 4 weeks from 16 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
216
Q

when is birth planned for monochorionic monoamniotic twins?

A

32-34 weeks
Must be sectioned

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
217
Q

when is birth planned for monochorionic diamniotic twins?

A

36-37 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
218
Q

when is birth planned for dichorionic diamniotic twins?

A

37-38 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
219
Q

when is birth planned for triplets?

A

before 35+6 weeks

220
Q

What are 11 things obesity increases risk of in pregnancy?

A

Gestational diabetes (screen BMI >30)
Pre-eclampsia and HTN (BMI >35)
VTE (BMI > 30)
mental health problems
inaccurate symphysis fundal height measurements
PPH
Caesarean birth
Congenital anomalies
Stillbirth
Prematurity
Macrosomia

221
Q

what causes gestational diabetes?

A

due to insulin resistance and relative glucose intolerance in pregnancy

222
Q

what are 7 risk factors for gestational diabetes?

A

prev. gestational diabetes
prev. macrosomic baby
BMI>30
Ethnic origin

FHx of diabetes (1st degree relative)
Advanced maternal age
PCOS

223
Q

what counts as a macrosomic baby?

A

> 4.5kg (9lb 12oz)

224
Q

what test is use for gestational diabetes?

A

glucose tolerance test between 24-28 weeks

225
Q

what are 3 indications of gestational diabetes?

A

large for date foetus
polyhydramnios
Glu on dipstick

226
Q

what is gestational diabetes on fasting GTT level?

A

> 5.6 mol/L

227
Q

what is gestational diabetes at 2 hour GTT level?

A

> 7.8 mmol/L

228
Q

what is the follow up of gestational diabetes?

A

monthly US scans

229
Q

what is the initial management of gestational diabetes?n (3)

A

1 - diet and exercise (fasting glucose <7 mmol/L)

2 - metformin (if not under control after 2 weeks)

3 - Insulin
(fasting >7 mmol/L or >6 mmol/L with macrosomia)

230
Q

what is the fasting glucose target for pregnant women?

A

<5.6 mmol/L

231
Q

what is the 1 and 2 hour post prandial glucose target for pregnant women?

A

1 hour - 7.8mmol/L
2 hours - 6.4 mmol/L

232
Q

How much folic acid should those with existing diabetes take in the 1st trimester?

A

5mg OD

233
Q

when is delivery planned for those with pre-existing diabetes in pregnancy?

A

between 37-38+6 weeks

234
Q

what is the maximum gestation women with gestational diabetes can give birth up to?

A

40+6 weeks

235
Q

when is retinal screening performed for diabetics in pregnancy?

A

at booking and at 28 weeks

236
Q

what is the post-natal management of mothers with gestational diabetes?

A

Can usually stop antidiabetic medications immediately

Fasting glucose at 6 weeks

237
Q

what is the maternal risk in pre-existing diabetes?

A

miscarriage
pre-eclampsia risk increased
infection - uti, resp, endometrial. andwound
increased c-section rate

238
Q

what are 6 risks to the baby of a diabetic mother?

A

neonatal hypoglycaemia
neonatal jaundice
congenital abnormalities - heart, skeletal, neural tube
shoulder dystocia
polycythaemia
childhood obesity

239
Q

When is a variable rate insulin infusion (sliding scale) started intrapartum?

A

with 2 BMs >7

240
Q

What is the target intrapartum blood glucose level?

A

4-7 mmol/L

241
Q

what is given preconception to pregnant women to prevent neural tube defects?

A

Folic acid 400microg till 12 weeks unless there are risk factors for neural tube defects or obesity in which case 5mg is given

242
Q

can ACEI or ARBs be taken in pregnancy?

A

NO

cause oligohydramnios, miscarriage, hypocalvaria (malformation of skull), renal failure in neonate, hypotension in neonate

243
Q

can thiazide like diuretics be taken in pregnancy?

A

NO

244
Q

what usually happens to BP in 1st trimester?

A

falls until 20-24 weeks then increases to pre-pregnancy pressures

245
Q
A
246
Q

what is the management of pre-existing HTN in pregnancy?

A

1 - Labetalol

2 - CCB - nifedipine

Alpha blockers - doxazosin

247
Q

what is the 1st line management of severe hypertension in pregnancy <37 weeks?

A

labetalol (>160 systolic but also for consideration >140)

248
Q

what is gestational hypertension vs pre-existing hypertesion?

A

gestation has onset >20 weeks, pre-existing = <20 weeks gestation

there is no proteinuria or oedema in gestational HTN and usually resolves following birth

249
Q

what is the management of gestational hypertension >37 weeks?

A

delivery (+labetalol if >160/110)

250
Q

what is pre-eclampsia?

A

New-onset blood pressure ≥ 140/90 mmHg after 20 weeks of pregnancy, AND 1 or more of proteinuria
or organ involvement

251
Q

what is the pathophysiology of pre-eclampsia?

A

when blastocyst implants the outermost syncytiotrophoblast grows chorionic villi into endometrium

trophoblast invasion sends signals to spiral arteries to become more fragile, reduce vascular resistance and form pools (lacunae) at around 20 weeks

when this process does not occur it causes pre-eclampsia due to increased vascular resistance leading to increased oxidative stress in placenta and systemic inflammation

252
Q

what are 5 high risk factors for pre-eclampsia?

A

pre-existing HTN
Prev. HTN in pregnancy
autoimmune consitions
diabetes
CKD

253
Q

what are 6 moderate risk factors for pre-eclampsia?

A

> 40 years
BMI >35
10+ years since prev. pregnancy
multiples
first pregnancy
FHx of pre-eclampsia

254
Q

what are 8 symptoms of pre-eclapsia?

A

headache
visual disturbance/blurring
nausea and vomiting
upper abdo/epigastric pain
oedema
reduced urine output, proteinuria
brisk reflexes
RUQ/Epigastric pain

255
Q

what is needed for a diagnosis of pre-eclampsia?

A

blood pressure >140/90
+
Proteinuria OR
Organ dysfunction (^creatinine, ^liver enzymes,seizures, thrombocytopenia, haemolytic anaemia) OR
Placental dysfunction (foetal growth restriction or abnormal dopplers)

256
Q

how can proteinuria be quantified in pre-eclampsia?

A

urine protein:creatinine ratio >30mg/mmol

urine albumin:creatinine ration >8 mg/mmol

257
Q

what blood test can be used to test for pre-eclapsia?

A

placental growth factor (between 20-35 weeks)

258
Q

what is the prophylaxis treatment for pre-eclampsia?

A

Aspirin 75-150mg OD from 12 weeks-birth

women with 1 high risk or 2 moderate risk factors

259
Q

what is the management for gestational hypertension?

A

aim 135/85 mmHg
Urine dip every week
bloods weekly - FBC U+E LFTs
Serial growth scans
PlGF test once (20-35 weeks)

Admit if >160/110 mmHg

260
Q

How often are scans with pre-eclapsia?

A

every 2 weeks

261
Q

what is the medical management of pre-eclapsia?

A

1st line - labetalol
2nd line - nifedipine
3rd line - methyldopa

262
Q

what can be given in severe pre-eclampsia or eclapsia?

A

IV hydralazine

263
Q

what is the management in labour of pre-eclamptics?

A

IV magnesium sulphate (prevent seizures) - give for 24 hours post birth

Fluid restriction to avoid fluid overload

264
Q

what is the post delivery management of pre-eclampsia?

A

1st line - enalapril
1st line in black afro or Caribbean people - Nifedipine/amlodipine
3rd line labetolol or atenolol

265
Q

what are 3 foetal complications of pre-eclampsia?

A

IUGR
Prematurity
Placental abruption

266
Q

what is HELLP syndorme?

A

complication of pre-eclampsia and eclampsia

Haemolysis
Elevated liver enzymes
Low Platelets

management = delivery

267
Q

what are 8 complications of pre-eclampsia?

A

foetal growth restriction
eclampsia
pulmonary oedema
stroke
placental abruption
CVD
renal failure
still birth

268
Q

what are the levels for anaemia in pregnacy?

A

<110 g/L 1st trimester
<105 g/L 2nd/3rd trimester
<100g/l postpartum

269
Q

why does physiological anaemia occur in pregnancy?

A

blood volume increases naturally in pregnancy to a greater extent than red cell mass

270
Q

what is the management of anaemia in pregnancy?

A

Oral iron - ferrous sulphate 200mg OD
B12 if needed - IM hydroxocobalamin, oral cyanocobalamin
Folic acid - 5mg if deficient

271
Q

what counts as postpartum anaemia?

A

Hb <100 g/l

272
Q

what is the management of postpartum anaemia?

A

<100 g/l - Oral ferrous sulphate
<90 g/l - iron infusion
<70 g/l - blood transfusion

273
Q

why is pregnancy a hypercoagulable state?

A

increase in factors VII, VIII, X and fibrinogen
Decrease in protein S
Uterus presses on IVC causing venous stasis

274
Q

What are 12 risk factors for VTE in pregnancy?

A

smoking
Para >3
Age >35
BMI >30
reduced mobility/immobility
Multiples pregnancy
pre-eclampsia
gross varicose veins
FHx of VTE
Thrombophilia
IVF pregnancy

275
Q

what are the guidelines for starting VTE prophylaxis in pregnancy?

A

from 28 weeks with 3 risk factors
from booking with 4+ risk factors

until 6 weeks pospartum

276
Q

what blood thinner is contraindicated in pregnancy?

A

Warfarin

277
Q

what prophylaxis is given for VTE in pregnancy?

A

LMWH - Dalteparin enoxiparin, tinzaparin

Given until 6 weeks postnatal

278
Q

what are 5 presentations of DVT?

A

unilateral calf/leg swelling (>3cm difference)
dilated superficial veins
tender calf
oedema
colour changes to leg

279
Q

what are 8 presentations of PE?

A

SOB
cough/haemoptysis
pleuritic chestr pain
hypoxia
tachycardia
tachypnoea
low-grade fever
haemodynamic instability

280
Q

what is the gold standrd investigation for DVT?

A

compression duplex US

281
Q

what is the gold standard investigation for PE?

A

CT pulmonary angiogram (CTPA)

282
Q

what weight is used for treatment dose LMWH in pregnancy DVT/PE?

A

booking weight

283
Q

what are 3 conditions that group b strep infection of the newborn can cause?

A

meningitis
sepsis
pneumonia

284
Q

what increases baby’s risk of GBS infetion from mother?

A

preterm birth
previous baby with GBS
signs of infection during labour
+ urine or GBS swab in pregnancy
ROM >24 hours before birth

285
Q

what is the risk of GBS infection in a second pregnancy?

A

50% - should have prophylactic Abx or testing in late pregnancy

286
Q

who should receive intrapartum Abx?

A

GBS in prev pregnancy
Prev Baby with GBS disease
Premature labour
Pyrexia during labour

287
Q

which antibiotic is used for intrapartum antibiotic prophylaxis in group B strep?

A

IV benzylpenicillin 3g (+1.5g 4 hourly until delivery)

288
Q

which antibiotic is given intrapartum for GBS in women with penicillin allergy?

A

Vamcomycin 1g every 12 hours (in severe beta-lactam allergy)

Cephlasporins can be used in non sever penicillin allergy

289
Q

What test is used for Group B strep in pregnancy?

A

enriched culture medium test at 35-37 weeks

290
Q

what is the treatment for BV in pregnANCY?

A

oral metronidazole 400mg BD 5-7 days
OR
Intravaginal metronidazole gel 0.75% OD 5 days

291
Q

what are the 3 different types of puerperal infection?

A

endometritis (most common)
myometritis
parametritis (supporting tissue around uterus)

292
Q

what are 6 signs of puerperal infection?

A

pain below waist/in pelvic area
pale clammy skin due to blood loss
foul smelling vaginal discharge
raised HR
fever/chills/aches
Loss of appetite

293
Q

what bacteria most commonly causes puerperal infection?

A

Group B strep (or other streps)

294
Q

what are 5 risk factors for puerperal infection?

A

caesarean
many VEs
delay of birth after ROM
retained tissues
meconium in liquor
use of balloon for induction

295
Q

what antibiotics are usually used for puerperal infection?

A

Clindamycin and gentamicin

296
Q

what is the treatment for trichomonas in pregnancy?

A

metronidazole 400-500mg TD 5-7days

CANNOT DO 2g SINGLE DOSE

297
Q

What does UTI in pregnancy increase the risks of ?

A

preterm delivery
posibly - low birth weight, pre-eclampsia

298
Q

what would be seen on a dipstick of someone with a UTI?

A

Nitrites
Leukocytes
?blood

299
Q

what is the management of uti in pregnancy?

A

SEND FOR CULTURE

1 - Nitrofurantoin (trimester 1+2) 50mg QDS 7 days or 100mg MR

2 - Amoxicillin 500mg TDS 7 days
OR Cefalexin 500mg BD 7 days

300
Q

how should asymptomatic bacteriuria be treated?

A

managed like UTI due to risk of progression to acute pyelonephritis

301
Q

can nitrofurantoin be used in pregnancy?

A

Yes but NOT IN THIRD TRIMESTER
Risk of neonatal haemolysis

302
Q

Can trimethoprim be used in pregnancy?

A

NOT IN FIST TRIMESTER

folate antagonist => risk of neural tube defects and congenital malformations

303
Q

what 4 things can congenital rubella cause?

A

deafness
congenital cataracts
congenital heart disease
learning disabilities

304
Q

Can pregnancy women get the MMR vaccine?

A

NO - live vaccine

305
Q

what complications can varicella zoster cause in pregnant mothers?

A

varicella pneumonitis
hepatitis
encephalitis

306
Q

what are 5 features of congenital varicella syndrome?

A

foetal growth restriction
microcephaly, hydrocephalus and learning disability
limb hypoplasia
cataracts and eye inflammation

307
Q

what kind of bacteria is listeria?

A

gram pos bacilli

308
Q

what can listeria cause in pregnancy?

A

miscarriage or foetal death
sever neonatal infection

309
Q

what are 6 complications of congenital cytomegalovirus?

A

foetal growth restriction
microcephaly
hearing loss
vision loss
learning disability
seizures

310
Q

where does toxoplasma gondii come from?

A

parasite from cat poo

311
Q

what is the classical triad of congenital toxoplasmosis?

A

intracranial calcification
hydrocephalus
chorioretinitis (eye inflamation)

312
Q

what are the complications of parovirus B19 in pregnancy?

A

miscarriage or foetal death
severe fetal anaemia
hydrops fetalis (foetal heart failure)
maternal pre-eclampsia like syndrome

313
Q

what are 3 signs of congenital zika syndrome?

A

microcephaly
foetal growth restriction
intracranial abnormalities

314
Q

what is the management of varicella zoster exposure in pregnancy?

A

Check maternal varicella antibodies if unsure of status

Oral Acyclovir - take day 7-14 post exposure

historically IV varicella zoster immunoglobulins

315
Q

what is the management of chickenpox in pregnancy?

A

> 20 weeks - oral acyclovir

316
Q

what hormone causes uterine contraction?

A

oxytocin

317
Q

what are 6 risk factors for atonic uterus?

A

primiparity/grand multiparity
Multiples
high BMI
foetal macrosmia
polyhydramnios
uterine fibroids

318
Q

what is oligohydramnios?

A

too little amniotic fluid below the 5th centile

319
Q

what is the aprox average amount of amniotic fluid at term?

A

500ml

320
Q

what are 7 causes of oligohydramnios?

A

preterm ROM
placental insufficiency (too much blood to brain rather than abdo and kidneys)
renal agenesis
non-functional foetal kidneys
obstructive uropathy
genetic/chromosomal abnormalities (neuropathies)
viral infections

321
Q

what are 7 causes of polyhydramnios?

A

conditions stopping foetal swallowing
anaemia or foetal hydrops
twin-twin transfusion
maternal DM
maternal lithium ingestion (causes foetal DI)
macrosomia
idopathic (most common)

322
Q

what are 5 complications of polyhydramnios?

A

congenital malformations or abnormalities
increased risk preterm labour
increased risk atony and PPH
increased risk malpresentations
increased risk cord prolapse

323
Q

what are the 3Ps of labour?

A

Power (uterine contractions)
Passenger (size/position/presentation of baby)
Passage (shape/size of pelvis)

324
Q

what is the latent phase of labour?

A

from 0-3cm dilation
irregular contractions

325
Q

is the active phase of labour?

A

4-10cm dilation
Strong regular contractions

326
Q

What is. the second stage of labour?

A

from 10cm to delivery

327
Q

what is the 3rd stage of labour?

A

delivery of baby to delivery of placenta

328
Q

How long should delivery of the placenta take with active management?

A

30 mins

329
Q

how long should delivery of the placenta take without intervention?

A

60 mins

330
Q

what is active management of the 3rd stage of labour?

A

IM oxytocin
Controlled cord traction

331
Q

what are the 3 different types of breech presentation?

A

extended breech
flexed breech
footling breech

332
Q

what are 6 risk factors for malpresentation?

A

multparity
uterine malformations/fibroids
placenta praevia
macrosomia
polyhydramnios
multiples/prematurity

333
Q

what are 5 complications. of malpresentation?

A

foetal head entrapment
premature ROM
birth asphyxia
intracranial haemorrhage
cord prolapsd

334
Q

what are 7 risk factors for uterine rupture?

A

prev c section
prev uterine surgery
increased BMI
High parity
increased age
Induction of labour
use of oxytocin

335
Q

what are 5 signs of uterine rupture?

A

abdo pain
vag bleeding
ceasing of contractions
hypotension
tachycardia
collapse

336
Q

what is. an incomplete uterine rupture?

A

when. the perimetrium remains intact

337
Q

what is classed as premature?

A

<37 weeks

338
Q

what are 2 prophylaxis for preterm labour?

A

vaginal progesterone
cervical cerclage (stitch)

(<25mm on TV USS 16-24 weeks)

339
Q

what 2 proteins can be tested for to check ROM?

A

insulin like growth factor binding protein 2
Placental alpha-microglobin-2

340
Q

what is the management of preterm ROM?

A

prophylactic Erythromycin 250mg QDS for 10 days/until labour

induction of labour from 34 weeks

341
Q

what are 5 management options for preterm labour?

A

foetal monitoring
Suppression of labour with nifedipine or terbutaline
maternal corticosteroids (<35 weeks)
IV Mag sulphate (<34 weeks for brain protection)
Delayed cord clamping and milking

342
Q

what are 3 signs of magnesium toxicity?

A

reduced resp rate
reduced BP
absent reflexes

343
Q

what is the management for cord prolapse?

A

Initial - call for help, get pt to adopt left lateral or knee-chest position, Give O2 and toncolysis

Continue to monitor foetus

Elevate presenting part off cord until delivery

Fill bladder with saline to elevate presenting part

emergency caesarean section

344
Q

what are the 2 causes of foetal hypoxia in cord prolapse?

A

cord compression
arterial vasospasm (cold air)

345
Q

what are 5 risk factors for cord prolapase?

A

Malpresentation - breech, transverse, unstable
Artificial rupture of membranes + induction
Polyhydramnios
PROM

346
Q

what are 5 presentations of cord prolapse?

A

Abnormal foetal heart rate
Foetal bradycardia
Palpable umbilical cord
Supped onset symptoms post rupture of membranes
Patient reported sensation

347
Q

what are 3 neonatal complications of cord prolapse?

A

Hypoxic ischaemic encephalopathy
Intrapartum asphyxia
Neonatal death

348
Q

what are 3 cord prolapse complications for the mother?

A

C-section and associated risks
Emotional trauma
Risk of uterine rupture

349
Q

what are 4 indications for instrumental delivery?

A

failure to progress
foetal distress
maternal exhaustion
control of head position

350
Q

what are 5 risks of instrumental delivery to the mother?

A

PPH
episiotomy/tears
injury to anal sphincter
incontinance of bladder/bowel
nerve injury

351
Q

what 2 nerves can be damaged in instrumental delivery?

A

obturator or femoral

352
Q

what are 5 risks of instrumental delivery to the baby?

A

cephalohaematoma w/ ventouse
facial nerve palsy w/ foreceps
skull fracture
subgaleal haemorrhage
spinal cord injury

353
Q

what is obstructed labour?

A

when a physical blockage prevents childbirth - too small pelvis, too big baby, fibroids, malpresentation

more common in asia and africa

354
Q

what is placenta accreta?

A

where placenta implants into the myometrium but not beyond

355
Q

what is placenta increta?

A

where the placenta attaches deeply into the myometrium

356
Q

what is placenta percreta?

A

when the placenta invades past the myometrium and perimetrium into the abdomen

357
Q

what are 6 risk factors for placenta accreta?

A

prev accreta
prev endometrial curettage
prev c-section
multigravida
increased maternal age
low lying/placenta praevia

358
Q

how does placenta accreta present?

A

Painless PV bleeding in 3rd trimester
antenatal uss
At birth

359
Q

when is a baby with placenta accreta induced?

A

35 to 36+6 weeks
reduce risk of spont labour
given steroids antenatally

360
Q

what are 3 options for placenta accreta management?

A

hysterectomy
uterus preserving surgery
expectant management

361
Q

what are 5 complications of placenta accreta?

A

PPH
DIC
Hysterectomy
Preterm birth
Foetal death

362
Q

what are 4 causes of antepartum haemorrhage?

A

placenta praevia
placental abruption
vasa praevia
placenta accreta

363
Q

what are 3 possible causes of minor pv spotting in pregnancy?

A

cervical ectropian
infection
vaginal abrasion

364
Q

what is the presentation of placenta praevia?

A

Painless vaginal bleeding usually after 30 weeks - often diagnosed on 20-week anomaly scan

365
Q

what are 6 complications of placenta praevia?

A

antepartum haemorrhage
emergency c-section
emergency hysterectomy
maternal anaemia and transfusions
preterm birth and low birth weight
still birth

366
Q

what is classed as a low lying placenta?

A

within 20mm of internal cervical os

367
Q

what is placenta praevia?

A

placenta overlying cervical os

90% resolve spontaneously before becoming symptomatic

368
Q

what are 6 risk factors for placenta praevia?

A

prev c-section
prev placenta previa
IVF
older maternal age
maternal smoking
structural uterine abnormalities

369
Q

what is the management for placenta praevia?

A

Repeat TVUS at 32 and 36 weeks

Corticosteroids 34-35+6 weeks for lung maturity

elective c-section at 36-37 weeks

370
Q

what is the grading for placenta praevia?

A

1 - low lying <20mm to os

2 - marginal - reaches margin of Os but does not cover

3 - partially covers os

4 - complete

371
Q

what is the gold standard imaging for placenta praevia?

A

MRI

372
Q

what are 10 risk factors for placental abruption?

A

prev. placenta abruption
pre-eclampsia
bleeding in early pregnacy
trauma
multiple pregnancy
foetal growth restriction
multigravida
increased maternal age
smoking
cocaine or amphetamine use

373
Q

what is the presentation of placental abruption?

A

sudden onset severe continuous abdo pain
vaginal bleeding
shock
CTG abnormality
woody uterus on palpation

374
Q

what are 3 investigations for placental abruption?

A

US Abdo
CTG - to assess foetus
Bloods - FBC, Coag, LFTs, U+E - Kleihauer test for foetal cells in maternal circulation

375
Q

what is the management of placental abruption?

A

A-E + Resus
Delivery if >37 weeks,
Corticoteroids if 24-34 weeks and stable
Active 3rd stage management
Anti-D immunoglobulin

376
Q

what are 3 maternal and 3 foetal complications of placental abruption?

A

Maternal
- Severe haemorrhage + DIC
- Hysterectomy to control bleeding
- Death

Foetal
- Prem
- Stillbirth
- Low birth weight

377
Q

what is classed as a minor antepartum haemorrhage?

A

<500ml

378
Q

what is classed as a major antepartum haemorrhage?

A

500-1000ml loss

379
Q

what is classed as a massive antepartum haemorrhage?

A

> 1000ml blood loss
OR
signs of shock

380
Q

what is the management of massive antepartum haemorrhage?

A

senior review
2x grey canula
blods - FBC, UE, LFT. Coag
cross match 4 units of blood
Flood and blood resus as required
CTG monitor foetus
close monitoring. ofmother

381
Q

what connective tissue in the umbilical cord protects the blood vessels?

A

whartons jelly

382
Q

what are the two types of vasa praevia?

A

1 - foetal vessels exposed as cord inserts into membranes outside placenta
2 - vessels exposed as travel to accessory placental lobe from placenta

383
Q

what are 3 risk factors for vasa praevia?

A

low lying placenta
IVF
multiples

384
Q

what are 3 presentations of vasa praevia?

A

antenatal TV scan
Painless antepartum haemorrhage in 2nd/3rd trimester
bright red blood on ROM in labour or foetal vessals seen on VE

385
Q

how is vasa praevia diagnosed?

A

transvaginal or transabdominal USS

386
Q

what is the management for vasa praevia?

A

corticosteroids from 32 weeks
elective c-section 34-36 weeks

387
Q

what are 5 complications of vasa praevia?

A

Foetal exsanguination
hypoxic ischaemic encephalopathy
preterm labour
IUGR
necessity for c-section

388
Q

what is classed as a minor PPH?

A

500-1000ml

389
Q

what is classed as a major PPH?

A

1000ml+

390
Q

what is a primary PPH?

A

bleeding within 24 hours of birth

391
Q

what is a secondary PPH?

A

24 hours -12 weeks after birth

392
Q

what are the 4 Ts of PPH?

A

tone (atony)
trauma (tears)
tissue (retained placenta)
thrombin (bleeding disorder)

393
Q

what are 12 risk factors for PPH?

A

previous PPH
grandmultiparity
obesity
macrosomnia/polyhydramnios
prolonged labour
pre-eclampsia
placenta accreta
placenta praevia
retained placenta
instrumental delivery
pre-existing anaemia
induction

394
Q

what are 4 preventative measures for PPH?

A

Tx anaemia antenatally
give birth with empty bladder
active management of 3rd stage
IV tranexamic acid during section in high risk patients

395
Q

what are 2 mechanical managements of PPH?

A

fundal massage
catheterisation

396
Q

what are 5 medical managements of PPH?

A

IV/IM oxytocin
IV/IM ergometrine (without Hx hypertension)
IM carboprost (without Hx asthma)
Misoprostol sublingual
Tranexamic acid

397
Q

what are 4 surgical managements of PPH?

A

1 - interuterine balloon tamponade
B-lynch suture (braces)
Uterine artery ligation
Hysterectomy

398
Q

what is antepartum haemorrhage?

A

bleeding PV from 24 weeks

399
Q

what does rhesus disease cause in the new born?

A

haemolysis

400
Q

what is the prophylaxis for rhesus disease of the newborn?

A

anti-D IM injection in negative mothers
prevents sensitasation in the mother given at 28 weeks

401
Q

when is anti-d given?

A

28 weeks
Birth (if baby +ve)
sensitisation events

402
Q

what test is used to titrate the dosage of anti-D?

A

Kleinhauer test

403
Q

what does the kleinhauer test check?

A

how much foetal blood has passed into the maternal circulation during a sensitisation event after 20 weeks

404
Q

what is low birth weight?

A

<2500g

405
Q

what is placental insufficiency?

A

when o2 and nutrients cannot sufficiently supplu placenta and foetus due to insufficient spiral arteries

406
Q

what are 6 risk factors for placental insufficiency?

A

Pre-eclampsia/hypertension
smoking, drinking, drugs
Advanced maternal age
primiparity
prev IU growth restriction baby
medications - cancer, antiepileptics

407
Q

what 2 medications can be given for placental insufficiency?

A

aspirin
heparin

408
Q

what is the combined test?

A

11-14 weeks gestation
uss - nuchal translucency >6cm
bloods -
bHCG - Raised
PAPPA - Low

Screening for downs

409
Q

what physiological changes in pregnancy are there in relation to maternal fluid retention?

A

Increased total plasma volume (30-50%)
Decreased plasma oncotic pressure

410
Q

How long does the corpus luteum produce progesterone for in pregnancy?

A

10 weeks

411
Q

what are 6 physiological hormonal changes in pregnancy?

A

Increased ACTH which causes an increase in steroid hormones (cortisol and aldosterone)
Increased prolactin - suppresses FSH and LH
Increased melanocyte stimulating hormone causes hyperpigmentation - linea nigra, melasma
Increase in T3 and T4
Increase in progesterone and oestrogen
increase then slow fall in HCG after 12 weeks

412
Q

what is the change in the size of the uterus in pregnancy?

A

from around 100g to around 1.1kg

413
Q

what hormone allows break down of collagen in the cervix to prepare for effacement?

A

prostaglandins

414
Q

what are 7 physiological cardiac changes in pregnancy?

A

Increased blood volume
increased plasma volume
increased cardiac output - increased stroke volume and HR
decreased peripheral vascular resistance
decreased BP (early and mid pregnancy)
varicose veins
peripheral vasodilations (can cause flushing and hot sweats)

415
Q

what are 2 physiological respiratory changes in pregnancy?

A

increased tidal volume
increased resp rate

416
Q

what are 5 physiological renal changes in pregnancy?

A

increased blood flow to kidneys
increased GFR
increased aldosterone => increased Na+ and water
increased protein excretion
dilation of the ureters and collecting system - physiological hydronephrosis (R>L)

417
Q

what are 3 nutrients that are in higher demand in pregnancy?

A

iron
folate
B12

418
Q

what is the first line management of cholestasis of pregnancy?

A

1 - emmolients and antihistamines

2- ursodeoxycholic acid

419
Q

what are 4 risk factors for shoulder dystocia?

A

macrosomia
High maternal BMI
Diabetes
Prolonged labours

420
Q

what is the 1st line management of shoulder dystocia?

A

McRoberts manoeuvre

421
Q

what is the management of one missed COCP?

A

take missed pill even if have to take two in one day

no additional contraceptive needed

422
Q

what is the management if 2+ OCPs are missed?

A

take yesterdays and todays dose then continue taking normally

Use condoms for 7 days

423
Q

what is the management of unprotected sex on OCP with missed pills in week 1?

A

emergency contraception

424
Q

what is the management of unprotected sex on OCP with missed pills in week 2?

A

no need for additional contraception

425
Q

what is the management of unprotected sex on OCP with missed pills in week 3?

A

finish pills in current pack and start new pack immediately no need for pill free interval

426
Q

where is the most common site of ectopic pregnancy?

A

ampulla of fallopian tubes

427
Q

what are 4 risk factors for hyperemesis gravidum?

A

increased levels of beta-hCG - multiple pregnancies, trophoblastic disease
nulliparity
obesity
family or personal history of NVP

428
Q

what is associated with decreased levels of hyperemesis gravidum?

A

smoking

429
Q

what is the triad of hyperemesis gravidum?

A

5% pre-pregnancy weight loss
dehydration
electrolyte imbalance

430
Q

what is the first line management of hyperemesis gravidum?

A

antihistamines: oral cyclizine or promethazine

phenothiazines: oral prochlorperazine or chlorpromazine

431
Q

what is the second line management of hyperemsis gravidum?

A

oral ondasetron
oral metoclopramide or domperidone

432
Q

what complication can ondansetron use in pregnancy cause?

A

cleft lip and palate

433
Q

what are 4 complications of hyperemesis gravidum?

A

acute kidney injury
Wernicke’s encephalopathy
oesophagitis, Mallory-Weiss tear
venous thromboembolism

434
Q

what are 4 different types of uterine fibroids?

A

intramural - within myometrium and distort shape
subserosal - grow outwards into abdomen
submucosal
pedunculated

435
Q

what are 7 features of fibroids?

A

asymptomatic
menorrhagia - may result in iron-deficiency anaemia
bulk-related symptoms
lower abdominal pain: cramping pains, often during menstruation
bloating
urinary/bowel symptoms
Deep dyspareunia
subfertility

436
Q

how are fibroids diagnosed?

A

Hysteroscopy for submucosal

TV Pelvic US

437
Q

when should people with fibroids be referred to gynae?

A

> 3cm

438
Q

what can be a cause of thick green nipple discharge most common in postmenopausal smokers?

A

Mammary duct ectasia

439
Q

what type of contraception can be used in trans men?

A

Progesterone only
non-hormonal

440
Q

How long after UPSI can Levonorgestrel (Levonelle) be taken?

A

72 hours

441
Q

How long after UPSI can Ulipristal (ella one) be taken?

A

120 hours

442
Q

what patients should Ulipristal use be cautioned in?

A

Asthmatics

443
Q

How long after taking Ulipristal do you need to wait to start hormonal contraception?

A

5 days

444
Q

How long after UPSI can the copper IUD be fitted?

A

5 days

445
Q

what is the most common ovarian cyst?

A

follicular cyst - due to non-rupture of the dominant follicle or failure of atresia in a non-dominant follicle

446
Q

what is the most common benign ovarian tumour in women <30?

A

Dermoid cyst - torsion in more likely

447
Q

what is amniotic fluid embolism?

A

when fetal cells/ amniotic fluid enters the mothers bloodstream and stimulates a reaction which results in cyanosis, hypotension, bronchospasms, tachycardia. arrhythmia and myocardial infarction.

448
Q

what antibiotics should be avoided in breast feeding?

A

ciprofloxacin, tetracycline, chloramphenicol, sulphonamides

449
Q

what psychiatric drugs should be avoided in breast feeding?

A

lithium, benzodiazepines

450
Q

What are 6 drugs that should be avoided in breast feeding?

A

aspirin
carbimazole
methotrexate
sulfonylureas
cytotoxic drugs
amiodarone

451
Q

what medication can be used to suppress lactation?

A

cabergoline

452
Q

what are 5 risk factors for breech presentation?

A

uterine malformations, fibroids
placenta praevia
polyhydramnios or oligohydramnios
fetal abnormality (e.g. CNS malformation, chromosomal disorders)
prematurity (due to increased incidence earlier in gestation)

453
Q

when should external cephalic version (ECV) be offered in breech presentation?

A

37 weeks (can be 36 in primies)

454
Q

what are 5 reasons for a Cat 1 section?

A

suspected uterine rupture
major placental abruption
cord prolapse
fetal hypoxia
persistent fetal bradycardia

455
Q

how quick should a cat 1 section be?

A

within 30 mis

456
Q

How quick should a cat 2 section be?

A

within 75 mins

457
Q

what is the results of a positive combined test?

A

↑ HCG, ↓ PAPP-A, thickened nuchal translucency => Downs likely

458
Q

what tests are included in the quadruple test?

A

alpha-fetoprotein
unconjugated oestriol
human chorionic gonadotrophin
inhibin A

459
Q

what is the quadruple test result for downs?

A

alpha-fetoprotein - LOW
unconjugated oestriol - LOW
human chorionic gonadotrophin - HIGH
inhibin A - HIGH

460
Q

what is the quadruple test result for edwards?

A

alpha-fetoprotein - LOW
unconjugated oestriol - LOW
human chorionic gonadotrophin - LOW
inhibin A - NORMAL

461
Q

what is the quadruple test result for neural tube defects?

A

alpha-fetoprotein - HIGH
unconjugated oestriol - NORMAL
human chorionic gonadotrophin - NORMAL
inhibin A - NORMAL

462
Q

what is the management of eclampsia in pregancy?

A

IV magnesium sulphate

463
Q

How long should magnesium sulfate continue after delivery in eclampsia?

A

24 hours

464
Q

what is the first line management for mag sulfate induced respiratory depression in eclampsia?

A

calcium gluconate

465
Q

what folic acid supplementation should pregnant women take?

A

400mcg of folic acid until the 12th week of pregnancy

466
Q

What risk factors mean women should take 5mg of folic acid pre-pregnancy?

A

Personal or FHx of neural tube defect
anti-epileptic drugs
coeliac disease, diabetes, or thalassaemia trait
BMI >30 kg/m2

467
Q

what is the diagnostic threshold for gestational diabetes?

A

fasting glucose is >= 5.6 mmol/L
2-hour glucose is >= 7.8 mmol/L

5,6,7,8

468
Q

what is the fasting glucose target in pregnancy for those with diabetes?

A

5.3 mmol/L

469
Q

what is the 1 hour post meal glucose target in pregnancy?

A

7.8 mmol/L

470
Q

what is the 2 hour post meal glucose target in pregnancy?

A

6.4 mmol/L

471
Q

what are 6 indications for induction?

A

Overdue >41 weeks
PPROM/PROM
diabetic mother > 38 weeks
pre-eclampsia
obstetric cholestasis
intrauterine fetal death

472
Q

what score is used to assess whether induction of labour is necessary?

A

Bishop score

473
Q

what is the bishop score that indicates need for induction?

A

<5

474
Q

what is the bishop score that indicates no need for induction?

A

> 8 inclusive

475
Q

what is the management of bishop score <6 inclusive?

A

vaginal prostaglandins or oral misoprostol

balloon catheter if higher risk of hyperstimulation or prev c-sections

476
Q

what is the management of bishop score >6?

A

amniotomy and an intravenous oxytocin infusion

477
Q

what is the main complication of induction of labour?

A

uterine hyperstimulation

478
Q

what are 4 complications of PROM?

A

fetal: prematurity, infection, pulmonary hypoplasia
maternal: chorioamnionitis

479
Q

what can be seen on sterile speculum exam in PROM?

A

pooling of amniotic fluid in the posterior vaginal vault

480
Q

How can PROM be tested for if fluid pooling not seen?

A

testing the fluid for placental alpha microglobulin-1 protein (PAMG-1) or insulin-like growth factor binding protein‑

481
Q

what medication should be given in PROM?

A

Oral erythromycin 10 (TEN) days
Corticosteroids (<34 weeks)

482
Q

What are 8 situations where anti-D should be given ASAP?

A

delivery of Rh +ve infant - live or stillborn
termination of pregnancy
miscarriage > 12 weeks
ectopic pregnancy - surgically managed
external cephalic version
antepartum haemorrhage
amniocentesis, chorionic villus sampling, fetal blood sampling
abdominal trauma

483
Q

what tests should be done on the cord blood of any baby born to Rh -ve mother?

A

FBC
Blood group and save
Direct coombs test

484
Q

what are the 3 stages of postpartum thyroiditis?

A

Thyrotoxicosis
hypothyroid
return to normal

485
Q

what is the management of the thyrotoxic phase of postpartum thyroiditis?

A

propanalol - to treat symptoms

486
Q

what is the management for fibroids <3cm?

A

1 - Mirena coil

symptomatic - tranexamic and mifenamic acid

2 - COCP, cyclical progestogens

Surgical - Endometrial ablation, resection of submucosal fibroids during hysteroscopy, Hysterectomy

487
Q

what is the management of fibroids >3cm?

A

refer to gynae - options as <3cm +

Uterine artery embolisation
Myomectomy
Hysterectomy

+ GnRH analogues to shrink before myomectomy

488
Q

what are 8 complications of fibroids?

A

iron deficiency anaemia
Reduced fertility
Pregnancy complications
Constipation
Urinary outflow obstruction + UTI
Red degeneration
Torsion of the fibroid
Malignant change to a leiomyosarcoma - very rare (<1%)

489
Q

what is red degeneration of fibroids?

A

ischaemia, infarction and necrosis of the fibroid due to disrupted blood supply usually in pregnancy

Presents with severe abdominal pain, low-grade fever, tachycardia and often vomiting. Management is supportive, with rest, fluids and analgesia.

490
Q

what are fibroids made out of?

A

smooth muscle proliferation

491
Q

what are endometrial polyps made out of?

A

endometrial tissue

492
Q

when should induction be offered in cholestasis of pregnancy?

A

37-38 weeks

493
Q

what are 8 things that increase risk of IUGR?

A

Maternal age of <16 or >35
low BMI or a pre-pregnancy weight of >75kg. interpregnancy interval < 6 months or >10 years
Pre-eclampsia
smoking, drugs and alcohol
clotting disorders
diabetes
congenital abnormalities

494
Q

what are 4 features of congenital syphilis?

A

Generalised lymphadenopathy
Hepatosplenomegaly
Rash
Skeletal malformations

495
Q

what are 4 causes of retrograde ejaculation?

A

Bladder neck surgery
Congenital abnormality
Diabetic autonomic neuropathy
Transurethral resection of the prostate

496
Q

what infectious disease screening is offered in pregnancy?

A

HIV
syphilis
hepatitis B

497
Q

when does the dating scan happen?

A

11+2-14+1 weeks

498
Q

when is the booking visit and what happens?

A

<10 weeks
Ht and Wt
screening offered
BP and urinalysis
risk assessed
vaccines offered

499
Q

when does the anatomy scan occur?

A

18-20+6 weeks

500
Q

when is Anti-D given in normal pregnancy?

A

28 weeks and 34 weeks

501
Q

what are 11 risk factors for small for gestational age baby?

A

Maternal age >40
Smoker
Maternal cocaine use
Maternal daily vigorous exercise
Previous SGA baby
Previous stillbirth
FHx SGA
Chronic hypertension
Diabetes with vascular disease
Renal impairment
Antiphospholipid syndrome

502
Q

what are 6 foetal surveillance techniques?

A

Symphyseal fundal height Foetal abdominal circumference.
Femur length.
Head circumference / biparietal diameter.
Liquor volume / amniotic fluid index (normal = 5-25cm)
umbilical/MCA artery Doppler

503
Q

what level is raised bile acids in pregnancy?

A

> 19 micromol/L

504
Q

what are 3 analgesias used in labour?

A

Entonox
IM opioids - diamorphine or morphine
Epidural - bupivacaie and fentanyl

505
Q

what counts as delay in the first stage of labour?

A

cervical dilation <2cm in 4 hours

506
Q

what counts as delay in the second stage of labour?

A

nuliparous > 2 hours
multiparous >1 hour

507
Q

what are 6 contraindications to the copper IUD and the IUS?

A
  1. PID
  2. Gonorrhoea or chlamydia
  3. Unexplained vaginal bleeding / endometrial cancer
  4. Postpartum / post-abortion septicaemia
  5. Gestational trophoblastic disease
  6. Purulent cervicitis, pelvic TB
508
Q

at what crown rump length should a foetus have a heart beat?

A

> 7 mm

509
Q

what is the normal positioning of the baby throughout birth?

A

Descent, engagement, flexion, internal rotation, crowning, extension of presenting part, external rotation of head, delivery

510
Q

what is the management of asymptomatic bacteriuria in pregnancy?

A

Confirm presence of bacteriuria with second culture and begin culture dependent antibiotic

511
Q

What counts as polyhydramnious?

A

AFI of >24cm (or 2000ml+)

512
Q

what counts as oligohydramnious?

A

AFI of <5cm (or under 200ml)

513
Q

what are 4 neonatal complications due to anti-epileptic use in pregnancy?

A

Orofacial defects
neural tube defects
congenital heart defects
haemorrhagic disease of the new born

514
Q

what are 6 causes of hydrops fetalis?

A

severe anaemia
cardiac abnormalities
chromsomal abnormalities (turners, downs, edwards, pataus)
Infection (toxoplasmosis, rubella, CMV, varicella, parvovirus)
twin-twin trasnfusion syndrome
chorioangioma

515
Q

what is the Hb monitored in pregnancy?

A

booking and 28 weeks

516
Q

How do you read CTGs?

A

DR C BRAVADO

DR - Define risk
C - contractions - <5 in 10 inclusive
BRa - Baseline rate - 110-160 BPM
V - Variability - 5 -25 bpm variability
A - Accelerations - rise of 15bpm for >15s, should be 2 every 15 mins
D - Decelerations - drop of 15bpm for >15s
O - overall impression

517
Q

o

A
518
Q

in what age range is cervical screening every 3 years?

A

25-49 - every 3 years

519
Q

in what age range is cervical screening every 5 years?

A

50-65 - every 5 years

520
Q

what happens if high risk HPV is found on a smear?

A

Cytology is examined

521
Q

what happens if there is inadequate results on a smear?

A

another smear in 3 months

522
Q

what happens if cytology is abnormal in cervical smear?

A

colposcopy

523
Q

what are 5 examples of abnormal cytology on cervical smear?

A

Borderline changes in squamous/endocervical cells
Low-grade dyskaryosis
High grade dyskaryosis
Invasive squamous cell carcinoma
Glandular neoplasia

524
Q

what happens in high risk HPV is positive but cytology normal in cervical smear?

A

Repeat smear in 12 months

525
Q

what happens in 2 inadequate samples in a row in cervical smear?

A

Colposcopy

526
Q

what happens if high risk HPV is +ve but cytology normal two smears in a row?

A

Repeat smear in 12 months

527
Q

what is the management of high risk HPV on 3 smears in a row? (screening, 12 mon recall, another 12 mon recall)

A

Colposcopy

528
Q

what 2 strands of HPV cause most cervical cancer?

A

16 and 18

529
Q

what increases risk of contracting HPV?

A

Ealy sexual activity
Increased number of sexual partners
Unprotected sex

530
Q

How often do women with HIV get cervical screening?

A

Every year

other immunocompromised women may also get increased screening frequency

531
Q

How long post partum should a cervical smear be delayed?

A

3 months

532
Q

What is different about cervical screening in Scotland?

A

every 5 years from 25-65 never every 3 years

533
Q

when is cytology performed in cervical screening?

A

only if +ve for high risk HPV

534
Q

what stains are used in colposcopy?

A

Acetic acid - causes abnormal cells to appear white - acetowhite
Iodine solution - abnormal areas do not stain

535
Q

what is the management of cervical intraepithelial neoplasia found on colposcopy?

A

Large loop excision of the transformation zone - LLETZ

Cone biopsy - under GA

536
Q

what 2 strains of HPV cause genital warts?

A

6 and 11

537
Q

when should patients with CIN return to colposcopy for test of cure?

A

6 months

538
Q

what is the risk of SSRIs in pregnancy?

A

1st trimester - risk of congenital heart defects
3rd trimester - risk of persistent pulmonary hypertension

539
Q

What SSRI has the highest risk of congenital malformations in 1st trimester?

A

Paroxetine

540
Q

how does pregnancy affect the thyroid?

A

increased levels of thyroxine binding globulin in pregnancy which causes an increase in the levels of total thyroxine but does not affect free thyroxine levels

541
Q

what are 3 risks of untreated thyrotoxicosis in pregnancy?

A

risk of foetal loss
maternal heart failure
premature labour

542
Q

what is the most common cause of thyrotoxicosis in pregnancy?

A

grave’s disease

543
Q

what is the management of thyrotoxicosis in pregnancy?

A

propylthiouracil 1st trimester

544
Q

why is carbimazole contraindicated in pregnancy?

A

can cause congenital abnormlities

545
Q

what is a risk of propylthiouracil use?

A

severe hepatic injury

546
Q

what is the management of hypothyroidism in pregnancy?

A

measure TSH every trimester and 6-8 weeks post partum

Need increased dose of thyroxine in pregnancy - up to 50% as early as 4-6 weeks gestation

Phase 4 (22 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions