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Year 3 MBChB > Obs and gynae > Flashcards

Obs and gynae Flashcards

1
Q

As a result of the plasma volume changes in pregnancy what happens to Hb?

A

Hb falls due to dilution

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2
Q

At which age is the vaccine for HPV given for HIV negative females?

A

11-13 years of age

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3
Q

Can pregnant women with HIV deliver vaginally?

A

Yes, if viral load is less than 50

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4
Q

Define a missed (delayed) miscarriage

A

A uterus which contains a dead foetus < 20 weeks

Sac with no foetal pole

Cervical os closed

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5
Q

Define an incomplete miscarriage

A

Not all products have been expelled

Pain and bleeding, os open

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6
Q

Define an inevitable miscarriage

A

Heavy bleeding with clots and pain

Cervical os is open

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7
Q

Define polyhydramnios?

A

2-3L of amniotic fluid

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8
Q

Define recurrent miscarriage

A

>3 consecutive spontaneous abortions

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9
Q

Define SGA

A

Less than 10th percentile on USS

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10
Q

During which stage does a chancre develop?

A

Primary

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11
Q

How are fibroids diagnosed?

A

Transvaginal USS

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12
Q

How can amenorrhoea be divided?

A

Primary and secondary

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13
Q

How can fluid in the pouch of douglas be drained?

A

Via a needle through the posterior fornix of the vagina

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14
Q

How can the lower segment of the uterus be defined?

A

Below uterovesicalperitoneal fold

Doesn’t contract; passively dilates

7cm above cervix

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15
Q

How can the risk of cleft palate be reduced in pregnant women on phenytoin?

A

Give vitamin K in the last month of pregnancy

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16
Q

How do the breasts attach to the skin?

A

Via suspensory ligaments

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17
Q

How do you look at a CTG?

A

Determine

Risk

Contractions

Baseline

Rate

Variability

Accelerations

Decelerations

Overall

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18
Q

How does depo provera work as contraception?

A

Inhibits ovulation

Effect on cervical mucus

Effect on endometrium

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19
Q

How does IUS act as contraception?

A

Renders endometrium unfavourable for implantation

Thickens cervical mucus

Pre-fertilisation effects

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20
Q

How does pregnancy increase the risk of thromboembolism, anatomically?

A

Uterus presses on IVC causing venous stasis in legs

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21
Q

How does the implant act as contraception?

A

Inhibition of ovulation

Effect on endometrium

Effect on cervical mucus

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22
Q

How is chlamydia diagnosed?

A

NAAT - vulvovaginal swab for females, first void urine for males

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23
Q

How is depo given?

A

IM injection every 13 weeks

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24
Q

How is gonorrhoea diagnosed?

A

Microscopy

Culture

NAATs

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25
Q

How is placenta praevia diagnosed?

A

USS

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26
Q

How is POP taken?

A

Daily at the same time

No break

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27
Q

How is syphilis diagnosed?

A

Dark ground microscopy

PCR

Serological testing

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28
Q

How is the COCP taken?

A

Daily for 21 days with 7 days off for a breakthrough bleed

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29
Q

How is the depo started beyond day 5?

A

Woman must be reasonably certain she is not pregnant and abstain/use condoms for 7 days

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30
Q

How long does the depo provera last?

A

14 weeks

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31
Q

How long does the implant last?

A

3 years

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32
Q

How long does the IUD last?

A

5 years

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33
Q

How long does the mirena last?

A

5 years

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34
Q

How should amenorrhoea be investigated?

A

FULL HISTORY

Gonadotrophins (low in hypothalamic, high in ovarian)

TFTs

Prolactin

Oestradiol

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35
Q

In pregnancy women with HIV, which factors reduce vertical transmission?

A

C section

Bottle feeding

Maternal antiretrovirals

Neonatal antiretrovirals

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36
Q

In what situations is anti-D given to mothers who are rhesus negative?

A

Women less than 12 weeks: uterine evacuation, ectopic prgenancies

All women with bleeding after 12 weeks

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37
Q

Is the BHCG low or high in Downs?

A

High

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38
Q

Is the PAPP-A low or high in Downs?

A

Low

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39
Q

Is thyroxine safe in pregnancy?

A

Yes

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40
Q

Label this diagram

A
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41
Q

Lable the hormones in this diagram

A
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42
Q

Name the pathway of the pudendal nerve

A

Exits pelviz via greater foramen

Passes posterior to sacrospinous ligament

Re-enters pelvis via lesser sciatic foramen

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43
Q

What age group has the highest incidence of cervical cancer?

A

25 - 29

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44
Q

What antibiotics are given during total abdo hysterectomy?

A

IV co-amoxiclav

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45
Q

What are complications from hyperemesis gravidarum?

A

Wernicke’s

Mallory-Weiss tear

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46
Q

What are fibroids?

A

Benign smooth muscle tumours of uterus

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47
Q

What are follicular cysts due to?

A

Non-rupture of the dominant follicle

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48
Q

What are hypertensive pregnant women at risk of?

A

Pre-eclampsia

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49
Q

What are predisposing factors for vaginal candidiasis?

A

Diabetes

Antibiotic use

Steroids

Pregnancy

HIV

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50
Q

What are risk factors for an ectopic pregnancy?

A

Damage to tubes

IUCD

POP

IVF

Previous ectopic

Endometriosis

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51
Q

What are risk factors for endometrial cancer?

A

Obesity

Nulliparity

Unopposed oestrogen

Diabetes

PCOS

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52
Q

What are risk factors for necrotising enterocolitis?

A

Not breastfeeding

Prematurity

IUGR

Hypoxic ischaemic insult

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53
Q

What are risk factors for PPH?

A

Previous PPH

Increasing maternal age

Placenta problems

Prolonged labour

Polyhydramnios

Macrosomia

Pre-eclampsia

Emergency C-section

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54
Q

What are risk factors for shoulder dystocia?

A

DM

Obesity

Macrosomia

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55
Q

What are risk factors from cord prolapse?

A

Prematurity

Multiparity

Twins

Abnormal presentation

Placenta praevia

High foetal station

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56
Q

What are signs of foetal distress?

A

Reduced foetal movements

Meconium stained liquor

Increased lactate

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57
Q

What are signs of obstruction in labour?

A

Moulding

Caput medusa

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58
Q

What are some causes of foetal distress?

A

Placental abruption

Vasa praevia

Cord collapse

Uterine rupture

Foeto-maternal haemorrhage

Hypoxia

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59
Q

What are some causes of post-coital bleeding?

A

Infection

Cervical ectropion (COCP!!)

Polyps

Trauma

Cancer

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60
Q

What are some causes of primary amenorrhoea?

A

Turner’s syndrome

Testicular feminisation

Congenital adrenal hyperplasia

Imperforate hymen

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61
Q

What are some causes of recurrent miscarriage?

A

APS

Poorly controlled DM

PCOS

Uterine abnormality

Parental chromosomal abnormalities

Smoking

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62
Q

What are some causes of secondary amenorrhoea?

A

Hypothalamic

PCOS (increased androgen levels)

Hyperprolactinaemia

Premature ovarian failure

Thyrotoxicosis

Intrasuterine adhesions

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63
Q

What are some of the causes of IMB?

A

Pregnancy related

Physiological

Vaginitis

Fibroids

Polyps

Tumours

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64
Q

What are the AFP, beta HCG and oestriol levels in Edward’s syndrome?

A

AFP decreased

BHCG increased

Oestriol decreased

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65
Q

What are the causes of IUGR?

A

Multiple pregnancy

Malformation

Smoking

DM

Hypertension

Asthma

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66
Q

What are the causes of multiple second trimester miscarriages?

A

Bicornuate uterus

APS

SLE

Cervical incompetence

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67
Q

What are the causes of polyhydramnios?

A

Drugs

Diabetes

Rhesus

GI obstruction

Increased urine output

Poor swallowing

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68
Q

What are the common causes of PPH?

A

Retained placenta

Endometriosis

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69
Q

What are the complications of prematurity?

A

RDS

PDA

Intraventricular haemorrhage

Sepsis

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70
Q

What are the conditions of use of operative delivery?

A

Head engaged

Membranes ruptured

Cervix dilated

Empty bladder

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71
Q

What are the features of an amniotic fluid embolism?

A

Sudden dyspnoea

Hypotension

DIC

Pulmonary oedema

SOB

Chest pain

N&V

Collapse

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72
Q

What are the features of an ectopic pregnancy?

A

Constant lower abdo pain

Vaginal bleeding: may be dark brown

History of amenorrhoea

Shoulder tip pain/pain on defecation

Cervical excitation

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73
Q

What are the features of baby blues?

A

Anxious

Tearful

Irritable

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74
Q

What are the features of cervical cancer?

A

PCB

IMB

PMB

Change in vaginal discharge

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75
Q

What are the features of cervical ectropion?

A

Change in vaginal discharge

PCB

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76
Q

What are the features of endometrial cancer?

A

PMB

IMB

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77
Q

What are the features of endometriosis?

A

Chronic pelvic pain

Deep dyspareunia

Dysmenorrhoea

Subfertility

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78
Q

What are the features of fibroids?

A

May be asymptomatic

Menorrhagia

Cramping lower abdo pain

Bloating

Urinary symptoms

Subfertility

Bulky uterus

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79
Q

What are the features of PCOS?

A

Subfertility

Oligomenorrhoea

Acne

Hirsutism

Obesity

Acanthosis nigricans

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80
Q

What are the features of placenta praevia?

A

Shock in proportion with visible blood loss

Painless blood loss

Can be triggered by sex, usually unprovoked

PP high

Malpresentation common

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81
Q

What are the features of placental abruption?

A

DIC

Shock inconsistent with blood loss

Constant pain

Tense (woody) uterus

Abnormal CTG

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82
Q

What are the features of PND?

A

Similar to depression

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83
Q

What are the features of post natal psychosis?

A

Mood swings

Perception problems

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84
Q

What are the features of uterine rupture?

A

Pain

Intraperitoneal bleeding

Shock

Cessation of contractions

Foetal distress

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85
Q

What are the features of vaginal candidiasis?

A

Cottage cheese like discharge

Dysuria

Dyspareunia

Itch

Vulval erythema

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86
Q

What are the features of vulval carcinoma?

A

Lump/ulcer on labia majora

May be associated with itch/irritation

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87
Q

What are the hormones doing in PCOS?

A

Increased insulin, increased androgens (testosterone), increased LH, increased oestrogen, low progesterone, normal or low FSH

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88
Q

What are the indications for a c section?

A

Absolute CPD

Pre-eclampsia

Failure to progress

Cervical cancer

Placenta praevia

Postmaturity

Breech

Vaginal infection

IUGR

Foetal distress

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89
Q

What are the non-contraceptive benefits of the COCP?

A

Control of heavy, painful periods

Acne control

Endometriosis

Menstrual migraine (NO AURA)

Protection against ovarian and endometrial cancers

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90
Q

What are the oncogenic strains of HPV?

A

16

18

31

33

45

51

58

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91
Q

What are the risk factors for breech presentation?

A

Uterine malformations

Placenta praevia

Polyhydramnios

Foetal abnormality

Prematurity

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92
Q

What are the risk factors for cervical cancer?

A

HPV 16 & 18

Smoking

Early first time

COCP

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93
Q

What are the risk factors for placental abruption?

A

Hypertension

Trauma

Drugs

Smoking

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94
Q

What are the risk factors for vulval carcinoma?

A

Age > 65

HPV

Immunosuppression

Lichen sclerosus

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95
Q

What are the side effects of combined hormonal contraception?

A

Unscheduled bleeding

Mood changes

Weight gain

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96
Q

What are the side effects of depo provera?

A

Weight gain

Delay in return of fertility

Irregular bleeding

Possible risk of osteoporosis

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97
Q

What are the side effects of IUD?

A

Heavy, prolonged menses

Pain/infection/PID in first 20 days

Perforation

Expulsion

Low ectopic risk

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98
Q

What are the side effects of the implant?

A

Irregular bleeding

Weight gain

Acne

Nerve damage

Deep insertion

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99
Q

What are the three layers of the uterus?

A

Perimetrium

Myometrium

Endometrium

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100
Q

What are the two main types of c section?

A

Lower segment

Classical (longitudinal incision)

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101
Q

What can be used to stop contractions in prematurity?

A

Tocolytics - nifedipine, indethemacin

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102
Q

What causes cervical ectropion?

A

Increased oestrogen levels

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103
Q

What causes Erb’s palsy?

A

Shoulder dystocia

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104
Q

What changes does oestrogen cause in pregnancy?

A

Increases breast and nipple growth Increases water retention and protein synthesis

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105
Q

What changes does progesterone cause in pregnancy?

A

Decreases smooth muscle excitability Increases body temp

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106
Q

What chromosome is Downs?

A

21

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107
Q

What complications can occur in pregnancy with diabetics?

A

Polyhydramnios

Preterm labour

Stillbirth

Macrosome

IUGR

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108
Q

What conditions can amniocentesis diagnose?

A

Neural tube defects (increased AFP) Chromosome disorders Inborn errors of metabolism

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109
Q

What contraception cannot be given with carbamazepine?

A

No systemic progesterone

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110
Q

What do aminoglycosides cause in pregnancy?

A

Ototoxicity

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111
Q

What do early decelerations indicate on a CTG?

A

Increased vagal tone due to head compression

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112
Q

What do fluoroquinolones cause in pregnancy?

A

Cartilage damage

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113
Q

What do late decelerations indicate on a CTG?

A

Placental insufficiency –> foetal distress

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114
Q

What do sulphonamides cause in pregnancy?

A

Kernicterus

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115
Q

What do tetracyclines cause in pregnancy?

A

Discoloured teeth

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116
Q

What do variable decelerations indicate on a CTG?

A

Umbilical cord compression/uterine contractions

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117
Q

What is AMH used for?

A

Assessing ovarian reserve prior to IVF

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118
Q

What does CMV cause?

A

Jaundice

Hepatosplenomegaly

Microcephaly

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119
Q

What does erythromycin cause in pregnancy?

A

Acute cholestatic hepatitis

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120
Q

What does metranidazole cause in pregnancy?

A

Mutagenesis

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121
Q

What does pearl index represent?

A

Number of contraceptive failures per 100 women per year

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122
Q

What does prolactin cause?

A

Enlargement of mammary glands

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123
Q

What does ribaviran cause in pregnancy?

A

Teratogenic

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124
Q

What dose of folic acid should be given to epileptic pregnant women?

A

5mg

125
Q

What dose of folic acid should diabetic pregnant women get?

A

5mg

126
Q

What drug is first-line for period pains?

A

NSAIDs

127
Q

What drugs should be avoided in pregnancy?

A

SAFE Mums Take Really Good Care

Sulphonamides, sodium valproate

Aminoglycosides, ACEIs, ARBS

Fluoroquinolones

Erythromycin

Metronidazole, methotrexate

Tetracyclines, trimethoprim in 1st trimester

Ribaviran

Griseofulvin

Chloramphenicol

128
Q

What drugs should be avoided in pregnancy?

A

Antibiotics: ciprfloxacin, tetracyclines, sulphonamides, chloramphenicol

Lithium

BZDs

Clozapine

Aspirin

Carbimazole

Sulphonylureas

Cytotoxic drugs

Amiodarone

129
Q

What effects can SGA in adult life?

A

Hypertension

T2DM

130
Q

What factors are associated with placenta praevia?

A

Multiparity

Lower segment scar

131
Q

What genital changes occur in pregnancy?

A

Muscle hypertrophy of uterus up to 20weeks Vaginal discharge increases

132
Q

What gestation is the booking visit done at?

A

8-12 weeks

133
Q

What happens if HPV is positive in those with mild dyskariosis?

A

Colposcopy

Negative - back to normal screening

134
Q

What happens if the patient misses one COCP?

A

Take missed pill as soon as remembered

Remaining pills taken as normal

Additional contraception not required

135
Q

What happens if the patient misses one dose of POP and has UPSI?

A

Emergency contraception plus two days of extra protection

136
Q

What happens if the patient misses two or more COCPs?

A

Take most recent missed pill

Take remaining pills at correct time

Use condoms until 7 pills have been taken consecutively

137
Q

What happens in moderate dyskariosis on a smear?

A

Refer for colposcopy

138
Q

What happens in severe dyskariosis on a smear?

A

URGENT colposcopy

139
Q

What happens to BP in pregnancy?

A

Decreases in first half, rises to baseline in second half

140
Q

What happens to coaguability in pregnancy?

A

Pregnancy is a hypercoaguable state

141
Q

What happens to cortisol and prolactin in pregnancy?

A

Both increase

142
Q

What happens to the CO in pregnancy and why?

A

Increases - stroke volume increases

143
Q

What happens to the eGFR in pregnancy?

A

Increases

144
Q

What happens to the plasma volume from 10 weeks of gestation?

A

Increases

145
Q

What happens to the RBC volume in pregnancy?

A

Increases

146
Q

What happens to TPR in pregnancy and why?

A

Decreases - progesterone has a vasodilatory effect

147
Q

What happens when bordeline/mild dyskariosis is seen on a smear?

A

Test for HPV

148
Q

What happens with a Bishops score of <5?

A

PGE2 to induce

149
Q

What investigation is done for persistent PCB?

A

Colposcopy

150
Q

What investigations are done at every visit with community midwife?

A

Weight BP urinalysis palpation foetal heartbeat

151
Q

What investigations are done in endometrial cancer?

A

Transvaginal USS - thickened endometrium

Hysteroscopy with biopsy

152
Q

What investigations are done in gestational trophoblastic disease?

A

Highly increased BHCG

USS

Histology

153
Q

What investigations are done in PCB/IMB?

A

Pregnancy test

Infection screen

Bloods

Transvaginal USS (if endometrium thickened > biopsy)

154
Q

What investigations are done in PCOS?

A

USS, hormone profile, GTT

155
Q

What is a breech presentation?

A

Caudal end of fetus occupies lower segment

156
Q

What is a chancre?

A

A painless ulcer

157
Q

How does a complete molar pregnancy arise and is there an embryo?

A

All genetic material from the father

No foetal tissue

158
Q

What is a galactocele?

A

Painless lump after stopping breastfeeding

159
Q

What is a main cause of uterine rupture?

A

Classical C-section scar

160
Q

How does a partial molar pregnancy arise and is there an embryo?

A

3 sets of chromosomes - two sperm, one egg

Embryo may be present at start

161
Q

Define a threatened miscarriage

A

Painless vaginal bleeding <24 weeks

Bleeding less than menstruation

Cervical os closed

162
Q

What is an ectopic pregnancy?

A

Implantation of fertilised ovum outside the uterus

163
Q

What is another name for fibroids?

A

Leiomyomas

164
Q

What is antepartum haemorrhage?

A

Bleeding after 24 weeks and before delivery

165
Q

What is caput succedaneum caused by?

A

Pressure against cervix and lower segment

Ventouse delivery causes a large one

166
Q

What is caput succedaneum?

A

Oedematous swelling of scalp, superficial to cranial periosteum

167
Q

What is cervical ectropion?

A

Eversion of epithelium on cervix (larger are of columnar epithelium on ectocervix)

168
Q

What is choriocarcinoma?

A

Tumour that forms after molar pregnancy

169
Q

What is complication of fibroids??

A

Red degenration - haemorrhage into the tumour

170
Q

What is cord prolapse?

A

Umbilical cord descending ahead of presenting part

171
Q

What is endometriosis?

A

Growth of ectopic endometrial tissue outside the uterine cavity

172
Q

What is Erb’s palsy?

A

Damage to upper brachial plexus resulting in a waiter’s tip posture

173
Q

What is hyperemesis gravidarum associated with?

A

Nulliparity

Multiple pregnancies

Gestational trophoblastic disease

Hyperthyroid

Obesity

174
Q

What is hyperemesis gravidarum?

A

Excessive vomiting during pregnancy

175
Q

What is lichen sclerosus?

A

Atrophy of epidermis of genitalia

176
Q

What is phenytoin associated with in pregnancy?

A

Cleft palate

177
Q

What is placenta accreta associated with?

A

Severe bleeding

PPH

Hysterectomy

178
Q

What is placenta accreta?

A

Placenta invades the myometrium

179
Q

What is placenta praevia?

A

Low lying placenta

Placenta lying wholly or partially in the lower uterine segment

180
Q

What is placental abruption?

A

Detachment of placenta

181
Q

What is post-maturity?

A

Babies born after 42 weeks

182
Q

What is postpartum haemorrhage?

A

Blood loss of >500mls

183
Q

What is prematurity?

A

Babies born before 36+6

184
Q

What is primary amenorrhoea?

A

Failure to start menses by 16

185
Q

What is primary postpartum haemorrhage?

A

Occurs within first 24 hours

186
Q

What is progesterone secreted by?

A

Corpus luteum Placenta

187
Q

What is secondary amenorrhoea?

A

Cessation of established menstruation > 6m

188
Q

What is secondary PPH?

A

Occurs between 24hours - 12 weeks

189
Q

What is shoulder dystocia associated with?

A

PPH and Erb’s palsy

190
Q

What is shoulder dystocia?

A

Impaction of anterior shoulder on pubic symphysis

191
Q

What is sodium valproate associated with in pregnancy?

A

Neural tube defects - DONT USE UNLESS ABSOLUTELY NECESSARY

192
Q

What is the AFP level in Down’s syndrome?

A

Decreased

193
Q

What is the aim for Hb levels in pregnancy?

A

110

194
Q

What is the anti-emetic of choice in pregnancy?

A

Cyclizine

195
Q

What is the antithyroid drug of choice in pregnancy?

A

PTU

196
Q

What is the commonest type of ovarian cyst?

A

Follicular cyst

197
Q

What is the drug management of fibroids?

A

Mirena, COCP, tranexamic acid, GnRH prior to surgery

198
Q

What is the gram status of chlamydia?

A

It doesn’t gram stain

199
Q

What is the histological appearance of gonorrhoea?

A

Gram negative intracellular diplococci (kidney shaped pairs)

200
Q

What is the investigation done for endometriosis?

A

Laparoscopy

201
Q

What is the lymphatic drainage of the breast?

A

Axillary –> supraclavicular –> R lymphatic duct

Parasternal –> same ones

202
Q

What is the management of a breech presentation after 36 weeks?

A

ECV

C section

203
Q

What is the management of a breech presentation before 36 weeks?

A

Many foetuses will turn spontaneously

204
Q

What is the management of an ectopic pregnancy?

A

Methotrexate

TOP

Laparotomy

205
Q

What is the management of baby blues?

A

Reassurance and support

206
Q

What is the management of cervical ectropion?

A

Leave it

If troublesome symptoms - ablation

207
Q

What is the management of chlamydia?

A

Azithromycin 1g stat

208
Q

What is the management of cord prolapse?

A

Push back presenting part

Keep cord warm and moist

All fours position

C section

209
Q

What is the management of endometrial cancer?

A

Total abdominal hysterectomy with bilateral salpingo-oophrectomy

210
Q

What is the management of endometriosis?

A

NSAIDs

COCP

Mirena

211
Q

What is the management of foetal distress?

A

Change position

IV fluids

Stop syntocinon

Scalp stimulation

Tocolysis

C section

212
Q

What is the management of genital herpes?

A

Swab for PCR

Oral acyclovir

Consider topical idocaine if very painful

Saline bathing

Analgesia

213
Q

What is the management of genital warts?

A

Podophyllotoxin

Imiquimod

Cryotherapy

Electrocautery

214
Q

What is the management of gestational trophoblastic disease?

A

Suction

Cutterage

Supportive

Monitor BHCG for 6m

Contraception

215
Q

What is the management of gonorrhoea?

A

500mg ceftriaxone IM + 1g azithromycin

216
Q

What is the management of hyperemesis gravidarum?

A

Anti-histamines

Admission for IV hydration

217
Q

What is the management of lichen sclerosus?

A

Topical steroids + emollients

218
Q

What is the management of PCOS if the woman doesn’t wish to get pregnant at this time?

A

Weight loss

COCP

219
Q

What is the management of PCOS if the woman wishes to fall pregnant?

A

Weight loss

Clomifene citrate

Gonadotrophins

Laproscopic ovarian drilling

Assisted conception

220
Q

What is the management of PND?

A

Reassurance & support

CBT

Paroxetine if severe

221
Q

What is the management of post natal psychosis?

A

Admit into hospital

222
Q

What is the management of PPH?

A

Uterine massage

IV syntocinon

IM carboprost

Ligation

223
Q

What is the management of thromboembolism in pregnancy?

A

LMWH

224
Q

What is the management of uterine rupture?

A

ABCDE

C-section

Hysterectomy

225
Q

What is the management of vaginal candidiasis?

A

The ‘zoles’; pessary or oral

226
Q

What is the management of vasa praevia?

A

C section

227
Q

What is the mode of action of COCP?

A

Inhibits ovulation via action on hypothalamic-pituitary-ovarian axis to reduce LH and FSH

Alters cervical mucus

Renders endometrium unfavourable for implantation

228
Q

What is the mode of action of the POP?

A

Thickening of cervical mucus

Decreased endometrial receptivity to blastocyst

Reduction in cilia activity in Fallopian tube

229
Q

What is the most common bacterial STI?

A

Chlamydia

230
Q

What is the most common benign ovarian tumour in women under 30?

A

Dermoid cyst

231
Q

What is the most common cause of PPH?

A

Uterine atony

232
Q

What is the most widely used mode of contraception?

A

Withdrawal

233
Q

What is the normal variability on a CTG?

A

5-25 bpm

234
Q

What is the organism in syphilis?

A

Treponema pallidum

235
Q

What is the pathophysiology of hypercoaguability in pregnancy?

A

Increase in factors VII, VIII, X and fibrinogen

Decrease in protein S

236
Q

What is the pearl index of IUD?

A

0.6-0.8%

237
Q

What is the pearl index of the implant?

A

0-0.1%

238
Q

What is the pearl index of the mirena?

A

0.2%

239
Q

What is the presentation of chlamydia in females?

A

PCB/IMB

Lower abdo pain

Dyspareunia

Mucopurulent cervicits

ASYMPTOMATIC (70%)

240
Q

What is the presentation of chlamydia in males?

A

Urethral discharge

Dysuria

Urethritis

Epididymo-orchitis

ASYMPTOMATIC (50%)

241
Q

What is the presentation of genital herpes?

A

Blistering and ulceration of external genitalia

Pain

External dysuria

Vaginal or urethral discharge

Local lymphadenopathy

Fever and myalgia (prodrome)

242
Q

What is the presentation of gonorrhoea in females?

A

Asymptomatic (up to 50%)

Increased/altered vaginal discharge

Dysuria

Pelvic pain

243
Q

What is the presentation of gonorrhoea in males?

A

Purulent urethral discharge

Dysuria

244
Q

What is the presentation of lichen sclerosus?

A

Older women, itch down below, white plaques

245
Q

What is the presentation of secondary syphilis?

A

Skin rash on palms and soles

Lesions of mucus membranes

Generalised lymphadenopathy

Patchy alopecia

Condylomata lata

246
Q

What is the primary mode of action of the IUD?

A

Prevention of fertilisation

Inflamm response in endometrium

247
Q

What is the risk of foetal loss in amniocentesis?

A

1%

248
Q

What is the role of oestrogen in the menstrual cycle?

A

Negative feedback on LH and FSH

Thickening of endometrium

Thinning of cervical mucus

249
Q

What is the surgical management of fibroids?

A

Myomectomy

Ablation

Hysterectomy

250
Q

What is used as a landmark for a pudendal nerve block?

A

Ischial spine

251
Q

What is used for a TOP before 13 weeks?

A

Surgical dilation and suction

252
Q

What is used for a TOP before 15 weeks?

A

Surgical dilation and evacuation/late medical abortion with methotrexate

253
Q

What is used for TOP before 9 weeks?

A

Mifepristone + prostaglandins 48 hours later

254
Q

What is vasa praevia?

A

Foetal blood vessels run near internal opening of the uterus

255
Q

What legal requirements are there for a TOP?

A

2 registered medical practitioners must sign a legal document

256
Q

What may need to happen to the dose of lamotrigine in pregnancy?

A

May need to increase the dose

257
Q

What nuchal thickness results in an increased risk of Down’s syndrome?

A

> 5-6mm

258
Q

What should diabetic mothers be encouraged to do?

A

Breast feed

259
Q

What should diabetic women avoid (wrt pregnancy)?

A

Unplanned pregnancies

260
Q

What should hypertensive pregnant women be given to reduce the risk of pre-eclampsia?

A

Aspirin 75mg up until 12 weeks gestation

261
Q

What should never be done in placenta praevia?

A

A digital exam

262
Q

What test is used for screening for syphilis?

A

ELISA - IgG and IgM

263
Q

What treatment is first-line for pregnant women with a Hb of >80?

A

Oral iron

264
Q

What type of cancer comprises the majority of vulval cancers?

A

SCCs

265
Q

What type of PPH is normal?

A

Red –> brown blood 1-2 weeks after birth

266
Q

When are intrapartum antibiotics given?

A

For women with a previous GBS +ve baby

267
Q

When can chlamydia be tested for following exposure?

A

14 days

268
Q

When can smear tests be done after birth?

A

12 weeks

269
Q

When can the depo provera be started without the need for additional contraception?

A

Up to and including day 5 of the cycle

270
Q

When can the downs screen be done (combined test)?

A

11-13+6 weeks nuchal scan, BHCG, PAPP-A

271
Q

When can you terminate a pregnancy up until?

A

24 weeks

272
Q

When do baby blues occur?

A

3-7 days after birth

273
Q

When do the majority of cord prolapses occur?

A

At artificial rupture of membranes

274
Q

When do women receive continuous HRT?

A

If they have had a previous hysterectomy

275
Q

When does a corpus luteum cyst occur?

A

When the corpus luteum breaks down

276
Q

When does an amniotic fluid embolism occur?

A

Shortly after delivery/at end of the first stage

277
Q

When does post natal depression occur?

A

Peaks 3m after birth

278
Q

When does post natal psychosis occur?

A

2-3 weeks after birth

279
Q

When does the blastocyst implant?

A

Day 6-10

280
Q

When is a membrane sweep done for postmaturity?

A

40 week

281
Q

When is amniocentesis performed?

A

16 weeks

282
Q

When is anti-D given?

A

28 and 34 weeks

283
Q

When is COCP contrainidicated after pregnancy?

A

Whilst breastfeeding

284
Q

When is hyperemesis gravidarum most common?

A

Between 8 and 12 weeks

285
Q

When is labour induced in postmaturity?

A

41-42 weeks

286
Q

When is screening done for cervical cancer?

A

3 yearly from age 25

5 yearly from 50-65

287
Q

Where do endometrial and ovarian cancers drain, lymphatically?

A

Para-aortic lymph nodes

288
Q

Where does fertilisation occur?

A

Ampulla

289
Q

Where does zygote implantation occur?

A

In body of the uterus

290
Q

Where is an epidural done?

A

L3-L5 - anaesthetises the cauda equina

291
Q

Where is nexplanon implanted?

A

Subdermally

292
Q

Where is pain from the inferior aspect of the pelvic organs felt?

A

S2-S4 - perineal pain

293
Q

Where is pain from the superior aspect of the pelvic organs felt?

A

T11-L2 - suprapubic pain

294
Q

Where is the fertilised ovum commonly implanted in ectopic pregnancies?

A

Ampulla of fallopian tube

295
Q

Which anti-epileptic is the least teratogenic?

A

Carbamazepine

296
Q

Which chromosome is Edwards?

A

18

297
Q

Which chromosome is Patau?

A

13

298
Q

Which days are morst fertile in a cycle?

A

8-18

299
Q

Which diabetic drugs are safe to use in pregnancy?

A

Metformin

Insulin

300
Q

Which investigations are done at the booking visit?

A

FBC, Blood group, BMI, BP, urinalysis, scan for dates/abnormalities, bloods for blood borne viruses/rubella

301
Q

Which neurotransmitter inhibits prolactin?

A

Dopamine

302
Q

Which ovarian cyst is most likely to undergo torsion?

A

Dermoid cyst

303
Q

Which population are fibroids more comon in?

A

Black women

304
Q

Which ribs does the breast extend across?

A

2-6

305
Q

Which STI is the ‘great imitator’?

A

Syphilis

306
Q

Which STIs can cause PID?

A

Chlamydia + gonorrhoea

307
Q

Why are steroids given in premature births?

A

To help foetal surfactant production to reduce the chance of foetal respiratory distress at birth

308
Q

Why is anti-D given?

A

To avoid sensitisation - mixing of foetal rhesus +ve blood with mums -ve blood and production of antibodies

Year 3 MBChB (4 decks)

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