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Obs and Gynae > Obs and Gynae > Flashcards

Obs and Gynae Flashcards

1
Q

Painful bleeding in pregnancy

A

Placental Abruption

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2
Q

Painless bleeding in pregnancy

A

Placenta Previa

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3
Q

Types of placenta accreta

A

Accreta - restricted to decide
Increta - invade myometrium
Percreta - invade perimetric

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4
Q

What is vasa praaevia?

A

Blood vessels overlie the os so when the waters break the vessels break and get a massive blood loss

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5
Q

Management of PPH

A 
Call for help
Lie flat
Give O2
Massage uterus
IV access 
Give syntocinon
Give carboprost
Give misoprostol
Give tranexamic acid
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6
Q

For Ts of PPH

A

Tone
Trauma
Thrombin
Tissue

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7
Q

Management of atony

A 
Empty bladder
Massage uterus
Bimanual compression
Syntocinon
Syntometrine
Prostaglandins IM
Misoprostol
Surgery
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8
Q

Surgical manoeuvres of atony

A 
Bakri ballon
Vaginal Pack
B Lynch suture
Ligation of the uterine and internal iliac arteries
Interventional radiology
Hysterectomy
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9
Q

Risk factors of placenta praaevia

A

Twins
High parity
Old age
Scarred Uterus

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10
Q

Risk factors for placental abruption

A 
IUGR
Preeclampsia
Autoimmune disease (antiphospholipid syndrome)
Maternal smoking
Cocaine usage
Previous history of placental abruption
Multiple pregnancy
High parity
Thrombophillia
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11
Q

Woody hard uterus

A

Placental abruption

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12
Q

What classes as a PPH

A

loss of > 500ml

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13
Q

Risk factors of PPH

A 
Previous hx
Previous c section
Coagulation defect
Retained placenta
APH
Multiparity 
Uterine malformation
Polyhydramniosis
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14
Q

Bleeding the first 12 weeks of pregnancy causes

A

Miscarriage
Ectopic pregnancy
Molar pregnancy

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15
Q

Commonest site of ectopic pregnancy

A

Ampulla of fallopian tube

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16
Q

What counts as an APH

A

Bleeding from 24 weeks onwards

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17
Q

How do you investigate placenta praaevia

A

TVUS

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18
Q

How do you investigate placenta accreta

A

MRI and doppler

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19
Q

Prevention of preeclampsia

A

Aspirin

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20
Q

Treatment of hyperreflexia in preeclampsia

A

Magnesium sulphate

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21
Q

Risk factors of cord prolapse

A 
Premature rupture of membranes
Polyhydramnios
Long umbilical cord
Fetal malpresentation
Multiparity
Multi pregnancy
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22
Q

Management of cord prolapse

A 
Fill bladder
Tredelenburg position - feet higher than head
Constant fetal monitoring
Alleviate pressure on cord
C-section
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23
Q

Myotomes affected in Erbs palsy

A

C5 and C6 - waiters tip

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24
Q

Management for shoulder dystocia

A 
H - help
E - episiotomy
L - legs in mc roberts
P - suPrapubic pressure
E - enter pelvis
R - rotational manoeuvres
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25
Q

What is zavanelli manoeuvre

A

push baby in and try for c-section

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26
Q

Principles of screening

A
  • knowledge of the disease (condition important, easy symptomatic stage, course of disease understood)
  • knowledge of test (suitable, test acceptable)
  • treatment of disease (accepted treatment, facilities available)
  • cost considerations
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27
Q

Fetal Anomaly screening happens when

A

18+0 - 20+6

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28
Q

what does metal anomaly screening screen for

A

downs
pataus
edwards

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29
Q

what does the newborn blood spot screen for

A 
cf
congenital hypothyroidism
sickle cell disease
pku
mcadd
msud
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30
Q

name the chromosome extra copies in downs, edwards and pataus

A

downs - 21
edwards - 18
pataus - 13

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31
Q

Risk factors for breast cancer

A 
age
FH
alcohol
obesity 
HRT
OCP
early menarche
late first child
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32
Q

protective factors of breast cancer

A

breast-feeding

exercise

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33
Q

when does breast screening happen

A

47-73 every 3 years mammography

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34
Q

name some genes in breast cancer

A

BRCA 1 and 2
Tp53
Peutz Jeghers

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35
Q

Locally advanced breast cancer presentation

A

palpable painless lump - irregular hard fixed
nipple discharge
nipple indrawing
skin tethering

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36
Q

Oestrogen sensitive breast cancer treatment

A

oestrogen sensitive breast cancer

  • tamoxifen (premenopausal)
  • aromatase inhibitors (postmenopausal)
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37
Q

What drug is HER2 sensitive

A

Trastuzumab

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38
Q

What else should you give to postmenopausal women with oestrogen receptor positive cancer

A

Bisphosphonates

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39
Q

Abortion act

A
  • not exceeded 24 wks and continuation of pregnancy is ore risky that terminating it
  • termination needed to prevent physical or mental health problems
  • continuation would involve risk to woman
  • if child was born they would suffer physical or mental abnormalities
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40
Q

Fraser guidelines

A
  • patient understands advice
  • encourage parental involvement
  • patient likely to have sex with or without contraception
  • pt physical or mental health will suffer if does not receive treatment
  • is it in its best interests to provide contraceptive treatment without parental consent
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41
Q

What is endometriosis

A

endometrial tissue outside the endometrial cavity - responsive to oestrogen so cyclical with periods

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42
Q

where is endometriosis commonly found

A

pouch of douglas

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43
Q

how does endometriosis present

A

constant pelvic pain worse during periods

pain during sex

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44
Q

where else can endometriosis occur

A

extraperitoneal

  • umbilicus
  • bladder
  • nose
  • lungs
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45
Q

CA125 is high in what

A

Ovarian cancer and endometriosis

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46
Q

Complications of endometriosis

A
  • high risk of recurrence
  • impact on fertility
  • impact on quality of life
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47
Q

what is the gold standard investigation of endometriosis

A

laparoscopy

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48
Q

Medical treatment of endometriosis

A

OCP - causes glandular atrophy and stops ovulation
GnRH agonist - continuous GnRH makes them menopausal
Oral progestogens
Depo provera
mirena coil

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49
Q

Surgery of endometriosis

A

ablation, excision, oophorectomy, pelvic clearance

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50
Q

why does endometriosis cause infertility

A

endometriosis release immune factors causing oocyte toxicity, adhesions, tubal dysfunction, ovarian dysfunction

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51
Q

What is adenomyosis

A

invasion of endometrial tissue into the myometrium

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52
Q

who does adenomyosis commonly occur in

A

menopausal women (not related to oestrogen bu pain similar)

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53
Q

fibroids affect what tissue

A

benign uterine smooth muscles tumours

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54
Q

symptoms of fibroids

A

heavy periods, infertility, miscarriages, pain

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55
Q

when is cancer no longer classed as benign

A

when abnormal cells invade the basement membrane and are so able to get into the bloodstream and lymphatic system

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56
Q

Name the tumour suppressor genes and their roles

A

P53 - regulates cell cycle

Rb - prevents excessive cell growth

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57
Q

Post menopausal bleeding is a red flag for what

A

Endometrial cancer

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58
Q

Risk factors for endometrial cancer

A

obesity (fat cells make more oestrogen), diabetes, nulliparity, late menopause, PCOS, HRT, tamoxifen, HNPCC

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59
Q

Staging of endometrial cancer

A

FIGO

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60
Q

Investigations for endometrial cancer

A

TVUS, biopsy, hysteroscopy

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61
Q

treatment of endometrial cancer

A

hysterectomy, radiotherapy, progesterone

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62
Q

Risk factors for HPV

A 
missed vaccination
early age intercourse
multiple sexual partners
STDs
previous CIN
OCP
cigarette smoking
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63
Q

What oncogenes does the HPV vaccine cover

A

16 and 18

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64
Q

what cells does cervical cancer effect

A

squamous cell carcinoma

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65
Q

treatment of cervical cancer

A

microscopic - just remove part of the cervix

macroscopic - hysterectomy

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66
Q

clinical features of vulval cancer

A 
vulval itching
vulval soreness
persistent lump
bleeding
pain on passing urine
PMH of lichen sclerosis
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67
Q

what is protective against ovarian cancer

A

OCP

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68
Q

What is the marker in ovarian cancer

A

CA125

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69
Q

what cells does ovarian cancer affect

A

epithelial cells

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70
Q

What is the risk of malignancy index of ovarian cancer

A

CA125 X USS X years postmenopausal

> 250 refer to gynae

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71
Q

clinical features of ovarian cancer

A 
no symptoms
bloating
abdo pain
change in bowel habit
urinary frequency
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72
Q

What is a molar pregnancy

A

Complete mole - mass of abnormal cells in the womb and no foetus develops
Partial mole - an abnormal foetus starts to develop but can’t survive

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73
Q

What is the latent phase of labour

A 
irregular contractions
show mucoid plug
cervix effacing and thinning
encourage to stay at home
6hrs - 2 days
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74
Q

What is the effacement of labour

A

starts in fungus
retraction/shortening of muscle fibres
build in amplitude as labour progresses
foetus forced down

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75
Q

How is labour assessed?

A

Presentation (anatomical part of the tutus which it presents itself through the birth canal)
Lie (the relationship between the long axis of the fetus and the long axis of the uterus)
Attitude (presenting part flexed or deflexed)
Engagement (widest part of the presenting part has passed through the brim of the pelvis)
Station (relationship between the lowest pint of the presenting part and the ischial spines)

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76
Q

When is active labour

A

4 cm dilated
regular and frequent contractions
progressive
oxytocin released

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77
Q

SE to entonox

A

nausea and vomiting

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78
Q

SE to opiates

A

fetal respiratory depression, diminished feeding behaviours, longer labour

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79
Q

SE to epidural

A

longer labour, decreased contractions

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80
Q

Role of thecal cells

A

sensitive to LH, synthesise progesterone and testosterone from cholesterol

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81
Q

role of granulose cells

A

sensitive to FSH convert testosterone to oestrogen,

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82
Q

What causes the dominant follicle to grow

A

FSH

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83
Q

what does hCG do

A

prevents the decline of corpus lute ensuring that corpus lute synthesises progestins until placenta forms

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84
Q

What is apposition

A

interaction between the blastocyst and maternal epithelium

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85
Q

What do endovillus trophoblasts do

A

invade maternal spiral artery to tap maternal blood supply

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86
Q

What do the NK cells do

A

mediate invasion of endovillus trophoblasts so that invasion does not reach the myometrium

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87
Q

risk factors for preeclampsia

A 
primigravidity
young females
black people
twins
HTN
renal disease
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88
Q

What is chronic HTN

A

HTN diagnosed before the 20th week gestation and not resolved postpartum

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89
Q

What is gestational HTN

A

new HTN after 20 wks gestation

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90
Q

Preeclampsia

A

New HTN after 20 wks with increase BP and proteinuria

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91
Q

Pathophysiology of preeclampsia

A

abnormal spiral artery formation causing an ischaemic placenta causing the release of thromboplastin causing DIC and renin causing vasoconstriction, HTN, proteinuria and oedema

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92
Q

What is HELLP syndrome?

A

Preeclampsia can lead to
H - haemolysis
EL - elevated liver enzymes
LP - low platelets

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93
Q

Risk factors for preterm birth

A 
genital infection
cervical weakness
vaginal bleeding
multiple pregnancy
previous term birth
smoking
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94
Q

What does a high fibronectin indicate

A

may indicate disruption of attachment of membranes and decidua

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95
Q

Investigation of incontinence

A

frequency volume chart
urinalysis
residual urine measurement
ePAQ

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96
Q

What is the histology of the detrouser muscle

A

smooth muscle

transitional epithelium

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97
Q

What is the detrouser muscle innervated by?

A

S2-S4

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98
Q

Treatment of overactive bladder

A

oxybutynin
mirabegron
botulism

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99
Q

Treatment of stress incontinence

A

restore pressure to utethra
colposuspension - stitched bilaterally in the vagina
tension free vaginal tape - mesh sling around the urethra

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100
Q

What would cause an abnormal CTG

A 
chromosomal abnormalities
SGD
LGD
twins
plataued growth
cord prolapse
oligo/polyhydramnios
group B strep
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101
Q

Interpreting a CTG

A 
Dr - define risk
C- contractions
Bra - baseline rate
V - variability (>5bpm)
A - accelerations
D - decelerations
O - overall assessment
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102
Q

What are variable decelerations indicative of

A

Cord compression

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103
Q

Late decelerations are a sign of what

A

hypoxia

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104
Q

treatment of chlamydia

A

azithromycin/doxycycline

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105
Q

What is a chocolate cyst

A

an ovarian endometrioma - benign oestrogen-dependent cyst found in women of reproductive age

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106
Q

what is a threatened miscarriage

A

there is bleeding but the foetus is still alive and os is closed

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107
Q

What is an inevitable miscarriage

A

bleeding and os is open

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108
Q

What is an incomplete miscarriage

A

some fetal parts passed, bleeding diminished, os closed

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109
Q

What is a missed miscarriage

A

relies on scan - fetus sis not develop but not recognised until bleeding occurs

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110
Q

How to tell the difference between miscarriage and ectopic pregnancy

A

Miscarriage: bleeding > pain (present at 10wks)

Ectopic : pain > bleeding (present earlier)

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111
Q

Risk factors for ectopic pregnancy

A

previous ectopic, PID, endometriosis, copper IUD, minipill)

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112
Q

Plateauing or declining hCG levels

A

Ectopic or non-viable pregnancy

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113
Q

Medical management of ectopic if hCG is < 3000

A

methotrexate (give anti D if rhesus negative)

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114
Q

Medical management of miscarriage

A

misoprostol +/- mifepristone

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115
Q

Surgical management of miscarriage

A

evacuation of retained products of conception (ERCP) under anaesthetic using vacuum aspiration

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116
Q

whats the difference between small for dates and IUGR

A

Small for dates - estimated fetal weight below 10th centile

IUGR - pathological small for dates

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117
Q

What is symmetrical IUGR early in pregnancy suggestive of?

A

chromosomal abnormalities

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118
Q

What is asymmetrical IUGR are in pregnancy suggestive of?

A

IGUR/preeclampsia

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119
Q

What is large for dates?

A

estimated fetal weight greater than 90th centile

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120
Q

Reduced placental function effect on fetus

A

polycythaemia
hypoglycaemic
increased adrenaline, noradrenaline
decrease in cardiac output

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121
Q

What is an absent EDF suggestive of?

A

placental insufficiency

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122
Q

Reversal of EDF is associated with an increased risk of what

A 
IUGR
neonatal thrombocytopenia
NEC
mortality
long term neurological damage
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123
Q

Management of absent EDF

A

Mother admitted given steroids if < 34wks and has daily CTG

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124
Q

Causes of polyhydramnios

A 
intrauterine infection
Rh incompatibility
maternal cardiac or renal problems
maternal DM (urine)
multiple pregnancies
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125
Q

Complications of polyhydramnios

A 
Cord prolapse
placental abruption
premature birth
perinatal death
congenital abnormalities
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126
Q

low level of PAPP-A at 12 weeks can be associated with what

A

Downs syndrome

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127
Q

If FBS pH is below 7.2 what should be done

A

expedite the delivery as sign of fetal distress

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128
Q

What is the most favourable position of a baby for vaginal delivery

A

Occipito-anterior

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129
Q

What acts on the hypothalamus and pituitary as a negative feedback

A

Inhibin and oestrogen produced by the ovaries

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130
Q

If the SRY gene is absent what happened in utero

A

Mullerian ducts persist and fuse to form the upper vagina, cervix and uterus

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131
Q

If the SRY gene is present what happens in utero

A

testes determinant factor is produced and Wolfian ducts persist and mullein ducts degenerate

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132
Q

What dose the anterior pituitary excrete?

A

GH, LH, FSH, prolactin

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133
Q

What does the posterior pituitary produce?

A

ADH, oxytocin

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134
Q

What is primary amenorrhea?

A

periods never started

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135
Q

causes of primary amenorhoea

A 
imperforate hymen
turners syndrome
kallmans syndrome (GnRH deficiency and impaired sense of smell)
low weight
stress
hypothalamic hypogonadism
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136
Q

what is secondary amennorhoea?

A

periods started but then stopped

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137
Q

causes of secondary amennorhoea

A 
pregnancy
hypothyroidism
hypothalamic hypogonadism
theehans syndrome 
cushings disease
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138
Q

how does cushings disease cause secondary amennorhoea

A

high cortisol inhibits LH secretion

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139
Q

What is Sheehans syndrome?

A

massive PPH causes avascular necrosis of the pituitary gland

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140
Q

What is Ashermans syndrome?

A

Adhesions cause infertility

141
Q

Symptoms of hyperprolactinaemia

A

milky nipple
headache
bitemporal hemianopia (if pituitary tumour)
amennorhoea

142
Q

Treatment of hyperprolactinoma

A

Cabagoline

143
Q

Hypothyroidism on blood results

A

High TSH

Low T3 T4

144
Q

PCOS triad

A

polycystic ovaries on US
irregular periods
excess androgens

145
Q

Blood results of PCOS

A

high testosterone
high LH (3 X higher than FSH)
high/normal prolactin
low SHBG

146
Q

Treatment of PCOS

A 
lose weight
OCP
metformin
clomifene - for when they re trying to get pregnant
laparoscopic ovarian drilling
147
Q

Causes of hypogonadotrophic hypogonadism

A 
Kallermanns (inherited)
damage to pituitary or hypothalamus from surgery, injury or infection
high dose steroids
high prolactin
severe stress
nutritional problems
148
Q

investigation of hypogonadotrophic hypogonadism

A

LH response to GnRH to see if it is a lack of GnRH production or a problem with the pituitary

149
Q

Treatment of hypogonadism

A

hormonal contraceptives or GnRH injections

150
Q

Hypothalamic causes of amennorhoea blood results

A

low FSH and LH

151
Q

How do we assess ovarian function

A

Mid luteal progesterone (usually day 21 on a 30 day cycle)

152
Q

What hormone is a reflection on the number of eggs

A

Anti-mullerian hormone

153
Q

Causes of female infertility

A 
Turners
Infection
Obesity
PCOS
Endometriosis
Ashermans
Anatomical abnormalities
Chemo
Mumps
154
Q

What are the tubal patency tests called

A

HSG

H1COS

155
Q

Causes of male infertility

A

CF
Steroids
kallermans
Previous STDs

156
Q

Commonest cause of anaemia in pregnancy

A

Iron deficiency

157
Q

Treatment of obstetric cholestasis

A

ursodeoxycolic acid

158
Q

Non hormonal treatment of menopause

A

Clonidine

159
Q

Risks of HRT

A

Increase risk of breast cancer, VTE, CVD (best put it in a patch do it does not pass through the liver and induce live enzymes and clotting factors)

160
Q

What is premature ovarian insufficiency

A

Menopause < 40

161
Q

How long do you stay fertile during the menopause

A

Fertile for 2 years if menopause < 50 years

Fertile for 1 year of menopause > 50 years

162
Q

Causes of menorrhagia

A 
Uterine fibroids
Uterine polyps
Adenomyosis
Endometriosis
Gynae malignancy
163
Q

How to treat painful bleeding

A

Mefanamic acid

164
Q

How to treat heavy bleeding

A

Transexamic acid

165
Q

Surgical treatment of menorrhagia

A

Endometrial ablation

166
Q

HNPCC/Lynch syndrome is a strong risk factor for what cancer

A

Endometrial cancer

167
Q

Factors for endometrial cnacer

A 
obesity
nulliparity 
early menarche
PCOS
late menopause
DM
168
Q

What does the Edinburgh scale screen for

A

post natal depression

169
Q

how does puberal psychosis present

A

in the first 2-3 weeks of childbirth

severe mood swings

170
Q

abortion management < 9wks

A

mifepristone

171
Q

abortion management < 13 wks

A

surgical dilation and suction

172
Q

abortion management > 15 wks

A

surgical dilatation and evaluation of uterine contents

173
Q

Name a muscarinic antagonist

A

tolterodine, oxybutynin, solifenacin

174
Q

at what weeks does routine care and anti-D prophylaxis occur

A

28 and 34 weeks

175
Q

what are dates of birth confirmed

A

10 - 13+6

176
Q

When are blood results back in ANC

A

16 wks

177
Q

when is the anomaly scan

A

18 - 20+6

178
Q

when is the booking visit

A

8 - 12 wks

179
Q

when is downs syndrome screened for

A

11 -13 + 6

180
Q

Name some drugs contraindicated in pregnacny

A 
tetracycline
ciprofloxacin
lithium
benzos
methotrexate
sulphonylurea
amiodarone
carbimazole
181
Q

what is the leading indirect cause of maternal deaths

A

cardiac disease

182
Q

Features of a normal CTG

A

accelerations present
variability > 5bpm
No decelerations
HR 110-160

183
Q

Prophylaxis of Group B strep

A

BenPen

184
Q

IUGR prevention

A

aspirin

185
Q

What drug for overactive bladder should not be used in the elderly

A

oxybutynin

186
Q

Treatment of mastitis

A

fluclox and continue breast feeding

187
Q

What is raised in fetal abdominal defects

A

AFP - raised in omphalocele and neural tube defects and multiple pregnancy

188
Q

When is AFP reduced

A

Downs
DM
Edwards
Maternal obesity

189
Q

what do you give id there is a magnesium sulphate induced respiratory depression

A

calcium gluconate

190
Q

Hyperemesis Gravidum treatment

A

IV fluids
antihistamine
Metoclopramide
Vit B and C

191
Q

What is given before hysterectomy to reduce the size of the uterus

A

GnRH agonists

192
Q

Name contraindications of the OCP

A 
> 35 and smoking cigs
BMI > 35
FH of VTE
HTN
immobility
carrier of BRCA
193
Q

Oligohydramnios causes

A 
premature rupture of membranes
fetal renal problem (renal agenesis)
intrauterine growth restriction
post-term gestation
preeclampsia
194
Q

treatment of hot flushes

A

fluoxetine

195
Q

what antibiotic is given in PROM

A

erythromycin

196
Q

What is Fitz-Hugh-Curtis syndrome

A

complication of PID where inflammation of the liver capsule causes lesions between the liver and abdominal wall

197
Q

Ovarian torsion on US

A

Whirlpool sign and free pelvic fluid

198
Q

what is rovsings sign

A

palpation of LIF causes RIF tenderness - appendicitis

199
Q

Stages of labour

A

stage 1: from the onset of true labour to when the cervix is fully dilated
stage 2: from full dilation to delivery of the fetus
stage 3: from delivery of fetus to when the placenta and membranes have been completely delivered

200
Q

where do bartholins abscess occur

A

glands next to the vagina entrance

201
Q

how do you treat bartholins abscess

A

marsupialisation

202
Q

what is an ectropion

A

columnar epithelium present on ectocervix due to elevated oestrogen
vagonal discharge, post-coital bleeding

203
Q

What causes a boggy uterus

A

adenomyosis

204
Q

what causes a bulky uterus

A

fibroids

205
Q

what does a bishops score of less that 5 indicate

A

labour is unlikely to start

206
Q

What is the treatment of BV and trichomonas

A

metronidazole

207
Q

what is the treatment of thrush

A

clotrimazole pessary

208
Q

PPH management

A 
Bimanual uterine compression 
IV syntocinon
Ergometrine (contraindicated in HTN)
Syntocinon infusion 
Carboprost
Misoprostol rectally
209
Q

what do you give if pregnant lady is exposed to chicken pox and is not immune

A

VZIG

210
Q

What causes hyperemesis gravidum

A

beta hCG levels

211
Q

Treatment of HTN in preeclampsia

A

Labetalol

Nifedipine if asthmatic

212
Q

When is ECV offered from in a nulliparous and breech baby

A

36 weeks

213
Q

Investigation of adenomyosis

A

MRI

214
Q

How often do women have smears between 50-64

A

5 years

215
Q

What is hCG secreted by

A

syncitotrophoblasts

216
Q

commonest cause of post coital bleeding

A

ectropion cervix

217
Q

what hormone is significantly raised in menopause

A

FSH

218
Q

circumstances when anti D is given

A 
delivery of a Rh + infant whether live or still for
any termination of pregnancy
miscarriage if > 12 weeks
ectopic pregnancy managed surgically
external cephalic version
APH
amniocentesis
FBS 
chorionic villus sampling
219
Q

treatment for a woman wit large fibroids but wants to conceive

A

myomectomy

220
Q

What is reduced in pregnancy

A

reduced urea

reduced creatinine

221
Q

Increase in nuchal translucency is indicative of what?

A

downs syndrome
congenital heart defects
abdominal wall defects

222
Q

What is meigs syndrome

A

bening ovarian tumour (usually a fibroma) associated with ascites and pleural effusion

223
Q

BP meds in pregnancy

A

labetalol
nifedipine
methyldopa
hydralazine (IV)

224
Q

Clinical features of preeclampsia

A 
headache
flashing lights
vomiting
abdo and epigastric pain
swelling of extremities and face
225
Q

Routine abs after c section

A

cef and met

226
Q

What is stage 3 of FGM (Infundibulation)

A

narrowing of the vaginal orifice with creation of a covering seal by cutting and appositioning the labia minor and or major with or without the excision of the clitoris

227
Q

reasons for FGM

A 
respect
preserves virginity
rite of passage
cleanliness
religious requirement
social acceptance
228
Q

What is the UN convention on childrens rights

A

Article 6 - survival and development right
Article 12 - respect of child’s views
Article 34 - all health parties should take measures to abolish damaging traditions
Article 19 - protection from violence

229
Q

Gynaecological complications of FGM

A 
dyspareunia
sexual dysfunction with anorgansmia
chronic pain
keloid scar formation
dysmenorrhoea
UTIs
PTSD
difficulty conceiving
230
Q

Obstetric complications of FGM

A

increased likelihood of csection, PPH, episotomy

difficulty monitoring fetus

231
Q

What causes precocious puberty

A

secretion of high amplitude pulses of GnRH by the hypothalamus

232
Q

Can you detain people without a psychiatric condition under the mental health act

A

No - it is unlawful to detain someone under the mental health act for treatment of any disease other than a psychiatric condition

233
Q

In which section are patients already inpatients

A

section 5

234
Q

When can lifesaving treatment not be administered in an emergency

A

when there is a valid advanced directive (signed by a doctor)

235
Q

Consent for treatment

A

patient understands
patients needs and wishes known
complexity of the treatment
risks

236
Q

What is in ellesette solo

A

estradiol only

237
Q

Symptoms of ovarian torsion

A

constant pain, does not improve with painkillers

238
Q

PCOS long term risks

A

endometrial hyperplasia
sleep apnoea
diabetes
acne

239
Q

RMI calculation

A

US (1-5 features) x menopause status (3 if menopausaL) x CA125
>250 = urgent referral

240
Q

Post menopausal bleed red flag

A

endometrial cancer - US pelvis and pipette biopsy

241
Q

PID treatment

A

IM ceftriaxone
oral doxycline
oral metronidazole

242
Q

Risk factors for 3rd degree tear

A

shoulder dystocia
maternal age
prolonged 2nd stage of labour
forceps delivery

243
Q

what is a suspicious and pathological CTG

A

suspicious - 1 non-reassuring features

pathological - 2 non-reassuring features or 1 abnormal features

244
Q

What should not be cut in an episiotomy

A

ischiocavernosus

245
Q

Drugs for infection of labour for intrauterine death

A

Mifepristone (cervical ripening)

Mifeprostol (onset of contractions)

246
Q

Manoeuvre for shoulder dystocia

A

McRoberts

247
Q

What is a contraindication to epidural

A 
hypotension
systemic infection
skin infection 
bleeding disorders
low platelets
248
Q

What makes up the lower vagina

A

cloaca

249
Q

What makes up the uterus

A

paramesonephric duct (mullerian)

250
Q

what makes up the vas and epididymis

A

mesonephric (wolfing)

251
Q

What does the corpus lutem secrete

A

progesterone

252
Q

What hormone does hCG shares the same alpha subunit with

A

TSH

253
Q

Combined test in downs

A

High nuchal translucency
Low PAPP-A
High beta hCG

254
Q

Slapped cheek is caused by

A

Parvovirus

255
Q

Neonatal meningitis is caused by

A

Group B strep

256
Q

Can a UTI lead to premature delivery

A

yes - irritable uterus

257
Q

Treatment of PROM

A

erythromycin

258
Q

What is anydramnios suggested of

A

renal agenesis

259
Q

Where is endometriosis commonly found

A

pouch of douglas

260
Q

where is cervical cancer found usually

A

transformational zone

261
Q

Turners karyotype

A

XO

262
Q

Endometrioma on US

A

groundless appearance

263
Q

Endometrioma on laparoscopy

A

chocolate cyst

264
Q

Ovarian cancer is related to what cells

A

epithelial

265
Q

Granulosa cell tumours are related to

A

precocious puberty

266
Q

Fibroids can mask what

A

leiomyosarcoma

267
Q

Clue cells are related to

A

BV

268
Q

Complete mole is

A

diploid

269
Q

partial mole is

A

triploid

270
Q

When do you manage a miscarriage expectantly

A

7-14 days

271
Q

SLE in pregnancy can cause what

A

miscarriage
preeclampsia
prematurity
IUGR

272
Q

Can women with GDM develop T2 DM after pregnancy

A

30-60% do develop T2 DM

273
Q

What is the quadruple test

A

unconjugated oestriadiol
hCG
AFP
inhibin A

274
Q

Changes in pregnancy

A

increase in fibrinogen and factors VII, X, XII
increase in stroke volume
decrease in Hb
soft systolic flow murmur

275
Q

What infections are screened for in ANC

A

syphyllis
rubella
Hep B
HIV

276
Q

How to treat embolism in pregnancy

A

enoxparin

277
Q

When can ECV be carried out

A

36 wks if nulliparous

37 wks if multiparous

278
Q

contraindications to ECV

A

preeclampsia
oligohydramnios
scarred uterus
APH

279
Q

what do you give a pregnant woman if she comes into contact with chicken pox

A

check for antibodies

give IVIg within 10 days

280
Q

Difference between threatened miscarriage and an APH

A

threatened miscarriage bleeding < 24 weeks

APH bleeding > 24 weeks

281
Q

treatment of incomplete miscarriage

A

misoprostol

282
Q

treatment of hyperemesis gravidarum

A

crystalloid and antiemetic

283
Q

when is a pseudo sac seen

A

ectopic pregnancies

284
Q

if a patient had dysparunia, post-coital bleeding and abdominal pain what is important to rule out

A

cervical cancer

285
Q

What scan do you do for an ectopic pregnancy

A

TVUS to see if anything is in the uterus

286
Q

treatment of PPH

A

1) flood resuscitation
2) oxytocin infusion
3) uterine massage
4) IV ergometrine
5) bimanual compression
6) Bakri ballon
7) intramyometrial uterotonics

287
Q

what does CMV cause in the neonate

A

visual/hearing loss
microcephaly
neurodevelopment disability

288
Q

DIC blood results

A

low platelets

high PT and APTT

289
Q

what does the APGAR score look at

A 
tone
colour
breathing
heart rate
reflex irritability
290
Q

PE blood gas

A

respiratory alkalosis

291
Q

what is peri-partum cardiomyopathy

A

develops in the last month of pregnancy to five months post part - SOB, tachycardia, tachypnoea

292
Q

Fetal physiology after birth

A

umbilical blood vessels occlude
decrease in venous turn back to the heart
increase in RA pressure (closes foramen ovale)
1st breath decreases pulmonary circulation pressure and increases RV output
increase in venous return back to the heart increases left side pressure and closes ductus arteriosus

293
Q

HPV for cervical cancer and genital wart

A

16 + 18 - cervical cancer

6 + 11 - warts

294
Q

pathophysiology of CAH

A

inadequate cortisol
adrenal hyperplasia
excessive androgenic precursors

295
Q

Hyaditidiform moles on US

A

snow storm appearance

296
Q

triad of PCOS

A

anno/oligoovulation
hyperandrogegism
US - < 12 follicles

297
Q

how does COCP affect cancer

A

decrease in bowel and ovarian cancer

increase in cervical

298
Q

when is a transvaginal tape used

A

urinary stress incontinence

299
Q

OHSS presentation

A

hyper coagulability - VTE

hyperprolactinaemia - ascites

300
Q

Hormone levels in hypothalamic hypogonadism

A

low FSH, LH, oestradiol

301
Q

Where does the ureter pass in relation to the uterine artery

A

Under

Water under the bridge

302
Q

what is megs syndrome

A

pleural effusion associated with ovarian fibroma

303
Q

investigation of ovarian cancer

A

CT

304
Q

symptoms of ovarian cancer

A

like IBD - bloating and abdominal pain

305
Q

First line management in pre-eclampsia management

A

labetalol (if asthmatic - nifedipine)

306
Q

Risk factors for pre eclampsia

A 
FH
CKD
DM
SLE
hypertensive disease during previous pregnancies
first pregnancy
> 40
high BMI
307
Q

What does preeclampsia predispose to

A 
eclampsia
HELLP
CVH
placental abruption
DIC
pulmonary oedema
308
Q

Features of severe preeclampsia

A 
HTN>170/110
proteinuria
headache
visual disturbance
papilloedema
epigastric pain
hyperreflexia
low platelets
309
Q

Prevention of group B strep

A

IV Ben Pen

310
Q

Risk factors for strep B

A

premature
PROM
previous sibling with GBS
maternal pyrexia

311
Q

Risk factors for placental abruption

A 
IUGR
preeclampsia
preexisting HTN
smoking
prev abruption
312
Q

Passage of fetus through the birth canal

A

E - engagement
D - descent

F - flexion
I - internal rotation
E - extension
R - rotation external
E - expulsion
313
Q

Mechanical factors that determine progress throughout labour

A

Power (degree of force expelling the fetus)
Passage (dimensions of pelvis and resistance of soft tissues)
Passenger (diameters of fetal head)

314
Q

Stages of labour

A

stage 1 - 4 cm - 10cm
stage 2 - delivery of baby
stage 3 delivery of placenta

315
Q

Induction of labour

A

1) membrane sweep
2) vaginal prostaglandin
3) amniotomy
4) oxytocin

316
Q

Prevention of cord compression

A

elevate the presenting part either manually or by filling the urinary bladder

317
Q

Complications which can occur to mother with shoulder dystocia

A

PPH
Perineal tear
Urethral and bladder injuries

318
Q

Complications which can occur to fetus in shoulder dystocia

A

brachial plexus injury (Erbs palsy C5-7)
hypoxia
hypoxic ischaemic encephalopathy
death

319
Q

risk facotrs for shoulder dystocia

A

macrosomia
high maternal BMI
DM
prolonged labour

320
Q

Shoulder dystocia management

A 
H - help
E - episiotomy
L - legs in mc roberts
P - suPrapubic pressure
E - enter pelvis
R - rotational manoeuvres
321
Q

risk factors for cord prolapse

A 
prematurity
breech
abnormal lie
polyhydramnios
artificial rupture of membranes
twins
322
Q

Presentation of uterine rupture

A 
3rd trimester
maternal shock
severe abdo pain
vaginal bleeding
severe abdo pain
fetal bradycardia
scar tenderness
chest or shoulder tip pain
323
Q

management of uterine rupture

A

urgent surgical delivery

324
Q

how does amniotic fluid embolisation present

A

Presents like a PE - tachypneoa, tachcardia, SOB, palpitations, cough
then has a haemorrhage phase - DIC

325
Q

Management of PPH

A

Syntocinon
Ergometrine
IM carboprost
surgical options

326
Q

Risk facotrs for PPH

A 
previous PPH
APH
prolonged labour
preeclampsia
polyhydramnios
increased maternal age
macrosomia
327
Q

Postnatal depression screening tool

A

Edinburgh Scale

328
Q

When would you give oestrogen and progesterone to treat menopause

A

if they still have a uterus to reduce risk of endometrial hyperplasia

329
Q

Treatment of menorrhagia

A

IUS
COCP
Tranexamic acid

330
Q

Causes of primary amenorrhoea

A 
consitutional delay
anorexia
hyperprolactinaemia
hypo/hyperthyroidism
adrenal hyperplasia
turners syndrome
androgen insensitivity
imperforate hymen
331
Q

causes of secondary amenorrhoea

A 
pregnancy
menopause
lactation
anorexia
hyperprolactinaemia
hypo/hyperthyroidism
adrenal tumour
PCOS
premoture ovarian failure
Ashermans
332
Q

Amenorrhoea investigations

A 
pregnancy test
FSH/LH
prolactin levels
testosterone
SHBG
TFTs
pelvic US (PCOS)
333
Q

Causes off painful periods

A 
endometriosis
adenomyosis
PID
ovarian tumour
fibroids
334
Q

Medical, surgical and radilogical treatment of fibroids

A

Medical - tranaexamic acid, IUS, COCP, ulipristal acetate, Zoladex
Surgical - hysterectomy, myomectomy
Radiological - uterine artery embolisation, myometrial ablation

335
Q

What is adenomyosis?

A

endometrium grows into the myometrium causing moderate enlargement

336
Q

Risk factors for endometrial carcinoma

A
  • exogenous oestrogen (unopposed oestrogen, tamoxifen)
  • endogenous oestrogen excess (PCOS, obesity)
  • T2DM
  • Lynch type II syndrome
  • HNPCC
337
Q

red flag for endometrial cancer

A

postmenopausal bleeding

338
Q

Blood results in PCOS

A

increased testosterone
increased insulin
decreased SHBG

339
Q

Management of PCOS

A
  • weight loss
  • COCP
  • clomifene or tamoxifen for ovulation
  • metformin
  • ovarian diathermy
340
Q

risk of malignancy index

A

US findings x menopausal status X CA125

pre menopausal = 1
post menopausal = 3

1 US sign = 1
> 2 US signs = 3

> 250 - MDT

341
Q

tx of PID

A

doxycycline, ceftriaxone, metronidazole

342
Q

ANC visit

A 
<12wks first visit
11-13 weeks scan (dates, nuchal translucency)
18-20 weeks anomaly scan
36weeks check lie and presentation
37 weeks head engaged
343
Q

when is aspirin given in pregnancy

A

if there is a risk of pre eclampsia

  • previous pre eclampsia
  • FH
  • diabetes
  • obesity
  • chronic HTN
  • autoimmune disorders
344
Q

frail old woman treatment for endometrial cancer

A

progestogens

345
Q

Most common type of cervical cancer

A

squamous cell

346
Q

HPV serotypes in cervical cancer

A

16
18
33

347
Q

What happens to fibroids in pregnancy

A

Red degeneration - presents with low-grade fever, pain and vomiting

348
Q

Why is there shoulder tip pain

A

peritoneal bleeding irritates diaphragm and causes shoulder tip pain through the phrenic nerve

349
Q

ovarian tumour histology

A

epithelial epithelium

Obs and Gynae (1 decks)

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