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Phase 3A > Obs and Gynae > Flashcards

Obs and Gynae Flashcards

1
Q

When is Hutchinson’s triad seen and what does it consist of? (4)

A

Congenital syphilis infection

Interstitial keratitis, teeth abnormalities, deafness

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2
Q

When is the combined test performed for trisomies? (1)

What does it involve and what results are expected if a trisomy is present? (6)

A

10-14 weeks
Nuchal translucency (Increased)
Serum PAPP-A (reduced)
Serum beta HCG (raised)

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3
Q

A woman presents and is 16 weeks pregnant, what test is performed to assess risk of trisomies? (4)

A

The quadruple test - alphafetoprotein, hCG, uE3 and inhibin A

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4
Q

At how many weeks is the test for structural abnormalities performed? (1)

A

18-21 weeks

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5
Q

When is the early pregnancy scan performed and what is its function? (4)

A

11-14 weeks
Assess gestational age, foetal demise, multiple pregnancies
Gross heart defects, anencephaly and increased nuchal translucency

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6
Q

When is the Guthrie/blood spot test performed? (1)

A

Within 5 days of birth

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7
Q

When is the newborn physical exam performed? (1)

A

Within 72 hours of birth

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8
Q

What malignancies are caused by exposure to unopposed oestrogen? (3)

A

Endometrial
Ovarian
Breast

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9
Q

Which HPV stains are associated with increased cervical cancer risk? (2)

A

16 and 18

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10
Q

What can be used to treat endometrial cancer? (3)

A

Surgery - hysterectomy +/- pelvic lymph nodes
Adjuvant radiotherapy
High dose progesterone

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11
Q

What is the treatment for the different stages of cervical cancer? (3)

A

Ia - Simple hysterectomy or cone biopsy to preserve fertility
Ib - Total hysterectomy, radiotherapy, chemotherapy
II-IV - Palliative chemotherapy

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12
Q

What is the treatment for CIN (cervical intraepithelial neoplasia? (1)

A

LLETZ - Large loop excision of the transformation zone

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13
Q

What histological type of cancer are the following?

1) Endometrial
2) Cervical
3) Ovarian
4) Vulval

A

1) Adenocarcinoma
2) Squamous cell carcinoma
3) Epithelial carcinoma
4) Squamous cell carcinoma

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14
Q

What cancer is the risk of malignancy index used for and how is it calculated? (4)
What is considered high risk? (1)

A

Ovarian cancer
CA125 x USS assessment x menopausal status
Score >200

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15
Q

What genetic predispositions are associated with ovarian cancer? (3)

A

HNPCC syndrome
BRCA1/BRCA2
Peutz-Jegers syndrome

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16
Q

What are ultrasound features that would differentiate between a likely benign versus malignant ovarian mass? (8)

A

Benign - Thin, uniform walls, smooth margins, anechoic, cystic
Malignant - Irregularly thickened septa, indistinct borders, variable echogenicity, variable density, central vascularisation, free fluid in pouch of Douglas

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17
Q

What time period is considered to be the puerperium? (1)

A

From delivery of the placenta to 6 weeks following the birth

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18
Q

What substances are in colostrum? (5)

A

Protein, vitamin A, NaCl, growth factors and antimicrobial factors

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19
Q

What substance is involved in the milk ejection reflex? (1)

A

Oxytocin

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20
Q

What are the four causes of postpartum haemorrhage? (4)

Which is the most common cause? (1)

A

Trauma
Tissue
Thrombin
Tone - most common

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21
Q

What are risk factors for reduced uterine tone following delivery? (3)

A

Prolonged labour
Polyhydramnios
Multiple pregnancy

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22
Q

When is a pregnant women at greatest risk of venous thromboembolism? (1)

A

Just after birth up to 6 weeks following the birth

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23
Q

How long are women with medium risk and high risk of VTE in pregnancy? (2)

A

Medium - from 28 weeks gestation until 10 days postpartum

High - Throughout pregnancy and up to 6 weeks postpartum

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24
Q

What scoring system is used to assess postpartum depression?

A

Edinburgh score

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25
Q

What is the management for postpartum haemorrhage? (4)

A

ABCDE assessment
Oxytocin
Bimanual compression
Blood transfusion

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26
Q

What hormone is responsible for pelvic girdle pain? (1)

A

Progesterone

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27
Q

What are the three phases of stage 1 of labour? Describe them (6)

A

Latent phase - Cervix shortens, effacement occurs and it dilates, irregular contractions.
Active labour - >4cm dilated, contractions are regular, frequent and progressive
Transition - Long, strong contractions with little gap in between, feeling of pressure. Contractions can stop.

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28
Q

What 3 things control the active stage of labour? (3)

A

Power of the uterus
Passage of the vaginal tract
Passenger (foetus)

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29
Q

What occurs in stage 2 of labour? (2)

A

Starts with full dilation with visible head and crowning

Baby is delivered

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30
Q

What occurs in stage 3 of labour? (1)

A

Delivery of placenta

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31
Q

What is the main method used to monitor foetal heart rate and what does it measure? (4)

A

Cardiotocography (CTG)

Baseline, variability and accelerations

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32
Q

What are risk factors for premature labour? (5)

A 
Previous preterm birth
Genital infection - Bacterial vaginosis, group B strep
Cervical weakness
Multiple pregnancy
Low socioeconomic status
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33
Q

At how many weeks and what substance in cervicovaginal fluid can predict increased risk of preterm labour? (2)

A 
Fetal fibronectin (fFN)
After 20 weeks
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34
Q

What is the management for preterm labour? (5)

A 
IM/Pessary Progesterone
Tocolytics - Magnesium sulphate 
Cerclage - for short cervix
Corticosteroids
Antibiotics - to treat GBS
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35
Q

When is breast screening offered to women? (1)

A

Every 3 years for women between 50 and 70

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36
Q

What does the breast lump triple assessment consist of? (3)

A

Physical examination
Mammography (If >40, otherwise use ultrasound)
Fine needle aspiration cytology

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37
Q

What plains are the breasts compressed between for mammogram? (2)

A

Craniocaudal and mediolateral oblique

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38
Q

What can be seen on imaging of ductal carcinoma in situ? (1)

A

Microcalcifications

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39
Q

What molacular marker differentiates luminal A and luminal B breast cancer? (2)

A

Ki67 - low in A, high in B

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40
Q

How is oestrogen receptor positive breast cancer treated? (3)

A

Endocrine therapy - if premenopausal - Tamoxifen
If postmenopausal - aromatase inhibitors (e.g.) Anastrozole). For 5 or more years.
Chemotherapy in luminal B

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41
Q

How is HER2 receptor positive breast cancer treated? (2)

A

With transtuzumab/Herceptin + chemotherapy

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42
Q

How is triple negative breast cancer treated? (3)

A

Chemotherapy
Bisphosphonates decrease rate of bone metastasis
Surgery - mastectomy, axillary clearance if sentinel node biopsy is positive

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43
Q

How is ductal carcinoma in situ treated? (2)

A

Lumpectomy and radiation therapy

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44
Q

When should early referral be considered for infertility? (2)

A

Maternal age >35

Known or suspected problem

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45
Q

What preconception advice is given in couples that are struggling to conceive? (7)

A 
Smoking cessation
BMI 19-30
Reduce alcohol intake
Rubella immunity (test and vaccination if needed)
Smear up to date
Folic acid supplements
Intercourse 2-3 times per week
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46
Q

What are the triad for signs for polycystic ovary syndrome? (3)
How many must be present for a diagnosis? (1)

A

Signs of hyperandrogenism
Oligo/anovulatory
Polycystic ovaries on ultrasound
2 must be present for diagnosis

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47
Q

What investigations are done in women in couples struggling to conceive? (4)

A

Ovulation - midluteal phase progesterone 7 days before end of cycle
Ovarian reserve - day 2 FSH, antral follicle count, antimullerian hormone levels

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48
Q

What test results are considered normal in semen analysis? (3)

A

Count > 15 million/ml
Motility > 40%
Morphology > 4%

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49
Q

What is the management for anovultatory infertility? (2)

A

Clomifene (antioestrogen) - for up to 6 months

Ovarian drilling

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50
Q

What can be used with clomifene to increases its effectiveness? (1)

A

Metformin

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51
Q

What are the risks of clomifene treatment? (2)

A

Increased risk of multiple pregnancy

Ovarian hyperstimulation syndrome

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52
Q

What is used to treat prolactinoma? (1)

A

Bromocriptine (dopamine agonist)

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53
Q

What investigations are done in suspected PCOS? (3)

A

Free androgen index - to measure testosterone
LH, FSH, TSH and prolactin to rule out differentials
TVUSS

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54
Q

What is the karyotype for a partial and complete hydatidiform mole? (2)

A

Partial - triploid

Total - diploid (most commonly 46XX)

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55
Q

What is the origin of the DNA in complete moles? (1)

A

Paternal

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56
Q

What are the clinical features of a molar pregnancy? (5)

A 
Large uterus for gestational age
Hyperthyroidism
Hyperemesis
Vaginal bleeding
Early pre-eclampsia
Elevated HCG
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57
Q

What is seen on ultrasound of a complete mole? (1)

A

Snowstorm appearance

58
Q

What is the malignant progression from a hydatidiform mole? (1)

A

Choriocarcinoma

59
Q

How is a molar pregnancy managed?

A

Removal by suction curettage
Histological diagnosis
Serial HCG levels

60
Q

What are risk factors for gestational hypertension? (4)

A 
Young
BME
Multiple pregnancy
Chronic hypertension
Renal disease
61
Q

What are red flag signs for risk of eclampsia? (2)

A

Hyper-reflexia, ankle clonus

62
Q

How is pre-eclampsia diagnosed? (2)

A

BP >140/90 6 hours apart

+2 protein on urine dipstick or protein creatinine ration >30%

63
Q

How are women with a history of pre-eclampsia treated in future pregnancies? (1)

A

Prophylactic low dose aspirin

64
Q

What are the features of HELLP syndrome? (3)

A

Haemolysis
ELevated liver enzymes
LP - Low platelets

65
Q

How is pre-eclampsia managed? (3)

A

> 150/100 - Labetalol
160/105 - Hydralazine and labetalol
Acute severe - Oral nifedipine

66
Q

How is eclampsia managed? (3)

A

Magnesium sulphate IV
Antihypertensives
Corticosteroids

67
Q

Name two key risk factors for stress incontinence (2)

A

Obesity

Old age

68
Q

What are the findings on urodynamics in stress incontinence? (1)

A

Normal

69
Q

What is the treatment for stress incontinence? (4)

A

Pelvic floor exercises
Ring pessary
SNRI - Duloxetine
Surgery - Sling procedure, tension free vaginal tape (TVT), cholposuspension

70
Q

What is the mechanism of urge incontinence? (2)

A

Involuntary contractions of the detrusor muscles due to detrusor instability or brain damage

71
Q

What lifestyle measures can improve the symptoms of urge incontinence? (4)

A

Reduce fluid intake
Reduce caffeine intake
Avoid irritant foods
Smoking cessation

72
Q

How is urge incontinence managed? (4)

A 
If vaginitis - estriol + cyclical progesterone
Pads
Toilet regimen
Anticholinergic drugs - Oxybutynin
Botox to the bladder neck
73
Q

What is the surgical management of vaginal prolapse? (1)

A

Sacrospinous fixation

74
Q

What range of days is considered a normal menstrual cycle? (1)

A

21-35 days

75
Q

What investigations can be done in mennorhagia? (3)

What is required if there is inter-menstrual bleeding? (1)

A

FBC
TVUS
Hysteroscopy

Endometrial biopsy

76
Q

What is the treatment for menorrhagia? (3)

A

1) Mirena coil
2) Tanexamic acid / Mefanamin acid. Or COCP
3) Fibroids >3cm - endometrial ablation or hysterectomy

77
Q

When should primary amenorrhoea be investigated?

A

14 year old with no secondary sexual characteristics

16 year old with secondary sexual characteristics

78
Q

What investigations can be done in secondary amenorrhoea?

A

FSH (can be elevated in early menopause)
LH
Testosterone (raised in PCOS)

79
Q

What is the likely cause of this bleeding in pregnancy? (1)
Intermittent, painless bleeding that is increasing in frequency. On abdominal examination, the foetus is in transverse position.
What should not be done and why, what should be done for diagnosis instead? (3)

A

Placenta previa

Vaginal examination - risk of causing bleeding
Ultrasound scan

80
Q

What is the management for a presentation of symptomatic placenta praevia before 34 weeks gestation? (1)

A

Admission

Corticosteroids

81
Q

What are risk factors for placental abruption? (5)

A

Intrauterine growth restriction, pre-eclampsia, chronic hypertension, maternal smoking, previous abruption

82
Q

What is a typical presentation for placental abruption? (4)

A

Woody hard uterus
Painful vaginal bleeding
Tachycardia
Foetal distress

83
Q

What investigations should be done in suspected placental abruption? (4)

A

CTG, FBC, coagulation screen and cross match

84
Q

How does vasa previa present? (3)

Name some risk factors (2)

A

Membrane rupture, painless bleeding, foetal bradycardia/death

Multiple pregnancy, IVF

85
Q

What are the symptoms of endometriosis? (4)

A

Dysmennorhoea before onset of menstruation
Deep dyspareunia
Subfertility
Pain on passing stool

86
Q

What are the signs of endometriosis? (3)

A

Lower abdominal tenderness
Thickening behind uterus
Retroverted, immobile uterus if advanced

87
Q

What procedure is diagnostic for endometriosis? (1)

A

Laparoscopy

88
Q

What are risk factors for fibroids? (4)

A

Menopausal
Afro-Caribbean
Family history
Nulliparous

89
Q

What pregnancy risks are fibroids associated with? (4)

A 
Premature labour
Malpresentation
Transverse lie
PPH
Obstructed labour
90
Q

Why can haemoglobin be high or low with uterine fibroids? (2)

A

Low - causes menorrhagia due to increased surface area

High - can secrete EPO

91
Q

What is the first line medical management for fibroids? (3)

A

Tranexamic acid (+ Mefanamic acid) or progestogens

92
Q

What is the secondary medical management for fibroids? (1)

A

GnRH agonists (e.g.) Lupron. Induce temporary menopausal state)

93
Q

What ovarian cysts are more common in younger, perimenopausal women? What cells do they originate from? (2)

A

Dermoid cysts - can progress to malignant teratomas
Originate from germ cells
Commonly bilateral

94
Q

What are complications of gestational diabetes? (4)

A 
Macrosomia - shoulder dystocia - Erb's palsy
Neural tube defects 
Cardiac defects
Preterm labour 
Intrauterine death
95
Q

What is damaged in Erb’s palsy? (1)

A

Brachial plexus

96
Q

What can be seen in Erb’s plasy as the child develops? (4)

A 
Anteriorly rotated shoulder
Atrophied muscle
Horner's syndrome
Shortened arm length
Waiter tip wrist deformity
97
Q

What is the management for gestational diabetes (1st, 2nd, 3rd, 4th)?

A

1) Diet control and blood glucose monitoring. Refer to dietician.
2) Metformin
3) Insulin
4) Glibenclamide

98
Q

What dose of folic acid is given to high risk groups? (1)

Who would be considered high risk? (3)

A

5mg daily

Gestational diabetes, on anti-epileptics, family history of neural tube defects, previous child with neural tube defect

99
Q

What is the daily folic acid dose for low risk pregnant women? (1)

A

400 micrograms

100
Q

Where is the most common location for an ectopic pregnancy? (1)
Where is the second most common? (1)

A

The ampulla of the fallopian tube

Isthmus

101
Q

What are the risk factors for ectopic pregnancy? (4)

A

PID/previous STIs, assisted contraception, previous pelvic surgery, smoking, history of ectopic

102
Q

What are the clinical signs of a ruptured ectopic? (5)

A 
Vaginal bleeding
Closed os
Uterus smaller than expected for gestational age
Shoulder tip pain
Syncope
Signs of haemodynamic instability
Hyperemesis
103
Q

What investigations can be done in suspected ectopic? (4)

A

Urine hCG - high
TVUS - absence of intrauterine pregnancy, free fluid in abdomen if ruptured
Quantitative hCG - if >1000 would expect to visualise a uterine pregnancy
Laparoscopy

104
Q

What type of miscarriage is this? (1)

There is heavy bleeding and the os is open but no foetal tissue has passed

A

Inevitable miscarriage

105
Q

What is the medical management for ectopic pregnancy? (2)

A

Single dose methotrexate and serial hCGs

106
Q

What is the surgical management for an ectopic pregnancy if there are concerns about the health and fertility of the other ovary? (1)

A

Salpingostomy

107
Q

What is the surgical management for an incomplete miscarriage? (1)

A

Evacuation of retained products of conception

108
Q

What is the medical management for a missed or incomplete miscarriage? (3)

A

Misoprostol
Ergometrine for bleeding
Anti-D if rhesus negative

109
Q

What drugs are used for medical termination of pregnancy? (2)

A

Oral Mifepristone

Vaginal Misoprostol

110
Q

Name some organic causes or erectile dysfunction (4)

A 
Spinal cord disease
Multiple sclerosis
Endocrine disease
Vascular disease
Hypertension or hypertensive drugs
111
Q

Name some psychological causes of erectile dysfunction (2)

A

Depression

Relationship problems

112
Q

What is the medical management for erectile dysfunction? (1)

A

PDE-5 inhibitor - Sildenfil

113
Q

What joint condition is associated with Chlamydia?

Which is associated with Gonorrhoea?

A

Reiter’s syndrome

Septic arthritis

114
Q

What investigations are done in suspected Chlamydia? (3)

A

NAAT (nucleic acid amplification test)
First void urine - male
Swab - female

115
Q

What is the management for Chlamydia? (1)

What is the management in pregnancy? (1)

A

Doxycycline

Azithromycin

116
Q

What is seen under a microscope in Gonorrhoea? (1)

A

Gram negative intracellular diplococci

117
Q

What is the management for Gonorrhoea? (2)

A

IM Ceftriaxone 1g

118
Q

What are the signs and symptoms of trichomoniasis? (4)

A

Green frothy discharge
Strawberry cervix
pH <4.5
Postcoital bleeding

119
Q

What is the management for trichomoniasis? (1)

A

Metronidazole

120
Q

What is a chancre? (2)

A

A painless solitary ulcer seen in primary syphilis

121
Q

What is the characteristic rash seen in secondary syphilis? (2)

A

Rough red spots seen on the soles of the feet and palms of the hand

122
Q

What investigation is done in suspected syphilis? (1)

A

Serology for cardiolipin antibody

123
Q

What is the management for syphilis? (1)

A

IM Benzypenicillin

124
Q

What is the treatment for thrush? (2)

A

Oral - Fluconazole

Topical - Clotrimazole

125
Q

What investigations are done for bacterial vaginosis? (3)

A

Whiff test with potassium hydroxide
pH > 4.5
Triple swab

126
Q

What is seen in microscopy in bacterial vaginosis? (1)

A

Clue cells

127
Q

What criteria is used to determine the safety of contraceptives in certain conditions? (1)

A

UKMEC guidelines

128
Q

What are contraindications for the combined oral contraceptive pill? (6)

A 
Smoking >15 cigarettes per day
BP > 160/100
Postpartum 0-6 weeks
Peripheral vascular disease 
Ischaemic heart disease
Atrial fibrillation
Antiphospholipid antibody positive
Migraine with aura
Current breast cancer
Major surgery with prolonged immobilisation
129
Q

What can be used to stimulate expulsion of the placenta? (2)

A

IM Syntocin

Breastfeeding

130
Q

When should insulin be commenced immediately in gestational diabetes? (1)

A

When fasting glucose in >7 mmol/l

131
Q

What is Mittelschmerz? (2)

A

Mid-cycle pelvic pain

There is often free fluid seen in the pouch of douglas

132
Q

Which method of HRT is associated with increased risk of VTE? (1)

A

Oral combined

133
Q

What test can be done to determine if there has been foeto-maternal haemorrhage? (1)

A

Kleihauer test

134
Q

At what point in pregnancy should the fundal height be at the umbilicus? (1)

A

20 weeks

135
Q

Which COCP is best for treating hirsutism in PCOS? (1)

A

Dianette (Co-cyprindiol)

136
Q

What genetic syndrome causes hypogonadotrophic hypogonadism? (1)
What sense is impaired in this syndrome? (1)

A

Kallmann syndrome

Smell

137
Q

What is the first line management for mild, moderate and severe PMS? (3)

A

Mild - lifestyle advice
Moderate - COCP
Severe - SSRIs (Fluoxetine)

138
Q

What alternative medication could be used for an epileptic woman treated on sodium valproate that wants to plan a pregnancy? (1)

A

Lamotrigine

Carbamazepine

139
Q

What is Sheehan’s syndrome and what are the symptoms? (4)

A

The pituitary gland is damaged by hypoxia due to excess blood loss in childbirth.
Symptoms vary depending on extent of damage and which hormone levels are reduced.
Commonly agalactorrhea, amenorrhoea, symptoms of secondary hypothyroidism, adrenal insufficiency

140
Q

How long into pregnancy should folic acid supplements be taken? (1)

A

12 weeks

Phase 3A (6 decks)

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