Obs and Gynae Flashcards
When is Hutchinson’s triad seen and what does it consist of? (4)
Congenital syphilis infection
Interstitial keratitis, teeth abnormalities, deafness
When is the combined test performed for trisomies? (1)
What does it involve and what results are expected if a trisomy is present? (6)
10-14 weeks
Nuchal translucency (Increased)
Serum PAPP-A (reduced)
Serum beta HCG (raised)
A woman presents and is 16 weeks pregnant, what test is performed to assess risk of trisomies? (4)
The quadruple test - alphafetoprotein, hCG, uE3 and inhibin A
At how many weeks is the test for structural abnormalities performed? (1)
18-21 weeks
When is the early pregnancy scan performed and what is its function? (4)
11-14 weeks
Assess gestational age, foetal demise, multiple pregnancies
Gross heart defects, anencephaly and increased nuchal translucency
When is the Guthrie/blood spot test performed? (1)
Within 5 days of birth
When is the newborn physical exam performed? (1)
Within 72 hours of birth
What malignancies are caused by exposure to unopposed oestrogen? (3)
Endometrial
Ovarian
Breast
Which HPV stains are associated with increased cervical cancer risk? (2)
16 and 18
What can be used to treat endometrial cancer? (3)
Surgery - hysterectomy +/- pelvic lymph nodes
Adjuvant radiotherapy
High dose progesterone
What is the treatment for the different stages of cervical cancer? (3)
Ia - Simple hysterectomy or cone biopsy to preserve fertility
Ib - Total hysterectomy, radiotherapy, chemotherapy
II-IV - Palliative chemotherapy
What is the treatment for CIN (cervical intraepithelial neoplasia? (1)
LLETZ - Large loop excision of the transformation zone
What histological type of cancer are the following?
1) Endometrial
2) Cervical
3) Ovarian
4) Vulval
1) Adenocarcinoma
2) Squamous cell carcinoma
3) Epithelial carcinoma
4) Squamous cell carcinoma
What cancer is the risk of malignancy index used for and how is it calculated? (4)
What is considered high risk? (1)
Ovarian cancer
CA125 x USS assessment x menopausal status
Score >200
What genetic predispositions are associated with ovarian cancer? (3)
HNPCC syndrome
BRCA1/BRCA2
Peutz-Jegers syndrome
What are ultrasound features that would differentiate between a likely benign versus malignant ovarian mass? (8)
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
What time period is considered to be the puerperium? (1)
From delivery of the placenta to 6 weeks following the birth
What substances are in colostrum? (5)
Protein, vitamin A, NaCl, growth factors and antimicrobial factors
What substance is involved in the milk ejection reflex? (1)
Oxytocin
What are the four causes of postpartum haemorrhage? (4)
Which is the most common cause? (1)
Trauma
Tissue
Thrombin
Tone - most common
What are risk factors for reduced uterine tone following delivery? (3)
Prolonged labour
Polyhydramnios
Multiple pregnancy
When is a pregnant women at greatest risk of venous thromboembolism? (1)
Just after birth up to 6 weeks following the birth
How long are women with medium risk and high risk of VTE in pregnancy? (2)
Medium - from 28 weeks gestation until 10 days postpartum
High - Throughout pregnancy and up to 6 weeks postpartum
What scoring system is used to assess postpartum depression?
Edinburgh score
What is the management for postpartum haemorrhage? (4)
ABCDE assessment
Oxytocin
Bimanual compression
Blood transfusion
What hormone is responsible for pelvic girdle pain? (1)
Progesterone
What are the three phases of stage 1 of labour? Describe them (6)
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.
What 3 things control the active stage of labour? (3)
Power of the uterus
Passage of the vaginal tract
Passenger (foetus)
What occurs in stage 2 of labour? (2)
Starts with full dilation with visible head and crowning
Baby is delivered
What occurs in stage 3 of labour? (1)
Delivery of placenta
What is the main method used to monitor foetal heart rate and what does it measure? (4)
Cardiotocography (CTG)
Baseline, variability and accelerations
What are risk factors for premature labour? (5)
Previous preterm birth Genital infection - Bacterial vaginosis, group B strep Cervical weakness Multiple pregnancy Low socioeconomic status
At how many weeks and what substance in cervicovaginal fluid can predict increased risk of preterm labour? (2)
Fetal fibronectin (fFN) After 20 weeks
What is the management for preterm labour? (5)
IM/Pessary Progesterone Tocolytics - Magnesium sulphate Cerclage - for short cervix Corticosteroids Antibiotics - to treat GBS
When is breast screening offered to women? (1)
Every 3 years for women between 50 and 70
What does the breast lump triple assessment consist of? (3)
Physical examination
Mammography (If >40, otherwise use ultrasound)
Fine needle aspiration cytology
What plains are the breasts compressed between for mammogram? (2)
Craniocaudal and mediolateral oblique
What can be seen on imaging of ductal carcinoma in situ? (1)
Microcalcifications
What molacular marker differentiates luminal A and luminal B breast cancer? (2)
Ki67 - low in A, high in B
How is oestrogen receptor positive breast cancer treated? (3)
Endocrine therapy - if premenopausal - Tamoxifen
If postmenopausal - aromatase inhibitors (e.g.) Anastrozole). For 5 or more years.
Chemotherapy in luminal B
How is HER2 receptor positive breast cancer treated? (2)
With transtuzumab/Herceptin + chemotherapy
How is triple negative breast cancer treated? (3)
Chemotherapy
Bisphosphonates decrease rate of bone metastasis
Surgery - mastectomy, axillary clearance if sentinel node biopsy is positive
How is ductal carcinoma in situ treated? (2)
Lumpectomy and radiation therapy
When should early referral be considered for infertility? (2)
Maternal age >35
Known or suspected problem
What preconception advice is given in couples that are struggling to conceive? (7)
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
What are the triad for signs for polycystic ovary syndrome? (3)
How many must be present for a diagnosis? (1)
Signs of hyperandrogenism
Oligo/anovulatory
Polycystic ovaries on ultrasound
2 must be present for diagnosis
What investigations are done in women in couples struggling to conceive? (4)
Ovulation - midluteal phase progesterone 7 days before end of cycle
Ovarian reserve - day 2 FSH, antral follicle count, antimullerian hormone levels
What test results are considered normal in semen analysis? (3)
Count > 15 million/ml
Motility > 40%
Morphology > 4%
What is the management for anovultatory infertility? (2)
Clomifene (antioestrogen) - for up to 6 months
Ovarian drilling
What can be used with clomifene to increases its effectiveness? (1)
Metformin
What are the risks of clomifene treatment? (2)
Increased risk of multiple pregnancy
Ovarian hyperstimulation syndrome
What is used to treat prolactinoma? (1)
Bromocriptine (dopamine agonist)
What investigations are done in suspected PCOS? (3)
Free androgen index - to measure testosterone
LH, FSH, TSH and prolactin to rule out differentials
TVUSS
What is the karyotype for a partial and complete hydatidiform mole? (2)
Partial - triploid
Total - diploid (most commonly 46XX)
What is the origin of the DNA in complete moles? (1)
Paternal
What are the clinical features of a molar pregnancy? (5)
Large uterus for gestational age Hyperthyroidism Hyperemesis Vaginal bleeding Early pre-eclampsia Elevated HCG
What is seen on ultrasound of a complete mole? (1)
Snowstorm appearance
What is the malignant progression from a hydatidiform mole? (1)
Choriocarcinoma
How is a molar pregnancy managed?
Removal by suction curettage
Histological diagnosis
Serial HCG levels
What are risk factors for gestational hypertension? (4)
Young BME Multiple pregnancy Chronic hypertension Renal disease
What are red flag signs for risk of eclampsia? (2)
Hyper-reflexia, ankle clonus
How is pre-eclampsia diagnosed? (2)
BP >140/90 6 hours apart
+2 protein on urine dipstick or protein creatinine ration >30%
How are women with a history of pre-eclampsia treated in future pregnancies? (1)
Prophylactic low dose aspirin
What are the features of HELLP syndrome? (3)
Haemolysis
ELevated liver enzymes
LP - Low platelets
How is pre-eclampsia managed? (3)
> 150/100 - Labetalol
160/105 - Hydralazine and labetalol
Acute severe - Oral nifedipine
How is eclampsia managed? (3)
Magnesium sulphate IV
Antihypertensives
Corticosteroids
Name two key risk factors for stress incontinence (2)
Obesity
Old age
What are the findings on urodynamics in stress incontinence? (1)
Normal
What is the treatment for stress incontinence? (4)
Pelvic floor exercises
Ring pessary
SNRI - Duloxetine
Surgery - Sling procedure, tension free vaginal tape (TVT), cholposuspension
What is the mechanism of urge incontinence? (2)
Involuntary contractions of the detrusor muscles due to detrusor instability or brain damage
What lifestyle measures can improve the symptoms of urge incontinence? (4)
Reduce fluid intake
Reduce caffeine intake
Avoid irritant foods
Smoking cessation
How is urge incontinence managed? (4)
If vaginitis - estriol + cyclical progesterone Pads Toilet regimen Anticholinergic drugs - Oxybutynin Botox to the bladder neck
What is the surgical management of vaginal prolapse? (1)
Sacrospinous fixation
What range of days is considered a normal menstrual cycle? (1)
21-35 days
What investigations can be done in mennorhagia? (3)
What is required if there is inter-menstrual bleeding? (1)
FBC
TVUS
Hysteroscopy
Endometrial biopsy
What is the treatment for menorrhagia? (3)
1) Mirena coil
2) Tanexamic acid / Mefanamin acid. Or COCP
3) Fibroids >3cm - endometrial ablation or hysterectomy
When should primary amenorrhoea be investigated?
14 year old with no secondary sexual characteristics
16 year old with secondary sexual characteristics
What investigations can be done in secondary amenorrhoea?
FSH (can be elevated in early menopause)
LH
Testosterone (raised in PCOS)
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)
Placenta previa
Vaginal examination - risk of causing bleeding
Ultrasound scan
What is the management for a presentation of symptomatic placenta praevia before 34 weeks gestation? (1)
Admission
Corticosteroids
What are risk factors for placental abruption? (5)
Intrauterine growth restriction, pre-eclampsia, chronic hypertension, maternal smoking, previous abruption
What is a typical presentation for placental abruption? (4)
Woody hard uterus
Painful vaginal bleeding
Tachycardia
Foetal distress
What investigations should be done in suspected placental abruption? (4)
CTG, FBC, coagulation screen and cross match
How does vasa previa present? (3)
Name some risk factors (2)
Membrane rupture, painless bleeding, foetal bradycardia/death
Multiple pregnancy, IVF
What are the symptoms of endometriosis? (4)
Dysmennorhoea before onset of menstruation
Deep dyspareunia
Subfertility
Pain on passing stool
What are the signs of endometriosis? (3)
Lower abdominal tenderness
Thickening behind uterus
Retroverted, immobile uterus if advanced
What procedure is diagnostic for endometriosis? (1)
Laparoscopy
What are risk factors for fibroids? (4)
Menopausal
Afro-Caribbean
Family history
Nulliparous
What pregnancy risks are fibroids associated with? (4)
Premature labour Malpresentation Transverse lie PPH Obstructed labour
Why can haemoglobin be high or low with uterine fibroids? (2)
Low - causes menorrhagia due to increased surface area
High - can secrete EPO
What is the first line medical management for fibroids? (3)
Tranexamic acid (+ Mefanamic acid) or progestogens
What is the secondary medical management for fibroids? (1)
GnRH agonists (e.g.) Lupron. Induce temporary menopausal state)
What ovarian cysts are more common in younger, perimenopausal women? What cells do they originate from? (2)
Dermoid cysts - can progress to malignant teratomas
Originate from germ cells
Commonly bilateral
What are complications of gestational diabetes? (4)
Macrosomia - shoulder dystocia - Erb's palsy Neural tube defects Cardiac defects Preterm labour Intrauterine death
What is damaged in Erb’s palsy? (1)
Brachial plexus
What can be seen in Erb’s plasy as the child develops? (4)
Anteriorly rotated shoulder Atrophied muscle Horner's syndrome Shortened arm length Waiter tip wrist deformity
What is the management for gestational diabetes (1st, 2nd, 3rd, 4th)?
1) Diet control and blood glucose monitoring. Refer to dietician.
2) Metformin
3) Insulin
4) Glibenclamide
What dose of folic acid is given to high risk groups? (1)
Who would be considered high risk? (3)
5mg daily
Gestational diabetes, on anti-epileptics, family history of neural tube defects, previous child with neural tube defect
What is the daily folic acid dose for low risk pregnant women? (1)
400 micrograms
Where is the most common location for an ectopic pregnancy? (1)
Where is the second most common? (1)
The ampulla of the fallopian tube
Isthmus
What are the risk factors for ectopic pregnancy? (4)
PID/previous STIs, assisted contraception, previous pelvic surgery, smoking, history of ectopic
What are the clinical signs of a ruptured ectopic? (5)
Vaginal bleeding Closed os Uterus smaller than expected for gestational age Shoulder tip pain Syncope Signs of haemodynamic instability Hyperemesis
What investigations can be done in suspected ectopic? (4)
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
What type of miscarriage is this? (1)
There is heavy bleeding and the os is open but no foetal tissue has passed
Inevitable miscarriage
What is the medical management for ectopic pregnancy? (2)
Single dose methotrexate and serial hCGs
What is the surgical management for an ectopic pregnancy if there are concerns about the health and fertility of the other ovary? (1)
Salpingostomy
What is the surgical management for an incomplete miscarriage? (1)
Evacuation of retained products of conception
What is the medical management for a missed or incomplete miscarriage? (3)
Misoprostol
Ergometrine for bleeding
Anti-D if rhesus negative
What drugs are used for medical termination of pregnancy? (2)
Oral Mifepristone
Vaginal Misoprostol
Name some organic causes or erectile dysfunction (4)
Spinal cord disease Multiple sclerosis Endocrine disease Vascular disease Hypertension or hypertensive drugs
Name some psychological causes of erectile dysfunction (2)
Depression
Relationship problems
What is the medical management for erectile dysfunction? (1)
PDE-5 inhibitor - Sildenfil
What joint condition is associated with Chlamydia?
Which is associated with Gonorrhoea?
Reiter’s syndrome
Septic arthritis
What investigations are done in suspected Chlamydia? (3)
NAAT (nucleic acid amplification test)
First void urine - male
Swab - female
What is the management for Chlamydia? (1)
What is the management in pregnancy? (1)
Doxycycline
Azithromycin
What is seen under a microscope in Gonorrhoea? (1)
Gram negative intracellular diplococci
What is the management for Gonorrhoea? (2)
IM Ceftriaxone 1g
What are the signs and symptoms of trichomoniasis? (4)
Green frothy discharge
Strawberry cervix
pH <4.5
Postcoital bleeding
What is the management for trichomoniasis? (1)
Metronidazole
What is a chancre? (2)
A painless solitary ulcer seen in primary syphilis
What is the characteristic rash seen in secondary syphilis? (2)
Rough red spots seen on the soles of the feet and palms of the hand
What investigation is done in suspected syphilis? (1)
Serology for cardiolipin antibody
What is the management for syphilis? (1)
IM Benzypenicillin
What is the treatment for thrush? (2)
Oral - Fluconazole
Topical - Clotrimazole
What investigations are done for bacterial vaginosis? (3)
Whiff test with potassium hydroxide
pH > 4.5
Triple swab
What is seen in microscopy in bacterial vaginosis? (1)
Clue cells
What criteria is used to determine the safety of contraceptives in certain conditions? (1)
UKMEC guidelines
What are contraindications for the combined oral contraceptive pill? (6)
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
What can be used to stimulate expulsion of the placenta? (2)
IM Syntocin
Breastfeeding
When should insulin be commenced immediately in gestational diabetes? (1)
When fasting glucose in >7 mmol/l
What is Mittelschmerz? (2)
Mid-cycle pelvic pain
There is often free fluid seen in the pouch of douglas
Which method of HRT is associated with increased risk of VTE? (1)
Oral combined
What test can be done to determine if there has been foeto-maternal haemorrhage? (1)
Kleihauer test
At what point in pregnancy should the fundal height be at the umbilicus? (1)
20 weeks
Which COCP is best for treating hirsutism in PCOS? (1)
Dianette (Co-cyprindiol)
What genetic syndrome causes hypogonadotrophic hypogonadism? (1)
What sense is impaired in this syndrome? (1)
Kallmann syndrome
Smell
What is the first line management for mild, moderate and severe PMS? (3)
Mild - lifestyle advice
Moderate - COCP
Severe - SSRIs (Fluoxetine)
What alternative medication could be used for an epileptic woman treated on sodium valproate that wants to plan a pregnancy? (1)
Lamotrigine
Carbamazepine
What is Sheehan’s syndrome and what are the symptoms? (4)
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
How long into pregnancy should folic acid supplements be taken? (1)
12 weeks
