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Anki 3a exports > Obs and Gynae anki 3 > Flashcards

Obs and Gynae anki 3 Flashcards

1
Q

What is stress incontinence?

A

Leaking small amounts when coughing/laughing

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2
Q

What is mixed incontinence?

A

Both urge and stress

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3
Q

What is overflow incontinence?

A

Due to bladder outlet obstruction
E.g. from prostate enlargement

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4
Q

When is cystometry not recommended?

A

In patients with clear histories and a clear cause of incontinence

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5
Q

When is a cystogram suggested as an investigation for urinary incontinence?

A

When a fistula is suspected

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6
Q

When should you be cautious in prescribing anticholinergics for urge incontinence?

A

In the elderly due to risk of falls

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7
Q

When is a vaginal vault prolapse most common?

A

After a hysterectomy

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8
Q

What is the surgical management for a uterine prolapse?

A

Hystrectomy, sacrohysteropexy

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9
Q

What is the surgical management of a rectocele?

A

Posterior colporrhaphy

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10
Q

When can’t LNG-IUS(levornegstrel intrauterine device) be used for treating uterine fibroids?

A

If there is distortion of the uterine cavity

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11
Q

What treatment/management should be used to shrink/remove fibroids?

A

GnRH agonists-> short term treatment to reduce size of fibroids
Surgical->myomectomty, ablation, uterine artery embolisation, hysterectomy

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12
Q

Why can’t GnRH agonists be used long term to treat fibroids?

A

Side effects such as menopausal symptoms (hot flushes, vaignal dryness) and loss of bone mineral density

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13
Q

Where do submucosal fibroids grow?

A

Just below the lining of the uterus (endometrium)

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14
Q

What is Meig’s syndrome?

A

Triad of:
Ovarian fibroma(benign ovarian tumour)
Pleural effusion
Ascites
Typically occurs in older women->remove tumour and other issues resolve

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15
Q

What should be considered in a patient presenting with recurrent ovarian cysts?

A

PCOS
Can’t be diagnosed just off cysts, needs 2 of:
Anovulation
Hyperandrogenism
Polycystic ovaries on US

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16
Q

What is the commonest type of ovarian cyst?

A

Follicular cysts

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17
Q

Whatg are the tumour markers for a germ cell tumour?

A

Lactate dehydrogenase(LDH)
Alpha-fetoprotein(α-FP)
Human chorionic gonadotropin(HCG)

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18
Q

What is taken into account with the risk of malignancy index for ovariance tumours?

A

Menopausal status
Ultrasound findings
CA125 level

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19
Q

What is ovarian torsion?

A

Ovary twists in relation to the surrounding connective tissue, fallopian tube and blood supply

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20
Q

When can ovarian torsion happen in normal ovaries in girls before menarche

A

When girls have longer infundibulopelvic ligaments that can twist more easily

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21
Q

What might be present upon examination of a patient with ovarian torsion?

A

Localised tenderness
Palpable mass in the pelvis-may be absent

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22
Q

What parts of the body does lichen sclerosus typically affect?

A

Gential and anal regions of the body

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23
Q

What is the most common type of cervical cancer?

A

Squamous cell carcinoma

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24
Q

What is the second most common type of cervical cancer?

A

Adeoncarcinoma

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25
Q

What is the most common casue of cervical cancer?

A

HPV-typically type 16 and 18

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26
Q

What is meant by dysplasia?

A

Premalignant changes

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27
Q

What is the grading system for the level of dysplasia in the cervix?

A

Cervical intraepithelial neoplasia(CIN)

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28
Q

What is the first thing smear tests looking for cervical cancer are tested for?

A

High risk HPV
If HPV is negative, cells aren’t examined further, returned to normalm screening programme

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29
Q

What might be seen in cervical cancer screening in women with the coil/IUD?

A

Actinomyces-like organisms-no treatment required unless symptomatic

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30
Q

What is pelvic exenteration?

A

Operation that involved removing ost or all of the pelvic organs including vagina cervix, uterus, fallopian tubes, ovaries bladder and rectum
Last resort for cervical cancer
Significant implications

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31
Q

What monoclonal antibody can be used to treat cervical cancer?

A

Bevacizumab(avastin) used in combination with other chemo to treat metastatic/recurrent cervical cancer

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32
Q

Which strains does the HPV vaccine Gardasil protect against?

A

Strains 6,11,16,18,31,33,45,52,58

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33
Q

What might you find on bimanual pelvic examination in a patient with endometrial cancer

A

Enlarged uterus(may be normal)

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34
Q

What is the most common type of endometrial cancer?

A

Adenocarcinoma

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35
Q

What stimulates the growth of endometrial cancer cells?

A

Oestrogen

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36
Q

Why is obesity a risk factor for endometrial cancer?

A

Adipose tissue is a source of oestrogen

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37
Q

Why are women with PCOS more at risk of endometrial cancer and how does this affect their treatment?

A

Less likely to ovulate and form a corpus luteum-> progesterone not produced-> endometrial lining has more exposure to unopposed oestrogen-> neoplasia/cancer
COCP, Mirena coil, cyclical progesterone-induce a withdrawal bleed

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38
Q

Why does ovarian cancer typically carry a poor prognosis?

A

Uusally diangosed late

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39
Q

What is the peak age of incidence of ovarian cancer?

A

60 years

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40
Q

What is the most common origin of ovarian cancer?

A

Epithelial origin-serous carcinomas

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41
Q

What is recognised as the site of origin of many ovarian cancers?

A

Distal end of the fallopian tubes

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42
Q

Where do epithelial ovarian cancers originate from?

A

Epithelium which lines the fimbria of the fallopian tubes or ovaries

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43
Q

Where do epithelial ovarian tumours typically spread to first?

A

Peritoneal cavity-> particularly bladder, paracolic gutters and diaphragm

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44
Q

Where do germ cell ovarian tumours typically originate from?

A

Germ cells in the embryonic gonad

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45
Q

Where do ovarian sex cord stromal tumours arise from?

A

Connective tissue

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46
Q

Which is more aggressive: sex cord stromal ovarian tumours or ovarian epithelial tumours?

A

Epithelial

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47
Q

Which genes are associated with developing ovarian cancer?

A

BRCA1&2

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48
Q

Why does late stage ovarian cancer cause ascites

A

Vascular growth factors causing increased vessel permeability

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49
Q

When should CA125 not be used?

A

For screening for ovarian cancer in asymptomatic women

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50
Q

What is the most common type of vulval cancer?

A

Squamous cell carcinoma

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51
Q

Which skin cancers can affect the vulva?

A

Squamous cell carcinoma-most common
Basal cell carcinoma
Melanomas

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52
Q

What proportion of patients with lichen sclerosus get vulval cancer?

A

About 5%

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53
Q

What is vulval intraepithelial neoplasia?

A

Premalignant condition affecting the squamous epithelium of the skin that can precede vulval cancer

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54
Q

What type of VIN is associated with HPV infection and younger women?

A

High grade squamous intraepithelial lesion

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55
Q

Which type of VIN is associated with lichen sclerosus?

A

Differentiated VIN

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56
Q

What might be seen on a pelvic exam of a patient with endometriosis?

A

Tender, nodular masses may be palpable on ovaries or ligaments surrounding the uterus
Reduced organ mobility
Visible vaginal endometriotic lesion

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57
Q

When do symptoms of adenomyosis tend to resolve?

A

After menopause

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58
Q

What might be found on examination of a patient with adenomyosis?

A

Enlarged and tender uterus
Feels more soft than a uterus containing fibroids

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59
Q

When is atrophic vaginitis most common?

A

After menopause

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60
Q

What is the difference between early and late miscarriages?

A

Early-most common: <13 weeks
Late: 13-24 weeks

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61
Q

What is the definitive way a miscarriage can be diagnosed?

A

Transvaginal US: fetal cardiac activity (from 5.5 weeks gestation)
Also fetal crown rump length(>7mm) and mean sac diameter
>25mm-failed pregnancy
<25mm: repeat scan in 10-14 days

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62
Q

What surgery would be performed in a miscarriage?

A

<12 weeks: manual vacuum aspiration
>12 weeks: evacuation of retained products of conception(ERPC)

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63
Q

What risks are associated with conservative management of msicarriage?

A

Allowing it to pass naturally
Risks: infection, hemorrhage

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64
Q

What risks are associated with surgical management of a miscarriage?

A

Infection
Uterine perforation
Haemorrhage

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65
Q

What would be seen on a transvaginal US in a threatened miscarriage?

A

Viable pregnancy

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66
Q

What would be seen on a transvaginal ultrasound of a patient with an inevitable miscarriage?

A

Internal cervical os open
Fetus viable or non-viable

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67
Q

What might be seen on a transvaginal US in a patient with a missed/delayed miscarriage?

A

No fetal heart pulsation where crown rump >7mm

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68
Q

What might be seen on an ultrasound of a patient who has had a complete miscarriage?

A

No POC in uterus
Endometrium <15mm diameter
Previous pregnancy proof

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69
Q

What might be found on examination of a patient with an ectopic pregnancy?

A

Bimanual exam: Cervical tenderness-Chandelier sign
Hameodynamic instability of ectopic ruptures, signs of peritonitis
Vaginal exam: Pouch of Douglas

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70
Q

When is IM methotrexate likely to be used as treatment for an ectopic pregnancy

A

Patients with:
Well controlled pain
B-HCG<1500iU
Unruptured and no visible heartbeat

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71
Q

What is the most common site for an ectopic pregnancy to occur?

A

Ampullary portion of fallopian tube

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72
Q

What is oligohydramnios?

A

Lower levels of amniotic fluid within the uterus

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73
Q

What results in low levels of amniotic fluid

A

Anything that decreases urine production, blocks urine outputs, or ruptures membranes

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74
Q

What is polyhydramnios?

A

Presence of too much amniotic fluid in the uterus

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75
Q

What is the first stage of labour?

A

Period that starts with regular uterine contractions and ends when cervix is fully dilated to 10cm

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76
Q

Which hormones are primarily indicated in the first stage of labour?

A

Prostaglandins and oxytocin

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77
Q

What is the second stage of labour?

A

Period from complete cervical dilation to delivery of the foetus

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78
Q

What is the third stage of labout?

A

Period beginning at the delivery of the foetus and ending with delivery of placenta and foetal membranes

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79
Q

What is pre-term labour?

A

Onset of regular uterine contractions and cervical changes occuring before 37 weeks gestation

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80
Q

What is preterm birth?

A

Delivery of baby >20wks but <37wks

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81
Q

What is the premature rupture of membranes?

A

Rupture of membranes at least one hour before onset of contractions

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82
Q

What is prolonged premature rupture of membranes?

A

Rupture of membranes >24 hours before onset of labour

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83
Q

What is pre-term premature rupture of the membranes?

A

Early rupture of the membranes <37 weeks gestation

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84
Q

What is menopause?

A

Permanent cessation of menstruation characterised by at lease 12 months of amenorrhoea in otherwise health women who aren’t using contraception

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85
Q

What is the underlying cause of menopause?

A

Ovarian failure resulting in oestrogen deficiency

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86
Q

What is perimenopause?

A

Period when symptoms of menopause begin, continues until 12 months after last menstrual period

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87
Q

What is the difference between premature ovarian insufficiency and menopause?

A

Premature ovarian insufficiency: <40 years

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88
Q

When should oestrogen only HRT be used vs oestrogen and progesterone?

A

Oestrogen only: for women with a hysterectomy
Otherwise use combined

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89
Q

What medication can be used as a non hormonal treatment for menopause

A

Clonidine
alpha 2 adrenergic receptor agonist

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90
Q

What is the normal duration of a menstrual cycle?

A

21-35 days

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91
Q

Which axis controls the menstrual cycle?

A

Hypothalamic-pituitary-gonadal axis

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92
Q

What is the role of FSH in menstruation?

A

Binds to granulosa cells to stimulate follicle growth, permit the conversion of androgens(from theca cells) to oestrogens and stimulate inhibin secretion

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93
Q

What is the role of LH in menstruation?

A

Acts on theca cells to stimulate production and secretion of androgens

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94
Q

What is the corpus luteum?

A

Tissue in the ovary that forms at the site of a ruptured follicle following ovulation.
Produces oestrogens, progesterone and inhibin to maintain conditions for fertilisation and implantation

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95
Q

What produces HCG?

A

synctiotrophoblast of embryo

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96
Q

When does menses occur?

A

Start of new menstrual cycle
Occurs in absence of fertilisation when corpus luteum has broken down and internal lining of uterus is shed

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97
Q

What is PCOS?

A

Condition characterised by hyperandrogenism, ovulation disorders and polycystic ovarian morphology

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98
Q

What might be seen on imaging in a patient with PCOS?

A

Transvag/Transabdo US
Increased ovarian volume and multiple cysts

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99
Q

What might be found on blood tests of patients with PCOS

A

increase in LH:FSH ratio
prolactin normal or mildly raised
testosterone normal or mildly raised
sex hormone-binding globulin normal/low

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100
Q

What is the most common cause of Asherman’s syndrome?

A

Post pregnancy related dilatation and curettage procedure e.g. retained products of conception

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101
Q

What is the prognosis of Asherman’s syndrome like?

A

Recurrence of adhesions post treatment is common

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102
Q

When do congenital malformations of the female genital tract typically present?

A

Often not until or after puberty

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103
Q

What is ovotesticular disorder of sex development?

A

‘True hermaphroditism’
Presence of both ovarian and testicula tissue in single patient
Many menstruate and some can become pregnant
Treatment: remove contradictory organs and reconstruct external genitalia corresponding to sex of rearing-can wait until person can decide gender

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104
Q

What symptoms might someone with endometrial polyps present with?

A

Asx
Abnormal uterine bleeding: menorrhagia, intermenstrual bleeding
Postmenopausal bleeding
Infertility or recurrent pregnancy loss

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105
Q

What is pelvic inflammatory disease(PID)?

A

Infeciton/inflammation of the pelvic organs including uterus, fallopian tubes, ovaries and peritoneum, usually due to ascending infection form endocervix from vagina

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106
Q

What is urolithiasis?

A

Urinary tract stones-> solid concretions or crystal aggregations formed in urinary system from substances present in urine

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107
Q

What is the circular body of the breast?

A

Large and most prominent part of the breast

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108
Q

What is the axillary tail of the breast?

A

Inferior lateral edge or pec major towards axillary fossa
Nipple at centre surrounded by areola

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109
Q

Where do veins in the breast drain into?

A

Axillary and internal thoracic veins

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110
Q

Where does the skin of the breast drain into?

A

Axillay, inferior deep cervical and infraclavicular nodes

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111
Q

Where does the nipple and areola of the breast drain into?

A

Drains to subareolar lymphatic plexus

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112
Q

Which hormones regulate the production and secretion of milk from the breast?

A

Prolactin
Oxytocin

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113
Q

Where do fibroadenomas originate from?

A

Originate from lobules

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114
Q

Where does breast cancer most commonly metastasise to?

A

Bones
Liver
Lungs
Brain

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115
Q

What is the most common subtype of breast cancer?

A

Invasive ductal carcinoma

116
Q

What is the difference between invasive and pre-invasive breast cancer?

A

Invassive: penetrated through the basement membrane

117
Q

What screening is in place for breast cancer?

A

Mammogram every 3 years for women aged 50-70yrs

118
Q

What is the criteria for a 2 week wait referral for breast cancer?

A

Unexplained breast lump in a woman >30yrs
>50 yrs with unilateral nipple changes: discharge, retraction etc
Consider if:
Skin changes suggestive of breast cancer
>30yrs with a lump in axilla

119
Q

What mammogram features might be seen in a patient with pre-invasive breast cancer?

A

Unifocal/widespread microcalcifications

120
Q

What mammogram features might be seen in a patient with invasive breast cancer?

A

Irregular spiculated mass
Clustered microcalcifications
Linear branching calcifications

121
Q

What surgical techniques might be used for a patient with breast cancer?

A

Tumour excision
Mastectomy
Breast reconstruction
Sentinel node biopsies during surgery/axillary node clearance if invasive

122
Q

When is radiotherapy used for breast cancer treatment?

A

Recommended after a wide local excision
Or after a mastectomy for those with >4 positive axillary nodes

123
Q

When might chemotherapy be used for breast cancer treatment?

A

Downstage a primary lesion or after surgery depending on stage of tumour, e.g. if axillary node disease

124
Q

Why is anastrazole used for post-menopausal women?

A

It’s an aromatose inhibitor
Sromatisation accounts for majority of oestrogen production in post menopausal women

125
Q

When is hormonal therapy offered to women?

A

If tumours are positive for hormone receptors
HER2 over expressing hormone receptor negative patients

126
Q

What is Paget’s disease of the nipple?

A

Rare condition characterised by the presence of cancer cells in the nipple
Often underlying DCIS/invasive breast cancer

127
Q

What is the role of oxytocin in labour?

A

Surge in levels at onset of labour will contract the uterus

128
Q

What is the role of prolactin in pregnancy

A

Starts the process of milk production in the mammary glands

129
Q

What is the role of oestrogen in labour

A

Surges at onset of labour to inhibit progesterone to prepare the smooth muscles for labour

130
Q

What is the role of prostaglandins in labour

A

Aid with cervical ripening

131
Q

What is the role of beta endorphins in labour?

A

Natural pain relief

132
Q

What is the role of adrenaline in labour?

A

Released when birth is imminent to give the woman energy for birth

133
Q

What is meant by dilation in pregnancy and how is this measured?

A

Diameter of opening of the cervix
Measured in cm through vaginal exam

134
Q

What is the most common pelvis type in females?

A

Gynaecoid

135
Q

When does ‘descent’ stage of labour happen?

A

Can be from 37 weeks gestation onwards
Might not happen until established labour

136
Q

What pain managment techniques might be used in labour

A

Non invasive:
Water immersion
Massage
TENS machine

Pharmacological:
Entonox(gas and air)
Paracetemol
Codeine
Diamorphine
Pethidine
Remifentanyl

137
Q

Whata re the disadvantages of using entotox?

A

Can cause nausea/light headedness
Effect wears off quickly

138
Q

What is the ventouse?

A

Instrument that attaches a cup to a fetal head via a vacuum

139
Q

What stage of labour should the decision for an operative vaginal delivery be based on?

A

2nd stage of labour

140
Q

What is the combined test?

A

Assesses chance of fetus having Down’s, Edward’s or Patau’s using maternal and fetal measurements

141
Q

When is the combined test done?

A

11-14 weeks-anomaly screen

142
Q

What things are measured in the combined test?

A

Maternal:
Age
Free B-HCG(high: downs, low: Edwards.pataus)
Pregnancy associated plasma protein A-PAPP-A(low in all 3)
Fetus via US:Nuchal translucency(high-Down’s)
Crown Rump length

143
Q

What is nuchal translucency?

A

Measure via US the thickness of the nuchal pad at the nape of the fetal neck

144
Q

What is the quadruple test?

A

Screens for Down’s syndrome

145
Q

When is the quadruple test offered?

A

14-20 weeks

146
Q

What weeks are in 1st trimester?

A

<13 weeks

147
Q

What weeks are in 2nd trimester?

A

14-27

148
Q

What weeks are in 3rd trimester?

A

28-40

149
Q

What things are check in the quadruple test?

A

Alpha fetoprotein(AFP)
hCG or free bhCG
Inhibin A
Unconjugated oestriol(uE3)

150
Q

Which is more accurate-the combined test or the quadruple test?

A

Combined
Quadruple has a lower detection rate and higher screen positive rate

151
Q

What is the cut off for combined/quadruple screening test?

A

> =1/150-higher risk

152
Q

What options are available for women who have been deemed higher risk of Down’s syndrome?

A

No further testing
Non-invasive prenatal testing(NIPT)
Prenatal diagnostic testing

153
Q

What is non-invasive prenatal testing(NIPT)?

A

Assess placental cell-free fetal DNA found in maternal blood and combines with mother’s probability of a trisomy to provide a likelihood ratio
Screening test only-positive result needs to be confirmed through invasive testing

154
Q

When is the anomaly scan offered?

A

18-20+6 weeks

155
Q

What is mastitis?

A

Inflammation of the breast tissue with/without infectoin associated with lactation

156
Q

What is puerperal mastitis?

A

Mastitis associated with lactation in postpartum women

157
Q

What organism is implicated in infective mastitis?

A

S.aureus

158
Q

What organism most commonly causes bacterial vaginosis?

A

Mc gardnerella vaginalis
Often polymicrobial

159
Q

What is the treaatment for bacterial vaginosis?

A

Oral/vaginal gel: metronidazole or clindamycin
Avoid douching, shampoos etc, recurrence is common

160
Q

What is vulvovaginal candidiasis?

A

‘Yeast infection/thrush’
Fungal infection of lower reproductive tract

161
Q

What should be done if treatement for vulvovaginal candidiasis fails?

A

Consider further ix
Assess risk factors-> diabetes control etc
Medication concordance
Specialist referral

162
Q

Why is vulvovaginal candidiasis more common in pregnancy?

A

Oestrogen->increased glycogen production-> promotes candida growth

163
Q

What organism causes chlamydia?

A

Chlamydia trachomatis
Obligate intracellular gram negative organism

164
Q

When would test of cure be done for chlamydia treatment?

A

Pregnant women
Poor compliance
Rectal infection
Persistent symptoms

165
Q

What is the incubation period of gonorrhoea

A

2-5 days

166
Q

What might be seen on microscopy in a patient with v

A

Gram negative diplococci
Polymorphonucelar leukocytes

167
Q

Which HPV strains are associated with cancer?

A

HPV 16/18-cervical cancer

168
Q

What is the best treatment for genital warts in pregnancy?

A

Physical ablation

169
Q

What should be monitored in patients with HIV?

A

CD4 count
HIV viral load
FBC
E&Es
Urinalysis
AST, ALT, bilirubin

170
Q

What is PEP?

A

Post exposure prophylaxis
Given within 72 hours, lasts for 1 month

171
Q

What medications are used in PEP?

A

Truvada(1 tablet daily) + raltegravir(1 tablet BD)

172
Q

What would be seen on transvagianl US in a threatened miscarriage?

A

Viable pregnancy

173
Q

What is the treatment for a threatened miscarriage?

A

Reassurance
If heavy: admit and observe
If >12 weeks + rhesus negative: Anti D

174
Q

What is the role of misoprostol in miscarriage management?

A

Vaginal misoprostol->stimulate cervical ripening and myometrial contractions

175
Q

What should be done if the cause of polyhydramnios is idiopathic?

A

Baby’s 1st feed needs to be examined
NG tube to check for fistula/atresia

176
Q

Why is there a higher risk of postpartum haemorrhage in patient with polyhydramnios?

A

Uterus has to contract more to achieve haemostasis

177
Q

What is the difference between post-term pregnancy and post dates pregnancy?

A

Post term: past 42 weeks
Post dates: pregnancy past estimated delivery date(EDD) or due date(40 weeks gestation)

178
Q

What should be considered as a differential for prolonged pregnancy?

A

Consider inaccurate dating
Incidence of this has decreased now due to 11-14 week scans

179
Q

What is the main complication of a prolonged pregnancy?

A

Stillbirth

180
Q

What is placenta praevia?

A

Placenta lying over the cervical os

181
Q

Why is it important to identify placenta praevia early?

A

Important cause of antepartum haemorrhage-> vaginal bleeding from 24 weeks gestation

182
Q

What is placental abruption?

A

Part of all of the placenta separates from the uterus prematurely

183
Q

What might be found on exam of a patient with placental abruption?

A

‘woody’ uterus
Tense all the time and painful on palpation

184
Q

What is meant by ‘breech’ presentation?

A

Baby present bottom down

185
Q

When is a vaginal breech brith contraindicated?

A

Footling breech due to risk of head trapping

186
Q

What is the difference between ‘lie’, ‘presentation’ and ‘position’ with regards to fetal position?

A

Fetal lie: relationship between long axis of fetus and mother
Presentation: fetal part that first enter the mother’s pelvis
Position: fetal head position as it enters the birth canal

187
Q

What is pre-eclampsia?

A

Placental condition affecting women from 20 weeks gestation characterised by hypertension and proteinuria

188
Q

What is the criteria for pre-eclampsia?

A

Criteria:
Htn(>140/90) on 2 occasions at least 4 hours apart
Significant proteinuria >300mg protein in 24 hr sample or >30mg/mmol urinary protein: creatinine ratio
Women >20 wks gestation

189
Q

What should be given for magnesium sulfate toxicity

A

Calcium gluconate

190
Q

What is the target MAP in a patient on treatment for eclampsia?

A

<120mmHg

191
Q

What is trichomoniasis?

A

STI caused by flagellated protozoan parasite: trichomonas vaginalis
Primarily infects the urogenital tract

192
Q

What kind of organism is trichomonas vaginalis?

A

Highly motile, flagellates protozoan parasite

193
Q

What is the incubation period of trichomoniasis

A

7 days

194
Q

What is lymphogranuloma venereum?

A

STI caused by L1, L2 or L3 serovars of chlamydia trachomatis

195
Q

What is the treatment for bacterial balanitis?

A

Oral flucloxacillin
Clarithromycin in penicillin allergy

196
Q

What is syphilis?

A

STI caused by the spircohete bacterium treponema pallidum

197
Q

What is the incubation period of syphilis?

A

9-90 days

198
Q

What tests can be used to diagnose syphilis?

A

Dark field microscopy: shouldn’t be used for oral lesions
PCR: oral lesions
Serological testing-main-used for screening, diagnosis confirmation and treatment monitoring
Serology usually done using a combination of treponemal and non-treponemal tests

199
Q

What is the treatment for breast cysts?

A

If large/painful: might need draining
Usually no treatment

200
Q

What is mammaary duct ectasia?

A

Dilatation of the large breast ducts

201
Q

When is mammary duct ectasia most common?

A

Most common around the menopause

202
Q

What might mammography look like in a patient with mammary duct ectasia?

A

Potentially similar to cancer

203
Q

When does HELLP syndorme usually manifest?

A

3rd trimester

204
Q

What is the main risk of a cord prolapse?

A

Acute risk ro umbilical blood supply to infant

205
Q

What is vasa praevia?

A

Fetal vessels unprotected by umbilical cord or placental tissue run dangerously close to or across the internal cervical os

206
Q

What od fetal vessels lack the protection of?

A

Wharton’s jelly

207
Q

What is velamentous insertion?

A

Umbilical cord inserts into the chorioamniotic membranes instead of centrally into placental mass

208
Q

What is puerperal psychosis?

A

Severe psych disorder that typicallly develops within the first 2 weeks following childbirth

209
Q

What is the main risk of peurperal psychosis

A

Self harm/suicide
Harm to baby

210
Q

What is postpartum depression?

A

Significant mood disorder that can develop any time up to one year after the birth of a baby

211
Q

Which antidepressants are safe for use in breastfeeding?

A

SSRIs: sertraline and paroxetine

212
Q

What needs to be balanced when deciding delivery time in a patient with PPROM?

A

Increased risk of maternal chorioamnionitis
Decreased risk of respiratory distress syndrome

213
Q

What is postpartum haemorrhage?

A

Loss of >=500ml blood within the first 24 hours of a vaginal delivery

214
Q

What is the difference between primary and secondary postpartum haemorrhage?

A

Primary: within 24 hours
Secondary: 24hours-12 weeks

215
Q

What usually causes secondary postpartum haemorrhage?

A

Retained placental tissue or endometritis

216
Q

What is the Kleihauer test?

A

Determines proportion of fetal RBCs present-used in rhesus negative pregnancies

217
Q

What tests are used in rhesus negative pregnancies?

A

All babies born to rheesus negative mother will have cord blood taken for FBC, blood group and direct Coombs test
Coombs test: direct antiglobulin, will demonstrate antibodies on RBCs of baby
Kelihauer test: add acid to maternal blood, fetal cells are resistant

218
Q

What is the current law surrounding abortion in the UK?

A

1967 abortion act
Abortion up to 24 weeks in most cases

219
Q

What kind of medication is mifepristone and how does it work?

A

Progesterone antagonist
Blocks progesterone required for continuation of pregnancy

220
Q

What kind of medication is misoprostol and how does it work?

A

Prostaglandin analogue
Stimulates uterine myometrium contractions resulting in expulsion of uterine contents

221
Q

Where can medical termination of pregnancy occur?

A

Early: 0-9 weeks:: at home
9-24weeks: clinic

222
Q

What might be required for later pregnancies undergoing medical termination of pregnancies?

A

> =22 weeks
Feticide(intracardiac KCl injection)-stops fetal heart before abortion

223
Q

What options are there for surgical termination of pregnancy?

A

Suction termination
Dilatation and evacuation/curettage
Cervical priming with misoprostol +/- mifepristone
Women generally offered local anaesthesia alone, conscious sedation with local anaethetics, deep sedation or general anaesthetic

224
Q

When are women considered high risk for developing neural tube defects?

A

Either partner has a neural tube defect, previous pregnancy affected by NTD, or fhx
Women is taking antieepileptic drugs, has coeliac disease, diabetes or thalassaemia trait
Woman is obese: BM>=30kg/m2

225
Q

What screening is done for gestational diabetes?

A

Oral glucose tolerance test: OGTT
If previous gestational diabetes: OGTT asap after booking and at 24-28 weeks if first test normal
Any other risk factors: OGTT at 24-28 weeks

226
Q

Whata re the features of pre-existing hypertension in pregnancy?

A

History of htn before pregnancy or elevated BP before 20 weeks gestation
No proteinuria or oedema
Mc in older women
3-5% of pregnancies

227
Q

What organism causes Group B strep infection?

A

Bacterium streptococcus agalactiae

228
Q

What is obesity during pregnancy defined as?

A

BMI>30kg/m2 at first booking visit

229
Q

What is the main consequence of cephalopelvic disproportion?

A

Obstructed labour-? dystocia etc

230
Q

What is the most common cause of cephalopelvic disproportion?

A

Contracted pelvis with an average sized infant

231
Q

What is prolonged labour?

A

AKA dystocia
Slow cervical dilation and/or descent of fetus, typically beyond expected time frame of 20 hrs for primigravida and 14 hrs for multigravida women

232
Q

What is obstetric cholestasis?

A

AKA intra-hepatic cholestasis of pregnancy
Impaired bile flow-> accumulation of bile acids, typically manifests after 24 weeks

233
Q

What is the main risk assoociated with obstetric cholestasis?

A

Risk of spontaneous intrauterine death

234
Q

What is shoulder dystocia?

A

Type of obstructed labour where following delivery of fetal head the anterior shoulder becomes impacted behind maternal pubic symphysis
Complication of vaginal cephalic delivery

235
Q

What is the McRoberts manoeuvre?

A

Hyperflexion and abduction of mother’s legs tightly into abdoment
Applied suprapubic pressure
Routine traction in axial direction to assess if shoulders have been delivered

236
Q

What is symphysiotomy?

A

Division of maternal symphysial ligament

237
Q

What is the Zavanelli manoeuvre?

A

Replacement of head into canal and subsequent delivery via C section

238
Q

What monitoring should be done following the delivery of a baby with shoulder dystocia?

A

Mother: examined for PPH, severe perineal tears and genital tract trauma
Baby: examined by neonatologist for injury including brachial plexus injury, hypoxic brain injury, humeral/clavicle fractures

239
Q

Why are pregnant women predisposed to anaemia?

A

During pregnancy: both plasma volume and RBC mass increase
Plasma volume increases disproportionately ->haemodilution effect

240
Q

What screening is done for anaemia in pregnancy?

A

All screened at booking and at 28 weeks
Mutiple pregnancy: extra screening at 20-28 weeks

241
Q

What is treatment for micro/normo-cytic anaemia in pregnancy?

A

Mc: iron deficiency anaemia
Trial of oral iron(100-200mg)-repeat FBC after 2 weeks of treatment
Parental iron infusion considered if poor complicance or evidence of malabsorption

242
Q

What is the treatment for beta thalassaemia in pregnancy?

A

Folate supplementation and blood transfusions as requiredAim for Hb of 80g/L during pregnancy and 100g/L at delivery

243
Q

What is the treatment for sickle cell disease in pregnancy?

A

Folate supplementation and irone supplementation if lab evidence of iron deficiency

244
Q

What is the incubation period and infectivity period of rubella?

A

Incubation period: 14-21 days
Infectious from 7 days before symptoms appear to 4 days after onset of rash

245
Q

What signs/sympotms might newborn with congenital rubella syndrome have?

A

Sensorineural deafness
Cataracts or retinopathy
Congenital heart disease

Also:
Organ dysfunction
Microcephaly
Micrognathia
Haematological abnormalities
Low birth weight
Developmental delay and learning disability later in life
Characteristic petechial rash described as a ‘blueberry muffin’ rash
Cerebral palsy’
Salt and pepper’ chorioretinitis

246
Q

Why is it important to check parvovirus B19 serology in patients who might have congenital rubella syndrome?

A

Difficult to distinguish rubella from parvovirus B19 clinically
Parvovirus B19-30% risk of transplacental infection with a 5-10% risk of fetal loss

247
Q

When should MMR vaccines not be givenn?

A

Women known to be pregnant or attempting to be pregnancy

248
Q

When is an amniotic fluid embolism most likely to occur?

A

During or shortly after labour

249
Q

When is hyperemesis gravidarum most common?

A

Between 8-12 weeks

250
Q

When should hospital admission be considered in patients with hyperemesis gravidarum?

A

Continued n+v and unable to keep down liquids/oral antiemetics
Continued n+v +ketonuria +/- weight loss despite treatment of oral antiemetics
Confirmed/suspected comorbidity(e.g. unable to tolerate abx for UTI)

251
Q

What risks are associated with metoclopramide use in pregnancy?

A

Can cause extrapyramidal side effects: don’t use for >5 days

252
Q

When does acute fatty liver of pregnancy most commonly develop?

A

Sx almost always ddevelop in 3rd trimester

253
Q

When might liver transplantation be considered for acute fatty liver of pregnancy

A

Heaptic rupture
Acute liver failure
Post birth

254
Q

What thromboprophylaxis might be used in pregnancy?

A

LMWH

255
Q

What VTE prophylaxis might be used in pregnancy?

A

LMWH

256
Q

What is obstructed labour?

A

Failure of fetus to descend through the birth canal due to a barrier blocking its descent despite strong uterine contractions
Usually occurs at pelvic brim

257
Q

What is ovarian hyperstimulation syndrome?

A

Complication arising from iatrogenic induction of ovulation, characterised by an exaggerated response to hormonal therapies used in procedures like IVF

258
Q

What is the risk to the mother of exposure to VZV in pregnancy?

A

5 times greater risk of pneumonitis

259
Q

What is placental insufficiency?

A

Oxygen and nutrients aren’t sufficiently transferred to the fetus via the placenta during pregnancy

260
Q

When should a VTE assessment be completed in a pregnant woman?

A

At booking and on any subsequent hospital admission

261
Q

What treatments/prophylaxis for VTE should be avoided in pregnancy?

A

DOACs
Warfarin

262
Q

What kind of twin is more at risk of complications and needs to be monitored more closely?

A

Monozygotic

263
Q

Why is the rate of dizygotic twins increasing?

A

Infertility treatment

264
Q

What is twin-to-twin transfusion syndrome?

A

Severe condition that can occur in 10-15% of twins sharing a placenta(monochorionic twins)

265
Q

What signs and symptoms might be exhibited in twin-to-twin transfusion syndrome

A

Heart failure in both twins
Fetal hydrops
Donor twin: high output cardiac failure: severe anaemia
Recipient twin: fluid overload due to excess blood volume

266
Q

What is the most common puerperal infection and why?

A

Endometritis
Lining of uterus undergoes trauma and tears during the birthing process

267
Q

Whata re the most common causes of puerperal infection?

A

S.pyogenes
S.auureus
E.coli

268
Q

What is primary amenorrhoea?

A

Never had a period
13+ no primary sex development
15+ no secondary sex development

269
Q

What is seconday amenorrhoea?

A

6 months without a period in normal cycle

270
Q

Whhat is an imperforated hymen?

A

Hymen blocks the passage of the vagina preventing menstrual blood and discharge

271
Q

What is Sheehan’s syndrome?

A

Postpartum hypopituitarism causing necrosis of pituitary secondary to hypovolaemic shock

272
Q

When is serum progesterone measured?

A

7 days before the end of the menstrual cycle(usually day 21)

273
Q

What medications might be used for treating fertility?

A

Clomiphene
FSH and LH injections
GnRH or DA agonists

274
Q

What surgical options are there for treating infertility?

A

Assisted reproductive technology including IVF or intracytoplasmic sperm injection
Treat underlying cause: e.g. fibroids, endo etc

275
Q

Which location of an ectopic pregnancy would increase the risk of rupture?

A

Isthmus

276
Q

Name some risk factors for placenta accreta

A

Previous C-section
Placenta praevia
Previous termination of pregnancy
D&C
Advanced maternal age
Uterine structural defects

277
Q

What are the different types of placenta accreta?

A

Placenta accreta
Placenta increta
Placenta percreta

278
Q

How is placenta accreta diagnosed?

A

Doppler USS
MRI
Can be hard to diagnose antenatally

279
Q

Name some complications of placenta accreta

A

Increased risk of severe postpartum bleeding
Preterm delivery
Uterine rupture

280
Q

How is placenta accreta managed?

A

Elective C section and hysterectomy
If fertility key: attempt placental resection

281
Q

What is placenta accreta?

A

Spectrum of abnormalities of placental implantation into the myometrium of the uterine wall due to a defective decidua basalis

282
Q

What is the placenta accreta type of the spectrum?

A

Chorionic villi attach into myometrium rather than being restricted within the decidua basalis(doesn’t penetrate through the thickness of the muscle)

283
Q

What is placenta increta?

A

Chorionic villi invade into but not through the myometrium

284
Q

What is placenta percreta?

A

Chorionic villi invade through the perimetrium(through full thickness of myometrium to the serosa)
Increased risk of uterine rupture and in severe cases may attach to other organs like bladder/rectum

285
Q
A

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