Obs and gynae: revision session Flashcards
1
Q
APH definition
A
Bleeding from genital tract from 24 weeks to birth of baby
2
Q
Minor APH
A
<50mls and stopped
3
Q
Major APH
A
50-100mls
4
Q
Massive APH
A
100mls + signs of shock
5
Q
Causes of APH
A
Cervical ectropian Vaginal infection Bleeding from placental edge Placenta praevia Abruption
6
Q
Placenta praevia
A
When placenta is within 2.5cm of cervix
7
Q
Management of APH
A
ABCDE IV access Bloods, G and S IV fluids Blood transfusion Delivery of baby
8
Q
32 weeks, Post coital bleed
A
Cervical ectropian
Infection
9
Q
6 weeks, PV bleeding, saw something jelly like, now bleeding stopped
A
Miscarriage
10
Q
28 weeks, large volumes, woody hard uterus, drug missuse
A
Abruption
11
Q
Painless PV bleeding, previous children
A
Placenta praevia
12
Q
Menorrhagia
A
Regular, heavy menstrual bleeding. Excessive amount which interferes with quality of life.
13
Q
Ix of menorrhagia
A
Detailed history Bimanual examination Speculum Blood test TV USS
14
Q
Bulky uterus
A
Adenomyosis
Fibroids
15
Q
Menorrhagia
A
Fibroids
Endometriosis
Polyps
Endometrial hyperplasia
16
Q
Which maternal non gynae diseases can cause menorrhagia
A
Hypothryoidism Coagulation problems Diabetes Liver/ kidney disease Anticoagulant therapy Copper IUD
17
Q
Red flag symptoms for menorrhagia
A
Postcoital bleeding
IMB
Dyspareunia
Dysmenorrhoea
18
Q
PCB
A
Cervical cancer
19
Q
IMB
A
Cervical cancer or endometrial cancer
20
Q
Dyspareunia
A
Cervical cancer
21
Q
Irregular periods
A
PCOS
22
Q
Pelvic pain and pressure symptosm
A
Prolapse or cancer
23
Q
Vaginal discharge
A
PID
24
Q
Menorrhagia first line
A
Levonorgesterel IUS- Mirena coil
25
Menorrhagia second line
Tranexamic acid
NSAIDS
COCP
26
Mirena benefits
Progesterone very local long term, mainly causes amenorrhoea
27
Why is tranexamic acid bad
VTE risk (avoid if fat and VTE risk already)
28
COCP cant be given to
Anyone with clot risks (high BMI, FHx)
29
Menorrhagia surgeries
Endometrial ablation
Uterine artery embolisation
Hysterectomy
Myomectomy
30
21 year old student, 3 months menorrhagia
Infection?
New contraception?
PCOS
31
What contraceptions can cause heavy bleeding
Copper coil, implant
32
Treatments for menorrhagia in young
Mirena coil
COCP
POP
33
45 year old lady
Heavy IMB
BMI 50
Flooding
Endometrial cancer
Fibroids
Endometriosis
34
Adenomyosis
Over growth of muscle of uterus
35
Treatment for endometrial cancer, fibroids, endometriosis
Surgery- ablation, hysterectomy, myomectomy
36
Whats a myomectomy for
Fibroids
37
Investigation for 45year old heavy bleeder (at risk for endometrial cancer)
Pipelle biopsy
38
Why does obesity risk factor for cancers
Fat cells produce oestrogen
39
Who gets endometrial
Menopause
40
Who gets ovarian cancer
50+
41
Who gets vulval cancer
70+
42
PCB in a young person
Cervical cancer
43
What causes cervical cancer
High risk HPV
44
Cervical cancer risk factors
```
High risk HPV
early age intercourse
multiple sexual partners
STDs
Cigarette smoking
Multiparity
OCP uses
Previous cervical intraepithelia neoplasia
```
45
Precancer of cervical cancer
Cervical intraepithelial neoplasia
46
Who gets high risk HPV
16, 18, 31 and 33
47
What do smears check for
CIN 1, 2 and 3 not cancer
48
CIN treatment
Lettz
49
Stage 1 cervical cancer treatment
Radical trachylectomy
| Hysterectomy
50
Stage 2 cervical cancer treatment
Radiotherapy
Chemotherapy
Palliative care
51
Endometrial cancer red flag
Postmenopausal bleeding
52
Main risk factor for endometrial cancer
Unopposed oestrogen
53
Risk factors for endometrial cancer
```
Obesity
Diabetes
Nulliparity
Late menopause
Ovarian tumours
HRT
Pelvic irradiation
Tamoxifen
PCOS
```
54
Treatment for endometrial cancer
Hysterectomy and pelvic lymph nodes
+radiotherapy
+progesterone therapy
55
What is brachytherapy
Radiotherapy from the inside out
56
What causes ovarian cancer
Ovulation and gene mutation (BRCA1 and 2)
57
Factors affecting ovulation
Early menarche and late meopause= more
| Breast feeding and parity= less
58
Ovarian cancer presentation
50s, IBS symptoms
Urinary frequency
Bowel obstruction
59
What cells do ovarian cancers normally come from
Epithelial
60
Risk of ovarian cancer calculator
```
Risk of malignancy index
Symptoms and age
CA125
Ultrasound score
Menopausal score
```
61
Treatment for ovarian cancer
Hysterectomy or debulking
Chemo/ radio
Palliative care
62
Vulval cancer causes
HPV and lichen sclerosis
63
What is lichen sclerosis
Premalignant condition
Scaly white plaques on vulva
Older population
64
Symptoms of vulval cancer
```
Vulval itching
Non healing lesion
Vulval soreness
Persistent lump
Bleeding
Pain on passing urine
Past history of HPV or lichen sclerosis
```
65
Vulval cancer treatment
Surgery
Chemotherapy
Radiotherapy
66
Late pregnancy problems
```
Symphysis pubis dysfunction
IUGR
Gestational diabetes
Anaemia
Reduced fetal movements
Preeclampsia
```
67
Differential diagnosis in obstetrics
```
Can just get migraines, tension headache etc
UTI
MSK pains
Diarrhoea and vomitting
Appendicitis
```
68
28 year old lady, 24 weeks pregnant, abdo pain
```
Appendicitis
Abruption
Miscarriage
Braxton hicks
Symphysis pubis dysfunction
```
69
40 year old lady, 36 weeks pregnant
Preeclampsia
Migraine
Tension headache
Venous sinus thrombosis
70
Stroke in pregnant woman and why
Venous sinus thrombosis, hypercoagulable when pregnant
71
16 year old, 8 weeks with vomitting
Hyperemesis
| Molar pregnancy
72
Why do people get sick in hyperemesis and molar pregancy and twins
Beta hCG
73
Infertility definition
Inability to conceive after 2 years of regular unprotected sexual intercourse and in the absence of known reproductive pathology
74
Pretesticular male infertility causes
Chemotherapy, hyperprolactinaemia
75
How does hyperprolactinaemia cause low testosterone
Surpresses FSH
76
Testicular causes of male infertility
Kleinfelters, trauma, infection, radiation
77
Post testicular causes of male infertility
Obstruction, retrograde ejaculation, absence of vas deferens
78
Causes of no eggs
```
Tuners syndrome
Trauma
Toxins (chemo and radio)
Oophrectomy
Premature ovarian failure
```
79
Turners syndrome
45X
80
What does the embryo inplant as
Blastocyst
81
Anovulation causes
PCOS
| increased androgens can cause hirsuitism and acne, weight gain
82
Problems with implantation of blastocyst
Recurrent miscarriage
Antiphospholipid syndrome
Polyps, fibroids, Ashermans syndrome
83
What is ashermans syndrome
Adhesions within the uterus
84
Male factor infertility treatment
Sperm donation, stop steroids
85
General fertility tips
Stop smoking, lose weight, good sleep, regular sex, stress reduction
86
Anovulation treatment
Clomiphene, metformin, ovarian drilling
87
Ovarian reserve treatment
Donor egg
88
Tubal fertility treatment
Tubal cannulation
89
Unexplained infertility treatment
IVF
90
On which days are women most likely to conceive in a cycle
8-14 days (14 days from end)
91
What number day is the first day someone bleeds
day 1
92
Fetal complications of maternal smoking
Prematurity, respiratory disease, IUGR, cot death
93
Fetal complications of maternal alcohol
Neurological damage, facial deformities, fetal growth retardation, spontaneous miscarriage
94
What vitamin is in liver and vitamins and can cause foetal abnormalities
Vitamin A
95
Why shouldnt pregnant people take multivitamisn
Vitamin A
96
Foods to avoid in pregnancy
```
Soft cheese (listeria)
Raw eggs (salmonella)
Liver (vitamin A)
Shellfish (
Tuna (mercury)
Caffeine
Alcohol
```
97
Why should you avoid cat litter in pregnancy
Toxoplasmosis
98
What is the normal dose of folic acid
400mcg
99
5mg of folic acid for
Family history of neural tube defect
Diabetes
Previous neural tube defect
Obese
100
Which drugs should you avoid in pregnancy
Propanolol and NSAIDS (premature PDA closure)
Warfarin (foetal abnormalities)
Furosemide (renal development problems)
101
What drug is defo safe in preganncy
Paracetamol
102
Serum markers triple test for risk of downs syndrome
Alpha feto protein, beta HCG, Estriol
103
When is the best time to do an ultrasound scan, for nuccal translucency
11-14 weeks- 12 week scan
104
What do you look for on ultrasound scan for downs syndrome
Nuccal translucency
105
Most appropriate time for amniocentesis
15 weeks+
106
Risk of miscarriage in amniocentesis
1%
107
Whats the most appropriate time for chorionic villous sampling
from 11 weeks as placenta needs to be big enough
108
What is commonly seen on USS at 12 weeks
Anencephaly (no brain)
109
When can you see oligohydramnios
18+ weeks
110
What can confuse looking at nuccal translucency
Cystic hydroma on the neck
111
At every appointment what do you look at
```
Blood pressure
Urine
Symphysis fundal height
Fetal heart beat
(not fetal position)
```
112
Physiological changes in pregnancy
Fall in BP in early pregnancy
Increased maternal ventilation
Hypercoagulability
Increased GFR
113
What hormone causes N and V
Beta HCG
114
Which serum makers increase in preganncy
T3, T4, thyroid binding globulin
| AlkPhos
115
Which serum markers go down in pregnancy
Protein and albumin
116
Preeclampsia diagnosis
High blood pressure, protien in urine
| Epigastric pain, facial swelling, headache
117
Risk factors for preeclampsia
```
Diabetes
Hypertension
Renal disease
Molar pregnancy
High BMI
```
118
HELLP syndrome
High liver enzymes
High Us and Es
Low platelets
119
Management for preeclampsia
Labetalol
