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3a self > Obs and gynae - stuff to learn pre exam > Flashcards

Obs and gynae - stuff to learn pre exam Flashcards

1
Q

What is hCG secreted by?

A

Secreted by – trophoblastic cells of the blastocyst
Prevents corpus luteum degenerating before placenta is formed

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2
Q

VArying degrees if morbid adherence of the placenta?

A

Placenta accreta – placenta invades into the superficial myometrium

Placenta increta - invades into the deeper myometrium

Placenta percreta – invades through myometrium, into nearby organs of the abdomen (bladder, bowel)

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3
Q

What is the only antibody that can cross the placenta?

A

IgG - role in rhesus disease of the newborn

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4
Q

When do you give anti-D prohphylaxis?

A

28 - 34 weeks and then after birth

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5
Q

What are some tocolytic drugs?

A

Cause myometrium to become hyperpolarised:
B2 agonists – salbutamol and ritodrine
CCB - nifedipine
These are known as TOCOLYTIC DRUGS (stop labor)

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6
Q

How do you induce labour?

A

Firstly – membrane sweep is done before medication to try and encourage labour to start on its own (promotes positive feedback of stretch  oxytocin release)

Prostaglandin PGE2 – pessary or vaginal gel
Oxytocin – the analogue given is syntocinon

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7
Q

Which drugs are given to prevent/stop post-partum bleeding?

A

Oxytocin

Ergometrine

Combined form – syntometrine

Helps the placenta be delivered after the baby comes out
Then makes the uterus contract to stop bleeding

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8
Q

What is the first stage of labour?

A

FIRST STAGE (preparation phase):
Latent phase - painful, irregular contractions, cervical effacement and dilation to 4cm
Active phase – >4cm, regular contractions, majority of dilatation happens in this phase

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9
Q

What is the second stage of labour?

A

SECOND STAGE (pushing stage):
Passive stage – complete diltation but no pushing
Active stage – maternal pushing until delivery

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10
Q

What are the 3 main causes of failure to progress in labour?

A
  1. Power: Poor uterine contractions
  2. Passenger: Malpresentation
  3. Passage: Pelvis not wide enough
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11
Q

What is the most common type of breech presentation?

A

Extended breech - bottom first

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12
Q

What is the correct positioning of a baby’s head when presenting?

A

Occipito anterior

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13
Q

What spinal level do you give an epidural at

A

L3-L4 usually bupivacaine

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14
Q

What three conditions do you screen for in the foetal anomaly screening programme?

A

Down’s syndrome – trisomy 21

Edward’s syndrome – trisomy 18

Patau’s syndrome – trisomy 13

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15
Q

When should the booking visit be?

A

8-12 weeks

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16
Q

Anomaly scan dates

A

18-20+6

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17
Q

What are the 3 infectious diseases should be screened for in pregnant women?

A

HIV

Hepatitis B

Syphillis

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18
Q

What diseases as newborns screened for on the blood spot programme?

A

Sickle cell disease (and thallassamia)
Congenital hypothyroidism
Cystic fibrosis
And 6 inborn errors of metabolism:
Maple syrup urine disease
Phenylketonuria
Homocysteinuria
3 more that I will never remember

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19
Q

When is the NIPE check done and what does it screen for?

A

First = within 72 hours of birth
Second = by GP at 6-8 weeks

Screens for problems with:
Hips – DDH
Reflexes
Eyes – absent red reflex, congenital cataracts
Heart
Mouth and palate
Undescended testes/checks of the genitals

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20
Q

What is the difference between early and late decelerations on a CTG?

A

Early – most likely due to uterine contractions - head compression due to uterine contractions

Late – whilst the uterus is relaxing, sign of distress of the baby

Variable deceleration - cord compression

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21
Q

Normal CTG values

A

Baseline HR - 110-160bpm

Variability - >5bpm

Accelerations present

No decelerations present

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22
Q

What is APH?

A

Genital tract bleeding from 24 weeks

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23
Q

Abruption vs praevia?

A

abruption is painful with relatively little PV bleeding
Placenta praevia is heavy bleeding that is painless -> if 2cm away from os normal vaginal delivery otherwise prepare for C-section at 37-38 weeks

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24
Q

What is vasa praevia?

A

PV bleeding with signs of foetal distress

The major foetal vessels are presenting before the foetus

These vessels are exposed meaning they are prone to rupture which can be potentially fatal for the foetus

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25
Q

Causes of primary pph?

A

The 4 T’s:

Tone – uterine atony - most common - unpalpable uterus

Tissue – retained products (i.e. placenta)

Trauma – i.e. a big tear in the genital tract

Thrombin – clotting disorder

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26
Q

Management of uterine atony?

A

Mechanical -> medical -> surgical
Emptying bladder can help
Rub the abdomen to help the uterus contract
Bimanual compression of the uterine

IV Syntocinon(combination of ergometrine and oxycotin to help the uterus contract)
IM Carboprost
Surgical options also available (B-lynch sutures, internal iliac artery ligation)

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27
Q

Managing a PPH

A

Medications to stop the bleeding – ergometrine, oxytocin, syntometrine (combination of ergo and oxy) - these cause the uterus to contract which should stop the bleeding
IM Carboprost if this doesn’t work

If mild/moderate – IV fluids, oxygen, blood products, try and find and prevent the source of bleeding

If severe (>1500mls) – medical emergency – call 2222

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28
Q

What is the sepsis 6?

A

Blood cultures
IV fluids
Monitor hourly urine output – catheterise
Broad spectrum IV antibiotics
ABG – lactate
High flow oxygen

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29
Q

What is HELLP syndrome?

A

H – haemolysis
E L– elevated liver enzymes (ALT and AST)
L P – low platelets

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30
Q

What prophylactic treatment should you give in subsequent pregnancies for someone with a history of pre-eclampsia?

A

Aspirin 75mg

From 10 – 36 weeks’ gestation

(the spiral arteries form around 12 weeks so aspirin is thought to help them develop properly)

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31
Q

What is the puerperium?

A

From delivery of the placenta to 6 weeks following birth

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32
Q

What antibodies would you be looking for in anti-phospholipid syndrome?

A

Lupus anticoagulant antibodies

Anti-cardiolipin antibodies

Phospholipid antibodies

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33
Q

What is foetal alcohol syndrome and how does it present?

A

Lupus anticoagulant antibodies

Anti-cardiolipin antibodies

Phospholipid antibodies

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34
Q

What are the different down antenatal screening tests?

A

Combined test - more reliable - nuchal, BHCG and PaPPA (11-14 weeks)
Triple - (14-20) weeks : Beta HCG , AFP , oestriol
Quad test - AFP, HCG, oestriol and inhibin A (14-20 weeks)

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35
Q

What are the chicken px guidelines in preg?

A

if the pregnant woman <= 20 weeks gestation is not immune to varicella she should be given varicella-zoster immunoglobulin (VZIG) as soon as possible
RCOG and Greenbook guidelines suggest VZIG is effective up to 10 days post exposure
if the pregnant woman > 20 weeks gestation is not immune to varicella then either VZIG or antivirals (aciclovir or valaciclovir) should be given days 7 to 14 after exposure

Aciclovir if >20 weeks and presents within 24 hrs of rash

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36
Q

Mx of UTI’s in pregnancy?

A

Nitrofurantoin (avoid in the third trimester)
Amoxicillin (only after sensitivities are known)
Cefalexin
Trimethopri, - avoid in 1st trimester

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37
Q

What is a breast cancer triple assessment ?

A

Clinical assessment (history and examination)
Imaging (ultrasound or mammography)
Histology (fine needle aspiration or core biopsy)

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38
Q

What are some features that may suggest breast cancer?

A

Lumps that are hard, irregular, painless or fixed in place
Lumps may be tethered to the skin or the chest wall
Nipple retraction
Skin dimpling or oedema (peau d’orange)
2 week wait!!!!!!

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39
Q

What is a fibroadenoma?

A

Fibroadenomas are common benign tumours of stromal/epithelial breast duct tissue. They are typically small and mobile within the breast tissue. They are sometimes called a “breast mouse”, as they move around within the breast tissue.
Smooth, round, mobile, defined edges and does not increase risk of actal cancer

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40
Q

Breast cysts?

A

On examination, breast cysts are:

Smooth
Well-circumscribed
Mobile
Possibly fluctuant

Require triple assessment size and pain dependent on menustral cycle

41
Q

Lipoma?

A

Lipomas are benign tumours of fat (adipose) tissue. They can occur almost anywhere on the body where there is adipose tissue, including the breasts.

On examination, lipomas are typically:

Soft
Painless
Mobile
Do not cause skin changes

They are typically treated conservatively with reassurance.

42
Q

What are the two types of breast pain?

A

Breast pain (mastalgia) is common. It can be:

Cyclical – occurring at specific times of the menstrual cycle - hx
Non-cyclical – unrelated to the menstrual cycle - meds, infection , preg

43
Q

In men with gynaecomastia what do you need to check for

A

Testicular cancer - leydig tumors
Causes : steroids and spirinolactone

44
Q

How do you treat hyperprolactinaemia

A

Dopamine agonists (e.g., bromocriptine or cabergoline) can be used to treat the symptoms of hyperprolactinaemia. They block prolactin secretion and improve symptoms

45
Q

Duct ectasia?

A

dilation of the large ducts in the breasts. Ectasia means dilation. There is inflammation in the ducts, leading to intermittent discharge from the nipple. The discharge may be white, grey or green.
Smoking a big RF -> Do triple assessment

46
Q

Intraductal papilloma?

A

intraductal papilloma is a warty lesion that grows within one of the ducts in the breast. It is the result of the proliferation of epithelial cells. The typical presentation is with clear or blood-stained nipple discharge.
Benign tumors
Triple assessment and excision

47
Q

Lactational mastitis

A

Mastitis mainly because of breast feeding -> Staph Aureus
Fluclox continue breast feeding
Complication: Can have a 2ndary candida infection after abx course ->miconazole topical

48
Q

Breast abscess

A

Can be lactational or non lactational -> Fluctualant tender lump in the breast
Start with conservative mx and if that does not work move onto using flucox

49
Q

Genes associated with breast cancer?

A

The BRCA1 gene is on chromosome 17. In patients with a faulty gene:

Around 70% will develop breast cancer by aged 80
Around 50% will develop ovarian cancer
Also increased risk of bowel and prostate cancer

The BRCA2 gene is on chromosome 13. In patients with a faulty gene:

Around 60% will develop breast cancer by aged 80
Around 20% will develop ovarian cancer

50
Q

DCIS

A

Pre-cancerous or cancerous epithelial cells of the breast ducts
Localised to a single area
Often picked up by mammogram screening
Potential to spread locally over years
Potential to become an invasive breast cancer (around 30%)
Good prognosis if full excised and adjuvant treatment is used

51
Q

Invasive ductal carcinoma?

A

NST means no special/specific type, where it is not more specifically classified (e.g., medullary or mucinous)
Also known as invasive breast carcinoma of no special/specific type (NST)
Originate in cells from the breast ducts
80% of invasive breast cancers fall into this category
Can be seen on mammograms

52
Q

Pagets disease of the nipple

A

Paget’s Disease of the Nipple

Looks like eczema of the nipple/areolar

Erythematous, scaly rash
Indicates breast cancer involving the nipple
May represent DCIS or invasive breast cancer
Requires biopsy, staging and treatment, as with any other invasive breast cancer

53
Q

What is the breast cancer screening on offer in the UK?

A

mammogram every 3 years to women aged 50 – 70 years.

Every year from even 3o onwards in high risk woman
First degree male relative, 1st degree<40, bilateral <50

54
Q

What meds can you give in conjunction with breast cancer tx?

A

Tamoxifen if premenopausal
Anastrozole if postmenopausal (except with severe osteoporosis)
Also used a prophylaxis chemo prevention in high risk owmen

55
Q

What imaging would be useful in what age group?

A

Ultrasound scans are typically used to assess lumps in younger women (e.g., under 30 years). They are helpful in distinguishing solid lumps (e.g., fibroadenoma or cancer) from cystic (fluid-filled) lumps.

Mammograms are generally more effective in older women. They can pick up calcifications missed by ultrasound.

MRI scans may be used:

For screening in women at higher risk of developing breast cancer (e.g., strong family history)
To further assess the size and features of a tumour

56
Q

Hormone treatment in oestrogen + cancers?

A

Tamoxifen for premenopausal women
Aromatase inhibitors for postmenopausal women (e.g., letrozole, anastrozole or exemestane)
anything -mab is something targetted to HER2

57
Q

Definition of primary amenorrhoea?

A

Failure to menstruate by the age of 16

Or failure to menstruate by the age of 14 in someone with no secondary sexual characteristics

58
Q

causes of primary amenorrhoea?

A

Tuner’s syndrome
GU malformations (i.e. an imperforate hymen – especially if they are having cyclical pain)
Hypothalamic failure (exercise, stress, anorexia) – switches off the drive from the hypothalamus
Constitutional delay
Kallmann’s syndrome (also has anosmia – can’t hear, can’t smell, can’t see, no periods)
Hyperprolactinaemia/ prolactinoma
Gonadal dysgenesis (i.e. they did not form ovaries or a uterus)
Swyer syndrome – XY but look like a girl
Late onset CAH

59
Q

2ndary amenorrhoea?

A

Absence of periods for ≥ 6 months

In someone who is not pregnant

60
Q

What are biochem findings in someone with premature ovarian failure?

A

Hypergondatrophism – they will have high levels of GnRH

Hypooestrogenism – low levels of oestrogen

Raised FSH

61
Q

Triad of features and criteria for PCOS?

A

ROTTERDAM CRITERIA – 2 out of 3 must be present:

12 cysts on the ovary OR an ovary > 10ml

Signs of clinical (excess hair) or biochemical (on a blood test) raised testosterone/hyperandrogenism

Oligo or amenorrhoea

62
Q

Tx of PCOS?

A

Clomifene – induces ovulation
Metformin
Ovarian drilling to help them get pregnant
If finished family/not wanting to get pregnant – COCP with regular withdrawal bleeds
Hair removal cream for hirsutism

63
Q

diagnosis of premature ovarian failure?

A

Age < 40 years

FSH > 25 in 2 samples > 4 weeks apart

Plus 4 months of amenorrhoea

64
Q

What is the definition of a recurrent miscarriage?

A

The loss of ≥ 3 consecutive pregnancies before 24 weeks’ with the same biological father

65
Q

Ectopic pregnancy signs Ix?

A

USS – intrauterine pregnancy? Foetal heartbeat?

Serial HCG measurements

Pelvic examination – CERVICAL EXCITATION /motion tenderness on speculum examination

66
Q

Stages of Cervical cancer?

A

1- cervix
2- top of vagina
3. Nearby organbs
4- everywhere

67
Q

Most common type of cervical and endometrial cancer?

A

cervical -> SCC
Endometrial: Adenocarcinoma

68
Q

What is adenomyosis and when would you see it?

A

Excess endometrial tissue in the myometrium (muscle layer of the uterus)

Unlike endometriosis (which is seen more commonly in younger ladies who haven’t had children), adenomyosis tends to happen in older women who have had lots of children

So presents much later than endometriosis

Period alot longer and often lasts 2 weeks after period ends - dyspareunia and dysmenorrhoea
tx - hysterectomy

69
Q

Signs you would see on examination for PID?

A

Cervical excitation (motion tenderness) on vaginal examination – BIG ONE FOR THE EXAMS
Vaginal discharge
Adnexal tenderness

70
Q

different types of prolapses and their features?

A

Cystocele – anterior wall of vagina and bladder – causes frequency and dysuria

Rectocele – lower posterior wall or vagina and rectum – may beed to insert finger to vagina or press on perineum to aid defecation

Enterocele – upper posterior wall of vagina and intestine

Uterine prolapse – protrusion of the uterus fown the vagina

Vault prolapse – if the woman has had a total hysterectomy

71
Q

Rf’s for ovarian cancer?

A

family history: mutations of the BRCA1 or the BRCA2 gene
many ovulations*: early menarche, late menopause, nulliparity

72
Q

What investigations would you do if you suspected ovarian cancer?

A

Ca125 - but this can be raised in endometriosis etc + ultrasound
generally managed by surgery

73
Q

Ovarian torsion?

A

Whirlpool sign on ultrasound :
Features
Usually the sudden onset of deep-seated colicky abdominal pain.
Associated with vomiting and distress
fever may be seen in a minority (possibly secondary to adnexal necrosis)
Vaginal examination may reveal adnexial tenderness

74
Q

What are the most common type of ovarian cysts?

A
  1. FOllicular cysts most common physiological cyst- due to non rupture of the dominant follicle - goes away by itself
  2. Corpus luteum cysts are also physiological cysts but are more likely to present with bleeding
75
Q

What are the hormonal changes in the menopause?

A

Oestrogen and progesterone levels are low
LH and FSH levels are high, in response to an absence of negative feedback from oestrogen

76
Q

What is premature ovarian insufficency and when does it begin?

A

Premature menopause is menopause before the age of 40 years. It is the result of premature ovarian insufficiency.

77
Q

What test can you use to dx menopause in women under 40?

A

NICE guidelines (2015) recommend considering an FSH blood test to help with the diagnosis in:

Women under 40 years with suspected premature menopause
Women aged 40 – 45 years with menopausal symptoms or a change in the menstrual cycle

FSH will be raised

78
Q

What are the general rules for the use of HRT’s?

A

remember the basics of choosing the HRT regime. Women with a uterus require endometrial protection with progesterone, whereas women without a uterus can have oestrogen-only HRT. Women that still have periods should go on cyclical HRT, with cyclical progesterone and regular breakthrough bleeds. Postmenopausal women with a uterus and more than 12 months without periods should go on continuous combined HRT.

79
Q

If cytology normal and hrHPV+?

A

the test is repeated at 12 months
if the repeat test is now hrHPV -ve → return to normal recall
if the repeat test is still hrHPV +ve and cytology still normal → further repeat test 12 months later:
If hrHPV -ve at 24 months → return to normal recall
if hrHPV +ve at 24 months → colposcopy

80
Q

What happens when a cervical screening sample is ‘inadequate’?

A

Repeat the sample within 3 months
2 consecutive inadequates will lead to colposcopy

81
Q

What bishops score would indicate an induction of labour?

A

Less than 5 means labour is unlikely to begin withut induction
8 or more - there is a high chance of spontaneous labour

82
Q

How do you induce labour? step by step

A

membrane sweep -> Vaginal prostaglandin E2 ->oxytocin

83
Q

What is a vault prolapse?

A

Vault prolapse occurs in women that have had a hysterectomy, and no longer have a uterus. The top of the vagina (the vault) descends into the vagina.

84
Q

Rectocele?

A

posterior vaginal wall -> associated with constipation and faecal loading
patients often describe using fingers to help stools pass

85
Q

Cystocele

A

Anterior vaginal wall -> bladder prolapses backwards

86
Q

What is the ix you would carry out for overflow incontinence ?

A

Urodynamic testing - it is basically chronic urinary retention and whatever the bladdr cannot hold you expel

87
Q

Stress incontinence mx?

A

Supervised pelvic floor exercises for at least three months before considering surgery
Surgery
Duloxetine - SNRI

88
Q

Urge incontinence?

A

Bladder retraining (gradually increasing the time between voiding) for at least six weeks is first-line
Anticholinergic medication, for example, oxybutynin, tolterodine and solifenacin
Mirabegron is an alternative to anticholinergic medications
Invasive procedures where medical treatment fails

89
Q

Booking visit?

A

8-12 weeks (ideally before 10)
General advice
Bloods and urine including infectious disease screen

90
Q

Dating scan?

A

10-13+6

91
Q

Nuchal scan for downs?

A

11-13+6

92
Q

Anomaly scan?

A

18-20+6

93
Q

When do you give anti-D

A

28 then 34 weeks

94
Q

What are the requirements for an instrumental delivery?

A

2nd stage of labour - failure to progress or maternal stress
The requirements for instrumental delivery can be easily remembered by the mnemonic FORCEPS:
Fully dilated cervix generally the second stage of labour must have been reached
OA position preferably OP delivery is possible with Keillands forceps and ventouse. The position of the head must be known as incorrect placement of forceps or ventouse could lead to maternal or fetal trauma and failure
Ruptured Membranes
Cephalic presentation
Engaged presenting part i.e. head at or below ischial spines the head must not be palpable abdominally
Pain relief
Sphincter (bladder) empty this will usually require catheterization

95
Q

In what situations should you just give anti D at unsched times

A

within 72hrs
delivery of a Rh +ve infant, whether live or stillborn
any termination of pregnancy
miscarriage if gestation is > 12 weeks
ectopic pregnancy (if managed surgically, if managed medically with methotrexate anti-D is not required)
external cephalic version
antepartum haemorrhage
amniocentesis, chorionic villus sampling, fetal blood sampling
abdominal trauma

96
Q

When would you use the coombs test and when the K one?

A

Coombs in the first trimester and K one in 2nd or thrid

97
Q

When can you give the copper IUD post 5 days ?

A

The copper intrauterine device can be used up to 120 hours of UPSI, OR within 5 days of the earliest expected date of ovulation

98
Q

What are accelerations and decelerations that you would find on a CTG

A

both are 15bpm for 15s either way

3a self (13 decks)

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