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Phase 3a > obs/gynae > Flashcards

obs/gynae Flashcards

1
Q

what happens to total plasma volume in pregnancy

A

increases by around 30-50%

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2
Q

what happens to kidney function in pregnancy

A

increases

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3
Q

what happens to BP in pregnancy

A

biphasic
decreases in early/mid pregnancy
increases in late pregnancy

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4
Q

what is aortocaval compression syndrome

A

compression of the abdominal aorta and inferior vena cava when pregnant woman lies supine

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5
Q

what speculum is used to examine prolapse

A

sims

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6
Q

lifestyle modifications for prolapse

A

weight loss
smoking cessation
reduce caffeine intake
avoid straining/constipation

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7
Q

what type of cells make up detrusor muscle

A

transitional epithelium

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8
Q

where do the sympathetic nerve fibres come off the spinal cord to relax the bladder

A

T11-L2

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9
Q

where do the parasympathetic nerve fibres come off the spinal cord to contract the bladder

A

S2-S4

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10
Q

what receptors are on the detrusor muscle

A

muscarinic M2 and M3

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11
Q

name some anticholinergics

A

oxybutynin
tolterodine
(propiverine, trospium, solifenacin)

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12
Q

side effects of oxybutynin

A

dry mouth
blurred vision
drowsiness
constipation

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13
Q

what class of drugs are given to manage incontinence

A

anticholinergics, antimuscarinics and beta-2 adrenergic agonists

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14
Q

name a beta-3 adrengeric agonist

A

mirabegnon

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15
Q

when is a person said to be in menopause

A

12 months of amenorrhoea
onset of symptoms if hysterectomy

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16
Q

what characterises perimenopause

A

irregular periods and symptoms

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17
Q

what are the central effects of decreased oestrogen levels in perimenopause

A

hot flushes/sweats
joint muscle/pain
low mood + sexual difficulties

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18
Q

what are the local effects of decreased oestrogen in perimenopause

A

vaginal dryness due to vaginal atrophy

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19
Q

non-hormonal medication to treat menopause

A

clonidine

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20
Q

indications for transdermal oestrogen

A

gastric upset e.g. crohns
need for steady absorption e.g. migraines/epilepsy
increased risk of VTE
older women
medical conditions e.g. htn

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21
Q

what is premature ovarian insufficiency

A

menopause <40

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22
Q

how do you diagnose premature ovarian insufficiency

A

FSH > 30 (2 samples more than 4 weeks apart)
4 months of amenorrhoea

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23
Q

medication often used for HRT in breast cancer patients

A

venlafaxine

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24
Q

problems with benzodiazepines in pregnancy

A

associated with cleft palate, neonatal withdrawal syndrome and floppy baby syndrome
avoid in 3rd trimester

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25
Q

potential problem with olanzapine in pregnancy

A

weight gain and increased risk of gestational diabetes

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26
Q

potential problems with risperidone in pregnancy

A

increased prolactin levels

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27
Q

potential problem with lithium in pregnancy

A

increased risk of abstain anomaly (tricuspid valve)
avoid in 1st trimester and when breast feeding

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28
Q

what is placenta acreta

A

when placenta attaches to myometrium

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29
Q

what is placenta increta

A

when placenta invades the myometrium

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30
Q

what is placenta percreta

A

when placenta invades through the myometrium

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31
Q

what is an endometrioma

A

collected old menstrual blood forming a ‘chocolate cyst when endometrial tissue grows on or in the ovaries

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32
Q

pain treatments for endometriosis

A

OCP, GnRH agonists to control cyclicality
oral progestogens, depot provera, morena coil for glandular atrophy

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33
Q

secondary care endometriosis treatment if fertility is desired

A

ablation
excision

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34
Q

secondary care endometriosis treatment if fertility is no longer desired

A

oophorectomy
pelvic clearance

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35
Q

what is adenomyosis

A

when endometrial tissue grows into the muscular wall of the uterus

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36
Q

how do you treat adenomyosis

A

hysterectomy

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37
Q

what are the 5 different types of uterine fibroids

A

pedunculated fibroid
intracavity fibroid
intramural fibroid
submucosal fibroid
subserosal fibroid

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38
Q

what are the 2 indicators of preeclampsia

A

proteinuria
hypertension

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39
Q

if a smear shows hPV positive and cytology negative when should a smear be repeated

A

in 12 months

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40
Q

name some associations with hyperemesis gravidum

A

trophoblastic disease (choriocarcinoma)
multiple pregnancies
hyperthyroidism
nulliparity
obesity

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41
Q

what does intrahepatic cholestsis of pregnancy present as and what does it put patient at higher risk of

A

intensive itching
risk of still birth (induction offered at 37/38 weeks)

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42
Q

when should progesterone bloods be taken in the menstrual cycle to check for ovulation

A

7 days before next menstrual period

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43
Q

when is lactational amenorrhoea a reliable method of contraception?

A

amenorrhoea
baby <6 months
exclusively breastfeeding

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44
Q

when should initial booking to midwife by made

A

8-12 weeks

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45
Q

when should ECV be offered if baby is breech

A

36 weeks

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46
Q

when should down syndrome screening with nuchal scanning be carried out

A

11-13+6 weeks

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47
Q

if a pregnant woman has a BMI >30, what investigation should she be offered, when and why

A

oral glucose tolerance test
24-28 weeks
test for gestational diabetes

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48
Q

how long do baby blues last for

A

3 days after giving birth

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49
Q

what is placenta previa

A

I - lower segment but not os
II - reaches os but doesn’t cover it
III - covers it but not when dilated
IV - completely blocks it

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50
Q

what type of ovarian tumour is associated with endometrial hyperplasia

A

granulosa cell tumours

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51
Q

what is the most common type of ovarian cancer

A

serous carcinoma

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52
Q

what can cause a raised AFP in a woman who is pregnant

A

omphalocele

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53
Q

what is HELLP syndrome

A

severe form of pre-eclampsia
haemolysis
elevated liver enzyme’s
low platelets

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54
Q

how would a patient with HELLP syndrome present

A

malaise
nausea
vomiting
headaches

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55
Q

3 main causes of bleeding in 1st trimester

A

spontaneous abortion
ectopic
hydatidiform mole (molar pregnancy)

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56
Q

what are the 3 most common causes of bleeding in the 2nd trimester

A

spontaneous abortion
hydatidiform mole
placental abruption

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57
Q

what are the 4 likely causes of bleeding in the 3rd trimester

A

bloody show
placental abruption
placenta previa
vasa previa

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58
Q

what are the 3 types of spontaneous abortion

A

threatened miscarriage
missed/delayed miscarriage
inevitable miscarriage (complete/incomplete)

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59
Q

how would a threatened miscarriage present

A

painless vaginal bleeding typically around 6-9 weeks

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60
Q

how would a missed/delayed miscarriage present

A

light vaginal bleeding and pregnancy symptoms disappear

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61
Q

how would an incomplete inevitable miscarriage present

A

heavy bleeding and cramps, lower abdominal pain

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62
Q

how would a hydatidiform mole typically present

A

bleeding in 1st/early 2nd trimester
exaggerated symptoms of pregnancy
uterus may be large for dates
Beta HCG may be high

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63
Q

how would placental abruption typically present

A

constant lower abdominal pain
woman more in shock than expected from visible blood loss
tender, tense uterus
normal lie and presentation
metal heart may be distressed

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64
Q

how would vasa praaevia typically present

A

rupture of membranes followed by immediate vaginal bleeding
fetal bradycardia

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65
Q

what is the diagnostic criteria for hyperemesis gravidarum

A

5% pre-pregnancy weight loss
dehydration
electrolyte imbalance

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66
Q

what is the normal dose of folic acid

A

400 micrograms

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67
Q

what is the higher dose of folic acid given and when

A

5 milligrams

previous child with neural tube defects, on certain anti epileptics, diabetes, sickle cell, thalassaemia, BMI>30

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68
Q

what is the first stage of labour

A

onset of labour until 10cm cervical dilatation

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69
Q

what is the 2nd stage of labour

A

10cm cervical dilatation until delivery of the baby

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70
Q

what is the 3rd stage of labour

A

delivery of the baby until delivery of placenta

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71
Q

what is the latent phase of the 1st stage of labour

A

0-3cm
0.5cm/hour progression
irregular contractions

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72
Q

what is the active phase of the 1st stage of labour

A

3-7cm
1cm/hour progression
regular contractions

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73
Q

what is the transition phase of the 1st stage of labour

A

7-10cm
1cm/hour progression
strong, regular contractions

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74
Q

what does the ‘show’ refer to

A

mucus plug in cervix falling out and creating space for the baby to move down

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75
Q

what is used to treat eclampsia

A

magnesium

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76
Q

3 causes of primary amenorrhoea

A
  • abnormal functioning of hypothalamus/pituitary gland
  • abnormal functioning of gonads
  • imperforate hymen
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77
Q

what does Kallman’s syndrome cause and what is it associated with

A

hypogonadotrophic hypogonadism
anosmia

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78
Q

what is the triad (Rotterdam Criteria) for diagnosing PCOS

A

oligoovulation/anovulation
hyperandrogenism
polycystic ovaries/ovarian volume >10cm3

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79
Q

what is the most common type of ovarian cyst

A

follicular

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80
Q

what are serous cystadenomas

A

benign tumours of the epithelial cells

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81
Q

what are mutinous cystadenomas

A

benign tumours of the epithelial cells

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82
Q

what are dermoid cysts/germ cell tumours

A

benign ovarian tumours derived from teratomas

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83
Q

what are sex cord-stomal tumours

A

rare - can be malignant or benign
several types:
- sertoli-leydig cell tumours
- granulose cell tumours

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84
Q

what is the triad of Meig’s syndrome

A

ovarian fibroma
pleural effusion
ascites

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85
Q

what would be seen on a pelvic ultrasound in ovarian torsion

A

whirlpool sign
free flu in the pelvis
oedema of the ovary

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86
Q

what is asherman’s syndrome

A

adhesions form in the uterus following damage to it

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87
Q

gold standard test for asherman’s

A

hysteroscopy

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88
Q

what are Nabothian cysts and what causes them

A

fluid filled cysts often seen on the surface of the cervix

mucus secreted by the endocervix (columnar epithelium) is trapped by the ectocervix (squamous epithelium)

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89
Q

what is a rectocele

A

defect in the posterior vaginal wall allowing the rectum to prolapse into the vagina

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90
Q

what is a cystocele

A

defect in the anterior vaginal wall allowing the bladder to prolapse into the vagina

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91
Q

what is a uterine procidentia

A

prolapse extending beyond the introitus

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92
Q

typical treatment for lichen sclerosis

A

clobetasol

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93
Q

what do the upper vagina, cervix, uterus and Fallopian tubes develop from

A

Mullein ducts (paramesonephria)

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94
Q

what is the most and 2nd most common cervical cancer

A

1st = squamous cell carcinoma
2nd = adenocarcinoma

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95
Q

what are the 2 strains of HPV that are responsible for most cervical cancers

A

16 and 18

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96
Q

what 2 proteins does hPV produce and what do they inhibit

A

E6 and E7
E6 inhibits P53
E7 inhibits pRb

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97
Q

what is the most common type of endometrial cancer

A

adenocarcinomas

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98
Q

what is the most common type and sub-group of ovarian cancer

A

epithelial cell tumours
- serous tumours

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99
Q

what is a Krukenberg tumour

A

metastasis in ovary usually from a GI tract cancer
- signet ring appearance under microscope

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100
Q

most common type of vulval cancer

A

squamous cell carcinoma

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101
Q

most common type of anaerobic bacteria associated with BV

A

Gardnerella vaginalis

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102
Q

what would BV look like under a microscope

A

clue cells

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103
Q

treatment for BV

A

metronidazole 2g single dose or 400g for 5-7 days (clindamycin as alternative)

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104
Q

most common cause of thrush/candidiasis

A

candida albicans

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105
Q

treatment for candidiasis

A

fluconazole 150 oral single dose

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106
Q

what is Lymphogranuloma Venereum (LGV)

A

affects lymphoid tissue around site of chlamydia (more common in MSM)

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107
Q

what are the primary, secondary and tertiary stages of LGV

A

1 - painless ulcer
2 - lymphadenitis
3 - proctitis

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108
Q

treatment for gonorrhoea when sensitivities are known/unknown

A

not known = IM ceftriaxone
known = oral ciprofloxacin

109
Q

what is Fitz-Hugh-Curtis syndrome

A

complication of PID
- inflammation/infection of the liver capsule (Glisson’s)
= RUQ pain and potentially radiation to right shoulder tipq

110
Q

what is the characteristic sign of Trichomoniasis and how is it treated

A

strawberry cervix
metronidazole 2g single dose or 400g 5-7 days

111
Q

what is given to HIV patients with low CD4 count to protect from PCP

A

co-trimoxazole

112
Q

what is given during a CS if a woman with HIV’s viral load is unknown/high

A

iV zidovudine

113
Q

what bacteria causes syphilis

A

treponema palidum

114
Q

what is primary syphilis

A

painless ulcer (chancre) at site of infection

115
Q

what is secondary syphilis

A

involves systemic symptoms (Particularly skin and mucous membrane)
resolves 3-12 weeks

116
Q

what is an Argyll Robertson pupil

A

finding in neurosyphilis
constricted pupil that accommodates when focusing on a near object but does not react to light

117
Q

treatment for syphilis

A

deep IM dose of benzathie benzylpenicilin

118
Q

when can the COCP be restarted after childbirth in women who are breastfeeding

A

6 weeks

119
Q

a COCP containing what hormones is 1st line

A

(microgynon)
levonorgestrel

120
Q

what type of progesterone in COCP is better for pMS

A

(Yasmin)
drospirenone

121
Q

what 2 side effects are unique to the progesterone injection

A

weight gain
osteoporosis

122
Q

medical management of an ectopic

A

methotrexate

123
Q

medical management of a miscarriage

A

misoprostol

124
Q

what are the 2 medical treatments given in an abortion

A

mifepristone
misoprostol

125
Q

ultrasound appearance in a molar pregnancy

A

snowstorm

126
Q

what is the triad of features in congenital toxoplasmosis

A

intracranial calcification
hydrocephalus
chorioretinitis

127
Q

treatment for obstetric choleastasis

A

ursodoexycholic acid

128
Q

what is given to relax the uterus before ECV

A

terbutaline (subcut)

129
Q

what test is used to determine the dose of anti-D needed

A

Kleihauer

130
Q

what are the 3 major causes of cardiac arrest in pregnancy

A

obstetric haemorrhage
pulmonary embolism
sepsis

131
Q

what is cervical clearage

A

putting a stitch in the cervix to keep it closed

132
Q

what antibiotic should be given in SROM to prevent chorioamnionitis

A

erythromycin

133
Q

what is Bishop’s score used for, and what 5 things are assessed

A

determining whether to induce labour
- fetal station
- cervical position
- cervical dilatation
- cervical effacement
- cervical consistency

134
Q

what Bishop’s score predicts a high chance of spontaneous labour

A

above 8

135
Q

what is McRoberts manoeuvre

A

in shoulder dystocia
hyeprflexion of mother at the hip providing a posterior pelvic tilt

136
Q

what is Rubins manoeuvre

A

in shoulder dystocia
reaching into the vagina to put pressure on the posterior aspect of the baby’s anterior shoulder

137
Q

what is woods screw manoeuvre

A

in shoulder dystocia
performed during rubins
other hand puts pressure on the anterior aspect of the posterior shoulder. top shoulder pushed forward, bottom shoulder pushed backwards in attempt to rotate the baby

138
Q

what is Zavanelli manoeuvre

A

in shoulder dystocia
pushing baby’s head back into the vagina in order to have an emergency CS

139
Q

what is the key risk to the baby in ventouse delivery

A

cephalohaematoma

140
Q

what is the key risk to the baby with a forceps delivery

A

facial nerve palsy

141
Q

what is the decision to delivery time for a Cat 1 CS

A

30 minutes

142
Q

what is the decision to delivery time for a Cat 2 CS

A

75 minutes

143
Q

what is Johnson manoeuvre

A

in uterine inversion
using hand to push the funds back up into the abdomen, hold for few minutes then administer oxytocin to induce a contraction

144
Q

when can the copper coil or IUS be used following birth

A

either within 48 hours or after 4 weeks

145
Q

most common bacteria causing mastitis

A

staph aureus

146
Q

treatment for candida of the nipple

A

topical miconazole

147
Q

typical pattern of postpartum thyroiditis

A

thyrotoxicosis - first 3 months
hypothyroid - 3-6 months
thyroid levels returning to normal within a year

148
Q

what is Sheehan’s syndrome

A

rare complication of pph
drop in blood volume leading to avascular necrosis of the anterior pituitary gland

149
Q

what is the presentation of Sheehan syndrome

A

reduced lactation
amenorrhoea
adrenal insufficiency/crisis
hypothyroidism

150
Q

what is first line medical management for hyperemesis gravidarum

A

antihistamines e.g. cyclizine

151
Q

what secretes HCG

A

syncytiotrophoblasts

152
Q

for how long following a termination can pregnancy tests be positive for

A

up to 4 weeks

153
Q

by what week should a patient be referred to a specialist for lack of fetal movements

A

24 weeks

154
Q

what is the most common site of an ectopic

A

ampulla of the Fallopian tube

155
Q

what is the treatment for PID

A

ceftriaxone followed by doxycycline and metronidazole

156
Q

what is the first line treatment for stress and urge incontinence

A

urge = bladder retaining
stress = pelvic floor muscle training

157
Q

how would an amniotic fluid embolism present

A

<30 minutes of delivery
respiratory distress
hypoxia
hypotension

158
Q

when should magnesium be stopped for eclampsia

A

24 hours after last seizure

159
Q

requirements for instrumental delivery to be carried out

A

FORCEPS
- fully dilated cervix
- OA position preferably
- Ruptured membranes
- Cephalic presentation
- Engaged presenting part
- Pain relief
- Sphincter (bladder) empty

160
Q

how long before an IUS is effective

A

7 days

161
Q

how long before an IUD is effective

A

immediately

162
Q

how before the POP is effective

A

2 days

163
Q

how long before the COCP is effective

A

7 days

164
Q

how long before the implant and injection is effective

A

7 days

165
Q

how far along in pregnancy would a woman have to be to be diagnosed with pre-eclampsia or pregnancy-induced hypertension

A

20 weeks

166
Q

first line treatment for fertility issues in PCOS

A

clomifene

167
Q

treatment for respiratory depression secondary to magnesium sulphate

A

calcium gluconate

168
Q

criteria for ectopic pregnancies to be managed surgically

A

> 35mm in size and beta HCG > 5000

169
Q

results on combined test indicating higher chance of Downs syndrome

A

thickened nuchal translucency
low pappa - A
increased beta HCG

170
Q

what is given to manage PMS is COCP is contraindicated

A

low dose SSRI

171
Q

if a semen sample is abnormal when should it be repeated

A

3 months

172
Q

what procedure carries greatest risk of haemorrhage in a newborn if the mother has ITP

A

prolonger ventouse delivery

173
Q

what procedure carries greatest risk of haemorrhage in the mother if she has ITP

A

C-section

174
Q

Where would you see a Rokitansky protuberance

A

teratoma - dermoid cyst

175
Q

why is aspirin contraindicated in breastfeeding

A

association with Reyes syndrome

176
Q

1st line for primary dysmennorhoea

A

mefanemic acid

177
Q

where is beta HCG secreted

A

trophoblastic cells of the blastocyst

178
Q

what is the role of human placental lactogen

A
  • mobilises glucose from fat reserves
  • diabetogenic to increase nutrient supply to the blastocyst
  • converts mammary glands into milk secreted tissue
179
Q

what is the only antibody to cross the placenta

A

IgG

180
Q

when do you give anti-D

A

28 and 34 weeks

181
Q

what drug stops effect of oxytocin

A

atosiban

182
Q

what level of the spine is an epidural given

A

L3-L4

183
Q

3 infectious diseases screened for in pregnant women

A

HIV
Hep B
Syphillis

184
Q

what are the 4 baseline parameters on CTG

A

Baseline foetal heart rate
FHR variability
number of accelerations
number of decelerations

185
Q

what test result is diagnostic for pre-eclampsia

A

protein creatinine ratio > 30

186
Q

what cell type produces oestrogen

A

granulosa

187
Q

gold standard investigation for adenomyosis

A

MRI

188
Q

when should methotrexate be stopped before trying to get pregnant

A

6 months

189
Q

how is the thyrotoxicosis phase of postpartum thyroiditis managed

A

propanolol

190
Q

an ectopic pregnancy located where increases risk of rupture

A

isthmus

191
Q

how long should someone wait before resuming hormonal contraception after taking upsilatte

A

5 days

192
Q

what would quadruple screening show in Edwards’ syndrome

A

decreased hcg, afp and oestrial
normal inhibin

193
Q

what type of tumour is characterised by psammoma bodies on histology

A

serous cystadenocarcinoma

194
Q

what do you give if a person is HER2 receptor positive breast cancer

A

trastuzumab

195
Q

what can trastuzumab cause

A

cardiotoxicity and in turn heart failure

196
Q

what can cause oligohydramnios

A

PROM
renal angenesis
IUGR
post term gestation
pre-eclampsia

197
Q

what should be considered with postpartum continuous dribbling

A

vesicovaginal fistula

198
Q

investigation for vesicovaginal fistula

A

urinary dye studies

199
Q

how long do you take folic acid for

A

first 12 weeks

200
Q

how long do you take vitamin d for

A

entire pregnancy

201
Q

components of the bishops score

A

cervical position, consistency, dilation, effacement
foetal station

202
Q

treatment for vaginal vault prolapse

A

sacrocolpoplexy

203
Q

what is a normal foetal baseline rate

A

110-160

204
Q

what is a normal foetal baseline variability

A

5-25

205
Q

when is an acceleration/decelartion pathologically abdominal

A

change in 15 bpm for > 15 seconds

206
Q

what are the causes of non-immune fetal hydrops

A

severe anaemia (parvovirus B19, alpha thalassaemia major, massive maternal-fetal haemorrhage)
cardiac abnormalities
chromosomal
infection (toxoplasmosis, rubella, CMV, varicella)
twin-twin transfusion syndrome in recipient twin
chorioangioma

207
Q

when would CVS be carried out

A

11-14 weeks

208
Q

when would amniocentesis be carried out

A

15-20 weeks

209
Q

what sign is seen on transvaginal USS in an ectopic

A

bagal

210
Q

indications for surgical management of an ectopic

A

> 35mm
BCG > 5000
fetal heart rate
pain/symptoms

211
Q

how long do nulliparous women have to push

A

2 hours

212
Q

how long do multiparous women have to push

A

1 hour

213
Q

how long do you have for active management of 3rd stage

A

30 minutes!!

214
Q

how long do you have for passive management of 3rd stage

A

1 hour

215
Q

what is the Amsel criteria for BV

A

3/4 needed
white homogenous thin discharge
fishy odour
clue cells on microscopy
ph > 4.5

216
Q

what do you give an oestrogen receptor positive post menopausal woman

A

anastrazole

217
Q

what do you do with a woman who gets pregnant with stable hypothyroidism

A

increase levothyroxine by 25mcg

218
Q

how many pulls are allowed on ventouse before c section

A

3 pulls

219
Q

how often should people with pre eclampsia have their bloods taken

A

3 times a week

220
Q

what is gold standard for confirming diagnosis of PCP

A

bronchoalveolar lavage

221
Q

what colour will cancerous cells appear on colposcopy

A

yellow

222
Q

when should women with gestational diabetes give birth by

A

40+6

223
Q

how long after a termination can women have a smear

A

3 months

224
Q

what is the treatment for a Batholian cyst

A

marsupialisation

225
Q

what is Naegele’s rule to calculate EDD

A

add 1 year and 7 days onto LMP, subtract 3 months

226
Q

order of layers dissected in a c section

A

skin
subcutaneous fat
rectus sheath
rectus abdominal muscle
peritoneum
uterine myometrium
amniotic sac

227
Q

what is the inheritance of androgen insensiviitvy syndrome

A

autosomal recessive

228
Q

where is vulval cancer most likely to affect

A

labia majora

229
Q

signs/symptoms of androgen insensitivity syndrome

A

primary amennorhoea
little to no pubic or axillary hair
undescended testes
breast development may occur

230
Q

management of lichen sclerosis

A

topical dermovate

231
Q

which STI would you see colpitis macularis

A

trichomoniasis

232
Q

what is criteria for RMI

A

ultrasound scan
ca125
menopausal status

233
Q

what is chandelier sign

A

another name for cervical excitation

234
Q

seen under microscope in syphilis

A

spirochaete

235
Q

what tests should be done in women under 40 with complex ovarian cyst

A

Lactate dehydrogenase
AFP
HCG

236
Q

what type of cancer is someone with lichen sclerosis at slightly higher risk of getting

A

squamous cell carcinoma of vulva

237
Q

when can you have cervical smear after pregnancy

A

3 months

238
Q

management of CIN and early stage 1a

A

LLETZ or cone biopsy

239
Q

management of cervical cancer 1b and 2a

A

radical hysterectomy and removal of local lymph nodes with chemotherapy and radiotherapy

240
Q

management of cervical cancer 2b-4a

A

chemotherapy and radiotherapy

241
Q

management of cervical cancer 4b

A

surgery, chemo, radiotherapy and palliative care

242
Q

treatment of endometrial hyperplasia

A

mirena
continuous oral progesterons

243
Q

how does a complete molar pregnancy occur

A

2 sperm fertilise an egg with no genetic material

244
Q

how does a partial molar pregnancy occur

A

2 sperm fertilise normal egg

245
Q

first line for heavy menstrual bleeding

A

mirena

246
Q

hormonal blood test results for PCOS

A

Raised LH
high LH to FSH ratio

247
Q

when would you induce someone showing signs of eclampsia

A

more than 34 weeks

248
Q

gold standard for investigating PCOS

A

transvaginal

249
Q

what could be seen on transvaginal ultrasound in PCOS

A

string of pearls

250
Q

how do you reduce risk of endometrial hyperplasia and cancer in someone with pcos

A

Mirena coil
induce withdrawal bleed 3-4 months with cyclical progestogens (medroxyprogesterone acetate) or cocp

251
Q

managing hirtuism in pcos

A

co-cyprindiol (cocp) - stopped after 3 months as increased risk of VTE

topical eflornithine (takes 6-8 weeks)

252
Q

when would you take a IUD out in pID

A

symptoms not resolved in 72 hours

253
Q

what is the process of foetal descent through birth canal

A

descent
engagement
flexion
internal rotation
crowing
extension of presenting part
external rotation of head
delivery

254
Q

what is classed as polyhydramnios

A

AFI more than 24cm

255
Q

what is classed as oligohydramnios

A

AFI less than 5

256
Q

what is hypoactive sexual desire disorder

A

persistent deficient sexual fantasies and desire for sexual activities that causes marked distress and interpersonal issues

257
Q

what is sexual aversion disorder

A

unwillingness to get involved in sexual activity, with avoidance to any touching or communication that may lead to sexual involvement

258
Q

what is sexual arousal disorder

A

you’re interest in sex may still be there but have difficulty in becoming aroused/maintaining arousal

259
Q

high risk factors for preeclampsia

A

HTN in previous pregnancy
CKD
autoimmune disease e.g. lupus
DM
chronic HTN

260
Q

moderate risk factors for preeclampsia

A

1st pregnancy
>40
pregnancy interval > 10 years
BMI > 35
multiple pregnancy
FH of preeclampsia

261
Q

when should you take aspirin for preeclampsia and why

A

12 weeks - gestation
1 high risk factor or 2 moderate

262
Q

when can you try and delay birth

A

before 24 weeks, history of preterm birth, ultrasound showing cervical length of 25mm or less

263
Q

2 methods of trying to delay birth

A

prophylactic vaginal progesterone
prophylactic cervical cerclage

264
Q

what can you give and when when trying to improve outcome of preterm labour

A

tocolysis with nifedipine to suppress labour
corticosteroids before 35 weeks
IV magnesium sulphate before weeks to protect babies brain
delayed cord clamping

265
Q

what age is primary amenorrhoea defined as with no other signs of pubertal development

A

13

266
Q

treatment for mycoplasma genitalium

A

doxycycline 100mg twice daily for 7 days
azithromycin 1g stat, 500mg once a day for 2 days

267
Q

when do you give prophylaxis for VTE from in pregnancy

A

28 weeks if 3 risk factors
12 weeks if 4

268
Q

when do you carry on VTE prophylaxis for 10 days

A

BMI>40
c section
admission > 3 days
any surgical procedure
any medical co morbidities

Phase 3a (7 decks)

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