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AMK > Obs & Gynae > Flashcards

Obs & Gynae Flashcards

1
Q

which anti-epileptic drug cannot be used in pregnancy and for what reason?

A

sodium valproate
causes neural tube defects

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2
Q

what antibiotic causes dental staining in pregnancy

A

tetracyclines

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3
Q

isotretenoin is not given in pregnancy for what reason?

A

causes congenital facial dysmorphogenesis eg. absent or defective ears

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4
Q

ACE inhibitors and angiotensin 2 receptor blockers are associated with what in pregnancy

A

oligohydramnios

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5
Q

bright red vaginal bleeding after 20 week pregnancy

PAINLESS

A

PLACENTA PREVIA

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6
Q

PAINFUL vaginal bleeding after 20 week pregnancy
‘woody’ uterus

A

placental abruption

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7
Q

IVF treatment requirements

A

trying for 2 years, not obese and not smoking

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8
Q

pregnant woman, has BP>140/90
no other symptoms
don’t have leaky capillaries
no protein in urine

A

pregnancy induced hypertension

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9
Q

pregnant woman
BP >140/90
BUT HAS OTHER SYMPTOMS EG headache, epigastric pain and visual problems

A

pre eclampsia

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10
Q

emergency contraception tablet that can be taken within 5 days of unprotected sex

CANNOT GIVE WITH ASTHMA

A

ELLAONE

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11
Q

emergency contraceptive pill
given within 72 hours

A

LEVONORGESTREL
LEVONENE

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12
Q

PT missed progesterone only pill

what should they do

A

take the missed pill
use condom for 2 days

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13
Q

what contraception can be used after pregnancy while breast feeding

A

progesterone only pill

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14
Q

when can the IUD be inserted in a woman who has given birth

A

after 48 hours of delivery or 4 weeks post partum

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15
Q

what is the best emergency contraception

A

IUD
can be used up to 5 days after having unprotected sex

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16
Q

which contraceptive pill helps with acne
lightens periods and doesn’t cause weight gain

A

combined pill

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17
Q

pt comes in with abdominal pain
bloating
menopause at 54
next step

A

serum 25

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18
Q

painful periods that before used to be painless
gets better over the period

what can this be a cause of

A

endometriosis

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19
Q

patient smokes and is older than 35

why is the patient not suitable for the combined contraceptive pill?

A

because the patient smokes

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20
Q

patient is post menopausal
on HRT
more bloating
more frequency to urinate
more urgency

what is it

A

ovarian cancer

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21
Q

placenta grows too much into the myometrium
when giving birth - too much bleeding and hysterectomy needs to be done

A

placenta acreta

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22
Q

red ring/grazae on cervix is what?

A

ectropion - proliferated cells on the cervix

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23
Q

what’s an ectropion

A

squamous cells of the cervix grow outside the cervix
common in females on hormonal contraception
bleeding after sex

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24
Q

labetalol is first line management for?

A

pre-eclampsia

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25
Q

snow storm appearance in the uterus on the scan

a uterus that is bigger than it should be
- what is it

A

trophalastic disease

  • abnormal trophoblast cells grow outside the uterus after conception
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26
Q

what is a molar pregnancy

A

problem with fertilised egg so the foetus and placenta doesnt grow the way it should
- baby can not survive

-‘woody uterus’
- bright red blood bleeding from the uterus in the first 3months
- grape-like cysts come out

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27
Q

the oral contraceptive pill increases the chances of which cancer?

A

breast and cervical cancer

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28
Q

the oral contraceptive pill decreases the chances of which cancer?

A

endometrial cancer

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29
Q

what is a risk factor in pregnancy for venous thromboembolism?

A

multiple pregnancies

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30
Q

what is bartholins’ gland?

A
  • it is a gland that is located on vaginal opening - labia minora
  • it produces lubrication for the vagina
  • if it the path from the duct to the vagina gets blocked, it becomes a cyst
  • if this gets infected - becomes abscess - very painful
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31
Q

symptoms of bartholins abscess

A

red lump in the opening of vagina
pain during sex
oozing from the abscess

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32
Q

when women take the oral combined pill what factor should be monitored?

A

their blood pressure
OCCP holds a risk of hypertension

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33
Q

what medication holds a risk of developing gynaecomastia

A

spironolactone

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34
Q

what anti-epileptic drug should be given to pregnant women?

A

diazepam

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35
Q

cyclical oestrogen-only HRT is used when?

A

used for women who menstruated LESS THAN A year ago
only those who DONT have uterus

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36
Q

continuous combined HRT is used when?

A

stopped menstruation OVER A YEAR AGO
and HAVE A UTERUS

contains oestrogen and progesterone which protects the endometrium from hyperplasia

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37
Q

continuous oestrogen only HRT is used when?

A

this increases the risk of endometrial cancer in women who have uterus

ONLY GIVEN TO WOMEN WITHOUT UTERUS

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38
Q

Cyclical combined HRT is used when?

A

stopped menstruation LESS THAN A YEAR AGO
and HAVE A UTERUS

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39
Q

smokers over what age who smoke >15 cigarettes a day cannot be given oral combined pill?

A

over 35

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40
Q

abdominal pain in pregnant women can be due to what reasons?

A

preterm labour
abruption
and other causes like:

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41
Q

what is placental abruption

A

bleeding behind the placenta - this can build up in the uterus and increase pressure
- so it is very painful
- blood flow to baby gets restricted

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42
Q

what are the two causes of vaginal bleeding in pregnancy?

A

placenta previa
placental abruption
cervial polyps

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43
Q

what is vasa previa

A
  • the placenta is like a disc that sits on the uterine wall
  • blood vessels travel from the placenta to the umbilical cord of the baby
  • these vessels can rupture and cause bleeding
  • blood loss can be fatal to the baby
  • requires emergency c-section
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44
Q

placenta previa

A
  • the placenta lies in the way of the cervical opening
  • can easily bleed (generally after 20 weeks of gestation)
  • can be complete: the placenta fully covers the internal os
  • partial: only partially covers the cervial os
  • as the uterine cavity grows it can cause damage to the blood vessels in the placenta - causes painless bright red bleeding
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45
Q

what is placenta accreta

A

a complication of placenta previa
when the placenta joins with the myometrium and cannot seperate
- requires c-section

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46
Q

common cause of still births?

A

reduced foetal movements
these need to be monitored closely

how?:

checke fluid around the baby as this is a clear indication of blood supply to baby
to cardiograph - check oxygen levels in baby

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47
Q

what is pre-eclampsia

A

specific to pregnancy
increased blood pressure AND protein urea

  • affects multiple organs
  • raised ALT
  • eGFR goes down
  • Increased creatinine
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48
Q

what is HELLP syndrome

(hemolysis, elevated liver enzyme levels, and low platelet levels)

A

complication of pre-eclampsia
- can cause nausea and vomiting
- cannot be fully treated until the placenta is there
- it goes away when the placenta is delivered
- beta-blockers and CCBs are given to manage the hypertension
- don’t give too much fluid to the mum as it can make the hypertension worse

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49
Q

which antihypertensives are given to mothers during pregnancy?

A

beta blockers
CCBs

other hypertension drugs can cause hard to the foetus

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50
Q

what is gestational diabetes?

A
  • diabetes that comes along with pregnancy
  • can be due to mum being overweight and not physically active
  • the raised blood sugars in the mum can cross the blood into the baby
  • the increased blood sugars in the babies blood can cause increased amounts of insulin to be produced
  • insulin is a growth hormone and causes babies to grow really fat and large
  • this increases the chances of shoulder dystocia as the baby is large
  • higher risk of still birth
  • this also means that the babies pancreas gets used to producing so much insulin which increases tolerance, can cause child to develop diabetes when they are born
  • baby can also get hypoglycaemia
  • gestational diabetes goes away after delivery, so any anti-diabetic drug that is given to mum during pregnancy should be taken off
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51
Q

pre-labour rupture of membranes - what is it

A

this is when there is rupture of the membranes in the uterus but labour doesn’t follow

  • it generally happens after 37 weeks
  • when this happens - always check for infection as this can be dangerous
  • if there is no infection then just try and induce labour and get the baby out as fast as possible
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52
Q

what should fundal height in babies be?
how do you work it out

A

fundal height should be 1cm above or below the number of weeks

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53
Q

what is an inevitable miscarriage

A
  • heavy uterine bleeding
  • painful
  • cervical os is open
  • explosion of the embryo up to 24 weeks

it is ‘inevitable’ that the foetus will be lost

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54
Q

what is threatened miscarriage

A
  • mild bleeding symptoms
  • generally happens in 6-9 weeks
  • cervical os is closed so the foetus is contained within the uterine cavity
  • little or no pain
  • there is the THREAT that a miscarriage will happen but not too sure
55
Q

what is a complete miscarriage

A
  • when the interuterine pregnancy has fully miscarried
  • all products of the conception have expelled and the uterus is empty
  • so the os will be closed
  • there would have been pain and bleeding prior to this
56
Q

what is a missed miscarriage

A
  • there is still some foetus tissue in the uterus but the foetus is no longer alive
  • cervical os is closed
  • ‘missed’ because the mother is not able to tell that something has happened
57
Q

what is a septic miscarriage

A
  • the products of conception are still inside the uterus
  • this is can get infected and get septic
  • mother can get sepsis
  • but the mother will have symptoms of fever etc
58
Q

group B septococcus infection in mother who is pregnant - what are the risks

A
  • this bacteria lives in the gut and many mothers are carries
  • there is the risk of giving the infection to the baby during delivery
  • so prophylaxis is given to the mother during delivery
  • so intrapartum prophylaxis
  • give penicillin
  • vancomycin if mother is allergic to penicillin
59
Q

what is bacterial vaginosis

A
  • happens when there is an imbalance in PH
  • gives a fishy odour
  • green/yellow/copper discharge

give metronidazole

60
Q

what is candial thrush

A

can get it due to diabetes/combined pill/anitbotics and pregnancy

  • white spots on the genital area or mouth
  • white curd like discharge
  • can be due to frequent washing and sex
  • if post menopausal women get it then it means they have diabetes
  • treat with fluconazole
61
Q

uvuodynia

A

painful vulva

62
Q

what is lichen planus

A

chronic skin condition
plain purple papules
very itchy
happens in the ankles and wrists

63
Q

what is done in shoulder dystocia?

A

McRobert’s manoeuvre

-bring mothers legs into hyperflexion, into the abdomen
- this releases pressure from the shoulders

64
Q

what is the most common gynaecological cancer

A

endometrial cancer
1 in 41 women
incidence has increased - increase in obesity
and ageing population
causes 26% deaths

65
Q

what is the most common type of cervical cancer

A

squamous cell carcinoma

in the transformation zone - where the cells transform from glandular to squamous

66
Q

risk factors of cervical cancer

A

HPV
most common type 16 and 18

genital warts are caused by 6 and 11

multiple sexual partners
smoking - weakens immune system
lower income
those on immunosuppressent meds
COCP

67
Q

what is cervical intraepithelial neoplasia

A

CIN 1, 2 and 3 - stages of the HPV virus and the cancer

68
Q

presentation of cervical cancer

A

abnormal bleeding (after sex)
abnormal discharge
bleeding after urine or poo
leg oedema
white and red patches on the cervix

69
Q

if smear is HPV positive but cytology negative?

A

do another screening in one year

70
Q

if HPV and cytology is positive

A

do colposcopy

71
Q

staging of cervical cancers

A

stage 1 - a: 4mm or smaller b: larger than 4mm
stage 2 - grown to the top part of the vagina

72
Q

common type of ovarian cancer

A

epithelial cancer - serous is the most common type

73
Q

risk factors for ovarian cancer

A

BRCA 1 gene
lyches disease
smoking
HRT

protective factors - COCP and breast feeding

74
Q

presentation of ovarian cancer

A
  • abdo discomfort
    ascites
    weight loss
    fatigue
    bloating
    uringe urgency and frequency

diagnosis happens a lot later

75
Q

investigations for ovarian cancer

A

AFP
ca 125

76
Q

staging for ovarian cancer

A

Figo staging

stage 1a - cancer is in the ovaries
1b - it is in both the ovaries
1c - a bit further than that

2 - spread to the bowel or bladder

3 - in the abdo
in the peritoneum
lymph nodes

4 - spread to other organs

77
Q

endometrial cancer

A

very fast detection of it
- removal of the uterus cures the cancer

78
Q

most common type of endometrial cancer

A

adenocarcinoma

79
Q

types of endometrial cancers

A

type 1 - oestrogen dependent
type 2 - oestrogen independent

80
Q

risk factor for endometrial cancer

A

nulliparous
obesity
hyperplasia
PCOS

81
Q

presentation of endometrial cancer

A

post menopausal bleeding !!!!
2ww

82
Q

staging of endometrial cancer

A

1 - cancer has grown into muscle wall/halfway into the muscle wall
2 - grown into cervix (take out uterus to treat this)
3 - spread to ovaries and vagina
4 - other organs

83
Q

vaginal cancer

A

squamous cell carcinoma
- posterior wall of the upper third of the vagina

84
Q

presentation of vaginal cancer

A

bleeding
abnormal discharge

refer for colposcopy
examine and vulva

treatment - depends on stage of the cancer
radio/chemo

85
Q

vulvar cancer

A

very rare

squamous cell
melanoma can happen in the vulva
labia majora - happens here
lichen scleoris - this can cause vulvar cancer

86
Q

which twin pregnancy carries the greatest risk

A

monochronioinic-monoamniotic twins

  • these twins share the same amniotic sac and placenta but with two seperate umbilical cords

greater risk of entanglement and spreading syndrome from one twin to another

87
Q

uterine rupture in labour

A

presents with sudden abdo pain and loss of contractions and history of foetal distress makes this diagnosis likely

in this case - emergency c-section should be done - laparotomy

88
Q

GBS infection in babies

A

babies can get infected with this during delivery as the bacteria (group b step) lives in the genitals of the mother

  • causes respiratory distress in neonates
89
Q

what is lichen sclerosus

A

inflammatory skin condition that affects genitals and anal area
causes itchiness, pain during sex and white patches

treat with topical corticosteroids

if left untreated, it can cause vulvar cancer

90
Q

what is an imperforate hymen

A

when the hymen blocks the entrance to the vagina
in young girls it can mean that their period blood is not able to leave the vagina but instead builds up

  • this can cause bloating
    -blue, bulging mass that is protruding
91
Q

what are the best analgesics for Dysmenorrhoea ?

A

NSAIDs like ibuprofen or mefenamic acid

92
Q

painless bleeding post sex - most common cause

A

ectropion
- common in women taking hormonal contraceptive

93
Q

medication given to induce pregnancy?

A

prostaglandin

94
Q

medication given to delay delivery?

A

tocolysis

BUT DO NOT:
- give before 24 weeks
- use after 33 weeks
- do not give in pre-eclampsia
or placental abruption
or if mother is infected

95
Q

what is gestational trophoblastic disease

A

Gestational trophoblastic disease is a rare complication of pregnancy in which trophoblastic cells of the placenta invade the uterine wall and become cancerous. Gestational trophoblastic disease is characterised by very high serum hCG concentrations, and hyperemesis gravidarum is commonly seen.

96
Q

hormone levels in menopause

A

progesterone and oestrodiol production is reduced and FSH and LH production is increased

97
Q

for what purpose in oxytocin given after labour

A

it is given if the mother has a risk of post partum haemorrhage
it helps contract the uterus and prevent bleeidng

98
Q

what test is done to determine how much anti-D immunoglobulin is required to Give to the mother

A

it is the Kleihauer test
it is done in a rhesus negative woman to know how much anti-D antibody she requires before another pregnancy

99
Q

polyhydrominnos is a risk for?

A

oesophageal atresia because too much amniotic fluid poses a risk to the foetus swallowing the fluid

  • makes it more likely to get infections and other abnormalities
100
Q

what is Obstetric Cholestasis

A

it is an issue where the liver produces too many bile salts
this can make the patient very ithy

101
Q

first line for morning sickness

A

anti-histamine - promethazine

102
Q

what is the purpose of cervical cancer screening - what is it testing for?

A

it is testing for high risk HPV virus and if this returns abnormal then test for abnormal cytology is done

25-64 years

103
Q

management of stress incontinece

A
  1. pelvic floor excises
  2. surgery - mid urtheral tape
    or duloxetine if they don’t want surgery
104
Q

management of urge incontinence

A
  1. bladder retainment - so fluids that don’t irritate the blader
  2. oxybutynin
105
Q

what are some physiological changes found in pregnancy?

A

increased ventilation
increased RBC count

106
Q

what is the pathology of haemolytic disease in pregancy

A

Haemolytic disease of the newborn is an alloimmune condition that develops due to the maternal production of IgG Ab against fetal red blood cells.

107
Q

what are the symptoms of gonnorrhea

A
  • rectal pain
  • green discharge
  • one of the causes behind PID
  • gram-negative diplococci,
  • abnormal bleeding
  • dysuria in men.
    The discharge comes from the Bartholin’s gland
  • and managed by ceftriaxone
108
Q

What are the symptoms of chlamydia?

A
  • Chlamydia is an STI caused by Chlamydia trachomatis bacteria.
  • Men may experience clear or cloudy discharge from the penis with a foul odor or watery/milky color.
  • Women may experience thin, watery, yellow or green vaginal discharge with an unusual odor.
  • Additional symptoms may include pain or burning during urination, testicular pain or swelling in men, lower abdominal pain, pain during intercourse, or bleeding between periods in women.
  • Some individuals may have mild or no symptoms, so testing is important for diagnosis.
  • If left untreated, chlamydia can lead to serious health problems such as pelvic inflammatory disease, infertility, and increased risk of HIV transmission.

managed with doxycycline

109
Q

what are the symptoms of trichomonias

A

sexual STD
yellow discharge
burning after urination

manage with metronidazole

110
Q

What are the symptoms of candiadis

A

It is common in pregnancy,

causes: dysuria, redness, and swelling, white, white spots on mouth that can be wiped away

curdd like discharge

managed with fluconazole.

If postmenopausal women presents with candy it is, then most likely she has diabetes.

111
Q

What are the symptoms of bacterial vaginosis?

A

A grey/brown discharge with the fishy odour, foul-smelling manage with clindamycin or metronidazole

112
Q

What is atrophic vaginitis

A
  • Atrophic vaginitis - low estrogen levels in the body, thinning and drying of the vaginal walls.
  • symptoms - vaginal dryness, itching, burning, pain during intercourse, and vaginal discharge
  • Treatment options - vaginal lubricants or moisturizers, estrogen therapy, or low-dose vaginal estrogen.
113
Q

what kind of environment does atrophic vaginitis cause in the vagina

A

creates alkaline environment which is prone to infection

oestrogen causes acidic environment which protects against infection

114
Q

what is the process for cervical smears and referalls

A

1, if smear is normal then no further test
2. if smear shows risk of high risk HPV then do cytology
3. if cytology shows normal - then come back again in 6 months
4. if cytology shows dyskaryosis and high risk HPV then refer for colonoscopy

115
Q

what is Chorioamnionitis

A

It is an infection of the amniotic fluid in pregnant women, which can cause severe pain, fever and abdominal tenderness. It can also cause increased fetal heart rate.

Give antibiotics or deliver baby

The major risk factor for this condition is premature rupture of membranes

116
Q

What is a molar pregnancy?

A

This is when an empty egg is fertilised by sperm, much than duplicates forming 46 paternal chromosomes.

This then grows and becomes a benign tumour like mass.

Complete molar pregnancy. There is no fetus and only the placenta grows and becomes a mass in partial molar pregnancy put the fetus and the placenta grow abnormally.

117
Q

presentation of molar pregnancy

A

Severe morning sickness, bleeding in the first trimester

uterus large for dates - the size of the uterus is larger than normal at that stage
very high levels of HCG hormone

118
Q

What is endometriosis characterised by?

A

deep dyspareunia and pain on defecation
vague pelvic pain
cyclical with periods
periods are still regular

119
Q

what condition causes hypergonadotropic hypogonadism?

A

Hypergonadotropic hypogonadism is a failure of the gonads to respond to gonadotropins secreted by the anterior pituitary gland.

  • gonads (ovaries or testes) do not develop properly - low sex steroid levels, even though LH and FSH is high,
  • these are released by the anterior pituitary gland as part of a feedback response
  • The elevated levels of LH and FSH are an attempt to stimulate the underdeveloped gonads to produce sex hormones, but the gonads do not respond properly
  • In females - causes primary amenorrhea, underdeveloped breasts, and infertility

In males - cause delayed puberty, underdeveloped testes, and infertility

Treatment options for gonadal dysgenesis may include hormone replacement therapy, surgery to remove the underdeveloped gonads, or assisted reproductive technologies.

120
Q

how much folic acid should be taken by women who are trying to conceive

A

400micrograms daily for 3 months before conception - take it until 12 weeks of pregnancy

121
Q

what is the most common cause of post partum haemorrhage

A

Atony of the uterus - normally after childbirth the uterus contracts and goes back to the size, it was before, but in this condition, the uterus does not do that which can cause bleeding

122
Q

other causes of postpartum haemorrhage

A

Tone (uterine atony): the vast majority of cases
Trauma (e.g. perineal tear)
Tissue (retained placenta)
Thrombin (e.g. clotting/bleeding disorder)

123
Q

Management of postpartum haemorrhage

A

IV oxytocin: slow IV injection followed by an
IV infusion ergometrine slow IV or IM (unless there is a history of hypertension)

124
Q

What is the mechanism of action of anastrozole?

A

It is an aromatase inhibitor which inhibits peripheral oestrogen synthesis

125
Q

jaundice in the new born

A

Jaundice appearing within 24 hours of age;
Haemolytic disease of the newborn
Infections
G6PD deficiency

Jaundice appearing between 24-72 hours;
Physiological
Sepsis
Polycythaemia

Jaundice appearing after 72 hours
Extrahepatic biliary atresia
Sepsis
Congenital hypothyroidism
Breastfeeding

126
Q

what is the common cause of prolonged jaundice in new borns

A

breastfeeding

127
Q

what deficiency is associated with neural tube defects

A

folic acid

128
Q

Causes of folic acid deficiency

A

phenytoin
methotrexate
pregnancy
alcohol excess

129
Q

Which combination of maternal and fetal Rh statuses would pose a risk of Rhesus disease?

A

Rh negative Mum and RH positive baby

130
Q

What is one of the rest of a molar pregnancy?

A

Choriocarcinoma

131
Q

recurrent nose bleeds, and heavy periods is associated with what condition

A

von Hillebrands disease - if suspected then do clotting screen

132
Q

which contraceptive pill can be used while breast feeding

A

progesterone only pill

133
Q

what is associated with uterine fibroids

A

enlarged uterus, heavy periods
infertility

AMK (27 decks)

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