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Clinical Medicine > Obs & Gynae 🤰🏽 > Flashcards

Obs & Gynae 🤰🏽 Flashcards

1
Q

how many categories of perineal tears are there

A

4

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2
Q

describe category 1 perineal tear

A

first degree tear
tear limited to superficial perineal skin or vaginal mucosa only

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3
Q

describe category 2 perineal tear

A

second degree tear
tear extends to perineal muscles and fascia but anal sphincter is intact

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4
Q

describe category 3 perineal tear

A

third degree tear
split into 3 subcategories :
3a: less than 50% of the thickness of the external anal sphincter is torn
3b: more than 50% of the thickness of the external anal sphincter is torn, but the internal anal sphincter is intact
3c: external and internal anal sphincters are torn, but anal mucosa is intact

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5
Q

describe category 4 perineal tear

A

fourth degree tear
Perineal skin, muscle, anal sphincter and anal mucosa are torn

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6
Q

describe category 4 perineal tear

A

fourth degree tear
Perineal skin, muscle, anal sphincter and anal mucosa are torn

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7
Q

describe category 4 perineal tear

A

fourth degree tear
Perineal skin, muscle, anal sphincter and anal mucosa are torn

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8
Q

mx of shoulder dystocia

A

immediately call for help
first line is McRoberts manoeuvre

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9
Q

describe the McRoberts manoeuvre

A

hyperflex maternal hips (knees to chest position) and tell the patient to stop pushing

may be accompanied with applied suprapubic pressure

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10
Q

second line manoeuvres for shoulder dystocia

A

Wood’s screw manoeuvre
Rubin manoeuvre II

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11
Q

does episiotomy help with shoulder dystocia

A

it will not relieve it as it is a bony obstruction but may be indicated to allow space for internal manoeuvres

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12
Q

what is cleidotomy

A

fracturing the fetal clavicle

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13
Q

what is symphysiotomy

A

cutting the pubic symphysis

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14
Q

what is the zavanelli manoeuvre

A

replacement of the head into the canal and then subsequent caesarean

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15
Q

clinical features of shoulder dystocia

A

Difficulty in delivery of the fetal head or chin.

Failure of restitution – the fetal remains in the occipital-anterior position after delivery by extension and therefore does not ‘turn to look to the side’.

‘Turtle Neck‘ sign – the fetal head retracts slightly back into the pelvis, so that the neck is no longer visible, akin to a turtle retreated into its shell.

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16
Q

oligohydramnios

A

lower than normal volume of amniotic fluid

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17
Q

oligohydramnios complications

A

clubbed feet, facial deformity and congenital hip dysplasia

underdevelopment of the lung can result in pulmonary hypoplasia

combination of the above = potter syndrome

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18
Q

pathophysiology of cervical ectropion

A

columnar epithelium of cervix extends out into ectocervix so its more fragile and prone to bleeding

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19
Q

how would cervical ectropion present on examination

A

red velvet halo appearance

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20
Q

how would cervical ectropion present clinically

A

post-coital bleeding
increased vaginal discharge
dyspareunia

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21
Q

mx cervical ectropion

A

self resolve
but can be cauterised with silver nitrate or cold coagulation

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22
Q

when should a woman attend cervical screening

A

every 3 years when ages 25-49
then every 5 years aged 50-64

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23
Q

risk factors for cervical cancer

A

early first sexual intercourse
many sexual partners
COCP use
smoking
HIV
family history
missed screening
high parity

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24
Q

how does cervical cancer present

A

mostly asymptomatic
post-coital bleeding

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25
Q

what investigations would you perform for a cervical cancer case

A

colposcopy to confirm
CT/MRI/PET for staging

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26
Q

investigations to perform for PCOS

A

LH - raised
LH:FSH ratio - raised
testosterone - raised
transvaginal USS shows a string of pearls

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27
Q

mx of PCOS

A

weight loss
mirena coil/COCP/cyclical progestogens

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28
Q

what is ovarian torsion

A

ovary twists in relation to surrounding connective tissue, Fallopian tube and blood supply

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29
Q

how does ovarian torsion present clinically

A

sudden onset severe unilateral pelvic pain that is constant and progressively worse
associated nausea and vomiting
localised tenderness and palpable mass

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30
Q

what ix do you want to do with ovarian torsion

A

transvaginal USS which will show a whirlpool sign

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31
Q

mx of ovarian torsion

A

laparoscopic surgery for definitive diagnosis

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32
Q

complications of ovarian torsion

A

loss of ovary function if mx is not prompt
may become necrotic and lead to abscess/sepsis
rupture may lead to peritonitis/adhesions

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33
Q

how do ovarian cysts present clinically

A

pelvic pain
bloating
fullness in abdomen
possible pelvic mass

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34
Q

ix to perform for ovarian cysts

A

pelvic USS

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35
Q

mx of ovarian cysts - not including pre or post menopausal women

A

order tumour markers + assess malignancy
under 40 - no further diagnosis
surgical intervention

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36
Q

mx of ovarian cysts - pre-menopausal women

A

<5cm - resolves
5-7 - refer to gynae for annual USS
>7cm - MRI scan or surgical evaluation

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37
Q

mx of ovarian cysts - post-menopausal women

A

raised CA125 need 2ww
simple cyst <5cm need USS every 4-6 months + CA125 monitoring

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38
Q

if a non immune pregnant women encounters varicella zoster virus < 20 weeks what do you do

A

give VZV Ig prophylaxis as this encounter could have teratogenic effects

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39
Q

if a non immune pregnant women encounters varicella zoster virus > 20 weeks what do you do

A

give oral aciclovir

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40
Q

how is congenital toxoplasmosis spread

A

toxoplasma gondii - cat faeces

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41
Q

intracranial calcification
hydrocephalus
chorioretinitis

A

features of congenital toxoplasmosis

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42
Q

how to treat congenital toxoplasmosis - first trimester

A

spiramycin

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43
Q

how to treat congenital toxoplasmosis - after 18 weeks

A

triple therapy
pyrimethamine
sulfadiazine
folinic acid

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44
Q

placenta accreta

A

placenta Attaching to myometrium

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45
Q

placenta increta

A

placenta Into the myometrium

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46
Q

placenta percreta

A

placenta PERforating through myometrium and reaching uterine serosa

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47
Q

mx of adherent placenta (intreat,accreta,percreta)

A

elective c-section between 35-36+6 weeks gestation

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48
Q

tx of post partum haemorrhage

A

ABCDE approach + insert 2 large bore cannulas + FBC
uterine massage + IV oxytocin

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49
Q

what is HELLP syndrome

A

combination of features which occurs as a complication of pre-eclampsia and eclampsia
Haemolysis
Elevated Liver enzymes
Low Platelets

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50
Q

sx of acute fatty liver in pregnancy

A

jaundice
headache
hypoglycaemia

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51
Q

ix acute fatty liver in pregnancy

A

raised ALT, AST, bilirubin, WBC
low platelets

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52
Q

features of acute fatty liver of pregnancy

A

rapid accumulation of fat within hepatocytes
usually occurs in 3rd trimester/immediately after delivery

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53
Q

features of cholestasis in pregnancy

A

reduced outflow of bile acids leading to build up of bile acids - pruritus
common in south asians
develops in later pregnancy

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54
Q

sx of cholestasis of pregnancy

A

jaundice + pruritus + pale greasy stool

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55
Q

ix cholestasis pregnancy

A

raised ALT, AST, GGT, bilirubin + bile acids

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56
Q

tx cholestasis pregnancy

A

ursodeoxycholic acids
induce at 37 weeks

57
Q

indications for induction of labour

A

41-42 weeks
PROM
pre-eclampsia

58
Q

firs line for induction of labour

A

membrane sweep

59
Q

what is an umbilical cord prolapse

A

umbilical cord descends below the presenting part of foetus and through the cervix into the vgaina after rupture of fetal membranes

60
Q

mx of umbilical cord prolapse

A

obstetric emergency
push presents part of foetus back into uterus
ask mother to go on all fours until c-section §

61
Q

what is a bartholin gland cyst

A

refers to cystic dilation of one of the greater vestibular glands due to obstruction

62
Q

what are bartholin glands

A

a paired structure located in the vulva
they produce a mucus fluid involved in vulval and vaginal lubrication

63
Q

who do bartholin gland cysts most commonly affect

A

sexually active women
not children - not developed properly or older women due to menopause causing atrophy of the glands

64
Q

what is bartholin gland cysts clinically characterised by

A

painless swelling in the vulva

65
Q

what are the clinical features associated with bartholin gland cyst

A

unilateral painless swelling
if large they may cause discomfort walking, sitting or during sex
also if large can be disfiguring
o/e soft non tender mass - normal gland shouldn’t be palpable

66
Q

clinical features associated with bartholin gland abscess

A

painful swelling
surrounding erythema
fluctuant soft painful mass

67
Q

mx of bartholin gland cysts

A

depends on size
<3cm - warm compresses or baths

> 3cm or abscess - surgical incision and drainage

68
Q

what is the most likely organism to cause a bartholin gland cyst

A

Escherichia Coli

69
Q

what virus is the most co moon cause of cervical cancer

A

HPV specifically HPV 16 and 18

70
Q

what is the most common type of cervical cancer

A

squamous cell carcinoma

71
Q

what should prompt you to refer women on 2ww suspected cervical cancer pathway

A

unexplained cervical sx
postmenopausal bleeding - if not on HRT
persistent premenopausal bleeding or blood-stained discharge

72
Q

stage 1a cervical cancer

A

invasive carcinoma <5mm

73
Q

stage 1b cervical cancer

A

invasive carcinoma >5mm

74
Q

stage 2a cervical cancer

A

involvement limited to upper 2/3 of vagina w/o parametrial involvement

75
Q

stage 2b cervical cancer

A

upper 2/3 of vagina with parametrial involvement

76
Q

stage 3a cervical cancer

A

lower third of vagina no extension to pelvic wall

77
Q

stage 3b cervical cancer

A

extension to pelvic wall and/or causes hydronephrosis or non-functioning kidney

78
Q

stage 3c cervical cancer

A

involvement of pelvic and/or para-aortic lymph nodes

79
Q

stage 4a +b cervical cancer

A

a - spread to adjacent pelvic organs
b- spread to distant organs

80
Q

mx of cervical cancer stage 1

A

1A - Large loop excision of the transformation zone (LLETZ) or knife cone biopsy can be used.

81
Q

mx of cervical cancer stage 1a2-2a

A

modified radical hysterectomy with lymphadenectomy <4cm

for over 4cm - chemo radiation

82
Q

mx cervical cancer stage 2b-4a

A

chemoradiation

83
Q

mx cervical cancer stage 4b

A

chemotherapy, single-agent therapy and palliative radiotherapy may all be used

84
Q

cervical smears should be delayed until 3 months after?

A

birth
miscarriages
terminations

85
Q

what is CIN

A

cervical intraepithelial neoplasia refers to pre-malignant cervical dysplasia
epithelial lesions that may progress to cancer

86
Q

how many types of CIN are

A

3

87
Q

what’s the mx if CIN 1 is found

A

repeat review in 12 months

88
Q

what the mx if CIN 2 is found

A

may resolve but as risk of cancer is increased removal if indicated

89
Q

mx if CIN 3 is found

A

removal
knife cone biopsy, laser conisation, large loop excision of the transformation zone (LLETZ), l and cryocautery

90
Q

clinical features of ectopic pregnancy

A

features may be subtle and non-specific therefore every woman of child bearing age must be offered a pregnancy test when presenting to hospital with an acute complaint

91
Q

sx ectopic pregnancy - more severe side

A

abdominal/pelvic pain
vaginal bleeding
amenorrhoea
shoulder tip pain
urinary discomfort
GI upset

92
Q

ix ectopic pregnancy

A

transvaginal USS

93
Q

first line mx for uterine fibroid <3cm

A

IUS Mirena

94
Q

what can cause a post partum haemorrhage

A

the four Ts
Tone
Trauma
Tissue
Thrombin

95
Q

Foetal complications of polyhydramnios

A

Umbilical cord prolapse
Preterm labour and delivery
PROM
Placental abruption
Malpresentation of foetus

96
Q

What is chandeliers sign

A

Informal name for cervical excitation
Cervical excitation is a sign of inflammation of pelvic organs and/or peritoneum
Most commonly presents in PID

97
Q

What factors makes a woman eligible for screening for gestational diabetes and should be offered an OGTT at 26-28 weeks

A

BMI above 30
Previous macrosomic baby (4.5kg or above)
Previous gestational diabetes
1st degree relative with diabetes
Ethnic origin with high prevalence of diabetes

98
Q

what does APGAR score stand for

A

activity
pulse
grimace
appearance
respiratory effort

99
Q

when is the APGAR score calculated

A

at 1 and 5 minutes of life

100
Q

how many categories of Caesarean section are there

A

4

101
Q

describe each category of c-section

A

cat 4 - elective
cat 3 - scheduled
cat 2 - urgent not immediately life threatening
cat 1 - emergency life threatening

102
Q

contraindications for vaginal delivery post Caesarean

A

classical vertical c-section scar
previous history of uterine rupture

103
Q

risk factors for neonatal GBS infection

A

positive GBS culture in current or previous pregnancy
previous birth resulting in GBS infection
pre-term labour
PROM
intrapartum fever
chorioamnionitis

104
Q

mx GBS

A

intrapartum antibiotic prophylaxis (couple of hours before delivery)

antibiotics are given IV during labour and delivery if risk factors present

usually penicillin

105
Q

how would a neonatal group b infection present

A

neonatal sepsis
pneumonia
meningitis

106
Q

what are the risk factors for thromboprophylaxis and how many does someone need to be started on LMWH?

A

Age > 35
Body mass index > 30
Parity > 3
Smoker
Gross varicose veins
Current pre-eclampsia
Immobility
Family history of unprovoked VTE
Low risk thrombophilia
Multiple pregnancy
IVF pregnancy

3 RFs = LMWH from 28 weeks until 6 weeks post natal
>3 = LMWH immediatley until 6 weeks post natal

107
Q

most common type of vulval cancer

A

squamous cell carcinoma
90%

108
Q

with ectopic pregnancies when is surgical management preferred (salpingectomy)

A

pt is in a lot of pain
mass is >35mm
USS identifies heartbeat
B-hCG levels are over 5000 IU/L

109
Q

features of fibroids

A

more common in afro-caribbean women
present with:
menorrhagia
lower abdo pain
infertility
+ compressive sx which include urinary frequency, pedal oedema and constipation

110
Q

treatment of fibroids

A

LNG-IUS 1st line
contraindicated if patient has large fibroids that make insertion hard
second line - COCP

111
Q

risk factors for endometrial cancer

A

exposure to unopposed oestrogen leads to an increased risk :

nulliparity
obesity
early menarche
late menopause
polycystic ovary syndrome
oestrogen-only hormone replacement therapy

112
Q

what test and when should it be carried out for a pt to check infertility

A

serum progesterone test 7 days before the end of the cycle at peak luteal level

113
Q

When is the first dose of anti-D prophylaxis administered to rhesus negative women?

A

28 weeks

114
Q

How does PCOS present

A

Oligomenorrhoea
Sub fertility
Acne
Hirsuitism
Obesity
Mood swings
Male pattern baldness

115
Q

Rotterdam criteria for PCOS

A

Used to diagnose PCOS when other causes have been excluded if 2 of the following are present

polycystic ovaries
Oligo-/anovulation
Clinical or biochemical findings of hyperandrogenism

116
Q

2 types of combined HRT and when are they used

A

Cyclical - perimenopausal women who are still having menstrual periods
Continuous - for post menopausal women who are not having menstrual periods

117
Q

When is combined HRT indicated

A

Helpful in treating vasomotor, cognitive and urogenital symptoms of menopause

For example if a menopausal lady came in with only urogenital symptoms e.g vaginal dryness and pain you would prescribe vaginal moisturiser and lubricants

118
Q

Vasomotor symptoms of menopause

A

Hot flushes
Night sweats

119
Q

Cognitive and psychological symptoms of menopause

A

Depression
Anxiety
Mood swings
Lethargy
Reduced concentration

120
Q

Urogenital symptoms of menopause

A

Vaginal dryness
Reduced libido
Problems with orgasm
Dyspareunia

121
Q

Risks of oral HRT

A

increased risk of breast and endometrial cancer
Increased risk of venous thromboembolism

122
Q

Clinical features of endometriosis

A

Dysmenorrhea
Dyspareunia
Subfertility

Young female with dysmenorrhea and Dyspareunia with normal sized uterus and normal speculum exam

123
Q

Medical management of endometriosis

A

Analgesia first line
Hormonal therapies e.g COCP

124
Q

Investigations for endometriosis

A

Trans vaginal ultrasound

GOLD STANDARD is diagnostic laparoscopy

125
Q

What is Pelvic inflammatory disease

A

Occurs when infection spreads from vagina through into the cervix and then into the upper genital tract

Spread sexually

126
Q

Causes of PID

A

chlamydia most common

127
Q

Clinical features of PID

A

Bilateral abdo pain
Discharge
Post coital bleeding

Fever
Cervical motion tenderness on bimanual exam
Adnexal tenderness

128
Q

Investigating PID

A

Pelvic exam
Pregnancy test
Swabs for gonorrhoea and chlamydia
Bloods
Transvaginal USS

129
Q

Management of PID

A

Analgesia
IM ceftriaxone, oral doxycycline and oral metronidazole

130
Q

Fitz-Hugh-Curtis syndrome features

A

Occurs when adhesion for, between anterior liver capsule to the anterior abdo wall or diaphragm on a background of PID

Laparoscopy is required for definitive diagnosis

Treatment involves abx

131
Q

What are fibroids

A

Benign smooth muscle tumours of the myometrium of the uterus

Incidence increased with age peak being in women in their 40s

132
Q

Presentation of fibroids

A

Often asymptomatic
Menstrual dysfunction
If large enough interfere with fertility
If large may be palpable

Pelvic exam may reveal irregularly emlarged uterus

133
Q

Non-surgical management of fibroids (<3cm)

A

NSAIDs
Anti-fibrinolytics
Combined hormonal contraception
Mirena coil - FIRST LINE depending on patients wishes of fertility

134
Q

What is atrophic vaginitis

A

Aka vulvovaginal atrophy is characterised by inflammation and thinning of the genital tissues due to a fall in oestrogen levels hence is most common after menopause

135
Q

Clinical features (presentation) of atrophic vaginitis

A

Loss of public hair
Loss of vaginal folds
Vaginal dryness and itching
Dyspareunia
Post coital bleeding
Vaginal discharge
Urinary symptoms

Might not tolerate speculum

136
Q

Treatment of atrophic vaginitis

A

Vaginal lubricants

137
Q

Clinical presentation of ovarian cancer

A

Abdo discomfort
Bloating
Early satiety
Urinary frequency
Change in bowel habits

138
Q

MOA of misoprostol

A

prostaglandin analog that causes uterine contractions

Clinical Medicine (26 decks)

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