Obs & Gynae 🤰🏽 Flashcards
1
Q
how many categories of perineal tears are there
A
4
2
Q
describe category 1 perineal tear
A
first degree tear
tear limited to superficial perineal skin or vaginal mucosa only
3
Q
describe category 2 perineal tear
A
second degree tear
tear extends to perineal muscles and fascia but anal sphincter is intact
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
5
Q
describe category 4 perineal tear
A
fourth degree tear
Perineal skin, muscle, anal sphincter and anal mucosa are torn
6
Q
describe category 4 perineal tear
A
fourth degree tear
Perineal skin, muscle, anal sphincter and anal mucosa are torn
7
Q
describe category 4 perineal tear
A
fourth degree tear
Perineal skin, muscle, anal sphincter and anal mucosa are torn
8
Q
mx of shoulder dystocia
A
immediately call for help
first line is McRoberts manoeuvre
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
10
Q
second line manoeuvres for shoulder dystocia
A
Wood’s screw manoeuvre
Rubin manoeuvre II
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
12
Q
what is cleidotomy
A
fracturing the fetal clavicle
13
Q
what is symphysiotomy
A
cutting the pubic symphysis
14
Q
what is the zavanelli manoeuvre
A
replacement of the head into the canal and then subsequent caesarean
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.
16
Q
oligohydramnios
A
lower than normal volume of amniotic fluid
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
18
Q
pathophysiology of cervical ectropion
A
columnar epithelium of cervix extends out into ectocervix so its more fragile and prone to bleeding
19
Q
how would cervical ectropion present on examination
A
red velvet halo appearance
20
Q
how would cervical ectropion present clinically
A
post-coital bleeding
increased vaginal discharge
dyspareunia
21
Q
mx cervical ectropion
A
self resolve
but can be cauterised with silver nitrate or cold coagulation
22
Q
when should a woman attend cervical screening
A
every 3 years when ages 25-49
then every 5 years aged 50-64
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
24
Q
how does cervical cancer present
A
mostly asymptomatic
post-coital bleeding
25
what investigations would you perform for a cervical cancer case
colposcopy to confirm
CT/MRI/PET for staging
26
investigations to perform for PCOS
LH - raised
LH:FSH ratio - raised
testosterone - raised
transvaginal USS shows a string of pearls
27
mx of PCOS
weight loss
mirena coil/COCP/cyclical progestogens
28
what is ovarian torsion
ovary twists in relation to surrounding connective tissue, Fallopian tube and blood supply
29
how does ovarian torsion present clinically
sudden onset severe unilateral pelvic pain that is constant and progressively worse
associated nausea and vomiting
localised tenderness and palpable mass
30
what ix do you want to do with ovarian torsion
transvaginal USS which will show a whirlpool sign
31
mx of ovarian torsion
laparoscopic surgery for definitive diagnosis
32
complications of ovarian torsion
loss of ovary function if mx is not prompt
may become necrotic and lead to abscess/sepsis
rupture may lead to peritonitis/adhesions
33
how do ovarian cysts present clinically
pelvic pain
bloating
fullness in abdomen
possible pelvic mass
34
ix to perform for ovarian cysts
pelvic USS
35
mx of ovarian cysts - not including pre or post menopausal women
order tumour markers + assess malignancy
under 40 - no further diagnosis
surgical intervention
36
mx of ovarian cysts - pre-menopausal women
<5cm - resolves
5-7 - refer to gynae for annual USS
>7cm - MRI scan or surgical evaluation
37
mx of ovarian cysts - post-menopausal women
raised CA125 need 2ww
simple cyst <5cm need USS every 4-6 months + CA125 monitoring
38
if a non immune pregnant women encounters varicella zoster virus < 20 weeks what do you do
give VZV Ig prophylaxis as this encounter could have teratogenic effects
39
if a non immune pregnant women encounters varicella zoster virus > 20 weeks what do you do
give oral aciclovir
40
how is congenital toxoplasmosis spread
toxoplasma gondii - cat faeces
41
intracranial calcification
hydrocephalus
chorioretinitis
features of congenital toxoplasmosis
42
how to treat congenital toxoplasmosis - first trimester
spiramycin
43
how to treat congenital toxoplasmosis - after 18 weeks
triple therapy
pyrimethamine
sulfadiazine
folinic acid
44
placenta accreta
placenta Attaching to myometrium
45
placenta increta
placenta Into the myometrium
46
placenta percreta
placenta PERforating through myometrium and reaching uterine serosa
47
mx of adherent placenta (intreat,accreta,percreta)
elective c-section between 35-36+6 weeks gestation
48
tx of post partum haemorrhage
ABCDE approach + insert 2 large bore cannulas + FBC
uterine massage + IV oxytocin
49
what is HELLP syndrome
combination of features which occurs as a complication of pre-eclampsia and eclampsia
Haemolysis
Elevated Liver enzymes
Low Platelets
50
sx of acute fatty liver in pregnancy
jaundice
headache
hypoglycaemia
51
ix acute fatty liver in pregnancy
raised ALT, AST, bilirubin, WBC
low platelets
52
features of acute fatty liver of pregnancy
rapid accumulation of fat within hepatocytes
usually occurs in 3rd trimester/immediately after delivery
53
features of cholestasis in pregnancy
reduced outflow of bile acids leading to build up of bile acids - pruritus
common in south asians
develops in later pregnancy
54
sx of cholestasis of pregnancy
jaundice + pruritus + pale greasy stool
55
ix cholestasis pregnancy
raised ALT, AST, GGT, bilirubin + bile acids
56
tx cholestasis pregnancy
ursodeoxycholic acids
induce at 37 weeks
57
indications for induction of labour
41-42 weeks
PROM
pre-eclampsia
58
firs line for induction of labour
membrane sweep
59
what is an umbilical cord prolapse
umbilical cord descends below the presenting part of foetus and through the cervix into the vgaina after rupture of fetal membranes
60
mx of umbilical cord prolapse
obstetric emergency
push presents part of foetus back into uterus
ask mother to go on all fours until c-section §
61
what is a bartholin gland cyst
refers to cystic dilation of one of the greater vestibular glands due to obstruction
62
what are bartholin glands
a paired structure located in the vulva
they produce a mucus fluid involved in vulval and vaginal lubrication
63
who do bartholin gland cysts most commonly affect
sexually active women
not children - not developed properly or older women due to menopause causing atrophy of the glands
64
what is bartholin gland cysts clinically characterised by
painless swelling in the vulva
65
what are the clinical features associated with bartholin gland cyst
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
clinical features associated with bartholin gland abscess
painful swelling
surrounding erythema
fluctuant soft painful mass
67
mx of bartholin gland cysts
depends on size
<3cm - warm compresses or baths
>3cm or abscess - surgical incision and drainage
68
what is the most likely organism to cause a bartholin gland cyst
Escherichia Coli
69
what virus is the most co moon cause of cervical cancer
HPV specifically HPV 16 and 18
70
what is the most common type of cervical cancer
squamous cell carcinoma
71
what should prompt you to refer women on 2ww suspected cervical cancer pathway
unexplained cervical sx
postmenopausal bleeding - if not on HRT
persistent premenopausal bleeding or blood-stained discharge
72
stage 1a cervical cancer
invasive carcinoma <5mm
73
stage 1b cervical cancer
invasive carcinoma >5mm
74
stage 2a cervical cancer
involvement limited to upper 2/3 of vagina w/o parametrial involvement
75
stage 2b cervical cancer
upper 2/3 of vagina with parametrial involvement
76
stage 3a cervical cancer
lower third of vagina no extension to pelvic wall
77
stage 3b cervical cancer
extension to pelvic wall and/or causes hydronephrosis or non-functioning kidney
78
stage 3c cervical cancer
involvement of pelvic and/or para-aortic lymph nodes
79
stage 4a +b cervical cancer
a - spread to adjacent pelvic organs
b- spread to distant organs
80
mx of cervical cancer stage 1
1A - Large loop excision of the transformation zone (LLETZ) or knife cone biopsy can be used.
81
mx of cervical cancer stage 1a2-2a
modified radical hysterectomy with lymphadenectomy <4cm
for over 4cm - chemo radiation
82
mx cervical cancer stage 2b-4a
chemoradiation
83
mx cervical cancer stage 4b
chemotherapy, single-agent therapy and palliative radiotherapy may all be used
84
cervical smears should be delayed until 3 months after?
birth
miscarriages
terminations
85
what is CIN
cervical intraepithelial neoplasia refers to pre-malignant cervical dysplasia
epithelial lesions that may progress to cancer
86
how many types of CIN are
3
87
what's the mx if CIN 1 is found
repeat review in 12 months
88
what the mx if CIN 2 is found
may resolve but as risk of cancer is increased removal if indicated
89
mx if CIN 3 is found
removal
knife cone biopsy, laser conisation, large loop excision of the transformation zone (LLETZ), l and cryocautery
90
clinical features of ectopic pregnancy
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
sx ectopic pregnancy - more severe side
abdominal/pelvic pain
vaginal bleeding
amenorrhoea
shoulder tip pain
urinary discomfort
GI upset
92
ix ectopic pregnancy
transvaginal USS
93
first line mx for uterine fibroid <3cm
IUS Mirena
94
what can cause a post partum haemorrhage
the four Ts
Tone
Trauma
Tissue
Thrombin
95
Foetal complications of polyhydramnios
Umbilical cord prolapse
Preterm labour and delivery
PROM
Placental abruption
Malpresentation of foetus
96
What is chandeliers sign
Informal name for cervical excitation
Cervical excitation is a sign of inflammation of pelvic organs and/or peritoneum
Most commonly presents in PID
97
What factors makes a woman eligible for screening for gestational diabetes and should be offered an OGTT at 26-28 weeks
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
what does APGAR score stand for
activity
pulse
grimace
appearance
respiratory effort
99
when is the APGAR score calculated
at 1 and 5 minutes of life
100
how many categories of Caesarean section are there
4
101
describe each category of c-section
cat 4 - elective
cat 3 - scheduled
cat 2 - urgent not immediately life threatening
cat 1 - emergency life threatening
102
contraindications for vaginal delivery post Caesarean
classical vertical c-section scar
previous history of uterine rupture
103
risk factors for neonatal GBS infection
positive GBS culture in current or previous pregnancy
previous birth resulting in GBS infection
pre-term labour
PROM
intrapartum fever
chorioamnionitis
104
mx GBS
intrapartum antibiotic prophylaxis (couple of hours before delivery)
antibiotics are given IV during labour and delivery if risk factors present
usually penicillin
105
how would a neonatal group b infection present
neonatal sepsis
pneumonia
meningitis
106
what are the risk factors for thromboprophylaxis and how many does someone need to be started on LMWH?
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
most common type of vulval cancer
squamous cell carcinoma
90%
108
with ectopic pregnancies when is surgical management preferred (salpingectomy)
pt is in a lot of pain
mass is >35mm
USS identifies heartbeat
B-hCG levels are over 5000 IU/L
109
features of fibroids
more common in afro-caribbean women
present with:
menorrhagia
lower abdo pain
infertility
+ compressive sx which include urinary frequency, pedal oedema and constipation
110
treatment of fibroids
LNG-IUS 1st line
contraindicated if patient has large fibroids that make insertion hard
second line - COCP
111
risk factors for endometrial cancer
exposure to unopposed oestrogen leads to an increased risk :
nulliparity
obesity
early menarche
late menopause
polycystic ovary syndrome
oestrogen-only hormone replacement therapy
112
what test and when should it be carried out for a pt to check infertility
serum progesterone test 7 days before the end of the cycle at peak luteal level
113
When is the first dose of anti-D prophylaxis administered to rhesus negative women?
28 weeks
114
How does PCOS present
Oligomenorrhoea
Sub fertility
Acne
Hirsuitism
Obesity
Mood swings
Male pattern baldness
115
Rotterdam criteria for PCOS
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
2 types of combined HRT and when are they used
Cyclical - perimenopausal women who are still having menstrual periods
Continuous - for post menopausal women who are not having menstrual periods
117
When is combined HRT indicated
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
Vasomotor symptoms of menopause
Hot flushes
Night sweats
119
Cognitive and psychological symptoms of menopause
Depression
Anxiety
Mood swings
Lethargy
Reduced concentration
120
Urogenital symptoms of menopause
Vaginal dryness
Reduced libido
Problems with orgasm
Dyspareunia
121
Risks of oral HRT
increased risk of breast and endometrial cancer
Increased risk of venous thromboembolism
122
Clinical features of endometriosis
Dysmenorrhea
Dyspareunia
Subfertility
Young female with dysmenorrhea and Dyspareunia with normal sized uterus and normal speculum exam
123
Medical management of endometriosis
Analgesia first line
Hormonal therapies e.g COCP
124
Investigations for endometriosis
Trans vaginal ultrasound
GOLD STANDARD is diagnostic laparoscopy
125
What is Pelvic inflammatory disease
Occurs when infection spreads from vagina through into the cervix and then into the upper genital tract
Spread sexually
126
Causes of PID
chlamydia most common
127
Clinical features of PID
Bilateral abdo pain
Discharge
Post coital bleeding
Fever
Cervical motion tenderness on bimanual exam
Adnexal tenderness
128
Investigating PID
Pelvic exam
Pregnancy test
Swabs for gonorrhoea and chlamydia
Bloods
Transvaginal USS
129
Management of PID
Analgesia
IM ceftriaxone, oral doxycycline and oral metronidazole
130
Fitz-Hugh-Curtis syndrome features
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
What are fibroids
Benign smooth muscle tumours of the myometrium of the uterus
Incidence increased with age peak being in women in their 40s
132
Presentation of fibroids
Often asymptomatic
Menstrual dysfunction
If large enough interfere with fertility
If large may be palpable
Pelvic exam may reveal irregularly emlarged uterus
133
Non-surgical management of fibroids (<3cm)
NSAIDs
Anti-fibrinolytics
Combined hormonal contraception
Mirena coil - FIRST LINE depending on patients wishes of fertility
134
What is atrophic vaginitis
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
Clinical features (presentation) of atrophic vaginitis
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
Treatment of atrophic vaginitis
Vaginal lubricants
137
Clinical presentation of ovarian cancer
Abdo discomfort
Bloating
Early satiety
Urinary frequency
Change in bowel habits
138
MOA of misoprostol
prostaglandin analog that causes uterine contractions
