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FINALS (all high yield study decks) > Obs, Gynae & sexual health > Flashcards

Obs, Gynae & sexual health Flashcards

1
Q

Describe the process of oocyte maturation

A
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2
Q

Describe the process of sperm development

A
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3
Q

How many days does it take to produce a sperm?

A

64 days

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4
Q

In the male, which cells does LH act upon?

A

LH acts on Leydig cells which make testosterone (negative feedback via testosterone)

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5
Q

In the male, which cells does FSH act upon?

A

FSH acts on Sertoli cells which produce Sperm (negative feedback via Inhibin)

fSh, Sertoli, Sperm

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6
Q

What is a normal sperm count?

A

> 15 million/ ml

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7
Q

What is a normal sperm motility (%)?

A

> 32%

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8
Q

which cells produce oestrogen?

A

Granulosa cells

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9
Q

What stimulates granulosa cells to produce oestrogen?

A

FSH

(F is next to G in the alphabet - Fhs Granulosa)

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10
Q

What produces progesterone?

A

Corpus luteum

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11
Q

What stimulates theca cells?

A

LH

(t and L look similar)

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12
Q

What do theca cells produce?

A

Androgens

thecA Androgens

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13
Q

Which hormone drives the follicular phase?

A

Oestrogen

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14
Q

Which hormone spikes and results in ovulation?

A

LH

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15
Q

Which hormone drives the luteal phase?

A

Progesterone

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16
Q

When in the cycle is the follicular phase?

A

0-14 days

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17
Q

On which day does ovulation occur?

A

14

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18
Q

on which day of the cycle does menstruation start?

A

day 28

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19
Q

List the stages of embryo implantation

A
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20
Q

Which part of the blastocyst forms the baby and which part forms the placents?

A

inner cell mass forms the baby
outer shell of trophoblastic cells forms the placenta

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21
Q

What hormones are needed during embryogenesis to form male genitals?

A

Testosterone and anti-mullerian hormone

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22
Q

Which hormone is needed during embryogenesis to form testes? (bonus points if you remember the gene that encodes it)

A

Testes determining factor produced from the SRY gene

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23
Q

What is
A) Gravidity
B) Parity

A

Gravidity = Total number of pregnancies, including miscarriages and terminations (Grand Total)

Parity = Number of pregnancies that Progressed past 24 weeks

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24
Q

What ultrasound scan sign is associated with - dichorionic/diamniotic twins?

A

lambda sign

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25
Q

What gestation should dichorionic/diamniotic be delivered?

A

37 weeks

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26
Q

What ultrasound scan sign is associated with - Monochorionic/diamniotic twins

A

T sign

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27
Q

What gestation should monochorionic/diamniotic be delivered?

A

36 weeks

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28
Q

What gestation should triplets be delivered?

A

35 weeks

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29
Q

What happens to insulin in pregnancy and why?

A

Insulin deficiency occurs due to human placental lactogen

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30
Q

What happens to iodine levels during pregnancy?

A

Iodine levels fall causing an iodine deficiency

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31
Q

what happens to the immune system during pregnancy?

A

Immunosuppression (to tolerate the baby!)

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32
Q

Name the heart murmur that is normal in pregnancy

A

End diastolic murmur

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33
Q

What happens to systemic vascular resistance in pregnancy?

A

reduces

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34
Q

What happens to blood gas in pregnancy

A

Compensated respiratory alkalosis

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35
Q

Is hydronephrosis in pregnancy normal?

A

Yes

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36
Q

What pathological urine findings are in fact normal in pregnancy?

A

Glycosuria and microscopic haematuria

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37
Q

Should you lie a pregnant woman on the left or on the right?

A

LEFT lateral tilt

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38
Q

When in the pregnancy would you expect to feel foetal movement?

A

> 20 weeks

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39
Q

When is the dating scan carried out?

A

10-14 weeks

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40
Q

What is the purpose of the dating scan?

A

Estimates due date
How many babies are in there
How is baby developing (+ nuchal translucency)?

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41
Q

What else is done at the same time as the 10-14 week scan?

A

Blood screening for rubella, hepatitis B, syphillis, HIV, anaemia, isoimmunisation (anti-D) & genetic screen for chance of downs/edwards/pataus

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42
Q

What happens at the 18-21 week scan?

A

this is the anomaly scan- it is looking for defects

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43
Q

Describe the screening that can be carried out for genetic anomalies such as downs, edwards and pataus and list the gestatation that each can be done at

A
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44
Q

What is the risk of miscarriage with chorionic villous sampling?

A

1:200 (0.5%)

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45
Q

What is the risk of miscarriage with amniocentesis?

A

1:100 (1%)

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46
Q

what is the definition of miscarriage?

A

Foetal loss<24 weeks

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47
Q

What is the definition of chronic/essential hypertension?

A

Hypertension present pre-pregnancy or ≤ 20 weeks gestation

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48
Q

What is the definition of gestational hypertension?

A

Hypertension present >20 weeks gestation

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49
Q

What is the definition of pre-eclampsia?

A

Hypertension present >20 weeks gestation with proteinuria or end organ malfunction

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50
Q

What is the definition of HELLP syndrome?

A

increased liver enzymes
decreased platelets
haemolysis

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51
Q

How is pre-eclampsia managed?

A

Magnesium sulphate, labetalol, corticosteroids & deliver the baby!)

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52
Q

What is the definition of eclampsia?

A

Pre-eclampsia with seizures

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53
Q

What is the management of eclampsia?

A

Magnesium sulphate, labetalol, corticosteroids & deliver the baby

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54
Q

What is the management of HELLP syndrome?

A

Magnesium sulphate, labetalol, corticosteroids & deliver the baby

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55
Q

What HbA1c should you aim for if you are diabetic and hoping to get pregnant?

A

HbA1c < 6.5% (48)

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56
Q

What sugar level should you aim for if you are diabetic and hoping to get pregnant?

A

4-7

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57
Q

What are the most common bacterial causes of chorioamnionitis?

A

usually E.coli or Group B strep

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58
Q

What are the foetal consequences of chorioamnionitis

A

Neonatal sepsis
Foetal brain damage and death

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59
Q

What are the foetal consequences of chicken pox infection in the 1st 28 weeks of pregnancy

A

Skin scarring, neurological issues, congenital eye disease, limb hypoplasia

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60
Q

What are the foetal consequences of parvovirus infection in the 1st 12-20 weeks of pregnancy

A

Anaemia, cardiac failure, hydrops fetalis & foetal death

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61
Q

What are the foetal consequences of toxoplasmosis infection in the third trimester of pregnancy

A

Hydrocephalus, intracranial calcification, microcephaly, chorioamnionitis, ventriculomegaly, hepatosplenomegaly, IGR, miscarriage, intrauterine death

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62
Q

What are the foetal consequences of HIV infection in pregnancy

A

Pre-eclampsia, miscarriage, pre-term birth, low birth weight.

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63
Q

Can you have a natural birth if you are infected with HIV?

A

Yes, but viral load must be <50 (undetectable viral load) for a safe vaginal birth

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64
Q

What are the foetal consequences of Hep B infection in pregnancy

A

Liver cirrhosis

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65
Q

What is given to HepB +ve mothers to reduce the chances of passing HepB onto the baby?

A

Offer mothers tenofovir monotherapy in 3rd trimester

66
Q

Is hep C problematic in pregnancy?

A

No, birth and breastfeeding are safe. Hep C cannot be treated in pregnancy

67
Q

What are the foetal consequences of syphillis infection in pregnancy

A

Miscarriage, stillbirth, hydrops fetalis, IUGR, congenital infection.

68
Q

When does congential syphillis infection manifest?

A

Any time after birth

69
Q

How does congenital syphillis present in children >2 years old?

A

Hutchinson’s Triad (deafness, interstitial keratitis & widely spaced, peg like teeth).

70
Q

what is the fist line anti-sickness drug in pregnancy?

71
Q

What is the firstline antihypertensive in pregnancy?

72
Q

What anti-epileptic drugs are safe for use in pregnancy?

A

lamotrigine + GIVE FOLIC ACID

73
Q

Which diabetic medications are safe for use in pregnancy?

A

Insulin (T1) or metformin (Gestational/T2DM)

74
Q

Which medication is used to manage thromboembolism in pregany?

75
Q

why is lithium contraindicated in pregnancy?

A

causes epstein’s anomaly

76
Q

what is the medical management of an ectopic pregnancy?

A

Methotrexate

77
Q

What is the surgical management of an ectopic pregnancy?

A

Salpingectomy

78
Q

What is an antepartum haemorrage?

A

Significant blood loss >24 weeks gestation

79
Q

What is the management of an antepartum haemorrage?

80
Q

Breech babies may turn themselves up to ___ weeks gestation

81
Q

What is the management of a breech baby between 37 and 39 weeks?

A

a planned external cephalic version

82
Q

When would a a planned external cephalic version be attempted?

A

between 37-39 weeks

83
Q

what happens if a planned cephalic version does not work?

84
Q

what is considered to be a term baby?

A

37-42 weeks

85
Q

What is a normal foetal heart rate?

A

110-160bpm

86
Q

What are the three stages in the induction of labour

A
  1. Ripen the cervix
  2. Rupture the membranes
  3. Start the contractions
87
Q

Which drug is used to ripen the cervix?

A

Misoprostol

88
Q

what must the bishops score be before rupture of membranes can be attempted?

89
Q

What medication is administered to try and start contractions?

A

IV Syntocin (oxytocin)

90
Q

What should syntocin be titrated to achieve?

A

4-5 contractions in 10 minutes

91
Q

Describe the 3 stages of labour

92
Q

At what rate should a primigravid women dilate during the first stage of labour?

93
Q

At what rate should a parous women dilate during the first stage of labour

94
Q

What should be given if women are not dilating fast enough during the first stage of labour?

A

IV Syntocin- contractions will increase which will push the baby’s head onto the cervix and cause it to dilate more quickly

95
Q

what is extremely preterm delivery?

A

24-28 weeks

96
Q

What is very preterm delivery?

A

28-32 weeks

97
Q

What is mildly preterm delivery?

A

32-36 weeks

98
Q

Name the type of drug that prevents contractions and delays labour

A

Tocolytics

99
Q

What is Remifentanil?

A

IV painkiller with push button used in birth.

100
Q

Why must women on remifentanil be on a consultant led unit?

A

it causes a reduction in respiratory rate

101
Q

Why must women who have had an epidural be on a consultant led unit?

A

It reduces BP which can affect baby

102
Q

Describe the positions of a baby during the process of birth

103
Q

The CTG is found to be abnormal and a fetal blood sample is collected. What actions should be taken in each scenario if foetal blood sampling revealed the following:

104
Q

What % of pregnancies are affected by placental abruption?

105
Q

Describe the different tears which can occur during childbirth

106
Q

What is the most significant cause of maternal mortality?

107
Q

What is the most common cause of PPH?

A

Uterine atony

108
Q

What is the most common cause of PPH?

A

Uterine atony

109
Q

how many women suffer a PPH?

110
Q

What amount of blood must be lost before it is considered a PPH?

111
Q

How many ml of blood loss constitutes a major bleed?

112
Q

What is the difference between a primary and a secondary PPH?

A

Primary = within 24hrs of birth

Secondary = 24hrs – 6 weeks after birth

113
Q

How is PPH managed?

A

uterine massage oxytocin, ergometrine, carboprost & tranexamic acid. If this fails, hysterectomy

114
Q

What is considered
A) Extremely low birthweight
B) Very low birthweight
C) Low birthweight

A

Extremely low = <1000g
Very low = 1500-2500g
Low = <2500g

115
Q

What medication is given if a women has a retained placenta?

116
Q

What does the neonatal heel prick test for?

A

Sickle cell
Cystic fibrosis
Congenital hypothyroid
Phenylketonuria
Medium chain acyl-CoA dehydrogenase deficiency
Maple syrup urine
Isovaleric acidaemia
Glutaric acidaemia Type I
Homocystinuria

117
Q

for how many weeks can a woman feel low post partum before it is classified as post partum depression

A

<2 weeks = baby blues
>2 weeks = post partum depression

118
Q

Up to how many weeks can a medical abortion be offered

A

24 weeks (but only 20-21 weeks in grampian)

119
Q

Can a women take the pills for an abortion at home?

A

Yes, if she is less than 10 weeks pregnant

120
Q

What medications are used to achieve a medical abortion

A

Mifepristone then Misoprostol

121
Q

What options are available if a woman wants to have a surgical abortion?

A

Vacuume aspiration if she is <14 weeks pregnant

Dilatation and evaculation if she is >14 weeks pregnant

Both surgical options also require mifepristone in order to end the pregnancy

122
Q

What is the medical management of ectopic pregnancy?

A

Methotrexate

123
Q

What is the most common cause of cervical cancer?

A

HPV16 & 18

124
Q

When in a woman’s life should she be screened for HPV?

A

Every 5 years between 25-64

125
Q

In which order are cervical abnormalities investigated?

126
Q

which area of the cervix should a smear test sample?

A

The transformation zone

127
Q

What type of epithelium can be found

A) on the outer surface of the cervix (vaginal side)

B) Inside the cervical Os

A

A) Stratified squamous non-keratinised

B) Simple columnar

128
Q

When can a coil be fitted post-partum?

A

Coils can be fitted within 48 hrs of birth. If not fitted within 48 hrs, mothers will need to wait 4 weeks.

129
Q

If a mother does not have a coil, what is the gold-standard contraception if she is breastfeeding?

130
Q

How long after starting on the Implant, patch, ring, COC, POP can a woman have unprotected sex?

A

If started/inserted on day 5 of your cycle or before, protection against pregnancy is immediate.

If started/inserted after day 5, it is not protective against pregnancy for 7 days

131
Q

How long after inserting the IUD can a woman have unprotected sex?

A

If inserted within 1st 7 days of cycle you are protected against pregnancy immediately.

If inserted after day 7, it is not effective against pregnancy for 7 days

132
Q

How long after inserting the copper coil can a woman have unprotected sex?

A

Immediately

133
Q

How long after unprotected sex can a copper coil be inserted?

A

within 120 hrs

134
Q

What is the gold standard emergency contraception?

A

Copper coil

135
Q

How long after unprotected sex can Levonorgestrel (Levonelle/PlanB) be taken?

A

within 72 hours

(L looks like an upside down 7)

136
Q

How does Levonorgestrel work?

A

Contains oestrogen and progesterone
Stops ovulation and inhibits implantation

137
Q

What is the advantage of Levonorgestrel over EllaOne?

A

Can use multiple times in a cycle

138
Q

How long after unprotected sex can Ullipristal (EllaOne) be taken?

139
Q

How does Ullipristal (EllaOne) work?

A

Progesterone receptor modulator

140
Q

Name the pathogen that causes gonorrhoea

A

Neisseria Gonorrhoea

141
Q

Name the pathogen that causes chlamydia

A

Chlamydia Trachomatis

142
Q

Name the pathogen that causes genital herpes

A

Herpes simples 1 + 2

143
Q

Name the pathogen that causes Trichomoniasis (green, frothy, stinky vag)

A

Trichomoniasis vaginalis (parasite!)

144
Q

Name the pathogen that causes syphillis

A

Treponema pallidum

145
Q

What is gonorrhoea treated with?

A

cephtriaxone

146
Q

What is chlamydia treated with?

A

Doxycycline (azithromycin if preg)

147
Q

What is herpes treated with?

A

Aciclovir & lidocaine ointment

148
Q

What is trichomoniasis treated with?

A

Metranizadole

149
Q

What is syphillis treated with?

A

Early (<2Y) + No neuro signs = doxycycline

Late (>2Y) / Neuro signs = Benzathine penicillin & doxycycline

150
Q

Explain how HRT is prescribed

151
Q

What is the most common ovarian cancer?

A

Serous carcinoma

152
Q

What is the serum biomarker used to detect ovarian cancer?

153
Q

What genetic mutation is linked to ovarian, fallopian tube and breast cancer?

154
Q

What increases the risk of ovarian cancer?

A

More ovulations = more risk (early menarche, late menopause, nulliparity)

155
Q

What is the most common endometrial cancer?

A

Endometrial carcinoma

156
Q

What are the risk factors associated with endometrial cancer?

A

Unopposed oestrogen, metabolic syndromes (diabetes, obesity, PCOS) HNPCC

157
Q

How is post-menopausal bleeding investigated?

A

transvaginal USS (endometrial thickness >4cm)

158
Q

What is protective against endometrial cancer?

159
Q

What is the most common cancer of the vulva and cervix?

A

Squamous cell carcinoma

160
Q

Name a scoring system for pelvic organ prolapse

A

POPO SCORE/ Baden-Walker-Halfway Grading

161
Q

Describe management of pelvic organ prolapse

A

Pessaries and pelvic floor physio. May need surgery.

162
Q

List the 4 types of FGM

A

Type 1 = Cliteridectomy

Type 2 = excision of cliterorus and labia/parts of labia

Type 3 = Infibulation (sealing the vagina)

Type 4 = Other

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