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Medical Finals 2020 > Obstetrics and Gynaecology > Flashcards

Obstetrics and Gynaecology Flashcards

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USMLE® Step 1 flashcards
1
Q

What are your management options for polycystic ovary syndrome?

A
  • metformin
  • COCP
  • clomiphene if wanting to increase fertility
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2
Q

What investigations do you do in someone with suspected PCOS?

A
  • transvaginal USS
  • laparoscopy
  • testosterone, LH:FSH ratio
  • cortisol
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3
Q

Oxybutynin is used for…?

A

Overactive bladder

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4
Q

Miscarriages can be divided into those with a closed os and those with an open os. Which falls under which category?

A

Closed - missed, threatened, complete

Open - inevitable, incomplete

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5
Q

Gestational Hypertension is defined by a blood pressure rise of…?

A

> 20/40

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6
Q

What are some risk factors for a primary post-partum haemorrhage?

A

Primary occurs in the first 24 hours
Usually due to uterine atony
RF: previous PPH, prolonged labour, pre-eclampsia, increased maternal age

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7
Q

What is your management of a primary PPH?

A
  • IV syncocinon 10 units or IV ergometrine
    14 gauge cannula x2
    IM carboprost
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8
Q

What is the definition of secondary PPH?

A

> 24hours-12 weeks

Usually a retained placenta

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9
Q

What is the definition of pre-eclampsia?

A

BP increase of >20/40 and proteinuria

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10
Q

What does eclampsia refer to?

A

Eclampsia = generalised tonic clonic seizures
++2 urine dipstick protein or >0.3g
Headaches, visual changes, nausea and vomiting
Give labetalol, atenolol, metoprolol or nifedipine

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11
Q

What is HELLP syndrome?

A

Haemolysis
ELevated liver enzymes
Low Platelets

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12
Q

What is chronic gestational hypertension?

A

Hypertension existing before pregnancy

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13
Q

What occurs in alloimmunisation of a pregnant mother?

A

Exposure of a rhesus negative mother may be alloimmunised against the foetal red blood cells during pregnancy is a father is rhesus positive.
Give prophylactic anti-D if bleeding after 12 weeks, give regardless at 28 weeks.

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14
Q

What sign is a ‘woody, tense’ uterus indicative of?

A

Placental Abruption

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15
Q

How does the coil work?

A

Reduces endometrial proliferation and shedding, making periods lighter and shorter, potentially stopping them altogether. (levonorgesterol)

Oestrogen stimulates growth of endometrium and progresterone maintains endometrium if pregnancy occurs.

It lasts 5 years.

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16
Q

What are the two phases of the menstrual cycle?

A

Follicular (Day 0-14) and Luteal (14-28). At Day 14 (ovulation) there is a peak in LH and FSH causing a Pr increase.

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17
Q

How is progesterone controlled?

A

Surge in LH from anterior pituitary causes release of corps luteum (remnants from the egg) which releases progesterone.

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18
Q

What is adenomyosis?

A

Proliferation of endometrial growing in the myometrium of the uterus (muscular layer instead of just the inner layer).
Sx: heavy painful periods, can often co-exist with endometriosis

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19
Q

What is TTP?

A

Thrombotic Thrombocytopaenia, TTP can occur at any time in pregnancy and is characterized with a pentad of microangiopathic haemolytic anaemia, thrombocytopenia, fever, neurological involvement and renal impairment

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20
Q 
What embryological structures give risk to the…
GI Tract
Lower part of the vagina
Kidneys
Uterus
A 
What embryological structures give risk to the…
GI Tract - endoderm
Lower part of the vagina - cloaca
Kidneys – metanephros
Uterus – paramesonephric ducts
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21
Q

How do you treat mastitis and should you continue breast feeding?

A

Warm compression, simple analgesia, continue breast feeding, can continue breast feeding with flucloxacillin, if left untreated could develop into abscess

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22
Q

What can cause breast lumps other than cancer?

A

Fibromadenomas (non-cancerous lump), nodularities (variation of normal), cyst (can be drained, usually hormonal caused)

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23
Q

Name some risks and causes of gynaecomastia

A

Steroid use, hyperthyroidism, aging, obesity, testicular failure

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24
Q

What treatments would you use for breast infection (peripheral and central)

A

Peripheral (lactational) can be treated with fluclox or erythromycin, non-lactational can be treated with Augmentin plus metronidazole

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25
Q

What is duct ectasia?

A

Ducts become filled with debris, dilated yellow or green discharge

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26
Q

What is a papilloma?

A

benign warty growth that can cause discharge

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27
Q

What is involved in a triple assessment?

A

Mammogram (US), Biopsy (fine needle aspiration cytology), clinical assessment. Other imaging includes USS, MRI

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28
Q

What are some risk factors for breast cancer?

Any protective factors?

A

Protective factors? RF: genetics (BRCA1&2), FH, weight, alcohol, oestrogen use (HRT, COCP), early menarche, previous radiotherapy. Breast feeding is protective.

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29
Q

What are some common metastatic sites of breast cancer?

A

Brain, Bone, Lung, Liver

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30
Q

What might indicate a more severe or aggressive cancer? What genetic factors are involved?

A

HER2+ - poor prognosis, can use Herceptin
Oe Receptor – positive is a good sign as it is oestrogen sensitive and can give tamoxifen, aromatase inhibitors (exemestane)
Progesterone negative, positive means sensitive to anti-Oe
Triple negative – poor prognosis

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31
Q

What surgical and medical managements are available?

A

Tamoxifen, aromatase inhibitors, radiotherapy, chemotherapy (young, Er-ve, HER2 positive, high grade, node involvement), mastectomy, lumpectomy, axillary surgery

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32
Q

What are the possible reconstruction options offered?

A

External prosthesis, skin sparing, implant and expander, dermal sling, latissimus dorsi reconstruction

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33
Q

Give the name of some different types of breast cancer

A

Lobular carcinoma, Ductal carcinoma, tubular mucinous, medullary, spindle cell

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34
Q

What are the 3 manouvres you can perform in a baby with shoulder dystocia?

A

Wood’s Screw, McRobert’s Flexion (flex and externally rotate hips to stretch symphysis and open pelvic outlet), episiotomy

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35
Q

What needs to be done in cord prolapse?

A

Elevate the presenting part, avoid touching the cord, urgent C/S, woman on left lateral tilt

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36
Q

What are the risk factors for uterine rupture?

A

Previous uterine rupture, previous c/s, abnormalities, oxytocin, obstructed uterus.

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37
Q

What is an amniotic fluid emboli and how is it managed?

A

ABCDE, give fluids, it is an embolism of the amniotic fluid that presents with sudden dyspnoea and hypotension, seizures, DIC, pulmonary embolism

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38
Q

What are some signs of a uterine rupture?

A

Signs of uterine rupture include tenderness, palpable foetus, vaginal bleeding, maternal shock

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39
Q

How do you manage a uterine rupture?

A

manage with resus and urgent LCSC

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40
Q

What are the 4 main indications for induction?

A

Post-dates, PROM, pre-eclampsia, diabetes

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41
Q

What are the 3 stages of induction?

A

Cervical ripening (give vaginal pessary – prostin), artificial rupture of membrane (amniotomy, using an amniohook, may risk cord prolapse or SROM), cervical dilation (IV oxytocin (syntocinon, risk of uterine hyperstimulation, needs continuous CTG) [Terbulaline is a beta-adrenergic receptor agonist that relaxes myometrial smooth muscle and opposes syntocinon]

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42
Q

What are the 4 options to help labour proceed?

A

Amniotomy, C/S, Instrumental, Induction

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43
Q

What might indicate failure to proceed?

A

Low Bishop’s score, ineffective uterine action, uterine hyperactivity. Passage – cephalon-pelvic disproportion, Passenger – foetal size, rotation, flexion, Power – ineffective uterine action, augmentation, hyperactivity of uterus

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44
Q

Give 3 known causes of PROM?

A

Infections, cervical weakness (previous cervical excision or LLETZ), overdistension of the uterus (polyhydramnios, twins), smoking

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45
Q

What is SROM?

A

Sudden rupture of membrane

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46
Q

What risks does prematurity hold?

A

Hypoxia, perinatal death, cerebral palsy, low birth weight, can be due to uterine abnormalities, infection, inflammation, multiple pregnancy, previous preterm

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47
Q

What is considered LBW and what can cause foetal growth restriction?

A

<5.5lbs, can be idiopathic, multiple pregnancies, placental insufficiency, smoking, pre-eclampsia, low maternal weight, congenital infection, risks of RDS, infection, uterine artery doppler to investigate, karyotyping

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48
Q

What problems could a LGA baby cause?

A

FTT, Failure to progress, shoulder dystocia

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49
Q

What causes a LGA baby?

A

Diabetes, previous large baby

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50
Q

What defines prematurity?

A

<37 weeks

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51
Q

What scans are used to detect congenital abnormalities?

A

Dating scan at 12 weeks

Anomaly scan at 18 weeks

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52
Q

What tests are used to check if a foetus is at risk of Down’s Syndrome?

A

Nuchal translucency and PaPP-A and B-hCG (combined test, 11-14 weeks)
bHCG
unconjugated oxytocin
AFP
Inhibin A (after 14 weeks, quadruple test)

Diagnosis is made with amniocenteses or CVS

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53
Q

Which mothers are more at risk of having a baby with Down’s Syndrome?

A

Older mothers
Previous child with Down’s
Genetic carrier

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54
Q

What is the difference between amniocentesis and CVS?

A

The one is a biopsy of amniotic fluid and the other of the trophoblast layer of the uterus, amniocentesis is done after 15 weeks, chorionic villous after 11 weeks (10-12 weeks)

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55
Q

What is the quadruple test and when is it done in pregnancy?

A

Quadruple test – inhibin A, serum b-hCG, oestriol, AFP

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56
Q

What is the combined test?

A

the combined test is AFP, NT, PAPP-A, bHCG, if they are high risk then they are offered amniocentesis

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57
Q

What is an appropriate set of booking tests?

A

Syphilis, HIV, Hep B, rubella

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58
Q

What does it mean by informed consent?

A

A woman must be notified of complications, including rare ones if they are serious.

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59
Q

What is clinical negligence?

A
  1. When practice falls below the generally acceptable standards
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60
Q

What are the 5 features of the Fraser Guidelines?

A

A young girl must be able to understand what the doctor is telling her, is unable to be persuaded to tell her parents, if likely to pursue a sexual relationship anyway, not prescribing her contraceptives could be dangerous to her physical or mental health and it is in her best interests

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61
Q

A 30-year old nulliparous woman is 29 weeks pregnant. She resents with a history of minor, unprovoked painless vaginal bleed of about a teaspoonful. Her anomaly scan at 20-weeks showed a low-lying placenta. Her foetus is moving well and continuous CTG is reassuring. What is the most appropriate management?

A

Admit, IV, G&S, administer steroids if further bleeds

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62
Q

What must never be done in placenta praevia?

A

Never examine

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63
Q

What are the two main types of placenta praevia and what signs do you find?

A

Major and minor (close to the os, major is over the os)

Painless bleeding, tightening, no pain

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64
Q

What is your investigation and management of placenta praevia?

A

TVUSS, G+S, ferritin

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65
Q

What are the 3 main types of placental haemorrhage?

A

Placental abruption, Placental praevia, Vasa Praevia, Placenta Accreta

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66
Q

Which, out of accrete, percreta and increta, is deepest abnormal implantation? What is given to help placental detachment?

A

Percreta is deepest, give methotrexate post-delivery to help with detachment, arrange for LSCS

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67
Q

What is your initial management of PPH?

A

ABCDE, Bloods (FBC, clotting screen, group and save, cross match), IV access and IV fluids

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68
Q

What drugs can you give for primary PPH?

A

IV oxytocin, ergometrine, carboprost, misoprostol

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69
Q

Define a primary and secondary PPH?

A

Primary <24hrs, Secondary 24hrs-12 weeks post-partum, >500mls blood loss

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70
Q

What are the 4 main causes of a post-partum haemorrhage?

A

Thrombin, Tissue, Trauma, Tone

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71
Q

How is a post-partum haemorrhage managed?

A

G+S, Fluids, FBC, blood transfusion, isotonic crystalloid, bimanual compression, hysterectomy

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72
Q

What causes secondary PPH?

A

Retained placenta, endometritis, RPOC

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73
Q

What is a gestational trophoblastic disease?

A

A hydatiform mole is when the chromosomes have an incorrect number and so the foetus is non-viable. This can sometimes lead to an invasive mole that can form a choriocarcinoma. It is treated through ERPS, serial B-hCG (suction curette), sign is a ‘snow storm’ on USS

74
Q

What are 3 indications for induction of labour?

A

Prolonged pregnancy >12 days post-delivery date
Pre-labour premature rupture of membranes
Diabetic mother >38 weeks
Rhesus incompatibility
Small for gestation size
Bishops Score <5

75
Q

How can labour be induced?

A 
Sweep
Propess - PGE5 vaginal prostaglandin
Prostin
Artificial rupture of membrane
Syntocinon - syntometrine
76
Q

How many vessels lie in the umbilical cord?

How many sides does it have?

A

3 - two arteries and one vein
2 - linings, the chorion and amnion
2 - sides; maternal and foetal

77
Q

What pregnancies count as high risk?

A

Multiple births
Woman >35
High blood pressure
Diabetes

78
Q

What is the duration of each trimester?

A

1st (0-12weeks)
2nd (13-27weeks)
3rd (28-40weeks)

79
Q

Give 6 physiological changes that occur during pregnancy.

A

Haematological: RBC count increases but not as much as plasma volume so woman become anaemic.
Cardiovascular: There is increased CO, increased stroke volume but decreased TPR so BP decreases.
Skin and Breast: Increased skin pigmentation. Breast and nipple enlargement.
GI: Decreased gut motility.
Renal: Increased GFR.
Respiratory: Increased tidal volume.
Liver: Increased coagulability.
Uterine: hypertrophy, cervical gland hypertrophy, vaginal lactobacilli proliferation, decreased pH

80
Q

How much does stroke volume increase during pregnancy?

A

> 30%

81
Q

Where would you expect the top of the fundus to lie at 20 weeks gestation?

A

The top of the fundus should lie at the level of the umbilicus

82
Q

What is a concealed pregnancy?

A

A pregnancy where a woman has had no antenatal input

83
Q

Name five factors that increase risk in pregnancy.

A

Maternal asthma, maternal gestational diabetes, maternal HTN, multiple gestation, previous CS, IUGR, preeclampsia, smoking, drugs

84
Q

What hormones are involved in pregnancy and what is their effect?

A

bHCG - hCG is secreted by the syncytiotrophoblast into the maternal bloodstream. It acts to maintain progesterone production by the corpus luteum. It can be detected 8 days after conception. Levels tend to double every 48 hours in early pregnancy. It sustains pregnancy, oestrogen production and progesterone
progesterone – produced by corpus luteum, then placenta, prevents uterine contractions, prevents miscarriage, placental support
oestrogen – regulates progesterone, produced by ovaries, levels rise during pregnancy, increase oxytocin receptors
prolactin – stimulates milk production
relaxin – limits uterine activity, softens cervix
oxytocin – caring behaviour, stimulates milk release and uterine contraction
prostaglandins – role in labour initiation
PAPP-A – low PAPP-A is a risk factor for pre-eclampsia, SGA, preterm

85
Q

What two rashes can you get in pregnancy?

A
  1. PUPP, Pruritic urticarial papules and plaques of pregnancy. (OTHER RASHES: Pemphigoid gestationis - a blistering condition that starts in the umbilicus and spreads, Prurigo gestationis - a rash of the trunk and upper limbs with abdominal sparing, Impetigo herpetiformis - blistering condition that always present with a febrile illness and if not treated early can lead to maternal and foetal death)
86
Q

Give some differential diagnoses of vaginal bleeding during pregnancy?

A

Chlamydia, CIN, ectopic, miscarriage, molar pregnancy

87
Q

What 3 investigations do you do in a positive pregnancy test in a female presenting with a new PV bleed and crampty abdo pain with LMP 9 weeks ago?

A

Serial bHCG 48 hours apart
TVUSS (test of choice)
PV examination

88
Q

What does a ‘snow storm’ on USS indicate?

A

Molar pregnancy

89
Q

What is your management of diabetes post-partum?

A

Once eating and drinking you can stop the sliding scale and resume a patient’s normal pre-pregnancy insulin

90
Q

What signs would you see on USS of an ectopic pregnancy?

A

Free fluid in the pouch of Douglas, an empty uterus on scan

91
Q

What management would you pursue for an ectopic pregnancy if you wanted to preserve fertility?

A

Salpingotomy (this is the removal of the ectopic from the fallopian tubes as opposed to a salpingectomy which removes the whole tube).

92
Q

Where are ectopic pregnancies most likely to occur?

A

Fallopian tube, then ovaries, then abdominal cavity

93
Q

What increases your risk of ectopic?

A

Previous ectopic, IVF, PID, IUD, smoking, appendicitis

94
Q

What are signs and problems with ectopics?

A

Ruptured ectopic can lead to shock – collapse, tachy, hypotension, pallor

95
Q

What investigations would you like to do in an ectopic why?

A

Serial bHCG, TVUSS, serum progesterone, laparoscopy, FBC, U&E

96
Q

What is the usual pattern of bHCG in pregnancy?

A

It doubles every 48hrs for the first 8 weeks

97
Q

List 3 causes of miscarriage.

A

PCOS, chromosomal abnormalities, Infection, Thrombophilia abnormalities, Endocrinal causes, antiphospholipid syndrome, anatomical abnormalities, causes after 16 weeks include cervical incompetence and infection (often bacterial vaginosis)

98
Q

What are the different types of miscarriage?

A

Os Closed (Missed, Threatened, Complete), Os Open (Incomplete, Inevitable)

99
Q

Give three risk factors for miscarriages.

A

Maternal age, previous miscarriages, occupational hazards, maternal factors (low BMI, connective tissue disease, fertility problems, uncontrolled DM), lifestyles (smoking, alcohol, illicit drug use)

100
Q

Five factors associated with miscarriage?

A

Smoking, increased maternal age, obesity, alcohol, caffeine intake, methotrexate, infections

101
Q

What is your medical management for a miscarriage?

A

Misoprostol (prostaglandin), sometimes preceded by mifepristone, surgical options include evacuation of retained products of conception

102
Q

What is the best management option for threatened miscarriage?

A

Watchful waiting

103
Q

What investigations are required for miscarriages?

A

TVUSS, urine pregnancy test, serum hCG, G+S, (On USS scan look for foetal pole, yolk sac, gestational sac and foetal pulse (pulse not seen if under 7mm)).

104
Q

A 22-year old girl comes in wanting a medical termination of pregnancy. She is 7 weeks pregnant. To what time period is medical termination still appropriate?

A

Medical termination is appropriate until 9 weeks, surgical from 7 weeks. Medical also appropriate if: no foetal pulse, no free fluid in the pouch of douglas, small ectopic, no clinical compromise – {medical termination = mifepristone + misoprostal]

105
Q

Up to how many weeks can an abortion be offered?

A

23+6

106
Q

What are some reasons for abortion?

A

Negative impact on mother’s health, social and physical life or child’s.

107
Q

Name 3 signs and symptoms of labour.

A

Regular contractions, increasing strength, amplitude, cervical dilation

108
Q

What are the possible interventions at Stage 1 of labour?

A

Stage 1 lasts from onset until the cervix is fully dilated. It has a latent and active phase. Possible interventions include a membrane sweep, prostaglandin pessary, amniotomy (breaking the membranes, not routinely done) or offering oxytocin (usually only for delayed first stage).

109
Q

How long does Stage 2 last?

A

1-3 hrs for new mums, 30-1hr for multiparous

110
Q

What are the 7 phases of labour and delivery (mechanically)?

A

Engagement, Descent, Flexion, Internal Rotation, Extension, Restitution, Lateral Flexion

111
Q

What are the 3 factors involved in labour?

A

Power, Passenger, Passage

112
Q

What hormones are influencing factors in labour?

A

What drugs will inhibit or induce labour? Inhibits – progesterone, ritodrine. Induction – syntocinonon, ergometrine

113
Q

What happens in the latent stage of labour? What occurs in the active phase of the first stage of labour?

A

Latent face – cervical effacement, dilation, baby moving into engagement. Active – increasing contractions until 4 in 10

114
Q

What increases your risk during labour?

A

Multiple pregnancy, APH, >35, BMI>20, HTP, diabetes

115
Q

What are absolute contraindications for VBAC?

A

Previous severe placenta praevia/vasa praevia, previous uterine rupture, previous classical c/s scar, current placenta praevia

116
Q

What are the different kinds of lie a foetus can take?

A

Longitudinal, Transverse, Oblique

117
Q

Name the different kind of presentations.

A

Face, Brow, Vertex, Breech, Shoulder

118
Q

How do you describe a foetal orientation?

A

Occipital-Anterior (baby facing away towards spine), Occipital-Posterior (baby facing away from spine), Left-Occipital Transverse (baby facing the left hip)

119
Q

Give some absolute contraindication for external cephalic version (ECV).

A

Multiple pregnancy, major uterine abnormality, antepartum haemorrhage within 7 days, ROM, polyhydramnios

120
Q

What is station?

A

How far the baby has progressed down the uterus/cervix

121
Q

How do you correct a baby in breech presentation?

A

ECV, C/S

122
Q

What risks exist for breech deliveries?

A

Shoulder dystocia, hypoxia, need for episiotomy

123
Q

What is the most appropriate treatment for a woman presenting with a breast lump at 29-weeks gestation? The lump has been proven to be a carcinoma.

A

Chemo is a viable treatment in 2nd and 3rd trimester

124
Q

What makes a foetus viable on ultrasound?

A

Gestational sac, foetal pole, foetal pulse, ??

125
Q

At what levels of bhCG will a foetus be visible on US?

A

> 1000 visible on TVUSS

126
Q

What would you see in the bloods of someone with DIC?

A

Raised PT, raised aPTT, decreased platelets, increased bleed

127
Q

What is rhesus disease? What effect does it have on the baby and what is your management?

A

Rhesus positive mother, rhesus negative baby, give anti-D usually at 28 weeks, after 12 if any bleeding, can cause haemolytic disease of the newborn, foetal anaemia, you do this even if both parents are rhesus negative as the father could be someone else

128
Q

What is hyperemesis and what is your management?

A

This is severe n+v in early pregnancy, leads to dehydration and fluid loss, requires urgent fluid resus and nutrition, risk of weight loss, electrolyte deficiency, ketoacidosis. Give NBM, antiemetics, IV fluids, vitamin supplements

129
Q

A 45-year old woman in her 12th week of as assisted-conception triplet pregnancy presents to A&E with severe nausea and vomiting. She has mild lower abdominal and back pain. Urine dipstick shows blood -ve, protein -ve, ketones ++++, glucose +. What is your diagnosis and most appropriate management?

A

Hyperemesis gravidarum, IV crystalloids and anitemetics

130
Q

What is obstetric cholestasis and it’s management?

A

Elevated bile acid in pregnancy causes itching, management is to induce at 38 weeks. Manage with ursodeoxycholic acid

131
Q

How can obstetric cholestasis present?

A

Intense itching (caused by bile build up), may be slightly jaundiced, management is to induce at 37 weeks

132
Q

What risks does SLE increase during pregnancy?

A

risks include foetal growth restriction, pre-eclampsia, stillbirth, preterm delivery

133
Q

A woman G2P1 presents with an AFI 26cm. What should her AFI be and what does a raised AFI indicate?
What does AFI stand for?

A

18-14, raised indicates polyhydramnios

134
Q

Give some causes of polyhydramnios?

A

Foetal congenital abnormality, heart failure, maternal diabetes (polyuria), twins

135
Q

Give some risks polyhydramnios causes?

A

Placental abruption, unusual lie, premature labour, prolapse of cord, PPH, perinatal mortality

136
Q

What is twin-to-twin syndrome?

A

When there is shared circulation and one baby gets volume overload and the other gets restricted nutrients and underload

137
Q

What does a formal embryonic disc suggest compared to an implanted bilaminar implantation at day 8?

A

Suggests conjoined baby

138
Q

What is a dichorionic diamniotic pregnancy?

A

Two amniotic sacs and two placentas

139
Q

What complications exist in multiple pregnancy?

A

Increased risk of hypoxia, malpresenation, IUGR, pre-eclampsia, anaemia, congenital abnormaltiies, PPT

140
Q

What are some risk factors for gestational diabetes?

A

Obesity, previously large baby, 1st degree relative, south east Asian/black Caribbean/middle eastern, previous GD

141
Q

What level of fasting venous plasma glucose is required for a diagnosis of diabetes?

A

> 7.0mmol.L, 2hr glucose needs to be 7.8-11.0 if just impaired of >11.0 for a dx of diabetes

142
Q

At what week will a diabetic check be done? What test is done for mother and baby?

A

Week 24

143
Q

What problems does having diabetes during pregnancy cause?

A

Increased maternal insulin resistance, leads to maternal hyperglycaemia and foetal hyperglycaemia and causes the foetal pancreas to produce more insulin causing foetal hyperinsulinemia

144
Q

Why is gestational diabetes a risk factor for the baby?

A

Macrosomia, foetal hyperinsulinemia, surfactant deficiency, LGA, retinopathy, nephropathy, IHD, ketoacidosis

145
Q

What are the risk factors for GD?

A

Previous GD, obesity, FH, >35, large baby, PCOS

146
Q

What are the maternal complications of GD?

A

What are the foetal complications?

147
Q

What is the management of GD?

A

Metformin, NOT gliclazide, folate

148
Q

What investigations would you do in someone at risk of eclampsia?

A

Urine dipstick, U&E (creatinine: protein ratio), Blood pressure, uterine artery doppler

149
Q

What is HELLP Syndrome?

A

Haemolysis, Elevated Liver Enzymes, Low Platelets

150
Q

At what level of protein is a pregnant woman determined to have pre-eclampsia (accepting that she already has high blood pressure)?

A

3+ on urine dipstick, proteinuria >5gm inn 24 hrs (>0.3g/nmol)

151
Q

Give 5 risk factors for pre-eclampsia?

A

Personal history, renal disease, older, family history, chronic hypertension, nulliparity, twin pregnancies, diabetes, obesity

152
Q

What is your management of someone with high blood pressure who has started seizing?

A

Magnesium sulphate

153
Q

What is your first line management of someone with HTN during pregnancy?

A

Labetalol, aspirin 75mg, nifedipine

154
Q

What are the risks and complications of pre-eclampsia?

A

HELLP Syndrome, DIC, seizures, renal failure, pulmonary oedema, cerebrovascular haemorrhage

155
Q

What symptoms can occur? What are some systemic features of hypertension in pregnancy?

A

Headache, drowsiness, visual disturbance, oliguria, oedema, n+v, epigastric pain

156
Q

What foods can’t a woman eat during pregnancy and what is the pathogen?

A

Cheese – listeria monocytogenes
Raw meat – toxoplasma gondii (also cat faeces)
Raw eggs - salmonella

157
Q

What are the effects on the foetus of syphilis infection in utero?

A

Miscarriage, stillbirth, congenital abnormalities

158
Q

What is the foetal effect of perinatal parvovirus B19 infection and how might you detect any complications in an infection during pregnancy?

A

Parvovirus B19 (also known as slapped cheek syndrome, fifth disease, erythema infectiosum) causes haemolytic anaemia. Can be detected on USS. Foetal death occurs in 10% cases usually before 20 weeks.

159
Q

How does CMV typically present and what would you see on USS?

A

USS: hepatic/cranial calcification. IUGR, pneumonia, thrombocytopaenia, hearing, visual, mental impairment

160
Q

What infections are you worried about infecting the neonate?

A

CMV, (IUGR, neurological damage and pneumonia) toxoplasmosis (learning difficulties, convulsions), rubella (deafness, eye problems, cardiac problems), parvovirus B19 (causes haemolytic anaemia)

161
Q

How can you prevent the vertical transmission of HIV in pregnancy?

A

Maternal ART, Elective C/S, avoid breastfeeding, neonatal ART

162
Q

What infections can cause problems in pregnancy?

A

Herpes Simplex (risk of vertical transmission), Group A strep (causes perinatal sepsis), Group B strep (causes neonate sepsis)

163
Q

A mother is exposed to someone with chicken pox – what is your management?

A

If exposed, check for antibodies and give VZIG (varicella zoster immunoglobulin) within 10 days

164
Q

What are some side-effects of the combined oral contraceptive pill and are these caused by the oestrogen or progesterone?

A

Headaches, nausea, increased DVT risk (Oe), increased risk of breast/cervical cancer

165
Q

Give five causes of primary amenorrhoea.

A

Constitutional delay. Congenital chromosomal defects (Turner’s, Kallman’s)(hypothalamic pituitary axis failure), ovarian failure (chemotherapy), GU malformation

166
Q

Give five causes of secondary amenorrhoea.

A

PCOS, weight loss (athletes), hypothalamic pituitary failure (hypothyroidism), hyperprolactinaemia, iatrogenic, chemotherapy, malignancy, menopause,

167
Q

What investigations could you carry out in amenorrhoea (primary). Give seven, be specific with what you are looking for in each.

A

Karyotyping – Kallmann’s/Turner’s (unlikely at this age), TFTs (Thyroid Disease), Prolactin (Prolactinoma), hCG (pregnant), USS, FSH and LH day 2, mid0luteal day 21 progesterone (to look for ovulation hormone problems), serum free androgen (raised in PCOS)

168
Q

A mother attends the GP with her 14-year-old daughter. She is concerned as her daughter has not yet started her periods although suffers cyclical pain. On examination the daughter looks well. What is the most likely diagnosis? She has secondary sexual features such as breast budding and pubic hair.

A

Imperforate hymen

169
Q

What is Ashermans and Sheehan’s Syndrome?

A

Asherman’s is adhesions of the endometrium that occurs after surgery. Sheehans is necrosis of the pituitary gland after significant PPH. Sheehan syndrome – hypopituitarism caused by ischaemic necrosis due to blood loss and hypovolaemic shock, features include agalactorrhea, amenorrhoea, symptoms of hypothyroidism, hypoadrenalism. Asherman’s syndrome/intrauterine adhesions post-surgery

170
Q

What affect does progesterone have on the body?

A

Endometrial receptivity. [oestrogens increase uterine growth, increase fat deposition and endometrial growth stimulation and bone resportion]

171
Q

Describe the hormones involves in the menstrual cycle.

A

FH is stimulated by GnRH which causes follicle growth which produces oestrogen which has a positive feedback of FH at low levels, at high levels it inhibits FH and thus follicle growth so only one follicle develops. Oestrogen increases through the first park of the cycle and then decreases. Progesterone is produced by the corpus luteum (the bit left behind by the follicle), it causes endometrial growth in the luteal phase

172
Q

What management can be used for someone with pre-menstrual syndrome (PMS)?

A

SSRI, vitamin b6, improved diet or physical exercise, CBT, COCP

173
Q

What are the main roles of Oe, Pr and LH in the menstrual cycle?

A

Oe – endometrial growth and cervical mucus, LH – stimulates ovulation which is why there is a surge around day 14, Pr – makes lining ready for implantation

174
Q

What types of ovarian cysts are concerning and should be considered for surgical management?

A

Bilateral cysts, multiloculated cysts, ascites, metastases

175
Q

What risks does PCOS have?

A

Acne, sleep apnoea, endometrial hyperplasia, acne (does not increase risk of breast cancer)

176
Q

A 30-yr old lady presents to her GP with cyclical abdominal pain. Give your top 3 differentials.

A

Endometriosis, adenomyosis, IBS

177
Q

What is the most appropriate management for someone with PID?

A

IM ceftriaxone, PO doxy, PO metro

178
Q

A 37-year-old female presents to her GP complaining of dyspareunia, irregular menstrual cycles for 6 months until she recently missed 3 periods. She also complains of sudden hot flushes for the past 3 months. Her only history of note includes previous breast cancer for which she was on chemotherapy and radiation. Examination reveals no abnormalities and her pregnancy test is negative. What is the most likely diagnosis?

A

Premature menopause/premature ovarian failure, cessation of menses for 1 year before the age of 40. Symptoms include hot flushes, vaginal dryness, vaginal atrophy, sleep disturbance, irritability, RF include FH, chemo, autoimmune disease

179
Q

What medication and treatment options are given for menorrhagia?

A

Mefenamic acid if painful, transexamic acid, NSAIDs, norethisterone, underlying problem

180
Q

What causes IM bleeding?

A

Cervical ectropian, cervical polyp, cervical cancer, fibroid,

181
Q

What causes dysmenorrhea?

A

Fibroid, endometriosis, decreased progesterone, pelvic pathology, adenomyosis, PID, polyps

182
Q

What can cause PC bleeding?

A

Cervical cancer, ectropion

Medical Finals 2020 (25 decks)

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