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Medicine - Finals > Obstetrics and Gynaecology > Flashcards

Obstetrics and Gynaecology Flashcards

1
Q

What should you do if you miss one COCP?

A

Take immediately and continue as normal

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2
Q

UTI in pregnancy

A
  • Treat even is asymptomatic
  • Nitrofurantoin (first-line) - avoid at term due to risk of neonatal haemolysis
  • Trimethoprim should be avoided in pregnancy, especially in the first trimester
  • Penicillins and cephalosporins are suitable for use during pregnancy, but sulfonamides (such as sulfasalazine) and quinolones (such as ciprofloxacin) should be avoided in pregnancy.
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3
Q

HRT. What is the patient at increased risk of due to the addition of progestogen?

A

Breast Cancer

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4
Q

Diagnosing Adenmyosis

A

TVUS

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5
Q

Cervical screening. Two consecutive inadequate samples

A

Refer for colposcopy in 6 weeks

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6
Q

Which vaccines are offered to pregnant women?

A

influenza and pertussis

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7
Q

Define parturition

A

Products of conception expelled from the uterine cavity after 24 weeks gestation

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8
Q

First stage of labour

A

Early Latent Phase

  • Regular contractions
  • “Show”
  • ROM
  • Effacement of cervix and dilation up to 4cm

Active Phase
- Dilation to 10 cm

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9
Q

Normal lengths of 2nd stage of labour

A

Primiparous

  • No epidural: 2 hours
  • Epidural: 3 hours

Multiparous

  • No epidural: 2 hours
  • Epidural: 1 hour
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10
Q

Active management of the third stage of labour

A

Routine use of uterotonic drugs (oxytocin or synometrine) after delivery of anterior shoulder or directly after birth (before cord stops pulsating)

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11
Q

What are the limits of a delayed third stage of labour?

A

Physiological >60 minutes

Active >30 minutes

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12
Q

Define Engagement (Cardinal Movement)

A

Passage of widest diameter of the presenting part to a level below the plane of the pelvic inlet (described in fifths)

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13
Q

How often should a vaginal exam be performed in normal labour?

A

Every 4 hours

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14
Q

Requirements and contraindications for FORCEPS delivery

A

Fully dilated
Occipitoanterior position (if OP use Kielland forceps to rotate first)
Ruptured membranes
Cephalic presentation
Engaged presenting part (below ischial spines)
Pain relief
Sphincter - catheterise to empty bladder

Contraindications: prematurity, face presentation, haemophilia, osteogenesis imperfecta, maternal HIV or Hep C

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15
Q

Difference between cephalohaematoma and caput succedaneum

A

Cephalohaematoma - develops hours after birth, limited by suture lines, associated with ventouse delivery, months to resolve

Caput - present at birth, crosses suture lines, associated with pressure against cervix and prolonged labour, days to resolve

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16
Q

What is the Bishop score used for?

A

Assessment of the cervix to predict likely outcome of an induction of labour

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17
Q

Artificial rupture of membranes

A

Cervix dilated <2 cm: PGE2 (Pessary) - contraindicated if has previous scar (use balloon cervical ripening instead) - risk of overstimulation (give terbutaline)

Cervix dilated >2cm: Amniotomy and Syntocinon

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18
Q

Risks of epidural

A 
Loss of "Ferguson' reflex" therefore less uterine activity 
Increased risk of assisted vaginal delivery 
Abnormal foetal heart rate 
Hypotension 
Accidental dural punture
Post dural headache 
Respiratory depression (if high block)
Atonic bladder
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19
Q

Interpreting CTG. Steps. Normal ranges

A 
DR - define risk - why is she on CTG?
C - contractions - 3-5 in 10 minutes 
BRA - baseline rate - 110-160 bpm
V - variability - 5-25bpm 
A - accelerations - >2
D - decelerations - none
O - overall impression - what should we do?
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20
Q

Action if Foetal scalp pH is 7.2-7.25

A

Borderline - normal is 7.25-7.35

Repeat CTG in 30 minutes

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21
Q

Action if Foetal scalp pH is <7.2

A

Immediate C-section

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22
Q

Reversible causes of maternal collapse

A 
Hypovolaemia (most common - due to haemorrhage) 
Hypoxia 
Hypo/Hyperkalaemia 
Hypothermia 
Thromboembolism 
Toxicity 
Tension PTX
Tamponade 
Eclampsia
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23
Q

Examples of X-linked recessive conditions

A

colour-blindness
haemophilia
Duchenne
G6PD

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24
Q

Foods to avoid in pregnancy

A 
Raw meat - toxoplasmosis 
Pate - Listeria 
Shark/Tuna - Mercury 
Liver - vitamin A is teratogenic 
Limit caffeine 
Avoid Alcohol

All should be offered vitamin D

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25
Q

Which conditions are screened for at booking scans?

A

Syphilis
HIV
Hep B

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26
Q

Difference between gastrochisis and exomphalos

A

Gastrochisis - abdominal contents outwith body (good prognosis)
Exomphalos - sac of abdominal contents protruding out of child (poorer prognosis)

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27
Q

When should high dose 5mg Folic acid be offered to pregnant mothers?

A

Diabetes
Obesity
Previous baby with neurodevelopment problem
Epilepsy

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28
Q

Signs of magnesium toxicity. Reversal.

A

hyporeflexia
respiratory depression
decreased concentration
arrhythmia

Reverse using calcium gluconate

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29
Q

If previous pre-eclampsia, how is it avoided in future pregnancies?

A

Aspirin from week 12

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30
Q

Risk of down syndrome in 40 year old

A

1 in 100

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31
Q

Interpreting nuchal translucency

A

> 3.5mm - 20% risk of chromosomal abnormality

>6.5mm - 66% risk of chromosomal abnormality

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32
Q

How is the risk of chromosomal abnormality calculated?

What is considered High risk?

what is then offered?

A

Biochemical markers
Maternal Age
Nuchal Translucency

1 in 150 is the cut-off for high risk

NIPT - if high risk progress to invasive tests e.g. CVS or amnio

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33
Q

Risk of miscarriage following invasive CVS or amniocentesis?

A

1 in 200

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34
Q

Biomarkers in downsyndrome

A

High BHCG
Low AFP
Low PPAP-A

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35
Q

When is Whooping cough vaccine offered to mothers?

A

28-32 weeks gestation

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36
Q

Rhesus sensitisation during first pregnancy

A

Exposure to rh antigen in first pregnancy causes IgM antibodies (too big to cross into placenta and harm foetus)
However, during second pregnancy IgG is formed which can cross into placenta causing haemolytic disease of the newborn

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37
Q

When is Anti-D given to Rh negative mothers?

A

28 weeks

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38
Q

When can CVS and Amniocentesis be offered?

A

CVS - 11-13+6 weeks

Amniocentesis - >15 weeks

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39
Q

Fetal complications of multiple pregnancy

A 
IUGR
Pre-term birth 
Cerebral palsy 
TTTS
Hyperemesis gravidarium 
Anaemia
Preeclampsia
Gestational diabetes
Antepartum haemorrhage
Preterm labour
C section
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40
Q

Antenatal management of multiple pregnancy

A 
Antenatal clinic every 2 weeks (monochorionic) or 4 weeks (dichorionic)
Iron and folic acid supplements
Low dose aspirin 
US from week16 every 2 weeks 
Anomaly scan at 18-20 weeks
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41
Q

Define neonatal mortality

A

death within first 28 days of life

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42
Q

Define early neonatal morality

A

death within first 7 days of life

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43
Q

Signs of severe pre-eclampsia

A 
Hypertension >170/100 mmHg 
Headache due to cerebral oedema 
Visual disturbance 
Papilloedema 
RUQ pain 
Sudden oedema 
Hyperreflexia 
Clonus 
HELLP Syndrome

Eclampsia - grand mal seizures

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44
Q

When should folic acid be taken in women wanting to get pregnant?

A

3 months before conception

to 12 weeks gestation

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45
Q

Define extremely pre term

A

<28 weeks

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46
Q

Define very pre term

A

28-32 weeks

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47
Q

Define Moderate to late pre term

A

32-37 weeks

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48
Q

Antibiotic to avoid chorioamnionitis following PROM

A

Erythromycin

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49
Q

Why should co-amoxiclav be avoided during pregnancy?

A

Risk of NEC

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50
Q

Buzzword. Woody hard uterus

A

Placental Abruption

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51
Q

Dark vaginal bleeding following ROM

A

Vasa praevia

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52
Q

If a pregnant woman has chicken pox when is the earliest a planned delivery should be scheduled

A

7 days after rash - allow passive immunity transfer

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53
Q

Post-exposure - chicken pox in pregnancy. If there is doubt about maternal exposure.

A

Urgently check maternal varicella antibodies

If not immune and under 20 weeks gestation give VZIG (effective up to 10 days after exposure)

if the pregnant woman > 20 weeks gestation is not immune to varicella then either VZIG or antivirals (aciclovir or valaciclovir) should be given days 7 to 14 after exposure

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54
Q

Chicken pox in pregnancy

A

suggest oral aciclovir should be given if the pregnant women is ≥ 20 weeks and she presents within 24 hours of onset of the rash

if the woman is < 20 weeks the aciclovir should be ‘considered with caution’

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55
Q

Management of life-threatening PE in pregnancy

A

Unfractionated Heparin - convert to LMWH once stable

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56
Q

Features of polyhydramnios on scan

A

Amniotic Fluid Index >25 cm

Deepest Vertical Pool >8cm

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57
Q

Example of GnRH analogues/agonists + Risk of Long-term use

A

Goserelin - stops oestrogen resulting in amenorrhoea

Long-term use can precipitate osteopenia (give with HRT)

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58
Q

Normal endometrial thickness after menopause

A

<3mm on TVUS
if on HRT then <5mm

If on tamoxifen then endometrium will be thickened so must investigate with hysteroscopy

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59
Q

Diagnosis of PCOS

A

Rotterdam Criteria 2 of 3

  • Oligo-/a-menorrhoea
  • Polycycstic Ovaries
  • Hyperandrogenism
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60
Q

LH:FSH in PCOS

A

High

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61
Q

Management of PCOS

A

Hormonal contraception
Metformin
Ovarian drilling

if wants to get pregnant then CC

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62
Q

Buzzword. Fixed retroverted uterus

A

Endometriosis

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63
Q

Define primary amenorrhoea

A

Failure of menstruation by 16 yo or 14yo if no sexual characteristics

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64
Q

Breast cancer and HRT

A

Contraindicated so use SSRI e.g. Fluoxetine

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65
Q

Contraindications to HRT

A 
Breast cancer 
Pregnancy 
Endometrial cancer
Acute liver disease 
Uncontrolled hypertension 
Known VTE 
Thrombophilia
Otosclerosis
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66
Q

Management of vulval lichen sclerosus

A

high dose steroids e.g. dermovate
emollients
topical calcineurin inhibitors (tacrolimus)

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67
Q

When is exclusive breastfeeding reccommended?

A

first 6 months - then alongside the introduction of soft foods up to 2 years

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68
Q

Antibiotic for mastitis

A

Fluclox

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69
Q

Difference between baby blues and post natal depression?

A

Baby Blues - tearful and irritability occurring typically on day 3 postpartum for a week or so. Self-limiting just give reassurance.

Postnatal depression - severe irritability, anxiety, anhedonia and problems sleeping. Onset 2-6 weeks postpartum. Lasting weeks to months hence affecting bonding.

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70
Q

When is newborn screening offered?

A

ideally 5 days after birth

eligible up to first birthday, but CF test only works before week 8

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71
Q

Most common endometrial cancer

A

Adenocarcinoma

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72
Q

Two types of endometrial carcinoma

A

Type 1 - endometrioid (80%) 50-60yo oestrogen dependent associated with lynch syndrome

Type 2 - serous or clear cell, >70yo not oestrogen dependent, more aggressive

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73
Q

Staging tool for endometrial cancer

A

FIGO staging

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74
Q

Eligibility for cervical screening

A

25-49 every 3 years

50-65 every 5 years

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75
Q

Buzzword. Koliocytosis on cervical screening

A

HPV

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76
Q

Cervical screening coincides with pregnancy

A

delay to 3 months postpartum

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77
Q

Cervical cancer screening: if sample is hrHPV +ve + cytologically normal →

A

repeat smear at 12 months

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78
Q

Management of Antiphospholipid syndrome in pregnancy

A

Aspirin and LMWH

The management of pregnant women with antiphospholipid syndrome and previous thrombotic events is with aspirin, which is started upon confirmation of pregnancy with a urinary test, and unfractionated or low molecular weight heparin (e.g. enoxaparin) which is started once a fetal heart is seen on ultrasound. LMWH is usually discontinued at 34 weeks gestation.

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79
Q

Muscles that make up the pelvic diaphragm

A 
Levator ani (PPI from medial to lateral)
- Puborectalis 
- Pubococcygeus 
- Iliococcygeus
Coccugeus
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80
Q

Management of Stress UI

A

Lifestyle - reduce caffeine intake, weight loss, smoking cessation

Pelvic muscle training - kegal exercises

Surgery - bulking agents, rectal fascial sling, colposuspension

Medical (if declines surgery) - Duloxetine

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81
Q

Side effects of Duloxetine

A 
Difficulty sleeping 
Headaches 
Dizziness
Blurred vision 
Change in bowel habits 
Nausea and vomiting 
Dry mouth 
Sweating
Decreased appetite 
Weight loss 
Decreased libido
82
Q

Which type of UI is associated with nocturia?

A

Urge

83
Q

Management of Urge UI

A

Lifestyle - reduce fluid intake, minimise caffeine intake, minimise alcohol intake

Bladder retraining

Medical - Oxybutynin (anticholinergic - in elderly use tolterodine or solifenacin instead), Mirabegron (good choice in elderly), Desmopressin helps with nocturia

Surgery - botox, percutaneous sacral nerve stimulation, augmentation cystoplasty

84
Q

Different degrees of prolapse

A

1st degree - mild -1cm of introitus
2nd degree - between -1 to +1 cm of introitus
3rd degree - beyond +1 cm of introitus
4th degree - procidentia (complete prolapse)

85
Q

Management of UTI in pregnancy

A

1-2 trimester: Nitrofurantoin

3rd trimester: Trimethoprim

86
Q

Cervical mucus at peak ovulation

A

Watery and clear

87
Q

Use of diaphragm/cap as contraception

A

Always use with spermacide
If it has been in for more than 3 hours reapply spermacide (do not remove to reapply spermacide)
Leave in for at least 6 hours after sex (up to 30 hours)

88
Q

When must the COCP be started to be effective immediately?

A

Within first 5 days of cycle - if after this then use barrier method for 7 days

89
Q

If 2 COCP pills are missed what should you do?

A

Week 1 - emergency contraception if sex within the last week
Week 2 - if pill taken last 7 days then no emergency contraception needed
Week 3 finish current pack and move straight on to next pack omitting week free interval

90
Q

UKMEC 3 for COCP

A 
>35 years old + smoking <15/day 
BMI >35 
First degree relative with VTE <45 years of age 
Controlled hypertension 
Immobility
BRACA1/2
Gallbladder/Liver disease 
Complicated diabetes
91
Q

UKMEC4 for COCP

A

> 35 yo and smoking >15/day
Migraine with aura
History of thromboembolic disease
History of stroke of ischaemic heart disease
Uncontrolled hypertension
Current breast cancer
Major surgery with prolonged immobilisation

92
Q

Use of CTP for contraception

A

Patch for 1 week, change on day 8

3 continuous weeks then one week off

93
Q

When should you use extra precautions on the combined vaginal ring contraception?

A

Ring is out for more than 3 hours in weeks 1 or 2 then use condoms for 7 days

If it occurs in week 3 then either allow withdrawal bleed or start new ring

94
Q

Which type of contraception should not be used in women who will want to try for pregnancy soon?

A

Depo

95
Q

How is success from vasectomy ensured?

A

Semen sample at 12 and 16 weeks post surgery

96
Q

When should the dose of LNG emergency contraception be doubled?

A

BMI >26
Over 70kg
Taking enzyme inducing drugs

97
Q

When should LNG emergency contraception be taken to be successful?

A

Within 72 hours

98
Q

Which emergency contraception pill can be used more than once in a menstrual cycle?

A

LNG

99
Q

When should UPA emergency contraception be taken to be successful?

A

Within 120 hours

100
Q

In which patients is UPA emergency contraception avoided?

A

Severe Asthma

Regular antacid medications

101
Q

For how long postpartum should combined contraception be avoided?

A

at least 3 weeks

6 weeks if additional VTE risk factors

102
Q

Medical abortion - steps

A 
2 medical practitioners should sign off on it (1 in an emergency)
Oral mifepristone (antiprogesterone), followed by Misoprostal (prstaglandin) 48 hours later

If <10 weeks choice of home or hospital
If >10 weeks hospital admission as multiple misoprostal doses may be required

103
Q

Surgical options for TOP

A

<14 weeks vacuum aspiration

>14 weeks dilatation and evacuation (not available in Scotland)

104
Q

Anti- D during TOP

A

If Rh - and >10 weeks gestation then give anti-D prophylaxis
All Rh- women undergoing surgical TOP should be given anti-D

105
Q

Difference between partial and complete molar pregnancy?

A

Partial - 1 egg and 2 sperm (or one sperm than reduplicated DNA material ) –> triploidy
Complete - egg with no DNA and 2 sperm (or one sperm than reduplicated DNA material ) –> Diploidy

106
Q

Normal HCG progression in early pregnancy

A

Should double every 48 hours

107
Q

When does foetal heart develop and begin to function?

A

5 week s

108
Q

Investigating possible miscarriage

A

USS for fetal heart beat
if absent measure CRL
- <7mm reassess heart beat in 7 days
- >7mm probable miscarriage (can reassess if not sure)

109
Q

Features of a threatened miscarriage

A

Risk to pregnancy - e.g. bleeding, cramping
Cervical os closed
USS - intrauterine pregnancy, foetal pole is present, CRL >7mm, heartbeat present

110
Q

Features of inevitable miscarriage

A

Pregnancy cannot be saved
Products in process of expulsion
Open cervical os

111
Q

Features of incomplete miscarriage

A

Some products of pregnancy already passed, all must pass to be termed complete miscarriage

112
Q

Antibodies associated with antiphospholipid syndrome

A

Lupus anticoagulant
Anticardiolipin antibodies
Anti-B2 Glycoprotein-1

113
Q

HCG progression in ectopic pregnancy

A

suboptimal rise in HCG (remember normally doubles every 48 hours)

114
Q

First and second-line anti-emetics used in pregnancy

A

1st line - Cyclizine or Prochloroperazine

2nd line is Ondansetron or Metclopromide (risk of oculogyric crisis - give procyclidine)

115
Q

Management of hyperemesis

A 
IV fluids 
IV magnesium 
Thiamine (PO or IV pabrinex)
Anti-emetic - cyclizine 
NG or TPN feeding if severe 
Ranitidine (H2 receptor blocker) or Omeprazole (PPI)
Oral steroids if severe 
VT prophylaxis
116
Q

Define infertility

A

Failure to get pregnant following 12 months of regular UPSI

117
Q

Site of spermatogenesis

A

Seminiferous tubules

118
Q

Infertility in men with CF

A

Obstruction or absence of the vas deferens bilaterally

Known as Congenital Absence of Vas Deferens (CABVD)

119
Q

Biochemistry seen in obstructive male factor infertility

A

Normal LH, FSH and testosterone

120
Q

By which age does the testes descend

A

6-9 months

121
Q

Features of Kleinefelter’s Syndrome (47XXY)

A 
Developmental delays as a child 
Reduced facial hair 
Poor muscle tone 
Gynaecomastia 
Infertility
122
Q

How can mumps precipitate infertility?

A

Mumps orchitis causes swelling that damages the seminiferous tubules

This often improves in the months following recovery from the infection

123
Q

Biochemistry seen in pituitary causes of infertility

A

Low LF, FSH and Testosterone/Oestrogen

124
Q

Biochemistry seen in Hypothalamic causes of infertility

A

Low LH, FSH and Testosterone/Oestrogen

125
Q

Which thyroid disorder is associated with hyperprolactinaemia?

A

Hypothyroidism

126
Q

Testosterone levels in congenital adrenal hyperplasia

A

High

127
Q

Symptoms of hyperprolactinaemia

A

Galactorrhoea

Oligomenorrhoea/Amenorrhoea

128
Q

Endocrine levels associated with PCOS

A

High LH
High Androgens
Impaired Glucose Tolerance

129
Q

Endocrine levels associated with POF

A

High FSH and LH

Low Oestradiol

130
Q

Management of PID - antibiotics

A

Metronidazole

Oflofloxacin

131
Q

What is Salpingitis Isthmica Nodosa?

A

Nodular scarring of the fallopian tube - risk of ectopic pregnancy and infertility

132
Q

Normal testicular volume

A

12-25ml

133
Q

Advice prior to semen sample

A

Avoid ejaculation for 72 hours before

Avoid caffeine and alcohol too

134
Q

Indications for intra-uterine insemination

A

sexual dysfunction e.g. ED, sexual pain disorders

same sex couples

135
Q

Steps of IVF

A

1 - down regulation with synthetic GnRH (TVUS to show thin endometrium)

2 - ovarian stimulation with gonotrophin injections for 10-14 days (TVUS to show thickened endometrium)

3 - oocyte collection in theatre transvaginally under USS guidance

4 - fertilisation with sperm; in IVF done in petri dish; in ICSI sperm is injected into oocyte

5 - embryo transfer on day 5 (blastocyst), give progesterone suppositories for 2 weeks after

136
Q

Indications for ICSI

A

Severe male factor infertility

Failed IVF

137
Q

Indications of IVF

A

2 years of unexplained infertility
pelvic disease
endometriosis
anovulatory infertility

138
Q

Features of Ovarian Hyper-Stimulation Syndrome (OHSS)

A 
Bloating 
Nausea 
Vomiting
VTE 
ARDS
139
Q

Risk of intrahepatic cholestasis

A

Intrahepatic cholestasis of pregnancy increases the risk of stillbirth; therefore induction of labour is generally offered at 37-38 weeks gestation

140
Q

Chlamydia Serovars

A

A-C: Trachoma (eye infection - not STI)
D-K: Genital Infection
L1-3: LGV (common in MSM)

141
Q

Management of Chlamydia

A

Doxycycline 100mg bd 7 days
or Azithromycin 3 days

In pregnancy Azithromycin

No test of cure needed, except in rectal infections

142
Q

Features of Reiter’s Syndrome

A

Urethritis, Arthritis and Conjunctivitis

Can’t see, pee or climb a tree

143
Q

Management of Gonorrhoea

A

IM Ceftriaxone

144
Q

What causes Trichomonas vaginalis?

A

Single celled protozoal parasite

145
Q

Diagnosis of Trichomonas vaginalis

A

High vaginal swab for microscopy

146
Q

Management of Trichomonas vaginalis

A

Oral Metronidazole 5-7 days

147
Q

HPV types that cause genital warts

A

6

11

148
Q

HPV types that cause cervical cancer

A

16

18

149
Q

Management of HPV genital warts

A 
Cryotherapy 
Trichloroacetic acid
Podophyllotoxin
Imiquimod
Surgical removal
150
Q

HPV vaccine

A

Given to both boys and girls between 11-13 years, MSM and those that are immunocomprimised e.g. HIV

Protect against types 6, 11, 16 & 18

151
Q

Diagnosing Syphilis

A

PCR swab

Dark Field Microscopy (Not used in Tayside)

152
Q

Screening test for syphilis

A

ELISA for IgG/IgM antibodies

153
Q

Syphilis testing. TPPA

A

remains positive lifelong

154
Q

Syphilis testing. RPR

A

Essential for monitoring response to therapy

155
Q

Treating syphilis

A

IM Benzylpenicillin

If latent then 3 injections at weekly intervals

156
Q

Diagnosing genital herpes

A

Swab base of ulcer -> PCR for HSV
or
NAAT

157
Q

Treatment of HSV genital infection

A

Oral Aciclovir

158
Q

Syphilis testing. VDRL

A

negative post treatment

159
Q

HPV incubation

A

3 weeks to 9 months

160
Q

Diagnosis of vaginal candida infection

A

High vaginal swab for culture

161
Q

Treatment of prostatitis

A

Ofloxacin 400mg bd for 28 days

162
Q

Most common cause of bacterial vaginosis

A

Gardnerella vaginalis

163
Q

Diagnosis of bacterial vaginosis

A

A wet mount of the sample from the vagina will show clue cells

164
Q

Treatment of bacterial vaginosis

A

Oral metronidazole (also used in pregnancy)

165
Q

Which sexual health conditions require partner notification?

A 
HIV
Gonorrhoea
Chlamydia 
Trichomoniasis 
Syphilis 
LGV
PID 
Hepatitis A, B and C
Epidiymo-orchitis
Mycoplasma genitalium 
Non-gonococcal urethritis
166
Q

Guidelines for giving contraceptives to under 16 year olds

A

Fraser Guidelines

  • sufficiently intelligent
  • cannot be persuaded to tell parent
  • likely to have sexual intercourse with or without contraception
  • physical or mental health will suffer without contraception
  • it is in their best interest
167
Q

Incubation period of Chlamydia

A

7-21 days

168
Q

Stages 1-4 for Ovarian Cancer

A

Stage 1 Tumour confined to ovary
Stage 2 Tumour outside ovary but within pelvis
Stage 3 Tumour outside pelvic but within abdomen
Stage 4 Distant metastasis

169
Q

Management of Cerebral Toxoplasmosis infection

A

sulfadiazine and pyrimethamine

170
Q

Features and Treatment of CNS Lymphoma

A

Associated with HIV and EBV
More likely to be a single lesion (whereas Toxoplasmosis is often several ring enhancing lesions)
Steroids and Chemotherapy (e.g. MTX)

171
Q

HIV Neurocomplications. Differentiating between Cerebral Toxoplasmosis and CNS Lymphoma

A

Toxoplasmosis

  • Multiple lesions
  • Ring or nodular enhancement
  • Thallium SPECT negative

Lymphoma

  • Single lesion
  • Solid (homogenous) enhancement
  • Thallium SPECT positive
172
Q

Most common Fungal Meningitis in HIV

A

Cryptococcus

173
Q

CNS Infections. India Ink +

A

Cryptococcus

174
Q

Cause of Progressive multifocal leukoencephalopathy (PML)

A

JC virus

175
Q

Symptoms of Progressive multifocal leukoencephalopathy (PML)

A

Behavioural changes
Speech
Motor
Visual impairment

176
Q

HIV opportunistic infections. CD4 200-500

A

Oral Thrush - Candida albicans
Shingles - HZV
Hairy Leukoplakia - EBV
Kaposi Sarcoma - HHV-8

177
Q

HIV opportunistic infections. CD4 100-200

A 
Cryptosporidiosis 
Cerebral Toxoplasmosis
Progressive Multifocal Leukoencephalopathy - JC Virus 
Pneumocystis jirovecii pneumonia
HIV dementia
178
Q

HIV opportunistic infections. CD4 50-100

A

Aspergillosis
Oesophageal candidiasis
Cryptococcal meningitis
CNS lymphoma - EBV

179
Q

HIV opportunistic infections. CD4 <50

A

CMV retinitis

Mycobacterium avium-intracellulare infection

180
Q

Side effects of NRTI for HIV

A

Peripheral neuropathy

Tenofovir - renal impairment and ostesoporosis

Zidovudine: anaemia, myopathy, black nails

Didanosine: pancreatitis

181
Q

Side effects of NNRTI for HIV

A

P450inducer, rashes

182
Q

Side effects of Protease Inhibitors for HIV

A 
diabetes 
hyperlipidaemia 
buffalo hump 
central obesity 
p450 inhibition
183
Q

Medications to avoid when breastfeeding

A 
antibiotics: ciprofloxacin, tetracycline, chloramphenicol, sulphonamides
psychiatric drugs: lithium, benzodiazepines
aspirin
carbimazole
methotrexate
sulfonylureas
cytotoxic drugs
amiodarone
184
Q

Neonatal infection < 4 days

A

GBS - if high risk give IV benzylpenicillin or IV clindamycin (if penicillin-allergic) is the recommended intrapartum prophylaxis for neonatal GBS infection.

185
Q

‘snowstorm’ sign on ultrasound of axillary lymph nodes

A

extracapsular breast implant rupture.

186
Q

Testing times for HIV

A

most cases of HIV infection can be detected by 4 weeks, a repeat test at 12 weeks is recommended to confidently exclude the diagnosis.

187
Q

When should you use continuous CTG in labour?

A

suspected chorioamnionitis or sepsis, or a temperature of 38°C or above

severe hypertension 160/110 mmHg or above

oxytocin use

the presence of significant meconium

fresh vaginal bleeding that develops in labour - this was a new point added to the guidelines in 2014

188
Q

Treatment of Lymphogranuloma venereum

A

Doxycycline

189
Q

Stages of Lymphogranuloma venereum infection

A

stage 1: small painless pustule which later forms an ulcer
stage 2: painful inguinal lymphadenopathy
may occasionally form fistulating buboes
stage 3: proctocolitis

190
Q

If there are no fetal movements by which gestation should referral to maternal unit be made

A

24 weeks

191
Q

Which HRT is used for individuals at risk of VTE?

A

Transdermal patches

192
Q

General side effects of HRT

A

Nausea
Breast tenderness
Fluid retention
Weight gain

Progestogens - increase breast cancer risk
Oestrogen - increased VTE risk

193
Q

Contraindication to HRT

A

Previous or current breast cancer
Oestrogen sensitive cancer
Undiagnosed vaginal bleeding
Untreated vaginal hyperplasia

194
Q

Non-HRT treatment of vasomotor menopause symptoms

A

Fluoxetine
Citalopram
Venlafaxine

195
Q

HRT and colorectal cancer

A

Reduced risk

196
Q

UKMEC 2 contraceptive in women aged >40 and aged >45

A

COCP (>40)

DEPO (>45)

197
Q

Is contraception required if on HRT

A

Yes - if not amenorrhoeic for 2 years (for under 50s) or 1 year (for over 50s)

POP is a good choice - but is not adequate as progesterone component of HRT so CH-HRT still required

198
Q

Features of Turner’s Syndrome (45X)

A

short stature (GH given in childhood)
shield chest, widely spaced nipples
webbed neck
bicuspid aortic valve (15%), coarctation of the aorta (5-10%)
primary amenorrhoea
cystic hygroma (often diagnosed prenatally)
high-arched palate
short fourth metacarpal
multiple pigmented naevi
lymphoedema in neonates (especially feet)
gonadotrophin levels will be elevated
hypothyroidism is much more common in Turner’s
horseshoe kidney: the most common renal abnormality in Turner’s syndrome

199
Q

Management of vaginal thrush

A

local treatments include clotrimazole pessary (e.g. clotrimazole 500mg PV stat)
oral treatments include itraconazole 200mg PO bd for 1 day or fluconazole 150mg PO stat
if pregnant then only local treatments (e.g. cream or pessaries) may be used - oral treatments are contraindicated

If recurrent: induction-maintenance regime

  • induction: oral fluconazole every 3 days for 3 doses
  • maintenance: oral fluconazole weekly for 6 months
200
Q

Layers cut-through/transversed during caesarian section

A 
Superficial fascia
Deep fascia
Anterior rectus sheath
Rectus abdominis muscle (not cut, rather pushed laterally following incision of the linea alba)
Transversalis fascia
Extraperitoneal connective tissue
Peritoneum
Uterus
201
Q

Management of Placental Abruption

A

<36 weeks + stable -> Steroids
<36 weeks + unstable -> C-section

> 36 weeks + stable -> induce vaginal delivery
36 weeks + unstable -> C-section

Medicine - Finals (21 decks)

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