Obstetrics and Gynaecology Flashcards
1
Q
What should you do if you miss one COCP?
A
Take immediately and continue as normal
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.
3
Q
HRT. What is the patient at increased risk of due to the addition of progestogen?
A
Breast Cancer
4
Q
Diagnosing Adenmyosis
A
TVUS
5
Q
Cervical screening. Two consecutive inadequate samples
A
Refer for colposcopy in 6 weeks
6
Q
Which vaccines are offered to pregnant women?
A
influenza and pertussis
7
Q
Define parturition
A
Products of conception expelled from the uterine cavity after 24 weeks gestation
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
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
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)
11
Q
What are the limits of a delayed third stage of labour?
A
Physiological >60 minutes
Active >30 minutes
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)
13
Q
How often should a vaginal exam be performed in normal labour?
A
Every 4 hours
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
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
16
Q
What is the Bishop score used for?
A
Assessment of the cervix to predict likely outcome of an induction of labour
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
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
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?
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
21
Q
Action if Foetal scalp pH is <7.2
A
Immediate C-section
22
Q
Reversible causes of maternal collapse
A
Hypovolaemia (most common - due to haemorrhage) Hypoxia Hypo/Hyperkalaemia Hypothermia Thromboembolism Toxicity Tension PTX Tamponade Eclampsia
23
Q
Examples of X-linked recessive conditions
A
colour-blindness
haemophilia
Duchenne
G6PD
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
25
Which conditions are screened for at booking scans?
Syphilis
HIV
Hep B
26
Difference between gastrochisis and exomphalos
Gastrochisis - abdominal contents outwith body (good prognosis)
Exomphalos - sac of abdominal contents protruding out of child (poorer prognosis)
27
When should high dose 5mg Folic acid be offered to pregnant mothers?
Diabetes
Obesity
Previous baby with neurodevelopment problem
Epilepsy
28
Signs of magnesium toxicity. Reversal.
hyporeflexia
respiratory depression
decreased concentration
arrhythmia
Reverse using calcium gluconate
29
If previous pre-eclampsia, how is it avoided in future pregnancies?
Aspirin from week 12
30
Risk of down syndrome in 40 year old
1 in 100
31
Interpreting nuchal translucency
>3.5mm - 20% risk of chromosomal abnormality
| >6.5mm - 66% risk of chromosomal abnormality
32
How is the risk of chromosomal abnormality calculated?
What is considered High risk?
what is then offered?
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
33
Risk of miscarriage following invasive CVS or amniocentesis?
1 in 200
34
Biomarkers in downsyndrome
High BHCG
Low AFP
Low PPAP-A
35
When is Whooping cough vaccine offered to mothers?
28-32 weeks gestation
36
Rhesus sensitisation during first pregnancy
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
37
When is Anti-D given to Rh negative mothers?
28 weeks
38
When can CVS and Amniocentesis be offered?
CVS - 11-13+6 weeks
| Amniocentesis - >15 weeks
39
Fetal complications of multiple pregnancy
```
IUGR
Pre-term birth
Cerebral palsy
TTTS
Hyperemesis gravidarium
Anaemia
Preeclampsia
Gestational diabetes
Antepartum haemorrhage
Preterm labour
C section
```
40
Antenatal management of multiple pregnancy
```
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
```
41
Define neonatal mortality
death within first 28 days of life
42
Define early neonatal morality
death within first 7 days of life
43
Signs of severe pre-eclampsia
```
Hypertension >170/100 mmHg
Headache due to cerebral oedema
Visual disturbance
Papilloedema
RUQ pain
Sudden oedema
Hyperreflexia
Clonus
HELLP Syndrome
```
Eclampsia - grand mal seizures
44
When should folic acid be taken in women wanting to get pregnant?
3 months before conception
| to 12 weeks gestation
45
Define extremely pre term
<28 weeks
46
Define very pre term
28-32 weeks
47
Define Moderate to late pre term
32-37 weeks
48
Antibiotic to avoid chorioamnionitis following PROM
Erythromycin
49
Why should co-amoxiclav be avoided during pregnancy?
Risk of NEC
50
Buzzword. Woody hard uterus
Placental Abruption
51
Dark vaginal bleeding following ROM
Vasa praevia
52
If a pregnant woman has chicken pox when is the earliest a planned delivery should be scheduled
7 days after rash - allow passive immunity transfer
53
Post-exposure - chicken pox in pregnancy. If there is doubt about maternal exposure.
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
54
Chicken pox in pregnancy
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'
55
Management of life-threatening PE in pregnancy
Unfractionated Heparin - convert to LMWH once stable
56
Features of polyhydramnios on scan
Amniotic Fluid Index >25 cm
| Deepest Vertical Pool >8cm
57
Example of GnRH analogues/agonists + Risk of Long-term use
Goserelin - stops oestrogen resulting in amenorrhoea
Long-term use can precipitate osteopenia (give with HRT)
58
Normal endometrial thickness after menopause
<3mm on TVUS
if on HRT then <5mm
If on tamoxifen then endometrium will be thickened so must investigate with hysteroscopy
59
Diagnosis of PCOS
Rotterdam Criteria 2 of 3
- Oligo-/a-menorrhoea
- Polycycstic Ovaries
- Hyperandrogenism
60
LH:FSH in PCOS
High
61
Management of PCOS
Hormonal contraception
Metformin
Ovarian drilling
if wants to get pregnant then CC
62
Buzzword. Fixed retroverted uterus
Endometriosis
63
Define primary amenorrhoea
Failure of menstruation by 16 yo or 14yo if no sexual characteristics
64
Breast cancer and HRT
Contraindicated so use SSRI e.g. Fluoxetine
65
Contraindications to HRT
```
Breast cancer
Pregnancy
Endometrial cancer
Acute liver disease
Uncontrolled hypertension
Known VTE
Thrombophilia
Otosclerosis
```
66
Management of vulval lichen sclerosus
high dose steroids e.g. dermovate
emollients
topical calcineurin inhibitors (tacrolimus)
67
When is exclusive breastfeeding reccommended?
first 6 months - then alongside the introduction of soft foods up to 2 years
68
Antibiotic for mastitis
Fluclox
69
Difference between baby blues and post natal depression?
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.
70
When is newborn screening offered?
ideally 5 days after birth
eligible up to first birthday, but CF test only works before week 8
71
Most common endometrial cancer
Adenocarcinoma
72
Two types of endometrial carcinoma
Type 1 - endometrioid (80%) 50-60yo oestrogen dependent associated with lynch syndrome
Type 2 - serous or clear cell, >70yo not oestrogen dependent, more aggressive
73
Staging tool for endometrial cancer
FIGO staging
74
Eligibility for cervical screening
25-49 every 3 years
| 50-65 every 5 years
75
Buzzword. Koliocytosis on cervical screening
HPV
76
Cervical screening coincides with pregnancy
delay to 3 months postpartum
77
Cervical cancer screening: if sample is hrHPV +ve + cytologically normal →
repeat smear at 12 months
78
Management of Antiphospholipid syndrome in pregnancy
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.
79
Muscles that make up the pelvic diaphragm
```
Levator ani (PPI from medial to lateral)
- Puborectalis
- Pubococcygeus
- Iliococcygeus
Coccugeus
```
80
Management of Stress UI
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
81
Side effects of Duloxetine
```
Difficulty sleeping
Headaches
Dizziness
Blurred vision
Change in bowel habits
Nausea and vomiting
Dry mouth
Sweating
Decreased appetite
Weight loss
Decreased libido
```
82
Which type of UI is associated with nocturia?
Urge
83
Management of Urge UI
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
Different degrees of prolapse
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
Management of UTI in pregnancy
1-2 trimester: Nitrofurantoin
| 3rd trimester: Trimethoprim
86
Cervical mucus at peak ovulation
Watery and clear
87
Use of diaphragm/cap as contraception
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
When must the COCP be started to be effective immediately?
Within first 5 days of cycle - if after this then use barrier method for 7 days
89
If 2 COCP pills are missed what should you do?
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
UKMEC 3 for COCP
```
>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
UKMEC4 for COCP
>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
Use of CTP for contraception
Patch for 1 week, change on day 8
| 3 continuous weeks then one week off
93
When should you use extra precautions on the combined vaginal ring contraception?
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
Which type of contraception should not be used in women who will want to try for pregnancy soon?
Depo
95
How is success from vasectomy ensured?
Semen sample at 12 and 16 weeks post surgery
96
When should the dose of LNG emergency contraception be doubled?
BMI >26
Over 70kg
Taking enzyme inducing drugs
97
When should LNG emergency contraception be taken to be successful?
Within 72 hours
98
Which emergency contraception pill can be used more than once in a menstrual cycle?
LNG
99
When should UPA emergency contraception be taken to be successful?
Within 120 hours
100
In which patients is UPA emergency contraception avoided?
Severe Asthma
| Regular antacid medications
101
For how long postpartum should combined contraception be avoided?
at least 3 weeks
| 6 weeks if additional VTE risk factors
102
Medical abortion - steps
```
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
Surgical options for TOP
<14 weeks vacuum aspiration
| >14 weeks dilatation and evacuation (not available in Scotland)
104
Anti- D during TOP
If Rh - and >10 weeks gestation then give anti-D prophylaxis
All Rh- women undergoing surgical TOP should be given anti-D
105
Difference between partial and complete molar pregnancy?
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
Normal HCG progression in early pregnancy
Should double every 48 hours
107
When does foetal heart develop and begin to function?
5 week s
108
Investigating possible miscarriage
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
Features of a threatened miscarriage
Risk to pregnancy - e.g. bleeding, cramping
Cervical os closed
USS - intrauterine pregnancy, foetal pole is present, CRL >7mm, heartbeat present
110
Features of inevitable miscarriage
Pregnancy cannot be saved
Products in process of expulsion
Open cervical os
111
Features of incomplete miscarriage
Some products of pregnancy already passed, all must pass to be termed complete miscarriage
112
Antibodies associated with antiphospholipid syndrome
Lupus anticoagulant
Anticardiolipin antibodies
Anti-B2 Glycoprotein-1
113
HCG progression in ectopic pregnancy
suboptimal rise in HCG (remember normally doubles every 48 hours)
114
First and second-line anti-emetics used in pregnancy
1st line - Cyclizine or Prochloroperazine
2nd line is Ondansetron or Metclopromide (risk of oculogyric crisis - give procyclidine)
115
Management of hyperemesis
```
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
Define infertility
Failure to get pregnant following 12 months of regular UPSI
117
Site of spermatogenesis
Seminiferous tubules
118
Infertility in men with CF
Obstruction or absence of the vas deferens bilaterally
Known as Congenital Absence of Vas Deferens (CABVD)
119
Biochemistry seen in obstructive male factor infertility
Normal LH, FSH and testosterone
120
By which age does the testes descend
6-9 months
121
Features of Kleinefelter's Syndrome (47XXY)
```
Developmental delays as a child
Reduced facial hair
Poor muscle tone
Gynaecomastia
Infertility
```
122
How can mumps precipitate infertility?
Mumps orchitis causes swelling that damages the seminiferous tubules
This often improves in the months following recovery from the infection
123
Biochemistry seen in pituitary causes of infertility
Low LF, FSH and Testosterone/Oestrogen
124
Biochemistry seen in Hypothalamic causes of infertility
Low LH, FSH and Testosterone/Oestrogen
125
Which thyroid disorder is associated with hyperprolactinaemia?
Hypothyroidism
126
Testosterone levels in congenital adrenal hyperplasia
High
127
Symptoms of hyperprolactinaemia
Galactorrhoea
| Oligomenorrhoea/Amenorrhoea
128
Endocrine levels associated with PCOS
High LH
High Androgens
Impaired Glucose Tolerance
129
Endocrine levels associated with POF
High FSH and LH
| Low Oestradiol
130
Management of PID - antibiotics
Metronidazole
| Oflofloxacin
131
What is Salpingitis Isthmica Nodosa?
Nodular scarring of the fallopian tube - risk of ectopic pregnancy and infertility
132
Normal testicular volume
12-25ml
133
Advice prior to semen sample
Avoid ejaculation for 72 hours before
| Avoid caffeine and alcohol too
134
Indications for intra-uterine insemination
sexual dysfunction e.g. ED, sexual pain disorders
| same sex couples
135
Steps of IVF
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
Indications for ICSI
Severe male factor infertility
| Failed IVF
137
Indications of IVF
2 years of unexplained infertility
pelvic disease
endometriosis
anovulatory infertility
138
Features of Ovarian Hyper-Stimulation Syndrome (OHSS)
```
Bloating
Nausea
Vomiting
VTE
ARDS
```
139
Risk of intrahepatic cholestasis
Intrahepatic cholestasis of pregnancy increases the risk of stillbirth; therefore induction of labour is generally offered at 37-38 weeks gestation
140
Chlamydia Serovars
A-C: Trachoma (eye infection - not STI)
D-K: Genital Infection
L1-3: LGV (common in MSM)
141
Management of Chlamydia
Doxycycline 100mg bd 7 days
or Azithromycin 3 days
In pregnancy Azithromycin
No test of cure needed, except in rectal infections
142
Features of Reiter's Syndrome
Urethritis, Arthritis and Conjunctivitis
Can’t see, pee or climb a tree
143
Management of Gonorrhoea
IM Ceftriaxone
144
What causes Trichomonas vaginalis?
Single celled protozoal parasite
145
Diagnosis of Trichomonas vaginalis
High vaginal swab for microscopy
146
Management of Trichomonas vaginalis
Oral Metronidazole 5-7 days
147
HPV types that cause genital warts
6
| 11
148
HPV types that cause cervical cancer
16
| 18
149
Management of HPV genital warts
```
Cryotherapy
Trichloroacetic acid
Podophyllotoxin
Imiquimod
Surgical removal
```
150
HPV vaccine
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
Diagnosing Syphilis
PCR swab
| Dark Field Microscopy (Not used in Tayside)
152
Screening test for syphilis
ELISA for IgG/IgM antibodies
153
Syphilis testing. TPPA
remains positive lifelong
154
Syphilis testing. RPR
Essential for monitoring response to therapy
155
Treating syphilis
IM Benzylpenicillin
If latent then 3 injections at weekly intervals
156
Diagnosing genital herpes
Swab base of ulcer -> PCR for HSV
or
NAAT
157
Treatment of HSV genital infection
Oral Aciclovir
158
Syphilis testing. VDRL
negative post treatment
159
HPV incubation
3 weeks to 9 months
160
Diagnosis of vaginal candida infection
High vaginal swab for culture
161
Treatment of prostatitis
Ofloxacin 400mg bd for 28 days
162
Most common cause of bacterial vaginosis
Gardnerella vaginalis
163
Diagnosis of bacterial vaginosis
A wet mount of the sample from the vagina will show clue cells
164
Treatment of bacterial vaginosis
Oral metronidazole (also used in pregnancy)
165
Which sexual health conditions require partner notification?
```
HIV
Gonorrhoea
Chlamydia
Trichomoniasis
Syphilis
LGV
PID
Hepatitis A, B and C
Epidiymo-orchitis
Mycoplasma genitalium
Non-gonococcal urethritis
```
166
Guidelines for giving contraceptives to under 16 year olds
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
Incubation period of Chlamydia
7-21 days
168
Stages 1-4 for Ovarian Cancer
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
Management of Cerebral Toxoplasmosis infection
sulfadiazine and pyrimethamine
170
Features and Treatment of CNS Lymphoma
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
HIV Neurocomplications. Differentiating between Cerebral Toxoplasmosis and CNS Lymphoma
Toxoplasmosis
- Multiple lesions
- Ring or nodular enhancement
- Thallium SPECT negative
Lymphoma
- Single lesion
- Solid (homogenous) enhancement
- Thallium SPECT positive
172
Most common Fungal Meningitis in HIV
Cryptococcus
173
CNS Infections. India Ink +
Cryptococcus
174
Cause of Progressive multifocal leukoencephalopathy (PML)
JC virus
175
Symptoms of Progressive multifocal leukoencephalopathy (PML)
Behavioural changes
Speech
Motor
Visual impairment
176
HIV opportunistic infections. CD4 200-500
Oral Thrush - Candida albicans
Shingles - HZV
Hairy Leukoplakia - EBV
Kaposi Sarcoma - HHV-8
177
HIV opportunistic infections. CD4 100-200
```
Cryptosporidiosis
Cerebral Toxoplasmosis
Progressive Multifocal Leukoencephalopathy - JC Virus
Pneumocystis jirovecii pneumonia
HIV dementia
```
178
HIV opportunistic infections. CD4 50-100
Aspergillosis
Oesophageal candidiasis
Cryptococcal meningitis
CNS lymphoma - EBV
179
HIV opportunistic infections. CD4 <50
CMV retinitis
| Mycobacterium avium-intracellulare infection
180
Side effects of NRTI for HIV
Peripheral neuropathy
Tenofovir - renal impairment and ostesoporosis
Zidovudine: anaemia, myopathy, black nails
Didanosine: pancreatitis
181
Side effects of NNRTI for HIV
P450inducer, rashes
182
Side effects of Protease Inhibitors for HIV
```
diabetes
hyperlipidaemia
buffalo hump
central obesity
p450 inhibition
```
183
Medications to avoid when breastfeeding
```
antibiotics: ciprofloxacin, tetracycline, chloramphenicol, sulphonamides
psychiatric drugs: lithium, benzodiazepines
aspirin
carbimazole
methotrexate
sulfonylureas
cytotoxic drugs
amiodarone
```
184
Neonatal infection < 4 days
GBS - if high risk give IV benzylpenicillin or IV clindamycin (if penicillin-allergic) is the recommended intrapartum prophylaxis for neonatal GBS infection.
185
'snowstorm' sign on ultrasound of axillary lymph nodes
extracapsular breast implant rupture.
186
Testing times for HIV
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
When should you use continuous CTG in labour?
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
Treatment of Lymphogranuloma venereum
Doxycycline
189
Stages of Lymphogranuloma venereum infection
stage 1: small painless pustule which later forms an ulcer
stage 2: painful inguinal lymphadenopathy
may occasionally form fistulating buboes
stage 3: proctocolitis
190
If there are no fetal movements by which gestation should referral to maternal unit be made
24 weeks
191
Which HRT is used for individuals at risk of VTE?
Transdermal patches
192
General side effects of HRT
Nausea
Breast tenderness
Fluid retention
Weight gain
Progestogens - increase breast cancer risk
Oestrogen - increased VTE risk
193
Contraindication to HRT
Previous or current breast cancer
Oestrogen sensitive cancer
Undiagnosed vaginal bleeding
Untreated vaginal hyperplasia
194
Non-HRT treatment of vasomotor menopause symptoms
Fluoxetine
Citalopram
Venlafaxine
195
HRT and colorectal cancer
Reduced risk
196
UKMEC 2 contraceptive in women aged >40 and aged >45
COCP (>40)
| DEPO (>45)
197
Is contraception required if on HRT
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
Features of Turner's Syndrome (45X)
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
Management of vaginal thrush
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
Layers cut-through/transversed during caesarian section
```
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
Management of Placental Abruption
<36 weeks + stable -> Steroids
<36 weeks + unstable -> C-section
>36 weeks + stable -> induce vaginal delivery
>36 weeks + unstable -> C-section
