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repro > PASSMED > Flashcards

PASSMED Flashcards

1
Q

MOA of HRT

A

has oestrogen combined with a progestrogen in women with uterus

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2
Q

SEs fo HRT

A

nausea
breast tenderness
fluid retention

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3
Q

potential complications of HRT

A

1) increased risk of breast cancer
- increased by the addition of a progestogen

2) increased risk of endometrial cancer
- oestrogen by itself should not be given as HRT to women with a womb

3) increased risk of VTE
- increased by the addition of a progestogen
- transdermal HRT does not appear to increase the risk of VTE

4) increased risk of stroke
5) increased risk of IHD if taken more than 10 years after menopause

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4
Q

when to suspect rubella

A
  • ‘pink or light red’ rash, small, red papules on her son’s soft palate
  • resolution of the rash after around 3 days then a diagnosis of rubella may be suspected - especially if the child has not had the MMR (measles, mumps and rubella) vaccination.
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5
Q

what is vasa praevia

A

complication in which fetal blood vessels cross or run near the internal orifice of the uterus. The vessels can be easily compromised when supporting membranes rupture, leading to frank bleeding.

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6
Q

what is the classic triad of vasa praevia

A

1) rupture of membranes
2) painless vaginal bleeding
3) fetal bradycardia

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7
Q

classification of FGM

A

Type 1 - Partial or total removal of the clitoris and/or the prepuce (clitoridectomy).

Type 2 - Partial or total removal of the clitoris and the labia minora, with or without excision of the labia majora (excision).

Type 3 - Narrowing of the vaginal orifice with creation of a covering seal by cutting and appositioning the labia minora and/or the labia majora, with or without excision of the clitoris (infibulation).

Type 4 - All other harmful procedures to the female genitalia for non-medical purposes, for example: pricking, piercing, incising, scraping and cauterization.

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8
Q

Mx for large fibroids

A

myomectomy

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9
Q

features of uterine fibroids

A
  • may be asymptomatic
  • menorrhagia
    • -> may result in iron-deficiency anaemia
  • lower abdominal pain: cramping pains, often during menstruation
    bloating
    urinary symptoms, e.g. frequency, may occur with larger fibroids
    subfertility
    rare features:
    polycythaemia secondary to autonomous production of erythropoietin
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10
Q

Diagnosis of fibroids

A

transvaginal US

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11
Q

bleeding in 1st trimester

A

spontaneous abortion
ectopic pregnancy
hydatidiform mole

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12
Q

bleeding in 2nd trimester

A

Spontaneous abortion
Hydatidiform mole
Placental abruption

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13
Q

bleeding in 2rd trimester

A
  • Bloody show
  • Placental abruption
  • Placenta praevia
  • Vasa praevia
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14
Q

what is hydatidiform mole

A

Typically bleeding in first or early second trimester associated with exaggerated symptoms of pregnancy e.g. hyperemesis. The uterus may be large for dates and serum hCG is very high

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15
Q

what is normal dose of folic acid

A

400mvg until the 12th week of pregnancy

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16
Q

what is high dose of folic acid and when will you give it

A

5mg before conception until the 12 th week

  • partner has a NTD, they have had a previous pregnancy affected by a NTD, or they have a family history of a NTD
  • the woman is taking antiepileptic drugs or has coeliac disease, diabetes, or thalassaemia trait.
  • the woman is obese (defined as a body mass index [BMI] of 30 kg/m2 or more).
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17
Q

bleeding and <6 weeks gestation Mx

A
  • to return if bleeding continues or pain develops
  • to repeat a urine pregnancy test after 7–10 days and to return if it is positive
  • a negative pregnancy test means that the pregnancy has miscarried
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18
Q

bleeding and >6 weeks gestation

A

EPAU

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19
Q

RFs for cord prolapse

A 
prematurity
multiparity
polyhydramnios
twin pregnancy
cephalopelvic disproportion
abnormal presentations e.g. Breech, transverse lie
placenta praevia
long umbilical cord
high fetal station
20
Q

major cause for cord prolapse and diagnosis

A

ARM

fetal HR abormal
cord is palpable vaginally
cord is visible beyond the level of the introitus.

21
Q

Mx for cord prolapse

A

presenting part of the fetus may be pushed back into the uterus to avoid compression

tocolytics

22
Q

clinical findings of chorioamnioitis

A

foul smelling discharge

uterine tenderness

fever
tachycardia
neutrophilia

23
Q

drugs that should be avoided when breastfeeding

A 
antibiotics: ciprofloxacin, tetracycline, chloramphenicol, sulphonamides
psychiatric drugs: lithium, benzodiazepines
aspirin
carbimazole
methotrexate
sulfonylureas
cytotoxic drugs
amiodarone
24
Q

What are women with PCOS at particular risk of when undergoing IVF?

A

ovarian hyperstimulation syndrome

25
Q

if woman has intrahepatic cholestasis when can IOL take place

A

37-38 weeks gestation

26
Q

causes if an increased nuchal translucency

A

Down’s syndrome
congenital heart defects
abdominal wall defects

27
Q

causes of hyperechogenic bowel

A

cystic fibrosis
Down’s syndrome
cytomegalovirus infection

28
Q

presentation of fibroid degeneration

A

low-grade
fever
pain
vomiting.

29
Q

what are false labour features

A

contractions felt in the lower abdomen. The contractions are irregular and occur every 20 minutes. Progressive cervical changes are absent.

occurs in the last 4 weeks of pregnancy

30
Q

what manouevre do you do for shoulder dystocia

A

McRobert’s

entails flexion and abduction of the maternal hips, bringing the mother’s thighs towards her abdomen. This rotation increases the relative anterior-posterior angle of the pelvis and often facilitates a successful delivery.

31
Q

define sensitisation

A

fetal red blood cells (RhD-positive) enter the maternal circulation, where the mother is RhD-negative. The fetomaternal haemorrhage (FMH) can cause antibodies to form in the maternal circulation that can haemolyse fetal red blood cells.

32
Q

potentially sensitising events in pregnancy

A
  • Ectopic pregnancy
  • Evacuation of retained products of conception and molar pregnancy
  • Vaginal bleeding < 12 weeks, only if painful, heavy or persistent
  • Vaginal bleeding > 12 weeks
  • Chorionic villus sampling and amniocentesis
  • Antepartum haemorrhage
  • Abdominal trauma
  • External cephalic version
  • Intra-uterine death
  • Post-delivery (if baby is RhD-positive)
33
Q

RFs for vaginal candidiasis

A

diabetes mellitus
drugs: antibiotics, steroids
pregnancy
immunosuppression: HIV

34
Q

features and Ix for vaginal candidiasis

A

‘cottage cheese’, non-offensive discharge
vulvitis: superficial dyspareunia, dysuria
itch
vulval erythema, fissuring, satellite lesions may be seen

35
Q

Mx for vaginal candidiasis

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

36
Q

recurrent vaginal candidiasis

A

BASHH define recurrent vaginal candidiasis as 4 or more episodes per year
compliance with previous treatment should be checked
confirm the diagnosis of candidiasis
high vaginal swab for microscopy and culture
consider a blood glucose test to exclude diabetes
exclude differential diagnoses such as lichen sclerosus
consider the use of an induction-maintenance regime
induction: oral fluconazole every 3 days for 3 doses
maintenance: oral fluconazole weekly for 6 months

37
Q

chocolate cysts

A

endometrial cyst

38
Q

what is HCG and its main role

A

hormone first produced by the embryo and later by the placental trophoblast.

main role is to prevent the disintegration of the corpus luteum

39
Q

Rokitansky protuberance means

A

dermoid cyst

40
Q

what is fibronectin

A

is produced by the gestational sac and its sort of indicates premature labour

41
Q

features of primary dysmennorhoea

A
  • pain typically starts just before or within a few hours of the period starting
  • suprapubic cramping pains which may radiate to the back or down the thigh
42
Q

Mx of primary dysmennorhoea

A

NSAIDs such as mefenamic acid and ibuprofen are effective in up to 80% of women. They work by inhibiting prostaglandin production

combined oral contraceptive pills are used second line

43
Q

features of secondary dysmennorhoea

A

In contrast to primary dysmenorrhoea the pain usually starts 3-4 days before the onset of the period. Causes include:

  • endometriosis
  • adenomyosis
  • pelvic inflammatory disease
  • intrauterine devices*
  • fibroids
44
Q

what is immune thrombocyopenia

A

autoimmune condition

can pass to the child

45
Q

complications of twin pregnancy

A

preterm labour and birth - c section
placental problems - slows fetal growth esp late 3rd trimester

twin-twin trasfusion - one gets more blood than the other

preeclampsia

diabetes

risk of cerebral palsy 4x

46
Q

what is conscientious objection in health care

A

A person is engaging in conscientious objection when they

  1. refuses to provide legal and professionally accepted goods or services that fall within the scope of their professional competence, and
  2. justifies their refusal by claiming that it is an act of conscience or is conscience-based
47
Q

when can a professional object and what are the legislations

A

The only two areas where the right to conscientious objection of health care professionals are:

Termination of pregnancy (Abortion Act 1967)
Fertility treatment (Human Fertilisation and Embryology Act 1990

Conscientious objection (Medical Activities) Bill 2017 (currently HoL)- relates to end of life care

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