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THIRD YEAR > Repro > Flashcards

Repro Flashcards

1
Q

what is an ovulation

A

ovaries don’t release an oocyte during a menstrual cycle

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2
Q

menstruation phase when
prolif phase when what is secreted
secretory phase when what is secreted

when is the max reception ability for blastocyte

A

d1-4
d4-14 oestrogen
d14-28 progesterone

secretory phase

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3
Q

HCG during pregnancy pattern

HCS during preg pattern

A

increased peaks then falls

increases from week 5 (not right from beginning tho)

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4
Q

IVF conditions

A 
unexplained infertility > 2years 
pelvic disease
anovulatory infertility 
other pre implantation genetic disease
male factor infertility >1x106 motile sperm
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5
Q

steps of IVF

A 
down regulation with synthetic GnRH analogue
baseline scan
ovarian stimulation GnRH with LH or FSH
action scan 
sperm sample 
oocyte collection 
embryologist
transfer
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6
Q

risks of buseralin

A

hot flushes
mood swings
nasal irritation
headaches

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7
Q

treatment for OHSS

A

before transfer - coasting, stop GNT, freeze, single embryo transfer
after transfer - moniter, anti thrombin, analgesia, admite

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8
Q

ART before treatment for females

A 
alcohol down to 4 units/ week 
weight 19-29
stop smoking 
FA 0.4g/day
cervical smear, rubella immunity, Hep B and C, HIV, assess ovarian reserve
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9
Q

IUI

A

increase the number of sperm reaching the fallopian tube

unexplained infertility, mild/mod endometriosis, mild male factor infertility

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10
Q

ICSI

A

severe male infertility, prev failed IVF, preimplantation genetic disease

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11
Q

Aspiration

A

azoospermia
sperm aspirated surgically then ICSI
95% success rate of obtaining sperm if obstructive - epididymis
50% in non

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12
Q

obstructive causes of male infertility

non obstructive

A

CF vasectomy, infection

crytochordism, mumps, orchis, chemo/radio, tumours, klinfelters, semen abnormality, systemic, endocrine

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13
Q

donor insemination

A

azoospermia or very low sperm count

genetic/infective disease

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14
Q

crytochordism treatment

A

<14s orchidopexy

adults orchidectomy

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15
Q

androgen insensitivity syndrome

A

46XY
primary amen. lack of pubic hair
no uterus no ovaries, short vagina

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16
Q

klinfelters

A

47XXY
gynacamastia, infertility, decreased facial and body hair, small testes
testosterone replacement therapy

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17
Q

liomyoma

A

can increased in response to oestrogen (pregnancy)

commoner in afrocarribean populations

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18
Q

liomyosarcoma

A

spindle cell morphology
aggressive tumour
surgical resection

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19
Q

endometritis

A

cervical mucous plug protects endometrium from ascending infection and so does cyclic shedding

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20
Q

chronic plasmocytic endometrium

A

associated with PID

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21
Q

adenomyosis

A

endometrial glands and stroma within the myometrium

mennorhagia/dysmennorhea

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22
Q

anovulatory causes of DUB

ovulatory

A

obese. extremes of repro life. PCOS, thyroid, prolactin, irregular cycle

35-45, regular heavy periods, inadequate progesterone production, abnormal follicles

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23
Q

treatment of DUB

A

progesterone, COCP, GnRH, NSAIDs, antifibrinolytics, capillary wall stabilisation, mirena
ablation/resection or hysterectomy

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24
Q

TVUS

A

> 16mm in pre meno
4mm in post meno

do biopsy

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25
Q

phamacokinetic changes in pregnancy

A 
increased volume of distribution 
decreased absorption (vom)
decreased protein binding - increased free drug
increased liver metab of phenytoin
increased GFR
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26
Q

period of greatest teratogenic risk

A

4-11 weeks

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27
Q

ACEi/ARBs

A

renal hyperplasia

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28
Q

andogenr

A

virisliation of females

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29
Q

antiepileptics

A

cardiac, facial, NT defects

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30
Q

cytotoxic drugs

A

multiple defects, IUD

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31
Q

lithium

A

CVD

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32
Q

retinoids

A

ear, CVD, skeletal

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33
Q

warfarin and opiates at labour

A

warfarin - bleed

opitaed - resp depression, premature close of DA

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34
Q

stilbestrol

A

1940-1971
vaginal adenocarcinoma in females aged now 15-20
urological malignancies in boys

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35
Q

foremilk

hindmilk

A

rich in protein
high fat content
longer feeds - high amount of fat soluble drugs

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36
Q

why might drugs accumulate

A

immature metabolism

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37
Q 
BF drugs:
phenobarbitone
amiodarone
cytotoxic
BZDs
bromecriptine
A 
suckling difficulties
neonatal hypothyroid - amiodarone
cyto-bone marrow suppression
BZD - drowsiness
brom-suprresses lactation
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38
Q

N and vom in preg
UTI
pain
heartburn

A

cyclizine
N and cefalaxin (3rd trim - trimethoprim)
paracetamol
antacids

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39
Q

tetra
phenytoin
valproate

A

staining of bones and teeth
cleft lip and palate
NT defects - SB and amencephaly

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40
Q

why is there an increase in seizures during preg

A

decreased compliance

changes in plasma concentration - vom, increased clearance

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41
Q

SU in preg

A

not safe

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42
Q

why does preg have a high increase in VTE

A

decreased levels of factors 7, 9, 10 and fibrinogen

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43
Q

epilepsy treatment

A

FA from 3 months before conception

Vit K 10-20mg PO from 34-36 weeks

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44
Q

risk of child developing epilepsy

A

5% if mum/dad
15-20% if both
10% if sibling and mum/dad

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45
Q

during preg and epilepsy

A

scan at 18-20 weeks
cardiac scan at 22 weeks

LCSC is recurrent generalised seizures in late preg/labour

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46
Q

post partum and epilepsy

A

neonates given Img IM vit K

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47
Q

BM and HbA1c in preg
LCSC if
growth scans

A

BG 4-6, <6%
if macrosomin and EFW >4kg
serial growth scans at 28, 32, 36 w

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48
Q

risks of DM

A 
fetal macrosomnia - shoulder dystonia C5-C6
polyhydraminoas
polycythaemia
neonatal hypoglycaemia
hypocalcaemia
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49
Q

LMWH for DVT

A

1mg/kg once or twice daily till 3m after delivery of 6m after treatment

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50
Q

hypothyroid

A

increase levothyroxine by 25-50mcg in first trim

TFTS every trim

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51
Q

hyperthyroid

A

gets worse due to HCG in first trim
improves in 2nd and 3rd
propylthiouracil, propranolol (IUGR)

TFTS every trim

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52
Q

APH

A

bleeding after 24 weeks

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53
Q

placental abruption

A

painful
blood loss
uterine wooden
difficult to feel fetal parts

clinical dx

steroids, deliver if compromised

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54
Q

major PP

minor PP

A

=<2cm from os/covering CS

>2cm from os - vaginal delivery

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55
Q

painless bleeding during third trim

uterus soft and non tender

A

PP

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56
Q

placenta praevia

A

dont perform vaginal exam till excluded

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57
Q

placenta accreta

A

severe bleeding, PPH

c sections

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58
Q

vasa praevia

A

fetal distress, bleeding

can be dx antenatally

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59
Q

uterine rupture

A

prev c sec/uterine repair

obstructed labour, fetal distress/IUD

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60
Q

local causes of APH

A

small volume
uterus soft non tender
no fetal distress
placenta placed normally

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61
Q

acute bleeding 23-32w
recurrent bleed after 28w
any bleed after 32w

A

24 hour bleed free then discharge
min stay 72 hours
min stay 72 hours

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62
Q

PPH cause

A

tone - uterine atony, distended bladder
trauma
tissue - placenta, clots
thrombin - pre existing or acquired coag

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63
Q

PPH treatment

A

uterine massage
5 units IV syntocin
40 units sync in 500mls

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64
Q

persistent PPH

A 
confirm placenta and membrane complete 
urinary catheter 
500mcg ergometrine IV (not in heart disease, htn)
arterial embolisation
surgery
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65
Q

os closed

os open

A

threatened

inevitable

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66
Q

implantation bleeding

A

10 days post ovulation

mistaken for period

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67
Q

chorionic haematoma

A

pooling of blood between endometrium and embryo due to separation

bleeding cramps threatened miscarriage
large - infection, irritability, cramps, miscarriage

self limiting, reassure and surveillance

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68
Q

type of pain relief for labour

A 
enter
water immersion 
morphine
IV remifentanil PCA
epidural anaethesia
pudendal nerve block
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69
Q

epidural anaethesthetic

A

v effective
does not impair uterine activity
may inhibit progress during stage 2

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70
Q

risks of epidural anae

A 
hypotension
headache
back pain
atonic bladder - empty bladder
dural puncture - severe headaches and photophobia due to CSF leak
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71
Q

stage 1 delay

A

nulliparous <2cm in 4 hours

parous <2cm in 4 hours or slowing in progress

72
Q

stage 2 delay

A

prim 2 hours 3 with epi

multi 1 hours 2 with epidural

73
Q

doppler auscultation

A

stage 1 done every 15 mins and at beginning and end of every contraction
stage 2 every 5-10 mins

74
Q

treatment of fetal distress

A 
change maternal position
IV fluids
sop syntocin
terbutaline 250mcg - stop contractions
maternal assessment 
fetal blood sampling 
op delivery
75
Q

fetal blood sampling

A

> 7.25 pH normal
7.2-7.25 repeat
<7.2 deliver hypoxic

76
Q

induction of labour

A

vaginal prostaglandin
mechanical
amniotomy - rupture of membrane
IV I syntocin

77
Q

observations during first stage of labour

A

hourly pulse
4 hourly temp and BP
freq of PU
VE 4 hourly

78
Q

preg induced htn

A

> =140/90 DBP>110 or SBP>160

dx in second half week of pregnancy. resolves 6 weeks post natally

79
Q

treatment of preg

A

labetalol (asthma) - can BF
nifedipine - can BF
hydralazine IV
methyldopa (depression)

80
Q

PET

A

proteinuria >=0.3g/24 hour
oedema
htn >30 systolic >14 diastolic compared to booking

81
Q

check for PET

A

maternal artery doppler done at 20-24 weeks to check if placentation has occured

82
Q

refer to daycare unit

A

> =140/90, proteinuria, oedema, symptoms like persistent headache

83
Q

admit

A 
BP>170/110 or 140/90 with lots of proteinuria, headaches/visual symp/abd pain
abnormal biochem
proteinuria
need antihypertensives
signs of fetal comprimise
84
Q

MAP>= 150

A

risk of cerebral haemorrhage

85
Q

aim with htn

A

<150/80-100

86
Q

eclampsia

A

tonic clonic seizure occurring with features of PET

over 1/3 will have seizure before onset of htn/protein

87
Q

when are most seizures in ec

A

in labour or after

assoc with ischaemia/cererbral vasospasm

88
Q

treatment of ec

A 
control BP, labetalol hydrazine
Mg sulphate 4g IV over 5mins IV infusion 1g/hour
further seizures mg sul 2g
further diazepam IV
fluid balance run px dry 80ml/hour
syntocin
89
Q

why should ergometrine be avoided during ec

A

can cause htn

90
Q

risk factors for PET

A

75mg aspirin

91
Q

steroids

A

betamethasone 12mg IM twice 24 hours apart up to 36 weeks

92
Q

wedge shaped nipple
pain after feeding
baby may vom blood

A

sore/cracked nipples

93
Q

treatment for sore/cracked nipples

A

breast feeding technique
express milk
scabs - lansinon cream

94
Q

engorgement treatment

cx

A

express before feeding
warm baths/press before feeding. cold press between feeds
mild analgesia
good attachment and emptying

cx mastitis

95
Q

treatment for mastitis

A

continue BF
anti inflam
AB if no improvement or worse after 12-14h
flucoxacillin 1g qds (PA clindamycin 450mg tds) for 7-10 days

96
Q

breast abscess

A

untreated mastitis
send pus for culture
same treatment as mastitis

97
Q

breast thrush when is it rare

A

candida albicans

<6w

98
Q

treatment for breast thrush

A

superficial miconazole cream 2% 7 days

deep fluconazole 300g loading dose 150mg daily for 10 days

99
Q

infant treatment fro breast thrush

A

nappy rash, oral

<4m nystatin suspension 1week
>4m miconzole oral gel 24mg/ml 4 times daily for a week

100
Q

resp congenital shit

A

trachea-oesophagus fistula

diaphragmatic hernia

101
Q

preterm
tem
post term

A

24-36(+6)
37-42
>42

102
Q

retinopathy of immaturity

A

6-8 weeks post

103
Q

gestational age 32-36 w old

<32 w

A

continued for 1 yr

2 yrs

104
Q

intraventricular haemorrhage

A

happens in premature infants

bleeding in germinal matrix 80% -> intraventrivular bleed

105
Q

RF for intravenctricular haemorrhage

A

RDS, prem

106
Q

grades 1 and 2

3 and 4

A

neurodevelopment delay 20% mortality 10%

delay 80% mortality 50%

107
Q

apnoea of prem

A

cessation of breathing for >20 seconds accompanied by hypoxia or bradycardia

108
Q

bronchopulmonary dysplasia

A

complication of prolonged ventilation to treat RDS

109
Q

early onset neonatal sepsis

late onset

A

bacteria before and during delivery

after delivery

110
Q

NEC

A

most common neonatal surgery

necrosis in small and large intestine

111
Q

NEC when

A

when recovering from RDS

112
Q

lethargy and gastric residuals, bloody stools, demo instability, apnoea and brady

A

NEC

113
Q

meconium ileus

A

not keen to feed, not emptying bowels, slightly distended abdomen, no menonium or little bits

114
Q

when should meconium be passed

A

within 48 hours

115
Q

meconium ileus

A

gets stuck in terminal ileus

1/3 of CF children present with it

116
Q

treatment of meconium ileus

A

contrast enema - if not laprotomy

117
Q

fairy liquid vom

A

malrotation

118
Q

cx of malrotation

A

SMA supplies midgut can be pinched

119
Q

atresia

A

absence of connective tube
vom, green stools, distended abd, doesn’t want to feed vom
can be seen on antenatal screens

120
Q

hernia

A

commonest inguinal

121
Q 
booking visit
booking scan
anomaly scan
monthly visits till
anti D
fortnight visits 
weekly visits
A 
8-12 weeks
11-12 week
20w
till 28 weeks
28 and 36 weeks
28-36 weeks
37 weeks onwards
122
Q

booking visit

A

FBC, hb, ABO-rheuss, rubella, syphillis, HIV, Hep B and C, urinalysis, VDRL, random BG, BP

123
Q

term normal baby weight

A

2.5-4kg

124
Q

male weight at 28 weeks
at term
daily weight gain

A

1150g
3550g
24g

125
Q

transplacental transfer

A

iron, vitamins, calcium, phosphate and ABs

126
Q

screening of child

A

Hep C, Hep B, HIV, TB-BCG, group B strep, syphilis, gonococilis, hearing, hip screening
gurthrie - hypothyroid, CF, MCCAD, PKU, haemaglobinopathies

127
Q

combined test

A

USS at 11+3 nuckal thickening

HCG and PAPPA

128
Q

quadruple test

A

14-20 weeks

bHCG, AFP, inhibin A, unconjugated oestrogen

129
Q

diagnostic tests for downs

A

chorionic villous sampling 12 weeks 2% risk of miscarriage

amniocentesis 15 weeks 1% risk

130
Q

dx of GTT

A

screened for GTT at booking and at 28 weeks

dx at 28 weeks fasting >5.1 2 hour >8.5

131
Q

aim for diabetes

A

3.5-5.9 fasting

1 hr post prandial <7.8

132
Q

regular monitering in diabates

A

for PET

growth 2-4 weekly FATs from 28 weeks or dx

133
Q

IUGR assym

sym

A

placental insufficeicney

baby just small

134
Q

risks of IUGR

A

hypoxia, hypoglycaemia, hypothermia, polycythaemia, abnormal neural development

135
Q

treatment of stress incontinance

A

physio
lose weight
caffeine
smoking

136
Q

treatment of urge incontincence

A

avoid caffeine
bladder retraining
oxybutinin

137
Q

overflow incontinance

A

assess renal function

catheter

138
Q

menopause av
early
prem
late

A

51
45
40
54

139
Q

HRT

A

oral or combined transdermal coestradiol and prog

if no uterus then just oestrogen

140
Q

prem manopause
urogenital
vaginal dryness
sexual dysf

A

steroid and HRT or CoC
vaginal oestrogens if atrophy
moisturise, lubrincants, vaginal oestrogen
prog off licence

141
Q

benefits of HRT

risks

A

decrease fragility fractures, decrease bowel cancer, effect on muscle mass and strength

VTE (oral>transdermal), increased risk of breast cancer, CHD and stroke

142
Q

anterior cystocele
middle/apical - enterocoele
retrocede - posterior
complete eversion

A

prolapse of bladder into vagina
herniation of pouch of douglas into vagina
prolapse of rectum into vagina
uterine procidentra

143
Q

RF for prolapse

A

age
vaginal deliveries
increased parity
increased BMI

144
Q

staging for prolapse

A 
0 no
1 >1cm above hymen (pos)
2 within 1cm
3 1-2cm below (neg)
4 eversion
145
Q

when can’t breast feed

A

8 units of alcohol
cocaine
HIV

146
Q

baby blues when

A

days 3-10

self limiting

147
Q

post natal depression when

A

2-6 weeks
lasts weeks to months. 1/3 up to a year
70% lifetime risk of depression
25% recurrance

148
Q

drugs for depression in preg

A

sertalline safe in BF

TCAs amitrip, nortryp safe in preg and ok in BF

149
Q

venlafaxine
paroxetine
citalopram and fluoexetine

A

htn
cardiac abnormalities
high levels in breast milk

150
Q

purpueral psychosis when

RF

A

2 weeks
BPD, prev, first relative with history

5% suicide risk 4% infantcide risk
80% 10 yr recurrence 25% develop BPD

151
Q

BPD which drug is the safest

A

lamotrigene

152
Q

risk of baby developing BPD

A

1/7

153
Q

risk of schiz to child

A

10%

154
Q

whats safe in schiz

whats unsafe

A

typical

atypicals gestational GM, IUGR

155
Q

clozapine

olanzapein

A

contraindicated in BF

can induce extrapyramidal reactions in BF babies

156
Q

avoid what in anxiety

A

benzos- cleft lip and neonatal withdrawal

157
Q

RF for cervical cancer

A

HPV (lots of sexual partners), age at first intercourse, long term use of PO contraceptives, no use of barrier contraception, smoking, immunosuppression

158
Q

cervical cancer staging

A 
1AI depth 3mm length 7mm
1AII depth 5mm length 7mm low risk of LN mets
1B confined to cervix
2a vaginal involvement 
2b parametrial involvement 
3 lower vagina/pelvic wall
4 bladder/rectum/mets
159
Q

cervical local spread
lymph
heam

A

uterine body, vagina, bladder, ureters, rectum
pelvic and para aortic early
liver, lungs, bones late

160
Q

cervical screening

A

25-64

every 3 years up to 49 then 5 yearly

161
Q

HPV vaccine

A

against 16 18 6 and 11

girls aged 11-13, MSM, HIV px

162
Q

cervical erosion

A

exposure of endocervical epithelium to acid of vagina - physio
squamous metaplasia v common

163
Q

nabothian follicles

A

endocervical glands that have expanded into mucous cysts

can form masses or polyps

164
Q

follicular cervitis

A

subepithelial reactive lymphoid follicles present in cervix

165
Q

endometrial adeno

A 
worse prognosis 
high SE status
later onset of sexual activity 
smoking 
HPV esp 18
166
Q

vulval intraepithelial neoplasia young women

elderly women

A

multifocal, recurrent or persisten causing treatment problems

greater risk of progression to invasive squamous

167
Q

spread to what is an important prognostic factor in vulvar squamous carcinoma

A

inguinal nodes

168
Q

pagets of vulvar is what

A

crusting rash. rumour cells in epidermis. contain mucin. pain itching
tumour arises from sweat glands in skin

excise

169
Q

type 1 endometrial cancer

A

endometroid and mucinous (always low grade)

unopposed oestrogen
precursor is atypical hyperplasia

170
Q

type 2 endometrial cancer

A

serous
clear cell
both high grade
precursor serous intraepithelial carcinoma

171
Q

obesity is a risk factor for endom cancer how

A

adipocytes contain aromatise that converts ovarian androgens to oestrogens which induce endometrial proliferation

172
Q

grading of endometriod

A

I 5% or less solid growth
II 6-50%
III >50%

173
Q

staging of endometrial cancer

A

IA <50% mymoetrial invasion
IB =>50%
2 cervical stroma
3 local and or regional spread
3A serosa of uterus and or adnexae
3B vaginal and or parametrial involvement
3C mets to pelvic and or para aortic nodes
4 bladder and or bowel mucosa and or distant mets

174
Q

endometrial stromal sarcoma

A

rare soft fleshy usually polypod masses
high grade

abnormal uterine bleeding but can present with lung/ovarian mets

175
Q

carcinosarcoma

A

mullerian

mixed epithelial and stromal

176
Q

presence of what worsens prognosis of mullerian

A

rhabdomyosarcomatrus

THIRD YEAR (27 decks)

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