Repro Flashcards

Question

what happens to platelet count in pregnancy?

Answer 1

it will fall - due to dilution.

Answer 2

1. improve diet - obesity affects rates of miscarriage and still-birth. may be challenging when measuring fundal height (monitoring fetal growth). venous thromboembolic events are also more common in obese patients. 2. optimise BMI 3. reduce alcohol consumption - associated with foetal abnormalities and learning disability 4. smoking cessation 5. folic acid - 400 mcg daily 6. age - teenagers (lack of support, smoke more, antenatal care may suffer), >40 (more prone to having medical conditions or develop complications such as gestational diabetes and hypertension 7. parity 8. occupation 9. substance misuse - heroin, methadone etc can be addictive for the baby (withdrawal)

Answer 3

inborn error of metabolism causing inability to metabolise phenylalanine. this can cause mental development impairment. women with PKU need to restart low phenylalanine diet to prevent high levels reaching the developing foetus.

Answer 4

hypothyroidism. treatment is thyroxine. demand for thyroxine will increase during pregnancy, therefore, doses need to be increased. normal thyroxine levels are needed for foetal brain development.

Answer 5

risks of TIIDM in pregnancy : 1. pre-eclampsia 2. still-birth 3. macrosomic infants (smaller babies) yes, discontinue her medication - switch her to insulin.

Answer 6

effect of anti-epileptic medication on the baby. sodium valproate is an extremely teratogenic drug

Answer 7

1. detect evolving hypertension 2. urinalysis 3. diabetes 4. UTI 5. abdominal palpation 6. assess symphyseal fundal height 7. estimate the size of baby 8. estimate the liquor volume 9. determine the foetal presentation 10. listen to the foetal heart

Answer 8

1. HIV - maternal treatment and careful planning reduces vertical transmission 2. syphilis - easily treated with penicillin 3. Hepatitis B - if infected can provide passive and active immunisation for the baby 4. Rubella - antibodies indicating immunity due to prior infection or immunisation. rubella can result in mental handicap in the child, blindness, deafness and heart defects. 5. MSSU - urinary tract infections all women will receive the top 4 - with their consent

Answer 9

1. growth restriction 2. hepato-splenomegaly 3. anaemia 4. thrombocytopaenia 5. skin rashes

Answer 10

Iron tablets this is actually very common. blood counts are taken at around 28/40 weeks gestation. additional iron is required to make extra maternal RBCs as normal adaptation of pregnancy and needed by the developing fetus and placenta.

Answer 11

anti-D antibodies are present in Rhesus disease. Women who are rheesus negative are given Anti D IgG prophylactically and after potentially sensitising events. if a rhesus negative woman is carrying a rhesus positive baby she will develop anti-D antibodies if the fetal RBC enter the maternal circulation. it may result in a miscarriage or ectopic pregnancy etc. antibodies will tend to develop during the first pregnancy. in subsequent pregnancies, the maternal antibodies will cross the placenta and cause the destruction of the fetal red blood cells cause fetal anaemia. screening can allow identification of women at risk (Rheesus negative women) and give them passive immunity to destroy all fetal RBC in maternal circulation before the maternal immune system has opportunity to be activated and produce its own antibodies.

Answer 12

1. viability of pregnancy 2. multiple pregnancies 3. abnormalities incompatible with life. 4. Down's syndrome screening

Answer 13

trisomy 21. the incidence of Down's increases with advancing age and family history

Answer 14

10-14 weeks gestation. it will use maternal factors such as: 1. serum B-HCG 2. pregnancy-associated plasma protein A (PAPP-A) 3. fetal nuchal translucency (NT) other tests include: - chorionic villi sampling - amniocentesis - non-invasive prenatal testing (testing maternal blood for fetal cell DNA) - alpha feto-protein

Answer 15

detecting fetal abnormalities 1. 50% with T21 will have a normal detailed USS 2. 17% with T18 will have a normal USS 3. 9% with T13 will have a normal USS

Answer 16

they both act on the ovaries. LH and FSH will initiate the growth of new follicles, beginning a new ovarian cycle the ovaries will then go on to produce steroid hormones - oestrogen and progesterone oestrogen has positive feedback during days 12-14 but will have negative feedback during most of the cycle.

Answer 17

ovulation tends to occur mid-month - around day 14. | the corpus luteum is formed after this.

Answer 18

the endometrial wall is thickest at day 28 - towards the end of the month but grows from day 5.

Answer 19

week 6 once a fetal pole is identified, a crown-rump length (CRL) measurement is made from one end of the embryo to the other. the length of the embryo closely correlates with the gestational age of the pregnancy and allows an estimated due date (EDD) to be decided upon.

Answer 20

neural tube defect. it results when the vault of the skull fails to develop. the brain is unprotected and becomes worn away - not compatible with life.

Answer 21

1. gestational age 2. diagnose miscarriage 3. multiple pregnancies (2 fetal poles will indicate twins) 4. exclusion of other abnormalities - hydatidiform, ectopic pregnancies (pregnancy outwith the uterus), anencephaly 5. evaluation of maternal ovaries

Answer 22

maternal age incidences of chromosomal abnormalities increases with maternal age.

Answer 23

between 11 and 14 weeks. if a patient books after this 14 weeks they can still receive a screening in the form a blood test for 4 serum markers between weeks 15 and 20: 1. AFP 2. total HCG 3. unconjugated oestriol 4. inhibin if the patient has levels indicating a high risk then it will necessitate an invasive test to be performed such as an amniocentesis

Answer 24

1. HCG 2. PAPP-A 3. nuchal translucency - crown-rump length (CRL) 4. AFP is used to screen for neural tube defects ( a serum AFP of >2 MoM - multiples of median - is considered abnormal. an AFP test is offered to all women.

Answer 25

identify fetal structural abnormalities

Answer 26

ensuring fetal well-being in the 3rd trimester scan, there is no routine US as there is no evidence of any benefit. scans are indicated if the baby feels small or large for their dates. standard measurements involve the head, abdomen and femur.

Answer 27

1. sickle cell 2. PKU 3. hypothyroidism 4. cystic fibrosis

Answer 28

Tay Sachs is a lysosomal storage disease in which hexosaminidase A deficiency results in the build-up of lipid GM gangliosides there is progressive neurological deterioration and is fatal by 3-5 years old.

Answer 29

1. interstitial (Leydig cells) 2. Sertoli cells - support the sperm-producing cells and produce inhibin 3. germ cells - produce sperm 4. seminiferous tubules (containing sustentacular cells and spermatids

Answer 30

they are released by the anterior pituitary

Answer 31

1. LH will act on Leydig cells (interstitial cells ). this will go on to aid in the formation of androgens necessary for secondary sex characteristics (testosterone) 2. FSH will act on the spermatogonia in the seminiferous tubules of the testes leading to spermatogenesis. FSH will act on the Sertoli cells

Answer 32

a low concentration of sperm is oligozoospermia. azoospermia means no sperm

Answer 33

during weeks 3.

Answer 34

1. pronephros 2. mesonephros 3. metanephros (the cloaca will divide to form the rectum and anteriorly the urogenital sinus)

Answer 35

the urogenital sinus the caudal end of the urogenital sinus will form the urethra and prostate. in males, the mesonephric duct is responsible for the production of the sex organs while the paramesonephric duct degenerates but... in females, the mesonephric duct will degenerate and the paramesonephric duct will form the fallopian tube, uterus and cervical part of the vagina. the urogenital sinus will form the bladder and the lower part of the vagina.

Answer 36

testis-determining factor (TDF) is the protein and it is encoded by the SRY (sex determining region Y). expression of SRY will form the Sertoli cells. The Sertoli cells will then secrete MIS (Mullerian-inhibiting substance). MIS promotes the formation of the Leydig cells. after the secretion of MIS then the paramesonephric duct will degenerate. Leydig cells are responsible for producing testosterone. remember that the Leydig cells are not formed from the epithelium

Answer 37

1. infertility 2. malignant transformation (germ cell tumour) 3. testicular torsion management of undescended testes is with an orchiopexy.

Answer 38

1. dramatic dilation of the urinary collecting system 2. increased renal plasma flow 3. GFR increases and creatinine clearance will increase 4. protein excretion is increased and microscopic haematuria may be present 5. 80% of women develop oedema and glycosuria is common 6. urate increases with an increasing gestation 7. . urea and creatinine levels will decrease

Answer 39

false - platelet count will decrease | WCC, on the other hand, will increase.

Answer 40

1. LMP 2. Cycle 3. contraception/sexually active 4. last smear test

Answer 41

1. menorrhagia 2. prolapse 3. pelvic pain 4. early pregnancy bleeding

Answer 42

1. position 2. size 3. mobility of the uterus 4. adnexal masses 5. tenderness 6. cervical excitation

Answer 43

the combined oral contraceptive pill (COCP)

Answer 44

1. pill 2. injectable 3. implant

Answer 45

true. they should also be 100% effective however no options are actually 100%. the best bet is a vasectomy followed by an implant.

Answer 46

vasectomy followed by an implant

Answer 47

1. HSV | 2. HPV

Answer 48

1. ethinyloestradiol (EE) 2. synthetic progesterone (progestogen) the COCP is usually taken for 21 days and then there is a pill free week

Answer 49

1. it will prevent ovulation by removing the surge of FSH and LH. 2, it will prevent implantation by providing an inadequate endometrium 3. it inhibits sperm penetration of the cervical mucus by altering the quality and character of the mucus

Answer 50

1. it increases the risks of developing a VTE 2. increase in risk of ischaemic stroke 3. breast cancer risk 4. cervical cancer

Answer 51

1. reduction in functional ovarian cysts 2. 50% reduction in ovarian and endometrial cancer 3. improvement in acne 4. reduction in benign breast disease, RA, colon cancer 5. reduction in osteoporosis

Answer 52

1. major surgery and immobility 2. thrombophilias 3. family history of VTE in those who are aged 45 and younger 4. BMI over 30 5. underlying vascular disease 6. post-natally within 21 days

Answer 53

none. there are no pill-free days with the progesterone only pill. the maximum effect of POP is 48 hours after ingestion.

Answer 54

the depot - depot medroxyprogesterone acetate (Depo-Provera) will act by preventing ovulation and altering cervical mucus making it hostile to sperm. it prevents implantation by rendering the endometrium unsuitable. it is very useful for those who are forgetful - given as an IM injection once every 12 weeks and doesn't contain oestrogen

Answer 55

1. delay in return to fertility 2. reversible reduction in bone density 3 problematic bleeding 4. weight gain

Answer 56

true it is composed of copper which creates a toxic environment for fertilisation

Answer 57

CU-IUD (copper intra-uterine device ) it can be used up to 72 hours of unprotected sex levonorgestrel and newer options are available that cover up to 120 hours. it is less effective however than ongoing contraception.

Answer 58

a vasectomy is the permanent division of the vans deferens under local anaesthetic. there is no evidence of a reduction in testosterone and semen will remain the same colour and volume. there is no evidence that vasectomy predisposes to testicular cancer or prosthatic cancer

Answer 59

1. low failure rate in terms of post-procedural pregancies | 2. there is less risk associated with the procedure than sterilisation carried out by laparoscopy and laparotomy

Answer 60

after 20 weeks. however, remember that the earlier the procedure, the less the complications.

Answer 61

1. ellaone (ulipristal cetate) should be given within 120h of unprotected sex. efficacy is not reduced by obesity but levonorgestrel may be) 2. levonelle 3. IUD - copper coil

Answer 62

1. condoms 2. IUD 3. diaphragms 4. caps - diaphragm stretching from pubic bone to posterior fornix (fit over the cervix)

Answer 63

1. OCP 2. contraceptive patch (transdermal) 3. vaginal ring 4. injection (depot)

Answer 64

1. they may be expelled 2. associated with pelvic inflammatory disease 3. risk of ectopic pregnancy 4. can cause dysmenorrhoea and menorrhoea

Answer 65

1. active pelvic infection/STD 2. pregnancy 3. allergy to copper 4. Wilson's disease 5. heavy painful periods 6. gynae malignancy IUCD will tend to last around 5 years.

Answer 66

yes. but do warn the patient about spotting +/- heavy bleeding for the first few weeks following insertion.

Answer 67

1. history of LMP 2. normal cycle 3. number of hours since unprotected sex 4. contraindications to later COCP 5. check BP 6. explain teratogenicity has not been proven 7. discuss future contraception 8. offer an infection screen to cover HIV 9. offer a follow up in 3-6 weeks if coil is inserted

Answer 68

1. venous disease - current or past VTE or giving sclerosing treatment for varicose veins 2. arterial disease - avoid if valvular or congenital heart disease 3. liver disease- hepatitis, cirrhosis etc 4. cancer - breast cancer 5. previous pregnancy complications -pruritis, obstetric cholestasis, chorea 6. hepatic enzymatic drugs - avoid if taking rifampicin or rifabutin

Answer 69

OESTROGENIC 1. breast tenderness 2. nausea 3. cyclical weight gain 4. bloating ``` PROGESTOGENIC 1. mood swings 2. PMT 3. vaginal dryness 4. sustained weight gain decreased libido ``` HEADACHE BREAKTHROUGH BLEEDING

Answer 70

1. VTE risk is doubled 2. ischaemic stroke 3. breast and cervical cancer 4. mood changes

Answer 71

1. improvement in acne 2. decreased menorrhagia decreased ovarian, endometrial and bowel cancer 4, decreased menopausal symptoms

Answer 72

1. thicken cervical mucus 2. reduce receptivity of the endometrium to implantation 3. inhibit ovulation they also have advantages of reducing pelvic infection and are used where oestrogen-containing contraceptives are contraindicated.

Answer 73

1. current breast cancer 2. trophoblastic disease 3. liver disease 4. new symptoms or diagnosis of migraine with aura/IHD/stroke 5. avoid if SLE with antiphospholipid antibodies 6. undiagnosed vaginal bleeding should be investigated before starting

Answer 74

1. higher failure rate than COCP 2. menstrual irregularities 3. increased risk of ectopic pregnancy 4. functional ovarian cysts 5. breast tenderness 6. depression 7. acne 8. reduced libido 9. weight change `

Answer 75

3 years it has no impact on bone density

Answer 76

sterilisation is the permanent, irreversible contraception. reversal i sonly 50% in either sex and is never funded by the NHS. a Filshie clip is used for females. vasectomy is safe than female sterilisation

Answer 77

full dilatation the first stage begins with regular contractions and ends in full dilatation

Answer 78

The second stage starts with full cervical dilatation and ends with delivery of fetus

Answer 79

The 3rd stage is the period in between delivery of fetus and delivery of placenta and fetal membranes.

Answer 80

induction of labour is when an attempt is made to instigate labour artificially using medications and/or by artificial rupture of membranes (performing an amniotomy) 1. diabetes 2. post-dates 3. maternal health problem that necessitates planning of delivery 4. fetal reasons (oligohydramnios)

Answer 81

the bishops score the higher the score the more progressive change there is in the cervix and this indicates that induction is likely t be successful. a lower score indicates that induction may be more likely to fail but can still be attempted once the cervix has dilated and effaced, an amniotomy can be performed

Answer 82

1. deliation (cm) 2. length of cervix (effacement) (cm) 3. position - posterior, mid or anterior 4. consistency - firm, medium or soft 5. station (cm)

Answer 83

1. vginal prostaglanings | 2. once cervix has dilated and effaced, an amniotomy can be performed

Answer 84

artificial rupture of the fetal membranes (waters) usually using a sharp device. once amniotomy is performed, IV oxytocin can be used to achieve adequate contractions - aim for 4-5 in 10 mins

Answer 85

P - power (contraction) P - passages (pelvic tract) P - passenger (baby)

Answer 86

the fetal head is in the correct position for labour but is too large to negotiate the maternal pelvis and be born. in these circumstances the babies head becomes compressed and caput and moulding develop

Answer 87

1. malposition - foetal head is in the incorrect position for labour and relative CPD occurs. the two main presentations are occipito-posterior and occipito-transverse 2. malpresentation (transverse, shoulder, hands, breech, oblique lies) 3. inadequate uterine activity - give synthetic IV oxytocin after excluding obstruction 4. ovarian cyst/fibroid 5. foetal distress

Answer 88

1. intermittent auscultation of the fetal heart 2. cardiotocography (CTG) - when there are too many contractions to keep up 3. fetal blood sampling - when suspicious or pathological CTG. pH will give a measure of likely hypoxaemia - are they getting enough oxygen 4. fetal ECG

Answer 89

1. infection 2. bleeding 3. VTE 4. visceral injury

Answer 90

retained placenta

Answer 91

tone trauma tissue thrombin

Answer 92

blood loss >500ml within 24 hours of delivery

Answer 93

blood loss>500 from 24 hours postpartum to 6 weeks this can be caused by 1. retained tissue 3. endometritis (infection) 3. tears 4. trauma

Answer 94

1. postpartum haemorrhage 2. venous thromboembolism 3. sepsis 4. psychiatric disorders of the puerperium 5. preeclampsia

Answer 95

1. uterine atony 2. local causes such as traumatic tears to perineum/vagina/cervix 3. retained tissue/placenta 4. coagulopathy 5. 4Ts tone trauma thrombin tissues

Answer 96

1. retained tissue 2. endometritis 3. tears/trauma

Answer 97

1. unilateral leg swelling and/or pain 2. SOB 3. chest pain 4. unexplained tachycardia

Answer 98

warfarin is teratogenic

Answer 99

1. doppler 2. ECG 3. CXR/VQ 4. CTPA treatment is with low molecular weight heparin

Answer 100

1. IV antibiotics 2. full septic screen - blood cultures - LVS - MSSU - wound swabs 3. IV fluids

Answer 101

false. 1/4 women who died between 6 weeks and 1 year after pregnancy died from mental-health related causes.

Answer 102

1. postnatal depression | 2. puerperal psychosis

Answer 103

progesterone will turn the endometrium into the decidua basalis 1. increased vascularity between the glands and vessels 2. stromal cells enlarge and become pro-coagulant (stops them bleeding). 3. thickening of the endometrium 4. increased vascularity if the cells outside of pregnancy there is a monthly shedding occurs from the endometrium/decidual wall lining

Answer 104

trophoblasts the b-hCG will act on the corpus luteum in the ovary. its function is to stimulate the corpus luteum to produce progesterone which stops the decidua from shedding

Answer 105

1. chromosomal abnormality 2. infection 3. maternal issues - ill-health, trauma, hormonal

Answer 106

methyltrexate typical presentations of an ectopic include 1. raised b-hCG 2. thickened lining of endometrium 3. expanded fallopian tube

Answer 107

the fallopian tubes

Answer 108

2 sperm fertilize one egg Molar pregnancies result in an imbalance in methylated genes (they become switched off). Molar pregnancy under microscopy will show some enlarged chorionic villi with abundant trophoblasts. A molar pregnancy has 2 lots of dad’s genes. This is a problem because in the testis, dad has inactivated several genes by adding methyl groups to stretches of DNA A molar pregnancy is a form of precancer of trophoblast cells. If it persists can (rarely) give rise to a malignant tumour called choriocarcinoma.

Answer 109

duodenal atresia TRisomy 21 can be confirmed with amniocentesis and can be first seen with nuchal thickening on an US

Answer 110

1. malformations 2. huge babies that obstruct labour (CPD?) 3. intrauterine death 4. neonatal hypoglycaemia

Answer 111

an ascending infection causing acute inflammation 1. neutrophils present in membranes, cord and fetal plate of the placenta. 2. bacteria are typically perineal/perianal flora (e.coli) which ascend vagina and get into the amniotic sac. 3. neutrophils produce a cytokine storm which activates some brain cells, which then get damaged by normal hypoxia of labour

Answer 112

false - there are 7 vertebral bodies ad 8 spinal nerves

Answer 113

false - it is caused by a cervical fracture there is also the risk of respiratory failure due to the loss of innervation of the diaphragm (C3-5)

Answer 114

follows the hemi-section of the cord and is usually brought on by penetrating injuries. patient's will experience paralysis on the side affected (corticospinal) with a loss of proprioception and fine discrimination (dorsal columns). pain and temperature loss on the opposite side below the lesion is also seen (spinothalamic tract)

Answer 115

transient depression of cord function below the level of an injury. the patient will experience flaccid paralysis and areflexia. it can last several hours to days after injury

Answer 116

1. age and duration of subfertility 2. any previous pregnancies and does partner have children 3. menstrual history 4. regularity, pelvic pain, history of STI's, previous surgery (tubal or ectopic for pregnancy) 5. smoking reduces fertility as does drinking 6. medical history and drug history to optimise both. 7. frequency of sexual intercourse and any problems during sex including erectile dysfunction 8. history of undescended testes, mumps 1. duration of infertility 2. previous contraception 3. fertility in previous relationships 4. menstrual history 5. medical and surgical history 6. sexual history 7. previous investigations 8. psychological assessment

Answer 117

this is a condition in which the opening of the urethra is on the underside of the penis genetic conditions such as Klinefelter's (47 XXY) syndrome can also affect the size of the testis

Answer 118

1. pelvic US 2. semen analysis 3. tubal patency test

Answer 119

1. androgen excess - hirsutism - abnormal testosterone level 2. polycystic ovaries - found with US 3. infrequent periods - anovulation for ovarian disorders, weight plays a big role ion treatment - encourage the patient to achieve a BMI of between 18 and 35

Answer 120

1. clomiphene citrate (binds to oestrogen receptors and thus tricks the hypothalamus into believing the body is in a hypoestrogenic state - triggering anterior pituitary to release more FSH it also has vasomotor and visual side effects. 2. gonadotrophins - used in specialist centre for clomiphene resistant PCOS or low oestrogen with normal FSH. 3. Laparoscopic ovarian drilling - only to be used in women with PCOS 4. weight loss or gain 5. metformin

Answer 121

amenorrhoea means the absence of menstrual periods

Answer 122

1. history 2. examination 3. FSH, LH, karyotype and PRL 4. CF screen

Answer 123

1. male factors: - semen abnormality (alcohol, nicotine, varicocele and cancer) - azoospermia - immunological - coital dysfunction 2. anovulation - can be caused by premature ovarian failure, turner's syndrome, surgery, chemo etc 3. unexplained 4. endometriosis 5. tubal factor

Answer 124

1. chlamydia screening 2. baseline hormonal profile (day 2-5 FSH and LH) 3. TSH, prolactin, and testosterone and rubella status (vaccinate if not immune) 4. mid-luteal progesterone level to confirm ovulation 5. semen analysis - repeat in 3 months if abnormal

Answer 125

1. transvaginal sonography (TVS) - ruling out adnexal masses, submucosal fibroids or endometrial polyps, or help confirm PCOS - polycystic ovarian syndrome 2. hysterosalpingogram (HSG) to demonstrate uterine anatomy and tubal patency. may cause period-like cramping and tubal spasm, giving false positive - only do when the chlamydia swabs are negative 3. hysterosalpingo-sonography uses US contrast and TVS 4. laparoscopy and dye test - gold standard test for assessing tubal patency

Answer 126

1. age 2. duration of subfertility 3. previous pregnancy (higher success rate) 4. smoking 5. high BMI (low success rate) 6. low anti-mullerian hormone (AMH) predict a poorer response

Answer 127

seminiferous tubules

Answer 128

in males, the function of LH is to stimulate Leydig cells to produce testosterone. the testosterone and FSH will stimulate Sertolli cells to produce essential substances for metabolic support of germ cells and spermatogenesis

Answer 129

1. plasma FSH 2. testosterone and LH (androgen deficiency) 3. karyotype - to exclude 47XXY 4. CF screening (CBAVD - Congenital Bilateral Absence of the Vas Deferens) main treatment (aside from lifestyle measures) is ICSI

Answer 130

1. engagement 2. descent 3. flexion 4. internal rotation 5. extension 6. restitution and external rotation 7. expulsion

Answer 131

1. latent phase (0-3cm) 2. active phase (3-7cm>) 3. transition phase (7-10cm>)

Answer 132

the chorion is responsible for providing the baby with nutrition the amnion is responsible for providing the baby with warmth and protection

Answer 133

1. placental insufficiency of one of the babies 2. cord entanglement 3. twin-twin transfusion syndrome 4. malpresentation 5. hypoxia of the second baby

Answer 134

this is when an attempt is made to instigate labour artificially using medications and/or by artificial rupture of the amniotic membranes - amniotomy

Answer 135

the bishops score the higher the score, the more progressive change there is in the cervix and indicates that induction is likely to be successful. a lower score indicates that induction is likely to take longer and may occasionally fail but can still be attempted

Answer 136

1. dilatation (cm) 2. length of cervix (effacement) 3. position 4. consistency 5. station

Answer 137

1. fetal lie is not longitudinal (you don't intentionally want to encourage the onset of labour with an abnormal lie) 2. known pelvic obstruction ( a tumour or ovarian cyst) 3. placental praevia - need C-section due to placental position 4. cardiac disease 5. fetal distress relative contraindications include: 1. previous c section - uterus has a scar which is at risk of dehiscence if you artificially stimulate labour 2. asthma - can cause respiratory smooth muscle contraction

Answer 138

1. oxytocin - initiates uterine contractions by attaching to the uterine oxytocin receptors; increases the frequency and force of contractions. - oxytocin is released by the posterior pituitary gland - women need CTG because there is a risk of uterine hypertonicity - may lead to hypotension and hyponatraemia 2. prostaglandins - eicosanoids (arachidonic acid derivation) - they encourage cervical dilatation and effacement - ripening the cervix so it can be used in the induction of labour. the analogues are inserted PV and placed in the posterior fornix - can lead to N&V, bowel upset, pyrexia and hypotension. be sure to continuously monitor the fetal heart (CTG)

Answer 139

augmentation of labour is required when contractions reduce in frequency or strength in active labour even after the spontaneous onset of labour.

Answer 140

1. syntocinon - synthetic oxytocin and can cause uterine contractions syntocinon can also be given as prophylaxis in post partum haemorrhage (PPH) in women where ergometrine is contraindicated (women who can't receieve syntometrine) 2. syntometrine - a mix of oxytocin and ergometrine (only given as M)

Answer 141

1. physical - bimanual compression - rubbing up a contraction 2. surgical 3. pharmacological - syntocinon: causes uterine contractions to treat/prevent PPH - syntometrine - carboprost - prostaglandin that causes uterine contractions - misoprostol - tranexamic acid - antifibrinolytic

Answer 142

they function to inhibit uterine contractions they can be used: 1. to facilitate the transfer of a woman in labour to appropriate hospital/appropriate neonatal unit 2. given to allow steroids enough time to work 3. fetal distress/emergency CS/obstructed labour/hypertonic uterus causing fetal distress

Answer 143

1. oxytocin receptor antagonist (atosiban) 2. CCB - nifedipine 3. B2 agonist - terbutaline, salbutamol (relaxation of smooth muscle) 4. indometacin

Answer 144

1. methyldopa 2. hydralazine 3. combined alpha and beta blockers - labetalol labetalol is actually the first line treatment for hypertension (it is a combined alpha and beta blocker) but be careful as it can be contraindicated in asthmatics and in some cardiac conditions such as bradycardias and cardiac failure.

Answer 145

IV magnesium sulphate

Answer 146

true spironolactone is also contraindicated diclofenac and ibuprofen are contraindicated as analgesics NSAIDs can cause closure of the ductus arteriosus

Answer 147

Non-pharmacological - breathing exercises - aromatherapy - warm baths - TENS therapy Simple analgesia - paracetamol - codeine - aspirin (avoid in labour as may increase risk of bleeding - entonox (gas and air) - nitrous oxide - opiates - local anaesthetic

Answer 148

1. perioral tingling 2. seizures 3. confusion 4. paraesthesia 5. light-headedness 6. drowsiness

Answer 149

1. thrombocytopaenia 2. coagulopathy 3. raised ICP 4. local sepsis 5. septic shock 6. allergy to local anaesthetic 7. lack of patient consent 8. anticoagulants within 12 hours of insertion

Answer 150

1. can fail to provide adequate analgesia 2. causes hypotension 3. reduces woman's mobility 4. epidural haematoma 5. risk of respiratory depression 6. risk of neurological deficits

Answer 151

1. intrauterine balloon tamponade 2. interventional radiology 3. B-Lynch suture 4. hysterectomy 5. fluid replacement

Answer 152

cord prolapse is the descent of the umbilical cord through the cervix alongside or past the presenting part in the presence of a ruptured membrane 1. call for help 2. replace the cord into the vagina 3. perform a digital elevation of the presenting part 4. catheterise and fill bladder to elevate the presenting part 5. encourage the mother to adopt the Knee-chest or left lateral position with raised hips . consider tocolysis 7. arrange a category 1 CS

Answer 153

Primary infertility refers to couples who have not become pregnant after at least 1 year having sex without using birth control methods Secondary infertility refers to couples who have been able to get pregnant at least once, but now are unable

Answer 154

Infertility is “a disease of the reproductive system defined by the failure to achieve a clinical pregnancy after 12 months or more of regular unprotected sexual intercourse

Answer 155

Oligomenorrhea is the medical term for infrequent, often light menstrual periods. Metrorrhagia is the term used for irregular menstruation that occurs between the expected menstrual periods

Answer 156

Diagnosis is made using the Rotterdam criteria (2/3 must be present) - Polycystic ovaries – 12 or more follicles - anovulation/oligo-ovulation - clinical/biochemical signs of hyperandrogenism also try to exclude other causes of irregular cycles before making diagnoses such as thyroid dysfunction, hyperprolactinaemia and androgen-secreting tumours

Answer 157

1. PCO refers to an ultrasound scan image of the ovaries that appear to be polycystic (ovaries containing high density of partially mature follicles) PCOS is a metabolic condition that may or may not come with having polycystic ovaries 2. if a woman has irregular periods and an increased male hormone she could have PCOS without her ovaries being polycystic. However, other conditions such as thyroid or pituitary dysfunction need to be excluded before PCOS diagnosis is made. PCO is a normal variant of a woman’s ovary, whereas PCOS is a diagnosed condition with short and long-term consequences 3. Women with PCOS should be aware of the associated risk which may include: diabetes, pregnancy complications (ie. gestational diabetes), cardiovascular disease, obesity and endometrial cancer. Women with PCO do not have the same risk profile 4. Conception with PCO may not be difficult, however, women with PCOS may have problems getting pregnant. In addition, women with PCOS have a higher miscarriage rates 5. Women with PCO may still possess the hormonal balance and continue to ovulate regularly. Whilst in PCOS, the hormonal balance is distorted which interferes with ovulation. In a large proportion of these women, the mechanism is linked to high insulin release that stimulates the production of androgens from the ovary disturbing ovulation

Answer 158

1. Weight loss and exercise are the mainstays of treatment (increase insulin sensitisation). 2. Smoking cessation. Find and treat diabetes, hypertension, dyslipidaemia and sleep apnoea. 3. Metformin – improves insulin sensitivity and may improve menstrual disturbance and ovulatory function but won't effect hirsutism or acne. 4. Clomiphene citrate – will induce ovulation but there is a risk of multiple pregnancy and ovarian cancer. 5. Ovarian drilling 6. The COCP – controls bleeding and reduce risk of unopposed oestrogen on the endometrium

Answer 159

PCOS is a diagnosis of exclusion. Other causes of irregular cycles should be excluded before the diagnosis is made if there is clinical suspicion e.g. – thyroid dysfunction, hyperprolactinaemia, congenital adrenal hyperplasia, androgen-secreting tumours, and Cushing’s syndrome. If clinically hyperandrogenic and total testosterone is high then check 17-hydroxyprogesterone and exclude androgen-secreting tumour.

Answer 160

MEDICAL Most cases of dysfunctional uterine bleeding respond to either oral or IV oestrogen. Because of the menstrual irregularities associated with anovulation, anaemia is a concern and must be treated with allogenic blood transfusion if blood parameters fall below critical levels. IV oestrogen or high-dose COCP may be needed to terminate the acute bleeding episode Dilation and curettage should never be the first line treatment. SURGICAL Ovarian drilling and ovarian wedge resection are other surgical modalities used in the treatment of anovulation due to PCOS, with a spontaneous ovulation rate of more than 80% after the procedure. DIET ACTIVITY

Answer 161

1. Hysterosalpingogram – demonstrates that the tubes are open when radiopaque dye spills into the abdominal cavity 2. Sonography will demonstrate tubal abnormalities such as hydrosalpinx (indicative of tubal occlusion) 3. Laparoscopy – status of tubes can be inspected and a dye can be injected. Laparoscopic chromotubation is the gold-standard of tubal evaluation

Answer 162

1. Female infertility – blocked tubes are unable to let the ovum and the sperm converge, thus making fertilisation impossible

Answer 163

1. Infection – pelvic inflammatory disease (PID) 2. Endometritis – infections after childbirth and intraabdominal infections including appendicitis and peritonitis 3. The formation of adhesions may not necessarily block a fallopian tube, but render it dysfunctional by distorting or separating it from the ovary. Women with distal tubal occlusion have a higher rate of HIV infection 4. Fallopian tubes may be blocked as a method of contraception. In these situations, tubes tend to be healthy and typically patients requesting the procedure have had children. Tubal ligation is considered a permanent procedure

Answer 164

TUBOPLASTY – fallopian tubal surgery – goal is to restore patency to the tubes and thus possibly normal function a. Fimbrioplasty – repairing the fimbriated end of the tubes b. Lysis of adhesions c. Salpinostomy – creating an opening for the tube IN VITRO FERTILIZATION ALTERNATIVE MEDICINE

Answer 165

While IVF therapy has largely replaced tubal surgery in the treatment of infertility, the presence of hydrosalpinx is a detriment to IVF success. It has been recommended that prior to IVF, laparoscopic surgery should be done to either block or remove hydrosalpinges

Answer 166

In vitro fertilisation is a process by which an egg is fertilised by sperm outside the body: in vitro. IVF is a major treatment for infertility when other methods of assisted reproductive technology have failed. The process involves monitoring a woman's ovulatory process, removing ovum or ova (egg or eggs) from the woman's ovaries and letting sperm fertilise them in a fluid medium in a laboratory

Answer 167

Azoospermia is the medical condition of a man whose semen contains no sperm

Answer 168

PRETESTICULAR - Inadequate stimulation of normal testis and genital tract. Typically, FSH is low - Hypopituitarism - Hyperprolactinaemia - Exogenous FSH suppression by testosterone - chemo TESTICULAR - testes are abnormal, atrophic, absent and sperm production is severely disturbed/absent. - FSH is high as the feedback loop is interrupted. - Cryptorchidism - Klinefelter’s syndrome POSTTESTICULAR - Sperm are produced but are not ejaculated. Main cause is a physical obstruction of the post testicular genital tracts. - Vasectomy - CF UNKNOWN

Answer 169

1. General health 2. Sexual health 3. Past fertility 4. Libido 5. Sexual activity 6. Drug history a. 5ASA inhibitors (sulfasalazine) b. Alpha-blockers c. 5ARIs d. Chemo e. Pesticides f. Weed, alcohol excess

Answer 170

1. Transrectal ultrasound (TRUS) 2. Genetic testing for CF 3. Levels of FSH and LH and gonadotrophins 4. Urine test for semen (retrograde ejaculation)

Answer 171

1. Treatment of hyperprolactinemia 2. Stop androgen consumption 3. IVF : ICSI 4. Testicular sperm extraction (TESE)

Answer 172

Unexplained infertility is infertility that is idiopathic in the sense that its cause remains unknown even after an infertility work-up, usually including semen analysis in the man and assessment of ovulation and fallopian tubes in the woman

Answer 173

1. Ovarian stimulation a. Clomiphene citrate b. Anastrozole c. letrozole 2. Intrauterine insemination (IUI) 3. Intracervical insemination (ICI) 4. In vitro fertilization (IVF)

Answer 174

IVF achieves a live birth rate approximately 2-3 times greater than ovarian stimulation combined with IUI (intrauterine insemination)

Answer 175

1. hypertension 2. asthma 3. epilepsy 4. migraine 5. mental health disorders (including depression and anxiety) 6. long term anti-coagulant use (for atrial fibrillation)

Answer 176

1. absorption - oral route (consider morning sickness - IM route (blood flow increased so absorption may also increase) - inhalation (increased cardiac output and decreased tidal volume 2. distribution increased plasma volume and fat increases distribution. decreased concentration of plasma proteins so fraction of increased drug increases. 3. metabolism and elimination oestrogen and progestogens have an affect on metabolism 4. excretion GFR is increased by 50% leading to an increased excretion of many drugs.

Answer 177

1. provide nutrients to the fetus 2. attach the fetus to the uterine wall 3. allows fetus to transfer waste products to the mother's blood (CO2, urea) 4. metabolism of certain drugs

Answer 178

1. size 2. electrical charge (non-ionized will cross) 3. protein binding 4. lipophilicity (high lipophilicity will increase the placental transfer

Answer 179

teratogenicity will take place during the first trimester fetotoxicity will mainly occur in the second and third trimester`

Answer 180

organogenesis (3-8 weeks). this can occur by many different mechanisms: 1. folate antagonism - this is a key process in DNA formation and new cell production - the main drugs affected here are methotrexate and trimethoprim as well as phenytoin, valproate and carbamazepine 2. neural crest cell disruption this mainly includes retinoid drugs - aortic arch anomalies,, ventricular septal defects, craniofacial malformations, oesophageal atresia etc 3. endocrine disruption - sex disruption 4. oxidative stress 5. vascular disruption 6. specific receptor (enzyme mediated teratogenesis drugs which inhibit/stimulate enzymes to produce therapeutic effects may also interact with specific receptors and enzymes damaging fetal development.

Answer 181

1. growth retardation 2. structural abnormalities 3. fetal death 4. functional impairment 5. carcinogenesis

Answer 182

valproate is associated with neural tube defects as is carbamazepine and phenytoin

Answer 183

warfarin is associated with haemorrhage in the fetus, as well as multiple malformations in the CNS and skeletal system

Answer 184

ACEI cause renal damage and may restrict normal growth patterns in the unborn child

Answer 185

premature closure of the ductus arteriosus

Answer 186

a micro-organism that derives food or other benefits from another organism without hurting or helping it.

Answer 187

1. syphilis (treponema pallidum 2. gonorrhoea (Neisseria gonorrhoea) 3. chancroid (haemophilus ducreyi)

Answer 188

1. fever 2. rash 3. lymphadenopathy 4. malaise 5. infertility

Answer 189

1. have you ever had sexual contact with a man 2. have you ever injected drugs 3. sexual contact with - anyone has ever injected drugs - someone from outside the UK 4. medical treatment outside the UK 5. involvement with sex industry (had sex with a prostitute

Answer 190

1. last sexual contact 2. casual contact or a regular partner - how long have you being going out with them 3. were they male/female 4. asking about nature of sexual contact is sometimes useful - anxiety about a specific incident - if its going to alter where you fwab from? 5. did you use condoms 6. other contraception? 7. nationality of contact

Answer 191

1. vulvovaginal candidosis 2. bacterial vaginosis 3. balanitis

Answer 192

candida albicans but also can be caused by c. glabrate. this condition is usually acquired from the bowel and asymptomatic.

Answer 193

1. thrush 2. itch 3. characteristic discharge - thick, cottage cheese like appearance 4. fissuring 5. erythema with satellite lesions vulvovaginal candidiasis is more common in those who have diabetes, are on oral steroids or are on immune suppression (HIV). it also very common in pregnant women and women who are of reproductive age - maybe th oestrogen leads to glycogen production and thus more food for the yeast.

Answer 194

vulvovaginal candidiasis is more common in those who have diabetes, are on oral steroids or are on immune suppression (HIV). it also very common in pregnant women and women who are of reproductive age - maybe th oestrogen leads to glycogen production and thus more food for the yeast.

Answer 195

GRam stained preparation: - low sensitivity and might look at an unrepresentative patch Culture - Sabouraud's medium - low specificity as yeast are foten commensal treatment is with antifungals 1. clotrimazole fluconazole

Answer 196

1. clotrimazole | fluconazole

Answer 197

1. asymptomatic in 50% of women 2. watery grey/yellow fishy discharge and may be worse after periods or sex 3. itch and sore from dampness 4. caused by an imbalance of bacteria rather than infection 5. reduced lactobacilli 6. associated with vitamin D deficiency in black women 7. associated with premature labour and increases the risk of HIV acquisition

Answer 198

1. characteristic history 2. examination findings will see a thin and homogenous discharge 3. do a gram stained smear of the vaginal discharge treatment is with metronidazole or clindamycin (either oral, avoid ethanol or vaginal gel)

Answer 199

treatment is with metronidazole or clindamycin (either oral, avoid ethanol or vaginal gel)

Answer 200

staph aureus or strep pyogenes | treatment is with circumcision, antibiotics and hygeine advice

Answer 201

the loss of a pregnancy before 24 weeks gestation with no evidence of life the incidence of this is 15%

Answer 202

1. threatened - bleeding from gravid uterus before 24 weeks gestation when there is a viable fetus with no evidence of cervical dilatation. management here is conservative 2. inevitable - abortion becomes inevitable as the cervix has already began to dilate. management is with evacuation if the bleeding is heavy 3. incomplete - this is when there is only partial expulsion of the products of conception. following incomplete miscarriage there is always risk of ascending infection into the uterus which can spread throughout the pelvis and this is known as a septic abortion 4. complete - passed all products of conception (POC), cervix is closed and bleeding has stopped. 5. septic - often seen with incomplete miscarriage. management is with antibiotics and evacuating the uterus. 6. missed - aka early fetal demise. pregnancy where the fetus has died but the uterus has made no attempt at expelling the POC. the gestational sac can still be seen but there is no clear fetus (empty gestational sac or a fetal pole and fetal heart. treatment here is conservative. medically give prostaglandins (misoprostol)

Answer 203

1. missed - aka early fetal demise. pregnancy where the fetus has died but the uterus has made no attempt at expelling the POC. the gestational sac can still be seen but there is no clear fetus (empty gestational sac or a fetal pole and fetal heart. treatment here is conservative. medically give prostaglandins (misoprostol) 2. incomplete - this is when there is only partial expulsion of the products of conception. following incomplete miscarriage there is always risk of ascending infection into the uterus which can spread throughout the pelvis and this is known as a septic abortion 3. threatened - bleeding from gravid uterus before 24 weeks gestation when there is a viable fetus with no evidence of cervical dilatation. management here is conservative

Answer 204

1. abnormal conceptus - chromosomal/genetic/structural 2. uterine abnormality - congenital: failure of fusion of mullerian ducts - fibroids: mainly submucous fibroids due to distortion of the uterine cavity 3. cervical incompetence - trauma - When cervical incompetence is present the cervix opens prematurely with absent or minimal uterine activity and the pregnancy is expelled 4. maternal - increasing age or diabetes - destruction of the corpus luteum. - SLE, thyroid disease, appendicitis 5. unknown

Answer 205

this is a pregnancy that is implanted outside of the uterine cavity

Answer 206

false - it is the ampulla.

Answer 207

1. pelvic inflammatory disease 2. previous tubal surgery 3. previouss ectopic 4. assisted conception

Answer 208

1. amenorrhoea 2. vaginal bleeding 3. abdominal pain 4. GI/urinary symptoms

Answer 209

1. scans - no intrauterine gestational sac - may see adnexal mass and fluid in the pouch of douglas 2. serum BHCG levels 3. serum progesterone levels

Answer 210

medical - methotrexate surgical - laparoscopic, salpingotomy conservative

Answer 211

bleeding from the genital tract after 24th week of pregnancy but before the delivery of the baby APH is one of the gravest obstetric emergencies and is associated with significant maternal and neonatal morbidity and mortality

Answer 212

this is when all or part of the placenta implants in the lower uterine segment. it will occur in 1/200 pregnancies. it is more common in multiparous women, multiple pregnancies and previous CS's. the placenta will lie in front of the presenting part of the fetus.

Answer 213

grade IV is when there is central placental praevia.

Answer 214

1. painless PV bleeding - this is due to the separation of the placenta as the lower uterine segment forms and the cervix effaces. the blood loss occurs from the venous sinuses in the lower segment. usually the blood loss if painless and recurrent. 2. malpresentation of the fetus 3. uterus is soft and non-tender with possible fetal malpresentation.

Answer 215

1. USS but can be difficult with posterior placenta praevia. | 2. MRI scanning - allows identification of the internal os but is not widely available.

Answer 216

depends on many factors including - gestation at presentation and the severity of blood loss. 1. admission vaginal examination is contraindicated and diagnosis is confirmed with USS. 2. cross match blood and blood transfused depending on the maternal condition. 3. baby is delivered by CS - there is a risk of PPH in placenta praevia. 1. gestation 2. severity and CS and watch PPH

Answer 217

placental abruption is where the placenta has started to separate from the uterine wall before the birth of the baby and is associated with a retroplacental clot. - haemorrhage is the result of a premature separation of the placenta before the birth of the baby.

Answer 218

1. pre-eclampsia/chronic hypertension 2. multiple pregnancy 3. polyhydramnios 4. smoking, increasing age and parity 5. previous abruption 6. cocaine use

Answer 219

1. pain 2. vaginal bleeding 3. increased uterine activity

Answer 220

in concealed placental abruption, the bleed occurs between the placenta and the uterine wall causing the uterine contents to increase in volume and the fundal height to be larger than would be consistent for gestation. in reelaved placental abruption the major haemorrhage is apparent externally because the blood is released from the placenta escapes via the cervical os.

Answer 221

this is when the blood penetrates the uterine wall in concealed placental abruption and then the uterus appears to be bruised

Answer 222

1. maternal shock and collapse 2. fetal death 3. maternal DIC, renal failure 4. PPH - couvelaire uterus

Answer 223

onset of labour before 37 weeks of gestation - 259 days. this can be spontaneous or induced.

Answer 224

1. multiple pregnancies 2. polyhydramnios 3. antepartum haemorrhage 4. pre-eclampsia 5. infection (UTI) 6. pre-labour premature rupture of membrane remember that the majority of preterm labour cases have no cause diagnosis is with contractions with evidence of cervical change on the VE

Answer 225

1. tocolytics 2. transfer to neonatal unit 3. attempt vaginal delivery 4. steroids unless contraindicated

Answer 226

1. mild hypertension = 140-149/90-99 2. moderate hypertension = 150-159/100-109 3. severe = 160/110

Answer 227

1. mild HT on 2 occasions more than 4 hours apart 2. moderate to severe HT and proteinuria of more than 300mgms/24hours this is a new hypertension developed after 20 weeks of pregnancy and is associated with significant proteinuria significant proteinuria: 1. automated regent strip urine protein estimation >1 2. spot urinary protein :Creatinine>30mg/mmol 3. 24 hours urine protein collection >300mg/day

Answer 228

1. ramipril 2. ARBS - losartan 3. antidiuretics

Answer 229

1. methyldopa 2. nifedipine 3. labetalol

Answer 230

1. first pregnancy 2. extremes of age 3. pre-eclampsia in previous pregnancy a. delivery <34 weeks b. IUD c. abruption 4. pregnancy interval >10 years 5. BMI>35 6. muliple pregnancy 7. underlying medical disorders a. chronic hypertension b. pre-existing renal disease c. pre-existing diabetes d. autoimmune disorders (Antiphospholipid antibodies - SLE

Answer 231

1. renal 2. liver 3. vascular 4. cerebral 5. pulmonary

Answer 232

1. eclampsia - seizure 2. severe hypertension - cerebral haemorrhage 3. HELLP - haemolysis, elevated liver enzymes and low platelets 4. DIC - disseminated intravascular coagulation 5. renal fialure 6. pulmonary oedema complications for the FETUS include: 1. impaired placental perfusion 2. fetal distress 3. prematurity 4. increased PN mortality 5. IUGR - intrauterine growth restriction

Answer 233

1. headache/blurring of vision, epigastric pain, pail below elbows, vomiting, swelling of hands and face 2. severe hypertension > 3+ proteinuria 3. clonus/brisk relfexes; papillodaema, epigastric tenderness 4. reducing urine output 5. convulsions (eclampsia)

Answer 234

1. raised liver enzymes, bilirubin if HELLP present 2. raised urea 3. raised urate 4. creatinine is raised haemotological abnormalities 1. low platelets 2. low Hb and signs of haemolysis 3. features of DIC

Answer 235

1. frequent BP checks and urine protein 2. check symptomatology - headaches, epigastric pain and visual disturbances 3. check for hyperreflexia (clonus), tenderness over the liver 4. bloods a. liver function tests b. renal function - serum urea, creatinine and urate c. coagulation tests if indicated 5. fetal investigations a. scan for growth b. cardiotocography (CTG)

Answer 236

delivery of the baby and placenta conservative management is to increase the fetal maturity - close observation of clinical signs and investigations - antihypertensives (labetalol, methyldopa and nifedipine) - steroids for fetal lung maturity <36 weeks consider the induction of labour /CS if maternal/fetal conditions deteriorates irrespective of gestation. risk of preeclampsia may persist into the puerperium therefore monitoring must be continues post-delivery.

Answer 237

1. magnesium sulphate bolus +infusion 2. control of blood pressure - hydralazine and labetalol 3. avoid fluid overload. prophylaxis is low dose aspirin from 12 weeks till delivery

Answer 238

1. Older mothers, increasing parity 2. Increased BMI, smoker 3. IVDA 4. PET – pre-eclamptic toxaemia 5. Infection 6. Decreased mobility 7. Dehydration – hyperemesis 8. Operative delivery or prolonged labour 9. Haemorrhage, blood loss >2l 10. Previous VTE (not explained by other predisposing – fractures, injury), 11. those with thrombophilia (protein C, S and anti-thrombin III deficiencies etc) 12. strong history of VTE 13. Sickle cells disease

Answer 239

MANAGEMENT 1. TED stockings 2. increased mobility 3. prophylactic anticoagulation SYMPTOMS 1. pain in calf 2. SOB 3. pain of breathing 4. cough 5. tachycardia 6. hypoxia 7. calf muscle tenderness 8. pleural rub

Answer 240

1. ECG 2. blood gasses 3. doppler 4. VQ scan 5. lung scan 6. CTPA

Answer 241

1. carbohydrate intolerance with onset in pregnancy 2. abnromal glucose tolerance that returns back to normal after delviery these women are more at risk of developing type II diabetes later in life. in pregnancy the insulin reqquirements of the mother will increase

Answer 242

they have anti-insulin properties. as do cortisol and placental lactogen

Answer 243

macrosomia - big baby for gestational age post-natally there is more risk of neonatal hypoglycaemia

Answer 244

1. fetal congenital abnormlaties 2. miscarriage 3. pre-eclampsia 4. fetal macrosomia and polyhydramnios 5. opertaive delivery 6. worsening of maternal retinopathy, hypoglycaemia and reduced awareness of hypoglycaemia 7. infection 8. stillbirth and increased perinatal mortality 9. neonatal - impaired lung maturity and neonatal hypoglycamia and jaundice

Answer 245

1. better glycaemic control, keep BG around 4-7mmol/l 2. folic acid 3. dietary advice 4. retinal and renal assessment

Answer 246

1. optimize glucose control - insulin requirements will increase 2. could continue oral anti-diabetic agents (metformin) but may need to change for better glucose control 3. should be aware of the risk of hypoglycaemia - provide glucagon injections/conc 4. watch for ketonuria/infections 5. repeat retinal assessments 6. watch fetal growth 7. observe PET 8. labour usually induced 38-40 weeks, earlier if fetal/maternal concerns 9. Elective C-section if significant macrosomia 10. maintain blood sugar in labour with insulin - dextrose insulin infusion 11. continuous CTG fetal monitoring in labour 12. early feeding of baby to reduce neonatal hypoglycaemia 13. diet 14. post-delivery - check OGTT 6 to 8 weeks PN 15. yearly check on HbA1c/blood sugar as at a higher risk of developing overt diabetes can go back to pre-pregnancy regimen of insulin post-delivery

Answer 247

1. increased BMI 2. previous macrosomic baby 3. previous GDM 4. previous history of diabetes 5. family history for diabetes 6. women from high risk groups for dveloping diabetes - asian origin 7. polyhydramnios/big baby in current pregnancy 8. recurrent glycosuria in current pregnancy

Answer 248

measuring from the symphysis pubis to the top of the fundus of the uterus in cms. it should usually be +/-3 cm gestational age in weeks. after measurement taken then plot on the GAP/GROW charts

Answer 249

1. abdominal circumference (AC) 2. femur length (FL) 3. head circumference (HC) from this it is possible to estimate the fetal weight. 4. liquor volume - amniotic fluid index

Answer 250

1. low BMI, maternal build 2. age 3. ethnicity, familial or genetic 4. social class 5. smoking 6. substance misuse 7. alcohol misuse 8. maternal diseases such as a. preeclampsia b. chronic hypertension c. severe asthma d. autoimmune disorders - SLE, antiphopspholipid syndrome and repeated antepartum haemorrhages 9. infections - toxoplasma and CMV 10. fetal abnormality - gastroschisis, chromosomal abnormality like triploidy and turners XO

Answer 251

1. parity )multiparity) 2. ethnicity/familial/social class/genetic 3. polyhydramnios a. fetal abnormalities - duodenal atresia, TOF b. unexplained 4. maternal diabetes 5.m multiple pregnancy tests : 1. confirm good fetal movement 2. fetal cardiotocgraphy 3. good doppler blood flow in umbilical artery

Answer 252

tis refers to the descent of the pelvic organs towards or through the vagina.

Answer 253

1. uterosacral ligament 2. pubocervical fascia 3. rectovaginal fascia

Answer 254

1. levator ani | 2. coccygeus

Answer 255

1. pregnancy and vaginal birth a. forceps delivery b. large baby c. prolonged second stage of labour 2. previous pelvic surgery - continence procedures - elevation of bladder neck (may lead to defects in other pelvic departments) - culposuspension 3. other - hormonal factors - quality of connective tissue - constipation - occupation with ehavy lifting - exercise: weight lifting and high impact aerobics

Answer 256

urethrocele is the prolapse of the lower anterior vaginal wall involving the urethra only cystocele is the prolapse of the upper anterior vaginal wall involving the bladderr

Answer 257

1. uterus 2. upper vagina 3. cervix

Answer 258

this is the prolapse of the upper posterior wall of the vagina usually containing loops of small bowel - aka apical prolapse

Answer 259

this is the prolapse of the lower posterior wall of the vaing involving the rectum bulging forwards into the vagina

Answer 260

1. sensation of a bulge or prolapse 2. seeing/feeling a bulge or protrusion 3. pressure 4. heaviness 5. difficulty in inserting tampons

Answer 261

1. urinary incontinence 2. frequency/urgency 3. weak or prolonged urinary stream/hesitancy/feeling of incomplete emptying. 4. Manual reduction or prolapse to start or complete voiding

Answer 262

1. incontinence of flatus/liquid/solid stool 2. feeling of incomplete emptying/straining 3. straining 4. urgency 5. Digital evacuation to complete defacation 6. splinting/pushing on or around the vagina/perineum to start or complete defacation

Answer 263

1. baden-walker -halfway grading | 2. POPQ score - gold standard

Answer 264

1. USS/MRI 2. urodynamics 3. IVU or Renal USS

Answer 265

1. avoiding constipation 2. effective management of chronic chest pathology 3. smaller family size 4. improvements in antenatal and intrapartum care 5. PFMT - increases pelvic floor strength relieving the tension on the ligaments

Answer 266

a caesarean section is defined as the delivery of a fetus through an incision in the abdominal wall and uterine wall. possible complications are bladder and ureteric injury

Answer 267

over the pelvic brim it crosses the bifurcation of the common iliac arteries and runs retroperitoneally on the lateral pelvic wall

Answer 268

an episiotomy is a surgically planned incision on the perineum and posterior vagina wall during the second stage of labour. this may be required for normal birth/forceps delivery and may have a spontaneous tear. an episiotomy may tear further which could be a complication an episiotomy is a third degree laceration extending from the vaginal opening to the anus.

Answer 269

false. they are composed of smooth muscle. they are often asymptomatic but may present with dysmenorrhoea (painful periods), menorrhagia and pressure symptoms/pelvic pain

Answer 270

painful periods

Answer 271

dyspareunia

Answer 272

it is the presence of endometrial-like tissue outside of the uterine cavity. the endometriotic tissue detach and bleed - resulting in internal bleeding, degenerate blood and tissue shedding inflammation of the surrounding areas, pain and possibly formation of scar tissue.

Answer 273

TV USS | laparoscopy

Answer 274

brain lungs eyes muscles

Answer 275

1. intrauterine death 2. structural (congenital) malformations 3. IUGR - intrauterine growth restrictions 4. neurodevelopmental/behavioural dysfunction 5. developmetnal delay 6. carcinogenesis

Answer 276

this is true

Answer 277

``` micophalthmia absent ears cardiac anomalies microcephaly cleft lip and palate nervous system abnormalities ```

Answer 278

1. small head 2. epicanthal folds 3. flat midface 4. smooth philtrum 5. underdeveloped jaw 6. thin upper lip 7. short nose 8. small eye openings 9. low nasal bridge

Answer 279

there is no safe amount of alcohol in pregnancy

Answer 280

1. sensorineural deafness 2. eye abnormalities - retinopathy, cataract and microphthalmia 3. congenital heart disease - especially pulmonary artery stneosis and patent ductus arteriosus

Answer 281

1. child<16 can give/withhold consent if doctor feels she understands what is involved in an intervention, but in some certain situations parents can override the girl's wishes.

Answer 282

- mature enough to understand advice and implications of treatment - girl likely to begin or continue to have sex with/without treatment - doctor tried to persuade girl to inform her parents or to allow her/him to inform them - girls health would suffer without treatment/advice - in girls best interest to give treatment or advice

Answer 283

1. FSH/LH, PRL/ TSH, testosterone and oestrogen 2. Pelvic USG 3. progesterone withdrawal bleed: - pregnancy - not enough oestrogen

Answer 284

1. reassure 2. talk to girls directly 3. progesterone only pill 4. tranexamic acid 5. mefenamic acid 6. ocp 7. mirena

Answer 285

MALES thick profuse yellow discharge dysuria. rectal and pharyngeal infection often asymptomatic FEMALES vaginal discharge, dysuria or intermenstrual/post-coital bleeding

Answer 286

MALES epididymitis FEMALES pelvic inflammatory disease and Bartholin's abscess BOTH acute monoarthritis in elbow or shoulder. disseminated gonococcal infection and skin lesions- pustular with halo

Answer 287

1. Nucleic acid amplification test (NAAT) on urine or swab from an exposed site - vagina, rectum, throat. can be self or clinician obtained. 2. gram stained smear from urethra/cevix/rectum in symptomatic people 3. culture of swab-obtained specimen from an expose site using highly selective lysed blood agar. should be done for all confirmed cases to assess antibiotic sensitivity

Answer 288

ceftriaxone plus azithromycin

Answer 289

males slight watery discharge and dysuria females vaginal discharge and dysuria. intermenstrual/post-coital bleeding both sexes will experience conjunctivitis.

Answer 290

PID and hence ectopic pregnancy pelvic pain and infertility men will experience epididymitis both sexes will experience reactive arthritis and reiter's syndrome - urethritis/cervicitis + conjunctivitis and arthritis

Answer 291

first void urine in men self-taken or clinician-taken swab from cervix, urethra, rectum as appropriate all specimens are tested using NAAT.

Answer 292

azithromycin and doxycycline

Answer 293

treponema pallidum it is often entirely asymptomatic or mild symptoms which go unreported.

Answer 294

1. local ulcer (chancre) | 2. rash, mucosal ulceration, neurological symptoms, patchy alopecia and other symptoms

Answer 295

1. neurosyphilis - cranial nerve palsies are commonest, cardiac or aortal involvement 2. congenital syphilis

Answer 296

1. clinical signs 2. serology for TP IgGEIA, TPPA ad RPR 3. PCR on sample from an ulcer

Answer 297

benzathine penicillin or doxycycline

Answer 298

human papillomavirus types 6 and 11 the main symptoms are lumps with a surface texture of small cauliflower. occasionally itching or bleeding especially if perianal or intraurethral

Answer 299

diagnosis - appearance and biopsy if unusual to exclude intraepithelial neoplasia treatment is with podophyllotoxin and imiquimod. cryotherapy is also an option

Answer 300

cause - trichomonas vaginalis | complications - miscarriage and preterm labour

Answer 301

diagnosis is with PCR on a vaginal swab treatment is with metronidazole

Answer 302

it is caused by herpes simplex virus 1 and 2 80% of people will have no symptoms the other symptoms may be: 1. burning/itching then blistering the tender ulceration 2. tender inguinal lymphadenopathy 3. dysuria, neuralgic pain in the back, pelvis and legs

Answer 303

TREATMENT acyclovir and lidocaine ointment DIAGNOSIS clinical impression and swab from lesion tested using PCR.

Answer 304

30% most will present with advanced stage diseases

Answer 305

1. indigestion/early satiety/poor apetite 2. altered bowel habit/pain 3. bloating/discomfort/weight gain 4. pelvic mass - asymptomatic - pressure symptoms

Answer 306

1. surgical/pathological 2. USS abdomen and pelvis 3. CT scan 4. CA125 (glycoprotein antigen) CA125 is also associated with colon and pancreatic cancers as well as breast cancer

Answer 307

1. multilocular 2. solid areas 3. bilateral 4. ascites 5. intra-abdominal

Answer 308

1. surgery 2. chemotherapy - platinum and taxane - adjuvant and neoadjuvant

Answer 309

1. obtain tissue diagnosis 2. stage disease 3. disease clearance 4. bulk disease

Answer 310

platinum and taxane this is given within 88 weeks of surgery

Answer 311

false. Ovarian cancer screening is not recommended as there is limited sensitivity and specificity. For high risk women give a prophylactic oophorectomy Using imaging and CA125 this gives the RMI. Give surgery to stage and to reduce disease bulk. Chemo can also be given but overall there is a poor prognosis. M is the menopause status RMI = US x M x CA125

Answer 312

``` Surgical/Pathological MRI depth of myometrial invasion cervical involvement lymph node involvement ```

Answer 313

TYPE 1 Endometrioid adenocarcinoma By far the commonest Unopposed oestrogen Hyperplasia with atypia precursor TYPE 2 Uterine serous & clear cell carcinoma High grade, more aggressive, worse prognosis Generally older ladies Serous intraepithelial carcinoma precursor

Answer 314

``` Early Stage - Surgery TAH/BSO/washings High risk histology - Chemotherapy Advanced Stage - Radiotherapy Palliation - Progesterone Radiotherapy- External Beam Caesium Insertion - intra-cavity ```

Answer 315

true there is high circulating oestrogen levels which can be also affected by - obesity - HNPCC/lynch type II familial cancer syndrome - atypical endometrial hyperplasia - early menarche/late menopause

Answer 316

1. abnormal vaginal bleeding | 2. post menopausal bleeding

Answer 317

1. 8% of women with PMB will have endometrial cancer 2. Hormone Replacement Therapy (HRT) 3. Peri-menopausal bleeding 4. Atrophic vaginitis 5. Polyps cervical/endometrial 6. Other cancer eg cervix, vulva, bladder,anal

Answer 318

histology of endometrium main treatment is with a total abdominal hysterectomy with removal of tubes and ovaries and peritoneal wshings

Answer 319

the kidney and ureters this is a low pressure distensible conduit with intrinsic peristalsis it will transport urine from the nephrons via the ureters to the bladder

Answer 320

The bladder and urethra.

Answer 321

the hypogastric nerve (T10-L2) it forces the bladder muscles to relax and the external urethral sphincter to contract when in a fight or flight situation

Answer 322

the pelvic nerve - parasympathetic S2-4. the pudendal nerve gives voluntary control of urination and is under somatic control

Answer 323

the hypogastric nerve - T10-L2 the pudendal nerve S"-S4.

Answer 324

1 activates sympathetic pathways 2. reciprcoral inhibition of the parasympathetic pathway 3. mediates contraction of bladder base and proximal urethra.

Answer 325

UUI - involuntary leakage accompanied by or immediately preceded by urgency SUI- involuntary leakage on effort or exertion, on sneezing or coughing. Both stress and urge incontinence arise from the same anatomical defect in the anterior vaginal wall and pubo-urethral ligament (PUL).

Answer 326

- Mixed urinary incontinence (UUI): this is the involuntary leakage accompanied by or immediately preceded by urgency and on effort or exertion, or on sneezing or coughing

Answer 327

1. age 2. parity 3. menopause 4. smoking 5. medical problem a. diabetes b. hypertension c. glaucoma 6. increased abdominal pressure 7. pelvic floor trauma 8. denervation 9. connective tissue damage 10. surgery

Answer 328

1. nocturia 2. dysuria 3. haematuria 4. increased daytime frequency 5. urgency

Answer 329

1. frequency 2. nocturia 3. urge incontinence

Answer 330

INCONTINENCE 1. stress UI 2. urgency UI 3. coital incontinence 4. severity - how many pads a day VOIDING 1. straining to void 2. interrupted flow 3. recurrent UTI

Answer 331

PROLAPSE 1. vaginal lump 2. dragging sensation in the vagina BOWEL SYMPTOMS 1. anal incontinence 2. constipation 3. faecal evacuation dysfunction 4. IBS

Answer 332

1. fluid intake - quality and quantity 2. urine output 3. daytime frequency 4. nocturia 5. average voided time a urine dipstick test would also be a good idea.

Answer 333

1. urinalysis - multistix and MSSU 2. post-voiding residual volume assessment - usually bladder scanning only if symptoms of voiding difficulties 3. urodynamics - only indicated if surgical treatment is contemplated

Answer 334

1. lifestyle changes a. smoking b. weight c. diet d. alcohol and caffeine 2. medical treatments 3. physiotheapy 4. surgery

Answer 335

- Pelvic floor muscle training 1. Reinforcement of cortical awareness of muscle groups 2. Hypertrophy of existing muscle fibres 3. General increase in muscle tone and strength - Surgery a. colposuspension b. tension free vaginal tape - Pharmacodynamic agents - duloxetine in primary carem if PFMT has failed then give duloxetine

Answer 336

Tension-free vaginal tape (TVT) is a minimally invasive procedure to reinforce the structures supporting the urethra. It depends on the hammock theory for continence. It uses polypropylene permanent synthetic tape; monofilament and macro-porous. - TVT is as effective as culposuspension for the treatment of primary SUI. It has now replaced culposuspension as the first-choice procedure in the surgical treatment of SUI. TVT’s main surgical complication is bladder perforation as well as vaginal and urethral erosions. There can be several vascular injuries, all attributed to blind penetration of the retro-pubic space

Answer 337

the detrusor muscle - detrusor overactivity (DO). the main symptoms are 1. Urgency: the complaint of a sudden, compelling desire to pass urine that is difficult to defer 2. Urge incontinence: the complain of involuntary leakage of urine accompanied or immediately preceded by urgency 3. Frequency: usually accompanies urgency with or without urge incontinence and is the complaint by the patient who considers that he/she voids to often by day. 4. Nocturia: usually accompanies urgency with or without urge incontinence and is the complaint that the individual has to wake at night one or more times to void

Answer 338

1. age 2. diabetes 3. UTI's 4. smoking you can use anti-depressants to treat OAB - imipramine - botulinum toxin A and B - solifenacin - fesoteridine

Answer 339

GAIT - observe gait - observe the patient in anatomical position ARMS - observe movement - hands behind head - observe palms - asess power grip and grip strength 7 - assess frine precision pinch - squeeze MCPJs LEGS - assess full flexion and extenmsion - assess internal rotation of the hips - perform pattellar tap - insepct feet - squeeze MTPJ SPINE - inspect spine - inspect laterall flexion of neck - assess lumbar spine movement. 1. do you have any pain or stiffness in your joints 2. can you dress without difficulty 3. can you walk up and down stairs? if all these questions are negative then there is unlikely significant msk problem.

Answer 340

1. swelling 2. deformity 3. discolouration (redness, pallor and bruising) 4. wasting 5. shortening 2. LOOK – skin/scars/wounds/sinuses, colour, swelling, wasting, deformity

Answer 341

1. stiffness 2. range of movements 3. limp 4. instability 5. crepitus also enquire whether the patient was woken up by their pain and do they feel this stiffness in the morning? it may be worth discussing their daily tasks of living - socks, shoelaces, cutting nails, baths etc. how far are they able to walk? can they do their own shopping?

Answer 342

1. severe and worsening pain 2. night pain disturbing sleep 3. non-mechanical pain 4. general malaise, febrile or rigors 5. unexplained wieght loss, anorexia and night sweats 6. past history of malignant disease

Answer 343

MISTI THREAD MI Stroke Thrombolysis (DVT/PE) Icterus (jaundice) ``` TB Hypertension Rheumatoid Epilepsy Asthma Diabetes ``` Allergy - AKDA? - penicillin? - iodine? - GA? - latex? - elastoplast?

Answer 344

1. current and recent medications 2. are they on any prescription drugs from their own doctor? 3. any other drugs - recreation/paracetamol 4. OCP 5. aspirin/warfarin/clopidogrel 6. NSAIDs 7. Steroids

Answer 345

a. Real – (ASIS/greater trochanter/tibial tuberosity to medial malleolus) – legs in the same position b. Apparent – midline marker e.g. xiphisternum or umbilicus to medial malleolus

Answer 346

1. analgesia 2. shoe wear modification 3. activity modification 4. weight loss 5. physiotherapy 6. orthotics including insoles and bracing

Answer 347

true hallux valgus is the lateral deviation of the greater toe. hallux rigidus is arthritis of the first MTP morton's neuroma is a type of interdigital neuralgia

Answer 348

DIAGNOSIS diagnosis is typically made with XR or is made clinically MANAGEMENT (non-operative) - shoe wear modification - orthotics to offload pressure - activity modification - analgesia (operative) - release lateral soft tissue - osteotomy 1st metatarsal generally good outcome but recurrence is inevitable.

Answer 349

hallux rigidus will mainly affect the 1st metatarsophalangeal joint.. patients will experience pain and limitation with range of movement. diagnosis is with clinical examination and use of radiographs. MANAGEMERNT (non-operative) - activity modeficiation - shoe wear with a rigid sole - analgesia (operative) - arthroplasty (articular surface of a joint is replaced remodelled or realigned by osteotomy) - arthrodesis (artificial ankylosis, induction of joint ossification) - cheilectomy (removing a bony lump at top of main joint of big toe) something to remember is that the gold standard for treatment of Hallux Rigidus is 1st MTPJ fusion or 1st MTPJ hemiarthroplasty

Answer 350

It typically affects the 3rd followed by the 2nd webspace/toes. There is neuralgic burning pain into toes that comes intermittently. There is also altered sensation in the toes. Morton’s neuroma is a type of interdigital neuralgia. This is a mechanically induced degenerative neuropathy that affects females aged 40-60. It is frequently associated with wearing high heels.

Answer 351

1. clinical 2. Mulder's click 3. USS 4. MRI Management is with injections for small lesions and surgery for the excision of lesions including a section of normal nerve. the surgery may lead to numbness, recurrence and 1/3rd of patients have pain 1 year post surgery

Answer 352

Metatarsalgia is a symptom and not a diagnosis. Careful examination should be able to localise the cause (synovitis, arthritis, bursitis, neuralgia or neuromata). If there is no obvious cause of metatarsalgia then consider a tight gastrocnemius. i. To treat either CHANGE shoe wear/orthotics/activity or ii. Many of the other described techniques or 1st MTPJ arthrodesis or 2-5th toe excision arthroplasty

Answer 353

they arise from the tendon sheath and can be idiopathic or characteristic of underlying arthritis or tendon pathology. symptoms can be pain from pressure from shoe wear or pain from another underlying problem. Management can be aspiration, family bible or excision. there is a very high rate of recurrence.

Answer 354

1. activity/shoe wear/orthotics 2. injections - XR guided 3. operation - fusion

Answer 355

Non-Operative: - Avoid pressure - Shoe wear/orthotics Operative: - Excision (up to 80% risk of recurrence) Radiotherapy Combination of radiotherapy/surgery has a low recurrence rate but a high complication rate

Answer 356

1. clinical examination -tenderness and tests for rupture 2. lab investigations - XR and MRI 3. simmonds test - gently squeezing the soleus muscle and seeing if the foot moves. ``` MANAGEMENT Non-operative: - Activity modification - Weight loss - Shoe wear modification – slight heel - Physiotherapy – eccentric stretching - Extra-corporeal shockwave treatment - Immobilisation (in below knee cast) Operative Treatment - Gastrocnemius recession - Release and debridement of tendon ```

Answer 357

This should really be referred to as plantar fasciosis. This is a chronic degenerative change with fibroblast hypertrophy and an absence of inflammatory cells. the blood vessels and collagen are disorganised and dysfunctional and body cant make extra cellular matrix required for repair and remodelling. Symptoms will see pain on weight bearing after rest (post-static dyskinesia), first thing in the morning and located at the origin of the plantar fascia. The symptoms tend to be long lasting (>2 years) The diagnosis is made with clinical reasoning and occasionally XR, US and MRI.

Answer 358

- Rest, change training - Stretching – achilles +/- direct stretching - Ice - NSAIDs - Orthoses – Heel pads - Physiotherapy - Weight Loss - Injections – Corticosteroids - Night splinting The newer 3rd line treatments are listed below: 1. Extracorporeal shockwave therapy 2. Topaz Plasma Coblation 3. Nitric Oxide 4. Platelet Rich Plasma 5. Endoscopic/ Open surgery

Answer 359

- Arthrodesis is the gold standard treatment for ankle arthritis. It has a very good long-term outcome also. - Joint replacement should also be considered to maintain the range of movement.

Answer 360

1. Diabetic control 2. Smoking 3. Vascular supply 4. External pressure (splints/shoes/weight bearing) 5. Internal pressure (deformity) 6. Infection 7. Nutrition Surgical treatment’s aim is to: 1. Improve vascular supply 2. Debride ulcers and get deep samples for microbiology 3. Correct any deformity to offload area 4. Amputation

Answer 361

true Diagnosis is often made with a high index of suspicion but also consider in any diabetic patient with acutely swollen erythematous foot especially with neuropathy. It is frequently not painful. Imaging with radiographs and MRI scanning is useful. Management again is with prevention. Immobilise/ make it non-weight bearing until the acute fragmentation has resolved and then correct the deformity (deformity leads to ulceration leads to infection leads to amputation)

Answer 362

the musculocutaneous nerve will arise from the lateral cord the ulnar nerve will airse from the medial cord.

Answer 363

posterior cord

Answer 364

1. high birth weight 2. shoulder dystocia 3. maternal diabetes 4. forceps delivery 5. clavicle fracture 6. prolonged labour

Answer 365

neuropraxia - myelin damage and axonal stretching that resolves within weeks. Axonotmesis is when there is axonal rupture and myelin damage, nerve sheath intact but takes months to resolve neurotmesis is a total nerve rupture requiring operative repair

Answer 366

C5 and 6. Erb’s palsy will give the waiter’s tip appearance and affects C5,6 and sometimes 7. The shoulder is internally rotated, elbow extended, wrist flexed and pronated. It is also very likely for the total plexus to be involved in the damage (C5-T1) and this will leave a completely flaccid limb Erb’s palsy is managed with early physiotherapy to maintain the range of movement and prevent shoulder stiffness/contracture is essential. However, most will spontaneously fully recover

Answer 367

the interruption of the stellate ganglion and can result in ptosis, myosis (excessive constriction of pupils) and enopthalmos (posterior displacement of the eye)

Answer 368

is the shortening of the sternocleidomastoid muscle. It is a painless ccondition - developmental hip dysplasia metatarsus adductus and plagiocephaly are associated conditions breech deliveries are a common risk factor for the condition.

Answer 369

- Physiotherapy - USS hips - Plain radiograph c-spine for congenital abnormalities Torticollis tends to resolve within the first 12 months and rarely requires surgical intervention.

Answer 370

12% - If a parent and a child have DDH the risk of a subsequent child having it is 36%. If the diagnosis is missed it can be picked up in an older child with the use of imaging US or XR or just clinical examination. Treatment can be with: - Hip abduction braces - Pavlik Harness (with clothes placed over them

Answer 371

with the knees flexed and heels carefully aligned the knees are seen to be at a different level implying the femoral (or tibial) segment is short. When seen in an infant it raises the possibility of DDH. In bilateral hip abnormality, asymmetry may not be a feature but when unilateral there is limited hip abduction

Answer 372

. It is in association with oligohydramnios and DDH. It is a soft tissue contracture foot deformity characterized by excessively dorsiflexed hindfoot with some valgus. There is excessive hindfoot dorsiflexion correctable to neutral. The dorsum of the foot is often in contact with the anterior tibia.

Answer 373

1. rigid flatfoot with a rocker-bottom appearance of the foot 2. persian slipper appearance 3. calcaneus in fixed equinus 4. achilles tendon is very tight7 5. the hindfoot is in valgus 6. the head of the talus is found medially in the sole 7. the forefoot is abducted and dorsiflexed . Treatment is reverse the ponsetti serial casting

Answer 374

congenital, Talipes, equino and varus. The foot affected is smaller. The hindfoot has equinus and supination (varus) whereas the forefoot/midfoot is adducted and cavus. The leg has mild length discrepancy and muscle wasting. There is a distinction between positional and structural club foot: Positional - Intrauterine positioning and crowding theory. It is associated with hip dysplasia. There is an abnormal postural position that is entirely passively correctable but spring back. Structural - If the foot foes not correct then it is a true clubfoot. There is true bone anatomical malalignment. It is not fixed as often but there may be a variable amount of passive correction The piriani score is used to assess the severity of clubfoot. The total worst score is 6 – the max score for the midfoot is 3 and hindfoot is also 3.

Answer 375

the last ever period the average age for this occurring is 51 years old. premature menopause occurs <40.

Answer 376

ovarian insufficiency 1. oestradiol falls and the FSH levels rise there is still some oestriol from the peripheral conversion of adrenal androgens in fat it may be natural or follow an oopherectomy/chemo or radiotherapy

Answer 377

1. vasomotor - hot flushes 2. vaginal dryness/pain 3. low libido 4. muscle and joint aches 5. mood changes/poor memory 6. osteoporosis?

Answer 378

1. thin 2. white 3. smokers 4. alcohol 5. positive family history 6. amenorrhoea 7. malabsorption 8. steroids 9. hyperthyroid

Answer 379

1. WB exercise 2. adequate calcium and vitamin D 3. HRT 4. bisphosphonates 5. calcitonin, strontium 6. denosumab

Answer 380

1. local - vaginal oestrogen pessary/ring/cream 2. systemic - transdermal/oral Transdermal avoids first pass metabolism a. oestrogen only if no uterus is present b. oestrogen and progesterone if the uterus is present c. progesterone oral, transdermal or LNG IUS - Levonorgestrel Intrauterine System Contraindications to HRT are not the same as contraindications to combined hormonal contraception – very few CI

Answer 381

- Current hormone dependent cancer breast/endometrium - Current active liver disease - Uninvestigated abnormal bleeding Seek advice if previous VTE, thrombophilia or family history of VTE. Also seek advice if there are previous cases of breast Ca or BRCA carrier

Answer 382

there is no age limit. it is often supplemented with daily oestrogen when used in HRT treatment

Answer 383

there is no CV risk increase if started before the age of 60 Other risks a. Ca Breast b. Ca Ovary c. VTE d. Fracture femur e. Ca Colon

Answer 384

a. Ca Breast b. Ca Ovary c. VTE d. Fracture femur e. Ca Colon HRT should ALSO be used for treatment of severe vasomotor symptoms but review this annually It is for women with premature ovarian insufficiency. HRT benefits outweigh risks until the age of 50. Not as first line for osteoporosis prevention/ treatment (bisphosphonates instead). Vaginal oestrogen should be given for vaginal symptoms.

Answer 385

50 years old It is for women with premature ovarian insufficiency. Not as first line for osteoporosis prevention/ treatment (bisphosphonates instead).

Answer 386

Andropause is when the testosterone falls by 1% a year after 30. DHEAS (Dehydroepiandrosterone) also falls. Fertility remains and there is no sudden change

Answer 387

primary - never had a period | secondary - no period in the last 6 months

Answer 388

1. pregnancy/breast feeding 2. contraception related - current or recent use of depoprovera 3. polycystic ovaries 4. early menopause 5/ thyroid disease/cushing 6. raised prolactin - prolactinoma/medication related 7. hypothalamic - stress/weight change/exercise 8. androgen secreting tumour (testosterone) 9. sheehan's syndrome - pituitary failure 10. Asherman's syndrome - intrauterine adhesions

Answer 389

1. BP/BMI/hirsutism, acne, cushingoid 2. enlarged clitoris/deep voice 3. abdominal/bimannual 4. urine pregnancy test +dipstick for glucose 5. Bloods a. FSH b. LH c. Oestradiol d. Thyroid function e. testosterone 6. pelvic US -PCO (polycystic ovaries)

Answer 390

Treat specific causes 1. aim for a BMI between 20 and 25. - If premature ovarian insufficiency then offer HRT till 50 emotional support - Assume that the patient is fertile and need contraception unless 2 years after confirmed menopause

Answer 391

2 out of 3 - Oligo/amenorrhoea – infrequent or no periods - Androgenic symptoms – excess hair/acne - Anovulatory infertility PCO results in a higher risk of diabetes and CVD for any given BMI. There is also a risk of endometrial hyperplasia if <4 periods a year (not on hormones). Polycystic ovaries do not cause weight gain or pain dont forget - There is plenty of oestrogen but also high androgens. - There may also be an underlying insulin resistance

Answer 392

- Weight loss and exercise can help all symptoms whilst increasing sex hormone binding globulin SHBG so there are less free androgens. There is also an increased risk of NIDDM. Do a glucose tolerance test. - Give antiandrogen – combined hormonal contraception (CHC), spironolactone, eflornithine cream facial hair. - Endometrial protection CHC, progestogens, mirena IUS - Fertility Rx clomiphene/metformin - Metformin- helps ovulation but not good evidence that help androgenic SE or weight loss.

Answer 393

menarche - 13 menopause - 51 Menstruation is triggered by fall in progesterone 2 weeks after ovulation if not pregnant

Answer 394

heavy periods

Answer 395

painful periods Intermenstrual bleeding means bleeding between periods. Postcoital bleeding means bleeding after intercourse. Oligomenorrhoea means infrequent bleeding

Answer 396

1. - General - Abdominal - Speculum - Bimanual 2. - Full blood count if menorrhagia - Endometrial biopsy - Chlamydia - Only check thyroid/coagulation if other symptoms - Pregnancy test

Answer 397

- Full blood count if menorrhagia - Endometrial biopsy - Chlamydia - Only check thyroid/coagulation if other symptoms - Pregnancy test - TV ultrasound scan - Hysteroscopy - Laparoscopy - Not dilation and curettage

Answer 398

is when there is endometrial type tissue found outside the uterine cavity Usually ovary, pouch of Douglas or pelvic peritoneum. It may be asymptomatic and may resolve without Rx. It can be the cause of a retrograde bleed or peritoneal neoplasia

Answer 399

1. premenstrual pain 2. dysmenorrhoea 3. deep dyspareunia 4. subfertility The condition doesn’t always present with signs but there can also be tender nodules inside the rectovaginal septum and limited uterine mobility

Answer 400

1. laparoscopy 2. MRI 3. USS endometrioma

Answer 401

SURGICAL – 1. excision of deposits from peritoneum 2. ovary diathermy 3. laser ablation of deposits hysterectomy 4. oophorectomy MEDICAL 1. progestogen oral/inject/ 2. Mirena IUS. 3. Or combined pill 3 months at a time. 4. GnRH analogues – leuprorelin

Answer 402

Diagnosis: 1. Probably normal USS 2. laparoscopy 3. hysteroscopy (MRI may suggest diagnosis but limited availability) 4. Histology of uterine muscle – not an endometrial biopsy as for treatment the mirena may help. Often failed medical Mx/ablation and diagnosed on pathology at hysterectomy

Answer 403

true diagnosis is with US, hysteroscopy and clinicaL EXAM

Answer 404

- Clinical exam - US - Hysteroscopy they may grow fast in pregnancy causing bleeding, pain and obstruction

Answer 405

submucosal - protrudes into the uterine cavity subserosal will project out of the uterus into the peritoneal cavity

Answer 406

intramural - within the wall of the uterus

Answer 407

1. do nothing 2. standard menorrhagia Rx 3. GnRH analogues 4. ulipristal oral Rx (an antiprogestogen) 5. transcervical resection (submucosal fibroids) 6. myomectomy - can cause haemorrhage however 7. uterine artery ablation

Answer 408

1. tranexamic acid - blood loss but doesnt affect cycle (antifibrinolytic) 2. mefenamic acid - blood losses 3. combined contraceptive reduces bleeding and pain and will regulate the cycles The mirena progestogen IUS reduces bleeding – initial 3-4 months or irregular bleeding

Answer 409

if her family is not complete then this treatment is too radical

Answer 410

This is the one-off removal of endometrium to below the basal layer using either diathermy or a thermal balloon

Answer 411

This is the surgical removal of the uterus In a total hysterectomy, the cervix and uterus are removed but in a subtotal hysterectomy the uterus is removed and the cervix is left

Answer 412

the removal of the tubes and ovaries

Answer 413

the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management, but not from accidental or incidental causes

Answer 414

maternal mortality ratio is the number of maternal deaths during given time per 100’000 live births during the same time. It represents the risk associated with each pregnancy – the obstetric risk The maternal mortality rate is the number of maternal deaths in given time per 100’000 women of reproductive age, or woman-years of risk exposure, in same time. It considers not only the obstetric risk, but also the frequency with which women are exposed to that risk

Answer 415

1. DELAY IN DECISION TO SEEK CARE i. Lack of understanding of complications ii. Acceptance of maternal death iii. Socio-cultural barriers to seeking care iv. Low social status of women 2. DELAY IN REACHING CARE i. Mountains, islands, rivers – poor organisation 3. DELAY IN RECEIVING CARE i. Supplies, personnel ii. Poorly trained personnel with punitive attitude iii. Finances

Answer 416

1. Antenatal care: a. 4 visits, monitoring weight, blood pressure and proteinuria, folic acid and malaria. 2. Skilled attendant at birth 3. Emergency obstetric care  Clean delivery  Active management of 3rd stage  Parental antibiotics/oxytocics/magnesium sulphate  Manual removal of placenta/products of conception  Blood transfusion  Caesarean section/operative deliver

Answer 417

the birth of a dead baby after 20/24/28 weeks of gestation or weighing more than 500g. stillbirth rate is the number of stillbirths per 1000 births.

Answer 418

- Ensuring that the baby is breathing - Starting the newborn on exclusive breastfeeding right away - Keeping the baby warm and - Washing hands before touching the baby

Answer 419

Early neonatal death is the death of a bay within the week of life Infant mortality is the death of an infant within the first year of life Child mortality is the death of a child within the first 5 years of life

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