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4th Year Key Summaries > Repro > Flashcards

Repro Flashcards

1
Q

Clinical triad of pre-eclampsia?

A

BP elevated, usually above 140/90
Proteinuria on dipstick or 0.3g or more over 24hrs collection
Oedema of the face/hands/legs/feet

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2
Q

Symptoms of pre-eclampsia

5

A 
Headache
Visual disturbance
Vomiting
Flash oedema
Subcostal pain
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3
Q

Antihypertensives safe in pregnancy

3

A
  1. LABETALOL
  2. Methyldopa
  3. Nifedipine
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4
Q

Prenatal care in pre-eclampsia

incl. foetal monitoring x4

A

ONCE-ONLY proteinura assessment with dipsticks, if more than 1+, do P:CR or 24 collection

Control BP - almost always labetalol, usually only treat @ 150/100 or more
Measure BP several times per day

Bloods:
Regular U&Es, FBC, bilirubin

Foetal monitoring:
CTG @ diagnosis and weekly
USS foetal growth @ diagnosis
Amniotic fluid volume assessment @ diagnosis
Umbilical artery doppler velocimetry @ diagnosis
Regular assessment of syx

Timing of birth:
Manage conservatively (i.e. not immediate delivery) until 34 weeks unless severe where birth may be offered before
If moderate/mild, offer birth in 24-48hrs where HTN persists to 37+0
REMEMBER STEROIDS IF PRE 36 WEEKS

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5
Q

Intrapartum/postpartum antihypertensive use in pre-eclampsia

A 
Intra:
Monitor BP hourly in mild/mod
Monitor BP continuously in severe
Continue antihypertensive through labour
Recommend operative birth in 2nd stage in severe cases not responding to treatment

Post:
Continue treatment postnatally and consider reducing if achieve below 140/90

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6
Q

Maternal complications of eclampsia

8

A 
Placental abruption
Neurological defecits
Aspiration pneumonia
HELLP
Pulmonary oedema
Cardiovascular problems - IHD, stroke, chronic HTN etc.
Acute renal failure
Death - via DIC, sepsis, stroke etc
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7
Q

Risk factors for pre-eclampsia

9

A 
Primigravida
Extremes of age
HTN
DM
Previous pre-eclampsia
Family hx
Renal disease
Obesity
SLE, APLS
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8
Q

Clinical signs of pre-eclampsia

5

A 
HTN
Papilloedema
Brisk reflexes
Clonus
Visual defect 
HELLP syndrome
(Seizure - eclampsia)
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9
Q

Foetal complications of eclampsia

3

A

Prematurity - STEROIDS
IUGR
Bronchopulmonary disease

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10
Q

What is HELLP syndrome? When may it occur?

A

Haemolysis, elevated liver enzymes, low platelets

As a severe form of pre-eclampsia, patients are at high risk of DIC, abruption, renal failure and pulm oedema

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11
Q

Risks associated with pre-existing maternal DM?

6

A 
Congen abnormalities
Misacarriage
Macrosomia as a result of foetal hyperinsulinaemia, predisposed to IUD
Polyhydramnios
Infection
Stillbirth
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12
Q

Produce testosterone

A

Leydig cells

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13
Q

Form the blood-testis barrier

A

Sertoli cells

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14
Q

Days of the menstrual cycle when menses occur

A

1 to 7

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15
Q

Causes ovulation

A

Luteal surge, massive rise of LH @ day 14

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16
Q

Proliferating stage of menstrual cycle

A

days 7 to 14

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17
Q

Follice becomes this after ovulation

A

Corpus luteum

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18
Q

Causes proliferation of the endometrium

A

Progesterone

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19
Q

Produced by the corps luteum when it forms

A

Progesterone

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20
Q

Progesterone stimulates these to be formed in the endometrium

A

Spiral arteries

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21
Q

Increases uterine secretions to nourish embryo

A

Progesterone

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22
Q

Produced by a blastocyst upon implantation

A

hCG

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23
Q

Happens to the corpus luteum if no implantation, and why

A

atrophies and dies, as LH no longer being produced, then means no progesterone and next follicular phase can begin

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24
Q

Happens to corpus luteum if implantation occurs

A

hCG resembles LH, so CL can survive and continue to produce

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25
Q

Produces progesterone from 2-3 months to delivery

A

Placenta

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26
Q

Biochemical test of ovulation

A

21 day progesterone

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27
Q

2 hormones which surge at ovulation

A

LH, oestrogen

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28
Q

Hormone detected by preg test

A

hCG

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29
Q

Cryptochordism

A

Undecended testes

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30
Q

Primary infertility

A

Never concieved

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31
Q

Secondary infertility

A

Concieved before but not this time

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32
Q

Infertility

A

failure to conceive after 1 year of regular unprotected sex with no other cause

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33
Q

Aspermia

A

Absence of ejaculate

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34
Q

Oligozoospermia

A

less than 15 mil sperm per mil

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35
Q

Azoospermia and causes

A 
Absence of sperm in the semen
Primary -  problem with testes (likely Leydigs) or secondary testicular failure (higher up the axis)
CFTR mutation
Blockage of the repro tract
Chromosomal abnormality
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36
Q

Reduced sperm motility important diagnosis

A

Kartagener syndrome aka primary ciliary dyskinesia

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37
Q

3 things that are nor labour

A

Braxton Hicks contractions: irreg, no increase in frequency or intensit
Show - mucous plug
PROM

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38
Q

1st stage of labour

A

onset of true labour to full dilation (10cm)

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39
Q

2nd stage of labour

A

full cervical dilation (10cm) to delivery of baby

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40
Q

3rd stage of labour

A

delivery of baby to delivery of placenta and membranes

should happen within 30 mins

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41
Q

1st trimester

A

Last day of last menses to end of week 12

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42
Q

2nd trimester

A

Start of week 13 to end of week 27

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43
Q

3rd trimester

A

Start of week 28 to end of week 40

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44
Q

Causes of female infertility

5

A

Ovarian dysfunction - PCOS (androgen excess)
Tubular problem - blockage - test with Hysterosalpingography
Premature ovarian failure (diminished reserve)
Endometriosis - adhesions
PID

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45
Q

Causes of male infertility
Pre-testicular (4)
Intrinsic (6)
Post (5)

A 
Pre:
Hormonal - impaired secretion of GnRH
Drugs - illicit and chemo, anabolic steroids, spironolactone, phenytoin, sulfasalazine 
Alcohol
Coeliac disease
Intrinsic:
Varicocele
Kleinfelter's - 46XY
Neoplasm
Cryptochordism
Trauma
Hydrocele
Post: 
Vas deferens - obstruction, absence (CF)
Retrograde ejeculation
Hypospadias
Impotence
Infection e.g. prostitis
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46
Q

Missed miscarriage management

A

Conservative
Prostaglandins
Surgical

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47
Q

Most common ectopic locataion

A

Ampulla of fallopian tube

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48
Q

Period of amenhorroea and +ve preg test with nothing in uterus likely diagnosis

A

Ectopic

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49
Q

Management of ectopic

A

Methotraxate

Salpingectomy (tubes preserved)

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50
Q

Painless PV bleed in pregnancy most likely cause

A

Praevia

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51
Q

Contraindicated in praevia

A

PV EXAMINATION

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52
Q

Grades of praevia

A

1 to 4

  1. not reaches os
  2. reached os
  3. partially covering os
  4. totally covering os - centrally located
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53
Q

Painful PV bleed in pregnancy most likely casue

A

Abruption

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54
Q

Types of abruption

A

Revealed - blood scapes through os
Concealed - bleed between placenta and uterine wall
Mixed

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55
Q

Risk factors for abruption

6

A 
Pre-eclampsia
Chronic HTN
Multiparity
Polyhydramnios
Cocaine
Smoking
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56
Q

Complications of abruption

4

A

Maternal shock, collapse - blood loss may be deceptive
Foetal demise
MAternal DIC, renal failure
PPH!!!

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57
Q

Management of abruption

A 
Live foetus >34 weeks:
Foetus stable - vaginal delivery
may need induction
may need blood products
may need OXYTOCIN
may need STEROIDS
may need ANTI-D
Foetus/mother unstable - emergency CS
Live foetus <34 weeks:
Foetus stable - conservative
STEROIDS
consider delivery by 37-38 weeks
Foetus/mother unstable - 
emergency CS
may need OXYTOCIN

Foetal demise:
Mother stable - vaginal delivery
Mother unstable - emergency CS

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58
Q

Eclampsia treatment

A

Emergency delivery of foetus
Magnesium sulphate
Labetalol

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59
Q

Causes of APH

3

A

Praevia (30%)
Abruption (30%)
Benign bloody show

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60
Q

APH definition

A

Genital bleeding post 24 weeks and pre-labour

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61
Q

IOL definiton

A

forced commencement of labour through medication or rupture of membranes artificially - amniotomy

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62
Q

Bishop score above which IOL unlikely to be required

A

7 and above

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63
Q

Indications for IOL

4

A 
DM
Term +7
DVT treatment
IUG concerns
Oligohydramnios
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64
Q

Drug used to initiate contractions and reduce uterine atony

A

OXYTOCIN

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65
Q

Reasons for inadequate progress in labour

3

A

Cephalopelvic dispropotion
Malposition
Malpresentation

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66
Q

Determinants of progress

3

A

Cervical effacement
Cervical dilation
Descent of the foetal head

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67
Q

Ways to monitor the foetus

5

A 
Heart auscultation
Foetal movements
CTG
Blood sampling
ECG
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68
Q

Normal foetal blood pH

A

> or = to 7.25

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69
Q

Contraindications to vaginal delivery

A

Obstruction - Praevia, masses e.g. cyst, fibroid

Malpresentation - certain settings

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70
Q

Complications of 3rd stage of labour

3

A

PPH
Tear (grades 1-4)
Retained placenta

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71
Q

Major postnatal compliactions

5

A 
PPH - primary and secondary
VTE
Sepsis
Psychiatric disorders
Pre-eclampsia
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72
Q

Primary PPH definition

A

> 500mls blood loss within 24hrs of delivery

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73
Q

Secondary PPH definition

A

> 500mls blood loss from 24hrs post delivery to 6 weeks

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74
Q

Causes of primary PPH

A

4 T’s!!! - Tone, Trauma, Tissue, Thrombin

Tone
  - uterine atony - oxytocin
Trauma
  - tears
  - uterine rupture
  - inverted uterus
Tissue
  - retained placenta
Thrombin
  - inherited coagulopathies, DIC
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75
Q

Common teratogens and their effects

10

A

ACEIs - IUGR, renal dysplasia/failure
Alcohol - IUGR, foetal alcohol syndrome, mental retardation
Lithium - various, usually heart and great vessel malformations
Phenytoin/carbamazepine - foetal hydantoin syndrome - cleft lip/palate, depressed nasal bridge, short nose, mental retardation
Sodium valproate - foetal valproate syndrome - high forehead, infraorbital crease or groove, small mouth
Methotrexate - multiple skeletal abnormalities
Doxycycline - affect bone and teeth development
Radiation - microcephaly, mental retardation
Retinoic acid - NTDs e.g. spina bifida
Warfarin - foetal warfarin syndrome

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76
Q

Common teratogenic infections and their effects

6

A

CMV - microcephaly, chorioretinitis, mental retardation, deafness
HSV - microcephaly, microphthalmia, retinal dysplasia
Rubella - cataracts, glaucoma, deafness
VZV - skin scarring, muscular atrophy, mental defects
Treponema pallidum - hydrocephalus, deafness
Toxoplasma gondii - microcephaly, mental retardation, chorioretinitis

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77
Q

Period of greatest risk to foetus of teratogenicity

A

Organogenesis - 3-8 weeks

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78
Q

COCP mechanisms of action

3

A

Prevents ovulation - prevents LH surge
Temporarily renders endometrium inadequate
Thickens cervical mucus

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79
Q

Benefits of COCP

3

A

Increases regularity of menses
May help in menorrhagia
Reduces risk of ovarian and cervical cancer

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80
Q

Risks of COCP

3

A

3x increase risk of VTE
Small risk of ischaemic stroke - GREATER IN MIGRAINE WITH AURA - CONTRAINDICATED
Small increase in risk of breast cancer

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81
Q

POP mechanism of action

A

Thickens cervical mucus

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82
Q

Major downside of POP

A

Must be taken in same 3 hour window each day

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83
Q

DepoProvera mechanism of action

A

Mainly prevents ovulation

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84
Q

How often is Depo given

A

Every 12 weeks

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85
Q

Benefits of Depo injection

2

A

Good in poorly compliant patients

70% amenorrhoeic during treatment

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86
Q

Problems with Depo injection

4

A

Only one to cause a delay in return to fertility
Reversible decrease in bone density
Problematic bleeding when it occurs
Weight gain

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87
Q

Subdermal implant mechanism of action

A

Inhibition of ovulation

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88
Q

How long does a subdermal implant last?

A

3 years

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89
Q

What are the two forms of intrauterine contraception?

A

Copper coil - older method, makes periods heavier

Mirena - FIRST LINE IN MENORRHAGIA

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90
Q

3 forms of emergency contraception and their period of effect

A

Levonorgestrel pill - 72 hours
Ella one pill - 120 hours
Cu ICD - 120 hours

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91
Q

Up to what point can TOP be carried out in Scotland?

A

20 weeks

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92
Q

2 drugs used in medical TOP

A

Misoprostol

Mifepristone

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93
Q

Normal upper limit for abortion

A

24 weeks

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94
Q

Normal upper limit for medical abortion

A

10 weeks

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95
Q

Law under which abortion is legal in the UK

A

The Abortion Act 1967

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96
Q

Two key conditions of the abortion act

A

The abortion is carried out in a hospital or licensed clinic

Two doctors agree that continuing with the pregnancy would be more harmful to the physical or mental health of the pregnant woman or any existing children of her family than if the pregnancy was aborted

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97
Q

Conditions under which an abortion can be carried out after 24 weeks

A

It is necessary to save the woman’s life; or

It will prevent grave, permanent injury to the physical or mental health of the pregnant woman; or

There is substantial risk that if the child were born it would suffer from such physical or mental abnormalities as to be seriously handicapped.

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98
Q

Classical findings of vulvovaginal candidiasis (thrush)

3

A

Fissuring
Erythema with satellite lesions
Discharge - may be cottage-cheese like or simply more than usual

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99
Q

Treatment for candidiasis

A

Clotrimazole

Fluconazole

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100
Q

Condition which may be asymptomatic in 50% of cases or in some produce a watery grey, fishy discharge

A

Bacterial vaginosis (BV)

101
Q

Diagnostic findings in BV

A

Characteristic hx - grey/yellow watery/fishy discharge

Thin homogenous discharge

102
Q

Commonest cause of abnormal vaginal discharge

A

BV

103
Q

Treatment for BV (and trichomoniasis)

A

Metronidazole

104
Q

Causative organism in 90% of candidiasis

A

Candida albicans

105
Q

Risk factors for candidiasis

A 
DM
Steroid use
Pregnancy
Immunosupression
HIV
106
Q

Causative organism in BV

A

No organism, it’s an imbalance of native bacteria

107
Q

STIs which can be transmitted by genital contact alone

A

Scabies
Pubic lice
Warts - HPV 6&11
Herpes - HSV 1&2

108
Q

Virus and subtypes which cause genital warts

A

HPV, 6&11

109
Q

4 most common STIs worldwide

A
  1. Chlamydia trachomatis
  2. Neisseria gonorrhoea
  3. Syphilis
  4. Trichomonas vaginalis
110
Q

4 components of management in a patient presenting with STI-like symptoms

A

A good history
Partner notification where appropriate
HIV testing where appropriate
Health promotion

111
Q

7 questions to ask in a sexual history

A
  1. last contact
  2. casual or regular partner
  3. male or female
  4. nature of sex
  5. condoms?
  6. other contraception
  7. nationality of contact
112
Q

6 questions to risk assess man re sexual history

A
  1. ever contact with man
  2. ever injected drugs
  3. sexual contact with person who has injected drugs
  4. sexual contact with anyone from outside the UK
  5. medial treatment outside the UK
  6. involvement with the sex industry
113
Q

Percentage of chlamydia cases that are asymptomatic

A

85

114
Q

Signs and symptoms when chlamydia case is not asymptomatic

5

A 
Cervical discharge - cloudy/yellow
Friable cervix
Postcoital or intermenstrual bleeding
Penile discharge
Vaginal discharge - odourless mucoid
115
Q

Investigation for chlamydia

A

Nucleic acid amplification test

116
Q

Treatment for chlamydia

A

Azithryomycin
OR
Doxycycline (not in pregnancy)

117
Q

Men or women more likely to be asymptomatic in gonorrhoea

A

Women

118
Q

Most common gonorrhoeal symptoms in men

A

Dysuria
Urethral irritation
Urethral discharge

119
Q

Ethnic risk factor for gonorrhoea

A

Black ancestry

120
Q

Appearance of gonorrhoea on gram staining

A

Gram-negative diplococci

121
Q

Stains positive in gonorrhoea culture

A

Chocolate agar

122
Q

Test for gonnorhoea

A

Fluid culture

Nucleic acid amplification test

123
Q

Gonorrhoea treatment

A

Cefotaxime
AND
Azithromycin

124
Q

Define PID

A

Acute ascending polymicrobial infection of the female gynaecological tract that is frequently associated with Neisseria gonorrhoeae or Chlamydia trachomatis

125
Q

3 pelvic examination finding criteria for PID

A

Cervical excitation
Uterine tenderness
Adnexal tenderness

126
Q

Risk factors for PID

A

Previous PID
Previous chlamydia/ gonorrhoea
High risk sexual behaviour

127
Q

Causes of acute pelvic pain

14

A 
Ectopic
PID
Appendicitis
Degenerating uterine fibroid 
Abruption
Miscarriage
Ovarian abscess
Ovarian torsion
Ovarian cyst rupture
Corpus luteal cyst rupture
Endometriosis
UTI/Pyelonephritis
Cystitis
Dysmenorrhoea
128
Q

Complications of chlamydia

4

A

PID
Infertility
Ectopic
Reactive arthritis

129
Q

Complications of gonorrhoea

5

A 
Chronic pelvic pain
Infertility
PID
Ectopic pregnancy
Reactive arthritis
130
Q

Common signs of PID outwith the clinical criteria

5

A 
Lower abdominal pain
Fever
Nausea
Vomiting
Vaginal or cervical discharge
131
Q

Investigative options in PID

9

A 
FBC, WCC
Smear
ESR
Secretion culture
TVUSS
Pelvic CT
Pelvic MRI
Laparoscopy
Biopsy
132
Q

Treatment of PID

A 
Mild to mod:
Ceftriaxone 
AND
Doxycycline
\+/-
Metronidazole
AND
Treatment of sexual contacts

Severe:
Hospital admission and IV antibiotics

133
Q

What might you have to consider doing in the management of PID?

A

Removal of IUD

134
Q

Complications of PID

4

A

Where associated with/caused by chlamydia/gonorrhoea complications are as per untreated cases of those infections

Infertility
Tubo-ovarian abscess
Chronic pain
Ectopic

135
Q

Causes of ano-genital lumps/bumps

13

A 
Vulval cysts
Vaginal cysts
Fordyce sports
Varicosities
Ingrown hairs
Skin tags
Lichen sclerosis
PPP
Lichen planus
Genital herpes
Genital warts (HPV 6&amp;11)
Molluscum
Normal anatomical variations
136
Q

Symptoms of genital herpes

A 
Vulval irritation and pain
Fever
Groin swelling
Vaginal discharge
Blisters which go on to ulcerate
137
Q

Medication which suppresses symptoms of genital herpes

A

Aciclovir

138
Q

Risk factors for genital herpes

A

HIV infection
Immunosupression
High risk sexual behaviour

139
Q

Often first symptom in women with primary genital herpes

A

Dysuria

140
Q

Investigations for genital herpes

A

Viral culture

HSV PCR

141
Q

Nerves supplying the bladder and their nerve roots

A

Hypogastric T10-12
Pelvic S2-4
Pudendal S2-4

142
Q

3 types of FUI

A

Stress
Urgency
Mixed

143
Q

Risk factors for FUI

6

A 
PREGNANCY
CHILDBIRTH
Menopause
Increasing age
Increasing parity
Prev surgery
144
Q

Management of FUI

A

Pelvic floor training 60-70% cure
LIFESTYLE - smoking, weight, alcohol, caffeine
Pharmacological - Duloxetine
Surgery - tape, culposuspension, slings

145
Q

Percentage of parous women with some degree of prolapse

A

50

146
Q

Main support of anterior vaginal wall

A

Pubocervical fascia

147
Q

Risk factors for prolapse

7

A 
PARITY
AGE
OBESITY
Forceps delivery
Macrosomia
Prolonged second stage
Heavy lifting
148
Q

Vaginal symptoms of prolapse

A

Bulging/protruding
Pressure
Heaviness - “something coming down”
Difficulty with tampons

149
Q

Urinary symptoms of prolapse

A

Incontinence
Frequency/urgency
Week stream

150
Q

Bowel symptoms of prolapse

A

Incontinence
Flatus
Incomplete emptying/straining
Urgency

151
Q

Assessment of prolapse

A 
Exclude masses
QOL assessment
POPQ SCORE
USS/MRI
Urodynamics
152
Q

Management of prolapse

A

Lifestyle
Physio
Pessaries
Surgery - hysterectomy may be indicated

153
Q

Score for assessing baby’s status immediately after delivery, maximum score, score below which baby needs specialist paediatric care and oxygen

A

APGAR
10
7

154
Q

Parameters measured on partogram

11

A 
Temperature
BP
Urine dipstick results
Maternal HR
Foetal HR
Cervical dilation
Drugs and fluid balance
Contractions
Liquor description
Head moulding
Head engagement
155
Q

What is CTG? What is being measured?

A

Cardiotocograph(y)

Foetal heart rate and the strength of contractions

156
Q

Definition of foetal bradycardia

A

Baseline HR of <100bpm

157
Q

Nerve roots damaged in Erb’s palsy

A

C5&6

158
Q

Definition of menopause

A

Amenorrhoea for at least 12 months in a woman aged 45 or over

159
Q

Average age of menopause in the UK

A

51

160
Q

Definition of foetal tachycardia

A

Baseline HR of above 160

161
Q

Rough time of ovulation in a 28-day cycle

A

Day 14

162
Q

What is an alternative treatment of hot flushes where HRT is contra-indicated? Where might this be the case

A

SSRI

In a woman with history of VTE/stroke etc

163
Q

Causes of postcoital bleeding in pre-menopausal women

6

A 
Cervical ectropion
Infection e.g. cervicitis secondary to chlamydia
Cervical or endometrial polyps
Vaginal cancer
Cervical cancer
Trauma
164
Q

Define precocious puberty

A

Development of secondary sexual characteristics before 8 years in girls and 9 years in boys

165
Q

Scale describing secondary sexual characteristics

A

Tanner staging

166
Q

Affects 3-7 year old girls, may be green/yellow offensive discharge, vaginal soreness/itching and/or red ‘flushing’ around the vulva and anus

A

Vulvovaginitis

167
Q

Management of vulvovaginitis

A

Conservative treatment and improvement of perineal hygiene

168
Q

Management of labial adhesions

A

Oestrogen cream only if symptomatic, rarely surgery where cream fails and symptoms persist

169
Q

Cause of 40% of cases of adolescents presenting with chronic pelvic pain

A

Endometriosis

170
Q

Symptoms of endometriosis

A

Pelvic pain
Deep dyspareunia
Dysuria
Subfertility

Dyschezia
Dysmenorrhoea
Bladder and bowel symptoms

171
Q

3 places endometriosis commonly occurs

A

Ovaries
Uterosacral ligaments
Rectovaginal septum

172
Q

Classic appearance and nickname of endometriomas

A

Chocolate-like appearance due to altered blood, so called chocolate cysts
(endometriosis)

173
Q

Best way to confirm endometriosis (with experience)

A

Diagnostic laparoscopy

174
Q

Management of endometriosis

A 
COCP
NSAIDs
GnRH analogues
If endometrioma - surgery
Hysterectomy if all else fails
175
Q

Causes of abnormal uterine bleeding (there’s a mnemonic)

A

PALM.COEIN

Polyps
Adenomyosis
Leiomyoma
Malignancy/hyperplasia

Coagulopathies - vWD, platelet dysfunction, low platelets
Ovulatory dysfunction - PCOS, thyroid, anovulatory cycles or disturbed cycles - disturbance of oestrogen feedback mechanism/axis
Endometrial - endometritis, molecular disturbances
Iatrogenic - hormonal contraception, anticoagulants, IUDs
Not yet classified - Undiagnosed pregnancy complications, trauma, smoking, foreign body

176
Q

Define secondary amenorrhoea

A

Absence of menstruation for more than 6 months

177
Q

Causes of secondary amenorrhoea

A

Physiological - pregnancy, breastfeeding, anorexia

Pathological - hypothalamic dysfunction, thyroid, PCOS

178
Q

Investigations for secondary amenorrhoea

A

Preg test, LH, FSH, prolactin, USS

179
Q

Definition of miscarriage

A

Loss of pregnancy before 24 weeks

180
Q

Definition of recurrent miscarriage

A

3 consecutive pregnancy losses

181
Q

Things to test for in recurrent miscarriage

A

APLS antibodies, chromosome abnormalities and PCOS

182
Q

Definition of hyperemesis gravidarum

A

Persistent vomiting beginning before 20 weeks

183
Q

Complications of hyperemesis

3

A

Encephalopathy
Renal failure
Hepatic failure

184
Q

Management of cord prolapse

5

A

Tocolytics to reduce cord compression
Push presenting part of the foetus back into the uterus
Have patient go onto all fours
Do not push the cord back into the uterus
Immediate CS

185
Q

Drug used as second line after oxytocin in major PPH

A

Carboprost

186
Q

Normal variability on CTG

A

5-25bpm

187
Q

Drug and class which reduced the size of the uterus pre surgery

A

Leuprolidel, GnRH analogue

188
Q

HbA1c target when planning pregnancy

A

48

189
Q

Risk factor for endometrial hyperplasia

A

Tamoxifen

190
Q

Molar pregnancy - painful or painless?

A

Painless

191
Q

What is the main contributor to amniotic fluid

A

Foetal passage of urine

192
Q

Preferred treatment for early stage cervical cancer in postmenopausal women

A

Simple hysterectomy

193
Q

AFP high or low in 1.NTDs, 2.T21

A

High in NTDs

Low in T21

194
Q

Period of Down Syndrome testing where nuchal translucency is available

A

11 to 13+6 weeks

195
Q

Period of booking scan

A

8-12 weeks

196
Q

The 3 features of Meig’s syndrome

A

Benign ovarian tumour
Ascites
Pleural effusion

197
Q

Period for early scan to confirm dates

A

10 to 13+6 weeks

198
Q

First and second doses of Anti-D in Rhesus neg women

A

28 and 34 weeks

199
Q

Things done at booking visit and time window, including bloods
(15+)

A

8-12 weeks, ideally before 10 weeks

General information - diet, alcohol, smoking, folic acid, vit D, antenatal classes
Basic checks - BP, urinalysis, BMI

Bloods -
FBC
Blood group
Rhesus status
Red cell alloantibodies
Haemoglobinopathies
Rubella
Syphilis
Hep B

Urine culture for asymptomatic bacteruria

200
Q

Downs screening window including nuchal translucency

A

11 - 13+6 weeks

201
Q

Second screen for anaemia and red cell alloantibodies

A

28 weeks

202
Q

Score for risk of baby blues

A

Edinburgh depression scale

203
Q

First line and second line ovulation inducing dugs used in PCOS

A

Clomifine

Metformin

204
Q

Two strongest associations with increased nuchal translucency

A

Down’s

Congential heart defects

205
Q

Most common cause of recurrent first trimester miscarriage

A

Antiphospholipid syndrome

206
Q

Classical triad of vasa previa

A

Rupture of membranes

207
Q

Greatest risk factor for hyperemesis

A

Twin pregnancy

208
Q

What should be given in women at moderate risk of pre-eclampsia and from when

A

Low dose aspirin from 12 weeks

209
Q

Definition of premature ovarian failure

A

Onset of menopausal symptoms and elevated gonadotrophin levels before 40yrs

210
Q

Commonest stage of presentation in endometrial cancer

A

1

211
Q

Test for Feoto-maternal haemorrhage to determine Anti-D dose

A

Kleihauer test

212
Q

Initial management of late decelerations

A

Foetal blood sampling for hypoxia and acidosis

213
Q

What makes up the combined test for down’s

A

Nuchal translucency
bHCG
PAPP-A (pregnancy-associated plasma protein A)

214
Q

Most common benign tumour in women under 25

A

Dermoid cyst (teratoma)

215
Q

Most common cause of ovarian enlargement in women of a reproductive age

A

Follicular cyst

216
Q

Most common cause of minimal baseline variability of less than 40 mins duration

A

Foetal sleeping

217
Q

Uterine tenderness, rupture of the membranes with a foul odour of the amniotic fluid and maternal signs of infection - likely diagnosis

A

Chorioamnionitis

218
Q

Copper IUD mechanism of action

A

Toxic to the ovum and the sperm

219
Q

Levonorgesterel emergency contraception mechanism of action

A

Inhibits ovulation

220
Q

Absolute contraindications to COCP use

8

A 
Breast cancer
Migraine with aura
Personal history of DVT/PE
Personal history of stroke or IHD
Breastfeeding and postpartum <6 weeks
Over 35 and smoking more than 15 cigarettes per day
Uncontrolled HTN
Recent major surgery and immobilisation
221
Q

Age under which a child is always consider incapable of giving consent, regardless of Gillick competence

A

13

222
Q

Window after giving birth where contraception is not required

A

21 days

223
Q

Single dose of levonorgesterel

A

1.5mg

224
Q

Contraindication to all hormonal forms of contraceptive

A

Breast cancer

225
Q

POP time until effective

A

2 days

226
Q

COCP, injection, implant, IUS time until effective

A

7 days

227
Q

IUD time until effective

A

Immediately

228
Q

Length of normal cycle

A

28 days

229
Q

2 cancers COCP increases risk of and two it decreases risk of

A

Increased: breast and cervical
Decreased: ovarian and endometrial

230
Q

Classic blood result triad of DIC

A

Thrombocytopaenia
Elevtaed PT
Elevated aPTT

231
Q

Time when amniotic fluid embolism most commonly occurs

A

Following a contraction

232
Q

Most important aspect of management in amniotic fluid embolism

A

Adequate oxygenation

233
Q

First line drugs in ovarian cancer

A

Platinum based drugs e.g. carboplatin

234
Q

Gestation when fundus reaches umbilicus

A

20 weeks

235
Q

Test for women with a risk factor for DM

A

OGTT 24-28 weeks

236
Q

Drugs used to incur multiple ovulations in IVF patient

3

A

Clomiphene citrate
FSH
Human menopausal gonadotrophin

237
Q

Most accurate blood test and the result in confirming menopause

A

FSH - elevated

238
Q

Earliest point at which CVS is available

A

11 weeks

239
Q

Earliest point at which amniocentesis is available

A

15 weeks

240
Q

Karyotype of Turner’s syndrome

A

45X/45X0

241
Q

Where is GnRH prouced

A

Hypothalamus

242
Q

What does GnRH stimulate the release of

A

LH

FSH, both from the pituitary

243
Q

Pregnancy which progresses beyond this point is considered term

A

37 weeks

244
Q

Percentage of molar pregnancies which become invasive

A

15%

245
Q

Best mode of delivery for HRT in women with a history or risk factors for VTE

A

Transdermal combined patches

246
Q

Breast cancer risk factors

A 
Age
Geography
Prev. breast disease incl. benign
Radiation
Obesity
Alcohol
COCP
HRT
247
Q

Two main types of breast cancer

A

Carcinoma in situ

Invasive carcinoma

248
Q

Commonest cause of blood stained nipple discharge in a younger woman

A

Intraductal papilloma

4th Year Key Summaries (5 decks)

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