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year 3. > Repro Ixs > Flashcards

Repro Ixs Flashcards

1
Q

Miscarriage ixs

A

Fbc, blood group and rhesus status, serum hcg,

definitive diagnosis- transvaginal ultrasound

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2
Q

Gold standard ix for ectopic pregnancy

A

Trans vaginal ultrasound scan

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3
Q

Molar pregnancy ix and appearance

A

Uss diagnoses it- snowstorm appearance +/- fetus, theca lutein cysts

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4
Q

Infertility ixs woman

A

serum progesterone 7 days prior to expected next period. (28 day cycle= day 21): establish ovulation
Tsh
Rubella immunity
Chlamydia screeb
Ensure cervical smear test is up to date

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5
Q

Male infertility ix

A

Semen analysis
if abnormal repeat in 3 months

min. of 3 days and max of 5 days abstinence required for test

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6
Q

tests to check tubal patentcy
(first line and diagnostic)

A

Hsg (x-ray procedure to look at uterus and fallopian tubes)

Diagnostic: laproscopy and hyrdrotubation
^ indications: signific pelvic pain etc

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7
Q

When is hysteroscopy done

A

In cases where suspected endometrial pathology, ie: uterine septum, adhesions, polyp

(camera inserted in vagina and through cervix to view inside uters)

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8
Q

Pcos diagnostic criteria

A

the Rotterdam criteria state that a diagnosis of PCOS can be made if 2 of the following 3 are present:

  • infrequent or no ovulation (usually manifested as infrequent or no menstruation)
  • clinical and/or biochemical signs of hyperandrogenism (such as hirsutism, acne, or elevated levels of total or free testosterone)
  • polycystic ovaries on ultrasound scan (defined as the presence of ≥ 12 follicles (measuring 2-9 mm in diameter) in one or both ovaries and/or increased ovarian volume > 10 cm³)
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9
Q

ART eligibility

(8)

A

Stable relationship 2yrs
Female age <40 (<42)
Female bmi 18.5-30
Non smokers
No biological child
No illegal/abusive substances (inc methadone)
Neither partner can have been previously sterilised
Duration unexplained fertility for 2 yrs

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10
Q

Primary genital hsv ix

A

Swab lesion for hsv-1 and 2 pcr
Recommend full sti screen (chlamydia, gonnorhoea, syphillis, HIV)

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11
Q

Syphillis

A

non treponemal test + treponemal specific test

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12
Q

fibroids Ix

A

tv ultrasound

rarely MRI

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13
Q

premenopausal ovarian cysts Ix (1st line and other ixs)

A

1st: ultrasound scan

MRI, tumour markers CA125 and AFP (embryonal carcinoma),HCG (choriocarcinoma), LDH (dysgerminoma)

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14
Q

post menopausal masses Ix

A

CT and CA125

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15
Q

Gold standard ix for endometriosis

A

Laparoscopy

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16
Q

gestational diabetes Ixs
givecut off range for diagnosis

A

1st line: oral glucose tolerance test

fasting glucose: >=5.6
2 hour glucose: >= 7.8mmol

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17
Q

testing for chlamydia type II

A

NAAT

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18
Q

> = 55 presenting with post-menopausal bleeding
^what is this a red flag for and what should the management be

A

endometrial cancer
refer using cancer pathway :

  • transvaginal ultrasound scan and consideration of hysteroscopy with endometrial biopsy
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19
Q

when does ectopic pregnancy qualify for surgical management

A

> 35mm
if it is ruptured
pain
visible heartbeat
HCG>5000

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20
Q

Hypertension definition in pregnant women

A

> =140/90 on 2 occasions 4 hrs apart

> = 160 systolic once
=140 diastolic once

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21
Q

Proteinuria definition

A

UPCR>30mmol
(Urine protein creatinine ratio)

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22
Q

when should women with risk factors for gestational diabetes be offered screening test

A

oral-glucose tolerance test should be offered at 24-28 weeks

if woman has previously had gestational diabetes then offer it straight away and at 24-28 weeks

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23
Q

what score is used to determine if labour can commence

A

bishops score
<5 = labour is unlikely to start without induction
>/=8 indicates cervix is ripe

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24
Q

placenta praevia investigations

A

confirm by: TV ultrasound
MRI to exclude placenta accreta

do NOT do digital examination

check anomaly scan

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25
Q

vasa praevia diagnostic test

A

ultrasound TA and TV with doppler

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26
Q

test to aid diagnosis of epidural abscess

A

MRI

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27
Q

rubella investigations

A

IgG specific to rubella and IgM within 10 days of exposure

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28
Q

when is amniocentesis offered

A

between weeks 15-20

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29
Q

test for persistent pulmonary hypertension of the newborn

A

measure pre and post ductal O2 sats= 10-20% difference

(pre duct is right arm and head and neck)

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30
Q

hyperemesis gravidarum diagnostic criteria

A

5% pre-pregnancy weight loss
dehydration
electrolyte imbalance

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31
Q

pre-eclampsia diagnostic criteria

A

blood pressure of systolic 140 or diastolic 90 (or greater) and 1 or more of: proteinuria, organ dysfunction

32
Q

when does pre-eclampsia occur

A

> 20 weeks

33
Q

down syndrome antenatal testing (SCREENING tests):
when can test(s) be done
which test is more accurate

A

combined test result: 11-13+6 weeks

quadruple test: 15-20 weeks

combined test more accurate

34
Q

diagnostic test for downs

A

chorionic villus sampling or amniocentesis

however women will be offered a second screening test called NIPT which is non invasive and has a very high sensitivity and specificity

35
Q

what are the positive test results for downs syndrome (combined test)

A

high HCG, low PAPP-A, thickened nucheal translucency

all low except Hcg, H for High

36
Q

what are the positive test results from quadruple test for downs syndrome

A

high hcg, high inhibin A, low AFP, low oestriol

37
Q

screening tool for postnatal depression

A

the edinburgh scale

38
Q

scoring system if induction of labour is required

A

bishop score

39
Q

cervical cancer screening- if the results are positive

A

positive hrHPV- refer to cytology.
if cytology abnormal> colposcopy if cytology normal then the test is repeated at 12 monthss.
if hrHPV -ve 12 months later> return to normal recall.

if the repeat test is still hrHPV +ve and cytology still normal → further repeat test 12 months later:

If hrHPV -ve at 24 months → return to normal recall
if hrHPV +ve at 24 months → colposcopy

40
Q

cervical cancer screening- what to do is results are inadquate

A

if inadequate- refer for another test in 3 months
if inadequate again refer for colposcopy

41
Q

how often is cervical screening offered in scotland

A

25-64 yrs every 5 years

42
Q

preterm labour rupture of the membranes ix

A

1st line: sterile speculum examination (to look for pooling of the amniotic fluid in the posterior vaginal vault) & avoid digital examination

-if pooling of fluid is not observed NICE recommend testing the fluid for placental alpha microglobulin-1 protein (PAMG-1) (e.g. AmniSure®) or insulin-like growth factor binding protein‑1

ultrasound may also be useful to show oligohydramnios

43
Q

what can transvaginal ultrasound determine regarding pregnancy

A

whether pregnancy is intrauterine or ectopic, if there is a foetal heartbeat & the presence of any other abnormalities, such as a subchorionic haematoma

44
Q

stereotypical PCOS results

A

raised LH:FSH ratio
testosterone may be normal or mildly elevated
SHBG is normal to low

45
Q

diagnostic threshold for gestational diabetes

A

fasting glucose>= 5.6mmol/L
2 hour glucose is >= 7.8mmol/L

46
Q

reduced fetal movements investigations for woman <24 weeks pregnant

A

handheld doppler if movements previously felt, otherwise refer to maternity

47
Q

reduced feotal movements 24-28 weeks ix

A

handheld doppler

48
Q

reduced foetal movements >28 weeks ix

A

1st handheld doppler,
if no foetal heartbeat> immediate ultrasound

if foetal heartbeat present- CTG

49
Q

when is the anomaly scan performed and what is it for

A

18-20+6 weeks

Anomaly scan evaluates anatomical structures of the foetus, placenta, and maternal pelvic organs. This allows for careful planning of the pregnancy as well delivery

50
Q

what is baseline bradycardia feotus

A

hr <100bpm

51
Q

baseline tachycardia foetus

A

hr> 160/min

52
Q

what does early deceleration mean /indicate

A

early: deceleration of HR which commences w/ onset of a contraction and returns to normal on completion of contraction

usually normal, can indicate head compression

53
Q

Late deceleration (ctg) meaning/indication

A

pathological!

Deceleration of the heart rate which lags the onset of a contraction and does not returns to normal until after 30 seconds following the end of the contraction

Indicates fetal distress e.g. asphyxia or placental insufficiency

54
Q

Variable decelerations: meaning/indications

A

Independent of contractions

may indicate cord compression

55
Q

reassuring CTG:
baseline heart rate
variability
decelerations

A

Baseline heart rate: 110 to 160 bpm
Baseline variability: 5 to 25 bpm
Decelerations: None or early
Variable decelerations with no concerning characteristics for less than 90 minutes

56
Q

late deceleration foetus- ix

A

late decerelation- do foetal sampling. should be ph>7.2

if fetal acidosis consider urgent delivery

57
Q

normal endometrial thickness

A

<4mm

58
Q

how is low molecular weight heparin monitored in DVT (which blood test)

A

anti-xa activity

59
Q

what is assessed in bishops score

A

cervical position
cervical consistentcy
cervical effacement
cervical dilation
fetal station

60
Q

what should fundal height be

A

match gestational age from 20 weeks onward- within 1 or 2cm

61
Q

what are the cut offs for recieving iron therapy in pregnancy

A

first trimester <110
2nd trimester <105
pospartum <100

62
Q

how is menapause diagnosed

A

< 50 years of age AND amenorrhoeic for at least 2 years.
> 50 years of age AND amenorrhoeic for at least 1 year.

63
Q

chorioamniocentesis tx

A

IV antibiotics and immediate cesarean

64
Q

premature ovarian insufficiency tx

A

hormone replacement therapy (HRT) or a combined oral contraceptive pill should be offered to women until the age of 51 years

(for symptoms and to protect bones)

65
Q

what should symphisis fundal height be after 16 weeks

A

same as gestational age +/- 2

66
Q

when is a pregnancy test carried out after TOP

A

3 weeks after.

67
Q

Most sensitive test for gonnorhoea

A

NAAT- requires urine or a swab to obtain the genetic materials

68
Q

HIV Investigations

A

p24 antigen 1st line as it can detect HIV 1 -4 weeks after infection whereas HIV antibody test can take up to 3 months.

HIV p24 antigen and HIV antibody tet are now standard for diagnosis and screening- reapeat test for confirmation

69
Q

cervical cancer staging and how is it staged

A

FIGO staging
Ia, Ib, II, III, IV

Ia- microscopic, confined to cervix

II- invades uterus/upper 2/3rds of vagina

IV- extension of tumour beyond the pelvis or involvement of bladder or rectum

70
Q

ovarian cancer ix

A

first CA125, if raised > abdo + pelvic us, if pos > urgently refer
diagnosis usually involves laparotomy.

71
Q

ovarian cancer staging

A

Stage 1 Tumour confined to ovary
Stage 2 Tumour outside ovary but within pelvis
Stage 3 Tumour outside pelvic but within abdomen
Stage 4 Distant metastasis

72
Q

endometritis ix

A

high vaginal swab, transvaginal ultrasound

endometrial biopsy diagnostic but rarely used.

73
Q

secondary post parum haemorrage ix

A

high vaginal swab for infection and tv us to look for retained products of pregnancy

74
Q

abx tx for secondary pph
and if penicillin allergic

A
    • Antibiotics - co-amoxiclav (co-trimoxazole + metronidazole if penicillin allergic)
75
Q

when can chorionic villus sampling be carried out

A

11-14 weeks

76
Q

when can amniocentesis be carried out

A

15-20

year 3. (32 decks)

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