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Year 3 > Repro last min stuff > Flashcards

Repro last min stuff Flashcards

1
Q

3 blood supplies to breast and where they come from?

A

Internal mammary from internal thoracic

Posterior intercostal from thoracic aorta

Lateral thoracic from subclavian

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2
Q

Most lymph from breast drains to axillary - where does the rest drain to?

A

Parasternal
Abdorminal nodes
Nodes of contralateral breast

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3
Q

Popcorn calcification on mammography?
Tea cup?
Rod shaped?
Microcalcifications?

A

Popcorn - fibroadenoma
Tea cup - micro cyst
Rod - duct ectasia
Micro - normally DCIS, some may be invasive carcinoma (usually pleomorphic)

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4
Q

Cobblestone breast and cyclical pain

A

fibrocystic change

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5
Q

older women, lump, blood stained discharge

A

pappiloma

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6
Q

subareolar lump, purulent +/- blood stained discharge

A

duct ectasia

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7
Q

Grading of breast cancer?

A

Grade based on

  • pleomorphism (1-3)
  • tubular differentiation (1-3)
  • Mitotic activity (1-3)

3-5 = grade 1
6, 7 = grade 2
8, 9 = grade 3

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8
Q

Staging of breast cancer?

A

T1 <2cm
T2 2-5cm
T3 >5cm

N0 no nodes
N1 mobile node
N2 fixed node

M0 no mets
M1 mets

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9
Q

Best & worst prognosis of breast cancer in terms of hormones?

A

Best - ER +, PR +, HER2 -

Worst = ER -, PR -, HER2 +

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10
Q

Poor prognostic factors for breast cancer?

A

<35
HER2 +
ER -
PR -

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11
Q

When is WLE done?

A

<4cm

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12
Q

When is mastectomy done?

A

> 4 nodes
Grade 3
4cm
Poor surgical margins <1cm

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13
Q 
Extremely low birth weight?
Very low?
Low?
Normal?
Large?
A 
Ex <1000g
VL <1500g
Low <2500g
Normal 2500-4000g
Large >4000g
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14
Q 
Miscarriage?
Still birth?
Perinatal mortality?
Neonatal mortality?
Postnatal mortality?
Infant mortality?
A 
Miscarriage <24 weeks
Still 24 weeks - birth
Peri - 24 weeks - 1 week post 
Neonatal - birth - 4 weeks
Post - 4 weeks-1 year
infant - birth - 1 year
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15
Q

APGAR?

A

Appearance: 0 pals, 1 pale extremities, 2 pink
Pulse: 0 absent, 1 <100, 2 >100
Grimace: 0 no reaction, 1 grimace/ pull away, 2 grimace + cough/sneeze cry
Activity: 0 floppy, 1 some tone, 2 active motion
Resp: 0 absent, 1 slow, irregular, 2 cries well

> 7 normal
4-6 low
<4 critical

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16
Q

Histology of bronchopulmonary dysplasia?

A

Necrotising bronchitis

Hyperinflation

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17
Q

mucous/bloodstained diarrhoea, poor feeding, abdo distension/tenderness, CXR bowel wall oedema + pneumostasis intestinalis?

A

Necrotising enterocolitis

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18
Q

Hypoxic ischaemic encephalopathy?

A

Complication of birth-related asphyxia - failure to establish spontaneous breathing after birth

Seizures, loss of muscle tone, decreased ability to breathe

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19
Q

Sign on head of intraventricular haemorrhage?

A

Bulging frontanelles

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20
Q

Causes of pathological jaundice? (5)

A

sepsis, haemorrhagic disease of newborn, Rh/ABO incompatability, G6PD deficiency, spherocytosis

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21
Q

Causes of prolonged jaundice? (4)

A

hypothyroidism
Infection (TORCH/UTI)
biliary atresia
CF

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22
Q

2 main cyanotic heart defects? CXR?

A

tetralogy of fallot - boot shaped cardiomegaly

transposition of great vessels - egg-shaped cardiomegaly

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23
Q

Gastroschisis?

Exomphalos?

A

extrusion of abdo viscera

herniation of viscera covered in peritoneum - more common in chromosomal abnormalities

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24
Q

Causes of early (<48hrs) sepsis?

Late (>48 hrs)?

A

GBS, e. coli

Listeria, staph

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25
Q

Standard treatment of neonatal sepsis?

Treatment of neonatal pneumonia?
Meningitis?
UTI?

A

Benzylpenicillin + gentamicin

Amox
Ceftriaxone + amoxicillin
amox + gent

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26
Q

Presentation of PPHN?

Rx?

A

RDS, cyanosis, loud S2

Supportive, inotropes

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27
Q

Male repro duct?

A

Male - Wolffian duct/mesonephric

Female - Mullerian/paramesonephric

28
Q

How does male/female differentiation occur?

A

If Y chromosome then testes sectete testosterone (wolffian duct grows) and anti-mullerian hormone (mullerian duct degenerates)

If no Y chromosome absence of testosterone (wolffian duct degenerates) and absence of anti-mullerian hormone (mullerian duct grows)

Presnce/absence of testosterone causes development of male/female genitalia
Presence/absence of anti-mullerian hormone causes development of male/female repro tract

29
Q

When does sex differentiation occur?

When is it seen on USS?

A

9 weeks

16 weeks

30
Q

What is androgen insensitivity syndrome?

A

Congenital insensitivity to androgens
46 XY genotype but female phenotype - X-linked recessive
Testes develop but do not descend
Mullerian inhibition occurs so testes, and short vagina
Presents at puberty with primary amenorrhoea and failure to develop secondary sexual characteristics

31
Q

Management of cryptorchidism? (undescended testes)

A

Orchidoplexy if <14y/o

If adult then orchidectomy (6x risk of testicular germ cell cancer)

32
Q

Function Leydig cells?

Sertoli cells?

A

Leydig - release testosterone in response to LH

Sertoli - form blood/testicular barrier, nutrients, phagocytosis, secrete inhibin/activin, secrete androgen binding globulin

33
Q

Release of LH/FSH in males?

A

Controlled by GnRH, under -ve feedback from testosterone

34
Q

Function of activin and inhibin?

A

Inhibin prevents FSH release

Activin causes FSH release

35
Q

Systemic causes of amenorrhoea?

A

hyperthyroidism
Renal failure
Pituitary disease
Haemochromatosis

36
Q

Genetic causes of amenorrhoea?

A

Kallmann’s
Turner’s syndrome
Prader willi

37
Q

Systemic causes of menorrhagia?

A 
Hypothyroidism
Diabetes
Adrenal disease
ITP
vWD
Renal disease
Liver disease
38
Q

Pearl index of:

  • depot?
  • coil?
  • mirena?
  • Implant?
  • tubal ligation?
A 
depot - 0.3%
coil - 0.5%
mirena - 0.2%
implant - 0.1%
tubal - 0.5
39
Q

MOA:

  • depot?
  • coil?
  • mirena?
  • implant?
A 
depot - inhibits ovulation
coil - prevents fertilisation
mirena - prevents implantation
implant - inhibits ovulation
COCP - inhibits ovulation
POP - thickens cervical mucous +/- inhibits ovulation
40
Q

CI depot?

A

Breast cancer

41
Q

Side effects of depot?

A

weight gain
delay in return of fertility
irregular bleeding

42
Q

CI copper coil/mirena?

A

peptic ulcer disease
PID
fibroids
Hx endometrial/cervical cancer

43
Q

SE copper coil?

A

menorrhagia
infection
ectopic

44
Q

SE mirena?

A

irregular bleeding initially
infection
ectopic

45
Q

Problems with patch?

A

Reduced efficacy if obese

Breast pain, nausea, painful periods, increased thrombotic risks compared to other combined ones

46
Q

How long after EC can contraception be used?

A

Levonelle immediately

EllaOne 5 days

47
Q

CO COCP?

A 
BP>160/95
Migraine with aura
Smoking >15 if >35
BMI >34
IHD
Hx breast cancer
APS
Hx thrombosis
Advanced diabetes
48
Q

Oestrogen changes around menopause?

A

Decreased E2 - produced from ovaries, main one

Increased E1 - produced from fat

49
Q

3 most common symptoms of pre eclampsia?

A

headache
visual disturbance
epigastric discomfort

50
Q

Treatment of eclampsia?

A

Mg SO4

consider diazepam if repeated seizures despite repeated MgSO4 boluses

51
Q

Who would the following cases be referred to:

  • woman with ovarian cyst strongly suggestive of malignancy
  • woman with stage III cervical cancer?
  • woman with strong FHx of breast/ovarian Ca
  • woman with fibroids wanting embolisation
A
  • gynaecological oncologist
  • radiotherapist
  • geneticist
  • radiologist
52
Q

Treatment options for fibroids?

A

Symptomatic - tranexamic/mefanamic acid

pre-surgery - GnRH anologues

Nulliparous - myomectomy

Family complete - hysterectomy

53
Q

Is the COCP CI before laparoscopic sterilisation?

A

No - only major surgery

54
Q

Treatment of HPV warts in pregnancy?

A

NOT podophyllin, local techniques?

55
Q

First line Ix for woman with PMB on Tamoxifen?

A

Hysterescopy & Biopsy - TVUS cannot differentiate potential cancer from thickening due to tamoxifen

56
Q

3 things that cause polyhydramnios?

A

Diabetes mellitus

multiple pregnancy

Things that decrease foetal swallowing e.g. trachea-oesophageal fistula/anencephaly

57
Q

Things that cause oligohydramnios?

A

NSAIDs

renal agenesis

58
Q

Ix for tubal infertility?

A

Laparoscopy and dye hydrotubulation

59
Q

Staging of uterine cancer?

A 
1A <50% myometrium
1B >50%
2 - cervical stroma
3A - serosa
3B - vagina
4A - bladder/bowe;
4B - distant mets
60
Q

Contraindications for forceps/ventouse?

A

mal-presentation i.e. breech

Absolute cephalopelvic disproportion

61
Q

Definition of:

  • extremely preterm?
  • very preterm?
  • mod-late preterm?
  • term?
  • post-term?
A 
<28
28-32
32-37
37-42
>42
62
Q

If woman goes into premture labour - meds for baby?

A

If <34 weeks delay with Nifedipine
Dexamethasone
MgSO4

Consider dexamethasone up till 36 weeks

63
Q

When is OFTT done if RF?

A

28 weeks

64
Q

Combined test?

A

up to 14 weeks

nuchal thickness
PAPPA
hCG

65
Q

Quadruple test?

A

15-20 weeks

hCG
PAPP-A
AFP
E3

66
Q

If sensitisation event <20 weeks?

If >20 weeks?

A

< 20 = anti-D

>20 weeks = anti-D + kelihauer

Year 3 (19 decks)

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