Repro last min stuff Flashcards
3 blood supplies to breast and where they come from?
Internal mammary from internal thoracic
Posterior intercostal from thoracic aorta
Lateral thoracic from subclavian
Most lymph from breast drains to axillary - where does the rest drain to?
Parasternal
Abdorminal nodes
Nodes of contralateral breast
Popcorn calcification on mammography?
Tea cup?
Rod shaped?
Microcalcifications?
Popcorn - fibroadenoma
Tea cup - micro cyst
Rod - duct ectasia
Micro - normally DCIS, some may be invasive carcinoma (usually pleomorphic)
Cobblestone breast and cyclical pain
fibrocystic change
older women, lump, blood stained discharge
pappiloma
subareolar lump, purulent +/- blood stained discharge
duct ectasia
Grading of breast cancer?
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
Staging of breast cancer?
T1 <2cm
T2 2-5cm
T3 >5cm
N0 no nodes
N1 mobile node
N2 fixed node
M0 no mets
M1 mets
Best & worst prognosis of breast cancer in terms of hormones?
Best - ER +, PR +, HER2 -
Worst = ER -, PR -, HER2 +
Poor prognostic factors for breast cancer?
<35
HER2 +
ER -
PR -
When is WLE done?
<4cm
When is mastectomy done?
> 4 nodes
Grade 3
4cm
Poor surgical margins <1cm
Extremely low birth weight? Very low? Low? Normal? Large?
Ex <1000g VL <1500g Low <2500g Normal 2500-4000g Large >4000g
Miscarriage? Still birth? Perinatal mortality? Neonatal mortality? Postnatal mortality? Infant mortality?
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
APGAR?
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
Histology of bronchopulmonary dysplasia?
Necrotising bronchitis
Hyperinflation
mucous/bloodstained diarrhoea, poor feeding, abdo distension/tenderness, CXR bowel wall oedema + pneumostasis intestinalis?
Necrotising enterocolitis
Hypoxic ischaemic encephalopathy?
Complication of birth-related asphyxia - failure to establish spontaneous breathing after birth
Seizures, loss of muscle tone, decreased ability to breathe
Sign on head of intraventricular haemorrhage?
Bulging frontanelles
Causes of pathological jaundice? (5)
sepsis, haemorrhagic disease of newborn, Rh/ABO incompatability, G6PD deficiency, spherocytosis
Causes of prolonged jaundice? (4)
hypothyroidism
Infection (TORCH/UTI)
biliary atresia
CF
2 main cyanotic heart defects? CXR?
tetralogy of fallot - boot shaped cardiomegaly
transposition of great vessels - egg-shaped cardiomegaly
Gastroschisis?
Exomphalos?
extrusion of abdo viscera
herniation of viscera covered in peritoneum - more common in chromosomal abnormalities
Causes of early (<48hrs) sepsis?
Late (>48 hrs)?
GBS, e. coli
Listeria, staph
Standard treatment of neonatal sepsis?
Treatment of neonatal pneumonia?
Meningitis?
UTI?
Benzylpenicillin + gentamicin
Amox
Ceftriaxone + amoxicillin
amox + gent
Presentation of PPHN?
Rx?
RDS, cyanosis, loud S2
Supportive, inotropes
Male repro duct?
Male - Wolffian duct/mesonephric
Female - Mullerian/paramesonephric
How does male/female differentiation occur?
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
When does sex differentiation occur?
When is it seen on USS?
9 weeks
16 weeks
What is androgen insensitivity syndrome?
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
Management of cryptorchidism? (undescended testes)
Orchidoplexy if <14y/o
If adult then orchidectomy (6x risk of testicular germ cell cancer)
Function Leydig cells?
Sertoli cells?
Leydig - release testosterone in response to LH
Sertoli - form blood/testicular barrier, nutrients, phagocytosis, secrete inhibin/activin, secrete androgen binding globulin
Release of LH/FSH in males?
Controlled by GnRH, under -ve feedback from testosterone
Function of activin and inhibin?
Inhibin prevents FSH release
Activin causes FSH release
Systemic causes of amenorrhoea?
hyperthyroidism
Renal failure
Pituitary disease
Haemochromatosis
Genetic causes of amenorrhoea?
Kallmann’s
Turner’s syndrome
Prader willi
Systemic causes of menorrhagia?
Hypothyroidism Diabetes Adrenal disease ITP vWD Renal disease Liver disease
Pearl index of:
- depot?
- coil?
- mirena?
- Implant?
- tubal ligation?
depot - 0.3% coil - 0.5% mirena - 0.2% implant - 0.1% tubal - 0.5
MOA:
- depot?
- coil?
- mirena?
- implant?
depot - inhibits ovulation coil - prevents fertilisation mirena - prevents implantation implant - inhibits ovulation COCP - inhibits ovulation POP - thickens cervical mucous +/- inhibits ovulation
CI depot?
Breast cancer
Side effects of depot?
weight gain
delay in return of fertility
irregular bleeding
CI copper coil/mirena?
peptic ulcer disease
PID
fibroids
Hx endometrial/cervical cancer
SE copper coil?
menorrhagia
infection
ectopic
SE mirena?
irregular bleeding initially
infection
ectopic
Problems with patch?
Reduced efficacy if obese
Breast pain, nausea, painful periods, increased thrombotic risks compared to other combined ones
How long after EC can contraception be used?
Levonelle immediately
EllaOne 5 days
CO COCP?
BP>160/95 Migraine with aura Smoking >15 if >35 BMI >34 IHD Hx breast cancer APS Hx thrombosis Advanced diabetes
Oestrogen changes around menopause?
Decreased E2 - produced from ovaries, main one
Increased E1 - produced from fat
3 most common symptoms of pre eclampsia?
headache
visual disturbance
epigastric discomfort
Treatment of eclampsia?
Mg SO4
consider diazepam if repeated seizures despite repeated MgSO4 boluses
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
- gynaecological oncologist
- radiotherapist
- geneticist
- radiologist
Treatment options for fibroids?
Symptomatic - tranexamic/mefanamic acid
pre-surgery - GnRH anologues
Nulliparous - myomectomy
Family complete - hysterectomy
Is the COCP CI before laparoscopic sterilisation?
No - only major surgery
Treatment of HPV warts in pregnancy?
NOT podophyllin, local techniques?
First line Ix for woman with PMB on Tamoxifen?
Hysterescopy & Biopsy - TVUS cannot differentiate potential cancer from thickening due to tamoxifen
3 things that cause polyhydramnios?
Diabetes mellitus
multiple pregnancy
Things that decrease foetal swallowing e.g. trachea-oesophageal fistula/anencephaly
Things that cause oligohydramnios?
NSAIDs
renal agenesis
Ix for tubal infertility?
Laparoscopy and dye hydrotubulation
Staging of uterine cancer?
1A <50% myometrium 1B >50% 2 - cervical stroma 3A - serosa 3B - vagina 4A - bladder/bowe; 4B - distant mets
Contraindications for forceps/ventouse?
mal-presentation i.e. breech
Absolute cephalopelvic disproportion
Definition of:
- extremely preterm?
- very preterm?
- mod-late preterm?
- term?
- post-term?
<28 28-32 32-37 37-42 >42
If woman goes into premture labour - meds for baby?
If <34 weeks delay with Nifedipine
Dexamethasone
MgSO4
Consider dexamethasone up till 36 weeks
When is OFTT done if RF?
28 weeks
Combined test?
up to 14 weeks
nuchal thickness
PAPPA
hCG
Quadruple test?
15-20 weeks
hCG
PAPP-A
AFP
E3
If sensitisation event <20 weeks?
If >20 weeks?
< 20 = anti-D
>20 weeks = anti-D + kelihauer
