Repro Misc. Flashcards
What are the two primitive genital tracts called
Mesonephric/ Wolffian
Paramesonephric/ Mullerian
Which two chemicals do fetal testes release and what does this cause
Testosterone and Mullerian Inhibiting Factor
Causes the Mullerian tract to degenerate
What is metrorrhagia
Bleeding between periods
Define Polymenorrhoea
Bleeding < 21-day interval
Define Oligomenorrhoea
Bleeding > 35-day interval
What endometrial thickness on transvaginal ultrasound is indicative of a need for biopsy
Premenopausal - >16mm
Postmenopausal - >4mm
Name a normal bacterial flora in the vagina
Lactobacillus
What do Lactobacillus produce in the vagina
produce lactic acid and hydrogen peroxide
Which organism causes vaginal thrush
Candida Albicans
How is vaginal thrush diagnosed
Swab + culture
Clue cells on microscopy indicate which disease
Bacterial vaginosis
How is vaginal thrush treated
Topical Clotrimazole
How is bacterial vaginosis treated
Oral Metronidazole
How is bacterial prostatitis diagnosed and treated
Diagnosed by first pass urine sample
Treated with ciprofloxacin for 28 days
How are chlamydia and gonorrhoea diagnosed
NAAT/ swab
How is gonorrhoea treated
IM Ceftriaxone 500mg
How is chlamydia treated
100mg Doxycycline bd 7 days
What is another name for gestational trophoblastic disease
Molar pregnancy
What is the main difference between a miscarriage and a molar pregnancy
The embryo is viable in miscarriage
The embryo is abnormal in a molar pregnancy
What is a buzzword for a partial molar pregnancy
Grape-like clusters
Which type of molar pregnancy involves 1 or 2 sperm fertilising an egg with no DNA
Complete mole
Describe the genetic material in a partial mole
1 sperm ( reduplicating DNA material) or 2 sperms fertilising an egg, resulting in triploidy
A woody hard uterus suggests which pathology
Placental abruption
What is the classical presentation of Placenta Praevia and what should you do next
Recurrent painless bleeding > 24 weeks
Ultrasound
*do not perform PV exam
What is Placenta Accreta and what is a major risk factor
The placenta invades the myometrium
previous C-section is a risk factor
How is Pearl Index calculated
[Number of accidental pregnancies x 1200] / total months of exposure
Which three forms must be filled out after an abortion and which one requires 2 doctors to sign it
HSA1, HSA2, HSA4
HSA1 requires 2 doctors
HSA2 completed within 24hours
HSA4 sent to CMO in 7 days
What is the limit for social termination of pregnancy
23weeks 6 days
What is the Tayside medical termination of pregnancy limit
18 weeks 6 days
What is the Tayside surgical termination of pregnancy limit
12 weeks
What is the lamda sign on ultrasound a buzzword for
Strongly suggests a dichorionic (each twin has its own placenta) twin pregnancy
Which sign may be seen on ultrasound to suggest a monochorionic pregnancy
T- sign
Name 2 ways in which Hypertension in pregnancy is diagnosed
> 140/ 90 on 2 ocassions
> 160/ 110 once
What are the three 1st line drugs for hypertension during pregnancy
Methyldopa
Nifedipine
Labetalol
When might methyldopa be contra-indicated
Depression
Name two drugs which are 2nd line for hypertension during pregnancy
Hydralazine
Doxazocin
What should be given to those women at risk of pre-eclampsia
75mg Aspirin from 12 weeks gestation till birth
Which system is used to grade vaginal prolapses and which structure does it use as a reference
POP-Q system
Hymen used as a reference point
How long should a baby be exclusively breastfed
6 months
How and when should mastitis be treated
If poor attachment, flucloxacillin 1g qd
Define hydrops fetalis and give an example
Accumulation of fluid in at least 2 fetal compartments
e.g ascites and pleural effusion
What are the two types of ultrasound scan and which one requires the bladder to be full
Trans-abdominal –> bladder full
Trans-vaginal
Lynchy syndrome predisposes to which 2 reproductive tumours
Ovarian mainly
also endometrial
Which tumour marker is raised in up to 80% of ovarian tumours
CA 125
Which tumour marker is tested to exclude metastases from a primary GI tumour
Carcinoembryonic antigen (CEA)
What is the vertex of the fetal skull
Area of fetal skull outlined by anterior & posterior fontanelles & parietal eminences
What are the two layers of the endometrium
Stratum Functionalis
Stratum Basalis
Which pathology is being described by “sub-epithelial lymphoid follicles present in the cervix”
Follicular Cervicitis
How does follicular cervicitis typically present and what are the consequences of this
Usually asymptomatic
Can lead to infertility due to silent fallopian tube damage
What do
sudden unilateral pelvic pain + free fluid in pelvic cavity suggest
Ruptured ovarian cyst
What are the guidelines with regards to breech position of a fetus
If breech before 36 weeks –> watch and wait
Offer External Cephalic Version if breech at 36 weeks
What is a mnemonic for the fetal cardinal movements
Don't --> Descent and engagement Forget --> Flexion I --> Internal rotation Enjoy --> Extension Really --> Restitution Expensive --> External Rotation Equipment --> Expulsion
What are Mefenamic acid and Tranexamic acid and which condition can they be given for
Mefenamic acid - NSAID
Tranexamic acid - Anti-fibrinolytic
Given for Menorrhagia
What drugs are used for rapid tranquillisation
if a history of cardiac disease/ no previous typical anti-psychotics –> Lorazepam 1-2mg
If significant typical antipsychotic use –> Lorazepam ± Haloperidol
What 3 things are included in the diagnostic criteria for Hyperemesis Gravidarum
5% pre-pregnancy weight loss
Dehydration
Electrolyte imbalance
What is the best measure of ovulation and when should this be measured
Progesterone level
Should be measured 7 days post ovulation (day 21 in a 28-day cycle)
Which ovarian tumour can be associated with atypical endometrial hyperplasia
Granulosa Cell tumours
they can secrete estrogen
After which week gestation would you suspect gestational related hypertension rather than pre-existing hypertension
20 weeks
What differentiates gestational hypertension from pre-eclampsia
No proteinuria
How does Tamoxifen act in the body
Anti-estrogen in breast tissue
Pro-estrogen in uterus
With regards to surgery, when should the COCP be stopped and restarted
Stopped 4 weeks prior
Can be restarted 2 weeks after
Which contraceptive method is associated with a delay in return to normal fertility
Progesterone injection
up to 1-year delay
What is the definitive management for placenta accreta
Hysterectomy with placenta left in situ
What is the medical management of a missed miscarriage
Vaginal misoprostol
Which drugs can be given to shrink fibroid size before surgery
GnRH agonists e.g leuprolide
Which 3 contraceptive methods are unaffected by enzyme inducing drugs e.g. carbamazepine
IUS
IUD
Progesterone only pill
How can you test for premature ovarian failure
FSH levels
high in menopausal patients
What is adenomyosis and how is it diagnosed
Endometrial tissue in the myometrium
Diagnosed via MRI
What are 2 management options for adenomyosis
GnRH agonists
Hysterectomy
What is the Rokitansky protuberance
The inner lining of a mature cystic teratoma
Which three things can cause increased nuchal translucency
Down’s syndrome
Congenital heart defects
Congenital abdominal wall defects
Which two conditions should you suspect with cervical excitation
Pelvic Inflammatory Disease
Ectopic Pregnancy
When does the IUD become effective as contraception if it isn’t started on the 1st day of a period
instantly as it is non-hormonal
When does the progesterone only pill become effective as contraception if it isn’t started on the 1st day of a period
in 2 days time
When do the IUS and COCP become effective as contraception if it isn’t started on the 1st day of a period
in 7 days time
With regards to Down Syndrome screening, when are Nuchal translucency, BHcG and PAPP-A checked
10-14 weeks
combined test
What is the quadruple test
AFP, Unconjugated Estriol lowered
BHcG, Inhibin A raised
14-20 weeks, to screen for Down’s syndrome
When would you be required to give a double dose of the levonorgestrel emergency contraceptive
If BMI >26 or if weight >70kg §
What is the mnemonic used for CTG reading
DR C BraVADO
Name 4 maternal illnesses which would render a pregnancy as high risk
Epilepsy
Gestational diabetes
Asthma
Hypertension
What is a normal duration and frequency of uterine contractions
10-45 seconds
3-4 per 10minutes
How is the baseline fetal heart rate measured on CTG
The average heart rate of the fetus over a 10min window
What is a normal fetal heart rate
110-160bpm
Name 4 causes of fetal tachycardia
Fetal/Maternal Anaemia
Hypoxia
Chorioamnionitis
Hyperthyroidism
Define fetal bradycardia on a CTG
HR <110 for 3 or more mins
Name 4 causes of fetal bradycardia
Cord prolapse
Cord compression
Maternal seizure
Rapid fetal descent
What does variability refer to with regards to a CTG
Refers to the variation of the fetal HR from one beat to the next
How is variability calculated with regards to a CTG
Observing how much the peaks and troughs deviate from the baseline rate
What are reassuring, non-reassuring and abnormal values for variability on a CTG
Reassuring 5-25bpm
Non-reassuring <5bpm for 30mins OR >25bpm for 15mins
Abnormal -
<5 for 50mins OR >25 for 25mins OR sinusoidal
What does sinusoidal variability on CTG indicate
Severe hypoxia/haemorrhage/anaemia
What are some causes of decreased CTG variability
Fetus sleeping
Fetal hypoxia –> acidosis
Define accelerations on a CTG
An abrupt increase in the fetal baseline rate of >15bpm for >15 seconds
What does the presence of accelerations on a CTG indicate
A healthy fetus –> reassuring sign
Define decelerations on a CTG
An abrupt decrease in the fetal baseline rate of >15bpm for >15 seconds
What are the 3 types of decelerations seen on CTG and what do each of them indicate
Early –> physiological due to increased ICP and increased vagal tone
Variable –> often indicate oligohydramnios
Late –> Begin at peak of the contraction and recover after it has ended –> indicates hypoxia + acidosis
