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Ned's PassMed notes 2019/20 > Repro - week 1 and 2 > Flashcards

Repro - week 1 and 2 Flashcards

1
Q

what is OHSS

A

over enlarged ovaries - excess follicles

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2
Q

what are some signs of OHSS

A

central fluid accumulation:

ascites, pleural effusion, pericardial effusion
due to the membranes becoming leaky

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3
Q

treatment of OHSS if it occurs before egg transfer

A

coasting
elective egg freeze
single embryo transfer

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4
Q

what is coasting in IVF

A

withdraw the HCG and gonadotrophin treatments to let estradiol levels settle down and settle OHSS

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5
Q

treatment of OHSS if it occurs after egg transfer

A 
monitor:
bloods and scans 
antithrombotic: fluids, compression stockings, fragmin 
analgesia 
drain excess fluid
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6
Q

what produces progesterone in the menstrual cycle

A

corpus luteum

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7
Q

how many days post ovulation does luteolysis occur

A

day 14

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8
Q

what is polymenorrhagia

A

increased bleeding and frequent cycle

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9
Q

what is metorrhagia

A

regular intermenstrual bleeding

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10
Q

why does ovulatory dysfunctional uterine bleeding occur

A

not enough progesterone being produced by the corpus luteum

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11
Q

what steroid is mainly used to treat endometriosis

A

danazol

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12
Q

1st line treatment for menorrhagia

A

mirena IUS

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13
Q

where is hCG secreted from and what is its role

A

secreted from the syncytiotrophoblast into the maternal bloodstream

it acts to maintain progesterone production by the corpus luteum
(ie - prevent disintegration of corpus luteum)

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14
Q

describe how hCG multiply over 48hours

A

hCG levels double approx every 48hrs

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15
Q

describe the differences in pain between placental abruption and placenta praaevia

A

painful vaginal bleeding in placental abruption

painless vaginal bleeding in placenta praevia

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16
Q

what is a particular risk for women with PCOS who are undergoing IVF

A

OHSS

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17
Q

which cancers does the COCP increase your risk of

A

breast and cervical

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18
Q

which cancers does the COCP reduce your rusk of

A

ovarian and endometrial

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19
Q

what is HELLP syndrome

A

a severe form of pre eclampsia

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20
Q

what are the features of HELLP syndrome

A

Haemolysis
Elevated Liver enzymes
Low Platelets

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21
Q

what antibiotic should be used as group B streptococcus prophylaxis

A

benzylpenicillin

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22
Q

most common site for an ectopic pregnancy

A

ampulla of Fallopian tube

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23
Q

how do you diagnose bacterial vaginosis

A

clinical diagnosis
vaginal pH >4.5
high vaginal swab for microscopy

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24
Q

what is seen in microscopy for bacterial vaginosis

A

clue cells

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25
Q

what is the treatment for bacterial vaginosis/trichomonas vaginalis

A

PO metronidazole

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26
Q

what chromosome is the sex determining region on

A

the Y chromosome

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27
Q

how is androgen insensitivity disorder inherited

A

X linked recessive

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28
Q

what is the karyotype of androgen insensitivity disorder

A

46XY

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29
Q

where does testosterone production occur

A

the leydig cells

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30
Q

which hormone stimulates testosterone production

A

LH

LH –> leydig cells –> testosterone

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31
Q

which 4 organisms are part of the normal vaginal flora

A

lactobacillus
group B beta- haemolytic strep
candidia
strep viridians

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32
Q

treatment of candidia infection

A

topical clotrimazole pessary
or
PO fluconazole

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33
Q

what is released from the Sertoli cells and why

A

inhibin and activin hormones

regulates the FSH secretion (by -ive feedback) and controls spermatogenesis

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34
Q

what hormones stimulate spermatogenesis

A

testosterone and FSH

35
Q

describe the endocrine features of non-obstructive male infertility

A

HIGH LH, FSH

LOW testosterone

36
Q

what organisms cause bacterial vaginosis

A

gardnerella vaginalis
mobiluncus
anaerobes

37
Q

what is the karyotype of a partial mole

A

69 XXX or 69 XXY or 69 XYY

38
Q

why are patients with kallmann’s syndrome infertile

A

they don’t have any gonadotropin releasing hormone so cannot produce LH or FSH

39
Q

what hormone is the growth of leiomyomas (uterine fibroids) dependant on

A

oestrogen

40
Q

what is the karyotype for klienfelters

A

XXY

41
Q

what is the treatment for acute bacterial prostatitis

A

ciprafloxicin 28 days

42
Q

what are the 3 serological groupings of chlamydia and what infection does this correspond to

A 
A-C = trachomonas 
D-K = genital infection 
L1-L3 = lymphogranuloma venereum
43
Q

what is the treatment of N.Gonorrhoea

A

IM ceftriazone and

PO azithromycin

44
Q

how do you diagnose syphilis

A

PCR of primary chancre
serology for antibodies (blood test)
IgM and IgG ELISA

45
Q

what non-specific serological tests are used to tell you about the response to therapy in syphilis

A

VDRL

RPR

46
Q

what specific antibodies are used to test for syphilis and why can’t they be used to test for response to therapy

A

TPPA
TPHA

they remain positive for life so cannot be used to measure response to therapy

47
Q

what is the treatment of syphilis

A

IM long acting pencillin

48
Q

how do you diagnose genital herpes

A

PCR of de-roofed blister

49
Q

what is the treatment of pubic lice

A

malathion lotion

50
Q

what is the medical management of an ectopic pregnancy

A

methotrexate IM or PO

51
Q

at what endometrial thickness in postmenopausal women is an indication for biopsy

A

> 4mm (normally it should be 1mm)

52
Q

what are the 3 phases of the ovarian cycle and the 3 phases of the uterine cycle that occur simultaneously

A

ovarian:

  1. follicular phase
  2. ovulation
  3. luteal phase

uterine:

  1. menstrual phase
  2. proliferative phase
  3. secretory phase
53
Q

what is the griffin follicle

A

the dominant follicle

54
Q

at what endometrial thickness in premenopausal women is an indication for biopsy

A

> 16mm

55
Q

what effect does the oestrogen secreted by the granulosa cell have on FSH levels and what does this cause

A

rising oestrogen levels -ivley feedback on FSH and reduce its secretion

results in atresia of follicles other than the dominant follicle

56
Q

what stimulates the differentiation of external male genitalia

A

dihydrotestosterone

57
Q

which cells are responsible for spermatogenesis

A

sertoli cells (driven by FSH)

58
Q

what is secreted by Sertoli cells and what is their purpose

A

inhibin and activin

feedback on FSH

59
Q

what gram stain is lactobacillus

A

gram +ive bacilli

60
Q

compare the 2 forms that chlamydia takes during its cycle

A

enters cell as an elementary body which is infectious

turns into a reticular body which isn’t infectious but allows it to replicate by binary fission

then transforms back into an elementary body and bursts, releasing the infected cells

61
Q

what is the screening test done for syphilis

A

IgG and IgM ELISA

62
Q

what are the 3 forms of emergency contraception

A

levonelle (3 days after UPSI)
ellaone (5 days after UPSI)
copper IUD (5 days after UPSI conception)

63
Q

what are the 4 main risks of the progesterone depot

A

weight gain
delay in return of fertility
osteoporosis
irregular bleeding

64
Q

Why should you avoid starting hormonal contraception for 5 days after ellaOne contraception

A

interferes with ulipristal acetate

65
Q

what is a UKMEC 4 contraindication to the POP

A

current breast cancer

66
Q

if you have the BRACA gene, CHC is what category of UKMEC

A

category 3

67
Q

what contraception options are there for patients on liver enzyme inducers such as anti-epileptics

A

IUS
IUD
progesterone depot

68
Q

how is pneumocystis pneumonia diagnosed

A

bronchoalveolar lavage and immunofluorescence

69
Q

treatment of pneumocystis pneumonia

A

high dose co-trimoxazole +/- steroid

70
Q

for patients with a CD4 <200, what prophylaxis for pneumocystis pneumonia do we offer

A

low dose co-trimoxazole

71
Q

what is the incubation period of primary syphilis

A

up to 90 days

72
Q

what is the incubation period of secondary syphilis

A

up to 6 months

73
Q

when in the course of acquired syphilis does it become non-infectious

A

late latent phase

74
Q

what disease in the eyes does CMV cause

A

retinitis

75
Q

why do patients with CD4<50 all get ophthalmic screening

A

to look for CMV retinitis

76
Q

what is the treatment for HPV

A

podophyllotoxin
imiquimod
cryotherapy

77
Q

what can toxoplasma gondii cause in the brain

A

multiple cerebral abscesses

78
Q

what does JC virus cause in HIV patients with CD4 counts <100

A

progressive multifocal leukencephalopathy

79
Q

what organism causes kaposi’s sarcoma

A

human herpes virus 8

80
Q

what organism causes non-hodgkins lymphoma

A

EBV

81
Q

how do you test for HIV

A

p24 test - combined antigen and antibody serology

82
Q

what should be used as VTE prophylaxis during pregnancy

A

LMWH

Given at delivery and for 7 days post partum

83
Q

how do you treat suspected VTE in early pregnancy

A

LMWH - AVOID WARFARIN IN EARLY PREGNANCY

84
Q

how do you treat suspected VTE in late pregnancy

A

LMWH - AVOID WARFARIN IN LATE PREGNANCY

risk of haemorrhage during delivery

Ned's PassMed notes 2019/20 (17 decks)

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