Reproduction Flashcards
1
Q
Where is gonadotrophin-releasing hormone (GnRH) released?
A
Hypothalamus
2
Q
GnRH travels where?
A
Anterior Pituitary
3
Q
anterior pituitary receives GnRH, it responds by releasing 2 hormones, which 2?
A
luteinising hormone (LH)
follicle-stimulating hormone (FSH).
4
Q
In the ovaries, LH and FSH stimulate the growth and development of small sacs called xxx. Inside these xxx, yyy can develop and mature.
What is xxx and yyy
A
In the ovaries, LH and FSH stimulate the growth and development of small sacs called follicles. Inside these follicles, eggs can develop and mature
5
Q
As the follicles grow, the special cells around them (called XXX and YYY cells) start to produce a hormone called ZZZ.
A
As the follicles grow, the special cells around them (called theca and granulosa cells) start to produce a hormone called oestrogen.
6
Q
Ashermanβs Syndrome (3)
A
Intrauterine adhesions
Secondary amenorrhea (> 3 months)
Infertility
7
Q
Intraductal Papilloma (3)
A
Bloody discharge
Single duct
Benign tumor
8
Q
Prolactinoma (3)
A
Galactorrhea
Amenorrhea
Pituitary adenoma
9
Q
Sheehanβs Syndrome (3)
A
Postpartum hemorrhage
Hypopituitarism
Failure to lactate (risperidone)
10
Q
Broad Ligament (3) buzzwords
A
uterus
fallopian tubes
and ovaries
11
Q
Round Ligament (2)
A
Uterine fundus
labia majora
12
Q
Cardinal ligament (2)
A
Cervix
uterine vessels
13
Q
Suspensory Ligament of the Ovary (2)
A
Ovarian vessels
lateral pelvic wall
14
Q
Ovarian Ligament (2)
A
Ovaries
uterus
15
Q
Uterosacral Ligament (2)
A
Cervix
sacrum
Provides posterior support; think of pelvic pain or prolapse.
16
Q
Pre-eclampsia (3)
A
A pregnancy complication characterized by new-onset hypertension and proteinuria after 20 weeks gestation, potentially leading to organ damage.
Hypertension, proteinuria, end-organ damage.
17
Q
Urge Urinary Incontinence (Overactive Bladder - OAB)
1st and 2nd Line Tx
A
1st Line: Bladder training for at least 6 weeks.
2nd Line : Anticholinergics (e.g., oxybutynin, tolterodine, solifenacin)
OR
Ξ²3-agonists (mirabegron) if anticholinergics are not suitable.
18
Q
Stress Urinary Incontinence (SUI)
1st and 2nd Line Tx
A
1st Line: Pelvic floor muscle training (PFMT) for at least 3 months.
2nd Line: Surgery (if refused , Duloxetine)
19
Q
Bartholinβs Cyst/Abscess
Who gets it, what is it?
Tx?
A
Young woman
painful fluctuant lump near vaginal opening
Word Catheter
20
Q
Vulval Cancer
A
Older woman
persistent itchy, non-healing lesion with irregular edges
21
Q
Mastitis breast (3)
A
Lactational (most common in breastfeeding women)
Staph aureus
Erythema + warmth (classic signs of inflammation)
22
Q
Intraductal Papilloma breast (3)
A
Bloody nipple discharge (key feature)
Solitary mass (usually central, near the nipple)
Benign (but slight malignancy risk)
23
Q
Fat Necrosis breast (3)
A
Trauma (history of injury or surgery)
Calcifications (can mimic malignancy on mammogram)
Foamy macrophages (histology finding)
24
Q
Breast Cyst (3)
A
Fluctuant (fluid-filled, compressible)
Pre-menopausal (common in women 30-50)
Aspirate β straw-colored fluid (diagnostic and therapeutic)
25
Breast Fibroadenoma (3)
Mobile (classically breast mouse)
Rubbery (firm but smooth)
Hormone-sensitive (may grow in pregnancy)
26
Gold-standard Tx for HER2-positive breast cancer
Trastuzumab
27
Tx ER+ (Pre-menopausal)
Tamoxifen (Selective Estrogen Receptor Modulator - SERM)
28
Risk of what when on Tamoxifen (2)
endometrial cancer
VTE (DVT/PE)
29
Tx Triple-negative breast cancer (TNBC) that is PD-L1 positive
Pembrolizumab / Chemo / Immunotherapy
30
ER+ (Post-menopausal)
Anastrozole (or Letrozole, Exemestane)
31
Invasive Ductal Carcinoma (IDC)
Buzzwords (3)
β Most common (80% of invasive breast cancers)
β Irregular mass (firm, fixed, spiculated on imaging)
β Lymphatic/axillary spread
31
1st Line BC Dx for women <40 years (denser breast tissue)
Ultrasound
32
1st Line BC Dx for women >40 years
Mammogram
33
1st Line BC Dx High-risk screening (e.g., BRCA carriers, strong family history)
MRI
34
Mammary-duct ectasia (1)
thick, sticky green or yellow nipple discharge with nipple inversion.
34
Radial scar on mamogram (1)
star or rosette-shaped lesion with a translucent centre
35
monitor bone mineral density on which drug?
anastrozole
36
Acute Fatty Liver of Pregnancy
hepatic dysfunction
hypoglycemia
coagulopathy ( β PT time)
37
HELLP Syndrome
hemolysis
elevated liver enzymes
low platelets.
38
UTI Treatment in Pregnancy 1st/2nd Line
- 1st line - Nitrofurantoin - 1st and 2nd trimester
- 2nd line - Amoxicillin or cefalexin - 3rd trimester
39
Dating Scan
Always 11+2 to 14+1 weeks
40
Anomaly Scan
Always 18β20+6 weeks
41
Rh-negative women
Think Anti-D at 28 and 34 weeks
42
Gestational Diabetes
Test between 24β28 weeks
43
Naegeleβs Rule =
EDD = LMP + 7 days β 3 months + 12 months
44
CIs to breastfeeding -
LAMBAST
LAMBAST
- L - Lithium
- A - Amiodarone
- M - Methotrexate
- B - Benzodiazepines
- A - Aspirin
- S - Sulfonamides
- T - Tetracyclines
45
VZV in Pregnancy Tx =
VZV in Pregnancy = Acyclovir
46
Rubella (3)
π§
Cataracts
PDA, Deafness
Blueberry muffin rash
47
CMV (3)
π§ Hearing loss, periventricular calcifications
48
Toxoplasmosis (3)
π§ Chorioretinitis, hydrocephalus, intracranial calcifications
49
Syphilis (3)
π§ Hutchinsonβs teeth, saddle nose, saber shins
50
Medical Management for Ectopic Pregnancy
IM Methotrexate
51
Surgical Management for Unruptured Ectopic Pregnancy (Fertility Preservation)
Salpingotomy (Conservative Surgery)
preserves a Fallopian tube
52
Surgical Management for Ectopic Pregnancy, definitive
Salpingectomy
53
π‘ Mnemonic for Ectopic Pregnancy Management
M.E.L.T
"M.E.L.T" β Methotrexate for Early, Laparotomy for Trouble
M: Methotrexate β 1st line for stable, small ectopics.
E: Expectant β For small, self-resolving ectopics with falling Ξ²-hCG.
L: Laparotomy (Salpingectomy) β Emergency for rupture.
T: Tubotomy (Salpingotomy) β Conservative surgery to preserve fertility.
54
Mnemonic: "HIT by an APE is Down's
β¬οΈ Markers Increased (UP) β Think "HIT"
π’ H β hCG (Human Chorionic Gonadotropin) πΌ High
π’ I β Inhibin A πΌ High
π’ T β Thickened Nuchal Translucency πΌ Increased
π Markers Decreased (DOWN) β Think "APE"
π΄ A β AFP (Alpha-Fetoprotein) π½ Low
π΄ P β PAPP-A (Pregnancy-Associated Plasma Protein A) π½ Low
π΄ E β Estriol (Unconjugated Estriol, uE3) π½ Low
π§ͺ Screening Tests:
π©Έ First Trimester (Combined Test):
β
β hCG, β PAPP-A, β Nuchal translucency
π©Έ Second Trimester (Quad Test):
β
β hCG, β Inhibin A, β AFP, β Estriol
55
Vaginal Candidiasis (Thrush)
1st line Tx pregnancy and nulligravida
Pregnancy: Clotrimazole pessary (7 days) (Avoid oral antifungals due to potential teratogenicity)
Non-pregnant (Uncomplicated): Oral fluconazole 150 mg single dose
Recurrent (>4 episodes/year): Fluconazole 150 mg every 72h (3 doses), then weekly for 6 months
56
Bacterial Vaginosis (BV)
1st line Tx
Oral metronidazole or intravaginal clindamycin
57
Trichomoniasis
1st line Tx
Frothy, yellow-green, foul-smelling discharge
First-line Treatment: Oral metronidazole (treat partner too)
58
Gonorrhoea
Symptoms: Purulent discharge, dysuria, lower abdominal pain
1st Line Tx
1st Line Tx: IM ceftriaxone (and treat for chlamydia with doxycycline)
Screening: NAAT (Nucleic acid amplification test)
59
gestational diabetes should be offered what and when?
oral glucose tolerance at 24-28 weeks
60
Gestational Diabetes, when does Tx start?
What is the rule?
5.6 mmol/L fasting (Diagnosis)
7.8 mmol/L at 2 hrs (OGTT) (Diagnosis)
7.0 mmol/L fasting (Insulin Start)
61
First Stage of Labour
Latent Phase: 0βX cm dilation (slow)
Active Phase: XβY cm dilation (fast)
What is X and Y
Latent Phase: 0β4 cm dilation (slow)
Active Phase: 4β10 cm dilation (fast)
62
π‘ First Stage of Labour
Slow progress: β X or Y
No progress >2 hrs (active): Primary arrest β what management?
Slow progress: β Oxytocin or amniotomy
No progress >2 hrs (active): Primary arrest β C-section
63
π Second Stage of Labour (Full dilation β Baby out)
Primigravida limit: 2 hrs (3 hrs with epidural)
Multiparous limit: 1 hr (2 hrs with epidural)
Prolonged second stage: β Instrumental delivery (forceps/ventouse)
Emergency: Shoulder dystocia β McRoberts maneuver, suprapubic pressure
Primigravida limit: 2 hrs (3 hrs with epidural)
Multiparous limit: 1 hr (2 hrs with epidural)
Prolonged second stage: β
Instrumental delivery
(forceps/ventouse)
Emergency: Shoulder dystocia β
McRoberts maneuver, suprapubic pressure
64
π’ Third Stage of Labour (Baby out β Placenta out)
Max time: 30 minutes
Active management (MLA gold standard): Oxytocin + controlled cord traction
PPH (β₯500 mL blood loss): Top cause = Uterine atony β Oxytocin, massage
Placenta not delivered in 30 minutes:
Retained placenta β Manual removal
π’ Third Stage of Labour (Baby out β Placenta out)
Max time: 30 minutes
Active management (MLA gold standard): Oxytocin + controlled cord traction
PPH (β₯500 mL blood loss): Top cause = Uterine atony β Oxytocin, massage
Placenta not delivered in 30 minutes:
Retained placenta β Manual removal
65
π£ Fourth Stage of Labour (First 1β2 hours post-placenta)
Monitor every 15 minutes: Bleeding, BP, HR, uterine tone
Most common complication: PPH (4 Tβs):
Tone: Uterine atony (commonest)
Trauma: Tears, rupture
Tissue: Retained placenta
Thrombin: Clotting issues (e.g., DIC)
π£ Fourth Stage of Labour (First 1β2 hours post-placenta)
Monitor every 15 minutes: Bleeding, BP, HR, uterine tone
Most common complication: PPH (4 Tβs):
Tone: Uterine atony (commonest)
Trauma: Tears, rupture
Tissue: Retained placenta
Thrombin: Clotting issues (e.g., DIC)
66
Memory Hacks 4 stages of Labour:
First stage: β4 to floorβ β Active at 4 cm
Second stage: β2 hours too longβ β Prolonged if >2 hrs
Third stage: β30 or outβ β Retained placenta if >30 minutes
PPH Causes: β4 Tβsβ (Tone, Trauma, Tissue, Thrombin)
Memory Hacks 4 stages of Labour:
First stage: β4 to floorβ β Active at 4 cm
Second stage: β2 hours too longβ β Prolonged if >2 hrs
Third stage: β30 or outβ β Retained placenta if >30 minutes
PPH Causes: β4 Tβsβ (Tone, Trauma, Tissue, Thrombin)
67
Early-Onset Neonatal Sepsis (EONS)
First-Line Treatment: β
IV Benzylpenicillin + Gentamicin
68
π§ Late-Onset Neonatal Sepsis (>72 hours)
First-Line Treatment: β
IV Cefotaxime + Vancomycin (to cover hospital-acquired pathogens).
69
Mnemonic for Early-Onset Sepsis Management
Baby Sick? Use B-G (Benzylpenicillin + Gentamicin
69
Pathological Jaundice (2)
Appears within 24 hours, causes include haemolysis or TORCH infections.
70
Physiological Jaundice (2)
Physiological: Appears after 24 hours, peaks 2β5 days, resolves by 2 weeks.
71
Key Causes of Neonatal Jaundice (2)
Haemolysis: Rhesus HDN, ABO incompatibility, G6PD deficiency, hereditary spherocytosis.
Non-Haemolytic: Breastmilk jaundice, physiological jaundice, infection.
72
G6PD Deficiency Key Points
73
Early-onset neonatal sepsis is bacteria is
Group B Streptococcus (GBS)
73
Symphysis-Fundal Height (SFH) normal range
Normal range = Gestational Age Β± 2 cm
74
Normal vs. Abnormal SFH
at 32 weeks
At 32 weeks, Normal SFH = 30β34 cm
β οΈ Too Small (<30 cm) β Possible Fetal Growth Restriction (FGR)
β οΈ Too Large (>34 cm) β Possible Macrosomia / Polyhydramnios / Twins
75
What to Do If SFH is Abnormal?
Do an Ultrasound Scan (USS) to check fetal growth
β
76
Molar Pregnancy 2 buzzwords
Snowstorm appearance
Suction curettage (1st-line treatment)
77
Oligohydramnios β Low Amniotic Fluid
Definition: AFI <5cm or DVP <2cm
π Causes: PROM, IUGR, fetal renal issues (Potterβs)
β οΈ Risks:
β
Umbilical cord prolapse & compression
β
Fetal lung hypoplasia (if <22 weeks)
β
Growth restriction
78
Flashcard 2: Polyhydramnios β Too Much Amniotic Fluid
Definition: AFI >25cm
π Causes: Maternal diabetes, fetal anomalies (anencephaly, TEF), twin pregnancy
β οΈ Risks:
β
Maternal respiratory compromise
β
Preterm labour
β
Macrosomia & malpresentation
78
neonatal herpes (HSV) (3)
vesicular lesions (eyes)
mouth
scalp
79
Group B Streptococcus (3)
πΉ Sepsis, Pneumonia, Meningitis in newborn
πΉ Screening at 35-37 weeks β IV benzylpenicillin in labour if positive
πΉ Early onset (<24h) vs. Late onset (>7 days, often meningitis)
80
Varicella Zoster Virus (VZV) β Congenital Varicella Syndrome
πΉ Limb hypoplasia, skin scarring
πΉ CNS defects (Microcephaly, Seizures)
πΉ High risk if mother infected in 1st or early 2nd trimeste
81
Perineal Tear Classification
MLA High-Yield
π 1st-Degree Tear (Mildest)
π 1st-Degree Tear (Mildest)
Involves: Skin & vaginal mucosa only
No muscle involvement
Minimal or no suturing needed
82
Perineal Tear Classification
π 2nd-Degree Tear (Most Common)
HIGH YIELD
Involves:
Vaginal mucosa + Perineal
muscles Does NOT involve anal sphincter
Requires suturing (Midwife)
83
Perineal Tear Classification
π 3rd-Degree Tear (Severe)
Involves: Perineal muscles + Anal sphincter **(not rectum OR the anal mucosa)
**
Subtypes:
3a = <50% external anal sphincter torn
3b = >50% external anal sphincter torn
3c = Both external & internal anal sphincter torn
Needs surgical repair in theatre (experienced obstetrician)
84
Perineal Tear Classification
π 4th-Degree Tear (Most Severe)
Involves: Full-thickness tear through (anal mucosa and rectal mucosa)
High risk of fecal incontinence & infection
Requires surgical repair + antibiotics + stool softeners
85
Diet-controlled GDM =
Induce by 40+6 weeks
86
GDM on insulin/metformin =
Induce by 37-39 weeks
87
GDM
C-section considered if fetal weight > x
What is x
4.5kg (risk of shoulder dystocia)
88
GDM
Early delivery (
Early delivery (<37 weeks) only if complications arise
89
1st Line emergency Tx Contraception
for heavy periods
Levonorgestrel
72 hours after sex
90
1st Line emergency Tx Contraception
General
Copper intrauterine device (IUD)
5 days after sex
91
Ovarian torsion 1st Line Tx
Definitive Tx?
Doppler
Definitive Diagnostic laparoscopy
92
Big bonus progesterone-only implant?
Lighter periods
93
1st Line Ix PCOS
Transvaginal ultrasound scan
94
1st Line contraception for breastfeeding woman <6 weeks postpartum?
β
Progesterone-Only Pill (POP)
95
When is the Lactational Amenorrhoea Method (LAM) an effective form of contraception?
β Fully breastfeeding (no formula)
β <6 months postpartum
β Amenorrhoeic (no periods yet)
π¨ Not effective if menstruation has returned!
96
When to Insert an IUD Postpartum
How soon after delivery can an IUD be inserted?
β Immediately (<48 hrs postpartum) β
β After 4 weeks postpartum β Best time if not inserted immediately.
β Avoid insertion between 48 hours - 4 weeks (highest risk of expulsion/perforation).
97
HRT After Hysterectomy
β No progestogen needed in HRT if the patient has had a hysterectomy (no risk of endometrial hyperplasia).
98
Postmenopausal HRT Regimen
β In postmenopausal women, use continuous oestrogen-only therapy (if no uterus) or continuous combined oestrogen + progestogen (if uterus present).
99
HRT and VTE Risk
β Transdermal oestrogen (patch/gel) is preferred over oral HRT as it avoids first-pass metabolism and has a lower risk of venous thromboembolism (VTE).
100
Low Libido and HRT
β Low libido in postmenopausal women? Consider adding testosterone (e.g., Testogel) if oestrogen alone is insufficient.
101
pelvic inflammatory disease Tx
stat IM ceftriaxone
+
14 days of oral doxycycline + oral metronidazole
102
gram-negative diplococci on vaginal specimen / PID
Which disease?
β
Gonorrhoea
103
Hyperprolactinemia Tx
Dopamine agonist eg Bromocriptine
104
Dysmenorrhoea Tx
Mefenamic acid/ Ibuprofen
105
No uterus (post-hysterectomy) HRT Tx
Oestrogen-only HRT
106
Perimenopausal (still having some periods) HRT Tx
Cyclical combined HRT
107
Postmenopausal (β₯1 year since last period) HRT Tx
Continuous combined HRT
108
Menopause Doesn't want hormones / has contraindications Tx
SSRIs or non-hormonal therapy
109
Painless ulcer (chancre)
primary syphilis
110
Copper palmar-plantar rash + flu-like illness β
secondary syphilis.
111
Prostitutes pupil" (accommodates, doesnβt react) β
Think neurosyphilis
112
syphilis, 1st line Tx
syphilis
113
What is the main cause of genital warts?
HPV types 6 and 11
114
What are the characteristic features of genital warts (4)
White
Rough
Raised
NOT painful
115
What are the treatment options for genital warts?
Cryotherapy (freezing warts off)
Podophyllotoxin cream (topical treatment)
Imiquimod cream (immune response modifier)
116
What virus causes most cases of genital herpes?
Herpes Simplex Virus type 2 (HSV-2)
117
What are the key clinical features of genital herpes (2)
Painful blisters/ulcers (most important!)
Dysuria
118
How is genital herpes diagnosed?
Swab vesicles β PCR (most sensitive test)
119
What is the first-line treatment for genital herpes?
Oral aciclovir + topical 5% lidocaine for pain relief
120
What is the first-line treatment for genital herpes?
Oral aciclovir + topical 5% lidocaine for pain relief
121
Is genital herpes painful?
Yes, painful (unlike genital warts, which are painless)
122
What is the difference between HSV-1 and HSV-2 in genital herpes?
HSV-2: More common in genital infections
HSV-1: Usually causes oral herpes but can also cause genital herpes
123
How do you manage recurrent genital herpes?
Suppressive therapy with aciclovir in frequent recurrences
124
Bishop Score Mnemonic
Pregnancy Can Enlarge Dainty Stomachs
P β Pregnancy
Position of the Cervix
Moves from posterior (unfavourable) β anterior (favourable) as labour approaches.
C β Can
Consistency of the Cervix
Can be firm (tip of nose), medium, or soft (lips). A soft cervix is favourable for labour.
E β Enlarge
Effacement (%)
Cervical thinning (0-100%). A fully effaced cervix (100%) is very favourable.
D β Dainty
Dilation (cm)
The cervix opens from 0 cm (closed) to 10 cm (fully dilated). More dilation = higher chance of successful labour.
S β Stomachs
Foetal Station
Position of the baby's head relative to the ischial spines (-3 to +3). A lower head (+ station) is more favourable.
125
Placental Abruption (3)
Painful vaginal dark red bleeding
Uterine tenderness
Rigid uterus.
126
Placenta Praevia (2)
Painless vaginal bright red bleeding
Soft uterus.
127
Uterine Rupture (3)
Severe pain
maternal instability
previous uterine surgery
128
3 types of Placenta Accreta Spectrum (PAS) Classification
Placenta Accreta - Placenta attaches to the myometrium.
Placenta Increta - Placenta invades into the myometrium.
Placenta Percreta - Placenta penetrates through the uterine wall and may invade nearby organs.
129
Biggest risk factors for Placenta Accreta (2)
Previous C-section
Placenta Praevia
130
How does Placenta Accreta typically present? (1)
Brisk postpartum haemorrhage after delivery
131
Definitive Tx for Placenta Accreta?
Planned Caesarean Hysterectomy
132
Antenatal 1st line Dx of Placenta Accreta?
USS
133
When is routine anti-D immunoglobulin given during pregnancy?
β
At 28 weeks gestation (routine prophylaxis for Rh-negative mothers carrying Rh-positive babies).
β
Within 72 hours postpartum (only if baby is Rh-positive) to prevent maternal sensitization.
133
Vasa praevia , what is it?
Vasa praevia is a condition where fetal blood vessels run unprotected near the cervix
134
What is Vasa praevia with velamentous cord insertion?
Where the umbilical cord inserts into the membranes instead of directly into the placenta.
134
Medication that can cause Ebstein's anomaly if used during pregnancy?
Lithium
135
recurrent early miscarriages + anti-phospholipid syndrome,
Tx
Aspirin (75mg daily)
+
LMWH (e.g., Enoxaparin) throughout pregnancy
136
The Naegleβs Rule is used to estimate the due date
EDD = First day of Last Menstrual Period (LMP) + 9 months + 7 days
136
Pregnant woman has baby, she has unfavourable Rh factor- what colour is baby?
Yellow
137
forceps delivery without epidural, which nerve is go to analgesia to block?
pudendal nerve (S2-S4)
138
Ergometrine CI
β Hypertension (HTN, Pre-eclampsia, Eclampsia)
β
Alternative: Oxytocin is 1st-line for postpartum hemorrhage (PPH).
Mnemonic:
Ergot = Elevates BP π (Avoid in HTN!)
139
