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Reproduction Flashcards

1
Q

What are the high risk malignant breast features that warrant an urgent hospital referral?

A

changes of contour
suspicious lump
blood stained nipple discharge

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2
Q

Basic structure of the breast?

A

15-25 lobes each containing tubuloacinar glands that each drain into their own lactiferous duct through lactiferous sinus and out the nipple
surrounded by fibrocoleginous and adipose tissue

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3
Q

main changes in the breast during pregnancy and stimulating factors?

A

oestrogen and progesterone
increase in secretory tissue
decrease in fibro fatty tissue

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4
Q

what are the ABs in breast milk?

A

secretory IgA

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5
Q

What is apocrine secretion and what uses it?

A

apical portion of the secretory cell/epithelial cell pinches off and loses part of cytoplasm releasing a membrane bound vesicle
Lipids

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6
Q

What is merocrine secretion and what uses it?

A

secretions enter lumen by exocytosis

proteins

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7
Q

common bacteria in acute mastitis?

A

staph aureus

strep pyogenes

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8
Q

Abx for staph aurea?

A

flucoxacillin

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9
Q

anti eostrogen therapy

A

tamoxifen

helps reduces swelling and pain

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10
Q

anti HER2 therapy

A

trastuzamab

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11
Q

Common metastatic cancers to the breast

A

bronchial
clear cell kidney
serous ovarian

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12
Q

type 1 endometrial Ca histological features?

A

microsatelite instability

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13
Q

type 2 endometrial ca histological features?

A

papillary and glandualr architecture with diffuse marked nuclear pleomorphism

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14
Q

what is meigs syndrome?

A

triad of bengin ovarian tumour
ascites
pleural effusion

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15
Q

HPV ass with cervical Ca?

A

16 & 18

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16
Q

chemotherapy drug used in cervical Ca?

A

cisplatin

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17
Q

Pagets disease of the nipple?

A

ductal carcinoma in situ progresses up to the nipple
common eczematic rash
underlying Ca in breast

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18
Q

in situ meaning?

A

no invasion of BM

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19
Q

Symptoms of DCIS?

A

usually asymptomatic- no mass

seen on US as calcification (no blood supply to the internal malignant cells so they die and calcify)

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20
Q

Bengin calcification lesions of the breast?

A

fat necrosis

sclerosing adenosis

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21
Q

cyproterone acetate uses?

A

acne and hirsutism
(anti androgen and progesterone)
prostate cancer

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22
Q

When is the COCP contraindicated?

A

migraine with aura

breast feeding women <6 weeks postpartum

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23
Q

Best contraception post partum?

A

mother protected to day 21
exclusively breast feed for 6months & ammenhoreic
POP after 21 days for breast feeding or not (additional contraception for first 2 days)

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24
Q

POP contraindications?

A

breast cancer in last 5 years

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25
Q

cottage cheese discharge

A

thrush

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26
Q

When is downs syndrome combined screening test?

A

10-14 weeks

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27
Q

What does downs screening test involve?

A

US- neural translucency

Blood test BHCG, PAPP-A (high and low in ds)

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28
Q

What screening test for downs is done if >14 weeks?

A 
quadruple test
(BhCG and inhibin A raised, AFP and unconjugated oestriol low)
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29
Q

menorrhagia treatment?

A

tranexamic acid

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30
Q

dysmenorrhoea treatment?

A

mefanamic acid

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31
Q

Contraception for menorrhagia?

A

IUS

COCP

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32
Q

What are the basic investigations for infertility?

A

semen analysis

day 21 progesterone

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33
Q

What are the values for day 21 progesterone?

A

<16 repeat and if low refer
<30 repeat
>30 ovulating

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34
Q

What are the high risk HPV subtypes?

A

16 & 18

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35
Q

What warrants urgent (2weeks) coloscopy referral?

A 
severe dyskariosis (CINIII)
suspected invasive Ca
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36
Q

What is placenta praevia?

A

placenta lying in the lower uterus. covers the internal OS completely partially or marginally

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37
Q

What is placental abruption?

A

separation of placenta from uterine wall causing maternal haemorrhage in the intervening space

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38
Q

What are the symptoms of placental praevia?

A

painless bright red vaginal bleeding after 20 weeks gestation

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39
Q

What is placental accreta?

A

placenta invades myometrium ad becomes inseperable from uterine wall

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40
Q

treatment of hyperthyroid in pregnancy?

A

PTU 1st trimester

carbimazole 2nd/3rd trimester

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41
Q

Why does hyperthyroidism get worse in first trimester?

A

HCG increase

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42
Q

How do you treat hypothyroid in pregnancy?

A

increase levothyroxine by 25-50 in 1st trimester

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43
Q

Treatment of gestational diabetes?

A

insulin

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44
Q

What is polyhydromnios and how it is diagnosed?

A

excess amniotic fluid

USS

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45
Q

What is threatened miscarriage?

A

painless bleeding before 24 weeks cervical OS closed

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46
Q

What can be used to screen for postnatal depression?

A

edinburgh scale

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47
Q

baby blues features and management?

A

3-7 days
tearful, anxious
reassurance and support

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48
Q

Postnatal depression features and management?

A

1-3 months
typical depression signs and effects on bonding
mod-sev: CBT and paraoxetine

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49
Q

peurperal psychosis features and management?

A

onset 2-3 weeks
severe mood swings
delusions, hallucinations
emergency hospital referral

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50
Q

pathophysiology of gestational diabetes?

A

placental products such as HCG and TNF alpha increase insulin resistance and cause a decrease in functioning B cells

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51
Q

is metformin safe in pregnancy?

A

yes

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52
Q

what is a chroinic haematoma?

A

pooling of blood between chorion and endometrium

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53
Q

Common presentation of chrionic haematoma and diagnosis?

A

bleeding in early pregnancy
threatened misscarraige
USS (crescent adjacent to the sac)

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54
Q

What are molar pregnancies?

A

chromosomally abnormal/non viable fertilised egg leading to abonormal placental overgrowth and swollen chorionic villie (grape like cluster) has the potential to become malignant
type of gestational trophoblastic disease

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55
Q

snow storm appearance?

A

molar pregnancy

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56
Q

What are the typical signs and symptoms of molar pregnancy?

A

bleeding
exagerated symptoms of preganacy
very high serum hCG

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57
Q

What is the difference between complete and partial moles?

A

complete mole - no maternal DNA. Haploid paternal egg duplicates after fertilisation
partial mole- maternal and paternal DNA. fertilised by two sperm or duplicating paternal DNA. Fetal reminents present

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58
Q

What is adenomyosis?

A

endometriosis in the myometrium

‘spongy’

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59
Q

What is a uterine/vaginal vault prolapse and when does it commonly occur?

A

upper portion of vagina drops down into vaginal canal or outside
post hysterectomy

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60
Q

What is a urthrocele?

A

urethra pressing into vagina wall

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61
Q

What is a cystocele?

A

anterior prolapse

bladder herniates into the vagina

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62
Q

What is a rectocele?

A

posterior prolapse

rectum pushes against wall of vagina

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63
Q

What is an enterocele?

A

pouch of douglas with small bowel herniates into vagina

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64
Q

what is listeria and where is it commonly found?

A

gram positive bacillus

pate, butter, soft cheeses, cooked sliced meat

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65
Q

Why listeria infection dangerous in pregnancy?

A

can lead to misscarraige

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66
Q

What is the treatment for listeria infection?

A

amoxicillin

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67
Q

What may CSF show in listeria meningitis?

A

pleocytosis (increased lymphocytes) and tumbling motility

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68
Q

How do you treat listeria meningitis?

A

IV amoxicillian and gentamicin

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69
Q

What is a second degree vaginal tear?

A

tear into subcutaneous tissue

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70
Q

What is a 1st degree vaginal tear?

A

tear into mucosa only

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71
Q

What is a 3rd degree vaginal tear?

A

tear into external anal sphincter

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72
Q

What is a 4th degree vaginal tear?

A

tear into ractal mucosa

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73
Q

What is obstetric cholestasis and the cause?

A

reduced flow of bile down the bile ducts to the liver and some leaks out into blood stream
unknown cause but proposed increase in oestrogen and progesterone slow down bile movement

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74
Q

What are the typical symptoms of obstetric cholestasis?

A

severe itch after 24 weeks

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75
Q

Management of fibroids?

A

IUS
Symptoms- tranexamic acid, COCP
GnRH- to reduce size but only short term as grows back rapidly
surgery- myomectomy
uterine artery embolisation- reduces blood flow thus oestrogen supply to the uterus

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76
Q

What is tranexamic acid?

A

antifibrinolytic- prevents plasmin from breaking down fibrin clots

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77
Q

What is hyperemesis and when is it most common?

A

excess vomiting due to increased hCG

most common weeks 8-12

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78
Q

treatment of BV?

A

metronidazole

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79
Q

musty frothy green discharge. strawberry cervix?

A

trichomonas vaginalis

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80
Q

treatment of trichomonas vaginalis?

A

metronidazole

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81
Q

gonorrhoea treatment?

A

im ceftriaxone and oral azithromycin

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82
Q

cottage cheese discharge?

A

candida

83
Q

What is used to facilitate placental delivery and reduce risk of PPH?

A

oxytocin/ergometrine

84
Q

What is used to initiate labour?

A

prostaglandin E2

85
Q

How do you treat primary PPH (within 24hrs)?

A

IV syntocinon/oxytocin or IV ergometrine

IM carboprost

86
Q

What is ashermans syndrome and what is it commonly associated with?

A

adhesions and fibrosis of the endometrium commonly after dilation and curettage

87
Q

What are the main signs of ashermans?

A

amenorrhoea
infertility
menstrual pain
recurrent misscarraige

88
Q

How do you diagnose ashermans?

A

hysteroscopy

89
Q

Why should women avoid eating liver in pregnancy?

A

high levels of vit A

90
Q

How can you calculate risk of malignancy index (RMI) in women?

A

serum CA 125

USS findings and menopausal status

91
Q

What should women high risk of pre-eclampsia take?

A

aspirin 75mg from week 12

92
Q

Who are high risk for pre-eclampsia?

A

exsiting hypertension or in previous pregnancy
CKD
autoimmune disorders- SLE, antiphospholipid syndrome
diabetes

93
Q

What happens to blood pressure in normal pregnancy?

A

falls in 1st trimester then raises 2nd trimester

94
Q

What is definition of pregnancy induced hypertension?

A

> 150/90

or an increase in >30/15 after week 20

95
Q

What is definition of pre-eclampsia?

A

pregnancy induced hypertension with proteinuria

96
Q

What is the treatment for gestational hypertension?

A

oral labetalol

97
Q

What is pre-exsisting hypertension in pregnancy?

A

history before pregnancy or >140/90 <20 weeks

98
Q

What happens in pre-eclampsia?

A

kidney function declines causing salt and water retention- oedema
renal blood flow and GFR decreases

99
Q

What is the management of pre-eclampsia?

A

1st labetalol
2nd methyldopa
3rd nefidipine

100
Q

What is pre-eclampsia?

A

multi sytem disorder with diffuse vascular endothelial dysfunction and widespread circulatory disturbance

101
Q

What is the cure for pre-eclampsia?

A

delivery

102
Q

when do you give steroids for promotion of fetal lung surfactant?

A

up to 36 weeks

103
Q

What is eclampsia seizure treatment and prophylaxis?

A

magnesium sulphate
if fails consider benzodiazepines
IV labetalol and hydralazine for BP

104
Q

What is premature ovarian failure?

A

menopausal symptoms and elvevated gonadotrophin level <40 yrs

105
Q

chlamydia treatment?

A

azithromycin single dose or doxycycline 7 days

106
Q

classic history of placenta praevia?

A

painless bright red bleeding after 24 weeks

previous c sections

107
Q

what is neuropathic pain?

A

pain arising from damage or disruption to nervous system

108
Q

Give some examples of neuropathic pain?

A

diabetic neuropathy
post herpetic neuralgia
trigeminal neuralgia
prolapsed intervetebral disc

109
Q

What is treatment of neuropathic pain?

A

1- amitriptyline, duloxetine, gabapentin or pregabalin

110
Q

When is tramadol useful?

A

rescue therapy for exacerbations of neuropathic pain

111
Q

When is topical capsaicin useful?

A

localised neuropathic pain eg post herpetic neuralgia

112
Q

Trigeminal neuralgia first line?

A

carbazepine

113
Q

What is clomiphene used for?

A

induce ovulation i npatients with anovulatory ovulation

114
Q

What antibiotic is safe in pregnancy?

A

trimethoprim

115
Q

What do smear tests show?

A

dyskaryosis

change in squamous epithelial cells

116
Q

CIN classification shows what?

A

cervical intraepithelial neoplasia-coverage/spread of the abnormal cells identifies on coposcopy

117
Q

What are the treatments for CIN?

A

cryotherapy
laser
cold coagulation
large loop incision of the transformation zone

118
Q

What is vulvular intraepithelial neoplasia?

A

dysplasia of squamous epithelium of the vulva with invasive/cancerous potential

119
Q

What is extramammary pagets disease and how does it present?

A

red itchy ulcerated skin

malignant epithelial cell in the epidermis of the vulva

120
Q

What is a defining feature of HPV infection?

A

koilocytic change- raisin like nucleus

121
Q

postmenopausal women with leukoplakia and parchment like vulvar skin?

A

lichen sclerosis

122
Q

what is lichen sclerosis and what does it increase risk of?

A

benign thinning and atrophy of epidermis
fibrosis of dermis
slight increased risk of squamous carcinoma

123
Q

what is lichen simplex chronicus?

A

thickening of the skin/hyperplasia of the squamous epithelium
leukoplakia with thick leathery vulvar skin
completely benign]ass with chronic irritation and scratching

124
Q

what is common presentation of vulvar squamous carcinoma?

A

leukoplakia

biopsy

125
Q

What are the main causes of vulvar carcinoma?

A

HPV related- infection of high risk HPV causing vulvar interepithelial neoplasia and leading to cancer
non HPV- long standing lichen sclerosis

126
Q

What is lynch syndrome?

A

cancer predisposition syndrome
AD
increases risk of endometrial, ovarian and colorectal cancer

127
Q

what causes the increased risk for cancer in lynch syndromes?

A

inherited mutations of the DNA mismatch repair system

128
Q

what is overflow incontinence?

A

involuntary release of urine from a permanently overfilled bladder

129
Q

What are the main causes of overflow incontinence?

A

bladder outflow obstruction
weakened/ loss of detruser muscle contraction- cant expel enough urine
side effect of anticholinergic side effects
autonomic neuropathy

130
Q

What are the signs of overflow incontinence?

A

huge palpable bladder, chronic retention, wet at night

131
Q

How do you treat overflow incontinence?

A

catheter

132
Q

How do you diagnose incontinence?

A

urodynamic studies

133
Q

What is stress incontinence and the cause?

A

urine leaks out of the bladder during increased intra-abdominal pressure and no detruser contraction due to insufficient closure of the bladder (damage of the pelvic floor or urethral function commonly in childbirth)

134
Q

What are the classic signs in stress incontinence?

A

involuntary leakage on exertion or when sneezing or coughing

135
Q

What is the treatment for stress incontinence?

A

pelvic floor exercises
weight loss
stop smoking
surgical correction

136
Q

What causes urge incontinence?

A 
detruser over activity:
afferent over stimulation due to irritant in bladder
excess central facilitation
loss of central inhibition
parasympathetic nerve damage
137
Q

What are the classic symptoms of urge incontinence?

A

feeling of constantly needing to pee
increased frequency
small voided volumes
nocturia

138
Q

What are the treatments of urge incontinence?

A

avoid caffeine
bladder retraining
oxybutynin- anticholinergic

139
Q

What are some key biochemical findings in PCOS?

A

elevated androgens

hyperinsulinemia, insulin resistance, raised LH

140
Q

PCOS triad?

A

hyperandrogenism
oligoovulation/anovulation
>12 enlarged follicles

141
Q

What is acanthosis nigricans?

A

darkened skin usually in neck or armpit

due to hyper insulinaemia

142
Q

What are the treatments in PCOS?

A

lifestyle
metformin
COCP
laproscopic ovarian drilling (destroys the tissue in the ovary that is producing the androgen)

143
Q

Typical presentation of PID?

A 
history of infection
bilateral abdo pain
abnormal bleeding or discharge
fever
cervical excitation
144
Q

treatment of PID?

A

Im ceftriaxone

2 week course of doxycyline and metronidazole

145
Q

How much does PID increase your risk of infertility?

A

10-20% after single episode

146
Q

what is a leiomyoma?

A

uterine fibroid

147
Q

What are uterine fibroids and what causes them?

A

benign smooth muscle tumours

oestrogen dependant

148
Q

What is the typical presentation of uterine fibrods?

A

menorrhagia- anemia
infertility
olderwomenwith longer exposure to oestrogen

149
Q

What is a complication of fibroids in pregnancy?

A

red degeneration

150
Q

What is red degeneration?

A

fibroids grow quicker due to increased oestrogen in pregnancy
haemorrhage in the middle of the fibroid

151
Q

What are the symptoms of red degeneration?

A

abdominal pain
vomitting
low grade fever
in middle trimester

152
Q

What are the treatments for larger fibroids?

A

mirenia coil/IUS

GnRH analogues to reduce bulk before surgery or induce menopausal state

153
Q

What part of the pituitary releases LH and FSH?

A

anterior

154
Q

Surgery options for fibroids?

A

hysterectomy

preserve fertility- myomectomy, embolisation

155
Q

Leiomyosarcoma cell morphology?

A

spindle cell

156
Q

what is adenomyosis?

A

endometriosis in the myometrium

157
Q

What are the classic symptoms and signs of endometriosis?

A 
asymtomatic
pelvic pain prior to period
heavy periods
dyspareunia
fixed retroverted uterus 
enlarged boggy tender uterus (adenomyosis)
158
Q

What is a chocolate cyst?

A

endometriosis in the ovaries

159
Q

What is the management of endometriosis?

A

if asymptomatic no treatment
COCP
surgery

160
Q

What is endometritis and what are the features of each type?

A

inflammation of the endometrium
acute- neutrophils
chronic- plasma cells

161
Q

What are the common symptoms of endometritis?

A

lower abdo pain, uterine tenderness

162
Q

What is treatment for endometritis

A

doxycycline and metronidazole

163
Q

What is the main cause of endometritis and what threat does this pose?

A

infection

risk of pID

164
Q

What is dysfunctional uterine bleeding?

A

abnormal bleeding patterns with no organic cause

usually due to hormone disturbances

165
Q

What are the 2 types of dysfunctional uterine bleeding?

A

anovulatory- irregular cycle

ovulatory- regular with cycle

166
Q

NSAIDs in menorhagia?

A

Pain management
mefanamic acid, naproxen
inhibits COX and reduces prostaglandin synthesis (linked to heavy periods)

167
Q

antifibrinolytic in menorrhagia?

A

stops the break down of fibrin clots

tranexamic acid

168
Q

progesterones in menorrhagia?

A

prevent the endometrium growing too quickly

169
Q

GnRHa in menorrhagia?

A

can reduce bleeding but cause symptoms of menopause

170
Q

classic presentation of placenta previa?

A

painless red bleeding in third trimester uterus soft and non tender

171
Q

What is an antepartum haemorrhage?

A

bleeding from the genital tract after 24 weeks pregnancy

172
Q

What are the main causes of APH?

A

placenta previa
placental abruption
vasa previa

173
Q

Why should a vaginal exam not be conducted for suspected APH?

A

placenta previa can easily rupture

174
Q

What is placenta previa?

A

placenta lies in lower uterine segment has big risk of haemorrhage

175
Q

Key differences between placenta previa and placental abruption?

A

preva- no pain, no tenderness, shock proportional to blood loss
abruption- pain, tense, swollen and tender uterus shoch outwith blood loss. fetal heart absent/destressed

176
Q

What is placenta accreda and the main risks?

A

placenta is attaches to the myometrium as isnt restricted by the decidua basalis
difficult detachment at birth causing PPH

177
Q

what are the key risk factors for placenta accreda?

A

c section

placenta previa

178
Q

what is placental abruption?

A

placenta separates from endometrium prior to delivery causing maternal haemorrhage

179
Q

What are some causes of placental abruption?

A

pre-eclampsia/HTN
trauma
increased maternal age
multiparity

180
Q

what are the signs of placental abruption?

A

CTG fetal heart absent or distressed

181
Q

treatment of placental abruption?

A

emergency admission
resus
steroids
delivery

182
Q

When is the best window to give steroids to reduce fds?

A

24-48 hrs before birth

183
Q

when should the placenta normally be expelled?

A

5-10mins

184
Q

What is meant by a retained placenta?

A

failure to deliver>30mins

185
Q

what is the risk with a retained placenta?

A

PPH

186
Q

How do you manage a retained placenta?

A

syntocinon and breast feeding

>hr surgical removal

187
Q

what is a post partum haemorrhage?

A

> 500ml blood loss

188
Q

what is meant by priamry and secondary pph?

A

primary <24hrs since birth

secondary >24hrs

189
Q

What are the 4 ts of post partum haemorrhage?

A

tone
trauma
tissue
thrombin

190
Q

What are the treatments for primary PPH?

A

uterine massage
IV syntocinon or ergometrine
IM carbopost
if severe surgical ligation or hysterectomy

191
Q

What does ergometrine do?

A

causes contraction of the uterus to reduce blood flow

192
Q

What is carboprost?

A

synthetic prostaglandin induces contraction and can be used for abortion or to treat PPH

193
Q

What is a moderate and major PPH?

A

500-1500ml

>15000ml

194
Q

What is a choriocarcinoma?

A

trophoblastic malignancy can arise from molar pregnancies

195
Q

What are trophoblast?

A

outer cells of the blastocyst that provide nutrients for embryo and develop into a large part of the placenta

196
Q

What is cervical incompetence?

A

cervix begins to dilate and efface before term

197
Q

treatment of cervical incompetence?

A

treated if threatened pregnancy

suture shut and removed at 36 weeks

198
Q

what is the genetics of androgen insensitivy sydrome?

A

X linked recessive

199
Q

what is another name for candida infection?

A

thrush

200
Q

What are the typical symptoms of thrush?

A

itchy white discharge

201
Q

What is candida balatitis?

A

thrus on tip of penis

202
Q

Most individuals are colonised with small numbers of candida what are the risks for becoming infected?

A

abx
immunocompromised
poor diabetes control
high oestrogen

203
Q

diagnosis of thrush?

A

high vaginal swab/vulvovaginal swab
culture- c.albicans
budding (yeast) on gram stain

204
Q

treatment of thrush?

A

topical clortimazole

oral flucanazole

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