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Year 3 Incorrect Questions > Reproduction/Sexual Health > Flashcards

Reproduction/Sexual Health Flashcards

1
Q

Gold standard investigation for endometriosis

A

Diagnostic laparoscopy

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2
Q

Treatment to prevent miscarriage in pt with anti-phospholipid syndrome

A

Low-dose aspirin and low-molecular-weight heparin (LMWH)

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3
Q

19yr old P0+0
Sudden onset RIF pain
Feeling faint
HCG positive
Hypotension
Tachycardia
Apyrexial

A

Ectopic pregnancy
- inv bloods/G&S, US, FAST trans vaginal US
- manage medical/conservative/surgical/vacuum

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4
Q

19yr old P0+0
Sudden onset RIF pain
Nausea and vomiting
HCG negative
Tachycardia
Normotensive
Apyrexial

A

Ovarian torsion
- inv bloods/CRP/G&S, palpable mass on VE, US
- manage resus, laparoscopy, detorsion, cystectomy, oopherctomy

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5
Q

19yr old P0+0
Gradual onset RIF pain
Anorexia
Nausea and vomiting
Diarrhoea
HCG negative
Normal HR and BP
Rebound/guarding
Rovsing’s positive
Raised WCC/CRP
Normal repro organs

A

Appendicitis
- inv CT
- manage appendectomy

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6
Q

19yr old P0+0
Sudden onset RIF pain
Occurred after sexual intercourse
HCG negative
Tachycardic
Hypotensive
Aprexial

A

Cyst rupture
- inv bloods/CRP/G&S, peritonism, US
- manage conservative/resus, laparoscopy, lavage, oopherectomy

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7
Q

19yr old P0+0
Gradual onset lower abdominal pain
Anorexia
Intermenstrual and post coital bleeding
Discharge
HCG negative
Normal HR & BP
Pyrexial

A

PID
- inv FBC/CRP/LFT, cervical motion tenderness, genital swabs
- manage 14 days metronidazole and doxycycline, STI counselling

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8
Q

Primary investigation for premature menopause (under 45)

A

Serum FSH

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9
Q

Management of HPV positive cytology on smear but no dysplastic changes

A

Repeat smear in 12 months, safety net in meantime

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10
Q

Which contraception would you advise in a young patient wanting period control and has migraine with aura?

A

Progesterone only method

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11
Q

Pt in 3rd trimester presents with severe abdominal pain, vomiting with a history of fibroids

A

Red dgeneration of fibroids
- the effect of oestrogen on fibroids late in pregnancy causes them to grow and blood vessels expand
- conservative management, reassure pt

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12
Q

Management of BV

A

Oral metronidazole

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13
Q

55 year old having sex with multiple partners, wants to have coil replaced, what do you recommend?

A

Advise barrier method of contraception
- hormonal control puts her at higher risk of cancer given her age

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14
Q

Management of gonorrhoea

A

IM ceftriaxone

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15
Q

16 year old, not started periods yet, normal ovaries and uterus on USS, what’s the likely diagnosis?

A

Hypogonadotrophic hypogonadism

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16
Q

Management of PID

A

Ceftriaxone IM + doxycycline (+ metronidazole)
Ofloxacin + metronidazole

Essentially just make sure what you’re giving covers the organisms causing the PID

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17
Q

Bright red ring surrounding cervical os, assoc with post-coital bleeding

A

Cervical ectropion

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18
Q

Which method of delivery poses the lowest infection risk for an HIV+ patient with a viral load >50?

A

C-section

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19
Q

25 year old presents with heavy bleeding, pelvic pressure and palpable mobile mass in lower abdomen

A

Fibroids

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20
Q

Whirpool sign on USS

A

Ovarian torsion

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21
Q

Types of HPV most assoc with cervical cancer

A

16 and 18

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22
Q

Investigation to confirm diagnosis of PID

A

Endocevrical swab

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23
Q

Medical management of PCOS

A

Clomifene citrate

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24
Q

When should serum progesterone test be carried out in menstrual cycle to assess fertility?

A

7 days before end of cycle
e.g. day 21 in a 28 day cycle
e.g. days 25 in a 32 day cycle

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25
Q

How often should HIV+ patients be getting cervical smear tests after diagnosis?

A

Annually
- due to incr risk for HPV and thus cervical cancer

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26
Q

Contraindications to HRT

A

Undiagnosed vaginal bleeding
Pregnancy
Breastfeeding
Oestrogen receptor-positive breast cancer
Acute liver disease
Uncontrolled hypertension
History of breast cancer or venous thromboembolism (VTE)
Recent stroke, myocardial infarction or angina

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27
Q

What substance is used during smear tests to visualise abnormal cells on the surface of the cervix?

A

Acetic acid
- appears bright white next to pink and healthy cervical tissue

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28
Q

For how long should patients beginning menopause after 50 continue to use contraception after their last period?

A

1 year after lastperiod

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29
Q

Pres of cystocele

A

Herniation of bladder into vagina
- stress incontinence, natural birth, anterior wall prolapse

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30
Q

Diagnosis of premature ovarian insuffieciency

A
  • under the age of 40
  • symptoms of menopause (eg. period cessation)
  • two FSH measurements of >25 IU/l
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31
Q

What type of HRT in menopausal pts with continuing periods?

A

Monthly cyclical HRT

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32
Q

Primary amenorrhoea, no breast development, webbed neck, wide chest, recurrent ear infections as a child?

A

Turner syndrome (hypergonadotrophic hypogonadism)

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33
Q

Heavy menstrual bleeding assoc with fatigue, weight gain, constipation and cold intolerance?

A

Hypothyroidism can be a really common cause of this!!!!!

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34
Q

Mainstay treatment for ovarian cancer

A

Chemo (platinum) and surgery (bilat salpingooopherectomy)

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35
Q

Why does chemo not work in slow growing cancers e.g. low grade ovarian tumours?

A

Chemo only works on hyperactive and fast replicating cells

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36
Q

Tumour markers for young pt with ovarian cancer

A

AFP, LDH, HCG, Ca125

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37
Q

Endo thickness on TVUS at which to offer endo biopsy

A

4mm

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38
Q

When can fibroids cause bleeding in post-menopausal bleeding?

A

If pt on HRT, oestrogen stimulates the fibroids

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39
Q

Why does ovarian cancer cause build up of ascites?

A

Intense mesothelial irritation
Low protein causes fluid toleak out into abdo space

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40
Q

Meek syndrome pres

A

R sided pleural effusion, benign ovarian mass, ascites
- transudate tends to accumulate in R side

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41
Q

If individual is negative high risk HPV on routine smear, when is their next smear?

A

5 years

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42
Q

When is test of cure done after treatment of high grade cervical neoplasia?

A

Smear at 6 months

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43
Q

Gardasil 9 vaccine protects against which types of HPV?

A

16
18
31
33

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44
Q

Hormone findings in PCOS

A

Raised testosterone, low sex hormone binding globulin (SHBG), raised luteinising hormone (LH) and normal follicle-stimulating hormone (FSH)

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45
Q

Menorrhagia, a bulky uterus on examination and a history of infertility are highly suggestive of?

A

Uterine fibroids

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46
Q

First line investigation for post-coital bleeding

A

Speculum exam and pelvic exam before anything else

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47
Q

Most common type of vulval cancer

A

Squamous cell carcinoma

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48
Q

Why is mefanamic acid used to manage dysmennhoroea and menorrhagia?

A

NSAID with anti-inflamatory function to reduce bleeding
It works by inhibiting prostaglandin synthesis and is better tolerated than tranexamic acid

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49
Q

Ratio of LH to FSH in PCOS

A

High LH:FSH

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50
Q

Hormone levels in premature ovarian failure

A

Raised LH, raised FSH, low oestradiol levels

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51
Q

Pres of PID

A

Dysuria
Menorrhagia
Purulent vaginal discharge
Objective markers of infection and inflammation.

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52
Q

Can testosterone replacement cure male infertility?

A

No, because it does not act on sperm producing cells in the testes. Gonadotrophin therapy is required for this to happen.

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53
Q

Why is Mirena coil better option than COCP in patient with heavy menstrual bleeding which is not controlled by tranexamic acid?

A

mirena is local
fewer side effects
don’t have to remember to take pill

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54
Q

Diagnosis of premature ovarian insufficiency

A

Elevated serum follicle-stimulating hormone (FSH) levels (>30 IU/l) on two samples taken 4–6 weeks apart
- woman under 40
- absence of periods for 12 months

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55
Q

Medical management of endo in a patient with Hx of DVT who smokes 20 cigarettes a day

A

POP

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56
Q

When are corpus luteum cysts seen?

A

In early pregnancy when the corpus luteum fails to break down

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57
Q

Why might a post-menopausal patient wit systemic symptoms not require progesterone RT?

A

Pt will only need progesterone if they have a uterus
- there’s no risk of endo cancer if pt does not have a uterus to be affected by unopposed oestrogen

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58
Q

Right upper quadrant pain, associated with shoulder tip pain and Hx of untreated chlamydia?

A

Fitz-Hugh-Curtis syndrome

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59
Q

Mech of action of misoprostol

A

synthetic prostaglandin that encourages the expulsion of the products of conception.

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60
Q

Period of greatest teratogenic risk from drug exposure

A

4-11 weeks

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61
Q

Management of bleeding in anaemic women before surgeyr

A

Gosrelin
- GnRH analogue that can be given prior to surgery to manage bleeding in anaemic women due to fibroids prior to surgery

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62
Q

Why do you get bloating in ovarian cancer?

A

cancer cells spread to peritoneum -> block lymphatic drainage -> ascites -> bloating

big ovaries -> mass effect -> less space in tummy for food

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63
Q

First line management uterine prolapse

A

Vaginal pessary
- rubber/plastic capsules that sit in vagina and essentially hold its shape

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64
Q

Mangement of pt who has missed 2 pills in a row in one pack and only remembered to take the 2nd one

A

Omit the 1st forgotten pill
Finish pack
Start new pack immediately (no pill-free break)

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65
Q

Decr visual acuity in HIV+ pt, fundoscopy shows spots within the retina, along with flame shaped haemorrhages.

A

CMV retinitis
- looks like pizza pie retina
- manage Intraocular Ganciclovir and PO Valganciclovir

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66
Q

Amsel criteria for BV

A

elevated vaginal pH, homogeneous discharge, positive whiff test, and presence of clue cells on wet mount.

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67
Q

Mech of action of doxycycline

A

Protein synthesis inhibition by blocking the 30S ribosomal subunit

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68
Q

Chancroid vs syphilis vs LV

A

Chancroid - Painful ulcer and tender lymphadenopathy
Syphilis - Painless ulcer and non-tender lymphadenopathy
Lymphogranuloma venereum - Painless ulcer and tender lymphadenopathy

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69
Q

Mangement of chancroid

A

Prescribe Ciprofloxacin and Ceftriaxone

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70
Q

Why are first babies unaffected by Rh status but second babies are?

A

IgM
- big antibody, can’t cross plaenta
IgG
- second babies, much smaller Ab

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71
Q

If Rh-ve mother is already sensitised to Rh+ve antibodies, would you give anti-D?

A

She’s already sensitised so anti-D won’t do anything to protect against haemolytic disease

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72
Q

How to manage Rh disease?

A

US to assess for signs of anaemia and blood flow to brain via MCA doppler
- baby will try to speed up blood flow to brain to compensate
- if doppler is elevated = baby is anaemic

Transfuse baby at foetal medicine unit in Glasgow

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73
Q

Normal foetal HR

A

110-160bpm

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74
Q

Management of pt presenting with triad of 5% prepregnancy weight loss, dehydration and electrolyte imbalance

A

Oral promethazine/cyclizine
- pt has hyperemesis gravidarum

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75
Q

Folic acid amount for pregnant mothers with BMI 30 and above

A

5mg

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76
Q

Fetal symptoms of maternal rubella infection

A

Sensorineural deafness
Congenital cataracts
‘Blueberry muffin’ rash
Salt-and-pepper chorioretinitis

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77
Q

Management of gestational diabetes

A

<7mmoll Metfomin 00mg OD if lifestyle/diet measures don’t work
>7mmoll Isophane insulin injection OD in the morning

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78
Q

Why is sertraline used in PPD rather than fluoxetine in a breastfeeding part?

A

Sertraline has a low milk-to-plasma ratio.
Fluoxetine should be avoided due to its long half-life.

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79
Q

When is anti D given in first pregnancy if no exposing event?

A

a one-dose injection between 28 and 30 weeks of pregnancy
OR two doses of injections at 28 weeks and 34 weeks of pregnancy.

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80
Q

Management of itch in obstetric cholestasis

A

Ursodeoxycholic acid

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81
Q

When is category 1 C section indicated?

A

Immediate threat to the life of mother or baby and delivery should expedite immediately within 30 minutes
- e.g. cord prolapse

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82
Q

Testing for gestational diabetes in someone with a high risk factor

A

OGT between 24-28 weeks

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83
Q

When is first anti-D dose given?

A

28 weeks
- or I think any blood exposing event

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84
Q

Management asymptomatic post-natal anaemia

A

Oral ferrous fumarate 200mg OD

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85
Q

Define vasa praevia

A

Foetal blood vessels run through the free placental membranes, unprotected by the umbilical cord
The foetal blood vessels run across internal os
Presents dark red bleeding

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86
Q

Management of premenopausal women with oestrogen-receptor-positive breast cancer.

A

Tamoxifen

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87
Q

Strawberry cervix, foul smelling discharge and lower abdo tenderness?

A

Trichomonas

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88
Q

Fever, sore throat, mouth ulcers and upon inspection it is noted there is a widespread maculopapular rash on chest?

A

HIV primary infection

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89
Q

Woody uterus

A

Placental abruption

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90
Q

Positioning of pt when cord prolapse occurs

A

Ask the patient to go on all fours, on knees and elbows

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91
Q

Presentation of Potter syndrome

A

Poor urine outflow and oligohydramnios causing pulmonary hypoplasia due to bilateral renal agenesis

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92
Q

Pres of acute fatty liver of pregnancy

A

Abdominal pain, nausea, vomiting, headache, jaundice, hypoglycaemia
- in severe cases, pre-eclampsia
Increased ALT above 500

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93
Q

Management malignant Phyllodes tumour

A

Clear margin excision

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94
Q

Lambert Eaton vs Myasthenia Gravis antibiodies

A

LE - Anti-voltage-gated Ca channel
MG - Anti-ACh

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95
Q

4 keymeasures to manage PPH (other than ABCDE etc)

A

Rub fundus
Catheterise
Oxytocin or other meds
Balloon (or suture, ligation, hysterectomy)

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96
Q

Why do you give magnesium sulfate in eclamptic seizures?

A

Terminates seizure, prevents further seizures
- protects parent and foetus

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97
Q

Limb hypoplasia, skin scarring and eye defets are all birth defects due to which virus…

A

Varicella zoster intrapartum
- Manage by testing for antibodies, if absent then dose oral aciclovir 24h after rash starts

98
Q

Woody uterus

A

Placental abruption

99
Q

How can you remember placental adhesion conditions?

A

Accreta - AT muscle
Increta - IN muscle
Percreta - PAST muscle

100
Q

1st preg, rhesus neg and no sensitising events?

A

Anti-D at 28 weeks
+ Further dose if any sensitising events

101
Q

G6 P3+2

A

Think of it as events
6 gravid events (pregnancies)
3 parous events (births incl stillbirth, twins = 1)
+ terminations/miscarriages (after 24w)

102
Q

Why does twin pregnancy put you at high risk of PET?

A

Larger/multiple placenta = more problematic spiral arterioles

103
Q

What one manoeuvre should you avoid in shoulder dystocia?

A

Fundal pressure
- incr risk of uterine rupture

104
Q

Smooth firm breast lump, recently stopped breast feeding

A

Galactocele
- build up of milk causes cystic lesion

105
Q

Most common med given before C section

A

Omeprazole
- prevents reflux by reducing gastric vol and acid
- decr risk of aspiration and subsequent pneumonitis

106
Q

Large, sick, bleeding pregnancy

A

Molar pregnancy
- large for dates
- lots of nausea/vomiting
- intrapartum bleeding

107
Q

Broad ligament contains

A

Ovaries and uterine tubes
- connects then to pelvic wall

108
Q

Painful lumpy boobs before period

A

Fibroadenosis

109
Q

Highest risk HPv for cervical cancer

A

16+18+33

110
Q

Mechanism of action of combined contraceptives

A

Inhibits ovulation (oestrogen) and thickens cervical mucus (progesterone)

111
Q

Management of meningitis in pregnancy

A

IV ceftriaxone and IV amoxicillin
- IV chloramphenicol and IV co-trimoxazole if severe pen allergy

112
Q

Every pt who has a wide local excision should also have…

A

Adjuvant raditherapy
- proven to reduce recurrence

113
Q

MoA of tamoxifen

A

Oestrogen receptor antagonist

114
Q

Smoking is a keeeeeyyyyyyy riak factor for which breast disease?

A

Periductal mastitis
- reduces vitamin A to cause chronic ductal inflammation
- pres with inverted nipple, bloody discharge, sinus draining pus

115
Q

MoA of letrozole

A

aromatase inhibitor
- medication of choice for postmenopausal women with oestrogen-receptor-positive breast cancers

116
Q

What does triple negative mean?

A

Breast cancer negative for oestrogen receptor, progesterone receptor, and HER2 expression

117
Q

Limited movement of arm and tightening of skin at axilla 4 weeks post-breast surgery

A

Axillary web syndrome
formation of fibrous cords that extend from the axilla to the ipsilateral hand.

118
Q

Drugs lowering seizure threshold

A

“I am Tramadol’s friend, keeping life less anxious”
I for imipenem
AM for abx:penicillins, cephalosporins, metronidazole, isoniazid
Tramadols for tramadol
Friend for fentanyl
Keeping for ketamine
Life for lidocaine
Less for lithium
Anxious for antihistamines

119
Q

Breast cancer difficult to see on mammogram

A

Invasive lobular carcinoma
- most have MRI to ID and stage

120
Q

When should ECV be offered for breech baby?

A

36w for primigravid
37w for multigravid

121
Q

Membrane or induction of labour for 41weeker as first line?

A

Membrane sweep
- if doesn’t work, proceed to IoL

122
Q

Fundal pressure is contraindicated in shoulder dystocia, why???

A

Risk of brachial plexus injury

123
Q

Key risk for thomboembolism in pregnancy

A

Multiple pregnancy

124
Q

WHat is reassuring variability on CTG?

A

5-25bpm

125
Q

What sort of variability would be non-reassuring?

A

Less than 5 bpm for between 30-50 minutes
More than 25 bpm for 15-25 minutes

126
Q

What is abnormal variability on CTG?

A

Less than 5 bpm for more than 50 minutes (sawtooth)
More than 25 bpm for more than 25 minutes
Sinusoidal (like a sine wave)

127
Q

What is acceleration?

A

abrupt increase in the baseline fetal heart rate of greater than 15 bpm for greater than 15 seconds
- reassurance, but absence shouldn’t be too worrying

128
Q

Main cause of variable deceleration

A

(apid fall in baseline fetal heart rate with a variable recovery phase)
Umbilical cord compression

129
Q

When do you see late decelerations?

A

Start at peak of the uterine contraction and recover after the contraction ends.
- maternal hypoT, PET, uterine hyperstimulation

130
Q

WHen do you worry about prolonged decelerations?

A

If it lasts between 2-3 minutes it is classed as non-reassuring.
If it lasts longer than 3 minutes it is immediately classed as abnormal.

131
Q

Most worrying CTG pattern

A

Sinusoidal
- v rare but v bad
- Severe fetal hypoxia
- Severe fetal anaemia
- Fetal/maternal haemorrhage

132
Q

Gush of fluid and drop in foetal heart rate in a previously normal pregnancy in G5 P4

A

Umbilical cord prolapse
- more common in high parity, polyhydramnios, artificial ROM, malpres

133
Q

WHat is the one medical CI to COCP you keep forgetting?

A

Postnatal period

134
Q

Management of ectopic >35mm or bHBG >1500

A

Surgical

135
Q

Trimethoprim safe in pregnancy?

A

Third trimester yes

136
Q

Bishop score

A

posterior cervical position
firm consistency
40-50% effacement
2cm dilation
foetal station at -2

137
Q

Bishop score >6

A

Amniotomy and IV oxytocin
(cerv ripening balloon if hyperstim risk or prev CS)

138
Q

Bishop score <6

A

Vaginal prostaglandin
Oral misoprostal

139
Q

How to remember the contraindications to COCP on UKMEC?

A

Abnormal clotting 3
Hypertension 4 (controlled 3)

Nocked up
Obesity >35BMI 4

Breastfeeding/PP <4
Aura migriane 4
Breast cancer 4
Immobility (prolonged 4, reduced 3)
hEpatoma/reduced clotting 3
Smoking >15 + >35

140
Q

Fasting glucose >7 in pregnancy

A

Insulin
(metformin or diet advice if <7)

141
Q

Urge vs stress incontinence mangement

A

Stress = SNRI (Duloxetine)
URge = URO = Oxybutynin

142
Q

Methotrexate and conception

A

Must stop 6 months before trying to conceive

143
Q

Which hepatitis is screened for in pregnancy?

A

Hep B

144
Q

Layers cut/pulledapart in C section after skin and fat

A

Anterior rectus sheath - rectus abdominis muscle - transversalis fascia - extraperitoneal connective tissue - peritoneum - uterus
43%

145
Q

Mnemonic for shoulder dystocia management

A

H- call for help
E- evaluate for episiotomy
L- leg to McRoberts
P- supraPubic Pressure
E- enter: rotational manouevres
R- remove the posterior arm
R- roll pt to hands and knees

146
Q

Hormone levels in PCOS

A

raised LH:FSH ratio
testosterone may be normal or mildly elevated
SHBG is normal to low

147
Q

CI in ullipristal/ellaONE

A

Severe asthma

148
Q

When should C section happen with twins?

A

36w if monochorionic
37w if dichorionic

149
Q

Triple test results in Down syndrome

A

Everything is DOWN, except what is HI (HCG, Inhibin A)

150
Q

Vasa praevia triad

A

Painless vaginal bleeding, rupture of membranes and fetal bradycardia (fetal heart rate <100bpm)

151
Q

Which layer of uterus regenerates tissue lost in menstruation?

A

Stratum basalis
- makes it Big again

152
Q

When do the ovaries contain the most germ cells?

A

7 months gestatin

153
Q

Two uteri would result from which embryological problem

A

An incomplete fusion of the paramesonephric duct

154
Q

What structure develops to form the vas deferens?

A

Mesonephric duct

155
Q

Which structre develops to form the superior portion of the vagina?

A

Paramesonephric duct

156
Q

Who regulates assisted conception and embryo research?

A

HFEA
- research up to 14 days

157
Q

Azoospermia and vasectomy - what method of assisted conception?

A

Surgical sperm aspiration and ICSI

158
Q

Most common cause of obstructive azoospermia

A

CF

159
Q

How many UK couples get infertility assessment?

A

1 in 6

160
Q

First line after unexplained infertility

A

IVF

161
Q

How long do pubic lice live?

A

Male 22 days

162
Q

What % of infertility treatment is due to male factor infertility?

A

30%

163
Q

Where does spermatogenesis occur?

A

Seminiferous tubules

164
Q

Which structure loosens in late pregnancy and can cause pelvic pain?

A

Pelvic inlet

165
Q

Foetal vertex is bordered by….

A

Anterior and posterior fontanelles and the parietal eminences

166
Q

Diagnosis of BV

A

Clue cells on VV swab

167
Q

What percent of abnormal uterine bleeding is caused by dysfunctional uterine bleeding?

A

50%

168
Q

What info is required when requesting endo biopsy

A

Date of last menstrual period

Pattern of bleeding

Hormonal therapy

Age

169
Q

Legal limit for social TOP

A

23+6 weeks

170
Q

Yellowish/green frothy discharge along with itching and soreness

A

Trichomonas
- pH >4.5
- manage with metro 5-7 days 500mg
- or metro 2g one off

171
Q

Most common cause of CMV retinitis in people with advanced immunosuppression

A

Reactivated infection

172
Q

COCP protects against whch type of cancer

A

Ovarian and endometria

173
Q

Factors affecting regret for sterilisation

A

Young age <30 yr old
Few or no children
Not in a mutually faithful relationship or not in a relationship
Coercion by partner or medical personnel
Done at time of ToP or childbirth

174
Q

WHat type of endo is rare?

A

Ovarian endo

175
Q

Which muscle cvers the majority of the pelvic side wall?

A

Obturator internus

176
Q

Does FRV increase of decrease during pregnancy?

A

Decrease

177
Q

How does CV function change in pregnancy?

A

Incr contractability

178
Q

RFs for pelvic girdle pain

A

Increased BMI before pregnancy
History of low back and pelvic pain or pelvic trauma
Hard physical job / poor work ergonomics
PGP in a previous pregnancy

179
Q

Boundaries of pelvic outlet

A

anteriorly by the pubic arch
laterally by the ischial tuberosities
posteriorly by the coccyx.

180
Q

Mx suspected PE in pregnancy

A

Chest examination, ECG, Chest Xray, admit to hospital, treatment dose with dalateparin and arrange VQ test

181
Q

Does maternal anaemia affect growth of foetus?

A

No

182
Q

Does IVF affect growth of foetus?

A

Yes
- recognised cause of IUGR

183
Q

Is big previous baby an indicating for GD screening?

A

Yessssss

184
Q

What type of anaesthesia can you not get with forceps delivery?

A

General

185
Q

Pain from the body of the uterus is carried by

A

Visceral afferent fibres to T11-L2 spinal cord levels

186
Q

Painless, usually recurrent bleeds in third trimester

A

Placenta praevia

187
Q

VSD and dysplastic kidneys assoc with which substance in pregnancy

A

Alcohol

188
Q

Classic signs indicating placental separation

A

Uterus contracts, hardens and rises
Increasing length of umbilical cord is visible at the introitus
Gush of blood appears
Mother has feeling of fullness in vagina

189
Q

Mania-like behaviour 1 week post partum?

A

Puerperal psychosis

190
Q

3 types of 3rd degree perineal tear

A

3a <50% of external anal sphincter, 3b > 50% of external anal sphincter, 3c internal anal sphinter

191
Q

Function of ductus arteriosus

A

To oxygenate the fetal venous return using the right ventricle

192
Q

3 key obstetric emergencies that would require a Datix

A

Maternal PPH >500ml
3rd or 4th degree perineal tear
Shoulder dystocia

193
Q

Which hormones stimulate the breasts to grow?

A

At puberty -oestrogen
After, extra growth -progesterone

194
Q

Which hormones stimulate lactation?

A

Milk production - prolactin
Duct contraction - oxytocin

195
Q

Most common breast cancer

A

Invasive ductal carcinoma

196
Q

How common is UK breast cancer?

A

1 in 8

197
Q

Extensive micocalcification confined to one quadrant on mammogram

A

DCIS

198
Q

Young pt with painless, firm, discrete, mobile mass, which has a solid appearance on ultrasound scan

A

Sclerosing adenosis

199
Q

Side effects of adjuvant radiotherapy to breast

A

Skin changes
Fatigue
Brachial plexopathy
Pulmonary fibrosis

200
Q

Most common cause of puerperal pyrexia

A

Endometritis

201
Q

LFTs in acute fatty liver of pregnancy

A

Hepatic pattern of derangement
AST/ALT > ALP/GGT

202
Q

Anastrozole =

A

After menopause

203
Q

Management of chickenpox exposure and infection in pregnancy

A

Exposure
-<20 wk non-immune - VZIg within 10 days
->20 wk non-immune - VZIg / acyclovir after 7-14 days

Chickenpox developed in pregnancy
< 20 wk - consider acyclovir with caution
>20 wk - acyclovir within 24hr of rash

204
Q

Nuchal translucency, PAPPA and HCG decr
Inhibin A incr

A

Patau (13) or Edward’s (18)

205
Q

When should you worry and refer on about lack of foetal movement?

A

24 weeks
- when foetus becomes viable
- 2, 4, kick the door

206
Q

Management DVT in pregnancy

A

LMWH and monitor with anti-Xa activity

207
Q

If pt has glucose >7 and has trialled max dose metformin and diet changes

A

Add on insulin
- don’t stop the metformin

208
Q

FL management of cord prolapse while awaiting C section

A

Push presenting part of foetus back up
Catheterise and fill bladder with 500-700ml saline

209
Q

HIV positive man comes to the emergency department with headache and fever for the last two days - CT shows ring enhancng lesion

A

Toxoplasmosis
- Administer sulfadiazine and pyramethamine

210
Q

Single non-tender penile ulcer with painful inguinal lymphadenopathy, associated fever and muscle pain

A

LGV

211
Q

Deep ulcer with a soft, irregular border and a friable base

A

Chancroid

212
Q

Most effective culture method for HSV

A

NAAT

213
Q

Management of trichomoniasis

A

Metronidazole 2g PO STAT
- treat both partners

214
Q

Thrush as an AIDS defining illness

A

Oesophgeal candidiasis

215
Q

Most common cause of BV

A

Gardnerella vaginalis

216
Q

Unwell, with a higher fever, high heart rate, and a widespread rash after receiving benzylpenicillin for syphilis

A

Jarisch-Herxheimer reaction
- reassurance and paracetamol

217
Q

Findings on micro for cryptococcal meningitis

A

Encapsulated yeast organisms on India ink stain

218
Q

WHen should new breast lump be refd to breast clinic?

A

Under 30 - routine referrral
30 and over - urgent referral

219
Q

Paget’s disease is assoc with which type of breast cancer

A

DCIS

220
Q

When is US used in breast lump?

A

<40 and asymptomatic
<35 and symptomatic
Dense breast tissue

221
Q

HER2-receptor-positive breast cancer endocrine management

A
222
Q

When is fluclox given in mastitis?

A

If pt is:
- systemically unwell
- a positive culture is seen
- a nipple fissure is present
- if symptoms do not improve after 12–24 hours of milk expression.

223
Q

Rapidly growing fibroadenoma

A

Phyllodes tumour
- commonly affect people in 40s and 50s

224
Q

3 Fs of Phyllodes

A

Forties
Fast growing
Fibroadenoma

225
Q

Arthralgia, menopausal symptoms, hypercholesterolemia, osteoporosis, and rarely Henoch–Schönlein purpura
- which breast cancer treatment is responsible?

A

Anastrozole
- aromatase enzyme inhibitor

226
Q

Management of cervical cancer to maintain fertility

A

IA1 to maintain fertility- core biopsy and follow up
IA2 to maintain fertility - LLETZ

227
Q

Bishop score >10

A

Likely to spontaneously labour

228
Q

Bishop score <5

A

Likely to need induced

229
Q

Antiemetic causing tremor and hypertonia

A

Metoclopramide

230
Q

Most common identifiable cause of post coital bleeding

A

Cervical ectropion

231
Q

Salpingectomy vs salpingotomy

A

ectomy - removal of tube, if no contralateral tube problems then fertility is still preserved
otomy - removal of tube contents, might still need treatment withe methotrexate etc

232
Q

How can you reduce uterine contraction in

A

Tocolytics e.g. terbutaline or nifedipine

233
Q

EPDS interpretation

A

<13 and no impact on ADL = CBT
>13 probs impacting on ADL = SSRI and CBT
Any risk/suicidal = inpatient ref

234
Q

Psammoma bodies

A

Serous cystadenocarcinoma

235
Q

Urethritis with >5 polymorphs per field, and no gm-neg diplococci - how do you treat?

A

Treat as chlamydia with doxycycline

236
Q

Management of primary CNS lymphoma

A

Commence cART and whole brain irradiation

237
Q

What pregnancy condition is a CI to the COCP?

A

Cholestatic jaundice

238
Q

Cause of Kaposi’s

A

Human herpesvirus 8

239
Q

Mx of genital warts

A

Inquimod
- cryotherapy if pregnancy

240
Q

Itchy rash on palms and soles, maybe had a genital lesion a few weeks ago that’s now healed

A

Syphilis (trepenoma)

241
Q
A

Year 3 Incorrect Questions (6 decks)

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