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Year 3 Finals > Reproductive > Flashcards

Reproductive Flashcards

1
Q

What happens to the following parameters with normal pregnancy:
Haemoglobin
Platelets
White cell count

A

Hb - decreases
Platelets - decreases
WCC - increases

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2
Q

What happens to the following parameters with normal pregnancy:
Creatinine
Urea
Total protein

A

Creatinine - lower
Urea - lower
Total protein - higher (due to high estrogen stimulating protein synthesis)

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3
Q

What happens to the following parameters during normal pregnancy:
D dimer
GFR
Haematocrit

A

D dimer - higher
GFR - higher
Haematocrit - lower

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4
Q

Which test for diabetic control can be unreliable in pregnancy and why?

A

HbA1c - decreased erythrocyte lifespan

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5
Q

What happens to albumin levels in normal pregnancy? What physiological sign may this lead to?

A

Lower; may lead to oedema

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6
Q

Which antibiotic should we use for a pregnant women with a UTI?

A

Nitrofurantoin

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7
Q

Increase in minute ventilation in normal pregnancy is driven by which hormone?

A

Progesterone

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8
Q

By what percentage does circulating blood volume increase in normal pregnancy?

A

50-70%

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9
Q

High hCG can cause which transient metabolic disturbance in pregnancy?

A

Hyperemesis gravidarum + hyperthyroidism

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10
Q

Trophoblast cells produce which hormone?

A

Beta hCG

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11
Q

Which hormone thickens the endometrial lining?

A

Progesterone

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12
Q

Beta hCG stimulates which group of cells?

A

Corpus luteum

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13
Q

Which hormone prevents the decidua from shedding?

A

Progesterone

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14
Q

Miscarriage is defined as spontaneous loss of intrauterine pregnancy before how many weeks of gestation?

A

24 weeks

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15
Q

Are decidual cells procoagualant or anticoagulant?

A

Procoagulant

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16
Q

Name the miscarriage type:
Closed cervical os + vaginal bleeding + viable pregnancy on USS

A

Threatened

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17
Q

Name the miscarriage type:
Vaginal bleeding + open cervical os +/- abdominal pain

A

Inevitable

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18
Q

Name the miscarriage type:
Vaginal bleeding + open cervical os + products of conception seen on examination

A

Incomplete

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19
Q

What complication are patients experiencing incomplete miscarriage at risk of?

A

Sepsis - due to presence of products of conception

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20
Q

Name the miscarriage type:
Closed cervical os + no products of conception + vaginal or abdominal pain have passed

A

Complete

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21
Q

Name the miscarriage type:
Non-viable intrauterine pregnancy + closed cervical os

A

Missed

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22
Q

Rebound tenderness and guarding are suggestive of what obstetric complaint?

A

Ectopic pregnancy

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23
Q

Which mode of investigation may be used to determine whether a pregnancy is intrauterine or ectopic?

A

Transvaginal USS

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24
Q

Which medical agent can be given in miscarriage?

A

Misoprostol

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25
Q

How does misoprostol work?

A

Prostaglandin analogue which induces uterine contractions and effacement of cervix

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26
Q

Under which circumstance is misoprostol indicated?

A

Miscarriage

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27
Q

Where is an ectopic pregnancy most commonly found?

A

Ampulla of fallopian tube

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28
Q

Name the obstetric complaint:
PMH pelvic inflammatory disease + shoulder tip pain + vaginal bleeding

A

Ectopic pregnancy

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29
Q

Fluid in the pouch of Douglas seen on USS suggests what?

A

Ectopic pregnancy

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30
Q

What medication may be administered in ectopic pregnancy?

A

Methotrexate injection

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31
Q

What management should be picked in a patient with ectopic pregnancy with a serum hCG of 800iu/l?

A

Conservative management

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32
Q

What size of mass in ectopic pregnancy would warrant surgical management?

A

Equal to or over 35mm

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33
Q

What management should be picked in ectopic pregnancy with a serum beta hCG of 1800iu/l?

A

Methotrexate injection

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34
Q

Name the obstetric complaint:
Large for gestational age + hyperemesis

A

Molar pregnancy

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35
Q

Which complication may occur in patients with a very high serum beta hCG?

A

Thyrotoxicosis - hCG has a very similar structure to TSH and hence can activate TSH receptors

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36
Q

Antepartum haemorrhage is described as occurring after how many weeks of pregnancy?

A

24 weeks

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37
Q

Name the obstetric complaint:
Painless bright red PV bleed

A

Placenta praevia

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38
Q

Which examination should not be carried out in placenta praevia?

A

Vaginal examination - may provoke major bleed

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39
Q

What grade of placenta praevia is described here:
Placenta partially covering internal os

A

Grade 3

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40
Q

Which grade of placenta praevia is described here:
Placental edge reaches the internal os but does not cover it

A

Grade 2

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41
Q

Name the obstetric complaint:
Vaginal bleeding + rupture of foetal membranes + foetal disorientation

A

Vasa praevia

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42
Q

Which medications can be given in placenta praevia to control bleeding?

A

Oxytocin, ergometrine, carboprost, tranexamic acid

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43
Q

How does oxytocin exert its anti-bleeding effect?

A

Increases intensity and frequency or uterine contractions

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44
Q

Name the obstetric complaint:
Painful PV bleed at 31 weeks

A

Placental abruption

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45
Q

Hypertension is only classed as gestational when it appears after how many weeks of pregnancy?

A

20 weeks

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46
Q

What is the BP aim for women with gestational hypertension?

A

150/100

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47
Q

Which BP medications are safe in pregnancy?

A

Labetolol, nifedipine, methyldopa

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48
Q

Which BP medications are not safe for use in pregnancy?

A

ACE inhibitors and ARBs

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49
Q

Name the obstetric complaint:
Gestational hypertension + proteinuria

A

Pre-eclampsia

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50
Q

The following signs are a warning for which obstetric complaint:
Headache + blurred vision + systolic BP over 160mmHg

A

Eclamptic seizure

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51
Q

Pre-eclampsia can lead to restriction of what in the foetus?

A

IUGR - intra-uterine growth restriction

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52
Q

Brisk reflexes and blurred vision are associated with what complication of pre-eclampsia?

A

Eclamptic seizure

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53
Q

Which medication and at what dose can be given in pre-eclampsia to improve placental flow?

A

Low dose aspirin - 150mg/day

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54
Q

Which obstetric complaint is a patient on these medications likely to have:
Low dose aspirin 150mg/day + labetolol

A

Pre-eclampsia

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55
Q

Which test for thrombosis is not reliable in pregnancy?

A

D-dimer - increases in pregnancy due to hypercoaguable state

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56
Q

Thrombosis in pregnancy should be treated with what?

A

Low molecular weight heparin - enoxaparin, dalteparin

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57
Q

Which treatment should be given in the event of an eclamptic seizure?

A

IV magnesium sulfate

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58
Q

Which foetal growth complication can occur in gestational diabetes?

A

Macrosomia

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59
Q

Which diabetic medications are safe in pregnancy?

A

Metformin and insulin

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60
Q

Menopause is associated with a drop in which hormone?

A

Oestrogen/oestradiol

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61
Q

Reduced oestrogen in menopause can lead to what skeletal disease?

A

Osteoporosis

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62
Q

The following patient is at risk of developing what:
Menopausal + long term steroid use + hyperthyroidism

A

Osteoporosis

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63
Q

Which monoclonal antibody can be given in menopause associated osteoporosis?

A

Denosumab

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64
Q

Under what circumstances can progesterone be omitted from HRT for menopause?

A

In those who have had a hysterectomy

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65
Q

Troublesome menopausal hot flushes can be medically managed by what?

A

Tibolone

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66
Q

Secondary amenorrhoea is described as a lack of periods for how many months?

A

6

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67
Q

Hyperprolactinaemia can lead to what gynaecological complaint?

A

Amenorrhoea

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68
Q

Which underlying hormone is responsible for this patients amenorrhoea:
Visual changes

A

Prolactin

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69
Q

Which underlying hormone is responsible for this patients amenorrhoea:
Ancne + voice change

A

Androgens - testosterone

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70
Q

Raised FSH and low oestradiol indicate which stage of menopause?

A

Early

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71
Q

A patient presents with amenorrhoea - their blood test shoes increased 17-hydroxy-progesterone. What is the likely underlying diagnosis?

A

Congenital adrenal hyperplasia

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72
Q

A patient presents with amenorrhoea - a blood test shows low SHBG. What is the likely underlying diagnosis?

A

PCOS

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73
Q

Low SHBG on blood test indicates what levels of free androgen?

A

Elevated

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74
Q

Exercise has what effect on SHBG levels?

A

Increases SHBG - and so can lower free androgen

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75
Q

What androgen receptor antagonist can be used in PCOS?

A

Spironolactone

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76
Q

What is the mode of action of clomiphene? When is this medication indicated?

A

Induces ovulation - indicated in infertility and PCOS

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77
Q

Name the gynaecological complaint:
Hirsutism + amenorrhoea + insulin resistance

A

PCOS

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78
Q

Heavy menstrual bleeding is defined by how many millilitres of blood loss over 7 days?

A

80ml or more

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79
Q

What is a leiomyoma?

A

Uterine fibroid made up of fibrous tissue

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80
Q

Gold standard diagnosis of endometriosis is via what?

A

Laparoscopy

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81
Q

Name the gynaecological complaint:
Endometrium has become embedded in myometrium.
What is the definitive treatment?

A

Adenomyosis - definitive treatment by hysterectomy

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82
Q

Sheehan’s syndrome is associated with which obstetric emergency?

A

Significant post partum haemorrhage

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83
Q

Pituitary gland infarction following major post partum haemorrhage is described as what?

A

Sheehan’s syndrome

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84
Q

Sheehan’s syndrome can lead to what dysfunction of menstruation?

A

Secondary amenorrhoea

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85
Q

What level of fasting plasma glucose is required for diagnosis of gestational diabetes?

A

5.6mmol/l +

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86
Q

What level of 2 hour plasma glucose is required to make a diagnosis of gestational diabetes?

A

7.8mmol/l +

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87
Q

Name the most probable type of gynae cancer:
Abdominal discomfort + bloating + polyuria

A

Ovarian cancer

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88
Q

Which blood marker is used for ovarian cancer?

A

CA-125

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89
Q

A patient has ovarian cancer with metastasis to the peritoneum. Which stage is this?

A

Stage 3

90
Q

Post menopausal bleeding indicates the likelihood of which cancer?

A

Endometrial

91
Q

Unopposed exposure to which hormone is a risk factor for endometrial cancer?

A

Oestrogen

92
Q

Endometrial thickness of how many millimetres is indication for biopsy?

A

4mm

93
Q

Adenocarcinoma is which type of endometrial cancer?

A

Type 1

94
Q

Name the most likely cancer:
Vulval itch + non healing ulcer

A

Vulval cancer

95
Q

Which 2 types of HPV infection increase risk of cervical cancer?

A

HPV 16/18

96
Q

Which grades of CIN have the potential to develop into cervical cancer?

A

2/3

97
Q

Those born after which date should have been immunised against HPV?

A

1 September 1990

98
Q

Cervical cancer screening is available for women of what ages?

A

25-64

99
Q

From which zone of the cervix are cells taken from during a smear test?

A

Transformation zone

100
Q

Which cells indicate HPV infection?

A

Koilocytes

101
Q

Under the current NHS screening programme, the neonatal heel prick test is carried out when?

A

Between day 5 and 9 of life

102
Q

Name 4 disorders the neonatal heel prick test screens for

A

Sickle cell disease
Cystic fibrosis
Congenital hypothyroidism
Phenylketonuria

103
Q

When is the combined test (trisomy test) carried out in pregnancy?

A

Between weeks 10 and 14

104
Q

Decreased levels of PAPP-A are associated with what genetic disorders?

A

Trisomy 18 and 21

105
Q

Trisomy 21 is related to what levels of bhCG and PAPP-A?

A

Increased bhCG, decreased PAPP-A

106
Q

What is the standard dose of folic acid given to pregnant patients?

A

400mcg

107
Q

The lambda sign during pregnancy indicates what?

A

A dichorionic pregnancy

108
Q

When is the nuchal translucency scan carried out in the UK?

A

Between 11 and 14 weeks

109
Q

What is an ideal crown rump length at 11-14 weeks of gestation?

A

45-84mm

110
Q

When should foetal movements be felt?

A

20 weeks

111
Q

Alpha fetoprotein, oestradiol, hCG and inhibin A are tested for during which trimester?

A

Second

112
Q

PAPP-A and free beta hCG are tested for during which trimester?

A

First

113
Q

The quadruple test can be offered after how many weeks of gestation?

A

13 weeks

114
Q

The combined test screens for what?

A

Edwards, Patau, Downs

115
Q

The quadruple test screens for what?

A

Downs

116
Q

What happens to the cervix during labour?

A

It softens

117
Q

What happens to progesterone levels during labour?

A

Decrease

118
Q

What happens to oxytocin and prostaglandin levels during labour?

A

Increase

119
Q

Stage 3 of labour consists of what?

A

Birth of baby to expulsion of placenta and membranes

120
Q

What type of stethoscope is used to monitor foetal wellbeing?

A

Pinard

121
Q

Normal foetal heart rate is what?

A

Between 110-160bpm

122
Q

Foetal bradycardia is an indication of what?

A

Foetal distress

123
Q

The active portion of the first stage of labour is defined as cervical dilatation between how many centimetres?

A

Between 3 and 10 cm

124
Q

Prolonged second stage of labour is defined as lasting how many hours after full dilatation?

A

3 hours

125
Q

Oxytocin given post labour can help prevent what?

A

PPH

126
Q

Post partum haemorrhage is defined as loss of how much blood over how long?

A

At least 500mls over 24 hours following birth

127
Q

Secondary post partum haemorrhage can occur until how many weeks post birth?

A

12

128
Q

What is the most common cause of PPH?

A

Uterine atony

129
Q

When is ergometrine contraindicated?

A

High blood pressure

130
Q

What must be done before rubbing the uterine fundus in cases of uterine atony?

A

Emptying the bladder via Foley catheter

131
Q

If medical management of uterine atony fails, what should be carried out next?

A

Intrauterine balloon tamponade

132
Q

Which antifibrinolytic medication can be given in cases of PPH?

A

Tranexamic acid

133
Q

Shoulder dystocia describes what situation?

A

Babies anterior shoulder becomes impacted on mothers pubic symphysis

134
Q

What is the first line management in shoulder dystocia?

A

McRoberts manoeuvre

135
Q

There is increased risk of shoulder dystocia with what maternal condition?

A

Gestational diabetes
- leads to macrosomia

136
Q

Which palsy can shoulder dystocia lead to?

A

Erb’s palsy

137
Q

Foetal bradycardia + decelerations + fluid expulsion from mother are suggestive of what?

A

Cord prolapse

138
Q

What presentation of the baby increases risk of cord prolapse?

A

Breech presentation

139
Q

What is the first line management in cord prolapse?

A

Replace cord into vagina and perform digital elevation

140
Q

Cord prolapse predisposes risk to what of the baby?

A

Hypoxia

141
Q

Definitive management of cord prolapse is via what?

A

Emergency cat 1 C section

142
Q

What is first line management for gestational hypertension without proteinuria?

A

Oral labetolol

143
Q

What 2 medications are indicated in pre-term labour?

A

Benzylpenicillin - to protect against group B strep
Betamethasone - to accelerate foetal lung maturation

144
Q

Corticosteroids can be given for foetal lung development in pre-term labours below how many weeks?

A

Below 34 weeks

145
Q

Erb’s palsy damages which vertebral levels of the brachial plexus?

A

C5-C6

146
Q

Gardnerella Vaginalis is associated with what condition?

A

Bacterial vaginosis

147
Q

What is the first line treatment for vaginal thrush?

A

Oral fluconazole 150mg one off dose

148
Q

What is the most common causative organism for genital candidiasis?

A

Candida albicans

149
Q

What is the first line antibiotic used in BV?

A

Metronidazole

150
Q

Thrush presents with what pH?

A

Normal

151
Q

BV presents with what pH?

A

Raised

152
Q

How is chlamydia infection managed?

A

Oral doxycycline twice a day for 7 days

153
Q

What is the test used to identify chlamydia infection?

A

NAATs

154
Q

Treponema pallidum is the causative organism in what disease?

A

Syphilis

155
Q

VDRL and RPR can be used to screen for what?

A

Syphilis

156
Q

Which antibiotic is used to treat syphilis?

A

IM penicillin G

157
Q

Pharyngitis may be an extragenital symptom of what?

A

Gonorrhoea

158
Q

Which urine sampling method is carried out in men suspected with gonorrhoea?

A

First pass urine

159
Q

Which test is used to assess gonorrhoea samples?

A

NAAT

160
Q

Diagnosis of trichomonas vaginalis is typically by what?

A

Direct microscopy

161
Q

Trichomonas vaginalis is treated by what?

A

Oral metronidazole

162
Q

Microscopy will show what type of bacteria in gonorrhoea infection?

A

Gram negative diplococci

163
Q

Strawberry cervical is a sign of what?

A

Trichomonas infection

164
Q

Reactive arthritis is a sign of what STI?

A

Chlamydia

165
Q

90% of vulval cancers are what type?

A

Squamous cell carcinoma

166
Q

Uterine hyper stimulation in induction of labour can lead to what effect on the foetal heart?

A

Bradycardia

167
Q

External cephalic version can be carried out when the foetus is in what position?

A

Breech

168
Q

Which score is used to clinically assess the cervix?

A

Bishop’s score

169
Q

How many contractions should we aim for every 10 minutes of labour?

A

4

170
Q

If a triangular shape is felt on examination of the foetal head, what position is the baby in?

A

Occiput anterior

171
Q

If a diamond shape is felt on examination of the foetal head, what position is the baby in?

A

Occiput posterior

172
Q

On foetal scalp blood sampling, a pH value of below what indicates hypoxia?

A

Below 7.2

173
Q

Foetal hypoxia increases the risk of what condition?

A

Cerebral palsy

174
Q

Category 1 C section should be carried out within how long?

A

30 minutes

175
Q

Category 2 C section should be carried out within how long?

A

90 minutes

176
Q

What 2 degrees of perineal tears should be managed in theatre?

A

3 and 4

177
Q

A perineal tear involving the perineal muscle is classed as what degree?

A

Second

178
Q

A perineal tear involving the anal mucosa is classed as what degree?

A

Fourth

179
Q

Which medication should patients with a perineal tear be administered on discharge?

A

Laxatives
- to stop the tear from getting worse or opening up again after suturing/repair

180
Q

Which medication should be given stat in clinic for those wishing an abortion?

A

Mifepristone 200mg

181
Q

What is the second medication in time given for those who wish to have an abortion?

A

Misoprostol

182
Q

After how many weeks is abortion not legal in Scotland?

A

20 weeks

183
Q

HELLP syndrome is characterised by what?

A

Haemolysis
Elevated Liver enzymes
Low Platelets

184
Q

Which 2 medications are safe for use for epilepsy in pregnancy?

A

Carbamazepine and lamotrigine

185
Q

Baby blues normally affects mothers for how long after birth?

A

1-3 days

186
Q

Increased exposure to which hormone can increase breast cancer risk?

A

Estrogen

187
Q

What does sentinel lymph node mean?

A

First node to receive lymphatic drainage from an area

188
Q

What is the most common type of breast cancer?

A

Ductal

189
Q

Between what ages and how often is breast cancer screening offered in the UK?

A

Between 50-70 every 3 years

190
Q

Which class of hormonal therapy should only be given to breast cancer patients who are post menopausal?

A

Aromatase inhibitors
- arimidex, letrozole, anastrozole

191
Q

What should patients taking tamoxifen be aware of?

A

Thromboembolism

192
Q

What should patients taking aromatase inhibitors be aware of?

A

Osteoporosis

193
Q

Trastuzumab can be used in what type of breast cancer?

A

HER2 positive

194
Q

Which type of scan can be used to assess cancer metastasis?

A

PET scan

195
Q

Which imaging modality is better for suspected breast cancer in under 40s?

A

USS

196
Q

Where does breast cancer most commonly spread to?

A

Bone

197
Q

In a case of infertility where we suspect Cushing’s disease, what test can we carry out to confirm the diagnosis?

A

Dexamethasone suppression test

198
Q

Infertility is classed as not being able to conceive over a period of how long?

A

A year

199
Q

BMI should be advised to stay under what, for optimum fertility?

A

30

200
Q

Serum progesterone should be taken on what day of a regular 28 day cycle to check if ovulation has happened?

A

Day 21
- day changes depending on how long cycle is - 7 days before end of cycle e.g. day 28 on a 35 day cycle

201
Q

Which anti-epileptic medication reduces the effectiveness of contraception?

A

Carbamazepine

202
Q

Progesterone has what effect on the cervical mucus?

A

Thickens

203
Q

Progesterone has what effect on the endometrium?

A

Inhibits proliferation

204
Q

Highest chance of pregnancy is with UPSI between what days of a women’s cycle?

A

8-19

205
Q

Which method of contraception is not a good choice in those with frequent GI upset?

A

The pill

206
Q

How often is the patch changed?

A

Every week

207
Q

How often is the contraceptive ring changed?

A

Every 3 weeks

208
Q

History of VTE is a contraindication for what type of contraception?

A

Combined

209
Q

How often is the progesterone injection taken?

A

Every 13 weeks

210
Q

How long does the contraceptive implant last?

A

3 years

211
Q

What is the best choice of contraception in a women with a history of hormone related cancer?

A

Copper IUD

212
Q

Pelvic inflammatory disease or active pelvic infection is a contraindication to what type of contraception?

A

IUDs

213
Q

The levonorgestrel pill can be given within how many hours of UPSI for emergency contraception?

A

72 hours

214
Q

The Ulipristal pill can be given within how many hours of UPSI for emergency contraception?

A

120 hours

215
Q

The copper coil can be inserted within how many days of UPSI for emergency contraception?

A

5 days

216
Q

Abortion can be carried out until how many weeks of gestation?

A

24

217
Q

Up to how many weeks gestation can you receive an abortion in Scotland?

A

20 weeks

218
Q

Erb’s palsy can occur via shoulder dystocia damaging which nerve roots?

A

C5-6

219
Q

Fundal height should be approximately gestation in weeks +/- ___ cm?

A

3

220
Q

Where should we auscultate for the foetal heart?

A

Over the anterior shoulder

221
Q

What cut off of endometrial thickness should be used in suspected endometrial cancer?

A

3mm

222
Q

What is the most common cause of pelvic inflammatory disease?

A

Chlamydia

Year 3 Finals (7 decks)

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