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
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)
3
Q
What happens to the following parameters during normal pregnancy:
D dimer
GFR
Haematocrit
A
D dimer - higher
GFR - higher
Haematocrit - lower
4
Q
Which test for diabetic control can be unreliable in pregnancy and why?
A
HbA1c - decreased erythrocyte lifespan
5
Q
What happens to albumin levels in normal pregnancy? What physiological sign may this lead to?
A
Lower; may lead to oedema
6
Q
Which antibiotic should we use for a pregnant women with a UTI?
A
Nitrofurantoin
7
Q
Increase in minute ventilation in normal pregnancy is driven by which hormone?
A
Progesterone
8
Q
By what percentage does circulating blood volume increase in normal pregnancy?
A
50-70%
9
Q
High hCG can cause which transient metabolic disturbance in pregnancy?
A
Hyperemesis gravidarum + hyperthyroidism
10
Q
Trophoblast cells produce which hormone?
A
Beta hCG
11
Q
Which hormone thickens the endometrial lining?
A
Progesterone
12
Q
Beta hCG stimulates which group of cells?
A
Corpus luteum
13
Q
Which hormone prevents the decidua from shedding?
A
Progesterone
14
Q
Miscarriage is defined as spontaneous loss of intrauterine pregnancy before how many weeks of gestation?
A
24 weeks
15
Q
Are decidual cells procoagualant or anticoagulant?
A
Procoagulant
16
Q
Name the miscarriage type:
Closed cervical os + vaginal bleeding + viable pregnancy on USS
A
Threatened
17
Q
Name the miscarriage type:
Vaginal bleeding + open cervical os +/- abdominal pain
A
Inevitable
18
Q
Name the miscarriage type:
Vaginal bleeding + open cervical os + products of conception seen on examination
A
Incomplete
19
Q
What complication are patients experiencing incomplete miscarriage at risk of?
A
Sepsis - due to presence of products of conception
20
Q
Name the miscarriage type:
Closed cervical os + no products of conception + vaginal or abdominal pain have passed
A
Complete
21
Q
Name the miscarriage type:
Non-viable intrauterine pregnancy + closed cervical os
A
Missed
22
Q
Rebound tenderness and guarding are suggestive of what obstetric complaint?
A
Ectopic pregnancy
23
Q
Which mode of investigation may be used to determine whether a pregnancy is intrauterine or ectopic?
A
Transvaginal USS
24
Q
Which medical agent can be given in miscarriage?
A
Misoprostol
25
How does misoprostol work?
Prostaglandin analogue which induces uterine contractions and effacement of cervix
26
Under which circumstance is misoprostol indicated?
Miscarriage
27
Where is an ectopic pregnancy most commonly found?
Ampulla of fallopian tube
28
Name the obstetric complaint:
PMH pelvic inflammatory disease + shoulder tip pain + vaginal bleeding
Ectopic pregnancy
29
Fluid in the pouch of Douglas seen on USS suggests what?
Ectopic pregnancy
30
What medication may be administered in ectopic pregnancy?
Methotrexate injection
31
What management should be picked in a patient with ectopic pregnancy with a serum hCG of 800iu/l?
Conservative management
32
What size of mass in ectopic pregnancy would warrant surgical management?
Equal to or over 35mm
33
What management should be picked in ectopic pregnancy with a serum beta hCG of 1800iu/l?
Methotrexate injection
34
Name the obstetric complaint:
Large for gestational age + hyperemesis
Molar pregnancy
35
Which complication may occur in patients with a very high serum beta hCG?
Thyrotoxicosis - hCG has a very similar structure to TSH and hence can activate TSH receptors
36
Antepartum haemorrhage is described as occurring after how many weeks of pregnancy?
24 weeks
37
Name the obstetric complaint:
Painless bright red PV bleed
Placenta praevia
38
Which examination should not be carried out in placenta praevia?
Vaginal examination - may provoke major bleed
39
What grade of placenta praevia is described here:
Placenta partially covering internal os
Grade 3
40
Which grade of placenta praevia is described here:
Placental edge reaches the internal os but does not cover it
Grade 2
41
Name the obstetric complaint:
Vaginal bleeding + rupture of foetal membranes + foetal disorientation
Vasa praevia
42
Which medications can be given in placenta praevia to control bleeding?
Oxytocin, ergometrine, carboprost, tranexamic acid
43
How does oxytocin exert its anti-bleeding effect?
Increases intensity and frequency or uterine contractions
44
Name the obstetric complaint:
Painful PV bleed at 31 weeks
Placental abruption
45
Hypertension is only classed as gestational when it appears after how many weeks of pregnancy?
20 weeks
46
What is the BP aim for women with gestational hypertension?
150/100
47
Which BP medications are safe in pregnancy?
Labetolol, nifedipine, methyldopa
48
Which BP medications are not safe for use in pregnancy?
ACE inhibitors and ARBs
49
Name the obstetric complaint:
Gestational hypertension + proteinuria
Pre-eclampsia
50
The following signs are a warning for which obstetric complaint:
Headache + blurred vision + systolic BP over 160mmHg
Eclamptic seizure
51
Pre-eclampsia can lead to restriction of what in the foetus?
IUGR - intra-uterine growth restriction
52
Brisk reflexes and blurred vision are associated with what complication of pre-eclampsia?
Eclamptic seizure
53
Which medication and at what dose can be given in pre-eclampsia to improve placental flow?
Low dose aspirin - 150mg/day
54
Which obstetric complaint is a patient on these medications likely to have:
Low dose aspirin 150mg/day + labetolol
Pre-eclampsia
55
Which test for thrombosis is not reliable in pregnancy?
D-dimer - increases in pregnancy due to hypercoaguable state
56
Thrombosis in pregnancy should be treated with what?
Low molecular weight heparin - enoxaparin, dalteparin
57
Which treatment should be given in the event of an eclamptic seizure?
IV magnesium sulfate
58
Which foetal growth complication can occur in gestational diabetes?
Macrosomia
59
Which diabetic medications are safe in pregnancy?
Metformin and insulin
60
Menopause is associated with a drop in which hormone?
Oestrogen/oestradiol
61
Reduced oestrogen in menopause can lead to what skeletal disease?
Osteoporosis
62
The following patient is at risk of developing what:
Menopausal + long term steroid use + hyperthyroidism
Osteoporosis
63
Which monoclonal antibody can be given in menopause associated osteoporosis?
Denosumab
64
Under what circumstances can progesterone be omitted from HRT for menopause?
In those who have had a hysterectomy
65
Troublesome menopausal hot flushes can be medically managed by what?
Tibolone
66
Secondary amenorrhoea is described as a lack of periods for how many months?
6
67
Hyperprolactinaemia can lead to what gynaecological complaint?
Amenorrhoea
68
Which underlying hormone is responsible for this patients amenorrhoea:
Visual changes
Prolactin
69
Which underlying hormone is responsible for this patients amenorrhoea:
Ancne + voice change
Androgens - testosterone
70
Raised FSH and low oestradiol indicate which stage of menopause?
Early
71
A patient presents with amenorrhoea - their blood test shoes increased 17-hydroxy-progesterone. What is the likely underlying diagnosis?
Congenital adrenal hyperplasia
72
A patient presents with amenorrhoea - a blood test shows low SHBG. What is the likely underlying diagnosis?
PCOS
73
Low SHBG on blood test indicates what levels of free androgen?
Elevated
74
Exercise has what effect on SHBG levels?
Increases SHBG - and so can lower free androgen
75
What androgen receptor antagonist can be used in PCOS?
Spironolactone
76
What is the mode of action of clomiphene? When is this medication indicated?
Induces ovulation - indicated in infertility and PCOS
77
Name the gynaecological complaint:
Hirsutism + amenorrhoea + insulin resistance
PCOS
78
Heavy menstrual bleeding is defined by how many millilitres of blood loss over 7 days?
80ml or more
79
What is a leiomyoma?
Uterine fibroid made up of fibrous tissue
80
Gold standard diagnosis of endometriosis is via what?
Laparoscopy
81
Name the gynaecological complaint:
Endometrium has become embedded in myometrium.
What is the definitive treatment?
Adenomyosis - definitive treatment by hysterectomy
82
Sheehan’s syndrome is associated with which obstetric emergency?
Significant post partum haemorrhage
83
Pituitary gland infarction following major post partum haemorrhage is described as what?
Sheehan’s syndrome
84
Sheehan’s syndrome can lead to what dysfunction of menstruation?
Secondary amenorrhoea
85
What level of fasting plasma glucose is required for diagnosis of gestational diabetes?
5.6mmol/l +
86
What level of 2 hour plasma glucose is required to make a diagnosis of gestational diabetes?
7.8mmol/l +
87
Name the most probable type of gynae cancer:
Abdominal discomfort + bloating + polyuria
Ovarian cancer
88
Which blood marker is used for ovarian cancer?
CA-125
89
A patient has ovarian cancer with metastasis to the peritoneum. Which stage is this?
Stage 3
90
Post menopausal bleeding indicates the likelihood of which cancer?
Endometrial
91
Unopposed exposure to which hormone is a risk factor for endometrial cancer?
Oestrogen
92
Endometrial thickness of how many millimetres is indication for biopsy?
4mm
93
Adenocarcinoma is which type of endometrial cancer?
Type 1
94
Name the most likely cancer:
Vulval itch + non healing ulcer
Vulval cancer
95
Which 2 types of HPV infection increase risk of cervical cancer?
HPV 16/18
96
Which grades of CIN have the potential to develop into cervical cancer?
2/3
97
Those born after which date should have been immunised against HPV?
1 September 1990
98
Cervical cancer screening is available for women of what ages?
25-64
99
From which zone of the cervix are cells taken from during a smear test?
Transformation zone
100
Which cells indicate HPV infection?
Koilocytes
101
Under the current NHS screening programme, the neonatal heel prick test is carried out when?
Between day 5 and 9 of life
102
Name 4 disorders the neonatal heel prick test screens for
Sickle cell disease
Cystic fibrosis
Congenital hypothyroidism
Phenylketonuria
103
When is the combined test (trisomy test) carried out in pregnancy?
Between weeks 10 and 14
104
Decreased levels of PAPP-A are associated with what genetic disorders?
Trisomy 18 and 21
105
Trisomy 21 is related to what levels of bhCG and PAPP-A?
Increased bhCG, decreased PAPP-A
106
What is the standard dose of folic acid given to pregnant patients?
400mcg
107
The lambda sign during pregnancy indicates what?
A dichorionic pregnancy
108
When is the nuchal translucency scan carried out in the UK?
Between 11 and 14 weeks
109
What is an ideal crown rump length at 11-14 weeks of gestation?
45-84mm
110
When should foetal movements be felt?
20 weeks
111
Alpha fetoprotein, oestradiol, hCG and inhibin A are tested for during which trimester?
Second
112
PAPP-A and free beta hCG are tested for during which trimester?
First
113
The quadruple test can be offered after how many weeks of gestation?
13 weeks
114
The combined test screens for what?
Edwards, Patau, Downs
115
The quadruple test screens for what?
Downs
116
What happens to the cervix during labour?
It softens
117
What happens to progesterone levels during labour?
Decrease
118
What happens to oxytocin and prostaglandin levels during labour?
Increase
119
Stage 3 of labour consists of what?
Birth of baby to expulsion of placenta and membranes
120
What type of stethoscope is used to monitor foetal wellbeing?
Pinard
121
Normal foetal heart rate is what?
Between 110-160bpm
122
Foetal bradycardia is an indication of what?
Foetal distress
123
The active portion of the first stage of labour is defined as cervical dilatation between how many centimetres?
Between 3 and 10 cm
124
Prolonged second stage of labour is defined as lasting how many hours after full dilatation?
3 hours
125
Oxytocin given post labour can help prevent what?
PPH
126
Post partum haemorrhage is defined as loss of how much blood over how long?
At least 500mls over 24 hours following birth
127
Secondary post partum haemorrhage can occur until how many weeks post birth?
12
128
What is the most common cause of PPH?
Uterine atony
129
When is ergometrine contraindicated?
High blood pressure
130
What must be done before rubbing the uterine fundus in cases of uterine atony?
Emptying the bladder via Foley catheter
131
If medical management of uterine atony fails, what should be carried out next?
Intrauterine balloon tamponade
132
Which antifibrinolytic medication can be given in cases of PPH?
Tranexamic acid
133
Shoulder dystocia describes what situation?
Babies anterior shoulder becomes impacted on mothers pubic symphysis
134
What is the first line management in shoulder dystocia?
McRoberts manoeuvre
135
There is increased risk of shoulder dystocia with what maternal condition?
Gestational diabetes
- leads to macrosomia
136
Which palsy can shoulder dystocia lead to?
Erb’s palsy
137
Foetal bradycardia + decelerations + fluid expulsion from mother are suggestive of what?
Cord prolapse
138
What presentation of the baby increases risk of cord prolapse?
Breech presentation
139
What is the first line management in cord prolapse?
Replace cord into vagina and perform digital elevation
140
Cord prolapse predisposes risk to what of the baby?
Hypoxia
141
Definitive management of cord prolapse is via what?
Emergency cat 1 C section
142
What is first line management for gestational hypertension without proteinuria?
Oral labetolol
143
What 2 medications are indicated in pre-term labour?
Benzylpenicillin - to protect against group B strep
Betamethasone - to accelerate foetal lung maturation
144
Corticosteroids can be given for foetal lung development in pre-term labours below how many weeks?
Below 34 weeks
145
Erb’s palsy damages which vertebral levels of the brachial plexus?
C5-C6
146
Gardnerella Vaginalis is associated with what condition?
Bacterial vaginosis
147
What is the first line treatment for vaginal thrush?
Oral fluconazole 150mg one off dose
148
What is the most common causative organism for genital candidiasis?
Candida albicans
149
What is the first line antibiotic used in BV?
Metronidazole
150
Thrush presents with what pH?
Normal
151
BV presents with what pH?
Raised
152
How is chlamydia infection managed?
Oral doxycycline twice a day for 7 days
153
What is the test used to identify chlamydia infection?
NAATs
154
Treponema pallidum is the causative organism in what disease?
Syphilis
155
VDRL and RPR can be used to screen for what?
Syphilis
156
Which antibiotic is used to treat syphilis?
IM penicillin G
157
Pharyngitis may be an extragenital symptom of what?
Gonorrhoea
158
Which urine sampling method is carried out in men suspected with gonorrhoea?
First pass urine
159
Which test is used to assess gonorrhoea samples?
NAAT
160
Diagnosis of trichomonas vaginalis is typically by what?
Direct microscopy
161
Trichomonas vaginalis is treated by what?
Oral metronidazole
162
Microscopy will show what type of bacteria in gonorrhoea infection?
Gram negative diplococci
163
Strawberry cervical is a sign of what?
Trichomonas infection
164
Reactive arthritis is a sign of what STI?
Chlamydia
165
90% of vulval cancers are what type?
Squamous cell carcinoma
166
Uterine hyper stimulation in induction of labour can lead to what effect on the foetal heart?
Bradycardia
167
External cephalic version can be carried out when the foetus is in what position?
Breech
168
Which score is used to clinically assess the cervix?
Bishop’s score
169
How many contractions should we aim for every 10 minutes of labour?
4
170
If a triangular shape is felt on examination of the foetal head, what position is the baby in?
Occiput anterior
171
If a diamond shape is felt on examination of the foetal head, what position is the baby in?
Occiput posterior
172
On foetal scalp blood sampling, a pH value of below what indicates hypoxia?
Below 7.2
173
Foetal hypoxia increases the risk of what condition?
Cerebral palsy
174
Category 1 C section should be carried out within how long?
30 minutes
175
Category 2 C section should be carried out within how long?
90 minutes
176
What 2 degrees of perineal tears should be managed in theatre?
3 and 4
177
A perineal tear involving the perineal muscle is classed as what degree?
Second
178
A perineal tear involving the anal mucosa is classed as what degree?
Fourth
179
Which medication should patients with a perineal tear be administered on discharge?
Laxatives
- to stop the tear from getting worse or opening up again after suturing/repair
180
Which medication should be given stat in clinic for those wishing an abortion?
Mifepristone 200mg
181
What is the second medication in time given for those who wish to have an abortion?
Misoprostol
182
After how many weeks is abortion not legal in Scotland?
20 weeks
183
HELLP syndrome is characterised by what?
Haemolysis
Elevated Liver enzymes
Low Platelets
184
Which 2 medications are safe for use for epilepsy in pregnancy?
Carbamazepine and lamotrigine
185
Baby blues normally affects mothers for how long after birth?
1-3 days
186
Increased exposure to which hormone can increase breast cancer risk?
Estrogen
187
What does sentinel lymph node mean?
First node to receive lymphatic drainage from an area
188
What is the most common type of breast cancer?
Ductal
189
Between what ages and how often is breast cancer screening offered in the UK?
Between 50-70 every 3 years
190
Which class of hormonal therapy should only be given to breast cancer patients who are post menopausal?
Aromatase inhibitors
- arimidex, letrozole, anastrozole
191
What should patients taking tamoxifen be aware of?
Thromboembolism
192
What should patients taking aromatase inhibitors be aware of?
Osteoporosis
193
Trastuzumab can be used in what type of breast cancer?
HER2 positive
194
Which type of scan can be used to assess cancer metastasis?
PET scan
195
Which imaging modality is better for suspected breast cancer in under 40s?
USS
196
Where does breast cancer most commonly spread to?
Bone
197
In a case of infertility where we suspect Cushing’s disease, what test can we carry out to confirm the diagnosis?
Dexamethasone suppression test
198
Infertility is classed as not being able to conceive over a period of how long?
A year
199
BMI should be advised to stay under what, for optimum fertility?
30
200
Serum progesterone should be taken on what day of a regular 28 day cycle to check if ovulation has happened?
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
Which anti-epileptic medication reduces the effectiveness of contraception?
Carbamazepine
202
Progesterone has what effect on the cervical mucus?
Thickens
203
Progesterone has what effect on the endometrium?
Inhibits proliferation
204
Highest chance of pregnancy is with UPSI between what days of a women’s cycle?
8-19
205
Which method of contraception is not a good choice in those with frequent GI upset?
The pill
206
How often is the patch changed?
Every week
207
How often is the contraceptive ring changed?
Every 3 weeks
208
History of VTE is a contraindication for what type of contraception?
Combined
209
How often is the progesterone injection taken?
Every 13 weeks
210
How long does the contraceptive implant last?
3 years
211
What is the best choice of contraception in a women with a history of hormone related cancer?
Copper IUD
212
Pelvic inflammatory disease or active pelvic infection is a contraindication to what type of contraception?
IUDs
213
The levonorgestrel pill can be given within how many hours of UPSI for emergency contraception?
72 hours
214
The Ulipristal pill can be given within how many hours of UPSI for emergency contraception?
120 hours
215
The copper coil can be inserted within how many days of UPSI for emergency contraception?
5 days
216
Abortion can be carried out until how many weeks of gestation?
24
217
Up to how many weeks gestation can you receive an abortion in Scotland?
20 weeks
218
Erb’s palsy can occur via shoulder dystocia damaging which nerve roots?
C5-6
219
Fundal height should be approximately gestation in weeks +/- ___ cm?
3
220
Where should we auscultate for the foetal heart?
Over the anterior shoulder
221
What cut off of endometrial thickness should be used in suspected endometrial cancer?
3mm
222
What is the most common cause of pelvic inflammatory disease?
Chlamydia
