Revision Flashcards
(194 cards)
1
Q
at what point do the ovaries contain the greatest number of germ cells
A
7 months gestation
2
Q
A 30-year-old pregnant woman undergoes a routine ultrasound scan. The scan reveals a normal pregnancy, however she has two uteri.
What is the most likely embryonic explanation?
A
incomplete fusion of the paramesonephric duct
3
Q
In males, which structure develops to form the vas deferens (ductus deferens)
A
mesonephric duct
4
Q
In females, which structure develops to form the superior portion of the vagina?
A
paramesonephric duct
5
Q
The provision of any assisted conception treatment and research using human embryos in the UK requires regulation.
What is the name of the regulatory body that provides this?
A
the human fertilisation and embryology authority
6
Q
Research on Human Embryos is legal in the UK.
Up to what stage can this research be performed?
A
day 14
7
Q
A couple attend an infertility clinic. The man had a vasectomy 5 years ago and was shown to be azoospermic following this.
What treatment option should be offered initially?
A
ICSI with sperm obtained from surgical sperm aspiration
8
Q
At which stage in embryo development is embryo transfer most successful?
A
blastocyst
9
Q
A couple present with a 5 year history of unexplained infertility. What is the best course of treatment?
A
IVF
10
Q
How long do male lice live, on average?
A
22 days
11
Q
A woman presents in her 3rd trimester with pelvic pain. What structures relax in pregnancy, which could be contributing to her pelvic pain?
A
pelvic inlet
12
Q
Which structures on the fetal skull outline the vertex?
A
Anterior and posterior fontanelles and the parietal eminences
13
Q
A non-sexually active woman presents with a vaginal discharge which contains bubbles and has an offensive smell.
What is the most likely infection?
A
bacterial vaginosis
14
Q
what cells on high vaginal swab can diagnose bacterial vaginosis
A
clue cells (epithelial cells of vagina covered in bacteria creating a stippled appearance)
15
Q
Changes in the Endometrium in the luteal phase are direct effect of which hormone?
A
progesterone
16
Q
how long is the luteal phase
A
14 days
17
Q
what info is need on endometrial biopsy
A
age LMP date pattern of bleeding length of cycle hormonal therapy recent pregnancy
18
Q
what type of cancer can molar pregnancies transform into
A
choriocarcinoma
19
Q
what is a missed miscarriage
A
<12 weeks gestation in which the dead embryo/ foetus is retained in the womb for a period of time without symptoms
20
Q
what is the difference between partial and complete moles
A
Partial mole: tissue is triploid from a dispermic fertilisation of a
normal ovum. Fetus can be present. Can result in a live birth.
Complete mole: diploid , genetic maternal paternal, it has
duplicated from haploid sperm in an empty ovum or rarely from
dispermic fertilisation of an empty ovum. No fetus present.
21
Q
is anti D ever given to Rhesus +ve women
A
no, will do nothing, too late to
use Anti D to ‘mop up’ fetal antibodies and
prevent an maternal immune reaction
22
Q
a miscarriage is only up to 24 weeks, what is it called after this
A
pre term labour
23
Q
when is anti D given
A
routinely at 28 weeks and then additional doses for
any sensitising event.
24
Q
what causes haemolytic disease of the fetus and newborn
A
when the mother has IgG red cell alloantibodies in her plasma that cross the placenta and bind to fetal red cells possessing the corresponding antigen. Immune haemolysis may then cause variable degrees of fetal anaemia
Red cell alloantibodies in the mother occur as a result of previous pregnancies (where fetal red cells containing paternal blood group antigens cross the placenta) or blood transfusion
25
what can fetal anaemia cause
in the most severe cases the fetus may die of heart failure in utero (hydrops fetalis). After delivery, affected babies may develop jaundice due to high unconjugated bilirubin levels and are at risk of neurological damage
26
are test results done in a sexual health clinic visible to GP
no, sent with anonymous number, chi number not used
27
what are the benefits of partner notification
Effective form of case finding
Cost effective
Early diagnosis reduces morbidity/mortality
Reduces incidence of STI in community
28
what is the partner notification look back period for chlamydia
Male urethral – 4 weeks; any other infection – 6 months
29
what is the partner notification look back period for gonorrhoea
Male urethral – 2 weeks; any other infection – 3 months
30
what is the partner notification look back period for non specific urethritis
4 weeks
31
what is the partner notification look back period for trichomonas vaginalis
4 weeks
32
what is the partner notification look back period for epididymitis
As CT/GC or if negative, 6 months
33
what is the partner notification look back period for PID
As CT/GC or if negative, 6 months
34
what is the partner notification look back period for HIV
4 weeks before negative test/ before most likely time of infection
35
what is the partner notification look back period for syphilis
Primary; 90 days
Secondary; 2 years
Other infections; 3 months before most recent negative test
36
what infections is partner notification not needed for
warts
herpes
(usually have sex when asymptomatic)
not STIs:
vaginal thrush
bacterial vaginosis
37
what vaccinations can be given to prevent STIs
```
Hepatitis B
MSM
High prevalence countries
Sexual assault
Contacts
```
Hepatitis A- FO transmission (sexually transmitted enteric infection):
MSM
HPV
in secondary schools
MSM aged <46
38
name two types of PrEP
Tenofovir disoproxil / emtricitabine
39
how can PrEP be taken
Daily or event-based dosing
40
what infections can PEPSE stop
hep b and HIV
41
hoe is hep B PEPSE taken
```
HBV vaccine (up to 7 days)
Immunoglobulin (vaccine non-responders)
```
42
how is HIV PEPSE taken
3 antiretrovirals
Start within 72 hours
28 days total
Probably 80% effective
43
what is rape defined as
Penetration of the vagina, anus or mouth by the penis without consent
44
when is sexual consent invalidated
Incapacitated by alcohol or drugs
Incarcerated
Violence or threat of violence
45
how common is rape
25% of women worldwide
| perpetrator usually known by victim
46
what are the sequelae of rape for the victim
```
Injuries
Unwanted pregnancy
STI
Psychological sequelae common
-PTSD
-Anxiety/depression
-Psychosexual morbidity
```
47
what should you consider in patients who have experienced recent rape
Consider forensic examination (If theres a possibility they would want to go to court have to do forensic exam first )
Immediate safety
Injuries
HBV vaccination
Consider PEPSE
STI/pregnancy care (Windows for test- will need to com back)
Bedding, tampons etc can also be given to forensics
48
what is the medium/ long term management for rape victims
```
Screening for STIs
Assessment of coping abilities
PTSD
HBV vaccines if indicated
Practical and psychosocial support
```
49
who is usually to victim/ perpetrator of gender based violence
towards women/ children (increases in pregnancy) usually by men
50
what are types of gender based violence
```
Domestic abuse
Rape and sexual assault
Childhood sexual abuse
Commercial sexual exploitation
Stalking/harassment
Harmful traditional practices (eg. FGM, breast ironing)
```
51
what are the risk factors for GBV
```
female
Disability
Pregnancy
Addictions
HIV
```
52
A 46 year old is looking for contraception. She has a BMI of 42 and smokes 20 cigarettes/day . She has a history of pelvic inflammatory disease. She also has a multiple fibroid uterus including intramural and submucous fibroid. What would you advice?
Progesterone only pill
53
A 17 yr old presents looking for emergency contraception. She had unprotected sexual intercourse 23 hours ago. Her last bleed was approximately 1 week ago. She has been using the combined patch but forgot to put this back on after a 7-day patch free interval. She was meant to restart using the patch 5 days ago but only remembered to restart it 2 days ago. She does not wish to have a cu IUD fitted even though she is fully aware this would be the most effective method. Which emergency contraception would you advice?
Give levonorgestrel emergency contraception and advise her to carry on the patch and that she can rely on this again, for contraception, in 5 days
54
A 30yo patient attends her booking appointment. She has a history of epilepsy and is currently taking Levetiracetam. What folic acid dose would you advise her to commence?
5mg once daily
55
A 40 yo patient is 16 weeks pregnant and has essential hypertension. She does not normally take any drugs and has no allergies. She has no other medical problems. Her BP is 150/100. What medication would advise her to start?
labetolol
56
A 48-year old previously well man is admitted to ITU with Type 1 respiratory failure. He is unconscious and ventilated. PCR of a broncho-alveolar lavage has confirmed Pneumocistis jiiroveci. His parents and his wife visit him daily.
Which is the most appropriate way to obtain an HIV test?
Obtain venous blood from the patient and request HIV antibody/antigen
57
A 28-year old MSM (man who has sex with men) presents to the sexual health clinic with a 2 week history of sore throat, fever and a rash on his chest. He last had sex 1 week ago with a regular male partner of 4 months with whom he has condomless receptive and insertive anal sex. He last had sex with a different person 1 year previously. On examination his BP and pulse are normal, his temperature is 37.9, he has small shotty neck nodes bilaterally, erythematous but not enlarged tonsils with no pus and a fine maculopapular rash to his chest. The patient is worried he may have HIV. A near-patient rapid 4th generation HIV Antibody/antigen test is non-reactive.
How do you explain the result and further management to the patient?
His symptoms may be due to Primary HIV infection and venous blood should be obtained and sent to the laboratory for HIV antibody/antigen testing
58
why might you avoid UPE as emergency contraception
y interaction with other meds (liver-enzyme
inducing drugs, antacids) and contraceptive methods (taken before
the UPA- expired implant, expired IUS, late injection, missed pills...).
You can't quick start directly after UPA EC either but have to wait 5
days, again due to the possible interaction with hormones
With the antacid absorption is affected. With liver enzyme inducing
drugs the drug level is affected. In women with systemic progestogen
levels (see above) the drug, an anti-progestogen, becomes "saturated"
and therefore works less well as it has fewer "active" metabolites.
59
Does the HIV antibody become positive 4 weeks or 3 months after
infection?
The 4th generation tests can detect antibody reliably after 4 weeks of
infection. The older assays were only able to exclude infection after 3
months
60
If a mother is due to give birth soon and is diagnosed with herpes,
is the birth plan always a C-section? Or can it be a vaginal birth?
if within 6 weeks of delivery and primary infection- recommend cs due to high risk of neonate HSV, both mum and baby treated
If secondary
infection recommend vaginal delivery (treatment given) as low
chance neonatal HSV- vigilance of neonatal health advised and paeds
informed
61
what ARV are used in PrEP
Tenofovir
| DF/Emtricitabine
62
what is a RITA test
shows the recency of HIV infection, given to everyone with a HIV diagnosis
63
Which contraceptives are not affected by
| enzyme inducing drugs?
DMPA injection (SayanaPress, DepoProvera), the IUS and IUD
64
can you insert an IUD if there is risk of early pregnancy (already implanted)
An IUD should not be
inserted to disrupt an implantation and is therefore contraindicated
if there is a chance of an early pregnancy (= implanted blastocyst)
65
what is quickstarting
(HCPs) can offer quick
start of any method of contraception at any time in the menstrual
cycle if it is reasonably certain that a woman is not pregnant or at
risk of pregnancy from recent unprotected sexual intercourse (UPSI).
An IUS can be used to quick start contraception if there is no risk of
pregnancy, for example to somebody presenting outside of their
period for an insertion but without pregnancy risk. If there is the risk
of an early pregnancy (for example unprotected sexual intercourse
under 3 weeks ad no "natural" period since, or after having taken
emergency contraception in the past 3 weeks); then an IUS is
contraindicated.
66
what medications for PE in pregnancy
dalteparin
67
are ACE inhibitors teratogenic
yes
68
are statins contraindicated in pregnancy
yes
69
A 32yo patient attends antenatal clinic at 28 weeks gestation for a review as she was measuring large for dates. An ultrasound has been performed, which shows the amniotic fluid index is 30cm.
What investigation would you request?
glucose tolerance test
70
A 35yo patient is 1 day postnatal and had gestational diabetes in her pregnancy, which was controlled with metformin. Her BMI is 23 and she is a non-smoker. She has no family history of diabetes. She would like to know what her follow up will be with regards to diabetes. What would you advise?
Fasting blood sugar in 6-8weeks
71
A 25yo patient presented with bleeding and back pain. Following colposcopy and biopsy, cervical cancer is diagnosed. The doctor orders an MRI and CT scan. What will be assessed in the CT scan?
Distant metastases to lungs and mediastinum
72
when is term
37-42 weeks
73
what is a normal fetal HR
120-160
74
what is normal fundal height at 38 weeks
38 cm +/- 2cm
75
what is SVD
spontaneous VERTEX delivery
76
can midwifes perform episiotomies and repairs of these
yes
77
what are the levels of fetal cord gases
Normal 7.25+, borderline 7.2-7.25, abnormal <7.2= fetal acidaemia
78
are early or late deceleration on CTG usually more innocent
early (in time with contractions)
79
is meconium normal beofre term
no
80
what can meconium be associated with
post term babies
fetal distress
breech presentation
81
what is the minimum progression needed on CTG
0.5cm per hour
82
what features suggest cephalopelvic disproportion
```
Excessive moulding
Caput- oedema under the scalp
Anuria
Vuval oedema
Haematuria
Dry and hot vagina
High station
```
83
what is the helperr mnemonic
```
H- call for Help
E-evaluate for episiotomy
L-legs: mcroberts maneuver
P- suprapubic pressure
E- enter- rotational maneuvers
R-remove the posterior arm
R- roll patient to her hands and knees and do maneuvers again
```
84
what should variability on CTG be
>5 bpm
85
what is the denominator in different presentations
```
vertex= the occiput
breech= sacrum
face= chin (mentum)
```
86
what are the different positions in a vertex presentation
```
Left occipito-anterior (LOA). The occiput points to the left iliopectineal eminence; the sagittal suture is in the right oblique diameter of the pelvis.
Right Occipito-anterior (ROA). The occiput points to the right iliopectineal eminence; the sagittal suture is in the left oblique diameter of the pelvis.
Left occipitolateral (LOL). The occiput points to the left iliopectineal line midway between the ilio-pectineal eminence and the sacro-iliac joint; the sagittal suture is in the transverse diameter of the pelvis.
Right occipitolateral (ROL). The occiput points to the right iliopectineal line midway between the ilio-pectineal eminence and the sacro-iliac joint; the sagittal suture is in the transverse diameter of the pelvis.
Left occipitoposterior (LOP). The occiput points to the left sacro-iliac joint; the sagittal suture is in the left oblique diameter of the pelvis.
Right occipitoposterior (ROP). The occiput points to the right sacro-iliac joint; the sagittal suture is in the right oblique diameter of the pelvis.
Direct occipito-anterior (DOA). The occiput points to the symphysis pubis; the sagittal suture is in the anteroposterior diameter of the pelvis.
Direct occipitoposterior (DOP). The occiput points to the sacrum; the sagittal suture is in the anteroposterior diameter of the pelvis.
```
87
what is engagement during labour
descent of presenting diameters through pelvic brim
88
what is internal rotation in labour
when occiput reaches plevic floor and rotates to the front (now in OA position)
89
what is resitution in labour
when the head external rotates after being delivery to align with the shoulders
90
what is uterine hyperstimulation
potential complications of labour induction
either a series of contractions lasting 2/ more minutes or a contraction frequency of five/ more in 10 minutes
may result in fetal HR abnormalities, uterine rupture or placental abruption
91
what is the treatment for uterine hyperstimulation
terbutaline
92
how do you calculate the coverage of a screening programme
screened population/ eligible population x 100
93
A 26 year-old para 0+0 woman is admitted at 33 weeks gestation with headaches and visual disturbance. She has a history of asthma. On examination her blood pressure is 150/101mmHg. There is no proteinuria. Serum biochemistry and haematology are normal and fetal well-being is satisfactory. Which is the most appropriate treatment?
nifedipine 10mg po
94
how do you define a delay in the 1st stage of labour
<2cm dilatation in 4 hours
95
A 40yo woman with a twin pregnancy presents with acute onset epigastric pain, facial, leg and hand oedema, headache and visual disturbance. Her BP is 170/110 and has 4+proteinuria. CTG of both twins and normal. Twin 1 is breech. What is the most appropriate management plan?
Admit, administer anti hypertensives, commence magnesium sulphate infusion and plan for delivery
96
what artery is most likely to be damages by the lateral port in a laparoscopic salpingectomy
inferior epigastric artery
97
what percentage of female cancers are cervical
2%
98
A 30 year old presents at 38 weeks gestation with headaches, visual disturbance and reduced fetal movements. Her BP is 155/101 and has 3+ proteinuria. Serum biochemistry and haematology are normal. A CTG is performed and is normal. What is the most appropriate management plan?
Admit, book for induction of labour and administer labetolol
99
what do you have to be careful not to damage in a hysterectomy at the level of the uterine arteries
ureter
100
what is the role of the ductus arteriosus
To oxygenate the fetal venous return using the right ventricle
101
A previously well newborn term infant on the postnatal ward is noticed to be breathing quickly and feeding poorly
what does this sound like
group B strep infection
102
what is the background risk of infertility
6%
103
What organism causes both early and late onset neonatal sepsis?
gram -ves
104
A 70 year old patient is referred to the urogynaecology clinic by the pelvic physiotherapist. Her most troublesome symptoms are nocturia, urinary frequency and incontinence. She has to wear a pad at all times and frequently floods her clothes if she does not make the toilet in time. She is otherwise fit and well and not taking any other medications. She has no allergies.
What medication would you recommend commencing in the first instance?
an anticholinergic medication- tolterodine
105
What class of drug is mirabegron?
beta-3 adrenergic agonist- used to treat overactive bladder
106
A 70 year old presents to gynaecology clinic with a vaginal prolapse. Following assessment and discussion, a 64mm ring pessary is inserted for management of her prolapse. When would arrange for this lady to come back for a review of her pessary?
6 months
107
A 30 yo patient has a normal vaginal delivery and sustains a 3rd degree tear. She is fit for discharge and wants to know what her follow up will be? What would you advise?
physio review in 8 weeks
108
what are the types of cervical cancer
```
Squamous carcinoma (develops from CIN - HPV infection)
Adenocarcinoma (endocervical epithelium
CGIN- also HPV)
```
109
when is endomtrriosis deep infiltrative
endometriosis that has penetrated deeper than 5 mm under the peritoneum
110
how does endometriosis present
primary or secondary dysmenorrhea, bleeding disturbances, infertility, dysuria, pain on defecation (dyschezia), cycle-dependent or (later) cycle-independent pelvic pain, nonspecific cycle-associated gastrointestinal or urogenital symptoms
111
what is the treatment for endometriosis
NSAID- ibruprofen, napoxen, mefenamic acid
combined oral contraceptive/ depot/ implant/ mirena
if dont want to take contraception: oral progesterone(Medroxyprogesterone or norethisterone)
gonadotrophin-releasing hormone (GnRH) analogues
laparoscopic removal of cyst
112
what is growth of fibroids dependent on
oestrogen
113
what are the risk factors for uterine fibroids
```
>40
black race
FHx of fibroids
nulliparity
obesity
```
114
what is the lymph drainage of the uterus
iliac
sacral
aortic
inguinal
115
what are the common locations of uterine fibroids
subserosal- commonly cause compression symptoms
pedunculated
intramural- distort the uterus, caused prolonged heavy periods, pain and pressure
submucosal- prolonged heavy period
116
what are the symptoms of uterine fibroids
```
often asymptomatic
menorrhagia
IMB
pelvic pressure, pain, urinary incontinence
subfertility
miscarriage
```
117
what is mefenamic acid used to treat
dysmenorrhoea
118
what is the management of uterine fibroids
asymptomatic- expectant
menorrhagia + fibroid <3cm - mirena, COCP, dept, implants, vaginal rings, patch, GnRH agonist, ullipristal acetate
menorrhagia + fibroid >3cm- myomectomy (can still get pregnant), uterine artery embolisation (can still get pregnant), hysterectomy
119
what are the risk factors for endometriosis
delayed child bearing
women with shorter cycles/ longer duration of bleeds
early menarche, late menopause
FHx
120
what are the signs of endometriosis
fixed retroverted uterus
adenexal mass
thickening/ nodularity of uterosacral ligament
tenderness in pouch of douglas
deep infiltrating nodules most reliably found on PV exam during menstruation
121
how can endometriosis cause infertility
scarring and adhesions of pelvic organs
122
what Ix or endometriosis
TVUSS
MRI
gold standard= diagnostic laparoscopy
123
what is lichen sclerosis
chronic destructive inflammatory skin condition
| thought to be autoimmune condition
124
what are the peaks of age of lichen sclerosis
prepubertal and post menopausal
125
what type of cancer is vuval cancer
squamous cell carcinoma
126
what is the histology of lichen scleorisis
vacuolar degeneration at the basal layer
127
what are the symptoms of vuval lichen sclerosis
```
can be asymptomatic
pruritus vulva (worse at night)
painful vulva (ulcer, fissure or erosion)
genital or anal bleeding
constipation
dyspareunia (fissure at posterior fourchette/ narrowing of introitus)
sexual dysfunction
dysuria
bruising
loss of labia minora, burying of clitoris
figure of eight anal involvement
ivory white skin
purpura
```
128
what are the risk of vuval lichen sclerosis
scarring
| small risk of squamous cell carcinoma
129
when would you do a biopsy for lichen sclerosis
existing or new skin lesions that are not responsive steroid treatment
130
what is the treatment for vuval lichen sclerosis
```
steroid ointments - step down approach
tacrolimus (2nd lines)
follow up at 3 months, 6 months then yearly
avoid dyed underwear and irritants (perfume)
stop smoking to reduce vulval cancer
lubricants and vaginal dilators
lifelong self examination
good hygeine
```
131
what does a branching pattern of calcification on mgm suggest
DCIS (branching as ductal follows the ducts)
| calcification will be irregular- different thickness at different areas
132
how do you ensure you have removed area of calcification in a biopsy
can x ray it to look for calcification
133
what do a stand for in B5a
a- in situ
B- biopsy
5- stage
134
what are the treatment options for DCIS
WLE/ mastectomy
| neo/ adjuvant therapies: radiotherapy (dont usually give hormone, no chemo as not systemic)
135
how do you localised DCIS
put clips after mgm then localise with wires
136
whats the smallest excision margin you can accept in a breast tumour
1mm- want to aim for 1cm
137
do you need to sample nodes in DCIS
no- in situ
138
what does a stellate abnormality of mgm suggest
radial scar or carcinoma
139
how accurate is an USS of axillary nodes
60% (so take sentinel nodes in invasive carcinomas even if USS -ve)
140
does chemo work well for well differentiated cancers
no
141
how do you identify the sentinel lymph nodes
patent blue dye and/or radioisotope (techietium) = combo of both gives best result
142
what are the components of the nottingham prognostic index
tumour size, grade and lymph node involvement
143
when do you use a mammogram for a patient with a breast lump
when over 40
144
what is the difference between grade 2 and 3 breast cancer
Grade 2- can still see some ducts but it doesn’t look normal
Grade 3- fully differentiated
145
where is HER2 expressed
on the cell membrane- is a transmembrane protein
146
what test to see HER2 overexpression and gene amplification
FISH HER2
147
why do you put clips in breast cancers before neoadjuvant Tx
incase very good response and cant see on imaging where to do surgery
148
what does scarring in lymph nodes suggest
cancer was there but treatment got rid of it
149
do you biopsy a fibroadenoma in a patient <23 in tayside
no
150
describe a firboadenoma histologically
bisphasic- stroma and epithelium
circumscribed
rubbery
grey/white
151
what is the treatment for fat necrosis in the breast
drainage and antibiotics
152
Tx for fibrocystic change
reassure
| advise them to stop smoking
153
what hormone increases prolactin in breastfeeding
decrease in prolactin inhibiting hormone
154
what does oxytocin do in breast feeding
contracts smooth muscle to eject milk
155
what is the difference between SIRS and SEPSIS
SIRS inflammatory response
| SEPSIS SIRS with a source of infection
156
what are cooper ligaments
suspensory ligaments of the breast
157
what type of structure is the breast
apocrine subcutaneou gland
158
what type of cancer is pagets
ductal carcinoma in situ
159
what extra issues are there in breast cancer during pregnancy
hormones increase breast proliferation
sentinel node biopsy due teratogenic
cant breast feed on ipsilateral side after surgery
radiotherapy works best in first three months of cancer, cant do whilst pregnant
avoid- chemo, hormone therapy, CT, bone scan, pelvic x ray
160
how long after breast cancer can you use hormonal contraceptives
5 years
161
how long after having tamoxifen can you conceive
3 months after stopping
162
what are the three mains things to look for in a neonate exam
eyes for red reflexes
hips for DDH
femoral pulse for coarctation
163
what causes the closure of ductus artertiosus
decreased pulmonary resistance
increase PO2 (oxygen responsive vessel)
fall in prostaglandins
increased placental + systemic vascular resistance
164
what are the symptoms of patent ductus arteriosus
cyanosis
murmur (machinery)
tachypnoeic
poor feeding
165
what treatment for patent ductus arteriosus
indomethacin (NSAID- causes fall in prostaglandins)
| supportive
166
how long should you breast feeding exclusively for
6 months
167
can you get pregnant when breastfeeding
no if also dont have periods
168
how long post partum can you start oestrogen contraceptive pill
wait 6 weeks to avoid clot risk
169
how does the composition of Hb change after birth
fetal Hb= 2 alpha + 2 gamma = higher affinity, shifts curve to the left
adult Hb= 2 alpha + 2 beta
babies born with higher concs of Hb than adults, reaches adult level at 3 months
170
what chromosome is responsible for conversion of fetal to adult haemoglobin
chromosome 11
171
how is bilirubin metabolised in the body
conjugated in liver
| goes into small intestine via biliary system, metabolised to urobilogen -> excreted in urine and faeces
172
what are the symptoms of neonatal jaundice
yellow skin and sclera
reduced feeding
dark urine
173
what causes neonatal jaundice
faster fetal Hb breakdown that adult Hb synthesis
174
when is jaundice in a baby pathological
when <24 hours or prolonged- >2 weeks term, 3 weeks pre term
175
what are the main therapies for neonatal jaundice
phototherapy
increased feeding and rehydration
transfusion
176
what is kernicterus
deposits of unconjugated bilirubin in basal ganglia (crosses BBB)
177
what are the symptoms of kernicterus
```
fever
reduced feeding
high pitched crying
hypotonia
opisthotonus (severe hyperextension)
```
178
what is a complication of kernicterus
ATHETOID cerebral palsy
179
what muscle covers the majority of the pelvic side wall
obturator internus
180
In the Figo staging system for Cervical Cancer what is Stage 4?
carcinoma has spread to distant organs
181
A 52 yo patient presents with hot flushes and night sweats. She has a history of breast cancer and does not want to commence hormone replacement therapy. What other class of drug can be used for menopausal symptoms?
SSRIs
182
A 55yo patient presents to her GP with a small amount of vaginal bleeding. She is otherwise well. Her last period was 5 years ago. She has hypertension and BMI is 40. She is nulliparous. What would be the most appropriate next step?
refer to post menopausal bleeding clinic
183
is CIN3 invasive
no non invasive lesions
184
How is Risk of Malignancy Index (RMI) calculated?
CA125 level x ultrasound score x menopausal score
185
A 30yo patient, known to have an 8cm ovarian cyst, presents with acute abdominal pain and vomiting. She is tachycardic and has colicky abdominal pain with associated guarding. Tumour markers were done 1 month ago and were normal and MRI characterised the cyst as a likely dermoid cyst. She is currently on the elective waiting list for a cystectomy, which has been appointed in the next 3 months. What would be the most appropriate plan of care?
Book emergency theatre for the same day
186
What type of ovarian cyst is a dermoid?
germ cell tumour
187
A 70 yo patient is diagnosed with a high grade serous carcinoma of the ovary. Where has this tumour most likely originated?
fallopian tube
188
Which hormone stimulates the lactiferous duct system to grow at puberty?
oestrogen
(After menarche progesterone induces further ductal growth and development of the rudimentary lobules at the end of the ducts)
189
what is the most common histological type of breast cancer
invasive ductal cancer
190
how many women in UK get breast cancer
1 in 8
191
what assessment for biopsy
triple assessment
192
A 53 year old female patient has been recalled after her first screening mammogram showing extensive microcalcifications in the inner quadrant of her left breast.
What is the most likely diagnosis?
ductal carcinoma in situ
193
A 28 year old woman presents with a painless, firm, discrete, mobile mass, which has a solid appearance on ultrasound scan.
What is the most likely diagnosis?
sclerosing adenosis
194
what side effects can be associated with adjuvant breast radiotherapy
pulmonary fibrosis
localised skin reaction
brachial plexopathy
fatigue
