RHCN - Block 3 Flashcards
What is the name given to the scale that we use to categorise pubertal development?
Tanner scales
What is the correct order of development for pubertal development in females?
Breast development>pubic hair growth>rapid height spurt>menarche
A 16.5 year old girl presents to your GP surgery concerned about menstruation. She reports that she has never had a true ‘period’, but sometimes has some pains that she feels could be related to her periods. Her health otherwise is good and did not report anergia. She is not sexually active. Mum describes a normal childhood development, and she is in the 60th centile for height for her age. Her BMI is 23.4. On examination she has normal breast development and pubic hair growth for her age. What is the most likely diagnosis?
a) Secondary amenorrhoea; b) Hypothyroidism; c) Menstrual outflow tract obstruction; d) Pituitary adenoma
c) Menstrual outflow tract obstruction
Which of the following is a known cause of Asherman’s syndrome?
a) IUD contraception; b) Myomectomy; c) Endometriosis; d) All of the above
d) All of the above
A 17 year old girl visits the gynae clinic with a PC of amenorrhea. She has not experienced menarche. On examination she has no secondary sexual characteristics. You perform a blood test that shows serum FSH 30 IU/L (5-20 IU/L). Which organ in the HPG axis is at fault?
Ovaries
A 59 year old post-menopausal women presents to your GP clinic with some PV bleeding. She first noticed this 2 months ago but recently it has become more regular. She has a PMH of asthma, COPD and has recently had surgery to remove a breast cyst. She smokes 20/day and drinks 17 units of alcohol per week. Her mother died of cancer ‘down below’ but cannot remember the name of the type. What is the most appropriate management of this patient?
a) Non-urgent referral to gynaecology for investigations; b) 2WW referral to gynaecology for ?endometrial cancer; c) Reassure and give lifestyle advice such as exercise; d) Prescribe TXA and ask her to come back in 2 weeks
b) 2WW referral to gynaecology for ?endometrial cancer
A 35 year old pre-menopausal woman presents to GP clinic with post-coital bleeding and intermittent pelvic pain. The bleeding started 3 months ago and pelvic pain has been a more recent feature. Examination findings were normal. She did not receive the HPV vaccination due to her age and has not participated in the screening programme due to a fear of internal examination. What is the most appropriate management for this patient?
a) Non-urgent referral to colposcopy clinic; b) Treat for infection for 6-8 weeks before considering referral; c) Smear and 2WW referral to colposcopy clinic; d) Smear test
c) Smear and 2WW referral to colposcopy clinic
Kathryn is a 29-year-old woman who attended for cervical cancer screening 12 months ago and the result was positive for high-risk human papillomavirus (hrHPV) with a negative cytology report.She has just attended for a repeat smear and the result is positive again for hrHPV with a negative cytology report. What is the most appropriate next step?
a) Refer for colposcopy; b) Repeat sample in 3 months; c) Return to routine call in 3 years; d) Repeat sample in 12 months
d) Repeat sample in 12 months
A 41-year-old female undergoes a cervical smear at her GP practice as part of the UK cervical screening programme. Her result comes back as an ‘inadequate sample’. What is the most appropriate action?
a) Colposcopy; b) Repeat test in 1 months; c) Repeat test in 3 months; d) Repeat test within 6 months
c) Repeat test in 3 months
A G2P1 32year old mother pregnant with MCDA twins presents with PV bleeding that started 2 hours ago. She has no pain and the blood is bright red and fresh in appearance. She has soaked 5 pads and the bleeding has not stopped even since her arrival at the emergency pregnancy unit. Her MEOWS score is normal. Ultrasound investigations revealed a low-lying placenta. What is the most likely cause of this lady’s antepartum haemorrhage?
Placenta praevia
A G6P3 32+6 pregnant mother presents to the emergency pregnancy unit with severe abdominal pain and small quantities of vaginal bleeding. The pain begun in the early hours of the morning, it is now 10AM. Her fundal-pubic symphysis height is measuring 35cm. At her last appointment (32+0) she was measuring 32cm. Her uterus feels tense and the blood is dark red. The CTG shows decelerations (90BPM) and uterine contractions. What is the most likely cause of antepartum haemorrhage?
Placental abruption
Which risk factor is specifically associated with vasa previa?
a) Smoking during pregnancy; b) Cocaine use during pregnancy; c) Multiparity; d) Velamentous umbilical cord insertion
d) Velamentous umbilical cord insertion
A young woman of 28 weeks gestation presents to the emergency department with painless vaginal bleeding, she appears well and is haemodynamically stable. Which investigation is most likely to help confirm the diagnosis?
Abdominal USS with colour flow doppler
How many appointments do NICE recommend a woman to have during pregnancy if nulliparous and uncomplicated?
10
Ideally, between what gestations does the booking visit take place?
8-10 weeks
When is the fetus screening for down’s syndrome?
11-13 weeks
Oestrogen level begins to rise around day 5-7 of the menstrual cycle. What triggered this change?
The maturation of follicles triggered by FSH leads to the selection of the Graafian follicle on day 5 -7 – the follicle releases oestrogen
What is the corpus luteum and what hormones does it produce?
Empty Grafiaan follicle (after the release of eggs). Produces inhibin, progesterone and oestrogen
What is the role of progesterone in the menstrual cycle?
Building and maintenance of endometrial lining
True or False. If fertilisation is successful, the corpus luteum degrades
False
Name 3 structural issues which can cause menorrhagia
i. Endometrial polyps (polyps is allowed)
ii. Endometriosis
iii. Uterine fibroids (fibroids is allowed)
iv. Endometrial hyperplasia
v. Endometrial Carcinoma
vi. Adenomyosis
Which endocrine abnormality can cause menorrhagia?
Hypothyroidism
True or false – IUS and IUD can help improve menorrhagia
False. IUS i.e. Mirena coil is a medical management of Menorrhagia, however, IUD can CAUSE iatrogenic menorrhagia
Name 3 possible “medical” management of menorrhagia:
IUS – Mirena coil Tranexamic acid Mefenamic acid COCP Norethisetrone Depo provera GnRh analogues
What is the minimum blood volume loss to satisfy the definition of PPH?
500ml - Minor PPH = 500-1000ml, major PPH >1000ml
What are the 4 T’s of PPH?
T - tone
T - tissue
T - trauma
T - thrombin
What is secondary PPH and what is the most common cause?
Secondary PPH = blood loss >24hrs – 12 weeks post-delivery
Most common cause = endometritis and/or retained product of conception
If the cause of primary PPH is atony – what are the 3 possible steps in management you may consider after having done an A-E approach?
Pharmacological – 1st line drug = Syntocinon IM/IV infusion (synthetic oxytocin – stimulates uterine contraction)
Mechanical – Bimanual compression
Surgical – intrauterine balloon tamponade or haemostatic sutures
Name 2/3 of the features required for a diagnosis of PCOS? (Rotterdam criteria):
Any 2 of the 3:
a. Irregular periods
b. Hyperandrogenism (clinical and/or biological signs)
c. Polycystic ovaries on pelvic USS
i. ≥12 follicles on 1 ovary
ii. Ovarian volume >10cm3
True or false. Excessive facial hair may be present in women with PCOS
True. Hyperandrogenic sign
True of false. Fertility is not compromised amongst women with PCOS.
False
True or false. 5% Weight loss in obese women can lead to a significant improvement in PCOS.
True
What is the definition of puberty?
The onset of sexual maturity, marked by the development of secondary sexual characteristics
What is precocious puberty?
Precocious puberty -secondary sexual characteristics occurring before the age of 8 in girls or 9 in boys
What is delayed puberty?
Delayed puberty in girls, the absence of breast development by the age of 13 or menarche by the age of 16. In boys, the absence of testicular enlargement by age 14
Which hormones stimulate the release of oestrogen and progesterone?
LH and FSH
What is the definition of menarche?
Onset of 1st period
What is the mechanism of action of Cabergoline?
Dopamine stimulates the “inhibition” of prolactin production
Which emergency contraception is toxic to sperm?
Copper IUD
Name 2 contradictions to the Mirena coil:
a) Gestational trophoblastic disease (persistantly raised hCG levels
b) Awaiting treatment for cervical cancer
c) Current breast cancer
d) Cannot be used in current chlamydia infection
Delayed puberty is absence of breast development in girls by the age of?
a. 11
b. 12
c. 13
d. 14
c. 13
Delayed puberty is absence of testicular enlargement in boys by the age of?
a. 14
b. 13
c. 12
d. 11
a. 14
Delayed puberty is absence of menarche by the age of?
a. 13
b. 14
c. 15
d. 16
d. 16
Pulsatile release of which hormone from the hypothalamus stimulates release of LH and FSH from the anterior pituitary?
a. Thyroid
b. Growth hormone
c. GnRH
d. Cortisol
c. GnRH
Which statement is correct?
a. Growth spurt is 26cm females and 30cm in males
b. Growth spurt is 26cm females and 28cm in males
c. Growth spurt is 28cm females and 30cm in males
d. Growth spurt is 28cm females and 28cm in males
b. Growth spurt is 26cm females and 28cm in males
In boys testicular enlargement by what amount is the first sign of puberty?
a. 4ml
b. 5ml
c. 6ml
d. 7ml
a. 4ml
Which statement is true regarding reproductive ability?
a. Menarche av age 11 and testicular volume 7ml
b. Menarche av age 12 and testicular volume 8ml
c. Menarche av age 13 and testicular volume 9ml
d. Menarche av age 14 and testicular volume 10ml
b. Menarche av age 12 and testicular volume 8ml
Define secondary ammenorhea?
a. No periods for 6 consecutive months
b. No periods for 12 consecutive months
c. No periods for 1 consecutive month
d. No periods for 3 consecutive months
b. No periods for 12 consecutive months
Most common cause of secondary amenorrhea?
a. PCOS
b. Hypothyroidism
c. Hypogonadotropic hypogonadism
d. Pregnancy
d. Pregnancy
Hypogonadotropic hypogonadism, amenorrhea, has which biochemical findings?
b. Low GnRh, low FSH /LH
Which vaginal infection is particularly associated with dyspareunia?
a. HPV
b. Bacterial vaginosis
c. Thrush
d. Group B streptococcus
c. Thrush
What level of Aimee’s fasting glucose would fit the criteria for gestational diabetes?
a. 3.2
b. 4.1
c. 5.3
d. 5.9
d. 5.9
According to NICE what is the first line treatment for GD IF their plasma fasting glucose level is below 7mM but is not reduced with diet and exercise?
a. Metformin
b. Insulin
c. Glicazide
d. Aspirin
a. Metformin
Define teratozoospermia
Abnormal sperm morphology
What percent of normally-formed sperm in an ejaculate is considered the lower limit of normal range for normal morphology?
4%
What investigations would a GP perform as part of a normal work-up for male fertility?
Sperm analysis
Screen for chlamydia
Measure of prolactin
Measure of testosterone, FSH and LH
Management of infertility is dependant on cause, true or false?
True
In females what drug can be given to induce ovulation?
Clomiphene
If the female has tubal occlusion, with no other fertility issue, which form of infertility treatment is likely to confer the most benefit?
IVF
What happens to platelets through the course of pregnancy?
They progressively fall in number
What happens to PT and APTT in pregnancy?
Pregnancy makes no difference to them
What happens to haemoglobin concentration in pregnancy?
Falls
Pregnancy is an insulin-sensitive state, true or false?
False
What happens to hepatic glycogen storage during pregnancy?
It reduces
Vitamin D deficiency is common in pregnancy and breast feeding, true or false?
True
In which week does hCG level peak?
Week 12
What is the triad of hyperemesis gravidarum?
Dehydration, electrolyte disturbance, weight loss of >5% pre-pregnancy weight
What scoring system is used in hyperemesis gravidarum?
PUQE
Which factor is least likely to predispose to hyperemesis gravidarum:
a. UTI
b. Multiple pregnancy
c. Molar pregnancy
d. Miscarriage
d. Miscarriage
What is the definition of infertility?
Failure to conceive after 2 years of unprotected sexual intercourse
What are the 3 female factors causes of infertility?
- Ovarian factor (anovulation)
- Tubal factor
- Uterine/structural factor
Give 5 causes leading to ovarian factor infertility:
- Anorexia
- Stress
- Hypogonadotrophic hypogonadism
- Hypopitutarism
- Hyperprolactinaemia
- PCOS
- Premature ovarian failure
- Menopause
- Turner’s syndrome
On what day of the menstrual cycle should a progesterone level be taken to investigate infertility?
Mid-luteal, therefore 7 days before day 1 of the next cycle
Give 3 causes of tubal factor infertility:
a. Hydrosalpinx
b. Tubal occlusion
c. Tubal dysfunction
What is the first-line pharmacological treatment for eclampsia?
Magnesium sulfate
What is the anti-hypertensive of choice in pre-eclampsia?
Labetalol
In which patients should labetalol NOT be used?
Asthmatic patients
What does the ‘HELLP’ of HELLP syndrome stand for?
H = haemolysis EL = elevated liver enzymes LP = low platelets
How is gestational diabetes diagnosed and what two drug may be used in its management?
Diagnosed by oral glucose tolerance test
Drugs include metformin and insulin
List 3 signs and symptoms of obstetric cholestasis:
- Pruritis WITHOUT a rash - hands and feet classically
- Jaundice
- Raised serum bile acids
- Abnormal liver function tests
What are the 3 main investigations used to investigate tubal infertility?
Hysterosalpingogram (HSP)
Hysterosalpingo-contrast-sonography (HyCoSy)
Laparoscopy and dye test
What condition affecting a woman might result in a couple seeking infertility services due to an inability to have penetrative sex?
Vaginismus
What is the primary diagnostic tool/imaging modality used to identify uterine/structural factor infertility?
TVUSS (+/- TAUSS)
Define azoospermia:
An absence of sperm in the ejaculate
Define oligozoospermia:
A low concentration of sperm (sperm count) within the ejaculate
Define asthenzoospermia:
Reduced motility of sperm within the ejaclate
What is the primary diagnostic tool used in male infertility?
Semen analysis
What is the pharmacological treatment used for an eclamptic fit?
Magnesium sulfate
What are the clinical findings of HELLP syndrome?
Epigastric pain, liver failure, abnormal clotting and bleeding which may lead to DIC
What are the diagnostic criteria for gestational diabetes?
Fasting blood glucose >5.6mmol/L
2 hours post 75g glucose >7.8mmol/L
What are the fetal complications of gestational diabetes?
Macrosomia (and therefore increased chance of birthing injury, e.g. shoulder dystocia)
Neonatal hypoglycaemia
Diabetes and/or obesity later in life
Congenital abnormalities
What is the pathophysiology of OC?
Increased sensitivity to the cholestatic effects of oestrogen
What are the treatment options for OC?
Ursodeoxycholic acid to relive itching
Vitamin K from 36 weeks to reduce risk of bleeding (vitamin K being a fat soluble vitamin that needs supplementation in OC since OC can reduce the absorption of dietary fats)
