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finals > saq book 3a qs > Flashcards

saq book 3a qs Flashcards

1
Q

Name 2 situations where placenta praevia is more commonly found

A

Multiple pregnancy
Women of high parity
Older women
Scarred uterus (prev CS)

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2
Q

What is the definition of APH?

A

Bleeding from genital tract after 24w gestation

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3
Q

Why is vaginal examination never performed in large APH?

A

Can provoke massive bleed

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4
Q

Name 3 investigations you would perform in APH

A

USS, FBC, clotting, group and save/cross match, CTG

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5
Q

What treatment would you give to a Rh-ve mother in APH?

A

Anti-D

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6
Q

What is placental abruption?

A

Separation of all or part of placenta prior to delivery

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7
Q

What do you expect the lie and presentation to be in abruption

A

Normal - longitudinal lie, cephalic presentation

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8
Q

Name 2 RFs for abruption

A

IUGR, prev abruption, smoking, pre-eclampsia, HTN, multiple pregnancy

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9
Q

A lady having an abruption is tachycardic and hypotensive but only a small amount of blood is seen PV. Why?

A

Degree of shock out of keeping with visual loss

Blood doesn’t escape out of uterus - concealed bleed

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10
Q

What would you see on clotting studies in a major abruption? Why?

A

Afibrogenaemia, due to placental damage causing DIC, fibrinogen is used up

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11
Q

What is vasa previa?

A

Foetal blood vessels running in front of presenting part

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12
Q

When is the earliest a pregnant uterus can be palpated?

A

12w

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13
Q

What 4 blood tests are routinely offered at the booking visit?

A

FBC (anaemia), blood group and Rh status, rubella, blood glucose, HIV, hep B

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14
Q

What can increased nuchal translucency be associated with?

A

Down’s
Turner’s
Cardiac abnormalities

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15
Q

Name the 3 components of the triple test and if they are increased or decreased in Down’s

A

AFP - decreased
Oestriol - decreased
HCG - increased

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16
Q

Name 3 RFs for developing gestational diabetes

A 
Prev history of gestational diabetes
Prev foetus >4kg
BMI>30
1st degree relative with DM
Asian, Black Caribbean
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17
Q

Explain how gestation diabetes results in a macrosomic baby

A

Increase in foetal blood glucose
Leads to hyperinsulinaemia in foetus
Leads to increased fat deposition

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18
Q

Name 2 risks to the foetus in women who suffer diabetes during pregnancy. What is the commonest neonatal complication post-delivery?

A

Shoulder dystocia/birth trauma, congenital abnormalities, preterm labour, macrosomia, polyhydramnios, sudden foetal death
Neonatal hypoglycaemia

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19
Q

What is the risk of developing diabetes after delivery when a woman has had gestational diabetes?

A

Higher risk of developing diabetes in the future

Also at higher risk of developing gestational DM in subsequent pregnancies

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20
Q

When is the usual time frame from delivery to onset of puerperal psychosis?

A

Nearly always first 2 weeks, usually 3-5d post birth

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21
Q

What is the risk of a patient with puerperal psychosis developing it in subsequent pregnancies?

A

Increased risk of developing mental illness in later life

50% chance of puerperal psychosis in subsequent pregnancy

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22
Q

Over what post-partum period does post-partum depression present? What % of women are affected?

A

In the first 3mo

5-15%

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23
Q

Name 2 maternal RFs for developing post-natal depression

A

Prev post-partum depression
Prev depression or bipolar
Lack of social support
Relationship problems with partner

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24
Q

What medical diagnosis should be considered in women presenting with depressive symptoms post-partum?

A

Post-partum thyroiditis

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25
Regarding "baby blues", apart from psychosocial factors, what is the probable cause?
Hormonal changes
26
What is pre-eclampsia?
BP >140/80 Proteinuria >0.3g/24h After 20w of pregnancy
27
Name 6 RFs for the development of pre-eclampsia
``` First pregnancy Multiple gestation Previous history FH Older maternal age Obesity Pre-existing hypertension ```
28
Name 4 signs and symptoms of severe pre-eclampsia
``` Headache Visual disturbance Nausea and vomiting Epigastric pain Brisk reflexes Clonus Acute oedema ```
29
Name 2 common antihypertensive drugs commonly used in pregnancy
Labetalol Nifedipine Hydralazine
30
What drug should be given in eclampsia? Name the method of monitoring its toxicity
Magnesium sulphate | Checking reflexes
31
What is HELLP syndrome?
Haemolysis, elevated liver enzymes (ALT, AST), low platelets
32
What 2 drugs would you administer in preterm prelabour rupture of membranes?
Erythromycin | Steroids - dexamethasone
33
Name one maternal and foetal sign of chorioamnionitis
Maternal: pyrexia, tachycardia, hypotension, offensive discharge, uterine tenderness Foetal: tachycardia
34
Name the 5 components of the Bishop score
Cervical dilatation, station of foetal head, position of cervix, effacement of cervix, consistency of cervix
35
What is the first-line pharmacological method for aiding cervical ripening
Vaginal prostaglandins
36
Why is DVT more common in the left leg than the right leg in pregnancy?
The gravid uterus puts more pressure on the L iliac vein than right, decreasing venous return and making VTE more likely
37
Name the 2 most useful bloods to do in obstetric cholestasis
LFTs | Bile acids
38
What are the risks of obstetric cholestasis?
Premature delivery, stillbirth, sleep deprivation of mother
39
Name 2 pharmacological methods of treating obstetric cholestasis
Ursodeoxycholic acid Antihistamines Topical emollients
40
What is the definitive management of obstetric cholestasis?
Induction of labour and delivery of baby
41
What is the chance of obstetric cholestasis recurring in subsequent pregnancies?
Increased risk of recurrence compared to general population
42
Name 2 pre-labour and two intra-partum risk factors for shoulder dystocia
Pre - gestational DM, fetal macrosomia, high maternal BMI, prev dystocia Intra - prolonged 1st stage, prolonged 2nd stage, use of oxytocin
43
What manouevres can be used in shoulder dystocia?
McRobert's - hyperflexion of hips (knees up to chest) | Suprapubic pressure
44
Name the 5 components of the APGAR score
``` Appearance Pulse Grimace Activity Respiration ```
45
Name 4 risk factors for cord prolapse. How can this be managed while awaiting emergency c section?
Breech presentation, transverse or oblique lie, prematurity, polyhydramnios, artificial rupture of membranes Put hand in vagina and lift baby's head to take pressure off cord
46
A patient in antenatal clinic feels tired and has a Hb of 10.8 and an ejection systolic murmur. Worried?
No - both due to physiological anaemia and hyperdynamic circulation
47
How do women increase their oxygen intake during pregnancy?
Increase their tidal volume
48
What 4 parameters represent a reassuring CTG trace?
Variability >5/min Baseline HR 110-160 Accelerations Lack of decelerations
49
Name 2 contraindications for foetal blood sampling. What pH is normal?
Maternal infection, foetal bleeding disorder, prematurity, abnormal presentation 7.25
50
Name 3 causes of severe R lower abdo pain
Ectopic pregnancy Ovarian cyst rupture Renal colic Appendicitis
51
Name 2 symptoms or signs of ectopic pregnancy
Amenorrhoea, vaginal bleeding, tachycardia, hypotension, shoulder tip pain, cervical excitation, adnexal mass
52
Name 2 factors predisposing to ectopic pregnancy
Prev PID, prev tubal surgery, prev ectopic, endometriosis, IUD, smoking
53
Name 2 sites where a fertilised ovum may implant
Fallopian tube, ovary, cervix, peritoneum, liver
54
How can ectopics be managed medically or surgically?
Laparotomy/laparoscopy with salpingectomy or salpingostomy | IM MTX
55
Name 3 risk factors for developing hyperemesis gravidarum
First pregnancy, young age, multiple pregnancy, molar pregnancy, hyperthyroidism, prev motion sickness
56
Name 1 bedside test and 2 blood tests you would perform in hyperemesis gravidarum
Urine dip looking for ketones - suggests starvation and ketosis U+E to assess renal function/dehydration TFT to assess hyperthyroid states LFT, ABG, FBC
57
What vitamins would you prescribe in hyperemesis gravidarum and why?
Thiamine | Prevent Wernicke's
58
How would you manage hyperemesis gravidarum?
LMWH, IV fluids, antiemetics, TPN, steroids
59
Define: Missed Incomplete Inevitable miscarriage
Missed: foetus dead but remains in utero Incomplete: some tissue expelled, yet some is maintained in utero Inevitable: cervix dilated but products of conception not expelled yet
60
List 3 management options of incomplete miscarriage
Surgical evacuation with dilation and curettage Medical treatment with misoprostol and mifepristone Expectant management
61
What are 2 possible complications of surgical evacuation of the uterus?
Asherman's syndrome Uterine perforation Injury to cervix Standard operative risks e.g. anaesthetic, bleeding, infection
62
Name 3 causes of recurrent spontaneous miscarriage
Infection, cervical incompetence, parental chromosomal abnormality, large fibroids, antiphospholipid syndrome
63
Name 3 causes of menorrhagia
Dysfunctional uterine bleeding, fibroids, endometrial Ca, von Willebrand disease, hypothyroidism, pelvic infection
64
Name 4 investigations you might do in menorrhagia
FBC, TFTs, clotting studies, TVUSS, endometrial sampling, hysteroscopy
65
Name a medication that can reduce bleeding in menorrhagia
Tranexamic acid
66
Name 3 procedures you could offer a patient for menorrhagia caused by dysfunctional uterine bleeding
Mirena IUS insertion Endometrial ablation Hysterectomy
67
List 2 complications of hysterectomy
Bleeding, infection, VTE, damage to surrounding organs (bowel, bladder, ureter), sexual dysfunction
68
Name 3 contraindications to taking the COCP
Smoking in over 35, current/prev history of VTE, migraine, oestrogen dependent Ca
69
What micro-organism is implicated in cervical cancer?
HPV 16 and 18
70
Name 2 risk factors for cervical cancer
HPV infection, multiple sexual partners, smoking, high parity, early first intercourse, other STIs
71
A lady has a smear which shows moderate dyskaryosis. What do you do?
Refer for colposcopy
72
What is an ectropion? What is the cause?
Growth of endocervical columnar epithelium outside external os Appears red in comparison to squamous epithelium COCP use, pregnancy
73
What is a CIN III?
Cervical intraepithelial neoplasia - premalignant condition where abnormally dividing cells have not invaded below basement membrane Abnormal cells occupy a full 3 thirds of epithelium
74
Name the 2 histological types of cervical cancer
Squamous cell | Adenocarcinoma
75
What procedure can remove CIN III?
LLETZ - large loop excision of transition zone
76
List 2 gynaecological causes of acute left lower abdominal pain. How might you investigate a patient presenting with this?
Ovarian cyst rupture, ovarian cyst haemorrhage, ovarian torsion, ectopic pregnancy Pelvic USS, urine BhCG
77
What are the clinical features of ovarian torsion, and how does it arise?
Sudden onset severe lower abdo pain, possibly with peritonism Arises when a small cyst rotates on a free pedicle and restricts its blood supply, causing potential ovarian necrosis
78
On USS a solid cystic mass if found on the left ovary, with calcified structures that look like teeth. What is the diagnosis? How does this arise? Is this cancerous?
Dermoid cyst Derived from primitive germ cells which can differentiate into any body tissue e.g. hair, teeth, sebaceous, bone etc Have v low risk of becoming malignant
79
Name 2 risk factors for ovarian cancer. What genetic mutations may increase the risk?
Nulliparity, infertility, FH, early menarche, late menopause, Caucasian BRCA1, BRCA2
80
What tumour marker is used in ovarian Ca?
Ca-125
81
What is endometriosis?
The presence of endometrial tissue outside the uterine cavity
82
Name 2 sites where endometrial foci may commonly be found
Retrovaginal pouch, ovary, pelvic peritoneum, lung
83
Name a factor associated with endometriosis
FH, smoking, long duration of IUCD use
84
Name 3 symptoms associated with endometriosis
Dysmenorrhoea, cyclical chronic pelvic pain, dyspareunia, dysuria, pain of defecation, cyclical diarrhoea
85
Name 2 findings you may find on vaginal examination in endometriosis
Fixed, retroverted uterus, tender uterus, enlarged ovaries, visible lesions in vagina or on cervix
86
Name 2 possible medical and surgical treatments for endometriosis
NSAIDs, COCP to suppress ovulation, POP, mirena IUS, GnRH agonists Laparoscopy with ablation of endometrial deposits, TAHBSO
87
Name 2 complications of endometriosis
Infertility, pelvic adhesions, ruptured cysts, bowel obstruction, chronic pelvic pain
88
What term describes endometrial glandular tissue found in the myometrium?
Adenomyosis
89
What is the difference between primary and secondary infertility?
Primary - couple never been able to conceive | Secondary - couple have achieved conception in past
90
Name 3 causes of female infertility
PID, endometriosis, PCOS, fibroids, prev chemo, hyperprolactinaemia, prev tubal ligations
91
Name 2 blood tests to look at ovulatory function
``` Day 21 (mid-luteal) progesterone FSH/LH, estradiol, prolactin ```
92
Name one test to assess tubal patency
Hysterosalpingogram, laparoscopy and dye
93
Name 2 possible symptoms of PCOS
Oligomenorrhoea/amenorrhoea Hirsutism, acne, male pattern baldness, central obesity, infertility, symptoms of DM Obesity
94
Name 2 treatments for PCOS associated infertility
Metformin Clomifene Gonadotrophins
95
List and advantage and disadvantage of: Laparoscopic tubal ligation Hormone-releasing IUCD
1. highly effective, permanent, cheaper if used for long period. abdo surgery and anaesthetic risks, nearly impossible to reverse 2. long term, no tablets, low mortality, reduced menstrual bleeding. small risk of ectopic and PID, insertion painful, progestogenic side effects
96
Name 2 CIs to IUCD insertion
Current pelvic infection, pregnancy, gynae cancer, trophoblastic disease
97
During IUCD insertion a patient feels faint and has a HR of 40. Why?
Cervical shock causes vasovagal reaction with reflex bradycardia
98
How might you initially treat PID?
IV Abx e.g. ceftriaxone and doxycycline +/- metronidazole
99
What are the complications of PID?
Infertility, chronic pelvic pain, ectopic pregnancy, dyspareunia and dysmenorrhoea
100
Name 3 causes of post-menopausal bleeding
Endometrial Ca, endometrial hyperplasia, atrophic vaginitis, ovarian Ca, vaginal trauma, infection
101
What is the commonest histological type of endometrial carcinoma?
Adenocarcinoma
102
What is the recommended treatment for stage I and II endometrial cancer?
TAHBSO
103
Name 2 treatments for stage III and IV endometrial cancer
Chemo, radiotherapy, palliation
104
Name 2 sites where endometrial Ca metastasises to
Peritoneum, lung, bone, vagina, liver
105
Name 2 RFs for endometrial Ca
Unopposed oestrogen e.g. HRT, obesity, tamoxifen, PCOS, FH, nulliparity

finals (8 decks)

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