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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
Q

Regarding “baby blues”, apart from psychosocial factors, what is the probable cause?

A

Hormonal changes

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26
Q

What is pre-eclampsia?

A

BP >140/80
Proteinuria >0.3g/24h
After 20w of pregnancy

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27
Q

Name 6 RFs for the development of pre-eclampsia

A 
First pregnancy
Multiple gestation
Previous history
FH
Older maternal age
Obesity
Pre-existing hypertension
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28
Q

Name 4 signs and symptoms of severe pre-eclampsia

A 
Headache
Visual disturbance
Nausea and vomiting
Epigastric pain
Brisk reflexes
Clonus
Acute oedema
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29
Q

Name 2 common antihypertensive drugs commonly used in pregnancy

A

Labetalol
Nifedipine
Hydralazine

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30
Q

What drug should be given in eclampsia? Name the method of monitoring its toxicity

A

Magnesium sulphate

Checking reflexes

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31
Q

What is HELLP syndrome?

A

Haemolysis, elevated liver enzymes (ALT, AST), low platelets

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32
Q

What 2 drugs would you administer in preterm prelabour rupture of membranes?

A

Erythromycin

Steroids - dexamethasone

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33
Q

Name one maternal and foetal sign of chorioamnionitis

A

Maternal: pyrexia, tachycardia, hypotension, offensive discharge, uterine tenderness
Foetal: tachycardia

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34
Q

Name the 5 components of the Bishop score

A

Cervical dilatation, station of foetal head, position of cervix, effacement of cervix, consistency of cervix

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35
Q

What is the first-line pharmacological method for aiding cervical ripening

A

Vaginal prostaglandins

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36
Q

Why is DVT more common in the left leg than the right leg in pregnancy?

A

The gravid uterus puts more pressure on the L iliac vein than right, decreasing venous return and making VTE more likely

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37
Q

Name the 2 most useful bloods to do in obstetric cholestasis

A

LFTs

Bile acids

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38
Q

What are the risks of obstetric cholestasis?

A

Premature delivery, stillbirth, sleep deprivation of mother

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39
Q

Name 2 pharmacological methods of treating obstetric cholestasis

A

Ursodeoxycholic acid
Antihistamines
Topical emollients

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40
Q

What is the definitive management of obstetric cholestasis?

A

Induction of labour and delivery of baby

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41
Q

What is the chance of obstetric cholestasis recurring in subsequent pregnancies?

A

Increased risk of recurrence compared to general population

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42
Q

Name 2 pre-labour and two intra-partum risk factors for shoulder dystocia

A

Pre - gestational DM, fetal macrosomia, high maternal BMI, prev dystocia
Intra - prolonged 1st stage, prolonged 2nd stage, use of oxytocin

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43
Q

What manouevres can be used in shoulder dystocia?

A

McRobert’s - hyperflexion of hips (knees up to chest)

Suprapubic pressure

44
Q

Name the 5 components of the APGAR score

A 
Appearance
Pulse
Grimace
Activity
Respiration
45
Q

Name 4 risk factors for cord prolapse. How can this be managed while awaiting emergency c section?

A

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
Q

A patient in antenatal clinic feels tired and has a Hb of 10.8 and an ejection systolic murmur. Worried?

A

No - both due to physiological anaemia and hyperdynamic circulation

47
Q

How do women increase their oxygen intake during pregnancy?

A

Increase their tidal volume

48
Q

What 4 parameters represent a reassuring CTG trace?

A

Variability >5/min
Baseline HR 110-160
Accelerations
Lack of decelerations

49
Q

Name 2 contraindications for foetal blood sampling. What pH is normal?

A

Maternal infection, foetal bleeding disorder, prematurity, abnormal presentation
7.25

50
Q

Name 3 causes of severe R lower abdo pain

A

Ectopic pregnancy
Ovarian cyst rupture
Renal colic
Appendicitis

51
Q

Name 2 symptoms or signs of ectopic pregnancy

A

Amenorrhoea, vaginal bleeding, tachycardia, hypotension, shoulder tip pain, cervical excitation, adnexal mass

52
Q

Name 2 factors predisposing to ectopic pregnancy

A

Prev PID, prev tubal surgery, prev ectopic, endometriosis, IUD, smoking

53
Q

Name 2 sites where a fertilised ovum may implant

A

Fallopian tube, ovary, cervix, peritoneum, liver

54
Q

How can ectopics be managed medically or surgically?

A

Laparotomy/laparoscopy with salpingectomy or salpingostomy

IM MTX

55
Q

Name 3 risk factors for developing hyperemesis gravidarum

A

First pregnancy, young age, multiple pregnancy, molar pregnancy, hyperthyroidism, prev motion sickness

56
Q

Name 1 bedside test and 2 blood tests you would perform in hyperemesis gravidarum

A

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
Q

What vitamins would you prescribe in hyperemesis gravidarum and why?

A

Thiamine

Prevent Wernicke’s

58
Q

How would you manage hyperemesis gravidarum?

A

LMWH, IV fluids, antiemetics, TPN, steroids

59
Q

Define:
Missed
Incomplete
Inevitable miscarriage

A

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
Q

List 3 management options of incomplete miscarriage

A

Surgical evacuation with dilation and curettage
Medical treatment with misoprostol and mifepristone
Expectant management

61
Q

What are 2 possible complications of surgical evacuation of the uterus?

A

Asherman’s syndrome
Uterine perforation
Injury to cervix
Standard operative risks e.g. anaesthetic, bleeding, infection

62
Q

Name 3 causes of recurrent spontaneous miscarriage

A

Infection, cervical incompetence, parental chromosomal abnormality, large fibroids, antiphospholipid syndrome

63
Q

Name 3 causes of menorrhagia

A

Dysfunctional uterine bleeding, fibroids, endometrial Ca, von Willebrand disease, hypothyroidism, pelvic infection

64
Q

Name 4 investigations you might do in menorrhagia

A

FBC, TFTs, clotting studies, TVUSS, endometrial sampling, hysteroscopy

65
Q

Name a medication that can reduce bleeding in menorrhagia

A

Tranexamic acid

66
Q

Name 3 procedures you could offer a patient for menorrhagia caused by dysfunctional uterine bleeding

A

Mirena IUS insertion
Endometrial ablation
Hysterectomy

67
Q

List 2 complications of hysterectomy

A

Bleeding, infection, VTE, damage to surrounding organs (bowel, bladder, ureter), sexual dysfunction

68
Q

Name 3 contraindications to taking the COCP

A

Smoking in over 35, current/prev history of VTE, migraine, oestrogen dependent Ca

69
Q

What micro-organism is implicated in cervical cancer?

A

HPV 16 and 18

70
Q

Name 2 risk factors for cervical cancer

A

HPV infection, multiple sexual partners, smoking, high parity, early first intercourse, other STIs

71
Q

A lady has a smear which shows moderate dyskaryosis. What do you do?

A

Refer for colposcopy

72
Q

What is an ectropion? What is the cause?

A

Growth of endocervical columnar epithelium outside external os
Appears red in comparison to squamous epithelium
COCP use, pregnancy

73
Q

What is a CIN III?

A

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
Q

Name the 2 histological types of cervical cancer

A

Squamous cell

Adenocarcinoma

75
Q

What procedure can remove CIN III?

A

LLETZ - large loop excision of transition zone

76
Q

List 2 gynaecological causes of acute left lower abdominal pain. How might you investigate a patient presenting with this?

A

Ovarian cyst rupture, ovarian cyst haemorrhage, ovarian torsion, ectopic pregnancy
Pelvic USS, urine BhCG

77
Q

What are the clinical features of ovarian torsion, and how does it arise?

A

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
Q

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?

A

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
Q

Name 2 risk factors for ovarian cancer. What genetic mutations may increase the risk?

A

Nulliparity, infertility, FH, early menarche, late menopause, Caucasian
BRCA1, BRCA2

80
Q

What tumour marker is used in ovarian Ca?

A

Ca-125

81
Q

What is endometriosis?

A

The presence of endometrial tissue outside the uterine cavity

82
Q

Name 2 sites where endometrial foci may commonly be found

A

Retrovaginal pouch, ovary, pelvic peritoneum, lung

83
Q

Name a factor associated with endometriosis

A

FH, smoking, long duration of IUCD use

84
Q

Name 3 symptoms associated with endometriosis

A

Dysmenorrhoea, cyclical chronic pelvic pain, dyspareunia, dysuria, pain of defecation, cyclical diarrhoea

85
Q

Name 2 findings you may find on vaginal examination in endometriosis

A

Fixed, retroverted uterus, tender uterus, enlarged ovaries, visible lesions in vagina or on cervix

86
Q

Name 2 possible medical and surgical treatments for endometriosis

A

NSAIDs, COCP to suppress ovulation, POP, mirena IUS, GnRH agonists
Laparoscopy with ablation of endometrial deposits, TAHBSO

87
Q

Name 2 complications of endometriosis

A

Infertility, pelvic adhesions, ruptured cysts, bowel obstruction, chronic pelvic pain

88
Q

What term describes endometrial glandular tissue found in the myometrium?

A

Adenomyosis

89
Q

What is the difference between primary and secondary infertility?

A

Primary - couple never been able to conceive

Secondary - couple have achieved conception in past

90
Q

Name 3 causes of female infertility

A

PID, endometriosis, PCOS, fibroids, prev chemo, hyperprolactinaemia, prev tubal ligations

91
Q

Name 2 blood tests to look at ovulatory function

A 
Day 21 (mid-luteal) progesterone
FSH/LH, estradiol, prolactin
92
Q

Name one test to assess tubal patency

A

Hysterosalpingogram, laparoscopy and dye

93
Q

Name 2 possible symptoms of PCOS

A

Oligomenorrhoea/amenorrhoea
Hirsutism, acne, male pattern baldness, central obesity, infertility, symptoms of DM
Obesity

94
Q

Name 2 treatments for PCOS associated infertility

A

Metformin
Clomifene
Gonadotrophins

95
Q

List and advantage and disadvantage of:
Laparoscopic tubal ligation
Hormone-releasing IUCD

A
  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
Q

Name 2 CIs to IUCD insertion

A

Current pelvic infection, pregnancy, gynae cancer, trophoblastic disease

97
Q

During IUCD insertion a patient feels faint and has a HR of 40. Why?

A

Cervical shock causes vasovagal reaction with reflex bradycardia

98
Q

How might you initially treat PID?

A

IV Abx e.g. ceftriaxone and doxycycline +/- metronidazole

99
Q

What are the complications of PID?

A

Infertility, chronic pelvic pain, ectopic pregnancy, dyspareunia and dysmenorrhoea

100
Q

Name 3 causes of post-menopausal bleeding

A

Endometrial Ca, endometrial hyperplasia, atrophic vaginitis, ovarian Ca, vaginal trauma, infection

101
Q

What is the commonest histological type of endometrial carcinoma?

A

Adenocarcinoma

102
Q

What is the recommended treatment for stage I and II endometrial cancer?

A

TAHBSO

103
Q

Name 2 treatments for stage III and IV endometrial cancer

A

Chemo, radiotherapy, palliation

104
Q

Name 2 sites where endometrial Ca metastasises to

A

Peritoneum, lung, bone, vagina, liver

105
Q

Name 2 RFs for endometrial Ca

A

Unopposed oestrogen e.g. HRT, obesity, tamoxifen, PCOS, FH, nulliparity

finals (8 decks)

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