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3A med mine > Selected Notes obgyn 3 > Flashcards

Selected Notes obgyn 3 Flashcards

1
Q

What is stress incontinence?

A

Leaking small amounts when coughing/laughing

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2
Q

What is mixed incontinence?

A

Both urge and stress

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3
Q

What is overflow incontinence?

A

Due to bladder outlet obstruction<br></br>E.g. from prostate enlargement

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4
Q

When is cystometry not recommended?

A

In patients with clear histories and a clear cause of incontinence

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5
Q

When is a cystogram suggested as an investigation for urinary incontinence?

A

When a fistula is suspected

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6
Q

When should you be cautious in prescribing anticholinergics for urge incontinence?

A

In the elderly due to risk of falls

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7
Q

When is a vaginal vault prolapse most common?<br></br>

A

After a hysterectomy

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8
Q

What is the surgical management for a uterine prolapse?

A

Hystrectomy, sacrohysteropexy

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9
Q

What is the surgical management of a rectocele?

A

Posterior colporrhaphy

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10
Q

When can’t LNG-IUS(levornegstrel intrauterine device) be used for treating uterine fibroids?

A

If there is distortion of the uterine cavity

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11
Q

What treatment/management should be used to shrink/remove fibroids?

A

GnRH agonists-> short term treatment to reduce size of fibroids<br></br>Surgical-> myomectomty, ablation, uterine artery embolisation, hysterectomy

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12
Q

Why can’t GnRH agonists be used long term to treat fibroids?

A

Side effects such as menopausal symptoms (hot flushes, vaignal dryness) and loss of bone mineral density

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13
Q

Where do submucosal fibroids grow?

A

Just below the lining of the uterus (endometrium)

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14
Q

What is Meig’s syndrome?

A

Triad of:<br></br><ul><li>Ovarian fibroma(benign ovarian tumour)</li><li>Pleural effusion</li><li>Ascites</li></ul><div>Typically occurs in older women-> remove tumour and other issues resolve</div>

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15
Q

What should be considered in a patient presenting with recurrent ovarian cysts?

A

PCOS<br></br>Can’t be diagnosed just off cysts, needs 2 of:<br></br><ul><li>Anovulation</li><li>Hyperandrogenism</li><li>Polycystic ovaries on US</li></ul>

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16
Q

What is the commonest type of ovarian cyst?

A

Follicular cysts

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17
Q

Whatg are the tumour markers for a  germ cell tumour?

A

<ul><li><b><i>Lactate dehydrogenase</i></b>&nbsp;(<b><i>LDH</i></b>)</li><li><b><i>Alpha-fetoprotein</i></b>&nbsp;(<b><i>α-FP</i></b>)</li><li><b><i>Human chorionic gonadotropin</i></b>&nbsp;(<b><i>HCG</i></b>)</li></ul>

<div>&nbsp;</div>

<br></br>

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18
Q

What is taken into account with the risk of malignancy index for ovariance tumours?

A

<ul><li>Menopausal status</li><li>Ultrasound findings</li><li>CA125 level</li></ul>

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19
Q

What is ovarian torsion?

A

Ovary twists in relation to the surrounding connective tissue, fallopian tube and blood supply

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20
Q

When can ovarian torsion happen in normal ovaries in girls before menarche

A

When girls have longer infundibulopelvic ligaments that can twist more easily

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21
Q

What might be present upon examination of a patient with ovarian torsion?

A

Localised tenderness<br></br>Palpable mass in the pelvis-may be absent

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22
Q

What parts of the body does lichen sclerosus typically affect?

A

Gential and anal regions of the body

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23
Q

What is the most common type of cervical cancer?

A

Squamous cell carcinoma

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24
Q

What is the second most common type of cervical cancer?

A

Adeoncarcinoma

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25
Q

What is the most common casue of cervical cancer?

A

HPV-typically type 16 and 18

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26
Q

What is meant by dysplasia?

A

Premalignant changes

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27
Q

What is the grading system for the level of dysplasia in the cervix?

A

Cervical intraepithelial neoplasia(CIN)

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28
Q

What is the first thing smear tests looking for cervical cancer are tested for?

A

High risk HPV<br></br>If HPV is negative, cells aren’t examined further, returned to normalm screening programme

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29
Q

What might be seen in cervical cancer screening in women with the coil/IUD?

A

Actinomyces-like organisms-no treatment required unless symptomatic

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30
Q

What is pelvic exenteration?

A

Operation that involved removing ost or all of the pelvic organs including vagina cervix, uterus, fallopian tubes, ovaries bladder and rectum<br></br>Last resort for cervical cancer<br></br>Significant implications

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31
Q

What monoclonal antibody can be used to treat cervical cancer?

A

Bevacizumab(avastin) used in combination with other chemo to treat metastatic/recurrent cervical cancer

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32
Q

Which strains does the HPV vaccine Gardasil protect against?

A

Strains 6,11,16,18,31,33,45,52,58

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33
Q

What might you find on bimanual pelvic examination in a patient with endometrial cancer

A

Enlarged uterus(may be normal)<br></br>

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34
Q

What is the most common type of endometrial cancer?

A

Adenocarcinoma

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35
Q

What stimulates the growth of endometrial cancer cells?

A

Oestrogen

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36
Q

Why is obesity a risk factor for endometrial cancer?

A

Adipose tissue is a source of oestrogen

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37
Q

Why does ovarian cancer typically carry a poor prognosis?

A

Uusally diangosed late

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38
Q

What is the peak age of incidence of ovarian cancer?

A

60years

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39
Q

What is the most common type of ovarian cancer?

A

Epithelial origin-serous carcinomas

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40
Q

What is recognised as the site of origin of many ovarian cancers?

A

Distal end of the fallopian tubes

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41
Q

Where do epithelial ovarian cancers originate from?

A

Epithelium which lines the fimbria of the fallopian tubes or ovaries

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42
Q

Where do epithelial ovarian tumours typically spread to first?

A

<ul><li>Peritoneal cavity-&gt;m particularly bladder, paracolic gutters and diaphragm</li></ul>

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43
Q

Where do germ cell ovarian tumours typically originate from?

A

Germ cells in the embryonic gonad

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44
Q

Where do ovarian sex cord stromal tumours arise from?

A

Connective tissue

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45
Q

Which is more aggressive: sex cord stromal ovarian tumours or ovarian epithelial tumours?

A

Epithelial 

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46
Q

Which genes are associated with developing ovarian cancer?

A

BRCA1&2

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47
Q

Why does late stage ovarian cancer cause ascites

A

Vascular growth factors causing increased vessel permeability

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48
Q

When should CA125 not be used?

A

For screening for ovarian cancer in asymptomatic women

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49
Q

What is the most common type of vulval cancer?

A

Squamous cell carcinoma

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50
Q

Which skin cancers can affect the vulva?

A

<ul><li>Squamous cell carcinoma-most common</li><li>Basal cell carcinoma</li><li>Melanomas</li></ul>

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51
Q

What proportion of patients with lichen sclerosus get vulval cancer?

A

About 5%

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52
Q

What is vulval intraepithelial neoplasia?

A

<span>Premalignant condition affecting the </span><b><i>squamous epithelium</i></b><span> of the skin that can precede vulval cancer</span>

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53
Q

What type of VIN is associated with HPV infection and younger women?

A

High grade squamous intraepithelial lesion

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54
Q

Which type of VIN is associated with lichen sclerosus?

A

Differentiated VIN

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55
Q

What might be seen on a pelvic exam of a patient with endometriosis?

A

<ul><li><span>Tender, nodular masses may be palpable on ovaries or ligaments surrounding the uterus</span></li><li><span>Reduced organ mobility</span></li><li><span>Visible vaginal endometriotic lesions&nbsp;</span></li></ul>

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56
Q

When do symptoms of adenomyosis tend to resolve?

A

After menopause

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57
Q

What might be found on examination of a patient with adenomyosis?

A

Enlarged and tender uterus<br></br>Feels more soft than a uterus containing fibroids

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58
Q

When is atrophic vaginitis most common?

A

After menopause

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59
Q

What is the difference between early and late miscarriages?

A

<ul><li>Early-most common: &lt;13 weeks</li><li>Late: 13-24 weeks</li></ul>

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60
Q

What is the definitive way a miscarriage can be diagnosed?

A

Transvaginal US: fetal cardiac activity (from 5.5 weeks gestation)<br></br>Also fetal crown rump length(>7mm) and mean sac diameter<br></br><ul><li>>25mm-failed pregnancy</li><li><25mm: repeat scan in 10-14 days</li></ul>

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61
Q

What surgery would be performed in a miscarriage?

A

<12 weeks: manual vacuum aspiration<br></br>>12 weeks: evacuation of retained products of conception(ERPC)

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62
Q

What risks are associated with conservative management of msicarriage?

A

<ul><li>Allowing it to pass naturally</li><li>Risks: infection, heamorrhage</li></ul>

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63
Q

What risks are associated with surgical management of a miscarriage?

A

<ul><li>Infection</li><li>Uterine perforation</li><li>Haemorrhage</li></ul>

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64
Q

What would be seen on a transvaginal US in a threatened pregnancy?

A

<ul><li>Viable pregnancy</li></ul>

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65
Q

What would be seen on a transvaginal ultrasound of a patient with an inevitable miscarriage?

A

<ul><li>Internal cervical os open</li><li>Fetus viable or non-viable</li></ul>

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66
Q

What might be seen on a transvaginal US in a patient with a missed/delayed miscarriage?

A

<ul><li>No fetal heart pulsation where crown rump &gt;7mm</li></ul>

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67
Q

What might be seen on an ultrasound of a patient who has had a complete miscarriage?

A

<ul><li>No POC in uterus</li><li>Endometrium &lt;15mm diameter</li><li>Previous pregnancy proof</li></ul>

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68
Q

What might be found on examination of a patient with an ectopic pregnancy?

A

<ul><li>Bimanual exam: Cervical tenderness-Chandelier sign</li><li>Hameodynamic instability of ectopic ruptures, signs of peritonitis</li><li>Vaginal exam: Pouch of Douglas</li></ul>

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69
Q

When is IM methotrexate likely to be used as treatment for an ectopic pregnancy

A

Patients with:<br></br><ul><li>Well controlled pain</li><li>B-HCG<1500iU</li><li>Unruptured and no visible heartbeat</li></ul>

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70
Q

What is the most common site for an ectopic pregnancy to occur?

A

<ul><li>Ampullary portion of fallopian tube</li></ul>

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71
Q

What is oligohydramnios?

A

Lower levels of amniotic fluid within the uterus

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72
Q

What results in low levels of amniotic fluid

A

<ul><li>Anything that decreases urine production, blocks urine outputs, or ruptures membranes</li></ul>

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73
Q

What is polyhydramnios?

A

<ul><li>Presence of too much amniotic fluid in the uterus</li></ul>

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74
Q

What is the first stage of labour?

A

<ul><li>Period that starts with regular uterine contractions and ends when cervix is fully dilated to 10cm</li></ul>

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75
Q

Which hormones are primarily indicated in the first stage of labour?

A

<ul><li>Prostaglandins and oxytocin</li></ul>

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76
Q

What is the second stage of labour?

A

<ul><li>Period from complete cervical dilation to delivery of the foetus</li></ul>

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77
Q

What is the third stage of labout?

A

<ul><li>Period beginning at the delivery of the foetus and ending with delivery of placenta and foetal membranes</li></ul>

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78
Q

What is pre-term labour?

A

<ul><li>Onset of regular uterine contractions and cervical changes occuring before 37 weeks gestation</li></ul>

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79
Q

What is preterm birth?

A

<ul><li>Delivery of baby &gt;20wks but &lt;37wks</li></ul>

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80
Q

What is the premature rupture of membranes?

A

<ul><li>Rupture of membranes at least one hour before onset of contractions</li></ul>

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81
Q

What is prolonged premature rupture of membranes?

A

<ul><li>Rupture of membranes &gt;24 hours before onset of labour</li></ul>

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82
Q

What is pre-term premature rupture of the membranes?

A

<ul><li>Early rupture of the membranes &lt;37 weeks gestation</li></ul>

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83
Q

What is menopause?

A

<ul><li>Permanent cessation of menstruation characterised by at lease 12 months of amenorrhoea in otherwise health women who aren't using contraception</li></ul>

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84
Q

What is the underlying cause of menopause?

A

<ul><li>Ovarian failure resulting in oestrogen deficiency</li></ul>

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85
Q

What is perimenopause?

A

<ul><li>Period when symptoms of menopause begin, continues until 12 months after last menstrual period</li></ul>

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86
Q

What is the difference between premature ovarian insufficiency and menopause?

A

<ul><li>Premature ovarian insufficiency: &lt;40 years</li></ul>

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87
Q

When should oestrogen only HRT be used vs oestrogen and progesterone?

A

<ul><li>Oestrogen only: for women with a hysterectomy</li><li>Otherwise use combined</li></ul>

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88
Q

What medication can be used as a non hormonal treatment for menopause

A

<ul><li>Clonidine</li><li>alpha 2 adrenergic receptor agonist</li></ul>

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89
Q

What is the normal duration of a menstrual cycle?

A

<ul><li>21-35 days</li></ul>

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90
Q

Which axis controls the menstrual cycle?

A

<ul><li>Hypothalamic-pituitary-gonadal axis</li></ul>

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91
Q

What is the role of FSH in menstruation?

A

<ul><li>Binds to granulosa cells to stimulate follicle growth, permit the conversion of androgens(from theca cells) to oestrogens and stimulate inhibin secretion</li></ul>

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92
Q

What is the role of LH in menstruation?

A

<ul><li>Acts on theca cells to stimulate production and secretion of androgens</li></ul>

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93
Q

What is the corpus luteum?

A

<ul><li>Tissue in the ovary that forms at the site of a ruptured follicle following ovulation.&nbsp;</li><li>Produces oestrogens, progesteron and inhibin to maintain conditions ofr fertilisation and implantation</li></ul>

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94
Q

What produces HCG?

A

<ul><li>synctiotrophoblast of embryo</li></ul>

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95
Q

When does menses occur?

A

<ul><li>Start of new menstrual cycle</li><li>Occurs in absence of fertilisation when corpus luteum has broken down and internal lining of uterus is shed</li></ul>

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96
Q

What is PCOS?

A

<ul><li>Condition characterised by hyperandrogenism, ovulation disorders and polycystic ovarian morphology</li></ul>

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97
Q

What might be seen on imaging in a patient with PCOS?

A

<ul><li>Transvag/Transabdo US</li><li>Increased ovarian volume and multiple cysts</li></ul>

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98
Q

What might be found on blood tests of patients with PCOS

A

<ul><li>increase in LH:FSH ratio</li><li>prolactin normal or mildly raised</li><li>testosterone normal or mildly raised</li><li>sex hormone-binding globulin normal/low</li></ul>

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99
Q

What is the most common cause of Asherman’s syndrome?

A

<ul><li>Post pregnancy related dilatation and curettgae procedure e.g. retianed products of conception</li></ul>

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100
Q

What is the prognosis of Asherman’s syndrome like?

A

<ul><li>Recurrence of adhesions post treatment is common</li></ul>

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101
Q

When do congenital malformations of the female genital tract typically present?

A

<ul><li>Often not until or after puberty</li></ul>

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102
Q

What is ovotesticular disorder of sex development?

A

<ul><li>'True hermaphroditism'</li><li>Presence of both ovarian and testicula tissue in single patient</li><li>Many menstruate and some can become pregnant</li><li>Treatment: remove contradictory organs and reconstruct external genitalia corresponding to sex of rearing-can wait until person can decide gender</li></ul>

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103
Q

What symptoms might someone with endometrial polyps present with?

A

<ul><li>Asx</li><li>Abnormal uterine bleeding: menorrhagia, intermenstrual bleeding</li><li>Postmenopausal bleeding</li><li>Infertility or recurrent pregnancy loss</li></ul>

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104
Q

What is pelvic inflammatory disease(PID)?

A

<ul><li>Infeciton/inflammation of the pelvic organs including uterus, fallopian tubes, ovaries and peritoneum, usually due to ascending infection form endocervix from vagina</li></ul>

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105
Q

What is urolithiasis?

A

<ul><li>Urinary tract stones-&gt; solid concretions or crystal aggregations formed in urinary system from substances present in urine</li></ul>

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106
Q

What is the circular body of the breast?

A

<ul><li>Large and most prominent part of the breast</li></ul>

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107
Q

What is the axillary tail of the breast?

A

<ul><li>Inferior lateral edge or pec major towards axillary fossa</li><li>Nipple at centre surrounded by areola</li></ul>

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108
Q

Where do veins in the breast drain into?

A

<ul><li>Axillary and internal throacic veins</li></ul>

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109
Q

Where does the skin of the breast drain into?

A

<ul><li>Axillay, inferior deep cervical and infraclavicular nodes</li></ul>

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110
Q

Where does the nipple and areola of the breast drain into?

A

<ul><li>Drains to subareolar lymphatic plexus</li></ul>

111
Q

Which hormones regulate the production and secretion of milk from the breast?

A

<ul><li>Prolactin&nbsp;</li><li>Oxytocin</li></ul>

112
Q

Where do fibroadenomas originate from?

A

<ul><li>Originate from lobules</li></ul>

113
Q

Where does breast cancer most commonly metastasise to?

A

<ul><li>Bones</li><li>Liver</li><li>Lungs</li><li>Brain</li></ul>

114
Q

What is the most common subtype of breast cancer?

A

<ul><li>Invasive ductal carcinoma</li></ul>

115
Q

What is the difference between invasive and pre-invasive breast cancer?

A

<ul><li>Invassive: penetrated through the basement membrane</li></ul>

116
Q

What screening is in place for breast cancer?

A

<ul><li>Mammogram every 3 years for women aged 50-70yrs</li></ul>

117
Q

What is the criteria for a 2 week wait referral for breast cancer?

A

<ul><li>Unexplained breast lump in a woman &gt;30yrs</li><li>&gt;50 yrs with unilateral nipple changes: dicharge, retraction etc</li></ul>

<div><br></br></div>

<div>Consider if:</div>

<div><ul><li>Skin changes suggestive of breast cancer</li><li>&gt;30yrs with a lump in axilla</li></ul></div>

118
Q

What mammogram features might be seen in a patient with pre-invasive breast cancer?

A

<ul><li>Unifocal/widespread microcalcifications</li></ul>

119
Q

What mammogram features might be seen in a patient with invasive breast cancer?

A

<ul><li>Irregular spiculated mass</li><li>Clustered microcalcifications</li><li>Linear branching calcifications</li></ul>

120
Q

What surgical techniques might be used for a patient with breast cancer?

A

<ul><li>Tumour excision</li><li>Mastectomy</li><li>Breast reconstruction</li><li>Sentinel node biopsies durng surgeryy/axillary node clearance if invasive</li></ul>

121
Q

When is radiotherapy used for breast cancer treatment?

A

<ul><li>Recommended after a wide local excision</li><li>Or after a mastectomy for those with &gt;4 positive axillary nodes</li></ul>

122
Q

When might chemotherapy be used for breast cancer treatment?

A

<ul><li>Downstage a primary lesion or after surgery depending on stage of tumour, e.g. if axillary node disease</li></ul>

123
Q

Why is anastrazole used for post-menopausal women?

A

<ul><li>It's an aromatose inhibitor</li><li>Sromatisation accounts for majority of oestrogen production in post menopausal women</li></ul>

124
Q

When is hormonal therapy offered to women?

A

<ul><li>If tumours are positive for hormone receptors</li><li>HER2 over expressing hormone receptor negative patients</li></ul>

125
Q

What is Paget’s disease of the nipple?

A

<ul><li>Rare condition characterised by the presence of cancer cells in the nipple</li><li>Often underlying DCIS/invasive breast cancer</li></ul>

126
Q

What is the role of oxytocin in labour?

A

<ul><li>Surge in levels at onset of labour will contract the uterus</li></ul>

127
Q

What is the role of prolactin in pregnancy

A

<ul><li>Starts the process of milk production in the mammary glands</li></ul>

128
Q

What is the role of oestrogen in labour

A

<ul><li>Surges at onset of labour to inhibit progesterone to prepare the smooth muscles for labour</li></ul>

129
Q

What is the role of prostaglandins in labour

A

<ul><li>Aid with cervical ripening</li></ul>

130
Q

What is the role of beta endorphins in labour?

A

<ul><li>Natural pain relief</li></ul>

131
Q

What is the role of adrenaline in labour?

A

<ul><li>Released when birth is imminent to give the woman energy for birth</li></ul>

132
Q

What is meant by dilation in pregnancy and how is this measured?

A

<ul><li>Diameter of opening of the cervix</li><li>Measured in cm through vaginal exam</li></ul>

133
Q

What is the most common pelvis type in females?

A

<ul><li>Gynaecoid</li></ul>

<div><img></img><br></br></div>

134
Q

When does ‘descent’ stage of labour happen?

A

<ul><li>Can be from 37 weeks gestation onwards</li><li>Might not happen until established labour</li></ul>

135
Q

What pain managment techniques might be used in labour

A

Non invasive: <br></br><ul><li>Water immersion</li><li>Massage</li><li>TENS machine</li></ul><div><br></br></div><ul><li>Entonox(gas and air)</li><li>Paracetemol</li><li>Codeine</li></ul><div><br></br></div><div><ul><li>Diamorphine</li><li>Pethidine</li><li>Remifentanyl</li></ul></div>

136
Q

Whata re the disadvantages of using entotox?

A

<ul><li>Can cause nausea/light headedness</li><li>Effect wears off quickly</li></ul>

137
Q

What is the ventouse?

A

<ul><li>Instrument that attaches a cup to a fetal head via a vacuum</li></ul>

138
Q

What stage of labour should the decision for an operative vaginal delivery be based on?

A

<ul><li>2nd stage of labour</li></ul>

139
Q

What is the combined test?

A

<ul><li>Assesses chance of fetus having Down's, Edward's or Patau's using maternal and fetal measurements</li></ul>

140
Q

When is the combined test done?

A

<ul><li>11-14 weeks-anomaly screen</li></ul>

141
Q

What things are measured in the combined test?

A

Maternal:<br></br><ul><li>Age</li><li>Free B-HCG(high: downs, low: edwards.pataus)</li><li>Pregnancy associated plasma protein A-PAPP-A(low in all 3)</li></ul><div>Fetus via US:</div><div><ul><li>Nuchal translucency(high-Down’s)</li><li>Crown Rump length</li></ul></div>

142
Q

What is nuchal translucency?

A

<ul><li>Measure via US the thickness of the nuchal pad at the nape of the fetal neck</li></ul>

143
Q

What is the quadruple test?

A

<ul><li>Screens for Down's syndreom</li></ul>

144
Q

When is the quadruple test offered?

A

<ul><li>14-20 weeks</li></ul>

145
Q

What weeks are in 1st trimester?

A

<ul><li>1-13</li></ul>

146
Q

What weeks are in 2nd trimester?

A

<ul><li>14-27</li></ul>

147
Q

What weeks are in 3rd trimester?

A

<ul><li>28-40</li></ul>

148
Q

What things are check in the quadruple test?

A

<ul><li>Alpha fetoprotein(AFP)</li><li>hCG or free bhCG</li><li>Inhibin A</li><li>Unconjugated oestriol(uE3)</li></ul>

149
Q

Which is more accurate-the combined test or the quadruple test?

A

<ul><li>Combined</li><li>Quadruple has a lower detection rate and higher screen positive rate</li></ul>

150
Q

What is the cut off for combined/quadruple screening test?

A

1/150<br></br><ul><li>Low: <1/150</li><li>High: >=1/150</li></ul>

151
Q

What options are available for women who have been deemed higher risk of Down’s syndrome?

A

<ul><li>No further testing</li><li>Non-invasive prenatal testing(NIPT)</li><li>Prenatal diagnostic testing</li></ul>

152
Q

What is non-invasive prenatal testing(NIPT)?

A

<ul><li>Assess placental cell-free fetal DNA found in maternal blood and combines with mother's probability of a trisomy to provide a likelihood ratio</li><li>Screening test only-positive result needs to be confirmede through invasive testing</li></ul>

153
Q

When is the anomaly scan offered?

A

<ul><li>18-20+6 weeks</li></ul>

154
Q

What is mastitis?

A

<ul><li>Inflammation of the breast tissue with/without infectoin associated with lactation</li></ul>

155
Q

What is puerperal mastitis?

A

<ul><li>Mastitis associated with lactation in postpartum women</li></ul>

156
Q

What organism is implicated in infective mastitis?

A

<ul><li>S.aureus<br></br></li></ul>

157
Q

What organism most commonly causes bacterial vaginosis?

A

<ul><li>Mc gardnerella vaginalis</li><li>Often polymicrobial</li></ul>

158
Q

What is the treaatment for bacterial vaginosis?

A

<ul><li>Oral/vaginal gel: metronidazole or clindamycin</li><li>Avoid douching, shampoos etc, recurrence is common</li></ul>

159
Q

What is vulvovaginal candidiasis?

A

<ul><li>'Yeast infection/thrush'</li><li>Fungal infection of lower reproductive tract</li></ul>

160
Q

What should be done if treatement for vulvovaginal candidiasis fails?

A

<ul><li>Consider further ix</li><li>Assess risk factors-&gt; diabetes control etc</li><li>Medication concordance</li><li>Specialist referral</li></ul>

161
Q

Why is<b> </b>vulvovaginal candidiasis more common in pregnancy?

A

<ul><li>Oestrogen-&gt; increased glycogen production-&gt; promotes candida growth</li></ul>

162
Q

What organism causes chlamydia?

A

<ul><li>Chlamydia trachomatis</li><li>Obligate intracellular gram negative organism</li></ul>

163
Q

When would test of cure be done for chlamydia treatment?

A

<ul><li>Pregnant women</li><li>Poor complicance</li><li>Rectal infection</li><li>Persistent symptoms</li></ul>

164
Q

What is the incubation period of gonorrhoea

A

<ul><li>2-5 days</li></ul>

165
Q

What might be seen on microscopy in a patient with v

A

<ul><li>Gram negative diplococci</li><li>Polymorphonucelar leukocytes</li></ul>

166
Q

Which HPV strains are associated with cancer?

A

<ul><li>HPV 16/18-cervical cancer</li></ul>

167
Q

What is the best treatment for genital warts in pregnancy?

A

<ul><li>Physical ablation</li></ul>

168
Q

What should be monitored in patients with HIV?

A

<ul><li>CD4 count</li><li>HIV viral load</li><li>FBC</li><li>U&amp;Es</li><li>Urinalysis</li><li>AST, ALT, bilirubin</li></ul>

169
Q

What is PEP?

A

<ul><li>Post exposure prophylaxis</li><li>Given within 72 hours, lasts for 1 month</li></ul>

170
Q

What medications are used in PEP?

A

<ul><li>Truvada(1 tablet daily) + raltegravir(1 tablet BD)</li></ul>

171
Q

What would be seen on transvagianl US in a threatened miscarriage?

A

<ul><li>Viable pregnancy</li></ul>

172
Q

What is the treatment for a threatened miscarriage?

A

<ul><li>Reassurance</li><li>If heavy: admit and observe</li><li>If &gt;12 weeks + rhesus negative: Anti D</li></ul>

173
Q

What is the role of misoprostol in miscarriage management?

A

<ul><li>Vaginal misoprostol-&gt; stimulate cervical ripening and myometrial contractions</li></ul>

174
Q

What should be done if the cause of polyhydramnios is idiopathic?

A

<ul><li>Baby's 1st feed needs to be examined</li><li>NG tube to check for fistula/atresia</li></ul>

175
Q

Why is there a higher risk of postpartum haemorrhage in patient with polyhydramnios?

A

<ul><li>Uterus has to contract more to achieve haemostasis</li></ul>

176
Q

What is the difference between post-term pregnancy and post dates pregnancy?

A

<ul><li>Post term: past 42 weeks</li><li>Post dates: pregnancy past estimated delivery date(EDD) or due date(40 weeks gestation)</li></ul>

177
Q

What should be considered as a differential for prolonged pregnancy?

A

<ul><li>Consider inaccurate dating</li><li>Incidence of this has decreased now due to 11-14 week scans</li></ul>

178
Q

What is the main complication of a prolonged pregnancy?

A

<ul><li>Stillbirth</li></ul>

179
Q

What is placenta praevia?

A

<ul><li>Placenta lying over the cervical os</li></ul>

<div><img></img><br></br></div>

180
Q

Why is it important to identify placenta praevia early?

A

<ul><li>Important cause of antepartum haemorrhage-&gt; vaginal bleeding from 24 weeks gestation</li></ul>

181
Q

What is placental abruption?

A

<ul><li>Part of all of the placenta separates from the uterus prematurely</li><li><img></img><br></br></li></ul>

<div><img></img><br></br></div>

182
Q

What might be found on exam of a patient with placental abruption?

A

<ul><li>'woody' uterus</li><li>Tense all the time and painful on palpation</li></ul>

183
Q

What is meant by ‘breech’ presentation?

A

<ul><li>Baby present bottom down</li></ul>

184
Q

When is a vaginal breech brith contraindicated?

A

<ul><li>Footling breech due to risk of head trapping</li></ul>

185
Q

What is the difference between ‘lie’, ‘presentation’ and ‘position’ with regards to fetal position?

A

<ul><li>Fetal lie: relationship between long axis of fetus and mother</li><li>Presentation: fetal part that first enter the mother's pelvis</li><li>Position: fetal head position as it enters the birth canal</li></ul>

186
Q

What is pre-eclampsia?

A

<ul><li>Placental condition affecting wmen from 20 weeks gestation characterised by hypertension and proteinuria</li></ul>

187
Q

What is the criteria for pre-eclampsia?

A

Criteria:<br></br><ol><li>Htn(>140/90) on 2 occasions at least 4 hours apart</li><li>Significant proteinuria >300mg protein in 24 hr sample or >30mg/mmol urinary protein: creatinine ratio</li><li>Women >20 wks gestation</li></ol>

188
Q

What should be given for magnesium sulfate toxicity

A

<ul><li>Calcium gluconate</li></ul>

189
Q

What is the target MAP in a patient on treatment for eclampsia?

A

<ul><li>&lt;120mmHg</li></ul>

190
Q

What is t<span>richomoniasis?</span>

A

<ul><li>STI caused by flagellated protozoan parasite: trichomonas vaginalis</li><li>Primarily infects the urogenital tract</li></ul>

191
Q

What kind of organism is trichomonas vaginalis?

A

<ul><li>Highly motile, flagellates protozoan parasite</li></ul>

192
Q

What is the incubation period of t<span>richomoniasis</span>

A

<ul><li>7 days</li></ul>

193
Q

What is l<span>ymphogranuloma venereum?</span>

A

<ul><li>STI caused by L1, L2 or L3 serovars of chlamydia trachomatis</li></ul>

194
Q

What is the treatment for bacterial balanitis?

A

<ul><li>Oral flucloxacillin</li><li>Clarrithromycin in penicillin allergy</li></ul>

195
Q

What is syphilis?

A

<ul><li>STI caused by the spircohete bacterium treponema pallidum</li></ul>

196
Q

What is the incubation period of syphilis?

A

<ul><li>9-90 days</li></ul>

197
Q

What tests can be used to diagnose syphilis?

A

<ul><li>Dark field microscopy: shouldn't be used for oral lesions</li><li>PCR: oral lesions</li><li>Serological testing-main-used for screening, diagnosis confirmation and treatment monitoring</li><li>Serology usually done using a combination of treponemal and non-treponemal tests</li></ul>

198
Q

What is the treatment for breast cysts?

A

<ul><li>If large/painful: might need draining</li><li>Usually no treatment</li></ul>

199
Q

What is mammaary duct ectasia?

A

<ul><li>Dilatation of the large breast ducts</li></ul>

200
Q

When is mammary duct ectasia most common?

A

<ul><li>Most common around the menopause</li></ul>

201
Q

What might mammography look like in a patient with mammary duct ectasia?

A

<ul><li>Potentially similar to cancer</li></ul>

202
Q

When does HELLP syndorme usually manifest?

A

<ul><li>3rd trimester</li></ul>

203
Q

What is the main risk of a cord prolapse?

A

<ul><li>Acute risk ro umbilical blood supply to infant</li></ul>

204
Q

What is vasa praevia?

A

<ul><li>Fetal vessels unprotected by umbilical cord or placental tissue run dangerously close to or across the internal cervical os</li></ul>

<div><img></img><br></br></div>

205
Q

What od fetal vessels lack the protection of?

A

<ul><li>Wharton's jelly</li></ul>

206
Q

What is velamentous insertion?

A

<ul><li>Umbilical cord inserts into the chorioamniotic membranes instead of centrally into placental mass</li></ul>

207
Q

What is puerperal psychosis?

A

<ul><li>Severe psych disorder that typicallly develops within the first 2 weeks following childbirth</li></ul>

208
Q

What is the main risk of peurperal psychosis

A

<ul><li>Self harm/suicide</li><li>Harm to baby</li></ul>

209
Q

What is postpartum depression?

A

<ul><li>Significant mood disorder that can develop any time up to one year after the birth of a baby</li></ul>

210
Q

Which antidepressants are safe for use in breastfeeding?

A

<ul><li>SSRIs: sertraline and paroxetine</li></ul>

211
Q

What needs to be balanced when deciding delivery time in a patient with PPROM?

A

<ul><li>Increased risk of maternal chorioamnionitis</li><li>Decreased risk of respiratory distress syndrome</li></ul>

212
Q

What is postpartum haemorrhage?

A

<ul><li>Loss of &gt;=500ml blood within the first 24 hours of a vaginal delivery</li></ul>

213
Q

What is the difference between primary and secondary postpartum haemorrhage?

A

<ul><li>Primary: within 24 hours</li><li>Secondary: 24hours-12 weeks</li></ul>

214
Q

What usually causes secondary postpartum haemorrhage?

A

<ul><li>Retained placental tissue or endometritis</li></ul>

215
Q

What is the Kleihauer test?

A

<ul><li>Determines proportion of fetal RBCs present-used in rhesus negative pregnancies</li></ul>

216
Q

What tests are used in rhesus negative pregnancies?

A

<ul><li>All babies born to rheesus negative mother will have cord blood taken for FBC, blood group and direct Coombs test</li><li>Coombs test: direct antiglobulin, will demonstrate antibodies on RBCs of baby</li><li>Kelihauer test: add acid to maternal lood, fetal cells are resistant</li></ul>

217
Q

What is the current law surrounding abortion in the UK?

A

<ul><li>1967 abortion act</li><li>Abortion up to 24 weeks in most cases</li></ul>

218
Q

What kind of medication is mifepristone and how does it work?

A

<ul><li>Progesterone antagonist</li><li>Blocks progesterone reqquired for continuation of pregnancy</li></ul>

219
Q

What kind of medication is misoprostol and how does it work?

A

<ul><li>Prostaglandin analogue</li><li>Stimulates uterine myometrium contractions resulting in expulsion of uterine contentss</li></ul>

220
Q

Where can medical termination of pregnancy occur?

A

<ul><li>Early: 0-9 weeks:: at home</li><li>9-24weeks: clinic</li></ul>

221
Q

What might be required for later pregnancies undergoing medical termination of pregnancies?

A

<ul><li>&gt;=22 wweeks</li><li>Feticide(intracardiac KCl injection)-stops fetal heart before abortion</li></ul>

222
Q

What options are there for surgical termination of pregnancy?

A

<ul><li>Suction termination</li><li>Dilatation and evacuation/curettage('D&amp;C')</li></ul>

<ul><li>Cervical priming with misoprostol +/- mifepristone</li><li>Women generally offered local anaesthesia alone, conscious sedation with local anaethetics, deep sedation or general anaesthetic</li></ul>

<div></div>

223
Q

When are women considered high risk for developing neural tube defects?

A

<ul><li>Either partner has a neural tube defect, previous pregnancy affected by NTD, or fhx</li><li>Women is taking antieepileptic drugs, has coeliac disease, diabetes or thalassaemia trait</li><li>Woman is obese: BMI&gt;=30kg/m2</li></ul>

224
Q

What screening is done for gestational diabetes?

A

<ul><li>Oral glucose tolerance test: OGTT</li><li>If previous gestational diabetes: OGTT asap after booking and at 24-28 weeks if first test normal</li><li>Any other risk factors: OFTT at 24-28 weeks</li></ul>

225
Q

Whata re the features of pre-existing hypertension in pregnancy?

A

<ul><li>History of htn before pregnancy or elevated BP before 20 weeks gestation</li><li>No proteinuria or oedema</li><li>Mc in older women</li><li>3-5% of pregnancies</li></ul>

226
Q

What organism causes Group B strep infection?

A

<ul><li>Bacterium streptococcus agalactiae</li></ul>

227
Q

What is obesity during pregnancy defined as?

A

BMI>30kg/m2 at first booking visit

228
Q

What is the main consequence of cephalopelvic disproportion?

A

<ul><li>Obstructed labour-? dystocia etc</li></ul>

229
Q

What is the most common cause of cephalopelvic disproportion?

A

<ul><li>Contracted pelvis with an average sized infant</li></ul>

230
Q

What is prolonged labour?

A

<ul><li>AKA dystocia</li><li>Slow cervical dilation and/or descent of fetus, typically beyond expected time frame of 20 hrs for primigravida and 14 hrs for multigravida women</li></ul>

231
Q

What is obstetric cholestasis?

A

<ul><li>AKA intra-hepatic cholestasis of pregnancy</li><li>Impaired bile flow-&gt; accumulation of bile acids, typically manifests after 24 weeks</li></ul>

232
Q

What is the main risk assoociated with obstetric cholestasis?

A

<ul><li>Risk of spontaneous intrauterine death</li></ul>

233
Q

What is shoulder dystocia?

A

<ul><li>Type of obstructed labour where following delivery of fetal head the anterior shoulder becomes impacted behind maternal pubic symphysis</li><li>Complication of vaginal cephalic delivery</li></ul>

234
Q

What is the McRoberts manoeuvre?

A

<ul><li>Hyperflexion and abduction of mother's legs tightly into abdoment</li><li>Applied suprapubic pressure</li><li>Routine traction in axial direction to assess if shoulders have been delivered</li></ul>

235
Q

What is symphysiotomy?

A

<ul><li>Division of maternal symphysial ligament</li></ul>

236
Q

What is the Zavanelli manoeuvre?

A

<ul><li>Replacement of head into canal and subsequent delivery via C section</li></ul>

237
Q

What monitoring should be done following the delivery of a baby with shoulder dystocia?

A

<ul><li>Mother: examined for&nbsp; PPH, severe perineal tears and genital tract trauma</li><li>Baby: examined by neonatologist for injury including brachial plexus injury, hypoxic brain injury, humeral/clavicle fractures</li></ul>

238
Q

Why are pregnant women predisposed to anaemia?

A

<ul><li>During pregnancy: both plasma volume and RBC mass increase</li><li>Plasma volume increases disproportionately -&gt; haemodilution effect</li></ul>

239
Q

What screening is done for anaemia in pregnancy?

A

<ul><li>All screened at booking and at 28 weeks</li><li>Mutiple pregnancy: extra screenign at 20-28 weeks</li></ul>

240
Q

What is treatment for micro/normo-cytic anaemia in pregnancy?

A

<ul><li>Mc: iron deficiency anaemia</li><li>Trial of oral iron(100-200mg)-repeat FBC after 2 weeks of treatment</li><li>Parental iron infusion considered if poor complicance or evidence of malabsorption</li></ul>

241
Q

What is the treatment for beta thalassaemia in pregnancy>

A

<ul><li>Folate supplementation and blood transfusions as required</li><li>Aim for Hb of 80g/L during pregnancy and 100g/L at delivery</li></ul>

242
Q

What is the treatment for sickle cell disease in pregnancy?

A

<ul><li>Folate supplementation and irone supplementation if lab evidence of iron deficiency</li></ul>

243
Q

What is the incubation period and infectivity period of rubella?

A

<ul><li>Incubation period: 14-21 days</li><li>Infectious from 7 days before symptoms appear to 4 days after onset of rash</li></ul>

244
Q

What signs/sympotms might newborn with congenital rubella syndrome have?

A

<ul><li>Sensorineural deafness</li><li>Cataracts or retinopathy</li><li>Congenital heart disease</li></ul>

<div>Also:</div>

<div><ul><li>Organ dysfunction</li><li>Microcephaly</li><li>Micrognathia</li><li>Haematological abnormalities</li><li>Low birth weight</li><li>Developmental delay and learning disability later in life</li><li>Characteristic petechial rash described as a 'blueberry muffin' rash</li><li>Cerebral palsy</li><li>'Salt and pepper' chorioretinitis</li></ul></div>

245
Q

Why is it important to check parvovirus B19 serology in patients who might have congenital rubella syndrome?

A

<ul><li>Difficult to distinguish rubella from parvovirus B19 clinically</li><li>Parvovirus B19-30% risk of transplacental infection with a 5-10% risk of fetal loss</li></ul>

246
Q

When should MMR vaccines not be givenn?

A

<ul><li>Women known to be pregnant or attempting to be pregnancy</li></ul>

247
Q

When is an amniotic fluid embolism most likely to occur?

A

<ul><li>During or shortly after labour</li></ul>

248
Q

When is hyperemesis gravidarum most common?

A

<ul><li>Between 8-12 weeks</li></ul>

249
Q

When should hospital admission be considered in patients with hyperemesis gravidarum?

A

<ul><li>Continued n+v and unable to keep down liquids/oral antiemetics</li><li>Continueed n+v +ketonuria +/- weight loss despite treatment of oral antiemetics</li><li>Confirmed/suspected comorbidity(e.g. unable to tolerate abx for UTI)</li></ul>

250
Q

What risks are associated with metoclopramide use in pregnancy?

A

<ul><li>Can cause extrapyramidal side effects: don't use for &gt;5 days</li></ul>

251
Q

When does acute fatty liver of pregnancy most commonly develop?

A

<ul><li>Sx almost always ddevelop in 3rd trimester</li></ul>

252
Q

When might liver transplantation be considered for acute fatty liver of pregnancy

A

<ul><li>Heaptic rupture</li><li>Acute liver failure&nbsp;</li><li>Post birth</li></ul>

253
Q

What thromboprophylaxis might be used in pregnancy?

A

<ul><li>LMWH</li></ul>

254
Q

What VTE prophylaxis might be used in pregnancy?

A

<ul><li>LMWH</li></ul>

255
Q

What is obstructed labour?

A

<ul><li>Failure of fetus to descend through the birth canal due to a barrier blocking its descent despite strong uterine contractions</li><li>Usually occurs at pelvic brim</li></ul>

256
Q

What is ovarian hyperstimulation syndrome?

A

<ul><li>Complication arising from iatrogenic induction of ovulation, characterised by an exaggerated response to hormonal therapies used in procedures like IVF</li></ul>

257
Q

What is the risk to the mother of exposure to VZV in pregnancy?

A

<ul><li>5 times greater risk of pneumonitis</li></ul>

258
Q

What is placental insufficiency?

A

<ul><li>Oxygen and nutrients aren't sufficiently transferred to the fetus via the placenta during pregnancy</li></ul>

259
Q

When should a VTE assessment be completed in a pregnant woman?

A

<ul><li>At booking and on any subsequent hospital admission</li></ul>

260
Q

What treatments/prophylaxis for VTE should be avoided in pregnancy?

A

<ul><li>DOACs</li><li>Warfarin</li></ul>

261
Q

What kind of twin is more at risk of complications and needs to be monitored more closely?

A

<ul><li>Monozygotic</li></ul>

262
Q

Why is the rate of dizygotic twins increasing?

A

<ul><li>Infertility treatment</li></ul>

263
Q

What is twin-to-twin transfusion syndrome?

A

<ul><li>Severe condition that can occur in 10-15% of twins sharing a placenta(monochorionic twins)</li></ul>

264
Q

What signs and symptoms might be exhibited in twin-to-twin transfusion syndrome

A

<ul><li>Heart failure in both twins</li><li>Fetal hydrops</li><li>Donor twin: high output cardiac failure: severe anaemia</li><li>Recipient twin: fluid overload due to excess blood volume</li></ul>

265
Q

What is the most common puerperal infection and why?

A

<ul><li>Endometritis</li><li>Lining of uterus undergoes trauma and tears during the birthing process</li></ul>

266
Q

Whata re the most common causes of puerperal infection?

A

<ul><li>S.pyogenes</li><li>S.auureus</li><li>E.coli</li></ul>

267
Q

What is primary amenorrhoea?

A

<ul><li>Never had a period</li><li>13+ no primary sex development</li><li>15+ no secondary sex development</li></ul>

268
Q

What is seconday amenorrhoea?

A

<ul><li>6 montjs without a period in normal cucle</li></ul>

269
Q

Whhat is an imperforated hymen?

A

<ul><li>Hymen blocks the passage of the vagina preventing menstrual blood and discharge</li></ul>

270
Q

What is Sheehan’s syndrome?

A

<ul><li>Postpartum hypopituitarism causing necrosis of pituitary secondary to hypovolaemic shock</li></ul>

271
Q

When is serum progesterone measured?

A

<ul><li>7 days before the end of the menstrual cycle(usually day 21)</li></ul>

272
Q

What medications might be used for treating fertility?

A

<ul><li>Clomiphene</li><li>FSH and LH injections</li><li>GnRH or DA agonists</li></ul>

273
Q

What surgical options are there for treating infertility?

A

<ul><li>Assisted reproductive technology including IVF or intracytoplasmic sperm injection</li><li>Treat underlying cause: e.g. fibroids, endo etc</li></ul>

274
Q

Which location of an ectopic pregnancy would increase the risk of rupture?

A

<ul><li>Isthmus</li></ul>

3A med mine (12 decks)

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