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Clinical > Women's health > Flashcards

Women's health Flashcards

1
Q

What are the indications for mammagraphy?

A
  • clinically suspicious lump in pts >40
    breast cancer where mammography not previously performed (any age)
    residual lump after cyst aspiration
    single duct blood stained nipple discharge
    nipple skin change
    triennial mammograms between ages 47 and 73 as part of national breast screening programme
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2
Q

contra-indications to mammography

A

breast pain without lump
symmetrical thickning
before commencing hrt
women under 40 years unless diagnosed with previous breast cancer

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3
Q

What features are common in a mammaogram if the pt has neoplastic lesions?

A

mass, often spiculation or more subtle irregular
microcalcification may be present
distortion of surrounding breast parenchyma

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4
Q

a 24 yr old with palpable mass in breast should have what minimum investigation?

A

Ultrasound, then maybe biopsy depending on findings. Risk of malignancy neglible in this age group

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5
Q

a 25-39 yr old with palpable mass in breast should have what minimum investigation?

A

breast ultrasound plus histology or cytology. Triple assessment

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6
Q

a 40+ with palpable mass in breast should have what minimum investigation?

A

mammography and ultrasound and either histoloy or cytology. Triple assessment

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7
Q

What are the different types of tissue diagnosis in breast cancer?

A

Fine needle aspiriation cytology (FNAC)
Core biopsy (gives histological diagnosis)
vacuum assisted biopsy
open (surgical biopsy)

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8
Q

What is a triple assessment in breast cancer?

A

combination of:
1. clinical assessment
2. radiological assessment (US/MMG/MRI)
3. pathological assessment (FNA, core biopsy).

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9
Q

What is the NHS breast screening program?

A

uk, women aged 47-73 years invited every 3 years to have screening mammography.

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10
Q

indications for mastectomy

A

pt choice
large tumour relative to pts breast,
multifocal
sub-areolar tumour
contra-indication to radiotherapy (prev radiotherapy, unable to lie flat, ataxia)
failed conservation surgery
BRCA gene in young pt
bilateral prophylactic mastectomy
local reccurence after wide load excision and radiotherapy
inflammatory breast cancer

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11
Q

indications for breast conservation

A

pts choice
operable unifocal primary tumour where resection less than 20%
tumour at favourable site for conservation
suitable for radiotherapy

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12
Q

What are the surgeries to the axilla following breast cancer?

A

axillary node clearance
sentinel node biopsy
non-surgical management

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13
Q

complications of axilllary node clearance (ANC)?

A

seroma formation (60%)
shoulder stiffness
permenant or temp paraesthesia under arm due to damage to intercosto brachial nerves (60%)
lymphoedema to arm
damage to long thoracic nerve of bell
damage to nerve and blood supply to latisimus dorsi muscle
damage to axillary vein and very rarely brachial plexus

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14
Q

Radiotherapy for breast cancer indications

A

always given to remaining breast after wide local excision
after some mastectomies for poor prognosis, high risk tumours
to palliate a large or inoperable primary cancer
treat symptomatic bone mets where it may cause disease regression and reduces bone pain after a few weeks
treat axilla in woman instead of axillary clearance
reduces local recurrence rates

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15
Q

Hormonal therapy treatment for breast cancer in pre-menopausal women

A

1st line - tamoxifen

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16
Q

Hormonal therapy treatment for breast cancer in post-menopausal women

A

Aromatase inihibitors (exemestane, letrozole, anastrozole)

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17
Q

How does an intraductal papilloma normally present?

A

benign breast lesion grows within mammary ducts of breast.
typically presents; blood tinged nipple discharge, without any skin changes or palpable lumps.

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18
Q

31yr, lump in right breast. Recently stopped breast feeding.
o/e: firm, well circumscribed mass, subareolar region. mobile, non-tender, 2cm diameter. left breast no abnormalities.
Most likely diagnosis?

A

galactocele - most common in women who recently have ceased breast feeding. milk builds up and stagnates within lactiferous ducts, leading to formation of a mobile cyst like lesion which can be tender

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19
Q

56 yr old woman, breast clinic for 3 yearly breast screening app. no abnormalities on physical exam.
mammogrm shows star shaped pattern of scarring with translucent centre in left breast.
Most likely diagnosis?

A

radial scar - benign which can mimic breast carcinoma,=. Idiopathic sclerosing hyperplasia of breast ducts. pts are typically asymptomatic and usually picked up incidentally on mammogram showing a star or rosette-shaped lesion with translucent centre

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20
Q

mammary duct ectasia presentation

A

perimenopausal, thick, sticky green or yellow nipple discharge with nipple inversion

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21
Q

What’s gestational age?

A

1st day last menstrual period (LMP), + 7 days, = 9 months (280 days)

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22
Q

When is term in pregnancy?

A

37+0 weeks

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23
Q

What is gravidity?

A

number of times a woman has been pregnant regardless of outcome

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24
Q

what is parity?

A

the number of times a womaaan has delivered a fetus with gestational age greater than 24wks

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25
Q

what is parity?

A

the number of times a woman has delivered a fetus with gestational age greater than 24wks

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26
Q

Definition of pre-eclampsia

A

placental condition affecting pregnant women commonly from around 20weeks gestation

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27
Q

clinical features of pre-eclampsia

A

hypertension and proteinuria
other signs; peripheral oedema, severe headache, drowsiness, visual distrubances, epigastric pain, nausea/vomiting and hyperreflexia

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28
Q

Aetiology of pre-eclampsia

A

related to dysfunctional trophoblast invasion of the spiral arterioles leading to decreased uteroplacental blood flow and resultant endothelial cell damage.

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29
Q

Risk factors for pre-eclampsia

A

nulliparity, previous hx or fhx of pre-eclampsia, increasing maternal age, exisiting disease (hypertension, diabetes, renal disease, autoimmune disease). Obesity, multiple pregnancy.

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30
Q

Maternal complications of pre-eclampsia

A

eclampsia (seizures due to cerebrovascular vasospasm), organ failure, disseminated intravascular coagulation (DIC), HELLP syndrome (presence of haemolysis (H), elevated liver enzymes (EL), and low platelets (LP).

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31
Q

Foetal complications of pre-eclampsia

A

intrauterine growth restriction, pre-term delivery, placental abruption, neonatal hypoxia

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32
Q

Management of pre-eclampsia

A

Anti-hypertensive treatment, delivery of placenta only curative treatment.
Labetalol recommended 1st line anti-hypertensive.
Magnesium sulfate can be used as prevention and treatment of eclamptic seizures

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33
Q

Why should you do FBC and LFTs as an investigation once a woman has pre-eclampsia?

A

important to screen for HELLP syndrome

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34
Q

How frequent should pts with severe pre-eclampsia have blood tests and which blood tests should these be?

A

U&Es, FBC, transaminases, and bilirubin
3 times a week
- to anticipate if a pt is developing HELLP syndrome

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35
Q

Which is a high risk factor for pre-eclampsia: Family history of pre-eclampsia, 1st pregnancy, type 2 diabetes mellitus

A

type 2 diabetes

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36
Q

What is chorioamnionitis?

A

infection of the membranes in the uterus

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37
Q

Clinical features of chorioamnionitis

A

fever, abdo pain, offensive vaginal discharge, evidence of preterm rupture of membranes
typical signs - maternal and foetal tachycardia, pyrexia, uterine tenderness

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38
Q

Management of chorioamnionitis

A

indication for admission and delivery
require IV broad spectrum antibiotic therapy as part of sepsis six protocol

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39
Q

What’s the definition of baby blues?

A

transient lability in mood from around 3days after birth, usually resolving within 2 weeks

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40
Q

Characteristics of baby blues

A

irritability, anxiety about parenting skills and tearful

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41
Q

Management of baby blues

A

supportive, reassuring

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42
Q

Definition of cord prolapse

A

during labour, the umbilical cord exits the cervix prior to delivery of the infant. Causes acute compromise of umbilical blood supply to the infant and necessitates immediate delivery.

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43
Q

Risk factors for cord prolapse

A

abnormal lie, multiple pregnancy, polyhydramnios, high head, multiparity, low birth weight, prematurity

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44
Q

Management of cord prolapse

A

foetus should be delivered as rapidly as possible
prevent further prolapse by adopting knees to chest position
filling bladder with 500ml warmed saline
avoid exposure and handling of the cord, reduce cord into vagina
terbutaline to stop uterine contractions

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45
Q

What is HELLP syndrome?

A

presence of haemolysis (H),
elevated liver enzymes (EL),
low platelets (LP)
often manifests during 3rd trimester

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46
Q

Clinical features of HELLP syndrome

A

headache,
nausea/vomiting,
epigastric pain,
right upper quadrant abdo pain
blurred vision,
peripheral oedema

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47
Q

Maternal complications of HELLP syndrome

A

organ failure,
placental abruption,
disseminated intravascular coagulopathy (DIC)

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48
Q

Foetal complications of HELLP syndrome

A

intrauterine growth restriction,
preterm delivery,
neonatal hypoxia

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49
Q

What are the causes of antepartum haemorrhage and whats the definition

A

PV bleed after 24wks gestation
Causes: placental abruption, placenta praevia, vasa praevia, cervical ectropion, 50% unexplained

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50
Q

What is the definition of placental abruption

A

premature separation of placental bed

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51
Q

Presentation of placental abruption

A

acute abdo pain (but not always), contractions,
antepartum haemorrhage (but not always),
woody uterus on palpation

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52
Q

Investigations for placental abruption

A

bloods,
coagulation screen,
USS foetus,
CTG monitoring

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53
Q

Management of placental abruption

A

Expedite delivery (induction or C section dependent on foetal condition)

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54
Q

What is placenta praevia?

A

placenta lying in lower segment of the uterus - graded system

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55
Q

Presentation of placenta praevia

A

painless antepartum haemorrhage,
soft uterus

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56
Q

Investigations for placenta praevia

A

bloods, coag screen, USS foetus, CTG monitoring

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57
Q

Management for placenta praevia

A

elective c section

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58
Q

What’s the steps of delivering the baby in normal labour?

A
  1. descent and engagement
  2. flexion - narrowest diameter
  3. internal rotation of head into OA
  4. extension - crowning
  5. restitution - head aligns with shoulders
  6. external rotation - shoulders rotate
  7. delivery of shoulders - gentle traction
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59
Q

What is the definition of failure to progress in labour

A

insufficient rate of dilatation / foetal descent

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60
Q

What are the causes of failure to progress in labour?

A

Power - hypotonic uterine activity
Passage - pelvic dimensions
Passenger - position, attitude, head size

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61
Q

Management for failure to progress in labour

A

augmentation of labour - ARM, syntocinon infusion
Instrumental delivery - forceps or ventouse
C section

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62
Q

What are the 7 layers that must be cut through in a c section?

A
  1. skin
    2 Camper’s fascia
  2. Scarpa’s fascia
  3. Rectus sheath
  4. seperate rectus abdominus
  5. parietal peritoneum
  6. uterus
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63
Q

What is shoulder dystocia?

A

normal gentle axial traction insufficient to deliver shoulders after head is born

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64
Q

Risk factors for shoulder dystocia?

A

previous hx, macrosomnia (big baby), diabetes, high maternal BMI

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65
Q

Complications of shoulder dystocia

A

brachial plexus injury, cerebral palsy, perinatal mortalitiy, PPH

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66
Q

Management of shoulder dystocia

A

1 call for help
2 tell mum to stop pushing, lie flat on bed
3. McRobert’s + suprapubic pressure + axial traction
4. internal manourves, deliver posterior arm
5. all fours, repeat
6. third line: cleidotomy, Zanvanelli, symphysiotomy

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67
Q

What is primary and secondary post partum haemorrhage?

A

primary - 500ml loss within 24hrs delivery
secondary - 500 ml loss 24hrs - 12 weeks post delivery

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68
Q

What are the causes of post partum haemorrhage? (4Ts)

A

Tone - atonic uterus (prolonged labour, macrosomnia, twins)
Trauma - genital tract injury
Tissue - retained placenta / membranes
Thrombin - coagulopathy (DIC in pre-eclampsia)

69
Q

Management of post partum haemorrhage

A

fundal massage + syntocinon + ergometrine
resus: fluids, oxygen, blood products

70
Q

Which is the most common gynae cancer?

A

Endometrial

71
Q

What age group is at risk for endometrial cancer?

A

post menopausal

72
Q

What is endometrial cancer

A

adenocarcinoma of the endometrium

73
Q

Risk factors for endometrial cancer

A

obesity, unopposed oestrogen, tamoxifen

74
Q

Presentation of endometrial cancer

A

post menopausal bleeding means 2ww - endometrial cancer until proven otherwise

75
Q

Investigations for endometrial cancer

A

Transvaginal USS, endometrial biopsy

76
Q

Management of endometrial cancer

A

total hysterectomy + bilateral salpingo - oophorectomy +/- brachytherapu +/- carboplatin/paclitaxel

77
Q

What is ovarian cancer and who does it affect?

A

adenocarcinoma (germinal epithelium)
postmenopausal women

78
Q

risk factors for ovarian cancer

A

BRCA, family hx, never used COCP

79
Q

Presentation of ovarian cancer

A

pelvic mass, ascites, IBS symptoms, urinary symptoms

80
Q

Investigations for ovarian cancer

A

CA125 (>35), USS abdomen

81
Q

Management of ovarian cancer

A

total abdominal hysterectomy + BSO + carboplatin / paclitaxel

82
Q

What is cervical cancer?

A

squamous cell carcinoma of ectocervix
peak incidence 30-35

83
Q

What is cervical cancer linked to cause?

A

HPV (strains 16 +18) - preventable by vaccine

84
Q

Risk factors for cervical cancer

A

HPV infection

85
Q

Presentation of cervical cancer

A

asymptomatic finding, post coital bleeding, intermenstrual bleeding, abnormal discharge

86
Q

When is screening for cervical cancer done

A

25-49 3 yearly, 5-64 5 yearly.

87
Q

Management for cervical cancer

A

dependent on stage, cone biopsy for CIN, hysterectomy + cisplatin + radiotherapy

88
Q

What is dysmenorrhea?

A

Very painful periods

89
Q

Top differentials for dysmenorrhea

A

Primary dysmenorrhea 6-12months after menarche, no specific cause
endometriosis, adenomyosis, fibroids, PID

90
Q

What is endometriosis

A

presence of endometrial stroma and glands outside the uterine cavity

91
Q

Presentation of endometriosis

A

dysmenorrhea, cyclic pelvic pain, subfertility

92
Q

Investigations for endometriosis

A

Transvaginal USS, laproscopy is gold standard

93
Q

Management of endometriosis

A

1: COCP, mirena, medroxyprogesterone
2. endometriosis surgery

94
Q

What is menorrhagia and what are top differentials

A

80ml loss per cycle/period lasting more than 7 days
dysfunctional uterine bleeding, fibroids, endometriosis, hypothyroidism, coagulopathy

95
Q

What are fibroids?

A

benign neoplasia of uterine smooth muscle

96
Q

Presentation of fibroids

A

menorrhagia, pelvic pressure, bloating, dysmenorrhoea

97
Q

Investigations for fibroids

A

transvaginal USS, hysteroscopy

98
Q

Management for fibroids

A
  1. mirena IUS, COCP, tranexmic acid, mefenamic acid
  2. leuprorelin (GnRH analogue) / mifepristone (anti-progestogen)
  3. myonectomy (fertility preserving), hysterectomy
99
Q

What is oligomenorrhea and what are top differentials

A

infrequent periods
function hypothalamic amenorrhoea - stress, exercise, weight loss, eating disorders.
PCOS
hyperthyroidism
perimenopause + many others

100
Q

Investigations for oligomenorrhea and amenorrhea

A

full gynae hx and obs hx
measure height and weight
FSH LH
serum testosterone
prolactin
TSH

101
Q

What is PCOS

A

2/3 Rotterdam criteria:
1. oligomenorrhea
2. features of hyperandrogenism
3. polycystic ovaries

102
Q

Pathophysiology of PCOS

A
  • abnormal ovarian steroidgenesis leads to raised androgens
  • increased GnRH frequency, high LH, low FSH, high androgens, low aromatase, high androgens, low oestrogen, no LH surge, no ovulation, cyst antral fluid remains
  • insulin resistance, mitogenic on ovaries and adrenals, high androgens
103
Q

Presentation of PCOS

A

oligomenorrhea, subfertility, acne, hirsutism

104
Q

Investigations for PCOS

A

FSH/LH, SMBG, testerone, TFTs, prolactin, USS

105
Q

Management of PCOS

A

COCP, metformin + clomiphene

106
Q

What are the differentials of acute lower abdo pain and what would you investigate?

A
  • appendicitis, ectopic pregnancy, ovarian torsion, miscarriage, cyst rupture, PID / tubal abscess
  1. urine pregnancy test
  2. Transvaginal USS - serum beta-hCG if no pregnancy found in positive UPT
107
Q

What is an ectopic pregnancy

A

implantation of conceptus anywhere outside of uterine cavity (usually tubal)
Site - usually ampulla of fallopian tube

108
Q

Presentation of an ectopic pregnancy

A

typically 6-8 weeks gestational age, acute iliac fossa pain, tenderness, guarding, PV bleed

109
Q

Investigations for ectopic pregnancy

A

pregnancy test, transvaginal USS, serial beta-hCG if pregnancy not found

110
Q

Management of ectopic pregnancy

A
  1. if not ruptured, methotrexate or laproscopic salpingectomy
  2. ruptured - laparoscopic salpingectomy / salpingotomy + resus +/- post op methotrexate
111
Q

Contraindications to breastfeeding

A

infants of mothers with TB infection
Infants of mothers with uncontrolled/unmonitored HIV
Infants of mothers who are taking medication which may be harmful such as amiodarone (arrythmia med)

112
Q

Which medication helps to stop a woman breastfeeding?

A

Cabergoline (dopamine receptor agonist, which inhibits prolactin production leading to suppression of lactation)

113
Q

What other medications should be avoided when breastfeeding apart from amiodarone

A

lithium, tetracycline, sitagliptin, methotrexate

114
Q

What is rhesus isoimmunisation

A

Occurs when a rhesus negative mother has a baby which is rhesus positive
if any foetal red blood cells enter maternal blood, mother will form anti-D antibodies against them.
maternal anti-D antibodies can cross placenta and cause rhesus haemolytic disease

115
Q

Sensitisation events in rhesus isoimmunisation

A

indications for anti-D prophylaxis
- antepartum haemorrhage
- placenta abruption
- abdominal trauma
- external cephalic version
- invasive uterine procedures; amniocentesis and chorionic villus sampling
- rhesus positive blood transfusion to a rhesus neg woman
- intrauterine death, miscarriage or termination
- ectopic pregnancy
- delivery (normal, instrumental, c section)

116
Q

Mx of Rhesus negative mother

A

prophylaxis of anti-D antibodies given at sensitisation events, and at 28weeks

117
Q

What is haemolytic disease of the newborn

A

immune condition which develops after rhesus negative mum becomes sensitised to rhesus positive blood cells of baby in utero

118
Q

Features of haemolytic disease of the newborn

A

hydrops foetalis; foetal odema in at least 2 compartments
yellow coloured amniotic fluids due to excess bilirubin
jaundice and kernicterus in neonate
foetal anaemia causing skin pallor
hepatomegaly or splenomegaly
severe odema if hydrops foetalis present in utero

119
Q

Paeds resus advice

A

5 rescue breaths followed by 15 chest compressions

120
Q

What is placenta accreta spectrum?

A

spectrum of abnormalities of placental implentation into uterine wall

121
Q

Placenta accreta?

A

adherence of placenta directly to superficialy myometrium but does not penetrate thickness of muscle

122
Q

Placenta increta

A

Villi invade into but not through the myometrium

123
Q

Placenta pecreta ?

A

villi invade through full thickeness of myometrium to serosa
increased risk of uterine rupture and in severe cases placenta may attach to other abdo organs such as bladder or rectum

124
Q

Risk factors for placenta accreta spectrum

A

previous termination of pregnancy
dilatation and curettage
previous csection
advanced maternal age
placenta praevia
uterine structural defects

125
Q

dx of placenta accreta spectrum

A

doppler USS
MRI
clinical dx difficult antenatally

126
Q

Complications of placenta accreta spectrum

A

increased risk of severe post partum bleeding, preterm delivery and uterine rupture

127
Q

mx of placenta accreta spectrum

A

elective c section and hyrestectomy

128
Q

Features of preeclampsia

A

hypertension
proteinuria
peripheral oedema
headaches
drowsiness
visual disturbances
epigastric pain
nausea/vomiting
hyperreflexia

129
Q

When are women offered a blood test to check for anaemia in pregnancy?

A

booking appointment and 28week appointment

other blood tests offered at these appointments: FBC, blood group, rhesus status, red cell alloantibodies, haemoglobinopathies, hep B, syphilis, HIV

130
Q

Which investigation is used to detect foeto-maternal haeemorrhage in a suspected event to ensure enough anti-D immunoglobulin has been given to mum

A

Kleinhauer test

used to detect amount of foetal haemoglobulin in mother’s blood stream

131
Q

concerning feature on a ctg?

A

deceleration of 15bpm beginning during and lasting 60s after a contraction has terminated

132
Q

Pregnant lady with pre-eclampsia, what is 1st line antihypertensive?

A

1st line - labetolol

CI in asthma, heart failure and heart block so then 1st line would be nifedipine

133
Q

What is magnesium sulfate used for in pregnancy

A

seizure prophylactic in severe pre eclampsia, and IV magnesium sulfate used to terminate eclamptic seizure

134
Q

Which antihypertensives are CI in pregnancy?

A

Ramipril and other ACE inhibitors

135
Q

What is a fibroadenoma

A

benign mass from fibrous tissue in breast
usually painless, small, rubbery mass that is mobile
common in 15-35
usually dissappears in menopause

136
Q

What is fetal hydrops

A

abnormal accumulation of serous fluid in 2+ fetal compartments (pleural, pericardial effusions, ascites, skin oedema, polyhydramnios or placental oedema)

137
Q

Causes of non-immune fetal hydrops

A

severe anaemia - congenital parvovirus B19 infection, alpha thalassaemia major, massive materno-feto haemorrhage
Cardiac abnormalities
Chromosomal - Trisomy 13,18,21 or Turners
Infection - toxoplasmosis, rubella, CMV, varicella
Twin - Twin transfusion syndrome
Chorioangioma

138
Q

what is main cause of anaemia in pregnancy

A

iron deficient anaemia (95%)

139
Q

Risk factors for developing pre-eclampsia

A

nulliparity
previous hx or family hx
increasing maternal age
exisiting disease (hypertension, diabetes, renal disease, autoimmune disease)
obesity
multiple pregnancy

140
Q

What is obstetric cholestasis

A

build up of bile acids

141
Q

Clinical features of obstetric cholestasis

A

pruritis (hands and feet worse, no rash)
fatigue or malaise
nausea or loss of apetite
rarely: dark urine, pale stools (jaundice)
upper R abdo pain

142
Q

mx of obstetric cholestasis

A

ursodeoxycholic acid (UDCA)

chlorphenamine to reduce itch
vit K reduce risk of haemorrhage
scheduling early delivery

143
Q

Clinical features of eclampsia

A

hypertension
proteinuria
peripheral oedema
severe headache
drowsiness
visual disturbances
epigastric pain
nasuea/vomiting
hyperreflexia

seizures

144
Q

Clinical features of eclampsia

A

hypertension
proteinuria
peripheral oedema
severe headache
drowsiness
visual disturbances
epigastric pain
nasuea/vomiting
hyperreflexia

seizures

145
Q

Risk factors for eclampsia

A

nulliparity
previous hx or family hx
increasing maternal age
exisiting disease: HTN, diabetes, renal disease, autoimmune disease
obesity
multiple pregnancy

146
Q

maternal complications of eclampsia

A

seizures
organ failure
HELLP syndrome (haemolysis, elevated liver enzymes, low platelets

147
Q

foetal complications of eclampsia

A

intrauterine growth restriction
pre term delivery
placental abruption
neonatal hypoxia

148
Q

mx of eclampsia

A

magnesium sulphate for seizures

labetalol 1st line anti hypertensive
if asthma, labetalol CI - nifedipine 2nd line

149
Q

what is Gilbert’s syndrome

A

autosomal recessive decreased activity of enzyme that conjugates billirubin with glucaronic acid

150
Q

Clinical features of Gilbert’s syndrome

A

intermittent mild jaundice in relation to stress, fasting, infection or exercise

mildly increased bilirubin but normal FBC

151
Q

Indications for Induction of labour

A

post dates (>41 wks gestation)
preterm prelabour rupture of membranes
intrauterine foetal death
abnormal CTG
pre eclampsia, diabetes, cholestasis

152
Q

CI for Induction of labour

A

previous classical incision during C section
multiple lower uterine segment C section
transmissable infections: herpes simplex
placenta praevia
malpresentations
severe foetal compromise
cord prolapse
vasa pravia

153
Q

MEthods of Induction of labour

A

membrane sweep
vaginal prostaglandins (PGE2)
amniotomy
balloon catheter

154
Q

reasons for each method of Induction of labour

A

membrane sweep 1st line
then vaginal pge2 unless CI of increased risk uterine hyperstimulation
oxytocin not used alone as primary unless CI to prostaglandins
misoprostol and mifepristone only used if indication is intrauterine foetal death

155
Q

Freya, a 42-year-old woman, presents to the GP complaining of increasingly frequent,
prolonged and heavy periods. She states she has been passing more clots than usual. Freya
also complains of some constipation which has developed recently, as well as some
discomfort in her lower abdomen. On abdominal examination, there is a palpable, non-tender
mass arising from the pelvis. What is the most likely cause of Freya’s heavy menstrual
bleeding?

A

fibroids - common cause heavy menstrual bleeding and making palpable mass (uterus) on examination

156
Q

Clinical features of endometriosis

A

cyclical pain
dysmenorrhoea
dysparuinia
subfertility
pelvic exam: tender, nodular masses on ovaries or ligaments surrounding uterus

157
Q

gold standard diagnostic for endometriosis

A

laparoscopy

158
Q

mx for endometriosis

A

analgesics
hormonal therapies:
COCP
medrixyprogesterone acetate
gonadotrophin-releasing hormone agonists

159
Q

Presentation of fibroids

A

asymptomatic
menstrual dysfunction - menorrhagia and dysmenorrhoea
may be palpable on examination if big enough - non-tender uterus

160
Q

You meet a 37-year-old woman on labour ward who is 40+5 weeks gestation and has elected to be induced. You return shortly after induction to find the patient is barely responsive and visibly dyspnoeic.

Your colleage takes some observations which show the patient is hypoxic and hypotensive. You suspect an amniotic fluid embolism.

Which of the following is the most appropriate next step in management?

A

give pt 15L O2 via non-rebreathe mask and call anaesthetist

161
Q

What is the commonest cause of anovulation in women?

A

PCOS

162
Q

definition of infertility

A

diminished ability of a couple to conceive a child or unexplained failure to conceive over a 2 year period

163
Q

Statistically a couple stands an 80% chance of conceiving within 1 year if:

A

woman under 40
do not use contraception
have regular intercourse

164
Q

factors affecting natural fertility

A

increasing age
obesity
smoking
tight fitting underwear (males)
excessive alcohol consumption
anabolic steroid use
ilicit drug use

165
Q

Genetic causes of infertility

A

Turner’s syndrome
Kleinfelter’s syndrome

166
Q

ovulation/endocrine disorders causing infertility

A

PCOS
pituitary tumours
Sheehans syndrome
Hyperprolactaemia
cushing’s syndrome
premature ovarian failure

167
Q

tubal abnormalities causing infertility

A

congenital anatomical abnormalities
adhesions following PID

168
Q

uterine abnormalities causing infertility

A

bicornate uterus
fibroids
asherman’s syndrome

169
Q

Whats most likely causative agent for Bartholin’s cyst

A

E. coli

Clinical (12 decks)

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