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Phase 3A > Womens > Flashcards

Womens Flashcards

1
Q

What is lactation mastitis?

A

Inflammatory condition of the breast commonly caused by milk stasis which is due to overproduction or inefficient removal

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2
Q

Presentation of lactation mastitis?

A

Breast pain with warm, tender, erythematous area

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3
Q

Management of lactation mastitis?

A

1st line: Analgesia and effective milk removal including checking attachment
2nd line (if symptoms do not improve within 12-24 hours): 500mg Flucloxacillin 4 times a day for 14 days with continuing breastfeeding

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4
Q

Investigation of choice of placenta praevia?

A

Transvaginal US

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5
Q

When should pregnant women with a first degree relative with diabetes be screened for gestational diabetes?

A

24-28 weeks with Oral glucose tolerance test

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6
Q

What is McRoberts manoeuvre?

A

Hyperflexing the legs tightly to the abdomen - used for shoulder dystocia

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7
Q

What position should women adopt with suspected cord prolapse?

A

On all fours - knees and elbows

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8
Q

If COC started within first 5 days of period, if any additional contraception needed?

A

No

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9
Q

If COC started at any day within the cycle after first 5 days, should any additional contraception be used?

A

Yes for 7 days

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10
Q

Cervical cancer risk factors?

A
  • Increased parity
  • Smoking doubles risk
  • COCP
  • Early first intercourse
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11
Q

Which contraceptives become effective after 7 days?

A

COCP, Implant, Injection, IUS

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12
Q

How quickly will the POP become effective?

A

2 days if started mid cycle

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13
Q

How do you diagnose gestational diabetes?

A

Fasting - >5.6
2 hours level - >7.8

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14
Q

What condition is it unacceptable to prescribe COCP for which women also have?

A

Migraine with aura

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15
Q

First line for pre-term PROM?

A

Speculum examination to look for pooling of fluid in the posterior vaginal vault

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16
Q

Pre-eclampsia triad?

A
  • HTN
  • Proteinuria
  • Oedema
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17
Q

High risk factors of pre-eclampsia?

A
  • CKD
  • HTN disease in previous pregnancy
  • Autoimmune disease
  • DM
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18
Q

Moderate risk factors of pre-eclampsia?

A
  • First pregnancy
  • > 40
  • BMI of 35 or more
  • First degree relative with pre-eclampsia
  • Multiple pregnancy
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19
Q

When should a women be given eclampsia prophylaxis and what is it?

A

If 1 or more high, 2 or more moderate risk factors
75-150mg aspirin once daily from 12 weeks

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20
Q

What is placental abruption?

A

Separation of a normally sited placenta from the uterine wall, resulting in maternal haemorrhage into the intervening space

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21
Q

Management of PA with no foetal distress < 36 weeks

A

Corticosteroids plus monitoring

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22
Q

Management of PA with foetal distress <36 weeks

A

C-section

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23
Q

Management of PA with foetal distress >36 weeks

A

C-section

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24
Q

Management of PA with no foetal distress > 36 weeks

A

NVD

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25
Q

First degree tear?

A

Superficial damage with no muscle involvement - no repair needed

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26
Q

Second degree tear?

A

Injury to the perineal muscle not involving the anal sphincter - requires suturing by a experienced midwife/clinician

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27
Q

Third degree tear?

A

Injury to the perineum involving the external/internal anal sphincter - requires repair in theatre

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28
Q

Fourth degree tear?

A

Injury to the perineum involving anal sphincter and rectal mucous - requires repair in theatre

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29
Q

Risk factors for reduced foetal movements?

A
  • Posture changes i.e. less prominent when sitting/standing
  • Anterior placenta position may have less awareness < 28 weeks
  • Alcohol/Sedatives
  • Obese patients
  • Oligo/Polyhydramnios
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30
Q

Management of RFM at > 28 weeks

A

Handheld doppler to confirm heartbeat - followed by CTG for 20 minutes
If no heartbeat, use ultrasound

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31
Q

Management of RFM at <28 weeks

A

Handheld doppler

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32
Q

First line for pregnancy HTN?

A

Labetolol

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33
Q

Indications for C-section

A
  • Placentra praevia
  • Pre-eclampsia
  • IUGR
  • Foetal distress
  • Failure to progress
  • Placental abruption
  • Cervical cancer
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34
Q

Cat 1 C-section?

A

Immediate theatre to mother/baby e.g. uterine rupture, major abruption, cord prolapse etc
C-section within 30 mins

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35
Q

Cat 2 C-section?

A

Maternal/Foetal compromise which is not immediately threatening
C-section within 75 minutes

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36
Q

Cat 3 C-section?

A

Delivery is needed but mother and baby are stable

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37
Q

Risks of C-section

A
  • Hysterectomy
  • Bladder/Ureteric injury
  • ICU admission
  • Death
  • Need for repeat C-section
  • Infection
  • Haemorrhage
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38
Q

What is Meigs syndrome?

A

A benign ovarian tumour (fibroma) associated with ascites and pleural effusion

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39
Q

Most common benign ovarian tumour in women under 25?

A

Dermoid cyst (teratoma)

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40
Q

Most common cause of ovarian enlargement in women of reproductive age

A

Follicular cyst

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41
Q

Cause of follicular cyst?

A

Non-rupture of the dominant follicle or failure of atresia in a non-dominant follicle

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42
Q

Cause of corpus luteum cyst?

A

When corpus luteum is not broken down and may fill with blood/fluid - presents with intraperitoneal bleeding

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43
Q

What is a dermoid cyst?

A

A benign germ cell tumour lined with epithelial tissue

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44
Q

How do dermoid cysts present?

A

Asymptomatic!

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45
Q

What is the most common benign epithelial tumours?

A

Serous cystadeomna - arises from ovarian surface epithelium

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46
Q

Indications for induction of labour?

A
  • Prolonged pregnancy
  • pre-labour PROM
  • Diabetic mother > 38 weeis
  • Pre-eclampsia
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47
Q

Options for induction?

A
  • Vaginal prostaglandin
  • Oxytocin infusion
  • Amniotomy
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48
Q

Management of HPV+ve sample + cystogically abnormal?

A

Colposcopy

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49
Q

Side effect of ovulation induction (GnR analogues)

A

Ovarian hyperstimulation syndrome

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50
Q

Presentation of OHSS?

A
  • Nausea
  • Vomiting
  • Abdominal pain
  • Bloating
  • Diarrhoea
  • SOB
  • Peripheral oedema
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51
Q

Risk factors for hyperemesis gravidarum?

A
  • Multiple pregnancy
  • Hyperthyroidism
  • Molar pregnancy
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52
Q

Why is multiple pregnancy a risk factor for HG?

A

Higher hCG which is associated with more severe N+V

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53
Q

3 main criteria for PCOS diagnosis?

A
  • Infrequent/Absent periods
  • Signs of Hyperandrogenism
  • polycystic ovaries on ultrasound
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54
Q

Most common cause of respiratory distress in <72 hours and >72 hours?

A

<72 hours - Group B Strep
>72 hours - Staph aureus

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55
Q

Antibiotic of choice for GB Strep prophylaxis?

A

Benzylpenicillin

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56
Q

Risk factors for Gestational Diabetes?

A
  • BMI > 30
  • Previous macrocosmic baby
  • Previous GD
  • First degree relative with diabetes
  • Family origin with high prevalence of diabetes
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57
Q

What is foetal fibronectin (fFN)

A

A protein released from the gestational sac which is associated with early labour

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58
Q

Most common SE of POPs?

A

Irregular vaginal bleeding

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59
Q

Complications of primary infection with varicella in pregnancy?

A

Life threatening such as pneumonitis

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60
Q

First line management of chickenpox exposure for pregnancy woman?

A

Check antibody levels
If not immune, give VZ immunoglobulins

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61
Q

UKMEC 3 contraindications for COCP? (Disadvantages generally outweigh advantages)

A

->35 years old and smoking < 15 cigs a day
- Controlled HTN
- Immobile
- FH of VTE disease in first degree relative < 45
- Gallbladder disease

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62
Q

UKMEC 4 contraindications for COCP?

A
  • > 35 with >15 cigs a day
  • Migraine with aura
  • History of VTE/Stroke/IHD
  • Uncontrolled HTN
  • Breast cancer
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63
Q

Why is trace glycosuria common in pregnancy?

A

Increased GFR and reduction in tubular reabsorption of filtered glucose

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64
Q

What cancer does unopposed oestrogen increase the risk of?

A

Endometrial cancer

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65
Q

Which cancer does combined oestrogen and progesterone HRT reduce risk of?

A

Endometrial cancer

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66
Q

What is placenta accreta?

A

Attachment of the placenta to the myometrium - will not separate properly so increased risk of PPH

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67
Q

What does female sex increase risk of?

A

Developmental dysplasia of the hip

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68
Q

First line for endometriosis?

A

3 month trial of analgesia (paracetamol + NSAIDs)

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69
Q

Second line for endometriosis?

A

COCP or progestogen

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70
Q

Definition of PPH

A

Loss of 500mls or more from the genital tract within 24 hours of birth

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71
Q

Causes of PPH?

A

Tone - uterine atony
Tissue - retained placenta
Trauma
Thrombin (coagulation problems)

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72
Q

Which type of tumour is associated with development of endometrial hyperplasia?

A

Granulosa cell tumours (due to unopposed oestrogen)

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73
Q

What is a late deceleration of CTG and what does it indicate?

A

Deceleration of HR which lags behind onset of contraction and does not return to normal until 30 seconds after contraction - indicates foetal distress

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74
Q

What should you do if late decelerations are seen on CTG?

A

Urgent foetal blood sampling to assess for hypoxia and acidosis

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75
Q

Management of breech position at 36 weeks +

A

External cephalic version - if unsuccessful, planned C-section

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76
Q

What is puerperal pyrexia?

A

Temp of >38 in the first 14 days after delivery

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77
Q

Causes of puerperal pyrexia?

A
  • Endometriosis
  • UTI
  • Wound infection
  • Mastitis
  • VTE
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78
Q

Target Hb cut offs in pregnancy?

A

1st trimester - 110
2nd trimester - 105
3rd trimester - 100

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79
Q

What is the most effective method of emergency contraception?

A

Copper IUD

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80
Q

When should Levonorgestrel be taken?

A

Within 72 hours of UPSI - 1.5mg dose

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81
Q

When should Ulipristal (EllaOne) be taken?

A

Within 120 hours of UPSI

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82
Q

Management of PPH?

A

1st - Medical management including IV oxytocin, IM carboprost, uterine massage
2nd - Surgical management where intrauterine balloon tamponade is first line, uterine artery ligation and then hysterectomy as last resort

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83
Q

Primary mode of action of COCP?

A

Inhibits ovulation

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84
Q

Primary mode of action of implant?

A

Inhibits ovulation

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85
Q

Primary mode of action of IUD?

A

Decreases sperm motility and survival

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86
Q

Primary mode of action of POP?

A

Thickens cervical mucus

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87
Q

If a woman with known placenta praaevia goes into labour (with/without bleeding)

A

Emergency C-section

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88
Q

What are tocolytics used for?

A

Pre-term labour to relax the uterus and halt contractions/labour

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89
Q

When can women restart taking hormonal contraception after taking Levonorgestrel?

A

Immediately

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90
Q

When can woman restart taking hormonal contraception after taking Ulipristal?

A

5 days

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91
Q

First line investigation for endometrial cancer?

A

Trans-vaginal ultrasound to measure endometrial thickness

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92
Q

What does intrahepatic cholestasis increase the risk of?

A

Stillbirth

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93
Q

Management of intrahepatic cholestasis?

A

Induction at 37-38 weeks

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94
Q

Clinical presentation of placental abruption?

A
  • Continuous abdominal pain
  • Woody/Firm uterus
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95
Q

Painless APH?
Painful APH?

A

Placenta praaevia
Placental abruption

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96
Q

When should zoster immunoglobulin be offered to women exposed to chickenpox?

A

First 20 weeks

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97
Q

What should a woman >20 weeks be given with a chickenpox rash within 24 hours?

A

[guidelines have changed] give oral Aciclovir between days 7-14 post-exposure

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98
Q

First line for management of hyperemesis/N+V?

A

Anti-histamines such as cyclizine/promethazine

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99
Q

What increases the risk of ectopic pregnancy?

A

PID

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100
Q

Causes of secondary amenorrhoea in an athletic woman?

A

Hypothalamic hypogonadism

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101
Q

Management of thrush in pregnant?

A

Clotrimazole

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102
Q

Second line for endometriosis?

A

OCP or progestogen

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103
Q

What should not be used in elderly patients?

A

Oxybutynin due to increased risk of falls

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104
Q

Older woman with labial lump and inguinal lymphadenopathy

A

Vulval carcinoma

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105
Q

If a semen sample is abnormal, when should a repeat test be arranged?

A

3 months later

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106
Q

What cancer does combined HRT increase the risk of?

A

Breast cancer

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107
Q

What is the treatment for vaginal vault prolapse?

A

Sacrocolpopexy

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108
Q

What medications can be used to help infertility in PCOS?

A

1st: Clomifene
2nd: Metformin

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109
Q

First line for dysmennorhoea pains?

A

NSAIDs

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110
Q

2nd line medical management of stress incontinence

A

Duloxetine

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111
Q

What are uterine fibroids sensitive to?

A

Oestrogen and Progesterone

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112
Q

What should be used to reduce size of fibroids in short term management?

A

GnRh agonists

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113
Q

Risk factor for endometrial hyperplasia

A

Tamoxifen

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113
Q

Risk factor for endometrial hyperplasia

A

Tamoxifen

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114
Q

How does metformin help in PCOS?

A

Appetite reduction
Decreases androgen production
Decreases LH from the anterior pituitary
Decreases sex-hormone binding globulin in the liver
Increases peripheral insulin sensitivity

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115
Q

Third line for Endometriosis?

A

GnRh agnonists

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116
Q

Second line management for pre-menstrual syndrome

A

COCP

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117
Q

Third line management for pre-menstrual syndrome

A

SSRI e.g Fluoxetine

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118
Q

What is the drug of choice for medical management of ectopic?

A

Methotrexate

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119
Q

What type of neoplasm does Rokitansky’s protuberance relate to?

A

Teratoma (dermoid cyst)

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120
Q

What is associated with a decreased incidence of hyperemesis?

A

Smoking

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121
Q

How does endometrial hyperplasia present?

A

IM bleeding, post menopausal bleeding, menorrhagia or irregular bleeding

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122
Q

What investigation should be done with menorrhagia with pelvic pain/IM bleeding/post-coital bleeding?

A

Transvaginal US

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123
Q

Which HRT should be used to reduce risk of VTE?

A

Transdermal HRT

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124
Q

What is the cause of primary amenorrhoea with cyclical pain?

A

Imperforate hymen

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125
Q

When should progesterone level be taken for fertility issues?

A

7 days before the expected next period

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126
Q

What should be excluded in patients with recurrent candidiasis?

A

Diabetes

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127
Q

What does raised FSH/LH with primary amenohhoea indicate?

A

Gonadal dysgenesis e.g. Turner’s syndrome

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128
Q

What is Sheehan’s syndrome?

A

Postpartum hypopituitarism - due to hypovalaemic shock following birth

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129
Q

What cancer does unopposed oestrogen increase the risk of?

A

Endometrial

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130
Q

What is HNPCC/Lynch syndrome a strong risk factor for?

A

Endometrial cancer

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131
Q

How long should Metoclopramide be used for?

A

No more than 5 days due to the risk of extrapyramidal effects?

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132
Q

In women with post-menopausal bleeding, what is the diagnosis until proven otherwise?

A

Endometrial cancer

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133
Q

What is a large cervical cone biopsy a risk factor for?

A

2nd trimester miscarriage

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134
Q

What is associated with whirlpool sign on US?

A

Ovarian torsion

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135
Q

What additional blood tests are part of the ‘Confusion Screen’?

A

TSH, B12, Folate and Glucose

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136
Q

Where does Alzheimers cause cerebral atrophy?

A

Cortex and Hippocampus

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137
Q

What should be measured in women over 50 presenting with regular abdominal distension/loss of appetite/pelvic pain/urinary urgency?

A

CA125 due to the risk of ovarian cancer

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138
Q

How should women < 6 weeks with vaginal bleeding and no pain be managed?

A

Expectant management

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139
Q

Which area of the Fallopian tube presents the highest risk of rupture?

A

Isthmus

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140
Q

What is the preferred method for induction of labour?

A

Vaginal prostaglandins

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141
Q

What are the 3 components of the RMI in ovarian cancer?

A

CA125 levels, menopausal status and US findings

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142
Q

What should be given to women with a previous baby with early/late Group B Strep?

A

Maternal IV antibiotics during labour

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143
Q

What is the screening tool for postnatal depression?

A

Edinburgh scale

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144
Q

First line treatment of intrahepatic obstetric cholestasis?

A

Ursodeoxycholic acid

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145
Q

When should methotrexate be stopped before conception in men and women?

A

6 months before

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146
Q

Management of cord prolapse?

A

Push the presenting part of the foetus back into the uterus

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147
Q

Management of pregnant women with abdominal trauma

A

Rhesus testing
If negative, should be given anti-D

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148
Q

Risk factors for placental abruption

A

Increasing maternal age
Multiparity
Maternal trauma

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149
Q

Management of fasting glucose > 7 at diagnosis

A

Commence insulin

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150
Q

Results of combined test at 10-14 weeks which suggests Downs

A
  • Increased hCG
  • Thickened nuchal translucency
  • Reduced PAPP-A
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151
Q

How much should the fundus height increase after 24 weeks?

A

1cm per week

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152
Q

What should HIV positive mothers not do w/r postpartum?

A

Breastfeed

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153
Q

When should induction of labour be offered for women with intrahepatic cholestasis?

A

37-38 weeks

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154
Q

Management of suspected cases of rubella in pregnancy

A

Discussion with local Health Protection Unit

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155
Q

What would be shown in quadruple test for Downs? Edwards?

A
  • Low AFP
  • Low unconjugated oestriol
  • Raised b-hCG
  • Raised inhibin A

Edwards - everything low but inhibin A

156
Q

What should NOACs be changed to during pregnancy?

A

LMWH

157
Q

Why should liver be avoided in pregnancy?

A

It contains high amounts of Vitamin A, a teratogen

158
Q

When do pregnancy related BP problems occur?

A

20 weeks and later

159
Q

Management of GORD in infants

A

1st: 2 week trial of alginate therapy
2nd: 4 week trial of PPI

160
Q

Why does pre-eclampsia cause oligohydramnios?

A

Hypoperfusion of the placenta

161
Q

What should be given to all women with PPROM

A

10 days of erythromycin

162
Q

What is the treatment for postpartum thyroiditis?

A

Beta-blockers

163
Q

When should CVS be performed?

A

11 - end of the 13th week

164
Q

When should amniocentesis be performed?

A

Week 15 onwards

165
Q

What could sudden increases in the size of the abdomen/breathlessness in someone with twins suggests?

A

Twin-twin transfusion syndrome

166
Q

What is the medication of choice for suppressing lactation when cessation of breastfeeding is indicated?

A

Cabergoline

167
Q

When can Copper IUD be inserted as a form of emergency contraception?

A

Within 5 days of earliest expected ovulation date

168
Q

What is the pH for someone with bacterial vaginosis?

A

pH > 4.5

169
Q

What are the drugs and in what order for pregnancy termination?

A
  • Oral mifepristone
  • Vaginal misoprostol
170
Q

Signs of premature ovarian insufficiency?

A
  • Secondary amenorrhoea
  • FSH > 25
  • Elevated LH
171
Q

Management of premature ovarian insufficiency?

A

Sequential HRT until 51 (COCP)

172
Q

Management of newborns with a minor risk factor for sepsis?

A

24 hour observations

173
Q

What ages is cervical screening done every 3 years?

A

25-49

174
Q

What ages is cervical screening done every 5 years?

A

50-64

175
Q

When should mid-luteal progesterone be measured?

A

7 days before the end of the regular cycle

176
Q

What is the diagnostic triad for hyperemesis gravidarum?

A
  • 5% of pre-pregnancy weight loss
  • Dehydration
  • Electrolyte imbalance
177
Q

What is a common complication of AROM?

A

Cord prolapse

178
Q

What can patients who have had a gastric sleeve/bypass/duodenal switch not have?

A

Any oral contraception including emergency due to lack of efficacy

178
Q

What can patients who have had a gastric sleeve/bypass/duodenal switch not have?

A

Any oral contraception including emergency due to lack of efficacy

179
Q

What is urge incontinence?

A

Detrusor muscle overactivity - bladder retraining and oxybuynin

180
Q

What is stress incontinence?

A

Weakening of the pelvic floor muscles - pelvic floor exercises and duloxetine

181
Q

Definitive management of atypical endometrial hyperplasia in postmenopausal women?

A

Total hysterectomy with bilateral salpingo-oopherectomy

182
Q

Features of threatened miscarriage?

A
  • Painless vaginal bleeding in first trimester
  • Closed cervical os
183
Q

Features of missed miscarriage?

A
  • Light bleeding with no pain
  • Closed os
  • Gestational sac which shows dead foetus
  • When the gestational sac is > 25mm
184
Q

Treatment for vaginal thrush?

A

Single dose of oral fluconazole

185
Q

When can medical management of fibroid be used?

A

When it is <3cm in size

185
Q

When can medical management of fibroid be used?

A

When it is <3cm in size

186
Q

What does continuous dribbling incontinence with prolonged labour suggest?

A

Vesicovaginal fistula

187
Q

How long is contraception needed for after the last period in women > 50?

A

12 months

188
Q

How long is contraception needed for after the last period in women < 50

A

24 months

189
Q

What is the hearing test for newborns? If abnormal what is next?

A

Otoacoustic emission test
Auditory brainstem response test

190
Q

What form of contraception is assoicated with a delay to natural fertility?

A

Injectable contraceptives

191
Q

What are the choice of anti-depressants in breastfeeding women?

A

SSRI / Paroxetine

192
Q

Which form of contraceptive is associated with weight gain?

A

Injectable contraceptives

193
Q

Which form of delivery has the highest risk of haemorrhage to the newborn?

A

Ventouse due to high pressure exerted by the vacuum

194
Q

Which form of delivery has the highest risk of haemorrhage to the newborn?

A

Ventouse due to high pressure exerted by the vacuum

195
Q

What should be tested to look for menopause?

A

FSH - raised in menopausal women

196
Q

What are antiphospholipid antibodies a CI to?

A

COCP

197
Q

When can the contraceptive implant be inserted after childbirth?

A

Immediately

198
Q

What may be measured in some (obese) women on LMWH for VTE in pregnancy?

A

Anti-Xa activity

198
Q

What may be measured in some women on LMWH for VTE in pregnancy?

A

Anti-Xa activity

199
Q

What is Wood screw’s manoeuvre?

A

Put your hand in the vagina and attempt to rotate the foetus by 180 degrees

200
Q

What is needed if unprotected sex occurred after a missed POP and within 48 hours of restarting the POP

A

Emergency contraception

201
Q

What does raised AFP in pregnancy suggest?

A

Foetal abdominal wall defects

202
Q

Risk factors for placental abruption

A

Abruption previous
Blood pressure high
Ruptured membranes
Uterine injury
Polyhydramnios
Twins
Infection
Old age
Narcotic use

203
Q

Risk factors for placenta accreta

A
  • PID
  • Previous C-section
  • Placenta praaevia
204
Q

When should Ulipristal be used with caution?

A

For those with severe asthma

205
Q

When should women be offered resection of the polyp?

A

All post-menopausal women with polyps and premenopausal women who are symptomatic or have endometrial polyps more than 1 cm should have a resection.

206
Q

What is imperforate hymen?

A

A congenital condition that is usually asymptomatic until puberty when amenorrhoea and cyclical pain due to outflow obstruction

207
Q

When does primary dysmenorrhoea usually present?

A

6-12 months after starting periods

208
Q

How does chorioamnionitis present?

A
  • pre-term PROM
  • Maternal fever
  • Maternal tachycardia
  • Foetal tachycardia
209
Q

Main adverse effect of Nexplanon implant?

A

Irregular menstrual bleeding

210
Q

When can the IUS/IUD be inserted following childbirth?

A

Within 48 hours of delivery otherwise should be delayed till 4 weeks after

211
Q

Who should be given anti-D prophylaxis at 28 weeks?

A

Rhesus negative mothers who are not sensitised

212
Q

Are ovarian cysts concerning in early pregnancy?

A

No, they are usually physiological and will resolve from 2nd trimester onwards

213
Q

Why is cervical ectropion more common in those taking the COCP?

A

Due to higher oestrogen levels

214
Q

Definition for premature ovarian failure?

A

Onset of menopausal symptoms and elevated gondatrophin levels at the age of <40

215
Q

Which epilepsy medication is indicated for pregnancy?

A

Lamotrigine

216
Q

What is first line for women with moderate/severe depression postpartum with no previous history of depression?

A

CBT then antidepressants if this is unsuccessful

217
Q

What should be offered for people with premature ovarian insufficiency?

A

HRT or COCP should be offered to women until the age of 51 years

218
Q

Do you need to take any precautions with POP and antibiotics?

A

No

219
Q

What is the imaging of choice for diagnosing adenomyosis?

A

MRI

220
Q

Treatment options for ovarian cancer?

A

Surgery and Chemotherapy

221
Q

1st and 2nd line treatment for pre-menstrual syndrome

A
  1. New COCP
  2. SSRI
222
Q

Symptoms of acute fatty liver of pregnancy?

A
  • Abdominal pain
  • N+V
  • Headache
  • Jaundice
223
Q

Signs of acute fatty liver of pregnancy?

A
  • Raised LFTs (ALT)
  • Raised WBC
  • Steatosis on liver US Doppler
224
Q

Features of HELLP?

A
  • Haemolysis
  • Elevated liver enzymes
  • Low platelets
225
Q

What position should a women be in for McRoberts manoeuvre?

A

Supine with both hips fully flexed and abducted

226
Q

Most common epithelial cell tumour?

A

Serous cystadenoma

227
Q

What is Fitz-Hugh Curtis syndrome?

A

A complication of PID where the infection tracks up to the liver from the pelvis associated with N.Gonorrhoea

228
Q

What blood test would be raised with malignant germ cell tumours

A

b-HCG

229
Q

Where is hCG secreted from?

A

syncytiotrophoblast

230
Q

COCP mode of action?

A

Inhibits ovulation

231
Q

POP mode of action?

A

Thickens cervical mucus

232
Q

Injectable and Implant contraceptive mode of action?

A

Primary: inhibits ovulation
2. thickens cervical mucus

233
Q

IUD mode of action?

A

Decreases sperm survival and motility

234
Q

IUD mode of action?

A

Prevents endometrial proliferation

235
Q

How long is the window for taking desogestrel?

A

12 hours

236
Q

What is secondary dysmenorrhoea?

A

Pain that starts 3-4 days before the onset of the period

237
Q

What is catatonia?

A

Stopping of voluntary movement or staying still in an unusual position

238
Q

What does Bishop score < 5 indicate?

A

Labour is unlikely to start without induction

239
Q

What does Bishop score > 8 indicate?

A

Labour is likely to start spontaneously

240
Q

What is the treatment of choice for postpartum thyroiditis?

A

Propranolol

241
Q

When does postpartum thyroiditis most commonly present?

A

3-4 months after giving birth (can be upto 1 year)

242
Q

What does Asherman’s syndrome often occur after?

A

Dilation and curettage

243
Q

Features of Sheehan’s syndrome?

A
  • Agalactorrhoea
  • Amennohoea
  • Hypothyroidism
  • Hypoadrenalism
244
Q

Features of Candida infection?

A
  • Cottage cheese discharge
  • Itching
245
Q

Features of Trichomonas vaginalis?

A
  • Offensive yellow-green, frothy discharge
  • Strawberry cervix
246
Q

Features of Bacterial Vaginosis?

A
  • Offensive thin white/grey fishy discharge
247
Q

What criteria is used to diagnose BV?

A

Amstel criteria:
- Thin, white discharge
- Vaginal pH > 4.5
- Positive whiff test
- Clue cells on microscopy (stippled vaginal epithelial cells)

248
Q

What is severe asthma a contraindication to?

A

Ullipristal/EllaOne

248
Q

Why should levongesterel dose be double?

A

If BMI > 26 or weight over 70kg

249
Q

Which contraceptive is not recommended in over 50s?

A

Progesterone injection as it reduces mineral bone density

250
Q

What is the contraceptive of choice for patients taking enzyme inducers e.g rifampicin?

A

IUD/Depo-Provera injection

251
Q

What should be monitored and followed up with patients on SNRIs (duloxetine, venlafaxine)

A

Blood pressure - as can cause HTN

252
Q

What should be monitored when patients are started on SSRI?

A

Sodium levels - can cause hyponatreaemia

253
Q

What is breastfeeding protective against?

A

Ovarian cancer

254
Q

When is red generation of fibroids more common?

A

2nd / 3rd trimester

255
Q

What kind of drug is trimethoprim and when should it be avoided in pregnancy?

A

folate antagonist - 1st trimester

256
Q

When should nitrofurantoin be avoided?

A

3rd trimester due to risk of haemolytic anaemia

257
Q

2nd line for endometriosis in those where COCP is C/I?

A

Progesterone IUD

258
Q

Management of pregnancy of unknown location?

A

Repeat b-HCG in 48 hours

259
Q

Management of PPROM?

A

Abx for 10 days or until woman in active established labour

260
Q

Chlamydia treatment?

A

100mg doxycycline for 7 days

261
Q

Treatment for trichomonas

A

Metronidazole

262
Q

Treatment for gonorrhoea

A

Ceftriaxone IM injection - one off

263
Q

Signs of secondary syphillis?

A

widespread rash, neurological symptoms and glomerulonephritis

264
Q

Cause of retrograde ejaculation?

A

Damage to internal urethral sphincter e.g. bladder surgery, tumour

265
Q

Preferred contraceptive for PCOS?

A

COCP

266
Q

What kind of contraceptive is Nexplanon?

A

Progesterone-only

267
Q

Which HPV are most associated with developing cervical cancer?

A

HPV 16,18

268
Q

Pan systolic murmur in child?

A

VSD

269
Q

History of flu-like illness and painful vesicular lesions around the vagina?

A

Herpes virus -> oral aciclovir and C-section

270
Q

First line tocolytic?

A

Oral nifedipine

271
Q

What HRT should be given to women going through menopause with regular periods?

A

Monthly, cyclical HRT

272
Q

White patches/skin on the labia?

A

Lichen sclerosis

273
Q

Treatment for lichen sclerosus?

A

Strong topical steroids e.g. Dermovate

274
Q

Why should dextrose solutions be avoided in hyperemesis?

A

Can cause Wernickes

275
Q

What does progesterone do?

A

smooth muscle relaxation in the digestive system, urinary system and uterus

276
Q

What medication should lithium be switched to?

A

Atypical antipsychotic

277
Q

Risks of bacterial vaginosis in pregnancy?

A
  • Preterm delivery
  • Late miscarrriage
278
Q

Itchy, red patches over the abdomen, normal LFTs?

A

Polymoprhic eruption of pregnancy

279
Q

Sign of placental separation?

A

Lengthening of the umbilical cord with gush of blood

280
Q

Mid-cycle ovulatory pain?

A

Mittleschmertz

281
Q

Most common analgesia for labour pain?

A

Entonox - inhaled NO + O2

282
Q

3a vs 3b perineal trauma?

A

3a - <50% of involvement of the external sphincter

283
Q

Nabothian cysts

A

Common cysts on the cervix in women who have had children

284
Q

What endometrial thickness would warrant more investigation?

A

> 5mm

285
Q

Lump coming forward?

A
  • Coming from posterior vaginal wall
  • Rectocele
  • Often assoicated with constipation
286
Q

Cystocele vs Rectocele?

A

Cystocele would cause urinary symptoms

287
Q

What does combined HRT reduce the risk of?

A

Osteoporosis

288
Q

What should be given to women before C-section?

A

PPI - to reduce risk of gastric reflux and aspiration during surgery

289
Q

What is an absolute contraindication to ECV?

A

APH in the last 7 day s

290
Q

Management of meconium aspiration syndrome?

A

Admission to NICU for O2 and Abx

291
Q

Management of meconium aspiration syndrome?

A

Admission to NICU for O2 and Abx

292
Q

Management of GBS?

A

Intrapartum Abx and during delivery

293
Q

What condition is mononeuritis multiplex associated with?

A

Diabetes Mellitus

294
Q

Indications for LLETZ?

A

Persistent CIN or high grade CIN (2,3)

295
Q

What is breastfeeding a risk factor for?

A

Neonatal jaundice

296
Q

When should uterus return to pre-pregnancy size?

A

4 weeks post partum

297
Q

Treatment to prevent further miscarriages?

A

Aspirin + Heparin

298
Q

Treatment of asymptomatic bacteruria?

A

Oral Abx

299
Q

What is abnormal pH and lactate of foetal blood sample?

A

pH - 7.20 and below
Lactate - 4.9 and above

300
Q

Blood or clots visible in the vaginal vault with abdominal/back pain in 3rd trimester?

A

Placental abruption

301
Q

Acute management of herpes?

A

Abstain from all sexual activity until asymptomatic

302
Q

Surgical management of ectopic with previous damage to other fallopian/infection?

A

salpingostomy

303
Q

Initial screening tool for syphillis?

A

Enzyme immunosorbent Assay

304
Q

Primary syphillis features?

A
  • Painless, genital/perianal lesions
305
Q

Secondary syphillis features?

A
  • Maculopapular symmetrical rash on palms legs face
  • Ulcers
  • Neurological symptoms
306
Q

Tertiary syphillis features?

A
  • Granulomatous lesions on shins
  • Cardiac complications e.g. aortic regurg
  • Neuro complications e.g. meningovascular sphillis, dementia
307
Q

Management of caput succedaneum?

A

Reassure that this will clear up within a few days

308
Q

What nerve is blocked in instrumental delivery?

A

Pudendal

309
Q

Criteria for lactational amenorrhoea?

A
  • The woman has complete amenorrhoea.
  • The woman is fully, or nearly fully (>85% of feeds are breast milk) breastfeeding.
  • It has been six months or less since the birth of the baby
310
Q

Psammoma bodies

A

Serous cystadenocarcinoma

311
Q

Most common type of epithelial ovarian tumour?

A

Serous cystadenoma

312
Q

Follow up of CIN1?

A

Discharge and screen again in community at 12 months

313
Q

Commonest cause of vaginal cancer?

A

Metastases from cervix/endometrium

314
Q

Risk factors for placenta praevia?

A
  • multiple pregnancy (e.g twins- multiple placentas)
  • smoking
  • intrauterine fibroids
  • maternal age >35
315
Q

Order of foetal descent?

A

Descent, engagement, flexion, internal rotation, crowning, extension of
presenting part, external rotation of head, delivery

316
Q

Management of asymptomatic bacteriuria?

A

tx urgently w nitro

317
Q

Diagnoses of polyhydramnios?

A

n AFI of >24cm (or 2000ml+)

318
Q

Diagnoses of oligohydramnios?

A

AFI of <5cm (or under 200ml)

319
Q

Most common cause of polyhydramnios?

A

Idiopathic

320
Q

blue and bulging membrane with a mass protruding from behind

A

Imperforate hymen

321
Q

What is the most likely US finding with someone with endometriosis?

A

Normal US

322
Q

What is Naegele’s rule?

A

Method for working out EDD: 9 months from last menstrual period + 7 days

323
Q

What does C-section increase the risk of for future pregnancies?

A

Placental abnormalities e.g. accreta

324
Q

How often should patients with severe pre-eclampsia have blood tests?

A

3 times a week

325
Q

Partial vs Complete molar pregnancy?

A

Complete will have the snowstorm appearance of US, partial has foetal tissue in uterine sac
Complete - 2 sperm cells fertilise an ovum with no genetic material
Partial - 2 sperm cells fertilise a normal ovum - 3 sets of genetic material

326
Q

What analgesia is safe in pregnancy?

A
  • Paracetamol
  • Codeine phosphate at low doses
327
Q

What is assessed in the Bishop score assessment?

A

Position of the cervix
Length of the cervix
Consistency of the cervix
Dilatation of the cervix
Station of the presenting part (distance in cm in relation to the ischial spines)

328
Q

What is Kleinhauer test?

A

Used to detect haemorrhage in sensitising event to work out if anti-D is needed

329
Q

When can tocolytics and corticosteroids be used for pre-term labour

A

24-34 weeks

330
Q

When would you start fertility investigations for someone who was on the COCP?

A

18 months of trying (6 months needed for fertility to return to normal)

331
Q

What can happen if CVS performed before 11 weeks?

A

Foetal limb abnormalities

332
Q

When is CVS and amniocentesis performed?

A

CVS - 11th - 13 weeks
Amnio - 15 weeks onwards

333
Q

Tense fontanelle + uveitis?

A

Congenital Toxoplasmosis

334
Q

Suction evacuation of miscarriage is not generally reccommended after what gestation?

A

13 weeks

335
Q

Ovarian torsion vs cyst rupture?

A

Cyst rupture will be following physical activity/sex with sudden onset pain, haemodynamic instability

336
Q

When is anaemia screening in pregnancy?

A

Booking + 28 weeks

337
Q

Lamotrigine in pregnancy?

A
  • Safe but may need increase dose as lamotrigine levels can fall during pregnancy
338
Q

Incomplete vs Inevitable miscarriage?

A
  • Incomplete will have products of conception being passed
339
Q

Incomplete vs Inevitable miscarriage

A
  • Incomplete will have products of conception being passed
340
Q

Main complication of induction of labour?

A

Uterine hyperstimulation

341
Q

Lifestyle changes for pre menstrual syndrome?

A

2-3 hourly small balanced meals rich in complex carbohydrates

342
Q

What is Potter syndrome?

A

Bilateral renal genesis -> Oligohydramnios
- Flattened ‘parrot-beaked’ nose
- Recessed chin
- Downward epicanthal folds
- Low-set, cartilage-deficient ears (known as ‘Potter’s ears’)

343
Q

Criteria for expectant management of ectopic?

A

1) An unruptured embryo
2) <35mm in size
3) Have no heartbeat
4) Be asymptomatic
5) Have a B-hCG level of <1,000IU/L and declining

344
Q

When should monochorionic twin ultrasounds monitor for twin-twin transfusion?

A

Between 16 and 24 weeks

345
Q

Tx options for vasomotor symptoms of menopause (hot flushes, sweats etc)

A

fluoxetine, citalopram or venlafaxine

346
Q

sudden collapse occurring soon after a rupture of membranes

A

Amniotic fluid embolism

347
Q

Management of more advanced cervical cancer to preserve fertility?

A

Radical Trachelectomy

348
Q

When would postpartum blue normally resolve?

A

Within 10 days

349
Q

PCOS increases the risk of which cancers?

A

Endometrial and Ovarian

350
Q

Management of vomiting in HG looking unwell?

A

IM Antihistamines

351
Q

If mum has Hx of previous depression and presents with postpartum depression, what should you do?

A

Start medical treatment early on

352
Q

What is frank breech presentation?

A

the legs are extended up to head, the buttocks are the presenting part

353
Q

What is complete breech presentation?

A

the hips and knees are flexed, buttocks are the presenting part

354
Q

What is incomplete breech presentation?

A

one or both hips are extended, knee or foot is the presenting part

355
Q

Women with uncomplicated monochorionic twin pregnancies should be offered elective birth when?

A

36 weeks onwards

356
Q

Women with dichorionic twin pregnancies should be offered elective birth when?

A

37 weeks onwards

357
Q

Bartholin gland cyst vs abscess?

A

Abscess occurs when cyst becomes infected, resulting in extreme pain, lymphadenopathy, erythema

358
Q

Symptoms of stress incontinence and prolapse?

A

Cystocele

359
Q

Treatment of cystocele?

A

Anterior colporrhaphy

360
Q

Hormones presentation in premature ovarian failure?

A

High FSH, LH

361
Q

Ovarian neoplasms features?

A

Hirsutism due to testosterone secretion
▪ Acute abdomen due to ovarian torsion
▪ Rupture or haemorrhage
▪ Thyrotoxicosis as in struma ovarii, and
▪ Amenorrhea

362
Q

haematocolpos – an accumulation of the blood in the vagina

A

Imperforate Hymen

363
Q

PCOS Horones

A

Normal/high LH, high Testosterone, FAI high

364
Q

Ovarian failure hormones

A

High FSH, LH

365
Q

Fluids physiological changes of pregnancy?

A
  • Increase in total plasma volume (more ECF, reduced plasma osmolality, reduced threshold for thirst and reduced plasma oncotic pressure)
366
Q

Renal physiological changes of pregnancy?

A
  • Increase in kidney size (dilation)
  • Increased renal blood flow, GFR, creatinine clearance
367
Q

Cardiac physiological changes of pregnancy?

A
  • BP: Decreases initially due to reduced resistance then rises again in later
  • Increase in cardiac output, HR, Stroke volume, plasma volume, red cell vollume, WCC, clotting factors
  • Decrease in haemoglobin concentration, haematocrit
368
Q

Respiratory changes in pregnancy?

A
  • Increased oxygen consumption
  • Reduced expiratory reserve volume, residual volume and increased tidal volume -> total lung volume reduced
  • Compensated respiratory alkalosis
  • O2 uptake favoured at alkaline pH by foetus - Double Bohr effect
369
Q

GI/Liver changes in pregnancy?

A
  • Delayed gastric emptying and cardiac sphincter relaxation
  • Reduced secretion of CCK, gall bladder motility
  • Increased gut transit time due to increased nutrient uptake and increased water reabsorption
  • Reduced gastric pH
370
Q

Metabolic changes in pregnancy?

A
  • Early pregnancy: maternal plasma peak lower leading to efficient glucose uptake and fat deposition
  • Late pregnancy: maternal plasma glucose peak stays higher for longer
  • Increase in progesterone, oestrogen and hPL (similar to growth hormone)
  • Increase in pituitary gland size and thyroid
371
Q

Reproductive changes in pregnancy?

A
  • Increase in uterine mass: smooth muscle hyperplasia and hypertrophy
  • Increased softness and vascularity of cervix with increased gestation
  • Blue tinge (oestrogen) -> Chadwick sign
  • Increased breast volume with fast deposition and increased serum prolactin
372
Q

Stages of Labour

A

Latent: contractions, mucoid plug, cervix begins to efface (thinning) and dilate upto 4cm
Active - cervix dilates upto 10cm
Stage 2 - full dilatation to the birth of the foetus
Stage 3 - from birth of the foetus to delivery of the placenta

373
Q

Where do contractions start?

A

In the fundus of the uterus

374
Q

Flexion in labour

A
  • Contraction put pressure down the spine and force the occiput to come into contact with the pelvic floor
  • This leads to flexion which allows the circumference of the head to reduce and aid passage through the pelvis
375
Q

Benefits of delayed cord clamping?

A
  • Allows time to transition to extra-uterine life
  • Increase in RBC, iron and stem cells which aid growth for 6 months
  • Reduced need for inotropic support
376
Q

Types of Fibroids?

A

Intramural - confined to the myometrium
Submucosal - Protrudes the uterine cavity and develops underneath the endometrium
Subserosa - Protrudes through the outer surface of the uterus

377
Q

Prolactinoma

A

Benign tumur of pituitary resulting in excess prolactin
- Oligomenorrhoea, galactorrhoea
- Tx with cabergoline

378
Q

Tx for PID

A
  • IM Ceftriaxone one dose
  • Doxycycline
  • Metronidazole
379
Q

Pathophysiology of Lichen Sclerosis

A

Atrophy of cells leaving behind a thin layer of stratified squamous

380
Q

Androgen insesitivity syndrome?

A
  • X linked recessive
  • Raised LH, normal/raised FSH, normal/raised testosterone, rasied oestrogen
381
Q

Tx for Ashermans?

A

Dissection during hysteroscopy

382
Q

Vasa Praevia

A
  • Foetal vessels are within the foetal membranes and travel across the internal os -> prone to bleeding when membranes rupture
383
Q

criteria for continuous CTG monitoring?

A

suspected chorioamnionitis or sepsis, or a temperature of 38°C or above
severe hypertension 160/110 mmHg or above
oxytocin use
the presence of significant meconium
fresh vaginal bleeding that develops in labouur

Phase 3A (10 decks)

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